There are significant health inequalities between Deaf and hearing people, including barriers to accessing care and communication difficulties in consultations. Such problems have particularly affected Deaf people with acquired cognitive deficits, leading to late and missed diagnoses. We therefore established a specialist cognitive clinic for the Deaf community in 2011 at the National Hospital for Neurology and Neurosurgery, which to our knowledge is the first of its kind in the world. In this study, we retrospectively analysed electronic patient records to evaluate the service and its impact since inception. We found that Deaf patients who use British sign language had difficulty obtaining an accurate diagnosis before attending our specialist clinic, highlighting the importance of tailored services for Deaf people. Our results show that the clinic improved communication for patients and accessibility to specialist investigations, ensuring diagnostic accuracy and overall reducing health inequality for this population.
Objective: During fenestrated endovascular aortic repair for complex visceral segment aneurysms, mesenteric vessels can be incorporated with a scallop or fenestration and reinforced with a bridging stent. The outcome of differences in visceral incorporation, specifically at the celiac axis, has not been previously contextualized to assess the cost/benefit of additional procedural complexity on patient outcomes perioperatively and at follow-up.Methods: A retrospective review of prospectively collected data from all patients who had undergone fenestrated endovascular aortic repair for degenerative juxtarenal and/or pararenal aneurysms from January 2015 to December 2019 at a single center (n ¼ 159) was performed to compare the primary outcomes of celiac instability during 5 years of follow-up and the type of celiac bridging strategy used. Secondarily, the "cost" of celiac stenting was measured, interrogating the procedural and perioperative complications and radiation exposure between the treatment groups.Results: The celiac axis of most patients was treated with a stented fenestration (n ¼ 74), followed by an unstented fenestration (n ¼ 59) and an unstented scallop (n ¼ 26). No differences were found between the groups in the procedural indication or anatomic aneurysm or celiac features, including no between-group differences in preoperative celiac stenosis. The fenestrated stented patients had a higher level of graft coverage above the celiac axis, had more often had a spinal drain placed, and, with the fenestrated unstented patients, had improved primary technical success compared with the scallop-only patients. During follow-up, the scallop-only patients were more likely to have developed an endoleak, although celiac instability was highest in the fenestrated unstented group. Celiac instability in the fenestrated unstented group was not associated with celiac reintervention, worse reintervention-free survival, or a difference in all-cause mortality. Regression analysis for any branch instability revealed significant predictors related to celiac scallop or nonstenting of the celiac, and diminished length of graft coverage above the celiac axis.Conclusions: Perioperatively, nonstenting of the celiac axis did not change radiation exposure or perioperative complication rates. At follow-up, nonstenting of the celiac axis was associated with clinically silent celiac instability. Increasing the length of graft coverage, regardless of the celiac bridging strategy, reduced any branch instability.
BackgroundEarly dementia diagnosis is crucial to ensure timely treatment and support. Approximately 100,000 people in the UK are Deaf and use British Sign Language as their first language. For this population access to healthcare can be difficult, clinical assessment challenging and misdiagnosis may occur.In August 2011, a specialist cognitive clinic for the Deaf community was established at the National Hospital for Neurology and Neurosurgery. We sought to evaluate this service to inform future provision of care.MethodsWe retrospectively analysed electronic patient records from August 2011 until December 2018.Results36 patients were reviewed aged 35–83 years (median 71.5). 83% of those referred did not have a prior diagnosis. 17% had previously been given a provisional diagnosis, however this was changed in 67% of cases following review in our clinic.All patients underwent neuropsychological assessment and in 92% cranial imaging was performed. 8% additionally underwent FDG-PET and 25% lumbar puncture. 47% were diagnosed with a neurodegenerative disorder (Alzheimer’s Disease in 77%), 6% mild cognitive impairment, 11% a pre-existing neurological disorder and 19% with subjective memory complaints without evidence of neurodegeneration.Donepezil was commenced in all patients diagnosed with Alzheimer’s disease. 9% experienced adverse effects and changed medication.ConclusionIn this evaluation, we found that Deaf patients had difficulties obtaining an accurate diagnosis prior to clinic and we observed a high proportion of neurodegenerative and neurological diagnoses (64%) compared to other cognitive clinics (reportedly 40–50%). We believe these results highlight the challenges Deaf patients have in accessing healthcare and this underscores the importance of this service in ensuring patients receive an accurate and timely diagnosis.
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