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Tariq MB, Qadri SKS, Sharrief A, Tulod K, Dhoble A, Gurung S, Jamilla Lacap M, Okpala M, Manwani B, Smalling RW, Gonzales N. Heart Brain Clinic: An Integrated Approach to Stroke Care. Neurol Clin Pract 2023; 13:e200206. [PMID: 38495079 PMCID: PMC10942000 DOI: 10.1212/cpj.0000000000200206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 09/21/2023] [Indexed: 03/19/2024]
Abstract
Background and Objectives Multidisciplinary clinics have been shown to improve care. Patients with patent foramen ovale (PFO)-associated stroke need evaluation by cardiology and neurology specialists. We report our experience creating a multidisciplinary Structural Heart Brain Clinic (HBC) with a focus on patients with PFO-associated stroke. Methods Demographic and clinical data were retrospectively collected for patients with PFO-associated ischemic stroke. Patients with PFO-associated stroke were divided into a standard care group and Heart Brain Clinic group for analysis. Outcome measures included time from stroke to PFO closure and number of clinic visits before decision regarding closure. Nonparametric analysis evaluated differences in median time to visit and clinical decision, while the chi square analysis compared differences in categorical variables between groups. Results From February 2017 to December 2021, 120 patients were evaluated for PFO-associated stroke. The Structural HBC began in 12/2018 with coordination between Departments of Neurology and Cardiology. For this analysis, 41 patients were considered in the standard care group and 79 patients in the HBC group. During data analysis, 107 patients had received recommendations about PFO closure. HBC patients required fewer clinic visits (p = 0.001) before decision about closure; however, among patients who underwent PFO closure, there was no significant difference in weeks from stroke to PFO closure. Clinicians were more likely to recommend against PFO closure among patients seen in HBC compared with those seen in standard care (p = 0.021). Discussion Our data demonstrate that a multidisciplinary, patient-centered approach to management of patients with PFO-associated ischemic stroke is feasible and may improve the quality of care in this younger patient population. The difference in recommendation to not pursue PFO closure between groups may reflect selection and referral bias. Additional work is needed to determine whether this approach improves other aspects of care and outcomes.
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Affiliation(s)
- Muhammad Bilal Tariq
- Department of Neurology (MBT), University of Texas Health Science Center at Houston; Department of Neurology (SKSQ), University of California Los Angeles; Department of Neurology and Stroke Institute (AS, KT, MO, BM), University of Texas Health Science Center at Houston; Department of Cardiology (AD, SG, MJL, RWS), University of Texas Health Science Center at Houston; and Department of Neurology (NG), University of Colorado Anschutz Medical Campus
| | - Syed Kalimullah S Qadri
- Department of Neurology (MBT), University of Texas Health Science Center at Houston; Department of Neurology (SKSQ), University of California Los Angeles; Department of Neurology and Stroke Institute (AS, KT, MO, BM), University of Texas Health Science Center at Houston; Department of Cardiology (AD, SG, MJL, RWS), University of Texas Health Science Center at Houston; and Department of Neurology (NG), University of Colorado Anschutz Medical Campus
| | - Anjail Sharrief
- Department of Neurology (MBT), University of Texas Health Science Center at Houston; Department of Neurology (SKSQ), University of California Los Angeles; Department of Neurology and Stroke Institute (AS, KT, MO, BM), University of Texas Health Science Center at Houston; Department of Cardiology (AD, SG, MJL, RWS), University of Texas Health Science Center at Houston; and Department of Neurology (NG), University of Colorado Anschutz Medical Campus
| | - Kathleen Tulod
- Department of Neurology (MBT), University of Texas Health Science Center at Houston; Department of Neurology (SKSQ), University of California Los Angeles; Department of Neurology and Stroke Institute (AS, KT, MO, BM), University of Texas Health Science Center at Houston; Department of Cardiology (AD, SG, MJL, RWS), University of Texas Health Science Center at Houston; and Department of Neurology (NG), University of Colorado Anschutz Medical Campus
| | - Abhijeet Dhoble
- Department of Neurology (MBT), University of Texas Health Science Center at Houston; Department of Neurology (SKSQ), University of California Los Angeles; Department of Neurology and Stroke Institute (AS, KT, MO, BM), University of Texas Health Science Center at Houston; Department of Cardiology (AD, SG, MJL, RWS), University of Texas Health Science Center at Houston; and Department of Neurology (NG), University of Colorado Anschutz Medical Campus
| | - Sidhanta Gurung
- Department of Neurology (MBT), University of Texas Health Science Center at Houston; Department of Neurology (SKSQ), University of California Los Angeles; Department of Neurology and Stroke Institute (AS, KT, MO, BM), University of Texas Health Science Center at Houston; Department of Cardiology (AD, SG, MJL, RWS), University of Texas Health Science Center at Houston; and Department of Neurology (NG), University of Colorado Anschutz Medical Campus
| | - Maria Jamilla Lacap
- Department of Neurology (MBT), University of Texas Health Science Center at Houston; Department of Neurology (SKSQ), University of California Los Angeles; Department of Neurology and Stroke Institute (AS, KT, MO, BM), University of Texas Health Science Center at Houston; Department of Cardiology (AD, SG, MJL, RWS), University of Texas Health Science Center at Houston; and Department of Neurology (NG), University of Colorado Anschutz Medical Campus
| | - Munachi Okpala
- Department of Neurology (MBT), University of Texas Health Science Center at Houston; Department of Neurology (SKSQ), University of California Los Angeles; Department of Neurology and Stroke Institute (AS, KT, MO, BM), University of Texas Health Science Center at Houston; Department of Cardiology (AD, SG, MJL, RWS), University of Texas Health Science Center at Houston; and Department of Neurology (NG), University of Colorado Anschutz Medical Campus
| | - Bharti Manwani
- Department of Neurology (MBT), University of Texas Health Science Center at Houston; Department of Neurology (SKSQ), University of California Los Angeles; Department of Neurology and Stroke Institute (AS, KT, MO, BM), University of Texas Health Science Center at Houston; Department of Cardiology (AD, SG, MJL, RWS), University of Texas Health Science Center at Houston; and Department of Neurology (NG), University of Colorado Anschutz Medical Campus
| | - Richard W Smalling
- Department of Neurology (MBT), University of Texas Health Science Center at Houston; Department of Neurology (SKSQ), University of California Los Angeles; Department of Neurology and Stroke Institute (AS, KT, MO, BM), University of Texas Health Science Center at Houston; Department of Cardiology (AD, SG, MJL, RWS), University of Texas Health Science Center at Houston; and Department of Neurology (NG), University of Colorado Anschutz Medical Campus
| | - Nicole Gonzales
- Department of Neurology (MBT), University of Texas Health Science Center at Houston; Department of Neurology (SKSQ), University of California Los Angeles; Department of Neurology and Stroke Institute (AS, KT, MO, BM), University of Texas Health Science Center at Houston; Department of Cardiology (AD, SG, MJL, RWS), University of Texas Health Science Center at Houston; and Department of Neurology (NG), University of Colorado Anschutz Medical Campus
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Wall SA, Stevens E, Vaughn J, Bumma N, Rosko AE, Borate U. Multidisciplinary Approach to Older Adults with Hematologic Malignancies-a Paradigm Shift. Curr Hematol Malig Rep 2022. [PMID: 35028826 DOI: 10.1007/s11899-021-00646-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 11/04/2022]
Abstract
Hematologic malignancies are most likely to present in the seventh and eighth decades of life. Continued population growth will lead to increasing numbers of older adults with hematologic malignancies. Oncology care for older adults is complex and must account for the effect of aging on disease biology and treatment tolerance. Multidisciplinary oncology care has been utilized in solid tumor oncology for decades, initially driven by the need for multi-modality treatment. In this review, we make the case for multidisciplinary oncogeriatric care for older adults with hematologic malignancies in order to best navigate the intersection of aging and blood cancer.
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Hossain S, Sharma A, Dubois L, DeRose G, Duncan A, Power AH. Preoperative point-of-care ultrasound and its impact on arteriovenous fistula maturation outcomes. J Vasc Surg 2018; 68:1157-1165. [DOI: 10.1016/j.jvs.2018.01.051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 01/22/2018] [Indexed: 10/16/2022]
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Mazari FAK, Sharma N, Reid D, Horgan K. The need for triple assessment and predictors for diagnosis of breast cancer in patients <40 years of age. Clin Radiol 2018; 73:758.e19-758.e25. [PMID: 29731127 DOI: 10.1016/j.crad.2018.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 03/28/2018] [Indexed: 11/28/2022]
Abstract
AIM To assess the safety of selective use of triple assessment with omission of radiological assessment proposed in patients <40-years old. MATERIALS AND METHODS Data were collected retrospectively for all patients seen in the one-stop breast clinic between January 2014 and August 2015. Demographics, symptoms, diagnostics, and treatment details were recorded. Subgroup and logistic regression analysis was performed to identify predictors for breast cancer. RESULTS Of the 3,305 patients included, 95.6% (n=3,161) were first-time referrals. 57.6% (n=1,903) had a breast lump, and 4% (n=133) had a high-risk family history; 75.6% (n=2,499) underwent imaging and 16.7% (n=552) underwent a biopsy. The median age was 29 years (interquartile range [IQR]=25-34). Breast cancer was diagnosed in 29 cases (0.88%) and 3.2% (n=105) had surgery. Median referral-to-diagnosis time was 13 days (IQR=9-14) and referral-to-surgery time was 44 days (IQR=34-95). Patients with breast cancer were significantly older (33 versus 28 years, p=0.016). All patients were first-time referrals. Most patients had a breast lump with low suspicion on clinical examination and breast cancer identified on imaging. Time-to-diagnosis (12 versus 14 days, p=0.017) and time-to-surgery (37 versus 67 days, p=0.012) was significantly shorter in the breast cancer group. Comparative older age (odds ratio [OR]=1.08, 95% confidence interval [CI]: 1.01-1.15) and breast lump (OR=11.43,95% CI: 2.72-48.07) were the only significant predictors of cancer on uni/multivariate regression. CONCLUSIONS Triple assessment is also the best practice for all patients in the younger age group. This cohort should not be treated any differently regarding one-stop clinic infrastructure as the cancers detected were not clinically malignant. Missed cancers in this age group would have significant personal, clinical, and legal consequences.
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Affiliation(s)
- F A K Mazari
- Leeds Breast Unit, Leeds Teaching Hospitals NHS Trust, UK.
| | - N Sharma
- Leeds Breast Unit, Leeds Teaching Hospitals NHS Trust, UK
| | - D Reid
- Leeds Breast Unit, Leeds Teaching Hospitals NHS Trust, UK
| | - K Horgan
- Leeds Breast Unit, Leeds Teaching Hospitals NHS Trust, UK
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McKevitt EC, Dingee CK, Leung SP, Brown CJ, Van Laeken NY, Lee R, Kuusk U. Reduced Time to Breast Cancer Diagnosis with Coordination of Radiological and Clinical Care. Cureus 2017; 9:e1919. [PMID: 29464133 PMCID: PMC5807023 DOI: 10.7759/cureus.1919] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 12/06/2017] [Indexed: 11/10/2022] Open
Abstract
Introduction Diagnostic delays for breast problems is a current concern in British Columbia and diagnostic pathways for breast cancer are currently under review. Breast centres have been introduced in Europe and reported to facilitate diagnosis and treatment. Guidelines for breast centers are outlined by the European Society for Mastology (EUSOMA). A Rapid Access Breast Clinic (RABC) was developed at our hospital applying the concept of triple evaluation for all patients and navigation between clinicians and radiologists. We hypothesize that the Rapid Access Breast Clinic will decrease wait times to diagnosis and minimize duplication of services compared to usual care. Methods A retrospective review was undertaken looking at diagnostic wait times and the number of diagnostic centres involved for consecutive patients seen by breast surgeons with diagnostic workups performed either in the traditional system (TS) or the RABC. Only patients presenting with a new breast problem were included in the study. Results Patients seen at the RABC had a decreased time to surgical consultation (33 vs 86 days, p<0.0001) for both malignant (36 vs 59 days, p=0.0007) and benign diagnoses (31 vs 95 days, p<0.0001). Furthermore, 13% of the patients referred to the surgeon in the TS without a diagnosis were eventually diagnosed with a malignancy and waited a mean of 84 days for initial surgical assessment. Of the patients seen at the RABC, 5% required investigation at more than one institution compared to 39% patients seen in the TS (p<0.0001). Cancer patients had a shorter time from presentation to surgery in the RABC (64 vs 92 days, p=0.009). Conclusion The establishment of the RABC has significantly reduced the time to surgical consultation, time to breast cancer surgery, and duplication of investigations for patients with benign and malignant breast complaints. It is feasible to introduce a EUSOMA-based breast clinic in the Canadian Health Care System and improvements in diagnostic wait times are seen. We recommend the expansion of coordinated care to other sites.
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Affiliation(s)
| | - Carol K Dingee
- Mt. St Joseph Hospital, University of British Columbia Vancouver
| | | | - Carl J Brown
- Surgery, University of British Columbia Vancouver
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Zhang J, Mavros MN, Cosgrove D, Hirose K, Herman JM, Smallwood-Massey S, Kamel I, Gurakar A, Anders R, Cameron A, Geschwind JFH, Pawlik TM. Impact of a single-day multidisciplinary clinic on the management of patients with liver tumours. ACTA ACUST UNITED AC 2013; 20:e123-31. [PMID: 23559879 DOI: 10.3747/co.20.1297] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE Multidisciplinary cancer clinics may improve patient care. We examined how a single-day multidisciplinary liver clinic (mdlc) affected care recommendations for patients compared with the recommendations provided before presentation to the mdlc. METHODS We analyzed the demographic and clinicopathologic data of 343 patients assessed in the Johns Hopkins Liver Tumor Center from 2009 to 2012, comparing imaging and pathology interpretation, diagnosis, and management plan between the outside provider (osp) and the mdlc. RESULTS Most patients were white (n = 259, 76%); median age was 60 years; and 146 were women (43%). Outside providers referred 182 patients (53%); the rest were self-referred. Patients travelled median of 83.4 miles (interquartile range: 42.7-247 miles). Most had already undergone imaging (n = 338, 99%) and biopsy (n = 194, 57%) at the osp, and a formal management plan had been formulated for about half (n = 168, 49%). Alterations in the interpretation of imaging occurred for 49 patients (18%) and of biopsy for 14 patients (10%). Referral to the mdlc resulted in a change of diagnosis in 26 patients (8%), of management plan in 70 patients (42%), and of tumour resectability in 7 patients (5%). Roughly half the patients (n = 174, 51%) returned for a follow-up, and 154 of the returnees (89%) received treatment, primarily intraarterial therapy (n = 88, 57%), systemic chemotherapy (n = 60, 39%), or liver resection (n = 32, 21%). Enrollment in a clinical trial was proposed to 34 patients (10%), and 21 of the 34 (62%) were accrued. CONCLUSIONS Patient assessment by our multidisciplinary liver clinic had a significant impact on management, resulting in alterations to imaging and pathology interpretation, diagnosis, and management plan. The mdlc is an effective and convenient means of delivering expert opinion about the diagnosis and management of liver tumours.
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Affiliation(s)
- J Zhang
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, U.S.A
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Smith GE, Samuel N, Khan J, Johnson BF, Chetter IC. Targeted Duplex Ultrasound in a One-Stop Dialysis Vascular Access Assessment Clinic. Ann Vasc Surg 2011; 25:1099-103. [DOI: 10.1016/j.avsg.2011.02.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 01/19/2011] [Accepted: 02/09/2011] [Indexed: 10/18/2022]
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Horvath LE, Yordan E, Malhotra D, Leyva I, Bortel K, Schalk D, Mellinger P, Huml M, Kesslering C, Huml J. Multidisciplinary care in the oncology setting: historical perspective and data from lung and gynecology multidisciplinary clinics. J Oncol Pract 2011; 6:e21-6. [PMID: 21358946 DOI: 10.1200/jop.2010.000073] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2010] [Indexed: 12/12/2022] Open
Abstract
Multidisciplinary care refers to a practice in which physicians from multiple specialties attend to the same patient population. There are many advantages to the model, including reduced time to treatment, coordinated treatment plans, increased patient and physician satisfaction, and increased enrollment onto clinical trials. At Central Dupage Hospital, multidisciplinary clinics have been instituted in lung and gynecologic cancer. We describe the structure and operation of each clinic and highlight their considerable success in improving patient care.
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Affiliation(s)
- Laura Elise Horvath
- Department of Medicine, Division of Hematology Oncology, Loyola University Medical Center; Loyola Cancer Care and Research Center at Central Dupage Hospital; Central Dupage Hospital Multidisciplinary Lung Clinic; Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Rush University Medical Center, Central Dupage Physician Group; Radiation Oncology Consultants; Suburban Lung Associates, Winfield, IL
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Brouwers M, Oliver TK, Crawford J, Ellison P, Evans WK, Gagliardi A, Lacourciere J, Lo D, Mai V, McNair S, Minuk T, Rabeneck L, Rand C, Ross J, Smylie J, Srigley J, Stern H, Trudeau M. Cancer diagnostic assessment programs: standards for the organization of care in Ontario. ACTA ACUST UNITED AC 2011; 16:29-41. [PMID: 20016744 PMCID: PMC2794680 DOI: 10.3747/co.v16i6.400] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Improving access to better, more efficient, and rapid cancer diagnosis is a necessary component of a high-quality cancer system. How diagnostic services ought to be organized, structured, and evaluated is less understood and studied. Our objective was to address this gap. Methods As a quality initiative of Cancer Care Ontario’s Program in Evidence-Based Care, the Diagnostic Assessment Standards Panel, with representation from clinical oncology experts, institutional and clinical administrative leaders, health service researchers, and methodologists, conducted a systematic review and a targeted environmental scan of the unpublished literature. Standards were developed based on expert consensus opinion informed by the identified evidence. Through external review, clinicians and administrators across Ontario were given the opportunity to provide feedback. Results The body of evidence consists of thirty-five published studies and fifteen unpublished guidance documents. The evidence and consensus opinion consistently favoured an organized, centralized system with multidisciplinary team membership as the optimal approach for the delivery of diagnostic cancer assessment services. Independent external stakeholders agreed (with higher mean values, maximum 5, indicating stronger agreement) that dap standards are needed (mean: 4.6), that standards should be formally approved (mean: 4.3), and importantly, that standards reflect an effective approach that will lead to quality improvements in the cancer system (mean: 4.5) and in patient care (mean: 4.3). Interpretation Based on the best available evidence, standards for the organization of daps are offered. There is clear need to integrate formal and comprehensive evaluation strategies with the implementation of the standards to advance this field.
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Affiliation(s)
- M Brouwers
- Program in Evidence-Based Care, Hamilton, ON.
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Awsare NS, Green JSA, Aldwinckle B, Hanbury DC, Boustead GB, McNicholas TA. The measurement of psychological distress in men being investigated for the presence of prostate cancer. Prostate Cancer Prostatic Dis 2008; 11:384-9. [DOI: 10.1038/pcan.2008.21] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Toomey DP, Cahill RA, Birido N, Jeffers M, Loftus B, McInerney D, Rothwell J, Geraghty JG. Rapid assessment breast clinics – Evolution through audit. Eur J Cancer 2006; 42:2961-7. [PMID: 16956758 DOI: 10.1016/j.ejca.2006.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2006] [Revised: 06/15/2006] [Accepted: 06/29/2006] [Indexed: 10/24/2022]
Abstract
This observational, cohort study aimed to examine the potential utility of Rapid Assessment Breast Clinics (RABC) beyond cancer detection at presentation. One thousand four hundred and twenty nine women were studied over an 18 month period. 154 (10.7%) had breast cancer - 87.7% of whom were seen expediently with 92.9% being diagnosed at one attendance. One hundred and forty three (10%) of those with a benign diagnosis were found by routine questioning to have significant familial risk separate to their reason for referral. Despite careful triage, considerable contamination of appointment allotment occurred with many who were correctly triaged as non-urgent being seen 'urgently'. One hundred and seventy six attendees (12.3%) had neither the symptom that triggered referral, nor breast lump, nipple discharge nor family history of breast cancer, while 283 (19.8%) had no objective clinical or radiological abnormality. Although RABC reliably categorise malignant versus non-malignant diagnoses despite cluttering by low risk women, a significant proportion of non-cancer patients still require address of future risk rather than reassurance of their present status alone.
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Affiliation(s)
- D P Toomey
- Department of Surgery, Tallaght Breast Unit, Adelaide and Meath Hospitals incorporating the National Children's Hospital, Tallaght, Dublin 24, Ireland
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Ranieri E, Caprio G, Civitelli L, Barberi S, Ceccarelli F, Virno F. Multidisciplinary Breast Unit: The Activity of the Past 15 Years. Breast J 2004; 10:554-7. [PMID: 15569220 DOI: 10.1111/j.1075-122x.2004.21514.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Purpose This systematic review was undertaken to identify clinical and economic evaluations of diagnostic assessment units for cancer; summarize measures used to evaluate such programs; and discuss the strengths and weaknesses of these evaluations. Methods The review was conducted to identify randomized controlled trials, case control studies, and prospective or retrospective cohort studies examining the outcomes of diagnostic centers for patients with a presumptive diagnosis of breast, colorectal, lung, head and neck, or prostate cancer. Data on methodology and study results were tabulated. Results Twenty articles were eligible for review. Eleven studies examined outcomes associated with breast cancer assessment units: six with head and neck assessment units and three with colorectal assessment units. No studies were found that examined one-stop diagnostic assessment centers for lung cancer or prostate cancer. Seventeen studies were case series, one was a case-control study, and two were randomized controlled trials. No thorough economic analyses have been undertaken. There were no studies that based their assessment on measures suggested by a conceptual framework or validated model of diagnostic care. Few studies explicitly based their investigations on established quality indicators or clinical practice guideline recommendations. Diagnostic assessment centers appear to decrease the time to arrive at a diagnosis, which in turn appears to decrease patient anxiety and increase patient satisfaction. Conclusion A comprehensive understanding of the benefit of diagnostic assessment centers can only be determined if such services are developed for a variety of disease sites and more rigorous evaluations are carried out to assess their benefit.
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Affiliation(s)
- Anna Gagliardi
- Cancer Care Ontario, 620 University Ave, Toronto, ON M5G 2L7 Canada
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Chau I, Kelleher MT, Cunningham D, Norman AR, Wotherspoon A, Trott P, Rhys-Evans P, Rovere GQD, Brown G, Allen M, Waters JS, Haque S, Murray T, Bishop L. Rapid access multidisciplinary lymph node diagnostic clinic: analysis of 550 patients. Br J Cancer 2003; 88:354-61. [PMID: 12569376 PMCID: PMC2747551 DOI: 10.1038/sj.bjc.6600738] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Lymphadenopathy is common, affecting patients of all ages. The current referral pattern for investigating patients with lymphadenopathy varies widely with no universally practised pathway. Our institution set up a lymph node diagnostic clinic (LNDC) accepting direct referrals from primary care physicians. Details of clinical presentation and investigations were recorded prospectively. Between December 1996 and July 2001, 550 patients were referred (M: 203; F:347). The median age was 40 years (range 14-90). The median time between initial referral and the first clinic visit was 6 days. Of 95 patients diagnosed to have malignant diseases, the median time from the first clinic visit to reaching malignant diagnosis was 15 days. Multivariate logistic regression analysis identified five significant predictors for malignant nodes: male gender (risk ratio (RR)=2.72; 95% confidence interval (CI): 1.63-4.56), increasing age (RR=1.05; 95% CI: 1.04-1.07), white ethnicity (RR=3.01; 95% CI: 1.19-7.6) and sites of lymph nodes: supraclavicular region (RR=3.72; 95% CI: 1.52-9.12) and > or = 2 regions of lymph nodes (RR=6.41; 95% CI: 2.82-14.58). Ultrasound and fine-needle aspiration cytology of palpable lymph nodes were performed in 154 and 289 patients, respectively. An accuracy of 97 and 84% was found, respectively. In conclusion, a multidisciplinary lymph node diagnostic clinic enables a rapid, concerted approach to a common medical problem and patients with malignant diseases were diagnosed in a timely fashion.
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Affiliation(s)
- I Chau
- Department of Medicine, Royal Marsden Hospital, Surrey, UK
| | - M T Kelleher
- Department of Medicine, Royal Marsden Hospital, Surrey, UK
| | - D Cunningham
- Department of Medicine, Royal Marsden Hospital, Surrey, UK
- Department of Medicine, Royal Marsden Hospital, Downs Road, Sutton, Surrey, SM2 5PT, UK. E-mail:
| | - A R Norman
- Department of Computing, Royal Marsden Hospital, Surrey, UK
| | - A Wotherspoon
- Department of Histopathology, Royal Marsden Hospital, Surrey, UK
| | - P Trott
- Department of Cytology, Royal Marsden Hospital, Surrey, UK
| | - P Rhys-Evans
- Head and Neck Unit, Royal Marsden Hospital, Surrey, UK
| | | | - G Brown
- Department of Diagnostic Imaging, Royal Marsden Hospital, London, UK
| | - M Allen
- Department of Medicine, Royal Marsden Hospital, Surrey, UK
| | - J S Waters
- Department of Medicine, Royal Marsden Hospital, Surrey, UK
| | - S Haque
- Department of Medicine, Royal Marsden Hospital, Surrey, UK
| | - T Murray
- Department of Medicine, Royal Marsden Hospital, Surrey, UK
| | - L Bishop
- Department of Medicine, Royal Marsden Hospital, Surrey, UK
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Vedhara K, Bennett PD, Brooks E, Gale L, Munnoch K, Schreiber-kounine C, Fowler C, Sammon A, Rayter Z, Farndon J. Risk factors for psychological morbidity in women attending a one-stop diagnostic clinic with suspected breast disease. Psychol Health 2001. [DOI: 10.1080/08870440108405498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Women's health literaturewatch. J Womens Health Gend Based Med 1999; 8:559-68. [PMID: 10839712 DOI: 10.1089/jwh.1.1999.8.559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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