AND lymphoma)) OR ((lymphoma[Title]) AND pathology[Title]). The pooled major discordance frequency was calculated using Neyeloff, Fuchs and Moreira's Excel random effects model (2012). Weighted averages using a random-effects model are reported with 95% confidence intervals with continuity correction. Results: Eight (8) articles evaluating and differentiating minor and major second-opinion discordance in lymphoma diagnosis were included in this study. Major discordance is defined as diagnostic discrepancy between the preliminary or final diagnosis and second-opinion review that is determined by the study authors could have an impact on patient management. The proportion of discordance that was major ranged from 4.27% to 20.00%. The pooled proportion of major discordance was 9.10% (95% CI 5.86%-12.35%) in a pooled sample of 5,322 lymphoma patients. Only 1 study, a published abstract, analyzed the actual patient impact of discordant pathological results through chart review, determining 2.9% of patients were over-treated, under-treated, had significant change in treatment or incorrect treatment due to diagnostic error (Kukreti et al., 2006). ConClusions: Diverse methodologies led to considerably variable estimates; however, this meta-analysis revealed that an estimated 9.10% of lymphoma diagnoses could be incorrect to the point of impacting patient treatment management.
BackgroundTransferring patients with palliative care needs between care settings via the Welsh Ambulance Service Trust (WAST) is a daily component of delivering palliative care. We hypothesised that patients would have quicker and more appropriate ambulance transfers if healthcare professionals working in palliative care had a better knowledge of the ambulance services available; including the pilot of the new End-of-Life Rapid Transport Service.MethodWe sent an electronic questionnaire to 236 healthcare professionals working in palliative care in Wales. We tested the respondent's knowledge of the available services provided by WAST and asked respondents to share their experiences of transferring patients via the ambulance service.ResultsWe had 52 responses to the questionnaire (response rate 22%). Respondents were predominantly palliative medicine consultants, registrars and clinical nurse specialists. There was a lack of knowledge about the WAST's ability to transfer patients with syringe drivers and the services ability to make decisions regarding not commencing cardio-pulmonary resuscitation. The Urgent Care Service was not well understood and only 12% of respondents could easily find the correct contact details for each service.We created and publicised an aide-memoire (attached) about the different ambulance services available in Wales. It contains information tailored to palliative care health care professionals. The aide memoire is designed to be easily accessible in paper and electronic format.ConclusionPalliative care healthcare professionals lack sufficient knowledge of the ambulance services available in Wales. The aide memoire we created contains the relevant information that is necessary to make the best use of the ambulance services available. The aide memoire is being used across Wales to improve the use of the ambulance service for patients with palliative care needs.
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