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BMC Health Services Research Sep 2022Effective care services for people whose work participation is at risk require low-threshold access, a comprehensive diagnostic clarification of intervention needs, a...
BACKGROUND
Effective care services for people whose work participation is at risk require low-threshold access, a comprehensive diagnostic clarification of intervention needs, a connection to the workplace and job demands, and interdisciplinary collaboration between key stakeholders at the interface of rehabilitation and occupational medicine. We have developed a comprehensive diagnostic service to clarify intervention needs for employees with health restrictions and limited work ability: this service is initiated by occupational health physicians.
METHODS/DESIGN
Our randomized controlled trial tests the effectiveness of a comprehensive diagnostic service for clarifying intervention needs (GIBI: Comprehensive clarification of the need for intervention for people whose work participation is at risk). The comprehensive intervention comprises three elements: initial consultation, two-day diagnostics at a rehabilitation center and follow-up consultations. We will include 210 employees with health restrictions and limited work ability, who are identified by occupational health physicians. All individuals will receive an initial consultation with their occupational health physician to discuss their health, work ability and job demands. After this, half the individuals are randomly assigned to the intervention group and the other half to the waiting-list control group. Individuals in the intervention group start two-day diagnostics, carried out by a multi-professional rehabilitation team in a rehabilitation center, shortly after the initial consultation. The diagnostics will allow first recommendations for improving work participation. The implementation of these recommendations is supported by an occupational health physician in four follow-up consultations. The control group will receive the comprehensive two-day diagnostic service and subsequent follow-up consultations six months after the initial consultation. The primary outcome of the randomized controlled trial is self-rated work ability assessed using the Work Ability Score (0 to 10 points) six months after study inclusion. Secondary outcomes include a range of patient-reported outcomes regarding physical and mental health, impairment, and the physical and mental demands of jobs.
DISCUSSION
This randomized controlled trial is designed to test the effects of a new complex intervention involving a comprehensive clarification of intervention needs in order to promote work participation and prevent the worsening of health and work disability.
TRIAL REGISTRATION
German Clinical Trials Register (DRKS00027577, February 01, 2022).
Topics: Diagnostic Services; Humans; Medicine; Occupational Health Physicians; Occupational Medicine; Randomized Controlled Trials as Topic; Rehabilitation Centers
PubMed: 36085150
DOI: 10.1186/s12913-022-08513-1 -
International Psychogeriatrics Apr 2022While early diagnosis of younger-onset dementia (YOD) is crucial in terms of accessing appropriate services and future planning, diagnostic delays are common. This study...
OBJECTIVES
While early diagnosis of younger-onset dementia (YOD) is crucial in terms of accessing appropriate services and future planning, diagnostic delays are common. This study aims to identify predictors of delay to diagnosis in a large sample of people with YOD and to investigate the impact of a specialist YOD service on this time to diagnosis.
DESIGN
A retrospective cross-sectional study.
SETTING
The inpatient unit of a tertiary neuropsychiatry service in metropolitan Victoria, Australia.
PARTICIPANTS
People diagnosed with a YOD.
MEASUREMENTS AND METHODS
We investigated the following predictors using general linear modeling: demographics including sex and location, age at onset, dementia type, cognition, psychiatric diagnosis, and number of services consulted with prior to diagnosis.
RESULTS
A total of 242 inpatients were included. The mean time to diagnosis was 3.4 years. Significant predictors of delay included younger age at onset, dementia type other than Alzheimer's disease (AD) and behavioral-variant frontotemporal dementia (bvFTD), and increased number of services consulted. These predictors individually led to an increased diagnostic delay of approximately 19 days, 5 months, and 6 months, respectively. A specialized YOD service reduced time to diagnosis by 12 months.
CONCLUSION
We found that younger age at onset, having a dementia which was not the most commonly occurring AD or bvFTD, and increasing number of services were significant predictors of diagnostic delay. A novel result was that a specialist YOD service may decrease diagnostic delay, highlighting the importance of such as service in reducing time to diagnosis as well as providing post-diagnostic support.
Topics: Age of Onset; Alzheimer Disease; Cross-Sectional Studies; Delayed Diagnosis; Diagnostic Services; Frontotemporal Dementia; Humans; Retrospective Studies
PubMed: 32854788
DOI: 10.1017/S1041610220001489 -
Australian Dental Journal Sep 2016Diagnostic services are the most common area of dental service in Australia. The objective was to investigate differences in services per visit for examinations and...
BACKGROUND
Diagnostic services are the most common area of dental service in Australia. The objective was to investigate differences in services per visit for examinations and radiographs in relation to the characteristics of patients receiving these services in terms of age and gender, aspects of visiting such as dental insurance and reasons for visit, and oral health such as number of teeth and presence of decay.
METHODS
A random sample of Australian dentists was surveyed in 2009-2010. Data on diagnostic services and patient characteristics were collected from a service log.
RESULTS
A total of 1148 dentists responded (response rate = 67%). Models adjusted for age and gender of patients showed that rates [Rate Ratio, 95% CI] of examinations were higher for insured patients [1.13; 1.06-1.21], while rates of radiographs were higher for emergency visits [1.25; 1.11-1.48]. Patients with 20 or more teeth had higher rates for examinations [1.15; 1.01-1.32] and radiographs [1.28; 1.02-1.60]. Decayed teeth were associated with lower examination rates [0.70; 0.65-0.76] but higher rates of radiographs [1.34; 1.16-1.55].
CONCLUSIONS
The finding that number of teeth was associated with higher rates of examinations and radiographs suggests that retention of teeth could be influencing the increasing rates of diagnostic services in Australia.
Topics: Adolescent; Adult; Aged; Australia; Child; Child, Preschool; Dental Care; Diagnostic Services; Female; Humans; Insurance, Dental; Male; Middle Aged; Practice Patterns, Dentists'; Radiography, Dental; Surveys and Questionnaires; Tooth Diseases; Young Adult
PubMed: 27480290
DOI: 10.1111/adj.12373 -
Research in Developmental Disabilities Oct 2019Fetal alcohol spectrum disorder (FASD) is of significant concern for Australians for many reasons, one being Australia's drinking culture which increases the potential...
BACKGROUND
Fetal alcohol spectrum disorder (FASD) is of significant concern for Australians for many reasons, one being Australia's drinking culture which increases the potential for FASD to occur.
AIMS
The current study aimed to explore the lived experiences of Australian caregivers who received a FASD diagnosis for a child in their care, usingthe Australian Guide to the Diagnosis of FASD.
METHODS AND PROCEDURES
Semi-structured interviews were conducted with seven caregivers whose children were assessed for FASD by a multidisciplinary team. Interviews explored how families experienced the FASD diagnostic process, and sought insight into outcomes for families following diagnosis, particularly in relation to accessing supports and services.
OUTCOMES AND RESULTS
Through thematic analysis, five overarching themes were identified: (1) receiving a FASD diagnosis had a positive impact; (2) caregivers' evaluation of assessment process; (3) positive support services relative to FASD; (4) ongoing difficulties regardless of diagnosis; and (5) need for societal knowledge of FASD.
CONCLUSIONS AND IMPLICATIONS
Given the global need for standardised FASD diagnostic procedures and accurate reporting of prevalence rates, the current study provides a contribution to the emerging diagnostic FASD literature, and insight into families' experiences who have children diagnosed with FASD.
WHAT THIS PAPER ADDS
This study provides additional information to the developing pool of literature attempting to create a typical profile of FASD. Most importantly, this paper highlights the implementation of the Australian Guide to the Diagnosis of FASD, and evaluates caregivers' experiences of their child's FASD assessment process, within a public FASD diagnostic service, using the revised guidelines.
Topics: Adult; Alcohol Drinking; Attitude of Health Personnel; Australia; Child; Diagnostic Services; Family; Family Health; Female; Fetal Alcohol Spectrum Disorders; Humans; Male; Middle Aged; Outcome and Process Assessment, Health Care; Practice Guidelines as Topic; Prevalence; Qualitative Research
PubMed: 31357176
DOI: 10.1016/j.ridd.2019.103428 -
Problemy Sotsial'noi Gigieny,... May 2022The modern trends in health care (strategies of optimizing costs, value-oriented medical care) require systematic development of laboratory services for administrative...
The modern trends in health care (strategies of optimizing costs, value-oriented medical care) require systematic development of laboratory services for administrative territories. The study was carried out to provide support for decision-making by systematizing models of laboratory services on the basis of principles of systematic approach. Four basic models (centralization, outsourcing, horizontal integration, point-of-care) were analyzed. The study applied such research methods as analytical and strategic SWOT-analysis. The SWOT-analysis was implemented using list of standard characteristics for each model of laboratory service organization. Each model is distinguished by complex combination of strengths, weaknesses, lines of functioning and development. The availability of implementing particular model depends on delicate balance of opportunities and risks against the background of local characteristics of administrative subject. The dynamics of the social economic and infrastructural development of administrative subject can significantly affect effectiveness of model implementation. The objective set of characteristics was obtained for each model of laboratory service organization. Actually it is impossible to select particular model for specific administrative subject. Hence, scientific substantiation of "flexible" model is needed to implement.
Topics: Delivery of Health Care; Diagnostic Services; Models, Organizational
PubMed: 35670405
DOI: 10.32687/0869-866X-2022-30-3-473-478 -
Journal of Clinical Virology : the... Dec 2008An increasing number of virology laboratories are now utilising in house real time PCR assays as the frontline diagnostic tests. As the number of tests on offer... (Review)
Review
An increasing number of virology laboratories are now utilising in house real time PCR assays as the frontline diagnostic tests. As the number of tests on offer increases the natural progression from this will be to rationalise their service via multiplexing. Since 2003 we have introduced a large number of qualitative and quantitative multiplex real time PCR assays into our routine testing service. This paper describes the development of the multiplex assays, the problems encountered and the resultant benefits to the routine service.
Topics: Diagnostic Services; Molecular Diagnostic Techniques; Polymerase Chain Reaction; Time Factors; Virus Diseases
PubMed: 18977692
DOI: 10.1016/j.jcv.2008.08.020 -
British Medical Journal Jul 1977In a haematuria diagnostic service, covering experience with 95 patients, 12 new cases of cancer of the bladder, one of cancer of the kidney, and one of cancer of the...
In a haematuria diagnostic service, covering experience with 95 patients, 12 new cases of cancer of the bladder, one of cancer of the kidney, and one of cancer of the penis were identified--all at an early stage. Patients presenting with haematuria were investigated rapidly without disruption of the routine work of the urological unit. Patients who identified the symptoms and sought advice early were given a definite diagnosis quickly, and treatment for any malignant disease was started early. The delay that undoubtedly endangers patients' lives has been considerably reduced by this service.
Topics: Adolescent; Adult; Aged; Child; Diagnostic Services; Female; Hematuria; Humans; Male; Middle Aged; Prognosis; Time Factors; Urologic Diseases
PubMed: 871745
DOI: 10.1136/bmj.2.6078.29 -
Malaria Journal Feb 2021In Ethiopia, malaria cases are declining as a result of proven interventions, and in 2017 the country launched a malaria elimination strategy in targeted settings....
BACKGROUND
In Ethiopia, malaria cases are declining as a result of proven interventions, and in 2017 the country launched a malaria elimination strategy in targeted settings. Accurate malaria diagnosis and prompt treatment are the key components of the strategy to prevent morbidity and stop the continuation of transmission. However, the quality of microscopic diagnosis in general is deteriorating as malaria burden declines. This study was carried out to evaluate the competency of microscopists and the performance of health facilities on malaria microscopic diagnosis.
METHODS
A cross-sectional study was conducted from 1 August to 30 September, 2019 in 9 regional states and one city administration. A standard checklist was used for on-site evaluation, archived patient slides were re-checked and proficiency of microscopists was tested using a WHO-certified set of slides from the national slide bank at the Ethiopian Public Health Institute (EPHI). The strength of agreement, sensitivity, specificity, and positive and negative predictive values were calculated.
RESULTS
In this study, 102 health facilities (84 health centres and 18 hospitals) were included, from which 202 laboratory professionals participated. In slide re-checking, moderate agreement (agreement (A): 76.0%; Kappa (K): 0.41) was observed between experts and microscopists on malaria detection in all health facilities. The sensitivity and specificity of routine slide reading and the re-checking results were 78.1 and 80.7%, respectively. Likewise, positive predictive value of 65.1% and negative predictive value of 88.8% were scored in the routine diagnosis. By panel testing, a substantial overall agreement (A: 91.8%; K: 0.79) was observed between microscopists and experts in detecting malaria parasites. The sensitivity and specificity in the detection of malaria parasites was 92.7 and 89.1%, respectively. In identifying species, a slight agreement (A: 57%; K: 0.18) was observed between microscopists and experts.
CONCLUSION
The study found significant false positive and false negative results in routine microscopy on slide re-checking of Plasmodium parasites. Moreover, reduced grade in parasite species identification was reported on the panel tests. Implementing comprehensive malaria microscopy mentorship, in-service training and supportive supervision are key strategies to improve the overall performance of health facilities in malaria microscopy.
Topics: Adult; Cross-Sectional Studies; Diagnostic Services; Diagnostic Tests, Routine; Ethiopia; Female; Health Facilities; Humans; Malaria; Male; Mentors; Microscopy; Middle Aged; Professional Competence; Sensitivity and Specificity; Young Adult
PubMed: 33632208
DOI: 10.1186/s12936-021-03655-9 -
Thorax Aug 2007A nationally funded diagnostic service should lead to improved outcome
A nationally funded diagnostic service should lead to improved outcome
Topics: Diagnostic Services; Early Diagnosis; Humans; Kartagener Syndrome; United Kingdom
PubMed: 17687094
DOI: 10.1136/thx.2007.083147 -
Clinical Microbiology and Infection :... Jul 2000The first part of this review discussed the facilities that are needed to provide a competent diagnostic virology service at the turn of the century. Just as important... (Review)
Review
The first part of this review discussed the facilities that are needed to provide a competent diagnostic virology service at the turn of the century. Just as important is to consider who will run it. Hitherto, there have been specialist virologists in most countries. Their roles have evolved with time, developing and running a variety of diagnostic tests, often to answer local needs and their own curiosity, and frequently linked to their research projects. Recently, the advent of an increasingly long list of commercial tests has raised the real possibility of introducing standardized centrally validated testing methods, and using them to bring laboratories up to a similarly uniform level. Unfortunately, they have also had the effect of seeming to make specialist virologists unnecessary, except in a few central reference laboratories. As a consequence, and because of increasing pressure on health service resources, vacated senior virology posts have remained unfilled and this now threatens the career structure of those who want to become, and continue as, virologists. This review explores these issues and offers a possible solution.
Topics: Diagnostic Services; Europe; Humans; Job Description; Microbiology; Virology
PubMed: 11168149
DOI: 10.1046/j.1469-0691.2000.00108.x