Rheumatoid arthritis (RA) is a chronic progressive autoimmune inflammatory disease with significant morbidity and mortality. The course of the disease can be modified if diagnosis is early and treatment appropriate.

In this study, we aimed to evaluate a new strategy for early identification of RA patients in primary care settings (the ‘diagnostic bottleneck’) based on serological biomarkers and to manage inappropriate rheumatoid factor (RF) laboratory test requests.

A two-arm study was carried out. The first arm corresponded to a retrospective observational descriptive study of patients referred for RF testing from primary care using the current laboratory workflow. The second arm included the following prospective interventions: cancelation of RF requests corresponding to patients with previous negative results for RF over a one-year period; and automatic reflex testing antibodies against cyclic citrullinated proteins (anti-CCP) for patients displaying RF values >30 IU/ml. Outcomes from both arms were then compared.

As double positivity for RF and anti-CCP notably increases the positive likelihood ratio of RA. The intervention enabled a reduction of 2813 tests in 22 months. Moreover, the frequency of unnecessary referrals was reduced from 22% to 8.2%, while that of missed patients decreased slightly (from 21% to 16%), with the number of patients diagnosed per RF request remaining unchanged. In terms of costs, we saved 19.4 RF tests per anti-CCP test added.

We developed a simple and cost-effective strategy for reducing the time to diagnosis of RA that can improve patients’ quality of life. This approach was supported by primary and specialised care.

Sudden sensorineural hearing loss is considered idiopathic in up to 90 per cent of cases. This study explored the role of blood tests as biomarkers for the diagnosis and prognosis of sudden sensorineural hearing loss.

Two researchers filtered 34 papers into the final review. This review was pre-registered on the Prospero database and conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines.

Raised inflammatory markers are almost universal in sudden sensorineural hearing loss, suggesting an inflammatory or autoimmune process. The most useful biomarkers are neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and fibrinogen level. Focused investigations should be deployed on a case-by-case basis to identify underlying metabolic, infective and autoimmune conditions.

A full blood count and coagulation screen (fibrinogen) is recommended in all cases of sudden sensorineural hearing loss. These are inexpensive, accessible and offer as much diagnostic and prognostic information as any other biomarker. There is emerging evidence regarding specific biomarkers for sudden sensorineural hearing loss prognosis, with heat shock protein-70, anti-endothelial cell antibody and prestin demonstrating potential; investigation of their validity through prospective, controlled research is recommended.

Ovarian cancer is the sixth most common cause of cancer-related death in the UK amongst women. Ovarian cancer presents particular challenges for general practitioners (GPs) to diagnose due to its rarity and presentation with non-specific symptoms.

A narrative overview of the literature was conducted by searching PubMed and Researchgate for relevant articles, using keywords such as “ovarian cancer,” “primary care” and “diagnosis.”

Studies have shown that in the UK, GPs have a lower readiness to refer and investigate potential cancer symptoms compared with their international counterparts; and this has been correlated with reduced survival. Early diagnosis can be facilitated through a people-focussed and system-based approach which involves both educating GPs and using risk algorithms, rapid diagnostic centres/multi-disciplinary centres and being data-driven through the identification of best practice from national audits. Further research is required into the best evidence-based early investigations for ovarian cancer and more effective biomarkers.

Studies in adults with bipolar disorder (BD), shows that in 25% of cases first affective episode occurs under the age of 13 and in 63-69% under the age of 19. The most difficult problem is the early identification of BD, which starts in adolescence as a result of polymorphism of clinical symptoms, their syndromic incompleteness.

Study of the structure of adolescents affective disorders on primary appointment in outpatient psychiatric unit.

Content analysis, sampling method, statistical method. 120 disease histories of adolescents who first applied for outpatient psychiatric unit in 2019 were used. 93 (77.5%) of them were girls and 27 (22.5%) of them were boys. The average age was 17 years.

In the structure of initial diagnoses, according to ICD-10, mood disorders [F30-F39] - 56.0% prevailed. [F40-F49] - 25%, [F00-F09] - 6.6%, [F20-F29] - 6.6%, [F50-F59] – 4,2%, [F90-F99] – 1,6% were less likely. Structure of complaints of adolescents and their parents on primary appointment for specialized psychiatric care is shown in Table 1 (p<0,05).

Initial signs of emotional disorders in adolescence are polymorphic, nosologically nonspecific, and can lead to diagnoses that are not limited only by the affective pathology. The most common symptoms (irritability, anxiety, mood falls) can act as transdiagnostic phenomena that must be taken into consideration both in the diagnostic study and in further clinical and dynamic follow-ups and treatment.

No significant relationships.

Depressive disorders (Dd) in childhood have a prevalence about 1-2%. Sometimes depression may be underdiagnosed with the risk of complications: comorbidity, chronicity or development of psychiatric diseases in adulthood. Although children often do not show a clear sad mood, they usually presents irritability as a cardinal symptom. Other common symptoms in children´s depression are lack of attention, difficult of concentration and impulsivity. These symptoms actually could define as well an Attention Deficit and Hyperactivity Disorder (ADHD), highly prevalent in school-aged children (5-7%).

-To deep into diagnosis and evolution of depressive disorder in primary school-aged children (7-12 years-old). -To contrast clinical evidence about specific aged-symptoms observed in the boy and follow-up until remission.

-Case study. Graphic description of diagnosis path and treatment in a 8-years-old boy suffers from depression. -Clinical case attended in Mental Health Unit, ambulatory consultation (outpatient). -Diagnosis tools: Clinical examination, family interview, evaluation tests and school psychopedagogical assessment.

-Treatment methods: psychotherapy, psychopharmacology and theater. -Specific depressive symptoms depends on childhood stages (*chart by ages). -Pharmacological treatment used: psychostimulants, benzodiazepines and antidepressants. -Efficacy of monotherapy with Fluoxetine 20mg/day 6-months. -Importance of individual psychotherapy and group activities 12-months. -Episode resolution and functional recovery 15-months.

Variability of symptoms in children´s depression can be confused with other psychiatric disorders like decreased school performance (ADHD), that may make diagnosis difficult. Sometimes, both disorders coexist, especially when the mood disorder is secondary to academic problems caused by ADHD. Early diagnosis and continued follow-up in specialized units is necessary to avoid progression and complications of Dd.

Clinically normal older adults (52–92 years old) were followed longitudinally for up to 8 years after completing a memory paradigm at baseline [Story Recall Test (SRT)] that assessed delayed recall at 30 min and 1 week. Subsets of the cohort underwent neuroimaging (N = 134, mean age = 75) and neuropsychological testing (N = 178–207, mean ages = 74–76) at annual study visits occurring approximately 15–18 months apart. Mixed-effects regression models evaluated if baseline SRT performance predicted longitudinal changes in gray matter volumes and cognitive composite scores, controlling for demographics.

Worse SRT 1-week recall was associated with more precipitous rates of longitudinal decline in medial temporal lobe volumes (p = .037), episodic memory (p = .003), and executive functioning (p = .011), but not occipital lobe or total gray matter volumes (demonstrating neuroanatomical specificity; p > .58). By contrast, SRT 30-min recall was only associated with longitudinal decline in executive functioning (p = .044).

Memory paradigms that capture longer-term recall may be particularly sensitive to age-related medial temporal lobe changes and neurodegenerative disease trajectories. (JINS, 2020, xx, xx-xx)

Keeping and maintaining mental health in a community or at a large in a soceity is a difficult,but promising task.Mental health is a dynamic state as that of state of health which is also going to be redefined than a state of complete physical, mental and soceial health. A positive mental health is not merely absence of any mental disorders, rather a flourishng environment where an individual can grow,work, and fulfil his dreams & aspiration & also nurcher own imagination in a fruitful manner.

Here it was a comparism between a rural and a community catchment area of 2 different places and mental health questionories were distributed among 2 high scool students who are derived fom 2 different socioeconomic status.

50 male & 50 female student of 2 catchment area in rural,as well in city school were collected in same proforma.Facilities in village school includes large playing ground,more joint family stucture & more choseveness.In city per capita income, library facility, playing facility,rcreationalsopes are more flourishly arranged.Mental disorders noted are early diagonosed and early intervenation done in city school.In rural scools all 12 known cases of some mentaldisturbances were takencare of in late.

From the questinary itself, from the reports of teachers and fellow student it shows mental health is more in positively maintanned state in city environment scools, as well early diagnosis & care.In rural settings good library and liberal friend ship & chosive pattern of family & soceity helps.

Schizophrenia is a leading cause of disability. People living with schizophrenia (PLWS) present unemployment, social isolation, excess mortality and morbidity, and poor quality of life. Early recognition and appropriate treatment reduce the risk of chronicity and comorbidity. Personalization and integration of pharmacological and psychosocial interventions, as well as accurate identification and management of psychiatric and somatic comorbidities, can significantly improve mental and physical health of PLWS, promoting recovery.

A three-step Delphi approach was used to explore consensus on the essential components of early recognition and intervention, personalization, and integration of care to improve schizophrenia outcome, and on barriers and challenges to close treatment gaps. The consensus involved 8 Italian experts of schizophrenia, 100 psychiatrists from academic and nonacademic settings, including representatives of Italian Society of Psychiatry, and 65 trainees in psychiatry.

A strong consensus (from mostly agree to totally agree) emerged on the importance of early diagnosis (97%), standardized assessments (91%), correct management of somatic and psychiatric comorbidities (99%), and personalization and integration of care (94%). Lack of time, human resources, and training were identified as the main barriers and challenges to the translation of knowledge into clinical practice.

The results of this Delphi study demonstrated a strong consensus on main components of schizophrenia care, as well as on unmet needs to promote best practice and gaps between knowledge and clinical practice. The involvement of a large group of professionals and trainees in this in-depth consensus process might contribute to raise awareness and stimulate innovative strategies to improve the outcome of PLWS.

Although early identification and management services for dementia have become more widespread, their efficacy and the clinical characteristics of service have yet to be fully evaluated. Therefore, the objective of this study is to clarify these issues.

The subjects were 164 Japanese users of an early identification and management program for dementia, known as the Initial-phase Intensive Support Team (IPIST), between 2013 and 2015. Nonhierarchical cluster analysis was used to derive subgroups based on cognitive status and ability in activities of daily living (ADL) and behavioral and psychological symptoms of dementia (BPSD). One-way analysis of variance was performed to evaluate differences among the groups derived by the cluster analysis. A paired t test was used to assess how the clinical status of the groups changed between baseline and follow-up.

Four groups were identified by cluster analysis, i.e. a mild group, a moderate group, a BPSD group with moderate cognitive impairment and severe BPSD, and a severe group with severe cognitive impairment and severe BPSD. Although there were no significant improvements in cognitive impairment or ADL in any group, significant improvements were found in BPSD in the BPSD and severe BPSD groups. Caregiver burden was significantly lessened in all groups. Clinical diagnosis and long-term care insurance service utilization rates were significantly improved overall.

The users of IPIST were classified into four subgroups based on their clinical characteristics. The IPIST program could improve the quality of life of people with dementia and their caregivers.

Rapid diagnosis of dementia is essential to ensure optimum patient care. This study used real-world data to quantify the dementia diagnostic pathway in Australia.

A real-world, cross-sectional survey of physicians and patients.

Clinical practice.

Primary care or specialist physicians managing patients with cognitive impairment (CI).

Descriptive analyses focused on key events in the diagnostic pathway. Regression modeling compared the duration between first consultation and formal diagnosis with various factors.

Data for 600 patients were provided by 60 physicians. Mean time from initial symptoms to first consultation was 6.1 ± 4.4 months; 20% of patients had moderate or severe CI at first consultation. Mean time from first consultation to formal diagnosis was 4.0 ± 7.4 months (1.2 ± 3.6 months if not referred to a secondary physician, and 5.3 ± 8.3 months if referred). Time from first consultation to diagnosis was significantly associated with CI severity at first consultation; time was shorter with more severe CI. There was no association of disease severity and referral to a secondary physician; 69.5% of patients were referred, the majority (57.1%) to a geriatrician. The highest proportion of patients were diagnosed by geriatricians (47.4%). Some form of test or scale was used to aid diagnosis in 98.8% of patients.

A substantial number of Australians experience cognitive decline and behavioral changes some time before consulting a physician or being diagnosed with dementia. Increasing public awareness of the importance of early diagnosis is essential to improve the proportion of patients receiving comprehensive support prior to disease progression.

None.

Olfactory disorders increase with age and often affect elderly people who have pre-dementia or dementia. Despite the frequent occurrence of olfactory changes at the early stages of neurodegenerative disorders such as Alzheimer's disease, olfactory disorders are rarely assessed in daily clinical practice, mainly due to a lack of standardised assessment tools. The aims of this review were to (1) summarise the existing literature on olfactory disorders in ageing populations and patients with neurodegenerative disorders; (2) present the strengths and weaknesses of current olfactory disorder assessment tools; and (3) discuss the benefits of developing specific olfactory tests for neurodegenerative diseases.

A systematic review was performed of literature published between 2000 and 2015 addressing olfactory disorders in elderly people with or without Alzheimer's disease or other related disorders to identify the main tools currently used for olfactory disorder assessment.

Olfactory disorder assessment is a promising method for improving both the early and differential diagnosis of Alzheimer's disease. However, the current lack of consensus on which tests should be used does not permit the consistent integration of olfactory disorder assessment into clinical settings.

Otolaryngologists are encouraged to use olfactory tests in older adults to help predict the development of neurodegenerative diseases. Olfactory tests should be specifically adapted to assess olfactory disorders in Alzheimer's disease patients.

This study aimed to develop a simple and accurate method to diagnose paediatric obstructive sleep apnoea hypopnea syndrome.

A total of 311 children with suspected paediatric obstructive sleep apnoea hypopnea syndrome were included in the study. Multiple clinical parameters, including sex, age, body mass index, history of snoring or gasping, history of nasal obstruction, history of running nose, palatine tonsil size, adenoid to nasopharynx ratio, and tympanogram type, were compared with polysomnography results using relevant correlation and regression analyses. A diagnostic scale was established using the regression equation and the correlation between the polysomnography result and scale result was determined.

The apnoea–hypopnea index correlated significantly with a history of snoring or gasping, palatine tonsil size, and tympanogram type. Stepwise logistic regression analysis revealed that the polysomnography result correlated significantly with a history of snoring or gasping, palatine tonsil size, and the adenoid to nasopharynx ratio. The percentage correlation between the scale and polysomnography results was 77.8 per cent.

The diagnostic scale can be used to diagnose paediatric obstructive sleep apnoea hypopnea syndrome for clinical application when polysomnography cannot be performed. However, it is not suitable for assessing the severity of paediatric obstructive sleep apnoea hypopnea syndrome.

This study aimed to compare the diagnostic effectiveness of narrow band imaging and autofluorescence imaging for malignant laryngopharyngeal tumours.

Between May 2010 and October 2010, 50 consecutive patients with suspected laryngopharyngeal tumour underwent endoscopic laryngopharynx examination. The morphological characteristics of laryngopharyngeal lesions were analysed using high performance endoscopic systems equipped with narrow band imaging and autofluorescence imaging modes. The diagnostic effectiveness of white light image, narrow band imaging and autofluorescence imaging endoscopy for benign and malignant laryngopharyngeal lesions was evaluated.

Under narrow band imaging endoscopy, the superficial microvessels of squamous cell carcinomas appeared as dark brown spots or twisted cords. Under autofluorescence imaging endoscopy, malignant lesions appeared as bright purple. The sensitivity of malignant lesion diagnosis was not significantly different between narrow band imaging and autofluorescence imaging modes, but was better than for white light image endoscopy (χ2 = 12.676, p = 0.002). The diagnostic specificity was significantly better in narrow band imaging mode than in both autofluorescence imaging and white light imaging mode (χ2 = 8.333, p = 0.016).

Narrow band imaging endoscopy is the best option for the diagnosis and differential diagnosis of laryngopharyngeal tumours.