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Although less common cancers account for over half of all cancer diagnoses in England, their relative scarcity and complex presentation, often with non-specific symptoms, means that patients often experience multiple primary care consultations, longer times to diagnosis and poorer clinical outcomes. An urgent referral pathway for non-specific symptoms, the Multidisciplinary Diagnostic Centre (MDC), may address this problem.
To examine the less common cancers identified during the MDC pilots and consider if such an approach improves the diagnosis of these cancers.
A service evaluation of five MDC pilot projects in England to 31st March 2019.
Data items were collected by pilot sites in near-real time, based mainly on the English cancer outcomes and services dataset, with additional project specific items. Simple descriptive and comparative statistics were used, including chi-squared tests for proportions and t-tests for means where appropriate.
From 5,134 referrals, 378 cancers were diagnosed, of which 218 (58%) were less common. Over 30 different less common tumour types were diagnosed within this cohort. 23% of MDC patients with less common cancers had ≥3 more GP consultations before referral and, at programme level, a median time of 57 days was recorded from GP urgent referral to treatment for these tumour types.
A non-specific symptomatic referral route diagnoses a broad range of less common cancers, and can support primary care case management for patients with symptoms of possible cancer that do not qualify for a site-specific urgent referral.
A non-specific symptomatic referral route diagnoses a broad range of less common cancers, and can support primary care case management for patients with symptoms of possible cancer that do not qualify for a site-specific urgent referral.
During lockdown due to the COVID-19 pandemic, telemedicine has become a necessary component of clinical practice for the purpose of providing safer patient care, and it has been used to support the healthcare needs of COVID-19 patients and routine primary care patients alike. However, this change has not been fully consolidated.
The objective of this study was to analyse the determinants of healthcare professionals' intention to use the eConsulta digital clinical consultations tool in the post-COVID-19 context.
A literature review of the Technology Acceptance Model (TAM) allowed us to construct a theoretical model and establish a set of hypotheses derived from it about the influence that a variety of different factors relating to both healthcare professionals and the institutions where they work had on those professionals' intention to use eConsulta. In order to confirm the proposed model, a mixed qualitative and quantitative methodology was used, and a questionnaire was designed to serve as the data coe satisfied with its use in practice and planned to incorporate it into their practices in the post-COVID-19 context. Perceived benefits and environmental pressure were determining factors in the attitude towards and intention to use eConsulta.
A mixed breed dog was anesthetized for diagnostic myelography to investigate acute onset neck pain. Instead of contrast medium, 444 μg/kg medetomidine were inadvertently injected into the cerebromedullaris cisterna owing to a human error. Severe bradycardia, undetectable peripheral pulse, respiratory arrest and loss of pupillary, palpebral and corneal reflexes were observed immediately after injection. Profound hypothermia developed and esophageal temperature, measured 20 minutes after medetomidine injection, was 33 °C. Atipamezole at 1 mg/kg im was administered, followed by a second dose of 0,5 mg/kg iv 20 minutes thereafter. In the meantime, cardiorespiratory parameters and body temperature were monitored, and supportive care that included manually assisted pulmonary ventilation, active warming, and administration of 5 μg/kg/min dopamine was initiated. The dog's clinical condition improved within one hour from the beginning of supportive care, at which time ocular reflexes and swallowing returned, spontanpersonnel involved prior to commencing the clinical procedure. click here Profound cardiovascular, respiratory, and thermoregulatory depression caused by intracisternal injection of medetomidine responded to parenteral administration of its antagonist and supportive care.
The lying and rumination behavior of dairy cows is internationally used as an animal welfare indicator. Dairy cow housing in Switzerland is subordinated to detailed legal requirements. It is particularly described that the lying area for cows must be covered with a sufficient amount of bedding. In the current study, we investigated whether bedding depth influences the lying and rumination behavior and thus, the animal welfare of healthy dairy cows housed in tie stalls. Bedding depth was categorized as ≤ 2 cm and > 2 cm. The lying and rumination behavior of 145 cows from 33 farms was recorded and analyzed considering farm effects; 105 cows were housed on ≤ 2 cm bedding, and 40 cows on > 2 cm bedding. Cows on > 2 cm bedding had on average a one hour longer daily lying time compared with cows on ≤ 2 cm bedding (mixed-effects linear regression mean difference [cows on > 2 cm bedding- cows on ≤ 2 cm bedding] = 60,7 min/d; standard error = 28,6 min/d; p-value = 0,037). The odds of a cow to lie while ruminating were significantly higher in cows on > 2 cm bedding against cows on ≤ 2 cm bedding (mixed-effects logistic regression Odds ratio = 1,27; CI95% [1,17-1,38]; p-value 2 cm can make a significant difference in the lying and rumination behavior of healthy dairy cows housed in tie stalls. Consequently, the animal welfare of dairy cows in tie stalls is improved by providing at least 2 cm of bedding.
2 cm bedding against cows on ≤ 2 cm bedding (mixed-effects logistic regression Odds ratio = 1,27; CI95% [1,17-1,38]; p-value 2 cm can make a significant difference in the lying and rumination behavior of healthy dairy cows housed in tie stalls. Consequently, the animal welfare of dairy cows in tie stalls is improved by providing at least 2 cm of bedding.
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