BackgroundNeurology patients with complex diagnoses in a busy tertiary centre can undergo multiple investigations to reach a diagnosis and are usually discharged with pending results, as tests can take a considerable amount of time to be processed (and released).AimWe set up a Virtual Clinic to follow-up patients’ results post discharge to avoid loss to follow up and improve safety of patient care.MethodsWe identified a significant proportion of neurology inpatients who were not followed-up efficiently (30.8% over 3-month-period) and addressed this issue by initiating a Virtual Clinic. The clinic was run weekly by neurology junior doctors, with protected clinic hours. The outcome of the clinic was communicated to the referring neurology consultant. We compared the follow up rates in the three months pre-clinic (October to December 2019) to the three months after setting up the clinic (January to March 2020).ResultsUsing the PDSA methodology, we successfully managed to increase the follow-up for outstanding investigations to 68.8% from 30.8% (pre-clinic setup), via the implementation of the Neurology Virtual Clinic. We re-audited for another three-month period using the same methodology. For the period September to November 2020, this percentage increased further to 73.68%.ConclusionThis new service was effective at improving test result monitoring and decreased the number of investigations that were not followed up promptly. Most importantly improved the safety of our patients’ care.
Background andAimBrainstem gliomas are rare, accounting for less than 2% of adult gliomas. They are difficult to diagnose and challenging to treat [Hu et al, 2016]. Here, we report a patient with an unusual clinical presentation of brainstem glioma, supported by radiological and histopathological findings.Clinical presentationA 61-year old male retired diver presented with 2-month history of worsening occipital headache, described as a constant pressure worse on lying down with migrainous features of nausea and light-sensitivity, and intermittent episodes of double vision and poor balance.Neurological examination on admission was normal. He progressed to develop double vision, left-sided weakness and worsening swallowing and respiratory function.InvestigationsBlood tests for infections and vasculopathy were negative. Two CSF samples taken showed high protein (1.7g and 3.25g respectively) with the first showing 100% lymphocytes and the latter 56% monocytes and 42% lymphocytes. There were no malignant cells on immunophenotyping.MRIs demonstrated progressive of ring-enhancing lesions in brainstem in keeping with inflammatory con- ditions. Biopsy was not possible due to the centrally-located lesions. Despite receiving wide spectrum antimicrobials, steroids and respiratory support, he died 2 months later. Autopsy of the brain showed a glioblastoma with brainstem infiltration and cystic necrosis in the pons.SummaryGliomatosis pattern and leptomeningeal and nerve root spreading of brainstem glioblastoma can be misleading signs with neuro-infections as a differential. Early neurosurgical intervention may aid diagnosis.kitwu@doctors.org.uk
BackgroundUnwarranted variation in treatment, care and support for people with dementia is well documented. To improve equity of service, in line with the NHS Long Term Plan, it is imperative that we understand how sociodemographic factors affect management and care of dementia.AimTo review published literature between sociodemographic factors and clinical factors, diagnosis, treatment and outcomes for people with dementia.MethodWe conducted a focused review of published literature between 2000-2021 to outline the evidence describing the relationship between the ten protected characteristics of the Equality Act 2010 and clinical factors, treatment and outcomes in dementia. Other factors such as deprivation, settlement status, education and employment were also explored.ResultsThere is an abundance of published literature on age, race, geographical variation, sex and gender. Evidence is lacking for relationship between disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, religion and belief, sexual orientation, immigration and settlement.DiscussionBetter understanding of sociodemographic factors of our patient group is key to improving equity of care. This review has identified gaps in knowledge on factors that may affect how patients access care to dementia services.
BackgroundTo improve equity of service provided to people with Multiple Sclerosis (MS), in line with the aspirations of public policy across the UK, it is imperative to understand how sociodemographic factors affect management and care of people with MS.MethodsWe conducted a focused review of literature published between 2000-2021 to outline the evidence describing the relationship between the nine protected characteristics of the Equality Act 2010 and the epidemiology, diagnosis, management, and outcomes of MS. Other factors such as deprivation, settlement status, education and employment were also explored.ResultsThere is much published literature on the relationship between age, sex, geographical factors, pregnancy and MS epidemiology and management. There is also good quality evidence regarding the large disability burden caused globally. Further research is required to explore racial differences in disease onset, progression, and disability as well as the relationship between MS care and religious factors, sexual orientation, gender reassignment and socioeconomic factors, particularly in UK settings.DiscussionBetter understanding of sociodemographic factors and their relationship with MS epidemiol- ogy and management is key to improving equity of care. This review has identified gaps in knowledge that require further research.
BackgroundEvidence suggests there is variation in the diagnosis, management, and support for people with migraine. To improve equity of service, in line with the aspirations of public policy across the UK, it is imperative to understand how sociodemographic factors affect management and care of migraine.MethodsWe conducted a focused review of literature published between 2000-2021 to outline the evidence describing the relationship between the nine protected characteristics of the Equality Act 2010 and the epidemiology, diagnosis, management, and outcomes of migraine. Other factors such as deprivation, settlement status, education and employment were also explored.ResultsThere is much published literature on the relationship between age and sex in migraine epidemi- ology and management. There is good quality evidence regarding the large disability burden caused globally. There is limited evidence outlining the relationship between gender reassignment, ethnicity, religious and cultural factors, sexual orientation, settlement status, immigration and migraine. Further work should also focus on variation in access to specialist advice, and newer migraine treatments such as CGRP therapy.DiscussionBetter understanding of sociodemographic factors and their relationship with migraine epide- miology and management is key to improving equity of care. This review has identified gaps in knowledge that require further research.
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