Browsing by Subject "Delayed diagnosis"

Now showing 1 - 4 of 4
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    Delayed presentation of HIV among older individuals: a growing problem
    (Elsevier, 2022) Justice, Amy C.; Goetz, Matthew B.; Stewart, Cameron N.; Hogan, Brenna C.; Humes, Elizabeth; Luz, Paula M.; Castilho, Jessica L.; Nash, Denis; Brazier, Ellen; Musick, Beverly; Yiannoutsos, Constantin; Malateste, Karen; Jaquet, Antoine; Cornell, Morna; Shamu, Tinei; Rajasuriar, Reena; Jiamsakul, Awachana; Althoff, Keri N.; Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health
    Late presentation for care is a major impediment to the prevention and effective treatment of HIV infection. Older individuals are at increased risk of late presentation, represent a growing proportion of people with late presentation, and might require interventions tailored to their age group. We provide a summary of the literature published globally between 2016-21 (reporting data from 1984-2018) and quantify the association of age with delayed presentation. Using the most common definitions of late presentation and older age from these earlier studies, we update this work with data from the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium, focusing on data from 2000-19, encompassing four continents. Finally, we consider how late presentation among older individuals might be more effectively addressed as electronic medical records become widely adopted.
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    Emergency department associated lung cancer diagnosis: Case series demonstrating poor outcomes and opportunities to improve cancer care
    (Elsevier, 2021) Pettit, Nicholas; Al-Hader, Ahmad; Thompson, Caroline A.; Emergency Medicine, School of Medicine
    The diagnosis of cancer through an emergency presentation of an undiagnosed malignancy constitutes around 20–50% of first-time cancer diagnoses. There is a paucity of evidence on the emergency presentations of undiagnosed malignancy with only a few epidemiological studies of large administrative databases. Limited administrative data has shown patients diagnosed with cancer after an emergency presentation suffer poorer clinical outcomes as compared to those diagnosed with cancer through elective routes. Further those diagnosed emergently are commonly among vulnerable populations, such as based on socioeconomic status and racial/ethnic groups. Lung cancer is the most common cancer diagnosed emergently, and while one of the most preventable and treatable, often presents to an emergency department in extremis. This case study of six patients seeks to augment administrative database research by adding detailed clinical information as to demonstrate the issues with diagnosing lung cancer through an emergency presentation. We found that patients diagnosed emergently have complex care pathways including delayed biopsies, delayed treatments, and poor outcomes. Research is needed to elucidate the optimal path on how to manage suspected lung cancer diagnoses from the emergency department.
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    Preadmission antidepressant use and bladder cancer: a population-based cohort study of stage at diagnosis, time to surgery, and surgical outcomes
    (Biomed Central, 2018-10-24) Steffensen, Ellen Hollands; Cary, Clint; Jensen, Jørgen Bjerggaard; Larsson, Heidi; Weiner, Michael; Nørgaard, Mette; Urology, School of Medicine
    BACKGROUND: Among cancer patients, prior antidepressant use has been associated with impaired survival. This could be due to differences in stage at diagnosis, in receipt of treatment, or in treatment complications. The purpose of this study was, therefore, to examine if preadmission antidepressant use in patients with bladder cancer is associated with tumor stage at diagnosis, rate of cystectomy, and surgical outcomes, including survival. METHODS: We performed a registry-based cohort study including all patients with incident invasive bladder cancer in Denmark 2005-2015. Exposure was defined as redemption of two or more antidepressant prescriptions one year before cancer diagnosis. We compared tumor stage using logistic regression, postsurgical inpatient length of stay using linear regression, and other outcomes using Cox regression. All results were adjusted for age, sex, comorbidity, and marital status. RESULTS: Among 10,427 bladder cancer patients, 10% were antidepressant users. At diagnosis, 51% of users and 52% of non-users had muscle-invasive disease. However, upon adjustment for age, sex, comorbidity, and marital status, users had lower odds of muscle-invasive disease (adjusted odds ratio 0.86 (95% confidence interval (CI) 0.74-0.99)). Among patients with muscle-invasive disease, fewer users than non-users had surgery within three months (15% vs. 24%, adjusted hazard ratio (aHR) 0.75 (95% CI 0.59-0.95)). Of 2532 patients undergoing surgery, 6% were antidepressant users. Postsurgical inpatient length of stay did not differ between users and non-users. The 30-day cumulative incidence of readmission was higher for users (41% vs. 33%, aHR 1.33 (95% CI 1.05-1.67)), while the 90-day incidence of postoperative procedures was 44% for users and 38% for non-users (aHR 1.18 (95% CI 0.93-1.51)). One-year mortality was comparable in users (15%) and non-users (14%). CONCLUSIONS: Antidepressant use in bladder cancer patients was associated with less advanced stage at diagnosis and lower rate of cystectomy. After cystectomy, users had higher rate of readmission and postoperative procedures than non-users, but we found no difference in length of stay or one-year mortality. The results point to the importance of differentiated clinical care according to individual patient characteristics.
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    "We did not know what was wrong"-Barriers along the care cascade among hospitalized adolescents with HIV in Gaborone, Botswana
    (Public Library of Science, 2018-04-09) Enane, Leslie A.; Mokete, Keboletse; Dipesalema, Joel; Daimari, Rahul; Tshume, Ontibile; Anabwani, Gabriel; Mazhani, Loeto; Steenhoff, Andrew P.; Lowenthal, Elizabeth D.; Pediatrics, School of Medicine
    High mortality among adolescents with HIV reflects delays and failures in the care cascade. We sought to elucidate critical missed opportunities and barriers to care among adolescents hospitalized with HIV at Botswana's tertiary referral hospital. We enrolled all HIV-infected adolescents (aged 10-19 years) hospitalized with any diagnosis other than pregnancy from July 2015 to January 2016. Medical records were reviewed for clinical variables and past engagement in care. Semi-structured interviews of the adolescents (when feasible) and their caregivers explored delays and barriers to care. Twenty-one eligible adolescents were identified and 15 were enrolled. All but one were WHO Clinical Stage 3 or 4. Barriers to diagnosis included lack of awareness about perinatal HIV infection, illness or death of the mother, and fear of discrimination. Barriers to adherence to antiretroviral therapy included nondisclosure, isolation, and mental health concerns. The number of hospitalized HIV-infected adolescents was lower than expected. However, among those hospitalized, the lack of timely diagnosis and subsequent gaps in the care cascade elucidated opportunities to improve outcomes and quality of life for this vulnerable group.