Patient journey to a specialist amyotrophic lateral sclerosis multidisciplinary clinic: an exploratory study.

BACKGROUND: The multidisciplinary approach in the management of Amyotrophic Lateral Sclerosis (ALS) has been shown to provide superior care to devolved care, with better survival, improved quality of care, and quality of life. Access to expert multidisciplinary management should be a standard for patients with ALS. This analysis explores the patient journey from symptom onset and first engagement with health services, to the initial visit to a specialist ALS Multidisciplinary Clinic (MDC) in Dublin, Ireland. METHODS: A retrospective exploratory multi-method study details the patient journey to the MDC. Data from medical interviews and systematic chart review identifies interactions with the health services and key timelines for thirty five new patients presenting with a diagnosis of ALS during a 6 month period in 2013. RESULTS: The time from first symptom to diagnosis was a mean of 16 months (median 13 months), with a mean interval of 19 months (median 14.6) from first symptoms to arrival at the MDC. The majority of patients were seen by a general practitioner, and subsequently by neurology services. There was an average of four contacts with health services and 4.8 investigations/tests, prior to their first Clinic visit. On the first visit to the MDC patients are linked into an integrated 'system' that can provide specialist care and link with voluntary, palliative and community services as required. CONCLUSIONS: Engagement with a multidisciplinary team has implications for service utilization and quality of life of patients and their families. We have demonstrated that barriers exist that delay referral to specialist services. Comprehensive data recording and collection, using multiple data sources can reconstruct the timelines of the patient journey, which can in turn be used to identify pathways that can expedite early referral to specialist services.

The structural transitions in 6CHBT-based ferronematic droplets.

In this work we describe the observations of structural transitions in ferronematics based on the thermotropic nematics 6CHBT (4-trans-4'-n-hexyl-cyclohexyl-isothiocyanato-benzene). The ferronematic droplets were observed in solutions of nematogenic 6CHBT dissolved in phenyl isocyanate and doped with fine magnetic particles. The phase diagram of the transitions from the isotropic phase to the nematic phase via a droplet state was found. Magneto-dielectric measurements of various structural transitions in this new system enabled us to estimate the type of anchoring of the nematic molecules on the magnetic particle surfaces in the droplets.

Uraemic gangrene syndrome: is parathyroidectomy always necessary?

This report presents a case of uraemic gangrene syndrome with multiple ulcerations and calcium (Ca) deposits in the vessel walls. High-dosage oral calcium carbonate (CaCO3) treatment alone resulted in rapid wound healing with decreased serum phosphorus (P), Ca x P product and parathormone and only slightly increased Ca levels. We suggest that this should be the first choice of treatment in such cases because positive clinical response can achieve symptom-free status for the patient until kidney transplantation, thus making parathyroidectomy unnecessary.

Optically induced periodic structures in smectic-C liquid crystals.

We explore periodic structures of smectic-C (SmC) liquid crystals, induced optically by a polarization grating. The studied cells contain a passive surface of rubbed polyimide and an active photosensitive substrate of azo-dye doped polyimide. In a nematic phase the director field can be periodic independent of the angle between the grating vector and the rubbing direction. In the SmA phase periodic structure can be induced only by layer undulations. The SmC behaves similarly to the nematic phase, but the director can rotate only on a cone, which results in a more complex geometry. The periodic pattern is superimposed with four different director and layer structures. In spite of the coexistence of the nonuniform structures the diffraction efficiency is better in the SmC, than in the nematic phase.

Bilateral ossification in the Achilles tendon: a case report.

Bilateral symmetrical Achilles tendon ossification is presented, with a fracture on one side. A 57 year old male patient was conservatively treated for bilateral clubfeet in his childhood. Part of his Achilles tendons were replaced by ectopic bony mass and on the left it fractured without any trauma. The fracture was treated surgically by vertical thinning, intraosseal suture "osteosynthesis", and tendon flap plasty. This pathological condition healed in three months. Seven years after the operation the X-ray revealed total bony rebuilding. The ectopic bone mass has the same biological behaviour as the anatomic bones.

Endoscopic laser foraminoplasty on the lumbar spine--early experience.

Since April 1995 this endoscope assisted laser technique has been used for widening the lumbar exit route foramina. Patient selection included individuals with primarily unilateral sciatica as well as low back pain and referred buttock pain following various operative interventions. Endoscopic laser foraminoplasty (ELF) utilises an endoscope, a uniportal posterolateral approach and a side firing holmium laser probe. Under direct vision and within the protection of saline solution, epidural scarring, extruded and sequestrated disc protrusions and/or osteophytes are removed by holmium laser ablation. The patient is responsive and aware under neurolept analgesia and this ensures the protection and the integrity of the nerve root. A total of 219 such interventions has been performed up to January 1, 1997. The first 48 cases with a follow-up exceeding 12 months have been included in this preliminary review. Initial experience is encouraging. The ELF seems to provide another means of addressing sequelae of primary degenerative disorders as well as the common consequences of conventional spine surgery. ELF provides an alternative to minimal intervention fenestrectomy and open surgical undercutting for predominantly unisegmental and unilateral lateral recess stenosis and in selected cases it may prevent or delay the indication of spinal fusion.

Researches on viral hepatitis markers correlated with pathomorphological and clinical aspects in chronic hepatitis.

A number of 112 patients hospitalized for chronic hepatitis and liver cirrhosis were investigated. According to the results of the pathomorphological examinations of liver biopsies, 29 (25.8%) were cases of persistent chronic hepatitis (PCH), 39 (34.8%) cases of active chronic hepatitis (ACH), and 44 (39.2%) cases of liver cirrhosis. The prevalence of the female sex was observed in PCH (61.6%) and ACH (64.7%) cases, whereas in liver cirrhosis the sex distribution was more balanced (53.3% patients were males). The patients' mean age ranged from 34 to 38 years in PCH cases, from 44 to 46 years in ACH cases and from 50 to 57 years in liver cirrhosis. The postviral cirrhosis was three times more frequent in the female sex (77%), while the alcoholic and mixed cirrhoses (of an associated alcoholic and viral etiology) were prevalent in males (63.2%, respectively 72.2%). Serological tests for detection of the serological markers of hepatitis viruses B (HBV), C (HCV) and Delta (HDV) were performed for the purpose of studying the correlations between the pathomorphological findings and the viral markers. Among the 39 patients with ACH, HBV markers were detected in 13 cases (33.3%), anti-HCV antibodies in 10 (25.6%), and associated HBV-HCV, respectively HBV-HDV infections in 9 (23%) cases (6, respectively 3 patients). In the remaining 7 cases (17.9%) of ACH, there were no serological markers in the three hepatitis viruses. Of the 29 patients with PCH, 17 cases (58.6%) displayed HBV markers, 4 (13.7%) anti-HCV antibodies, in one patient (3.4%) an associated HBV-HCV infection was present, and in 7 patients (24.1%) markers of none of the three hepatitis viruses could be identified. Of the 44 patients with liver cirrhosis, HBV markers were detected in 17 cases (38.6%), anti-HCV antibodies in 9 (20.4%) and associated HBV-HCV and, respectively, HBV-HDV infections in 11 cases (25%) (9, respectively 2 cases). In 7 (15.9%) of the 44 patients with cirrhosis, markers of none of the three hepatitis viruses could be identified.

[Idiopathic heterotopic ossification]. / Az idiopathiás heterotopiás ossificatióról.

Three cases of localized, benign heterotopic ossification, occurred in the hip joint region, are presented. The aspects of the pathogenesis, differential diagnosis and prognosis are briefly discussed.

[Effect of previous surgery on the results of total arthroplasty of the hip joint]. / Wplyw poprzedzajacej operacji na wynik totalnej alloplastyki stawu biodrowego.

Clinical and radiological results as well/as complications after 123 total hip arthroplasties performed as secondary procedure have been evaluated. These patients underwent primary operation because of femoral neck fracture or intertrochanteric osteotomy in the treatment of hip osteoarthritis. The scores of clinical results according to the Merle d'Aubigené and Postel scale were as follows: pain 4.48, walk 3.99, movements 4.02. Radiological features of loosening of the cup were observed in 14.4 per cent and of the stem in 17.3 per cent of those investigated. Early infections were 3 times higher and summed with late infections constituted 8.8 per cent of those operated on. Deep infections and aseptic loosening caused revision in 11.5 per cent of those investigated.

[Effect of direct current on bone regeneration]. / Wirkung von Gleichstrom auf die Knochenregeneration.

The data on bone biocurrent and on the bone regenerating effect of low intensity direct current are discussed. The stimulator constructed by the authors is described. With its help an improved callus formation could be achieved on the osteotanised femur of the rabbit.