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Abstract. Background: For people experiencing a suicidal crisis the emergency department (ED) is often the only option to find help. Aims: The aims of this study were (a) to identify predictors of patients' nonwillingness to return to the ED for help with a future suicidal crisis, and (b) whether nonwillingness to return was associated with follow-up appointment nonattendance. Method: This study utilized baseline data from the RESTORE online survey, and included 911 participants who had presented to an ED for suicidal crisis in the past 18 months, across participating local health districts in the Australian Capital Territory and New South Wales. Results: Patients who reported a more negative ED experience and longer triage wait times were less willing to return. Those who were less willing to return were also less likely to attend their follow-up appointment. Limitations: Due to the cross-sectional study design, causal inferences are not possible. Additionally, the self-report measures used are susceptible to recall bias. Conclusion: Patients' experience of service at EDs is a key indicator to drive improvement of patient outcomes for individuals experiencing a suicidal crisis.

The rapid advances in cancer immunotherapy using immune checkpoint inhibitors (ICIs) have led to significantly improved survival of patients. But at the same time, it also associates with multiple immune-related adverse events (irAEs). The irAEs can affect a wide range of organs, and induce nonspecific symptoms with delayed onset and prolonged duration that is easily neglected, which may lead to life-threatening disorders. Therefore, follow-up care for patients receiving ICIs for irAEs management has become an essential competency in cancer nursing. There are several guidelines about the management of irAEs, which focused on diagnosis, grading, and treatment. However, studies on relevant follow-up care are rare. Nurses play an important role in follow-up care, whose relevant knowledge and skills are indispensable. Combined with domestic and foreign guidelines and related studies, this paper reviewed the occurrence and characteristics of irAEs and highlighted the contents, timing, models, and effects of follow-up care for patients receiving ICIs, to provide a reference for clinical nursing practice and improve the safety of immunotherapy for patients.

Background: Quality indicators are used to benchmark and subsequently improve quality of healthcare. However, defining good quality indicators and applying them to high-volume care such as skin cancer is not always feasible. Objectives: To determine whether claims data could be used to benchmark high-volume skin cancer care and to assess clinical practice variation. Methods: All skin cancer care-related claims in dermatology in 2016 were extracted from a nationwide claims database (Vektis) in the Netherlands. Results: For over 220,000 patients, a skin cancer diagnosis-related group was reimbursed in 124 healthcare centres. Conventional excision reflected 75% of treatments for skin cancer but showed large variation between practices. Large practice variation was also found for 5-fluorouracil and imiquimod creams. The practice variation of Mohs micrographic surgery and photodynamic therapy was low under the 75th percentile, but outliers at the 100th percentile were detected, which indicates that few centres performed these therapies far more often than average. On average, patients received 1.8 follow-up visits in 2016. Conclusions: Claims data demonstrated large practice variation in treatments and follow-up visits of skin cancer and may be a valid and feasible data set to extract quality indicators. The next step is to investigate whether detected practice variation is unwarranted and if a reduction improves quality and efficiency of care.

Objective The aim of this study was to evaluate whether a patient with a cleft's age, associated syndrome, cleft phenotype or travel distance affects their follow-up rate. Design This study is a retrospective review of patients with CL/P treated by a craniofacial clinic. Setting The setting was a craniofacial clinic at a tertiary care university hospital. Patients, Participants Candidates were patients seen by the craniofacial clinic between January 2007 and December 2019. An initial pool of 589 patients was then reduced to 440 due to exclusion criteria. Interventions None Main Outcome Measure(s) The outcome measure was actual patient attendance to the craniofacial team compared to the team goal expectation of annual return visits. Results The mean age of participants at the end of the study was 9.0 ± 5.4 years with a mean follow-up period (total possible follow-up period length based on patient age at presentation and study window) of 5.5 ± 3.6 years. There was no association between cleft phenotype, type of syndrome, or distance to the clinic with attendance. Children with syndromes had an 11% decrease in the odds of attending follow-up visits with each 1-year increase in age compared to a 4% decrease in children without syndromes. Conclusions The only significant factors determining patient attendance were the presence of a syndrome and increasing age.

Introduction Survival of childhood cancer has increased over the past decades. This has led to the development of strategies aiming to enhance follow-up care and research, for which priorities may vary globally. We explored perspectives of an international healthcare workers panel. Methods Attendants of a meet-the-expert session on childhood cancer survivorship at the 2018 SIOP conference completed a survey about their view on important follow-up care and research aspects for survivors below and over 18 years. We analysed overarching categories and subtopics, and compared Asian versus European and North American healthcare workers. Results A total of 58 participants from different medical specialties (67.2% paediatric oncologists) and continents (48.3% Asia, 39.7% Europe/North America) responded. Follow-up care priorities for survivors below and over 18 years included physical care (39.3% ≤18 years, 35.9% >18 years) and healthcare structure (29.4%, 26.0%). Physical care was also the most important research aspect for both age groups (52.5%, 50.7%). Psychological support was the most frequently reported subtopic. Asian clinicians (n = 22) primarily prioritized physical care aspects of follow-up care, whereas European/North American (n = 19) clinicians underscored the importance of healthcare structure. Conclusion Physical care is the most important aspect of survivorship care and research according to clinicians from several continents. Asian and European/North American respondents shared most priorities, however, healthcare structure was a more important category for European/North American clinicians. The most common subtopic was psychological support, underlining also the need to involve psychologists in follow-up.

Background Differentiated thyroid cancer (DTC) is a common malignancy with increasing incidence. Follow-up care for DTC includes thyroglobulin (Tg) measurement and ultrasound (US) of the neck, combined with 131I remnant ablation when indicated. Diagnostic precision has evolved with the introduction of the new high-sensitive Tg-assays (sensitivity ≤0.1 ng/mL). The aim of the study was to determine the prognostic utility of high-sensitive Tg and the need for other diagnostic tests in DTC. Methods This was a retrospective, observational study. Patients with pathologically confirmed DTC, treated with total thyroidectomy and 131I remnant ablation, who had their complete follow-up care in our institution were selected (October 2013–December 2018). Subjects with possible thyroglobulin autoantibody interference were excluded. Statistical analysis was performed using the IBM SPSS® Statistics 24 software package. Results Forty patients were eligible for analysis. A total of 24 out of the 40 patients (60%) had an undetectable high-sensitive Tg 6 months after total thyroidectomy. None of these patients had a stimulated Tg above 1 ng/mL, or remnant on the 123I Whole-Body Scan (WBS) after 1 year of follow-up. Ultrasound of the neck, performed between 6 and 12 months postoperative, was negative in 21 out of the 24 patients. Conclusions This study shows that an undetectable high-sensitive Tg can change the management of patients with DTC and decrease the use and need of stimulated Tg and 123I WBS.

In March 2020, COVID-19 assessment centres were launched across the province of Ontario to facilitate COVID-19 testing outside of emergency departments. We aimed to study the degree to which assessment centres provide education and follow-up care for patients with suspected COVID-19.We conducted an online survey of Ontario COVID-19 assessment centre directors between September 15 and October 15, 2020. The primary outcomes studied were the types of educational modalities employed and information conveyed, methods and frequency of test result communication, and any follow-up care that was offered. Survey respondents were also asked to provide descriptions of barriers to patient education and test communication.A total of 56 directors (representing 73 assessment centres) completed the survey. The most frequent educational modalities employed were educational handouts (92%), direct in-person counselling (89%), and referral to website (72%). Seventy-one percent of respondents indicated patients with positive test results would be notified, and 61% of respondents indicated that follow-up care would be offered. The most frequently reported barriers to patient education were insufficient time and high volume of tests, while the most frequently reported barriers to communication of test results were difficulty accessing online health portals and high volume of tests.The ability of many assessment centres to provide patient education is limited by both individual patient and system-level factors. Assessment centres may benefit from standardization of educational materials, improved accessibility to test results for patients in marginalized groups, and virtual pathways to facilitate additional counselling and care for individuals who test positive.En mars 2020, des centres d’évaluation de la COVID-19 ont été lancés dans la province de l’Ontario afin de favoriser le dépistage de la COVID-19 hors des services d’urgence. Les chercheurs visaient à étudier dans quelle mesure ces centres transmettent de l’information et des soins de suivi aux patients chez qui on présume une COVID-19.Les chercheurs ont réalisé un sondage en ligne auprès des directeurs des centres d’évaluation de la COVID-19 de l’Ontario entre le 15 septembre et le 15 octobre 2020. Le type de modalités pédagogiques utilisé et d’information transmise, les modes et la fréquence de communication des résultats des tests et les soins de suivi offerts étaient les résultats cliniques primaires à l’étude. Les répondants au sondage ont également été invités à décrire les obstacles à la transmission d’information aux patients et à la communication des résultats.Au total, 56 directeurs (représentant 73 centres d’évaluation) ont rempli le sondage. Les principales modalités pédagogiques étaient la remise de document d’information (92 %), des conseils individuels directs (89 %) et l’orientation vers un site Web (72 %). Ainsi, 71 % des répondants ont indiqué que les patients obtenant un résultat positif en étaient avisés, et 61 %, que des soins de suivi seraient offerts. Les principaux obstacles à la transmission d’information aux patients étaient le manque de temps et le volume élevé de tests, tandis que les principaux obstacles à la transmission des résultats étaient la difficulté d’accès aux portails santé en ligne et le volume élevé de tests.La capacité de nombreux centres d’évaluation à transmettre de l’information aux patients est limitée à la fois par des facteurs liés aux patients eux-mêmes et par des facteurs systémiques. Les centres d’évaluation pourraient tirer profit de la standardisation des documents pédagogiques, d’un meilleur accès aux résultats des tests pour les patients de groupes marginalisés et de trajectoires virtuelles pour favoriser la transmission de conseils et de soins supplémentaires aux personnes dont les résultats sont positifs.

Background The benefits of bariatric surgery are well-established, however, concerns surrounding postoperative psychiatric destabilization and alcohol misuse remain. Research has initiated the process of identifying risks associated with bariatric surgery, although less is known regarding when or why psychiatric hospitalizations occur postoperatively. Objectives The goal of the current study was to examine the incidence of, and contributing factors to, behavioral health-related emergency room (ER) encounters and hospitalization after bariatric surgery. Setting Integrated multispecialty health system with an accredited bariatric surgery program. Methods Retrospective review of patients who underwent Roux-en-Y gastric bypass (RYGB) surgery and had been readmitted to the hospital or presented to the ER after bariatric surgery at least once for a behavioral-health related reason. Results Of 1449 patients, 93 had at least 1 psychiatric or substance use–related ER visit/hospitalization post-surgery and were included in the study; 53% had 1 ER/hospital encounter after bariatric surgery; 24% had 2 encounters, 11% had 3–4 encounters, and 10% of patients had ≥5 encounters. Across 267 postbariatric surgery encounters, 42.4% were due to alcohol-related problems. The index presentation for alcohol-related reasons occurred at a mean of 1942 days (approximately 5.3 yr; SD = 1217 d). Patients’ index presentation for a psychiatric concern (41.3%) occurred at a mean of 1278 days (3.5 yr; SD = 1056 d) post-surgery. Conclusion A significant percentage of patients who present to the ER or hospital for behavioral health reasons after RYGB surgery had alcohol-related problems, long after their surgery. Psychologists working with bariatric surgery teams should prioritize ongoing assessment of and education on alcohol misuse in those seeking RYGB and in the long-term postoperative period.

Females with a BRCA1/2 (BRCA) pathogenic variant have high lifetime risks for cancer. Regularly updated guidelines are in place that recommend screening and/or surgery to monitor and/or significantly reduce breast or ovarian cancer risk. Follow-up care decision making among this population is important to explore to understand the multi-faceted influences guiding cancer screening behaviors and risk-reducing surgery decisions. Using lived-experience theory and cognitive anthropology, this study explored emotional and social influences on decision making and behavioral adherence to guideline recommendations among twenty-seven female BRCA carriers. Ethnographic data from in-depth interviews were analyzed in parallel with self-reported survey data on perceived threat, response efficacy, and self-efficacy constructs. Survey results demonstrated high rates of adherence to guideline recommendations and high levels of perceived threat and response efficacy with lower levels of self-efficacy, while interview data revealed multi-faceted motivators and challenges associated with behavioral adherence. These findings unearth complex lived-experiences within the context of perceived threat, response efficacy, and self-efficacy and explore the cognitive relationship between motivators and challenges to inherited cancer follow-up care decision making and behavioral adherence. This study demonstrates how anthropological practice can aid in inherited cancer research and be used to support the development of interventions that consider cognitive influences on behavior.

Non-occupational Post-Exposure Prophylaxis for HIV (nPEP) is recommended by the CDC for isolated exposures that pose "substantial risk" for HIV transmission. To combat multiple barriers to nPEP utilization, a comprehensive program was developed through the local community sexual assault provider. The purpose of this study was to evaluate nPEP protocol implementation. A retrospective chart review was conducted of all sexual assault victims seen during a six-month period, and all patients who accepted nPEP were selected for follow-up phone interviews. 157 patients presented during the study period. Mean time to care was 32.4hrs, with 126/157 (80%) presenting ≤72hrs. 114/157 (73%) patients were offered nPEP by providers. 67/114 (59%) patients accepted, with the most common reason for declining being needing more time to decide. 10/13 (77%) patients able to be contacted reported completing nPEP, with side-effects cited as the most common noncompletion reason. 9 reported side effects and 4 received recommended follow-up HIV testing. 83/99 (84%) patients clearly eligible by chart review were offered nPEP, suggesting good adherence to CDC guidelines. Most patients contacted completed nPEP despite side-effects, suggesting good adherence. Our findings demonstrated multiple points status post-sexual assault to potentially improve the nPEP process.

Glioma is the most common primary brain cancer in adults. Long-term and progression-free survivals are dependent on the type and grade of glioma, as well as on the extent of resection and postoperative treatments. In Italy, it is unclear how long follow-up care should last and whether the primary care sector is either willing or able to take this on. The aim is to determine pathways of follow-up care and evaluate the professional attitude of doctors to prescribe to patient visits and exams after surgery. A retrospective study was performed on patients with glioma II and III who underwent surgery at tertiary care Neurological Institute Besta of Milan (FINCB) from 2012 to 2020. Data were collected through electronic medical records and inserted in an ad hoc developed database. Three pathways have been identified: a common preliminary pathway (from the pre-operative visit to surgery) for all patients undergoing surgery for gliomas II and III and two follow-up pathways (with or without second surgery). FINCB has developed care pathways that are sometimes personalized according to the doctor’s expertise and attitude to prescribe new examinations. Given the lack of guidelines on this issue, we can cautiously conclude that it is necessary to identify whether, in addition to standard care, personalized supportive care intervention and pathway plan can significantly improve patients’ outcome.

Background Stroke survivors require continuing services to limit disability. This study assessed the coverage and equity of essential care services received during the first six months of post-stroke follow-up of stroke survivors in the Western Province of Sri Lanka. Methods A multidisciplinary team defined the essential post-stoke follow-up care services and agreed on a system to categorize the coverage of services as adequate or inadequate among those who were identified as needing the said service. We recruited 502 survivors of first ever stroke of any type, from 11 specialist hospitals upon discharge. Six months following discharge, trained interviewers visited their homes and assessed the coverage of essential services using a structured questionnaire. Results Forty-nine essential post-stroke follow-up care services were identified and categorized into six domains: monitoring of risk conditions, treatment, services to limit disabilities, services to prevent complications, lifestyle modification and supportive services. Of the recruited 502 stroke survivors, 363 (72.3%) were traced at the end of 6 months. Coverage of antiplatelet therapy was the highest (97.2% (n = 289, 95% CI 95.3- 99.1)) while referral to mental health services (3.3%, n = 12, 95% CI 1.4–5.1) and training on employment for the previously employed (2.2%, n = 4, 95% CI- 0.08–4.32), were the lowest among the six domains of care. In the sample, 59.8% (95% CI 54.76–64.48) had received an ‘adequate’ level of essential care services related to treatment while none received an ‘adequate’ level of services in the category of support services. Disaggregated service coverage by presence and type of limb paralysis within the domain of services to prevent complications, and by sex and education level within the domain of education level, show statistically significant differences (p Conclusions Apart from treatment services to limit disabilities, coverage of essential care services during the post-stroke period was inadequate. There were no apparent inequities in the coverage of vast majority of services. However focused policy decisions are required to address these gaps in services.

The coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which is responsible for the current pandemic and results in a large number of hospitalizations. This highly contagious disease causes severe acute respiratory infection; thus, many patients require management in intensive care. At a time when there is a high influx of patients with COVID-19 in Intensive Care Units (ICU) all over the world, there is little literature concerning the physiotherapy management of these patients. This article provides information based on the latest evidence to help physiotherapists optimize care, to protect patients and care providers in the ICU, and for follow-up care.

Die postoperative Behandlung stellt einen entscheidenden Aspekt fur den Erfolg von Nasennebenhohleneingriffen dar. Zu den grundlegenden Masnahmen gehoren Nasenspulungen mit Salzlosung, mit denen bereits am ersten postoperativen Tag begonnen werden sollte, die topische Steroidapplikation und die Gabe von Antibiotika im Fall einer Infektion. Zur arztlichen Versorgung gehort das Absaugen des unteren Nasengangs in der ersten Woche. Die Krustenentfernung im Op.-Bereich sollte unter endoskopischer Kontrolle in der zweiten Woche beginnen. Dabei werden die Intervalle individuell festgelegt. Die Okklusion der Nase fur die Zeit der Epithelregeneration halt den ethmoidalen Raum feucht, was zu einer besseren Wundheilung fuhrt.

Background Incidentalomas, or unexpectedly identified masses, are frequently identified in diagnostic imaging studies. Incidentalomas may require timely follow-up care to determine if they are benign, disease-causing, or malignant lesions; however, many incidentalomas do not receive diagnostic workup. The most effective strategies to manage incidentalomas and optimal metrics for judging the efficacy of these strategies remain unclear. Objective To identify management strategies used to promote guideline-concordant follow-up for incidentalomas and commonly reported performance metrics associated with these strategies. Data sources We searched peer-reviewed literature for incidentaloma management studies published between 2003 and 2020. Data extraction and synthesis Data extraction included anatomical location, imaging modality, clinical setting, management strategy characteristics, and metrics used to assess the management strategy. Eligible studies were analyzed qualitatively to describe strategies and metrics. Results In all, 15 studies met inclusion criteria. Four types of interventions designed to promote guideline-concordant follow-up care for incidentalomas were identified: (1) physical or verbal guideline reminders (n = 3); (2) electronic guideline references (n = 4); (3) enhanced radiology templates (n = 3); (4) restructured clinical and communication pathways (n = 5). Strategy efficacy was assessed by measuring rates of patients who received recommended follow-up care (n = 6) or had care recommendations documented in clinical records (n = 5). Few studies measured diagnostic outcomes associated with incidentalomas. Conclusions Most management strategies target changes in radiologists’ behavior. Few studies address barriers to improving incidentaloma follow-up from interpretation to patient education of findings and care delivery. Hybrid effectiveness-implementation studies are needed to better address workflow barriers and rigorously evaluate care delivery outcomes.

Skin disorders are one of the most common complaints seen in primary care offices. This can be intimidating and frustrating for providers due to the wide variety of possibilities. Skin lesions that are difficult to manage or concerning are often referred to dermatology to determine the potential etiology. The following is a case study of an elderly woman who presented with a persistent rash for the past 6 months despite clinically appropriate treatment. This case study describes the interdisciplinary care implemented for diagnosis, treatment, and follow up-care.

Zusammenfassung Hintergrund Sinunasale Papillome sind Tumoren der Nasenhaupt- und Nasennebenhöhlen. Therapie der Wahl ist die vollständige Resektion unter tumorchirurgischen Kautelen. Zwei Eigenschaften machen die Tumornachsorge zu einer Herausforderung: Erstens die häufige Rezidiv-Entwicklung (auch viele Jahre nach Erstdiagnose) und zweitens die Möglichkeit der malignen Entartung. Diese Übersichtsarbeit beleuchtet diesbezügliche Risikofaktoren, um „Hochrisikopatienten“ zu identifizieren, die in der Tumornachsorge besondere Aufmerksamkeit verdienen. Materialen und Methoden Es erfolgte eine ausführliche Literaturrecherche in PubMed (NCBI). Ergebnisse Hauptrisikofaktor für Rezidive ist die unvollständige Tumorresektion. Daraus ergeben sich weitere Faktoren wie unzureichend radikale Operationstechnik, ausgedehnte Tumoren, erschwerte intraoperative Verhältnisse aufgrund der Tumorlokalisation oder bei der Rezidiv-Chirurgie. Zudem neigen junge Patienten und Raucher vermehrt zu Rezidiven. Risikofaktoren für eine maligne Entartung sind große Tumoren, Rauchen, höheres Alter bei Erstdiagnose, weibliches Geschlecht, Knocheninvasion und fehlende inflammatorische Polypen. Histopathologische Risikofaktoren für Rezidive sowie für maligne Entartung sind Dysplasien, Hyperkeratose, plattenepitheliale Hyperplasie und – sofern bestimmt – eine erhöhte Proliferationsrate, Aneuploidie sowie eine Infektion mit humanen Papillomaviren. Schlussfolgerungen Eine vollständige Resektion der sinunasalen Papillome unter tumorchirurgischen Kautelen ist der Goldstandard. Postoperativ ist eine engmaschige Tumornachsorge (analog zu malignen Tumoren) zwingend erforderlich. Die meisten Autoren empfehlen einen Nachsorgezeitraum von mindestens 5 Jahren, manche sogar eine lebenslange Nachsorge. Patienten mit einem oder mehreren Risikofaktoren sollten engmaschiger nachbetreut werden.

Covid-19 je infekcni onemocněni, ktere je způsobene virem SARS‑CoV-2 (syndrom těžke respiracni tisně koronaviru 2) (1). Celkova mortalita je nizka: pod 0,5 %. Umrti jsou převažně ve věkove skupině nad 60 let a u pacientů s jiným těžkým chronickým onemocněnim. Větsina nemocných se uzdravi v průběhu jednoho ci dvou týdnů, nicmeně u 5-10 % pacientů cast symptomů přetrvava týdny a měsice. Post‑covid syndrom je multi‑systemove onemocněni s překrývajicimi se symptomy a zasahuje jedince bez ohledu na tiži předchozi akutni infekce. Při pohledu na pocet postižených v Ceske republice odhadujeme, že během nasledujicich měsiců zde bude nejmeně 50 000 postižených vyžadujicich pozornost minimalně praktickeho lekaře, ale patrně i dalsich specialistů. K zvladnuti nasledků pandemie SARS‑CoV-2 je nezbytna znalost post‑covid syndromu a tvorba ucinných doporuceni, idealně založených na důkazech.

High rates of attrition to post-bariatric surgical care continue to be common, despite recommendations for lifelong follow-up. There is little available work focusing on the etiology of attrition to post-bariatric surgical follow-up. Patient-reported outcomes (PROs) are metrics of patients’ perceptions of their own health and have been used for their predictive value in other specialties. The relationships between PROs and loss to follow-up have not been explored. PRO data from patients who met the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) definition of loss to follow-up at 1-year postoperatively were reviewed and compared to patients who were compliant with 1-year follow-up. Patient-reported outcomes measurement information system (PROMIS) measures are routinely collected pre- and postoperatively at our institution using a series of validated computer-adaptive tests that assess depression, satisfaction with social roles, pain interference, and physical function. A series of univariate logistic regressions tested whether baseline PROs or change in PROs from baseline to 6-month postoperatively predicted loss to follow-up at 1 year. Neither baseline PROs nor change in depression, satisfaction with social roles, pain interference, or physical function were significant predictors of loss to follow-up. Similarly, patient state of residence, Charlson Comorbidity Index, BMI, and percent excess weight loss were not significant predictors of follow-up attrition. The PROs in this study were not significant predictors of loss to follow-up at 1-year postoperatively. The rate of bariatric procedures continues to increase nationally, so does the potential for late post-surgical complications. Given the potential impact of loss to follow-up on adverse late post-surgical outcomes, there is a need to facilitate long-term post-surgical follow-up and more investigation is needed to identify and intervene on underlying causes of bariatric patient follow-up attrition.

The Wellness Beyond Cancer Program is part of a tertiary care hospital in Ontario, Canada. It provides cancer survivors with information and resources needed to self-manage their follow-up care (i.e., learn relevant information and skills to adapt to life with a chronic illness) after active cancer treatment (i.e., chemotherapy, radiation). A program evaluation was conducted on the two-hour survivorship education class (one component of the overall Wellness Beyond Cancer Program) with the purpose of evaluating whether attendance increased survivors’ perceived knowledge and intent to self-manage follow-up care. Breast (n = 107) and colorectal (n = 38) cancer survivors who attended classes completed questionnaires on information needs and intent to self-manage pre- and postclass. Perceived increase in knowledge and intent to self-manage follow-up care were unrelated to age, gender, or time since diagnosis. After attending the class, survivors reported increased knowledge (F (1,11) = 144.6, p

Objective To assess if telemedicine can be used successfully for follow-up care of children with respiratory illnesses. The authors also assessed problems faced by the doctors and satisfaction of caregivers of these patients with telemedicine. Methods The authors conducted an ambispective observational study. Data related to demographic details and diagnoses of patients who had telemedicine consultation (teleconsultation) appointments between 2nd April 2020 to 15th May 2020 were reviewed retrospectively. They noted proportion of patients having successful prescription. To assess problems faced by doctors and satisfaction of caregiver of patients with teleconsultation, a prospective questionnaire was sent via Google Forms 6–10 wk after the initial appointment date. Those who did not respond to Google Forms were called by phone to assess the same. Results A total of 188 patients received teleconsultation during the study period. Team was able to prescribe treatment in 181 (96.3%) patients via teleconsultation and other seven (3.7%) required physical evaluation. Mean (SD) age of patients was 9.7 (4.9) y, range 3 mo to 18 y. There were 117 (62.2%) boys and 71 (37.8%) girls. Majority (58%) of the patients were asthmatics. The team advised refill prescription in 83% patients as symptoms were controlled. Three out of five residents faced minor problems while providing teleconsultation. In satisfaction assessment, 78% of caregivers rated teleconsultation 8 or more, out of 10 points, suggesting that most of them were satisfied with telemedicine. Conclusion In majority of children with respiratory illnesses, successful follow-up care can be provided by telemedicine. Supplementary Information The online version contains supplementary material available at 10.1007/s12098-020-03590-8.

Purpose Hearing loss can have a negative impact on a child's development. Hearing aids, if fitted appropriately, maintained well, and used regularly, can offer benefit to children with hearing loss. Regular reviews of hearing aid users can help to monitor a child's progress and provide timely intervention when problems arise or needs change. This study investigates the follow-up care received by children fitted with hearing aids at a clinic in Malawi. Method A clinical audit was done of the frequency of face-to-face follow-up appointments, following which all pediatric hearing aid users who had not recently received follow-up care were called to invite them for a review, and then a re-audit was conducted. Results Of the 47 children in the audit, 46 had not had a recent face-to-face follow-up appointment. Strenuous efforts were made to call those 46 children to the clinic for review: 20 caregivers agreed to bring their child for review, 10 of whom attended. It was not possible to contact 24 caregivers. Conclusions Reasons for low attendance for review at this service are not known, but may be related to the financial circumstances of the patients' families as well as difficulty in maintaining contact with families. It has not yet been possible to establish a system for routine follow-up care for pediatric hearing aid users at this well-established clinic in a low-income country.

Was ist neu? Vorsorge, Früherkennung und familiärer Brustkrebs Mit dem Mammografie-Screening für Frauen ab dem 50. Lebensjahr steht in Deutschland eine etablierte Früherkennungsmaßnahme zur Verfügung. Eine Reduktion der Mortalität ist gesichert. Das Screening kann mittlerweile auch bei Frauen über 70 fortgeführt werden. Durch intensive Forschung im Bereich des familiären Mammakarzinoms kann das Hochrisikopatientenkollektiv präziser bestimmt und einer intensivierten Früherkennung zugeführt werden. Therapie lokal begrenzter Stadien – Senkung der Radikalität Die Behandlung erfolgt zielgerichtet und so wenig radikal wie möglich. Nach neoadjuvanter Chemotherapie kann immer öfter auf eine Brustamputation verzichtet werden. Die axilläre Lymphknotendissektion (ALND) bleibt wenigen Fällen vorbehalten. Die molekulare Subtypisierung ermöglicht individualisierte medikamentöse Therapien in der kurativen Absicht. Rekonstruktive Chirurgie Das BIA-ALCL stellt eine seltene Brustimplantat-assoziierte Erkrankung dar, bei der in den meisten Fällen eine Heilung möglich ist. Trotz steigender Inzidenz ist von Implantateinlagen nach adäquater Aufklärung der Patientin in Deutschland nicht abzuraten. Therapie des metastasierten Karzinoms Zur Behandlung des metastasierten Mammakarzinoms sollte wenn möglich eine gut verträgliche Therapie zur Erhaltung der Lebensqualität gewählt werden. Auch hier stehen immer mehr individualisierte Optionen zur Verfügung. Nachsorge Der Zeitraum der Nachsorge weitet sich aufgrund der Tumorbiologie auf 10 Jahre aus. Ausblick Eine ESR1-Mutation kann zukünftig möglicherweise als prädiktiver Marker hinsichtlich einer antihormonellen Therapie in der Metastasierung genutzt werden. Für eine PD-1-Blockade gibt es vielversprechende Ergebnisse in der neoadjuvanten Behandlung des triple-negativen Mammakarzinoms (TNBC).

Objectives To analyse the treatment needs of patients who had received dental treatment under GA and the effectiveness of the treatment provided. Materials and methods Retrospective chart analysis of adult at risk and vulnerable patients requiring dental treatment under GA (2007–2017). Outcome variables were indications for GA, DMF/T, and type of treatment, failure rates of treated teeth, emergencies and recall intervals after GA. Results Four hundred fourteen subjects (median age 42 years, range 18–93 years) were assigned to four groups (people with disabilities (pwdis), dementias (pwd), dental phobias (pwph), and addictions/psychosocial disorders (pwapd)) and attended the pre-GA assessment. Of these, 247 subjects (median 37 years, range 18–93 years) were treated under GA, mostly pwdis (n = 154, 69.7%). The main indication for treatment under GA was suspicion of pain (n = 178, 72.1%). Pwd had the highest degree of restoration (46.7%), DMF/T value (23.8), and most missing teeth (5.8). Pwapd had the most decayed teeth (12.9). There was a 12-month recall augmented by 2–4 oral hygiene sessions depending on compliance. The failure rate of all treated teeth was 4%. Two dental emergencies were reported for patients who received a GA. Conclusions Dental treatment need was high for adult vulnerable people. The diagnostic groups differed mainly in their subjective reason for need of a GA, their DMF/T, treatment needs and type of treatments performed. Failure and dental emergency rates after GA were low in spite of a recall interval of 12 months. Clinical Relevance Regular annual recalls could avoid dental emergencies in patients requiring treatment under GA.

To improve the identification and intervention of suicide risk, the Veterans Health Administration implemented the use of electronic patient record flags (PRF) to indicate when a veteran is identified as high risk for suicide and to increase the clinical contacts made with the veteran. The current study utilized an intersectional approach to assess potential disparities in the likelihood of receiving a PRF and the likelihood of receiving post-PRF follow-up care among veterans with substance use disorders. Among 474,946 veterans who received a substance use disorder diagnosis in 2012, Black veterans were less likely to receive a PRF, although Black-disabled veterans and Black-female veterans were more likely to receive a PRF. Homelessness was related to greater likelihood of receiving a PRF and post-PRF care. Hispanic/Latinx veterans who experienced homelessness were more likely to receive post-PRF care while disabled veterans who experienced homelessness were less likely. Hispanic/Latinx, female veterans and Black-disabled veterans were significantly less likely to receive post-PRF care. Overall, few marginalized or intersecting identities were associated with decreased PRF or decreased follow-up care. There are be opportunities for specific strategies that promote engagement in VA follow-up services for veterans identifying as Hispanic-Latinx women, disabled Black veterans, and disabled homeless veterans.

The successful transition of childhood cancer survivors from pediatric- to adult-focused long-term follow-up care is crucial and can be a critical period. Knowledge of current transition practices, especially regarding barriers and facilitators perceived by survivors and health care professionals, is important to develop sustainable transition processes and implement them into daily clinical practice. We performed a systematic review with the aim of assessing transition practices, readiness tools, and barriers and facilitators. We searched three databases (PubMed, Embase/Ovid, CINAHL) and included studies published between January 2000 and January 2020. We performed this review according to the PRISMA guidelines and registered the study protocol on PROSPERO; two reviewers independently extracted the content of the included studies. We included 26 studies: six studies described current transition practices, six assessed transition readiness tools, and 15 assessed barriers and facilitators to transition. The current literature describing transition practices is limited and overlooks adherence to follow-up care as a surrogate marker of transition success. However, the literature provides deep insight into barriers and facilitators to transition and theoretical considerations for the assessment of transition readiness. We showed that knowledge and education are key facilitators to transition that should be integrated into transition practices tailored to the individual needs of each survivor and the possibilities and limitations of each country’s health care system. The current knowledge on barriers and facilitators on transition should be implemented in clinical practice to support sustainable transition processes.

Zusammenfassung. Pränatale Suchtmittelexposition ist ein großer Risikofaktor für organische, neurologische und psychische Entwicklungsstörungen. In der Gesamtstichprobe ( N = 84) erfolgte auf Grund der Schwere der Störung bei fast der Hälfte der Kinder eine medikamentöse Behandlung des Neonatalen Entzugssyndroms. 56 Familien nahmen das Nachsorgeangebot im Rahmen einer Kooperation zwischen Geburtsmedizin, Neonatologie und Kinder- und Jugendpsychiatrie wahr (BK-Gruppe) und 28 erschienen nicht (N-Gruppe). In der N-Gruppe nahmen die Mütter präpartal häufiger Substitutionsmittel ein ( p=0,02). Kinder aus der BK-Gruppe erhielten häufiger Unterstützung durch Jugendhilfe (22 %) und wurden seltener (46 %) in den elterlichen Haushalt entlassen ( p

Introduction. By follow-up care process is meant an individualized curative-prophylactic active medical method, which supervises, at the initiative of the doctor, categories of healthy persons - exposed to risk factors - or categories of sick persons suffering from certain conditions. Purpose. In this study, we will refer to the theoretical and practical aspects regarding the necessity of follow-up care in children patients (preschool children, pupils), adolescents and young people, an operation that must be performed by the doctors with specialization and/or competence in pediatric dentistry, by the doctors with specialization in orthodontics and dentofacial orthopedics, by the school doctors, as well as by the simple dental doctors, who perform very regular pediatric dentistry maneuvers. Material and method. This study was conducted with the help of 23 pedodontists or pediatric dentists in Bucharest. Results and discussions. The answers obtained by applying the questionnaire created a clear image of the follow-up care system currently existing in Bucharest. Conclusions. The follow-up care in pediatric dentistry is the most useful active dental care, and in order to have an increased efficiency it is necessary that it is extremely well organized and controlled.

The aim of this study was to determine the effectiveness of follow-up care and health counselling provided by midwives and nurses in maternalinfant attachment level and relationships between sociodemographic factors. The study was designed as a quasi-experimental pattern with a control group on pretest-posttest. The sample size was determined using a power analysis and a total of 90 people were included in the study. The study demonstrated that the mean PAI score was high both in experimental and control groups and there was no difference between the groups (p > 0.05). In both groups, the mean MAI score was above the average scale score, but it was significantly higher in the group receiving health counselling and follow-up care compared to the score of the other group (p < 0.05). The study demonstrated that health counselling and follow-up care contributed significantly to the motherinfant attachment.

Background Incidental findings (IFs) are common among injured patients and create a complex problem with no standardized solution. Materials and methods This is a retrospective review of adult trauma patients admitted to a level I trauma center from January to May 2017. IFs from abdominal, chest, and neck imaging were categorized based on previously published guidelines focused on clinically significant IFs. Patient demographics related to access to care were collected. Outcome measures included documentation and patient notification of IFs. A univariate analysis was performed to identify characteristics that were associated with these outcomes. Results Of 1671 patients, 682 met inclusion criteria, and 418 (61.3%) had any IF based on the a priori categorization scheme. In total, 67 (9.8%) were homeless, 58 (8.5%) had no health insurance, and 115 (16.9%) had no established primary care provider prior to admission. Documentation of IFs was included in discharge summaries and instructions 76.5% and 40.2% of the time, respectively. Physicians were statistically more likely to appropriately document IFs when radiologists provided specific recommendations. Transfer to another hospital service prior to discharge and discharge to another acute care facility were associated with reduced rates of successful documentation. No factors significantly affected documentation of patient notification. Conclusions Trauma patients are at risk for poor access to follow-up care of IFs. Expanding IF-specific guidelines, collaborating with radiologists to facilitate their inclusion in reports, and ensuring that IFs are part of patient hand-offs could provide systematic methods of improving their documentation.

Introduction: Since coronary artery angina pectoris is a chronic disease, it negatively affects patients` self-concept. In this study, the effect of follow-up care on the self-concept of patients undergoing coronary artery bypass grafting was investigated. Materials and Methodology: In this study, the clinical trial was measured using self-concept questionnaire considering the effect of follow-up or constant care on 60 patients under coronary artery bypass grafting in Seyed-al-shohada heart center of Urmia. Eight to twelve weeks after the operation, the follow-up care, which is an Iranian native model was administered through telephon. Data collection tools included patients` demographic data collection form as well as self-concept questionnaire consisting of 25 Likert-scale items of 1 to 5 (totally positive, positive, neutral, negative, totally negative), which measured 25 features. Results: In the current study, the mean age of patients in both groups (intervention and control) was 59.68±7.43 and 59.48±5.79 years old, respectively. In addition, the mean weight of patients in both groups (intervention and control) equaled 77.82±10.67 and 75.22±7.53 kg. According to the results of the mean, the perceived threat after the intervention was 45.16±4.28 in the intervention group and it was 40.43±5.22 in the control group, showing a significant statistical difference between two groups (p

Survival times for prostate cancer have increased substantially, meaning more survivors will be discharged to General Practitioners' (GP) services. The detection of recurrence and monitoring of symptoms and long-term side-effects in prostate cancer survivors requires the active involvement of GPs in their follow-up care. In order to address this, the transition and discharge from hospital to primary care must be managed effectively. The objective of this study was to examine the preparedness, concerns and experiences of GPs in relation to their role in providing follow-up care to prostate cancer survivors. Purposive sampling was used to recruit GPs with experience in providing care to prostate cancer survivors. Twenty semi-structured telephone interviews were conducted with GPs across England. The interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. Participants described their current role in the follow-up pathway, a number of challenges and barriers in assuming this role, and potential ways to resolve these and improve their involvement. They expressed a range of views about their preparedness and willingness to take over follow-up care after discharge for this group of patients. GPs had reservations about workload, lack of resources, expertise and deficiencies in communication with hospitals. Findings from this study suggest that GPs will be ready to take over the follow-up care of prostate cancer survivors if better information, additional training and adequate resources are provided and communication lines with hospital specialists are clear. Understanding the issues faced by GPs and overcoming identified barriers to providing follow-up care to prostate cancer survivors will provide the insight necessary to make the process of transferring care from secondary to primary teams a more straightforward task for all stakeholders.

Introduction: Type 2 diabetes mellitus has huge economic burden for both patient and health-care system. Management of the condition in India faces multiple challenges such as paucity of trained medical and paramedical staff, poor quality, lack of satisfaction with services, and unaffordability of services. Objective: To determine the level of satisfaction and the out-of-pocket expenditure for type 2 diabetes patients receiving treatment from public and private sectors in urban Puducherry. Methods: This was a cross-sectional analytical study conducted in Urban Health Centre area of tertiary care center from August to September 2016. A total of 200 patients suffering from type 2 diabetes mellitus for 1 year or more and resided for at least a year in Puducherry were included in the study. Among the 200 participants, 100 were receiving care from government and 100 from private facility. Result and conclusion: Median cost of diabetes care in government facility was 2000 INR while in private facility was 13050 INR. About 70.1% of the patients were satisfied with the health-care services received. There was no significant difference in the level of satisfaction between government and private health facility. Almost three-fourths of the diabetes patients are satisfied with the care received irrespective of the type of health facility. The cost of diabetes care is more for patients seeking care from private sector than public sector. Availability of insulin and free syringes in the primary health center, provision of specialized footwear, and spectacles free of cost can help in reducing the out-of-pocket expenditure.

Background Despite the high and rising burden of chronic kidney disease (CKD) in South Asia, factors that influence access to CKD care at the community level have not been studied previously, especially in the rural areas. We conducted a mixed methods study and interviewed key stakeholders to explore the views and experiences of key stakeholders, and identify barriers and potential facilitators that influence access to CKD care at the primary care level in rural India. Methods A total of 21 stakeholders participated in the study. We conducted 15 in-depth interviews on a purposive sample of stakeholders (CKD patients, healthcare providers and health planners) and one focus group discussion with 6 community health workers. The interviews were audio-recorded and transcribed verbatim. We employed the Lévesque’s framework for access to care to base interview guides and structure the initial codes. By inductive and deductive approaches, thematic analysis was undertaken using QSR NVivo version 11. Results The major patient-level barriers to CKD care as reported by the most patients and healthcare providers was poor knowledge and awareness of CKD. Health system-level barriers included shortages of skilled healthcare professionals and medicines, fragmented referrals pathways to the specialists at the hospitals with inadequate follow up care. Many patients and healthcare providers, when asked about areas for improving access to CKD care, reported educational initiatives to increase awareness of CKD among healthcare providers and patients, provision of CKD related supplies, and a systems-level approach to care coordination including task shifting by engaging community health workers in CKD care, as potential facilitators. Conclusions We identified several barriers to access CKD care at the primary care level in rural India that need urgent attention. Targeted CKD screening programs and CKD specific educational initiatives may improve awareness of CKD. Additionally, primary care infrastructure needs to be strengthened for CKD care, ensuring trained staff, availability of essential diagnostics and medications, and creating efficient referral pathways for quality CKD care.

Purpose: Follow-up care (FU-care) and self-management are recognized as important to ensure prolonged effects of rehabilitation. Objectives of this study were to explore current FU-care and self-management after specialized rehabilitation for patients with rheumatic and musculoskeletal diseases. Materials and methods: This multicentre cohort study included 523 patients who self-reported need and plans for FU-care and plans for self-management activities (SMAs) at rehabilitation discharge. The FU-care received and adherence to SMA were self-reported after 4-, 8-, and 12-months. Predictors for received FU-care and adherence to SMA were explored in multiple logistic regression models. Results: Plans for FU-care were significantly associated with received FU-care. Younger age, better coping skills, and performing regular social activities and hobbies were significant predictors for received FU-care. Throughout the follow-up year, 221 (51%) participants had adherence to their SMA plans. Older age, regular physical activity, more severe pain, and performing regular social activities and hobbies were significant predictors for adherence to SMA. Participants with SMA adherence more often reported planned FU-care, and more frequently received the FU-care they needed. Conclusions: Planning FU-care should be integrated in specialized rehabilitation. Patients with poor coping skills and sedentary lifestyle may need more support over longer time to implement behavioral changes for healthy self-management.Implications for rehabilitationPlanning follow-up should be integrated in specialized rehabilitation as it supports self-management and receiving follow-up at home.Patients with sedentary lifestyle, poor coping skills, and depression may need more support over longer time to implement healthy self-management.Structure and routines in daily life enhance self-management. This multicentre cohort study was funded by Dam Foundation.

Aim To evaluate parental mental health monitoring during follow up care for very preterm (VPT) infants, describe symptoms of anxiety and depression and risk factors for mothers and fathers at 1 and 12 months of corrected age. Methods Parents completed the Hospital Anxiety and Depression Scale (HADS). Psychological symptoms and risk factors were analyzed within and between mothers and fathers. Results In 4 years, the monitoring reached 1260 (48%) families. Of these, 693 mothers and 340 fathers (300 couples) completed the HADS twice. At 1 month, 22% and 15% of the mothers and 10% and 9% of the fathers respectively reported elevated symptoms of anxiety and depression. At 12 months, these rates were significantly reduced to 14% and 9% for mothers and 5% and 4% for fathers, respectively. Within couples, anxiety and depression were positively associated. At 12 months, in 20% of the couples, one or both parents reported elevated symptoms. Risk factors were length of hospital stay, migration background, educational level and employment status. Conclusion The mental health of parents of VPT infants improved, but elevated symptoms were still observed in 20% of included families after one year. Acknowledging and remediating parental mental health remains essential during follow-up care.