BACKGROUND: Globally, most people with head and neck cancers (HNCs) are diagnosed with advanced-stage disease. HNC diagnostic stage has multifactorial explanations, with the role of health system factors not yet fully investigated. METHODS: HNC centres (n = 18) from the HEADSpAcE Consortium were surveyed via a bespoke health system questionnaire covering a range of factors. Centres were compared using the least square means for the presence/absence of each health system factor to their proportion of advanced-stage HNC. RESULTS: Health system factors associated with lower proportion in advanced-stage diagnosis were formal referral triaging (14%, 95% CI-0.26, -0.03), routine monitoring of time from referral to diagnosis (16%, 95% CI-0.27, -0.05), and fully publicly funded systems (17%, 95% CI-0.29, -0.06). Several health systems factors had no routinely available data. CONCLUSIONS: Through identifying and monitoring health systems factors associated with lower proportions of advanced stage HNC, interventions could be developed, and systems redesigned, to improve early diagnosis.

• MeSH
• Benchmarking * MeSH
• Early Detection of Cancer MeSH
• Referral and Consultation statistics & numerical data   MeSH
• Humans MeSH
• Head and Neck Neoplasms * pathology   diagnosis   MeSH
• Surveys and Questionnaires MeSH
• Neoplasm Staging MeSH
• Triage MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

There are limited data on referral rates and the number of patients with idiopathic pulmonary fibrosis (IPF) who are eligible for lung transplantation. The aim of the present study was to assess adherence to the consensus of the International Society for Heart and Lung Transplantation (ISHLT) for the referral of patients with IPF among Czech interstitial lung disease (ILD) centers. Czech patients who were diagnosed with IPF between 1999 and 2021 (n = 1584) and who were less than 65 years old at the time of diagnosis were retrospectively selected from the Czech Republic of the European Multipartner Idiopathic Pulmonary Fibrosis Registry (EMPIRE). Nonsmokers and ex-smokers with a body mass index (BMI) of <32 kg/m2 (n = 404) were included for further analyses. Patients with a history of cancer <5 years from the time of IPF diagnosis, patients with alcohol abuse, and patients with an accumulation of vascular comorbidities were excluded. The trajectory of individual patients was verified at the relevant ILD center. From the database of transplant patients (1999-12/2021, n = 541), all patients who underwent transplantation for pulmonary fibrosis (n = 186) were selected, and the diagnosis of IPF was subsequently verified from the patient's medical records (n = 67). A total of 304 IPF patients were eligible for lung transplantation. Ninety-six patients were referred to the transplant center, 50% (n = 49) of whom were referred for lung transplantation. Thirty percent of potentially eligible patients not referred to the transplant center were considered to have too many comorbidities by the reporting physician, 19% of IPF patients denied lung transplantation, and 17% were not referred due to age. Among Czech patients with IPF, there may be a larger pool of potential lung transplant candidates than has been reported to the transplant center to date.

• MeSH
• Guideline Adherence statistics & numerical data   MeSH
• Adult MeSH
• Idiopathic Pulmonary Fibrosis * surgery   MeSH
• Lung Diseases, Interstitial surgery   MeSH
• Referral and Consultation * statistics & numerical data   MeSH
• Middle Aged MeSH
• Humans MeSH
• Registries MeSH
• Retrospective Studies MeSH
• Aged MeSH
• Lung Transplantation * statistics & numerical data   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Czech Republic MeSH

In Uganda, hypertension is an escalating health issue, but there is limited specific data regarding the prevalence of left ventricular hypertrophy (LVH) among hypertensive patients in eastern Uganda. This study aimed to establish the prevalence of LVH among hypertensive patients at Jinja Regional Referral Hospital. A cross-sectional study conducted at the hospital enrolled 323 participants using convenience sampling. The results revealed a prevalence rate of 19.50 % for LVH, primarily observed in male participants and younger age groups (25-35 years). Furthermore, the study found a low incidence of associated cardiac arrhythmia, with only 1.59 % of participants having atrial fibrillation. These findings indicate a relatively low burden of LVH and arrhythmia in this population, emphasizing the importance of continued efforts in hypertension management and LVH prevention. Further research and interventions are necessary to mitigate the impact of hypertension-related complications in the eastern region of Uganda.

• MeSH
• Adult MeSH
• Hypertension * epidemiology   MeSH
• Hypertrophy, Left Ventricular * epidemiology   MeSH
• Incidence MeSH
• Referral and Consultation statistics & numerical data   MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Prevalence MeSH
• Cross-Sectional Studies MeSH
• Risk Factors MeSH
• Aged MeSH
• Arrhythmias, Cardiac * epidemiology   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Review MeSH
• Geographicals
• Uganda MeSH

PURPOSE: To evaluate self-referral from the Internet for genetic diagnosis of several rare inherited kidney diseases. METHODS: Retrospective study from 1996 to 2017 analyzing data from an academic referral center specializing in autosomal dominant tubulointerstitial kidney disease (ADTKD). Individuals were referred by academic health-care providers (HCPs) nonacademic HCPs, or directly by patients/families. RESULTS: Over 21 years, there were 665 referrals, with 176 (27%) directly from families, 269 (40%) from academic HCPs, and 220 (33%) from nonacademic HCPs. Forty-two (24%) direct family referrals had positive genetic testing versus 73 (27%) families from academic HCPs and 55 (25%) from nonacademic HCPs (P = 0.72). Ninety-nine percent of direct family contacts were white and resided in zip code locations with a mean median income of $77,316 ± 34,014 versus US median income $49,445. CONCLUSION: Undiagnosed families with Internet access bypassed their physicians and established direct contact with an academic center specializing in inherited kidney disease to achieve a diagnosis. Twenty-five percent of all families diagnosed with ADTKD were the result of direct family referral and would otherwise have been undiagnosed. If patients suspect a rare disorder that is undiagnosed by their physicians, actively pursuing self-diagnosis using the Internet can be successful. Centers interested in rare disorders should consider improving direct access to families.

• MeSH
• Adult MeSH
• Genetic Testing MeSH
• Internet MeSH
• Referral and Consultation classification   statistics & numerical data   MeSH
• Middle Aged MeSH
• Humans MeSH
• Kidney Diseases diagnosis   genetics   MeSH
• Retrospective Studies MeSH
• Rare Diseases diagnosis   genetics   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Research Support, N.I.H., Extramural MeSH

• MeSH
• Cardiology methods   MeSH
• Cardiovascular Diseases complications   therapy   MeSH
• Referral and Consultation statistics & numerical data   MeSH
• Remote Consultation methods   MeSH
• Coronavirus Infections complications   therapy   MeSH
• Humans MeSH
• Pandemics MeSH
• Telemedicine methods   MeSH
• Pneumonia, Viral complications   therapy   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Letter MeSH

BACKGROUND: Low back pain (LBP) is the most common type of musculoskeletal pain, thus it is one of the most commonly encountered conditions in Physical and Rehabilitation Medicine. The physicians who are primarily responsible for the nonsurgical management of LBP are physiatrists. OBJECTIVE: The present study aimed to investigate the approaches of physiatrists to low back pain across Europe. Preferences, tendencies, and priorities in the diagnosis, management, and treatment of LBP, as well as the epidemiological data pertaining to LBP in PRM practice were evaluated in this Europe-wide study. METHODS: The study was conducted under the control of the European Society of Physical and Rehabilitation Medicine (ESPRM) Musculoskeletal Disorders Research Committee. A total of 576 physiatrists from most European countries participated in the survey. RESULTS: The results show that physiatrists frequently deal with patients with LBP in their daily practice. Most patients are not referred to other departments and are treated with various conservative methods. Less than one-fifth of patients are primarily referred for surgery. The physiatrists believe that a clear diagnosis to account for cases of low back pain is rarely established. The most common diagnosis is discopathy. History and physical examination remain the most valuable clinical evaluation tools for low back pain according to physiatrists. Less than half the patients require a magnetic resonance imaging. Non-steroidal anti-inflammatory drugs are the most commonly prescribed drugs for low back pain. Exercise, back care information, and physical therapy are the preferred conservative treatments. More than half of the physiatrists offer interventional treatments to patients with low back pain. CONCLUSION: The present study is a preliminary report that presents the attitudes of European physiatrists in the management of low back pain. Further researches are warranted to standardize the conservative management of LBP.

• MeSH
• Medical History Taking MeSH
• Anti-Inflammatory Agents, Non-Steroidal therapeutic use   MeSH
• Adult MeSH
• Physical Examination MeSH
• Referral and Consultation statistics & numerical data   MeSH
• Practice Patterns, Physicians' statistics & numerical data   MeSH
• Middle Aged MeSH
• Humans MeSH
• Low Back Pain therapy   MeSH
• Young Adult MeSH
• Cross-Sectional Studies MeSH
• Surveys and Questionnaires MeSH
• Physiatrists * MeSH
• Physical Therapy Modalities statistics & numerical data   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Europe MeSH

BACKGROUND: Understanding the organisational set-up of physiotherapy services across different countries is increasingly important as clinicians around the world use evidence to improve their practice. This also has to be taken into consideration when multi-centre international clinical trials are conducted. This survey aimed to systematically describe organisational aspects of physiotherapy services for people with multiple sclerosis (MS) across Europe. METHODS: Representatives from 72 rehabilitation facilities within 23 European countries completed an online web-based questionnaire survey between 2013 and 2014. Countries were categorised according to four European regions (defined by United Nations Statistics). Similarities and differences between regions were examined. RESULTS: Most participating centres specialized in rehabilitation (82 %) and neurology (60 %), with only 38 % specialising in MS. Of these, the Western based Specialist MS centres were predominately based on outpatient services (median MS inpatient ratio 0.14), whilst the Eastern based European services were mostly inpatient in nature (median MS inpatient ratio 0.5). In almost all participating countries, medical doctors - specialists in neurology (60 %) and in rehabilitation (64 %) - were responsible for referral to/prescription of physiotherapy. The most frequent reason for referral to/prescription of physiotherapy was the worsening of symptoms (78 % of centres). Physiotherapists were the most common members of the rehabilitation team; comprising 49 % of the team in Eastern countries compared to approximately 30 % in the rest of Europe. Teamwork was commonly adopted; 86 % of centres based in Western countries utilised the interdisciplinary model, whilst the multidisciplinary model was utilised in Eastern based countries (p = 0.046). CONCLUSION: This survey is the first to provide data about organisational aspects of physiotherapy for people with MS across Europe. Overall, care in key organisational aspects of service provision is broadly similar across regions, although some variations, for example the models of teamwork utilised, are apparent. Organisational framework specifics should be considered anytime a multi-centre study is conducted and results from such studies are applied.

• MeSH
• Ambulatory Care statistics & numerical data   MeSH
• Inpatients MeSH
• Referral and Consultation statistics & numerical data   MeSH
• Prescriptions MeSH
• Humans MeSH
• Surveys and Questionnaires MeSH
• Multiple Sclerosis therapy   MeSH
• Physical Therapy Modalities organization & administration   MeSH
• Patient Care Team organization & administration   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Geographicals
• Europe MeSH

Autor shrnuje své zkušenosti konziliárního psychiatra s hodnocením suicidálního rizika u pacientů, přijatých po sebevražedném pokusu v rámci konzilií na somatických odděleních. Prezentuje soubor pacientů konziliárně vyšetřených během jednoho roku v nemocnic i Slaný. V diskuzi se pokouší o zhodnocení faktorů nápomocných př i rozhodování o postupech péče o tyto pacienty. Zamýšlí se také nad výhodami a nevýhodami nedobrovolné hospitalizace.

The author summarises his experience of a liaison psychiatrist with the evaluation of suicide risk in patients admitted to medi cal wards after a suicide attempt. He presents a sample of patients assessed by his liaison psychiatric service in Slany Hospital over a period of one year. In discussion he tries to evaluate factors helpful in making decisions about the care for these patients. He also conside rs advantages and disadvantages of an involuntary admission.

• MeSH
• Mental Disorders diagnosis   psychology   MeSH
• Risk Assessment MeSH
• Hospitalization MeSH
• Inpatients * psychology   statistics & numerical data   MeSH
• Cohort Studies MeSH
• Referral and Consultation * statistics & numerical data   MeSH
• Humans MeSH
• Hospital Departments statistics & numerical data   MeSH
• Suicide, Attempted * psychology   statistics & numerical data   MeSH
• Patient Handoff statistics & numerical data   MeSH
• Suicide Prevention MeSH
• Suicide psychology   MeSH
• Check Tag
• Humans MeSH

BACKGROUND: Hepatitis C infection (HCI) case-finding programmes aim to identify infected persons in a well-defined population. This study assessed the effectiveness of three HCI case-finding programmes for intravenous drug usersBy examining the rate of their referral to antiviral treatment. METHODS: The Hepatology Outpatient Clinic of Szent László Hospital examines and treats all intravenous drug users who are found positive in HCI case-finding programmes inBudapest. The medical records of patients who visited the Hepatology Outpatient Clinic of Szent László HospitalBetween 1 January 2006 and 31 December 2008 were screened and records indicating a history of drug abuse were selected. These records were matched against the databases of the hepatitis case-finding programmes and the records that appeared inBoth datasets were analyzed. RESULTS: Of the 234 intravenous drug users identified as hepatitis C virus positive in theBudapest case-finding programmes, only 21 attended the Hepatology Outpatient Clinic of Szent László Hospital and only two started antiviral treatment,But their hepatitis C virus positive status had alreadyBeen known at the time of screening. CONCLUSION: In this study, not a single patient with drug abuse whose hepatitis C virus positive status was identified in one of the HCI case-finding programmes was referred for antiviral treatment.

• MeSH
• Antiviral Agents therapeutic use   MeSH
• Hepatitis C diagnosis   epidemiology   therapy   MeSH
• Substance Abuse, Intravenous epidemiology   therapy   MeSH
• Referral and Consultation statistics & numerical data   MeSH
• Humans MeSH
• Patient Acceptance of Health Care statistics & numerical data   MeSH
• Mass Screening statistics & numerical data   MeSH
• Health Behavior MeSH
• Health Services utilization   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Hungary MeSH

OBJECTIVE: The first 3 months after symptom onset represent an important therapeutic window for rheumatoid arthritis (RA). This study investigates the extent and causes of delay in assessment of patients with RA in eight European countries. METHOD: Data on the following levels of delay were collected from 10 centres (Berlin, Birmingham, Heraklion, Lund, Prague, Stockholm, Umea, Vienna, Warsaw and Zurich): (1) from onset of RA symptoms to request to see healthcare professional (HCP); (2) from request to see HCP to assessment by that HCP; (3) from initial assessment by HCP to referral to rheumatologist; and (4) from referral to rheumatologist to assessment by that rheumatologist. RESULTS: Data were collected from 482 patients with RA. The median delay across the 10 centres from symptom onset to assessment by the rheumatologist was 24 weeks, with the percentage of patients seen within 12 weeks of symptom onset ranging from 8% to 42%. There were important differences in the levels underlying the total delays at individual centres. CONCLUSIONS: This research highlights the contribution of patients, professionals and health systems to treatment delay for patients with RA in Europe. Although some centres have strengths in minimising certain types of delay, interventions are required in all centres to ensure timely treatment for patients.

• MeSH
• Time Factors MeSH
• Adult MeSH
• Referral and Consultation standards   statistics & numerical data   MeSH
• Middle Aged MeSH
• Humans MeSH
• Delayed Diagnosis * statistics & numerical data   MeSH
• Patient Acceptance of Health Care statistics & numerical data   MeSH
• Primary Health Care standards   statistics & numerical data   MeSH
• Arthritis, Rheumatoid * diagnosis   MeSH
• Aged MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Multicenter Study MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Europe MeSH