OBJECTIVE: To identify diagnostic opportunities, we investigated healthcare-seeking behavior among patients with Lyme neuroborreliosis (LNB) within 28 weeks before diagnosis.
METHODS: We conducted a population-based, nationwide matched nested case-control study (Denmark, 2009-2021). As cases, we included all Danish residents with LNB (positive Borrelia burgdorferi intrathecal antibody index test and cerebrospinal fluid pleocytosis). We randomly selected controls from the general population, matched 10:1 on date of birth and sex. Exposures were assignment of diagnostic codes for symptoms, contact to medical specialties, medical wandering, and undergoing diagnostic procedures. We calculated the weekly and 3-months proportion of individuals with exposures and calculated absolute risk differences with corresponding 95% confidence intervals (95%CI).
RESULTS: We included 1,056 cases with LNB and 10,560 controls. Within 3 months before diagnosis, the most frequent assigned symptoms were pain (difference: 13.0%, 95%CI: 10.9-15.1). Cases with LNB exhibited increased contact to most specialties, particularly general practitioners (difference: 48.7%, 95%CI: 46.0-51.4), neurology (difference: 14.3%, 95%CI: 11.7-16.8), and internal medicine (difference: 11.1%, 95%CI: 8.7-13.5), and medical wandering (difference: 17.1%, 95%CI: 14.3-20.0). Common diagnostic procedures included imaging of the brain (difference: 10.2, 95%CI: 8.3-12.1), the spine (difference: 8.8%, 85%CI: 7.0-10.6), and the abdomen (difference: 7.2%, 95%CI: 5.4-9.1). The increase in healthcare-seeking behavior was observed up to 12 weeks preceding diagnosis.
CONCLUSIONS: Pain appears to be an ambiguous symptom of LNB, potentially contributing to delays in establishing the correct diagnosis. It would be difficult to identify patients with LNB more effectively as the increased healthcare-seeking behavior preceding diagnosis is distributed across many medical specialties.

BACKGROUND: The indirect impact of the coronavirus disease 2019 pandemic on healthcare services was studied by assessing changes in the trend of the time to first treatment for women 18 or older who were diagnosed and treated for breast cancer between 2017 and 2021.
METHODS: An observational retrospective longitudinal study based on aggregated data from four European Union (EU) countries/regions investigating the time it took to receive breast cancer treatment. We compiled outputs from a federated analysis to detect structural breakpoints, confirming the empirical breakpoints by differences between the trends observed and forecasted after March 2020. Finally, we built several segmented regressions to explore the association of contextual factors with the observed changes in treatment delays.
RESULTS: We observed empirical structural breakpoints on the monthly median time to surgery trend in Aragon (ranging from 9.20 to 17.38 days), Marche (from 37.17 to 42.04 days) and Wales (from 28.67 to 35.08 days). On the contrary, no empirical structural breakpoints were observed in Belgium (ranging from 21.25 to 23.95 days) after the pandemic\'s beginning. Furthermore, we confirmed statistically significant differences between the observed trend and the forecasts for Aragon and Wales. Finally, we found the interaction between the region and the pandemic\'s start (before/after March 2020) significantly associated with the trend of delayed breast cancer treatment at the population level.
CONCLUSIONS: Although they were not clinically relevant, only Aragon and Wales showed significant differences with expected delays after March 2020. However, experiences differed between countries/regions, pointing to structural factors other than the pandemic.

BACKGROUND: Here we present the case of a newborn baby boy with severe plasminogen deficiency causing occlusive hydrocephalus and ligneous conjunctivitis.
METHODS: Shortly after birth, the hydrocephalus was treated with a ventriculoperitoneal shunt implantation. However, the child had to be readmitted soon afterward because of shunt obstruction. Subglottic microtrauma caused by the necessary intubations then led to another life-threatening complication - subglottic stenosis with pseudomembrane formation. Microsurgical removal had to be performed to secure the airway. Initially, regular plasma transfusions achieved slightly elevated plasminogen activity levels and short-term improvement of the respiratory situation. However, shunt dysfunction reoccurred, and alternative treatment options were needed. Since therapy with plasminogen concentrate is already available in the USA with encouraging results, this treatment option was organized in hopes of equally good results for this patient. Fortunately, under short-term substitution with plasminogen concentrates, the implantation of a new ventriculoperitoneal shunt was successful, and respiratory problems resolved.
CONCLUSIONS: Plasminogen concentrates are critically needed in Europe and other parts of the world to improve the care of and prevent complications among patients with plasminogen deficiency.

Treatment delay is the best explanation for the development of Korsakoff\'s syndrome. This study aimed to improve the patient pathway to reduce treatment delay and/or increase proper care on time for people with Korsakoff\'s syndrome by generating knowledge about the patient journey from the first moment that professional care was deemed necessary until the time of admission into a specialised residential facility for long-term care and treatment. This retrospective exploratory multiple-case study used an individual semi-structured interview approach in 14 cases, with a total of 56 respondents. Process mapping was used to understand the chronological patient journey and the multiple-case description was analysed by using the same question as used by the individual case studies: \'What risk factors do the respondents discuss that can explain treatment delay?\'. The exploration of the data revealed three reoccurring cross-case risk factors to explain treatment delay or delay in receiving proper care on time. Our respondents discussed: the lack of knowledge of KS, the fragmentation of care/waiting lists and the lack of specialistic home care. We recommend the development of knowledge programmes about Korsakoff\'s syndrome for family carers, GP\'s, healthcare professionals in general hospitals and home care workers, which could play an essential role in reducing treatment delays for patients with KS. There is also a need to find ways to organise coordinated care for patients with KS. Further research into the role of Korsakoff case managers is recommended.

暂无摘要。

To identify and compare treatment and system factors associated with survival in early-stage glottic cancer.
Retrospective study of cases in the Commission on Cancer National Cancer Database.
Adult patients with early glottic cancer (stage I or II) diagnosed between January 1, 2004, and December 31, 2012, were included. Demographic, tumor, and survival variables were included in the analyses. Multivariate Cox regressions as well as univariate Kaplan-Meier analyses were conducted.
In total, 5,627 patients were included in the study. Treatment factors associated with improved survival included larynx-preserving surgery alone (hazard ratio [HR] 0.740; P = 0.001) and larynx-preserving surgery with radiation (HR 0.837; P = 0.010) when compared to radiotherapy alone. System factors associated with worse survival included intermediate- (HR 1.123; P = 0.047) or low- (HR 1.458; P = 0.017) volume centers; Medicaid (HR 1.882; P < 0.001), Medicare (HR 1.532; P < 0.001), or other government insurance (HR 2.041; P < 0.001); and delay between diagnosis and treatment greater than 100 days (HR 1.605; P = 0.006).
A number of treatment and system factors were found to be significantly associated with survival when controlling for patient and tumor factors. These may present targets for the improvement of outcomes in early-stage glottic cancers.
4. Laryngoscope, 127:616-622, 2017.

Leptospirosis is not a major disease in urban areas of Japan. We describe a 49-year-old man with leptospirosis, who lived in an urban area and had no history of living in endemic area of leptospirosis. As he worked at a fish market infested with rats, he was suspected of having contracted leptospirosis and received antimicrobial agent treatment. Serum and urinary tests confirmed the diagnosis of leptospirosis. Although it took six days from the onset until treatment initiation, the patient improved in response to receiving ceftriaxone for seven days. Analyzing past reports of Japanese patients with leptospirosis who had no history of overseas travel, we identified 90 patients with courses similar to that of our patient, and the period from onset to treatment initiation was about six days on average (described in 46 cases). Health care providers as well as patients need to recognize that even people with no history of being in an endemic area of leptospirosis may still be at risk of developing this disease depending on occupations and activities.