Yes / Objective To identify the injury history features reported by patients with ACL injuries and determine whether history may be used to identify patients requiring follow-up appointments from acute trauma services. Multi-site cross-sectional service evaluation using a survey questionnaire design conducted in the UK. The four injury history features investigated (LIMP) were ‘Leg giving way at the time of injury’, ‘Inability to continue activity immediately following injury’, ‘Marked effusion’ and ‘Pop (heard or felt) at the time of injury’. 194 patients with ACL injury were identified of which 165 (85.5%) attended an acute trauma service. Data on delay was available for 163 (98.8%) of these patients of which 120 (73.6%) had a follow-up appointment arranged. Patients who had a follow-up appointment arranged waited significantly less time for a correct diagnosis (geometric mean 29 vs 198 days; p<0.001) and to see a specialist consultant (geometric mean 61 vs 328 days; p<0.001). Using a referral threshold of any 2 of the 4 LIMP injury history features investigated, 95.8% of patients would have had a follow-up appointment arranged. Findings support the value of questioning patients on specific injury history features in identifying patients who may have suffered ACL injury. Using a threshold of 2 or more of the 4 LIMP history features investigated would have reduced the percentage of patients inappropriately discharged by 22.2%. Evidence presented suggests that this would significantly reduce the time to diagnosis and specialist consultation minimising the chance of secondary complications.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2010.

Background: Brain tumors are the most common solid tumors found in children. Current research is determining whether diagnosing brain tumors earlier will help improve prognosis and reduce long-term deficits; however, childhood brain tumors are often diagnosed late with a median time of 1-4 months from onset of symptoms. Prolonged symptom intervals before diagnosis have been associated with life-threatening risks, neuro-cognitive disabilities, and detrimental professional relationships between healthcare providers and families. Pediatric brain tumor clinical presentations are often non-specific and resemble less serious illnesses; therefore, healthcare providers are failing to include this in their differential diagnoses list. Purpose: To assess healthcare provider knowledge of signs and symptoms of pediatric brain tumors using The Brain Pathways Guideline. Methods: A one group pre-test and post-test e-mailed separately to nurse practitioners that have active membership in National Association of Pediatric Nurse Practitioners (NAPNAP) Arizona Chapter. Results: The Wilcoxon Signed Rank Test revealed that the matched test scores were not statistically significant (p=0.157) after viewing The Brain Pathways Guideline educational materials. Conclusion: The results of this study did not show a statistically significant difference in the test scores and therefore it cannot be concluded that presenting an evidence-based guideline to assist healthcare providers to assess and diagnose patients with brain tumors will be helpful to improve pre-diagnostic symptom intervals.

The purpose of this study was to estimate disparities in late human immunodeficiency virus (HIV) diagnosis and all-cause mortality among varying populations of HIV-positive Latinos, and to identify neighborhood-level predictors. Florida HIV surveillance data for years 2000–2011 were merged with 2007–2011 American Community Survey (ACS) data. Multilevel logistic regressions were used to estimate adjusted odds ratios (aOR) for late HIV diagnosis (acquired immunodeficiency syndrome within 3 months of HIV diagnosis). Multilevel weighted Cox regressions were used to estimate adjusted hazard ratios (aHR) for mortality. Of 5522 Latinos diagnosed 2007–2011, males were at increased odds of late diagnosis compared with females (aOR 1.37, 95% confidence interval [CI] 1.13-1.67). Associated factors included residing in the lowest quartile of neighborhood education for females, and in the 3 highest quartiles of unemployment for males. Foreign-born compared with United States (US)-born Latinos were also at risk (aOR 1.24, 95% CI 1.08-1.42). Among foreign-born, residing in areas with

Bakgrund: Endometrios är en kronisk gynekologisk sjukdom som tio procent av alla kvinnor lider av. Symtomen är individuella men de vanligaste är bäckenbottensmärta, smärta vid menstruation och samlagsmärta. Kvinnor bemöts med misstro och normalisering av symtom, detta på grund av bristfällig kompetens från hälso- och sjukvården. Sjuksköterskans förhållningssätt gentemot dessa patienter bör innefatta lyhördhet, sympati och empati, ha en god kommunikation och finna mening vid varje möte med patienten.   Syfte: Syftet med litteraturstudien var att beskriva kvinnors erfarenheter i vardagen av att leva med endometrios. Vidare var syftet att beskriva de inkluderade artiklarnas datainsamlingsmetod.   Metod: Litteraturstudie med deskriptiv design. Data samlades in via PubMed och CINAHL där tio vetenskapliga artiklar med kvalitativ ansats fanns, dessa låg till grund för resultatet.   Huvudresultat: Vägen till diagnostisering var en lång process relaterat till misstro samt endometrios diffusa symtom. Endometrios begränsade kvinnornas fysiska, psykiska och sociala förmåga som sänkte livskvalitén. Smärta var det mest påtagliga symtomet, detta bidrog till ett ständigt sökande av strategier för att hantera smärtan. Strategierna varierade hos kvinnorna men den mest användbara strategin var kostförändringar. De tio inkluderade artiklarna i studien använde främst intervjuer för att beskriva kvinnors erfarenheter av att leva med endometrios.   Slutsats: Endometrios påverkar kvinnornas dagliga liv samt att relationer till andra människor blir lidande. Brister i hälso- och sjukvården sågs markant då de ej utgav adekvat  information samt en tydlig misstro relaterat till kvinnors symtom, vilket ligger till grund för den fördröjda diagnosen. För att hantera vardagen har kvinnorna själva funnit olika strategier som reducerar smärtan. / Background: Endometriosis is a chronic gynecological disease which ten percent of all women suffer from. The symptoms are individual but the most common are pelvic pain, pain during menstruation and intercourse pain. Because of insufficient competence in health care system women are treated with disbelief and normalization of symptoms. The nurse attitude towards these patients ought to include sensitivity, sympathy and empathy and also have a good communication and be able to find meaning in each meeting with patients.   Aim: The aim with this literature review was to describe womens experience in daily life of living with endometriosis. The aim was furthermore to describe the included articles data collections method.   Method: A literature review with descriptive design. Data were collected through databases PubMed and CINAHL where ten articles with a qualitative approach was found which laies to basis for the result.   Main results: The way to diagnosis was a long process that was related to disbelief and endometriosis diffuse symptoms. Endometriosis limited womens physical, psychological and social abilities that significantly reduced quality of life. Pain was the most substantial symptom and to be able to handle with the pain, they constantly search for strategies. The strategies varied slightly among the women but the most useful approach was a major dietary change. The ten articles that was included in this literature review  used interviews to collect data and supplemented with diarys and journal entries to describe womens experiences of living with endometriosis.   Conclusion: Endometriosis affects a womans daily life adversely and also her relationships with other people. Deficiencies in health care was significantly when non adequate information was given and a marked disbelief related to the womens symptom that can be one reason for a delayed diagnosis. To be able to handle everyday life women had found different strategies to reduce pain.

O processo de obtenção diagnóstica da tuberculose (TB) é permeado por aspectos relacionados à acessibilidade aos serviços de saúde, que interferem diretamente na conduta do doente em buscar por atendimento após perceber o início dos sintomas da doença. Reconhecer esses aspectos pode contribuir na elaboração de medidas que levem à identificação precoce dos casos, diminuição do tempo diagnóstico e disseminação do agravo na comunidade. O presente estudo teve como objetivo, analisar o tempo do doente na busca por serviço de saúde para o diagnóstico da tuberculose no município de Ribeirão Preto - SP, 2009. Estudo descritivo do tipo transversal, realizado em Ribeirão Preto. De 113 doentes de TB, que estavam em tratamento no período de julho a novembro de 2009, foram entrevistados 94, que atenderam os critérios de seleção. Utilizou-se um questionário estruturado baseado no Primary Care Assessment Tool (PCAT) adaptado para o enfoque no diagnóstico da TB. Para a análise dos dados, medidas de tendência central (mediana e intervalos interquartis) foram utilizadas para analisar a variável: \"tempo decorrido entre sentir-se doente e a primeira procura pelo serviço de saúde\". Estabeleceu-se a mediana como valor mais adequado para a caracterização dos dois grupos de doentes (atraso e não atraso). Considerou-se atraso ao diagnóstico, doentes que demoraram mais de 15 dias para buscar pelo primeiro atendimento em um serviço de saúde. Em seguida, por meio do cálculo da Razão de Prevalência identificaram-se as variáveis sócio-demográficas, clínicas e da dimensão porta de entrada de maior atraso na busca por atendimento. O primeiro serviço de saúde procurado foram os Serviços de Pronto Atendimento (SPA) (57,4%), seguidos pelas Unidades de Atenção Básica (UAB) (24,5%) e Serviços Especializados (SE) (18,1%). Já o acesso ao diagnóstico ocorreu nos SE (60,6%), seguidos dos SPA (26,6%) e das UAB (12,8%). Quanto ao tempo de atraso ao diagnóstico, em relação às informações sócio-demográficos, o perfil dos doentes que mais demoraram para buscar pelos SPA foram: idade entre 50 a 59 anos (30 dias); SE: gênero masculino (30 dias), com escolaridade (21dias); renda acima de cinco salários mínimos (30 dias). Informações clínicas: SE: forma clínica pulmonar, caso novo e com co-infecção TB/HIV, (20 dias). Dimensão porta de entrada (primeiro serviço de saúde pocurado): UAB: sintomas moderados da doença (30 dias); SPA: não consumiam bebidas alcoólicas (25 dias) e com conhecimento satisfatório sobre a TB (26 dias); SE: não realizavam controle preventivo de saúde (30 dias), fumavam (20 dias), com conhecimento satisfatório sobre a TB (26 dias), não procuravam o serviço de saúde mais próximo do domicílio (30 dias). O serviço de saúde de maior acessibilidade foram os SPA, (funcionamento de 24h, demanda livre). É necessário capacitar as equipes de saúde, para identificarem os doentes de TB que tiveram maior atraso na busca por atendimento, favorecendo a acessibilidade ao diagnóstico precoce e contribuindo no controle da doença. / The process of obtaining diagnosis for tuberculosis (TB) is permeated by aspects relating to the accessibility of health services, which impact directly on the conduct of patients in search of medical attention after noticing the first symptoms of the disease. Recognising these aspects can contribute to the development of measures that lead to the early diagnosis of cases, reduction in the overall time taken in the diagnostic process and alleviation of the impacts of TB on the community. The aim of the present study was to analyse the patient time in the search in first health service for the diagnosis of tuberculosis in city of Ribeirao Preto, SP, 2009. Descriptive study, cross sectional conducted in Ribeirao Preto. Of 113 TB patients that were in treatment during the period between June and November of 2009, 94 were interviewed that fulfilled the selection criteria. A questionnaire was used based on the Primary Care Assessment tool (PCAT), which was adapted for focus on the diagnosis of TB. For the analysis of data, measures of central tendency (median and interquartile intervals) were utilised to analyse the variable: ,,time elapsed between the appearance of symptoms and the first search for health services\". The median was established as the most appropriate value for the characterisation of two groups of patients (timely and delay). Patients were considered ,,delay\" if the time between the first signs of illness and the search for health sercices was greater than 15 days. Next, through calculation of the prevalence ratios, socioeconomic, demographic, clinical and gateway dimension were identified for the greatest delay in the search in first health service. The emergency services (ES) room was the most common health service first sought by patients (57.4%), followed by primary health care (PHC) (24.5%), and finally specialists services (SS) (18.1%). The leading service with regard to obtaining a diagnosis was that of SS (60.1%), followed by ES (26.6%), and PHC (12.8%). Regarding the delay in obtaining a diagnosis, and with relation to socio-demographic information, patients that took the longest to seek health services through ES rooms were: between 50-59 years of age (30 days); SS: masculine (30 days), educated (21 days), receive a salary greater than five times the minimum wage (30 days). Clinical Information: SS: lung clinics, new cases and with co-infection TB/HIV (20 days). Gateway dimension (the search in first health service): PHC: moderate symptoms of the disease (30 days); ES: non-drinkers (30 days), and with a satisfactory knowledge of TB (26 days); SS: not practicing preventative health control (30 days), smokers (20 days), satisfactory knowledge of TB (26 days), didn\"t seek the health service closest to residence (30 days). The most accessible health service proved to be ES (functioning 24 hours, on demand). It is necessary to properly equip health care professionals so as to facilitate the identification of patients from TB that delayed in the search in first health service, facilitating the health service accessibility thus enabling the early diagnosis of the disease and contributing to its control.

As características biológicas e comportamentais relacionadas aos doentes de tuberculose (TB) são importantes aspectos a serem considerados quando se almeja a precocidade da detecção dos casos, uma vez que determinam a procura e utilização dos serviços de saúde. Este estudo teve como objetivo descrever os aspectos relacionados aos doentes de TB que interferem no tempo de procura por um serviço de saúde após a percepção do início dos sintomas da doença na cidade de São José do Rio Preto - SP. Trata-se de um estudo epidemiológico descritivo e exploratório, do tipo inquérito. Participaram do estudo 100 doentes de TB entrevistados por meio de um instrumento que contemplou questões sócio-demográficas, clínicas, econômicas e comportamentais dos doentes. A partir da questão relacionada ao tempo para proceder a procura por um serviço de saúde realizou-se o cálculo da mediana e, por meio do valor obtido, definiu-se o ponto de corte a partir do qual se considerou atraso na procura por atendimento. O tempo mediano decorrido entre a percepção do início dos sintomas da TB e a primeira procura por um serviço de saúde foi de 15 dias, sendo a Unidade de Pronto Atendimento (UPA) o principal serviço de saúde procurado. Houve predominância de doentes do sexo masculino. Encontrou-se atraso (>15 dias) entre homens e indivíduos com idade entre 50 a 59 anos que procuraram pelas UPA e entre mulheres e indivíduos cuja faixa etária estava entre 18 a 29 e maiores de 60 anos que optaram pelas Unidades de Atenção Básica (UAB). No que se refere ao estado civil, somente tiveram atraso doentes que se declararam divorciados/separados. Doentes sem escolaridade ou com EF incompleto, sem remuneração e que possuíam a forma pulmonar da TB atrasaram ao buscar UPA. Doentes com forma extrapulmonar da TB e em recidiva/retratamento atrasaram quando a busca por atendimento ocorreu nas UAB. Co-infectados foram mais rápidos ao buscar por atendimento nos serviços especializados. Demoraram para buscar pelo primeiro atendimento aqueles que relataram os sintomas ao início da doença como sendo de fracos a moderados. Houve atraso entre doentes que não fumavam e procuraram por UAB e UPA. Houve demora superior a 15 dias somente quando a procura por assistência entre os doentes consumidores de bebidas alcoólicas ocorreu nas UAB. Tiveram retardo doentes com conhecimento precário que procuraram as UAB e aqueles com conhecimento satisfatório que optaram pelas UPA. A maioria dos doentes deste estudo tinham o hábito de procurar pelos serviços mais próximos do domicílio antes do diagnóstico da TB e não atrasaram ao buscar por atendimento em UAB e serviços especializados. Levanta-se a necessidade de maior atenção por parte da equipe dos serviços de saúde quanto às caracteristicas do perfil dos usuários que tiveram atraso na busca por atendimento. O reconhecimento dessas características e do padrão de utilização dos serviços de saúde é primordial para o planejamento em saúde e definição de estratégias que favoreçam a busca por atendimento entre os usuários em menor tempo, de modo a possibilitar o diagnóstico precoce da TB pelos serviços de saúde. / The biological and behavioral characteristics related to patients with tuberculosis (TB) are important aspects to be considered when the early detection of cases of the disease is aimed, since they seem to play an important role in demand and utilization of health services patterns. This study aimed to describe the aspects related to TB patients that affect time to search for a health facility after the perception of the onset of disease symptoms in Sao Jose do Rio Preto - SP. An epidemiological study, descriptive and exploratory type of investigation were conducted including 100 TB patients, who were interviewed by an instrument that included socio-demographic, clinical, economic and behavioral characteristics. From the issue related to time to search for a health service the median was calculated, and half the value obtained, we defined the cutoff point from which delay in seeking treatment was considered. The median time between the perception of TB symptoms\' onset and the first demand for a health service was 15 days, being the Emergency Unit (EU) the main health service sought. There was a predominance of male patients. A delay was found (> 15 days) among men and those with age from 50 to 59 years who sought first a EU and among women and those with age between 18 to 29, as well as seniors over 60, who opted for searching first a Primary Care Unit (PHU). Regarding to marital status, in general, only patients who declared themselves as divorced/separated had shown delay. Patients without education or with incomplete level of formation, without remuneration and who presented the TB pulmonary form seek the EU with delay. Patients with extrapulmonary TB and relapse/retreatment delayed when searching for treatment occurred in the PHU. Co-infection patients seek faster care at specialized services. Those who reported the symptoms of the disease as being low to moderate showed longer time to search. Patients who didn´t smoke and looked for PHU and EU also present delayed. Among patients who consumed alcohol, delay was greater than 15 days when demand for care occurred at UAB. Those who present poor knowledge and sought PHU and those with satisfactory knowledge that opted for the EU also showed longer delays. Most patients in this study were used to seek services closer to their homes before the diagnosis of TB and did not delay in seeking care at PHU and specialized services. Need for greater focus by the team of health services regarding the characteristics of the profile of users who have had to seek delays for care is raised. Recognition of patient\'s characteristics and health services\' utilization patterns, in their different ways of organizing and delivering assistance is central to health planning and developing strategies to promote the search for treatment among users in less time, in order to enable early diagnosis of TB at health services.

Diss. (sammanfattning) Linköping : Univ. / Härtill 5 uppsatser.

Background: Historically the identification of ACL injuries upon initial presentation is low and considerable diagnostic delays have been reported. However, specific evidence on the individual elements of, and factors which influence delay, is lacking. Aims: The overarching aim was to provide a comprehensive picture of delay to diagnosis and specialist consultation, including factors which influence delay. An additional aim was to determine whether the approach to examining acute knee injuries varied as a consequence of varying patient presentation or experience of the assessing clinician. Methods: Study 1: Cross -sectional survey. Study 2: Non-participant direct observation methodology. Results: Data from 194 patients were analysed in the survey. Only 15.5% of patients were given a correct diagnosis of ACL rupture at the initial consultation. Median delay to diagnosis was 67.5 days (IQR= 15 to 178 days) and specialist consultation 108 days (IQR= 38 to 292 days). The factors most influential on delay were whether a follow-up appointment was arranged after attending A&E, whether the site of attendance operated an acute knee clinic and whether MRI was performed. The direct observation study showed wide variation in approach to injury assessment. Specialist clinicians performed the most comprehensive examination. A&E clinicians were more likely to assess for bony, neurovascular and gross tendon injuries as opposed to ligamentous or meniscal injury. Conclusions: The diagnostic rate of ACL injury at initial presentation remains low. Considerable delays to diagnosis and specialist consultation are apparent following ACL injury, the majority of which is attributable to health system delay.

O processo de obtenção diagnóstica da tuberculose (TB) é permeado por aspectos relacionados à acessibilidade aos serviços de saúde, que interferem diretamente na conduta do doente em buscar por atendimento após perceber o início dos sintomas da doença. Reconhecer esses aspectos pode contribuir na elaboração de medidas que levem à identificação precoce dos casos, diminuição do tempo diagnóstico e disseminação do agravo na comunidade. O presente estudo teve como objetivo, analisar o tempo do doente na busca por serviço de saúde para o diagnóstico da tuberculose no município de Ribeirão Preto - SP, 2009. Estudo descritivo do tipo transversal, realizado em Ribeirão Preto. De 113 doentes de TB, que estavam em tratamento no período de julho a novembro de 2009, foram entrevistados 94, que atenderam os critérios de seleção. Utilizou-se um questionário estruturado baseado no Primary Care Assessment Tool (PCAT) adaptado para o enfoque no diagnóstico da TB. Para a análise dos dados, medidas de tendência central (mediana e intervalos interquartis) foram utilizadas para analisar a variável: \"tempo decorrido entre sentir-se doente e a primeira procura pelo serviço de saúde\". Estabeleceu-se a mediana como valor mais adequado para a caracterização dos dois grupos de doentes (atraso e não atraso). Considerou-se atraso ao diagnóstico, doentes que demoraram mais de 15 dias para buscar pelo primeiro atendimento em um serviço de saúde. Em seguida, por meio do cálculo da Razão de Prevalência identificaram-se as variáveis sócio-demográficas, clínicas e da dimensão porta de entrada de maior atraso na busca por atendimento. O primeiro serviço de saúde procurado foram os Serviços de Pronto Atendimento (SPA) (57,4%), seguidos pelas Unidades de Atenção Básica (UAB) (24,5%) e Serviços Especializados (SE) (18,1%). Já o acesso ao diagnóstico ocorreu nos SE (60,6%), seguidos dos SPA (26,6%) e das UAB (12,8%). Quanto ao tempo de atraso ao diagnóstico, em relação às informações sócio-demográficos, o perfil dos doentes que mais demoraram para buscar pelos SPA foram: idade entre 50 a 59 anos (30 dias); SE: gênero masculino (30 dias), com escolaridade (21dias); renda acima de cinco salários mínimos (30 dias). Informações clínicas: SE: forma clínica pulmonar, caso novo e com co-infecção TB/HIV, (20 dias). Dimensão porta de entrada (primeiro serviço de saúde pocurado): UAB: sintomas moderados da doença (30 dias); SPA: não consumiam bebidas alcoólicas (25 dias) e com conhecimento satisfatório sobre a TB (26 dias); SE: não realizavam controle preventivo de saúde (30 dias), fumavam (20 dias), com conhecimento satisfatório sobre a TB (26 dias), não procuravam o serviço de saúde mais próximo do domicílio (30 dias). O serviço de saúde de maior acessibilidade foram os SPA, (funcionamento de 24h, demanda livre). É necessário capacitar as equipes de saúde, para identificarem os doentes de TB que tiveram maior atraso na busca por atendimento, favorecendo a acessibilidade ao diagnóstico precoce e contribuindo no controle da doença. / The process of obtaining diagnosis for tuberculosis (TB) is permeated by aspects relating to the accessibility of health services, which impact directly on the conduct of patients in search of medical attention after noticing the first symptoms of the disease. Recognising these aspects can contribute to the development of measures that lead to the early diagnosis of cases, reduction in the overall time taken in the diagnostic process and alleviation of the impacts of TB on the community. The aim of the present study was to analyse the patient time in the search in first health service for the diagnosis of tuberculosis in city of Ribeirao Preto, SP, 2009. Descriptive study, cross sectional conducted in Ribeirao Preto. Of 113 TB patients that were in treatment during the period between June and November of 2009, 94 were interviewed that fulfilled the selection criteria. A questionnaire was used based on the Primary Care Assessment tool (PCAT), which was adapted for focus on the diagnosis of TB. For the analysis of data, measures of central tendency (median and interquartile intervals) were utilised to analyse the variable: ,,time elapsed between the appearance of symptoms and the first search for health services\". The median was established as the most appropriate value for the characterisation of two groups of patients (timely and delay). Patients were considered ,,delay\" if the time between the first signs of illness and the search for health sercices was greater than 15 days. Next, through calculation of the prevalence ratios, socioeconomic, demographic, clinical and gateway dimension were identified for the greatest delay in the search in first health service. The emergency services (ES) room was the most common health service first sought by patients (57.4%), followed by primary health care (PHC) (24.5%), and finally specialists services (SS) (18.1%). The leading service with regard to obtaining a diagnosis was that of SS (60.1%), followed by ES (26.6%), and PHC (12.8%). Regarding the delay in obtaining a diagnosis, and with relation to socio-demographic information, patients that took the longest to seek health services through ES rooms were: between 50-59 years of age (30 days); SS: masculine (30 days), educated (21 days), receive a salary greater than five times the minimum wage (30 days). Clinical Information: SS: lung clinics, new cases and with co-infection TB/HIV (20 days). Gateway dimension (the search in first health service): PHC: moderate symptoms of the disease (30 days); ES: non-drinkers (30 days), and with a satisfactory knowledge of TB (26 days); SS: not practicing preventative health control (30 days), smokers (20 days), satisfactory knowledge of TB (26 days), didn\"t seek the health service closest to residence (30 days). The most accessible health service proved to be ES (functioning 24 hours, on demand). It is necessary to properly equip health care professionals so as to facilitate the identification of patients from TB that delayed in the search in first health service, facilitating the health service accessibility thus enabling the early diagnosis of the disease and contributing to its control.