Science.gov

Sample records for care follow-up programmes

  1. Cancer follow-up care. Patients' perspectives.

    PubMed Central

    Miedema, Baukje; MacDonald, Ian; Tatemichi, Sue

    2003-01-01

    OBJECTIVE: To assess family physicians' and specialists' involvement in cancer follow-up care and how this involvement is perceived by cancer patients. DESIGN: Self-administered survey. SETTING: A health region in New Brunswick. PARTICIPANTS: A nonprobability cluster sample of 183 participants. MAIN OUTCOME MEASURES: Patients' perceptions of cancer follow-up care. RESULTS: More than a third of participants (36%) were not sure which physician was in charge of their cancer follow-up care. As part of follow-up care, 80% of participants wanted counseling from their family physicians, but only 20% received it. About a third of participants (32%) were not satisfied with the follow-up care provided by their family physicians. In contrast, only 18% of participants were dissatisfied with the follow-up care provided by specialists. Older participants were more satisfied with cancer follow-up care than younger participants. CONCLUSION: Cancer follow-up care is increasingly becoming part of family physicians' practices. Family physicians need to develop an approach that addresses patients' needs, particularly in the area of emotional support. PMID:12901486

  2. [Follow-up care of patients after heart attack].

    PubMed

    Bischof, Tobias R; Kurz, David J

    2015-08-01

    Survivors of a myocardial infarction are at increased risk for future cardiac events, including recurrent infarction, heart failure, arrhythmia, stroke, and sudden cardiac death. The primary care physician needs to be aware of the potential risks and complications facing these patients. Secondary preventive measures after myocardial infarction include an optimal medical therapy (dual antiplatelet therapy, Statin, ACE-inhibitor, and in most cases a beta-blocker) and life style modifications (quit smoking, regular physical activity, Mediterranean-style diet). Patients should be informed about how to recognize and react to cardiac symptoms. PMID:26242418

  3. Follow-Up Visit Patterns in an Antiretroviral Therapy (ART) Programme in Zomba, Malawi

    PubMed Central

    Rachlis, Beth; Cole, Donald C.; van Lettow, Monique; Escobar, Michael; Muula, Adamson S.; Ahmad, Farah; Orbinski, James; Chan, Adrienne K.

    2014-01-01

    Background Identifying follow-up (FU) visit patterns, and exploring which factors influence them are likely to be useful in determining which patients on antiretroviral therapy (ART) may become Lost to Follow-Up (LTFU). Using an operation and implementation research approach, we sought 1) to describe the timing of FU visits amongst patients who have been on ART for shorter and longer periods of time; and 2) to determine the median time to late visits, and 3) to identify specific factors that may be associated with these patterns in Zomba, Malawi. Methods and Findings Using routinely collected programme monitoring data from Zomba District, we performed descriptive analyses on all ART visits among patients who initiated ART between Jan. 1, 2007–June 30, 2010. Based on an expected FU date, each FU visit was classified as early (≥4 day before an expected FU date), on time (3 days before an expected FU date/up to 6 days after an expected FU date), or late (≥7 days after an expected FU date). In total, 7,815 patients with 76417 FU visits were included. Ninety-two percent of patients had ≥2 FU visits. At the majority of visits, patients were either on time or late. The median time to a first late visit among those with 2 or more visits was 216 days (IQR: 128–359). Various patient- and visit-level factors differed significantly across Early, On Time, and Late visit groups including ART adherence and frequency of, and type of side effects. Discussion The majority of patients do not demonstrate consistent FU visit patterns. Individuals were generally on ART for at least 6 months before experiencing their first late visit. Our findings have implications for the development of effective interventions that meet patient needs when they present early and can reduce patient losses to follow-up when they are late. In particular, time-varying visit characteristics need further research. PMID:25033285

  4. Health care personnel's experiences of a bereavement follow-up intervention for grieving parents.

    PubMed

    Liisa, Aho Anna; Marja-Terttu, Tarkka; Päivi, Åstedt-Kurki; Marja, Kaunonen

    2011-06-01

    The aim of this study is to investigate the experiences of health care personnel of a bereavement follow-up intervention for grieving parents and of the ways to develop it. The intervention included three components: a support package for grieving parents, peer supporters' and health care personnel's contact with parents. The sample included 29 health professionals. Data were collected via open-format questionnaires and telephone interviews from health care personnel. Content analysis was used as a means of data analysis. The support package for grieving parents was considered important and versatile. Health care personnel perceived the intervention and its viability as mostly good. Parents' willingness to receive support, health care personnel's good resources and organizational preconditions were important for the follow-up contact. The intervention clarified the policy related to supporting grieving parents. It was enabled by a good attitude, shift arrangements and co-worker support. However, the implementation was considered difficult because of scarce resources. Parental support engendered negative feelings in health care personnel and they desired systematic supervision to deal with these. Follow-up care of grieving parents is a demanding task. Continuous education about bereavement follow-up care and systematic supervision to health care personnel is needed. Family-focused care in supporting grieving families after leaving from hospital should be increased. Inter-organizational cooperation in supporting parents is important and feasible. PMID:21039718

  5. Effectiveness of a tinnitus management programme: a 2-year follow-up study

    PubMed Central

    Gudex, Claire; Skellgaard, Preben H; West, Torben; Sørensen, Jan

    2009-01-01

    Background Tinnitus impairs the possibility of leading a normal life in 0.5–1% of the population. While neither medical nor surgical treatment appears effective, counselling may offer some relief. An intervention combining counselling and hearing devices is offered to clients referred to the Centre for Help Aids and Communication (CHC) in southern Denmark. The aims of this exploratory study were to examine i) the characteristics of CHC's clients and their tinnitus, ii) the effectiveness of the treatment, and iii) whether particular client groups benefit more than others. Methods One hundred new clients presenting with tinnitus completed the Tinnitus Handicap Inventory (THI) three times – before their first consultation, after one month and after 1–2 years. The scores were tested for significant differences over time using tests for paired data. Logistic regression was used to examine factors associated with a clinically important difference (i.e. THI score improvement of at least 20 points). Results At final follow-up, total THI score was significantly lower than baseline, i.e. 29.8 (CI 25.5–34.2) vs. 37.2 (CI 33.1–37.2), p < 0.01. The programme achieved a clinically important difference for 27% and 24% of the clients one month and 1–2 years after the first consultation, respectively. It appeared that greater improvement in THI score was related to higher baseline THI score and possibly also to treatment by a particular CHC therapist. The absolute reduction in mean THI score after 1–2 years for clients with moderate and severe handicap was 14 and 20 points, respectively, i.e. similar to that previously reported for TRT (14–28 points). The cost of the current programme was approximately 200 EUR per client. Conclusion The tinnitus management programme appeared to provide significant benefit to many clients at a relatively low cost. It would be useful to conduct a randomised controlled study comparing the current programme with alternative forms of

  6. Perspectives on Pap Test Follow Up Care Among Rural Appalachian Women

    PubMed Central

    Schoenberg, Nancy; Baltisberger, Julie; Bardach, Shoshana; Dignan, Mark

    2010-01-01

    Approximately one to three quarters of women notified of abnormal Pap test results do not receive appropriate follow up care, dramatically elevating their risk for invasive cervical cancer (ICC). We explored barriers to/facilitators of follow up care for women in two counties in Appalachian Kentucky, where ICC incidence and mortality are significantly higher than the national average. In-depth interviews were conducted among 27 Appalachian women and seven local health department personnel. Those who had been told of an atypical Pap test result tended to have one of three reactions; (1) not alarmed and generally did not obtain follow-up care; (2) alarmed and obtained follow up care; or (3) alarmed, but did not obtain care. Each of these typologies appeared to be shaped by a differing set of three categories of influences: personal factors; procedure/provider/system factors; and ecological/community factors. Recommendations to increase appropriate follow up care included pursuing research on explanations for these typologies and developing tailored interventions specific to women in each of the response types. PMID:20981638

  7. Early Primary Care Provider Follow-up and Readmission After High-Risk Surgery

    PubMed Central

    Brooke, Benjamin S.; Stone, David H.; Cronenwett, Jack L.; Nolan, Brian; DeMartino, Randall R.; MacKenzie, Todd A.; Goodman, David C.; Goodney, Philip P.

    2014-01-01

    IMPORTANCE Follow-up with a primary care provider (PCP) in addition to the surgical team is routinely recommended to patients discharged after major surgery despite no clear evidence that it improves outcomes. OBJECTIVE To test whether PCP follow-up is associated with lower 30-day readmission rates after open thoracic aortic aneurysm (TAA) repair and ventral hernia repair (VHR), surgical procedures known to have a high and low risk of readmission, respectively. DESIGN, SETTING, AND PARTICIPANTS In a cohort of Medicare beneficiaries discharged to home after open TAA repair (n = 12 679) and VHR (n = 52 807) between 2003 to 2010, we compared 30-day readmission rates between patients seen and not seen by a PCP within 30 days of discharge and across tertiles of regional primary care use. We stratified our analysis by the presence of complications during the surgical (index) admission. MAIN OUTCOMES AND MEASURES Thirty-day readmission rate. RESULTS Overall, 2619 patients (20.6%) undergoing open TAA repair and 4927 patients (9.3%) undergoing VHR were readmitted within 30 days after surgery. Complications occurred in 4649 patients (36.6%) undergoing open TAA repair and 4528 patients (8.6%) undergoing VHR during their surgical admission. Early follow-up with a PCP significantly reduced the risk of readmission among open TAA patients who experienced perioperative complications, from 35.0% (without follow-up) to 20.4% (with follow-up) (P < .001). However, PCP follow-up made no significant difference in patients whose hospital course was uncomplicated (19.4% with follow-up vs 21.9% without follow-up; P = .31). In comparison, early follow-up with a PCP after VHR did not reduce the risk of readmission, regardless of complications. In adjusted regional analyses, undergoing open TAA repair in regions with high compared with low primary care use was associated with an 18% lower likelihood of 30-day readmission (odds ratio, 0.82; 95% CI, 0.71–0.96; P = .02), whereas no significant

  8. Implementation of standardized follow-up care significantly reduces peritonitis in children on chronic peritoneal dialysis.

    PubMed

    Neu, Alicia M; Richardson, Troy; Lawlor, John; Stuart, Jayne; Newland, Jason; McAfee, Nancy; Warady, Bradley A

    2016-06-01

    The Standardizing Care to improve Outcomes in Pediatric End stage renal disease (SCOPE) Collaborative aims to reduce peritonitis rates in pediatric chronic peritoneal dialysis patients by increasing implementation of standardized care practices. To assess this, monthly care bundle compliance and annualized monthly peritonitis rates were evaluated from 24 SCOPE centers that were participating at collaborative launch and that provided peritonitis rates for the 13 months prior to launch. Changes in bundle compliance were assessed using either a logistic regression model or a generalized linear mixed model. Changes in average annualized peritonitis rates over time were illustrated using the latter model. In the first 36 months of the collaborative, 644 patients with 7977 follow-up encounters were included. The likelihood of compliance with follow-up care practices increased significantly (odds ratio 1.15, 95% confidence interval 1.10, 1.19). Mean monthly peritonitis rates significantly decreased from 0.63 episodes per patient year (95% confidence interval 0.43, 0.92) prelaunch to 0.42 (95% confidence interval 0.31, 0.57) at 36 months postlaunch. A sensitivity analysis confirmed that as mean follow-up compliance increased, peritonitis rates decreased, reaching statistical significance at 80% at which point the prelaunch rate was 42% higher than the rate in the months following achievement of 80% compliance. In its first 3 years, the SCOPE Collaborative has increased the implementation of standardized follow-up care and demonstrated a significant reduction in average monthly peritonitis rates. PMID:27165827

  9. Taking care: practice and philosophy of communication in a critical care follow-up clinic.

    PubMed

    Hazzard, Anthony; Harris, Wendy; Howell, David

    2013-06-01

    Human consciousness is inextricable from communication. The conditions of communication in the clinical context are defined by the caring intention and the unequal relationship, which imply special responsibilities on the part of the clinician. The conventional hermeneutic model of communication proposes a close examination of the context of the other, and an objective effort to get close to their consciousness by interpretation of their expressions. The clinician is supposed to lay aside subjective factors but make use of her/his clinical knowledge and skills. At University College Hospital Critical Care follow-up clinic, the communicative task involves history taking; partly by questionnaire and partly by attention to the patient's agenda - assessing needs, providing information and facilitating access to further help. In recent years the provision of Critical Care has become ever more complex, both in terms of the sophisticated medical and nursing techniques it can offer to patients and in the range of conditions it can undertake to treat. This range and complexity is reflected in the variety of problems and consequences that may be encountered at follow-up. Communicative techniques should take account of the emotional vulnerability of patients emerging from severe illness. Attentive listening should identify special anxieties, and care with phraseology aims to avoid further distress. Issues of memory, depression and trauma may be expected, and the interview technique must be flexible enough to offer emotional containment if need be. The consultation should be therapeutic in its conduct but should not embark upon actual psychotherapy or seek to dismantle the patient's defences. Contemporary hermeneutic perspectives emphasise the contextual situatedness of the clinician's consciousness, and propose a model of communication as 'blending of horizons' rather than as objective interpretation. Systems theory contributes to an understanding of the influence on

  10. Follow-up Care Education and Information: Identifying Cancer Survivors in Need of More Guidance.

    PubMed

    O'Malley, Denalee M; Hudson, Shawna V; Ohman-Strickland, Pamela A; Bator, Alicja; Lee, Heather S; Gundersen, Daniel A; Miller, Suzanne M

    2016-03-01

    Cancer survivors engage in cancer screenings and protective health behaviors at suboptimal rates despite their increased risk for future illness. Survivorship care plans and other educational strategies to prepare cancer survivors to adopt engaged roles in managing long-term follow-up care and health risks are needed. In a sample of cancer survivors, we identified patient characteristics and psychosocial predictors associated with increased follow-up care informational needs. Cross-sectional surveys were administered to early-stage breast and prostate survivors (N = 278; 68 % breast) at least 2 years post treatment from four community hospital programs in New Jersey between May 2012 and July 2013. Patient demographics, medical history, psychosocial characteristics (i.e., worries about the future, fear of disease recurrence, and patient activation), and perceptions of oncology and primary care were assessed. African-American survivors (AOR = 2.69, 95 % confidence interval [CI] 1.27-5.68) and survivors with higher comorbidity (AOR =1.16, CI 1.01-1.33) were more likely to want additional information to guide follow-up care. Adjusting for race and comorbidities, survivors who wanted more information to guide their follow-up care reported greater worries about the future (p < 0.05) and fears about disease recurrence (p < 0.05) compared to those who did not want additional information. Results emphasize the need to develop cancer survivorship educational strategies that are both responsive to the needs of specific populations (e.g., African-American survivors and patients with multiple comorbidities) and the psychosocial profiles that motivate requests for more extensive follow-up guidance. PMID:25524391

  11. Follow-up Care Education and Information: Identifying Cancer Survivors in Need of More Guidance

    PubMed Central

    O’Malley, Denalee M.; Hudson, Shawna V.; Ohman-Strickland, Pamela A; Bator, Alicja; Lee, Heather S.; Gundersen, Daniel A.; Miller, Suzanne M.

    2015-01-01

    Background Cancer survivors engage in cancer screenings and protective health behaviors at suboptimal rates despite their increased risk for future illness. Survivorship care plans and other educational strategies to prepare cancer survivors to adopt engaged roles in managing long-term follow-up care and health risks are needed. In a sample of cancer survivors, we identified patient characteristics and psychosocial predictors associated with increased follow-up care informational needs. Methods Cross-sectional surveys were administered to early stage breast and prostate survivors (N=278; 68% breast) at least two years post-treatment from four community hospital programs in New Jersey between May 2012-July 2013. Patient demographics, medical history, psychosocial characteristics (i.e., worries about the future, fear of disease recurrence, and patient activation) and perceptions of oncology and primary care were assessed. Results African American survivors (AOR =2.69, 95% confidence interval [CI] 1.27–5.68) and survivors with higher comorbidity (AOR=1.16, CI 1.01–1.33) were more likely to want additional information to guide follow-up care. Adjusting for race and comorbidities, survivors who wanted more information to guide their follow-up care reported greater worries about the future (p<0.05) and fears about disease recurrence (p<0.05) compared to those who did not want additional information. Conclusions Results emphasize the need to develop cancer survivorship educational strategies that are both responsive to the needs of specific populations (e.g., African American survivors and patients with multiple comorbidities) and the psychosocial profiles that motivate requests for more extensive follow-up guidance. PMID:25524391

  12. Optimal delivery of male breast cancer follow-up care: improving outcomes

    PubMed Central

    Ferzoco, Raina M; Ruddy, Kathryn J

    2015-01-01

    Male breast cancer is a rare disease. There are limited data to inform optimal treatment and follow-up strategies in this population. Currently, most follow-up guidelines are drawn from the vast literature on female breast cancer, despite the fact that male breast cancer has unique biological characteristics. In this review, we discuss clinical characteristics of male breast cancer as well as current best practices for long-term care with a focus on surveillance, screening, and treatment-related symptom management in male breast cancer survivors. PMID:26648754

  13. Factors Associated with Follow-Up Attendance among Rape Victims Seen in Acute Medical Care

    PubMed Central

    Darnell, Doyanne; Peterson, Roselyn; Berliner, Lucy; Stewart, Terri; Russo, Joan; Whiteside, Lauren; Zatzick, Douglas

    2016-01-01

    Objective Rape is associated with Posttraumatic Stress Disorder and related comorbidities. Most victims do not obtain treatment for these conditions. Acute care medical settings are well-positioned to link patients to services; however, difficulty engaging victims and low attendance at provided follow-up appointments is well documented. Identifying factors associated with follow-up can inform engagement and linkage strategies. Method Administrative, patient self-report, and provider observational data from Harborview Medical Center were combined for the analysis. Using logistic regression, we examined factors associated with follow-up health service utilization after seeking services for rape in the emergency department. Results Of the 521 diverse female (n=476) and male (n=45) rape victims, 28% attended the recommended medical/counseling follow-up appointment. In the final (adjusted) logistic regression model, having a developmental or other disability (OR=0.40, 95% CI=0.21-0.77), having a current mental illness (OR=0.25, 95% CI=0.13-0.49), and being assaulted in public (OR=0.50, 95% CI=0.28-0.87) were uniquely associated with reduced odds of attending the follow-up. Having a prior mental health condition (OR= 3.02 95% CI=1.86-4.91), a completed SANE examination (OR=2.97, 95% CI=1.84-4.81), and social support available to help cope with the assault (OR=3.54, 95% CI=1.76-7.11) were associated with an increased odds of attending the follow-up. Conclusions Findings point to relevant characteristics ascertained at the acute care medical visit for rape that may be used to identify victims less likely to obtain posttraumatic medical and mental health services. Efforts to improve service linkage among these patients is warranted and may require alternative models to engage these patients to support posttraumatic recovery. PMID:26168030

  14. Patient satisfaction with breast cancer follow-up care provided by family physicians

    PubMed Central

    Thind, Amardeep; Liu, Yihang; Maly, Rose

    2011-01-01

    Purpose There is little evidence to document patient satisfaction with follow up care provided by family physicians/general practitioners (FP/GP) to breast cancer patients. We aimed to identify determinants of satisfaction with such care in low-income medically underserved women with breast cancer. Methods Cross sectional study of 145 women who reported receiving follow up care from a FP/GP. Women were enrolled in California’s Breast and Cervical Cancer Treatment Program and were interviewed by phone 3 years after breast cancer diagnosis. Cleary and McNeil’s model, which states that patient satisfaction is a function of patient characteristics, structure of care, and processes of care, was used to understand the determinants of satisfaction. Stepwise logistic regression was used to identify significant predictors. Results 73.4% reported that they were extremely satisfied with their treatment by the family physician/general practitioner. Women who were able to ask their family physicians questions about their breast cancer had six times greater odds of being extremely satisfied compared to women who were not able to ask any questions. Women who scored the family physician higher on the ability to explain things in a way she could understand had a higher odds of being extremely satisfied compared to women who scored their family physicians lower. Conclusions FP/GPs providing follow up care for breast cancer patients should encourage patients to ask questions, and must communicate in a way that patients understand. These recommendations are congruent with the characteristics of patient centered communication for cancer patients enunciated in a recent NCI monograph. PMID:22086814

  15. Optimal delivery of colorectal cancer follow-up care: improving patient outcomes

    PubMed Central

    Jorgensen, Mikaela L; Young, Jane M; Solomon, Michael J

    2015-01-01

    Colorectal cancer (CRC) is the third most commonly diagnosed cancer worldwide. With population aging and increases in survival, the number of CRC survivors is projected to rise dramatically. The time following initial treatment is often described as a period of transition from intensive hospital-based care back into “regular life.” This review provides an overview of recommended follow-up care for people with CRC who have been treated with curative intent, as well as exploring the current state of the research that underpins these guidelines. For patients, key concerns following treatment include the development of recurrent and new cancers, late and long-term effects of cancer and treatment, and the interplay of these factors with daily function and general health. For physicians, survivorship care plans can be a tool for coordinating the surveillance, intervention, and prevention of these key patient concerns. Though much of the research in cancer survivorship to date has focused on surveillance for recurrent disease, many national guidelines differ in their conclusions about the frequency and timing of follow-up tests. Most CRC guidelines refer only briefly to the management of side effects, despite reports that many patients have a range of ongoing physiological, psychosocial, and functional needs. Guidance for surveillance and intervention is often limited by a small number of heterogeneous trials conducted in this patient group. However, recently released survivorship guidelines emphasize the potential for the effectiveness of secondary prevention strategies, such as physical activity, to improve patient outcomes. There is also emerging evidence for the role of primary care providers and nurse coordinated care to support the transition and increase the cost-effectiveness of follow-up. The shift in focus from recurrence alone to the assessment and management of a range of survivorship issues will be important for ensuring that this growing group of

  16. Patient Barriers to Follow-Up Care for Breast and Cervical Cancer Abnormalities

    PubMed Central

    Darnell, Julie S.; Cho, Young I.; Stolley, Melinda R.; Markossian, Talar W.; Calhoun, Elizabeth A.

    2013-01-01

    Abstract Background Women with breast or cervical cancer abnormalities can experience barriers to timely follow-up care, resulting in delays in cancer diagnosis. Patient navigation programs that identify and remove barriers to ensure timely receipt of care are proliferating nationally. The study used a systematic framework to describe barriers, including differences between African American and Latina women; to determine recurrence of barriers; and to examine factors associated with barriers to follow-up care. Methods Data originated from 250 women in the intervention arm of the Chicago Patient Navigation Research Program (PNRP). The women had abnormal cancer screening findings and navigator encounters. Women were recruited from a community health center and a publicly owned medical center. After describing proportions of African American and Latina women experiencing particular barriers, logistic regression was used to explore associations between patient characteristics, such as race/ethnicity, and type of barriers. Results The most frequent barriers occurred at the intrapersonal level (e.g., insurance issues and fear), while institutional-level barriers such as system problems with scheduling care were the most commonly recurring over time (29%). The majority of barriers (58%) were reported in the first navigator encounter. Latinas (81%) reported barriers more often than African American women (19%). Differences in race/ethnicity and employment status were associated with types of barriers. Compared to African American women, Latinas were more likely to report an intrapersonal level barrier. Unemployed women were more likely to report an institutional level barrier. Conclusion In a sample of highly vulnerable women, there is no single characteristic (e.g., uninsured) that predicts what kinds of barriers a woman is likely to have. Nevertheless, navigators appear able to easily resolve intrapersonal-level barriers, but ongoing navigation is needed to address

  17. Treatment of active duty military with PTSD in primary care: A follow-up report.

    PubMed

    Cigrang, Jeffrey A; Rauch, Sheila A M; Mintz, Jim; Brundige, Antoinette; Avila, Laura L; Bryan, Craig J; Goodie, Jeffrey L; Peterson, Alan L

    2015-12-01

    First-line trauma-focused therapies offered in specialty mental health clinics do not reach many veterans and active duty service members with posttraumatic stress disorder (PTSD). Primary care is an ideal environment to expand access to mental health care. Several promising clinical case series reports of brief PTSD therapies adapted for primary care have shown positive results, but the long-term effectiveness with military members is unknown. The purpose of this study was to determine the long-term outcome of an open trial of a brief cognitive-behavioral primary care-delivered protocol developed specifically for deployment-related PTSD in a sample of 24 active duty military (15 men, 9 women). Measures of PTSD symptom severity showed statistically and clinically significant reductions from baseline to posttreatment that were maintained at the 6-month and 1-year follow-up assessments. Similar reductions were maintained in depressive symptoms and ratings of global mental health functioning. PMID:26519833

  18. Evaluation of Follow-Up Effects of the International Child Development Programme on Caregivers in Mozambique

    ERIC Educational Resources Information Center

    Skar, Ane-Marthe Solheim; Sherr, Lorraine; Clucas, Claudine; von Tetzchner, Stephen

    2014-01-01

    Parenting programs have been used to good effect in many settings, yet few are systematically introduced and evaluated in developing countries. This study explores the relative long-term effect of participation in the International Child Development Programme (ICDP) in a group of caregivers in Mozambique. A quasi-experimental design was used to…

  19. Multimorbidity and long-term care dependency—a five-year follow-up

    PubMed Central

    2014-01-01

    Background Not only single, but also multiple, chronic conditions are becoming the normal situation rather than the exception in the older generation. While many studies show a correlation between multimorbidity and various health outcomes, the long-term effect on care dependency remains unclear. The objective of this study is to follow up a cohort of older adults for 5 years to estimate the impact of multimorbidity on long-term care dependency. Methods This study is based on claims data from a German health insurance company. We included 115,203 people (mean age: 71.5 years, 41.4% females). To identify chronic diseases and multimorbidity, we used a defined list of 46 chronic conditions based on ICD-10 codes. Multimorbidity was defined as three or more chronic conditions from this list. The main outcome was “time until long-term care dependency”. The follow-up started on January 1st, 2005 and lasted for 5 years until December 31st, 2009. To evaluate differences between those with multimorbidity and those without, we calculated Kaplan–Meier curves and then modeled four distinct Cox proportional hazard regressions including multimorbidity, age and sex, the single chronic conditions, and disease clusters. Results Mean follow-up was 4.5 years. People with multimorbidity had a higher risk of becoming care dependent (HR: 1.85, CI 1.78–1.92). The conditions with the highest risks for long-term care dependency are Parkinson’s disease (HR: 6.40 vs. 2.68) and dementia (HR: 5.70 vs. 2.27). Patients with the multimorbidity pattern “Neuropsychiatric disorders” have a 79% higher risk of care dependency. Conclusions The results should form the basis for future health policy decisions on the treatment of patients with multiple chronic diseases and also show the need to introduce new ways of providing long-term care to this population. A health policy focus on chronic care management as well as the development of guidelines for multimorbidity is crucial to secure

  20. Follow-up to abnormal cancer screening tests: considering the multilevel context of care.

    PubMed

    Zapka, Jane M; Edwards, Heather M; Chollette, Veronica; Taplin, Stephen H

    2014-10-01

    The call for multilevel interventions to improve the quality of follow-up to abnormal cancer screening has been out for a decade, but published work emphasizes individual approaches, and conceptualizations differ regarding the definition of levels. To investigate the scope and methods being undertaken in this focused area of follow-up to abnormal tests (breast, colon, cervical), we reviewed recent literature and grants (2007-2012) funded by the National Cancer Institute. A structured search yielded 16 grants with varying definitions of "follow-up" (e.g., completion of recommended tests, time to diagnosis); most included minority racial/ethnic group participants. Ten grants concentrated on measurement/intervention development and 13 piloted or tested interventions (categories not mutually exclusive). All studies considered patient-level factors and effects. Although some directed interventions at provider levels, few measured group characteristics and effects of interventions on the providers or levels other than the patient. Multilevel interventions are being proposed, but clarity about endpoints, definition of levels, and measures is needed. The differences in the conceptualization of levels and factors that affect practice need empirical exploration, and we need to measure their salient characteristics to advance our understanding of how context affects cancer care delivery in a changing practice and policy environment. PMID:25073625

  1. Promoting Quality and Evidence-Based Care in Early-Stage Breast Cancer Follow-up

    PubMed Central

    Hayes, Daniel F.; Ramsey, Scott D.; Hortobagyi, Gabriel N.; Barlow, William E.; Gralow, Julie R.

    2014-01-01

    Evidence-based guidelines for long-term follow-up of early-stage breast cancer patients developed by oncology societies in the United States and Europe recommend that breast cancer survivors undergo regular evaluation with history and physical examination, as well as annual mammography. Routine blood tests, circulating tumor markers, and/or surveillance imaging studies beyond mammography are not recommended in the absence of concerning symptoms or physical examination findings because of lack of supportive clinical evidence. Despite these guidelines, studies have shown that 20% to 40% of oncologists assess serum tumor markers as part of routine monitoring of early-stage breast cancer patients. As part of efforts to both address the financial challenges confronting the health-care system and optimize patient outcomes, the American Society of Clinical Oncology’s Cost of Care Task Force identified adherence to breast cancer surveillance guidelines as an opportunity to improve care and reduce cost. However, these recommendations are based on trials done in an era of outdated technology and limited therapeutic options. It is possible that recent improvements in diagnostics and treatments could make earlier detection of recurrent disease important for improving both survival and quality of life outcomes. Research is necessary to further inform optimal breast cancer follow-up strategies, which could impact these recommendations. At this time, outside of well-conducted clinical trials, there is no role for ordering routine serial blood or imaging tests in monitoring for recurrence in early-stage breast cancer patients. PMID:24627271

  2. Assessing Implicit Cognition Among Patients Lost to Follow-up for HIV Care: A Preliminary Study

    PubMed Central

    Houston, Eric; Lyons, Thomas; Wolfe, Brenda; Rolfsen, Norma; Williams, Maryanne; Rucker, Monique; Glick, Nancy

    2016-01-01

    Objective: While a growing body of research indicates that implicit cognitive processes play an important role in a range of health behaviors, the assessment of these impulsive, associative mental processes among patients living with HIV has received little attention. This preliminary study explored how multidimensional scaling (MDS) could be used to assess implicit cognitive processes among patients lost to follow-up for HIV care and develop interventions to improve their engagement. Method: The sample consisted of 33 patients who were identified as lost to follow up for HIV care at two urban hospitals. Participants were randomly assigned to either the MDS assessment program or control group. All participants underwent measures designed to gauge behavioral change intentions and treatment motivation. Assessment group participants were interviewed to determine their reactions to the assessment program. Results: The MDS assessment program identified cognitive processes and their relationship to treatment-related behaviors among assessment group participants. Assessment group participants reported significantly greater behavior change intentions than those in the control group (p =.02; Cohen’s d = 0.84). Conclusion: MDS shows promise as a tool to identify implicit cognitive processes related to treatment-related behaviors. Assessments based on MDS could serve as the basis for patient-centered clinical interventions designed to improve treatment adherence and HIV care engagement in general. PMID:27347274

  3. Follow-up to abnormal cancer screening tests: Considering the multilevel context of care

    PubMed Central

    Zapka, Jane M.; Edwards, Heather M.; Chollette, Veronica; Taplin, Stephen H.

    2014-01-01

    The call for multilevel interventions to improve the quality of follow-up to abnormal cancer screening has been out for a decade but published work emphasizes individual approaches, and conceptualizations differ regarding the definition of levels. To investigate the scope and methods being undertaken in this focused area of follow-up to abnormal tests (breast, colon, cervical), we reviewed recent literature and grants (2007-2012) funded by the National Cancer Institute. A structured search yielded 16 grants with varying definitions of “follow-up” (e.g. completion of recommended tests, time to diagnosis); most included minority racial/ethnic group participants. Ten grants concentrated on measurement/intervention development, and 13 piloted or tested interventions (categories not mutually exclusive). All studies considered patient level factors and effects. While some directed interventions at provider levels, few measured group characteristics and effects of interventions on the providers or levels other than the patient. Multilevel interventions are being proposed, but clarity regarding endpoints, definition of levels, and measures is needed. The differences in the conceptualization of levels and factors that affect practice need empirical exploration and we need to measure their salient characteristics to advance our understanding of how context affects cancer care delivery in a changing practice and policy environment. PMID:25073625

  4. Staying Well: A Follow Up of a 5-Week Mindfulness Based Stress Reduction Programme for a Range of Psychological Issues.

    PubMed

    Mitchell, Melanie; Heads, Gary

    2015-11-01

    112 women and 37 men, with an average age of 50 years were referred for MBSR training with a range of chronic psychological issues. All participants completed the Warwick-Edinburgh Mental Wellbeing Scale (Tennant et al. in Health and Quality of Life Outcomes 5:63, 2007) before and after the mindfulness training programme. A significant overall effect of pre/post training was found and this difference was not related to a specific disorder. The results suggest that a 'brief' dose of MBSR can have a positive impact on measures of well-being in a manner that is not related to patient characteristics. A follow-up of 28 participants confirms that participation in the 5-week Living Mindfully MBSR programme significantly enhances psychological well-being immediately after training, and this benefit is maintained up to 4 years after training. Continued practice in mindfulness meditation showed an insignificant relationship to well-being scores at follow up. Qualitative data suggest that the 5 week MBSR is an effective means of developing emotion regulation and psychological well-being. PMID:25595955

  5. CMS proposes prioritizing patient preferences, linking patients to follow-up care in discharge planning process.

    PubMed

    2016-03-01

    Hospital providers voice concerns about a proposed rule by the Centers for Medicare and Medicaid Services (CMS) that would require providers to devote more resources to discharge planning. The rule would apply to inpatients as well as emergency patients requiring comprehensive discharge plans as opposed to discharge instructions. CMS states that the rule would ensure the prioritization of patient preferences and goals in the discharge planning process, and also would prevent avoidable complications and readmissions. However, hospital and emergency medicine leaders worry that community resources are not yet in place to facilitate the links and follow-up required in the proposed rule, and that the costs associated with implementation would be prohibitive. The proposed rule would apply to acute care hospitals, EDs, long-term care facilities, inpatient rehabilitation centers, and home health agencies. Regardless of the setting, though, CMS is driving home the message that patient preferences should be given more weight during the discharge planning process. Under the rule, hospitals or EDs would need to develop a patient-centered discharge plan within 24 hours of admission or registration, and complete the plan prior to discharge or transfer to another facility. Under the rule, emergency physicians would determine which patients require a comprehensive discharge plan. Both the American Hospital Association and the American College of Emergency Physicians worry that hospitals will have to take on more staff, invest in training, and make changes to their electronic medical record systems to implement the provisions in the proposed rule. PMID:26979045

  6. Treatment of Osteoporosis with Antiresoptive agent, Alendronate - warrants careful follow-up

    PubMed Central

    Jain, Sumit Kumar; Roy, Shuvendu Prosad; Nagi, Onkar Nath

    2011-01-01

    Introduction: Alendronate is the most popular bisphosphonate used to prevent fragility fracture of postmenopausal osteoporosis. There is common belief among physicians that Alendronates are very safe without many side effects and they continue it for long time. Recent papers have shown that, some patients who are on this drug from a long period suffered a rare type of fracture. We are reporting a similar type of case for the first time from Indian subcontinent but with a different associated medical condition. Case presentation: A 75 years old female presented with spontaneous fracture of right femur diaphysis. She was on Alendronate for past six years. Her bone metabolic picture also revealed vitamin D insufficiency and secondary hyperparathyroidism. Conclusion: Alendronate induced atypical fracture in association with secondary hyperparathyroidism is an unusual presentation which has not been reported in any of the case reports till date as per our knowledge. This type of presentation may need future investigation both for disease pathophysiology and future outcome in this type of fracture treatment. Treatment of osteoporosis with antiresoptive agent, alendronate; warrants careful follow-up

  7. Primary-care-based episodes of care and their costs in a three-month follow-up in Finland

    PubMed Central

    Heinonen, J.; Koskela, T.H.; Soini, E.; Ryynänen, O.P.

    2015-01-01

    Objective To explore patient characteristics, resource use, and costs related to different episodes of care (EOC) in Finnish health care. Design Data were collected during a three-month prospective, non-randomized follow-up study (Effective Health Centre) using questionnaires and an electronic health record. Setting Three primary health care practices in Pirkanmaa, Finland. Subjects Altogether 622 patients were recruited during a one-week period. Inclusion criteria: the patient had a doctor’s or nurse’s appointment on the recruiting day and agreed to participate. Exclusion criteria: patients visiting a specialized health guidance clinic for pregnant women, children, and mothers. Main outcome measures Patient characteristics, resource use, and costs based on the ICPC-2 EOC classification. Results On average, the patients had 1.22 EOCs during the three months. Patient characteristics and resource use differed between the EOC chapters. Chapter L, “Musculoskeletal”, had the most episodes (17%). The most common (8%) single EOC was “upper respiratory infection”. The mean cost of an episode (COE) was €389.56 (standard error 61.11) and the median COE was €165.00 (interquartile range €118.46–288.56) during the three-month follow-up. The most expensive chapter was K, “Circulatory”, with a mean COE of €909.85. The most expensive single COE was in chapter K, €32 545.56. The most expensive 1% of the COEs summed up covered 36% of the total COEs. Conclusion Patient characteristics, resource use, and costs differed between the ICPC-2 chapters, which could be taken into account in service planning and pricing. Future studies should incorporate more specific diagnoses, larger data sets, and longer follow-up times.Key pointsThe most common episodes were under the ICPC-2 “Musculoskeletal” chapter, but the highest mean and single-episode costs were related to the “Circulatory” chapter.The mean (median) cost of episodes that started in primary care

  8. Barriers to and Facilitators of Postpartum Follow-Up Care in Women with Recent Gestational Diabetes Mellitus: A Qualitative Study

    PubMed Central

    Ennen, Christopher S.; Carrese, Joseph A.; Hill-Briggs, Felicia; Levine, David M.; Nicholson, Wanda K.; Clark, Jeanne M.

    2011-01-01

    Abstract Objectives Women with a history of gestational diabetes mellitus (GDM) have an increased risk of developing type 2 diabetes (T2DM) but often do not return for follow-up care. We explored barriers to and facilitators of postpartum follow-up care in women with recent GDM. Methods We conducted 22 semistructured interviews, 13 in person and 9 by telephone, that were audiotaped and transcribed. Two investigators independently coded transcripts. We identified categories of themes and subthemes. Atlas.ti qualitative software (Berlin, Germany) was used to assist data analysis and management. Results Mean age was 31.5 years (standard deviation) [SD] 4.5), 63% were nonwhite, mean body mass index (BMI) was 25.9 kg/m2 (SD 6.2), and 82% attended a postpartum visit. We identified four general themes that illustrated barriers and six that illustrated facilitators to postpartum follow-up care. Feelings of emotional stress due to adjusting to a new baby and the fear of receiving a diabetes diagnosis at the visit were identified as key barriers; child care availability and desire for a checkup were among the key facilitators to care. Conclusions Women with recent GDM report multiple barriers and facilitators of postpartum follow-up care. Our results will inform the development of interventions to improve care for these women to reduce subsequent diabetes risk. PMID:21265645

  9. [Long-term follow-up in patients with spinal cord injury - prevention and comprehensive care].

    PubMed

    Spreyermann, Regula; Michel, Franz

    2014-01-15

    Patients with spinal cord injuries suffer not only from sensory and motor deficits, but from failure of the autonomic nerve system which in consequence involves many organs and metabolic pathways. These deficits lead to a different approach to these patients and their medical, psychological and social problems. Three examples will illustrate the different approaches to typical medical problems of these patients. Regularly ambulatory long term follow up visits in specialized centres in close collaboration with general practitioners help to diminish complications and rehospitalisations. Facing the now ageing population with a spinal cord injury we need evidence based guidelines in follow up and preventive strategies for these patients. We updated these recommendations recently. The brochure is available on the webside oft he swiss society of paraplegia www.ssop.ch. PMID:24425548

  10. Children with and without Disabilities in Residential Care: Risk at Program Entry, Departure and Six-Month Follow-Up

    ERIC Educational Resources Information Center

    Chmelka, M. B.; Trout, A. L.; Mason, W. A.; Wright, T.

    2011-01-01

    Although youth with disabilities represent nearly a third of the population served in residential care, little is known about the functioning of these children as compared to their peers without disabilities at program entry, departure and six-month follow-up. This study sought to extend previous research by evaluating the behavioral, mental…

  11. The XXL Survey. I. Scientific motivations - XMM-Newton observing plan - Follow-up observations and simulation programme

    NASA Astrophysics Data System (ADS)

    Pierre, M.; Pacaud, F.; Adami, C.; Alis, S.; Altieri, B.; Baran, N.; Benoist, C.; Birkinshaw, M.; Bongiorno, A.; Bremer, M. N.; Brusa, M.; Butler, A.; Ciliegi, P.; Chiappetti, L.; Clerc, N.; Corasaniti, P. S.; Coupon, J.; De Breuck, C.; Democles, J.; Desai, S.; Delhaize, J.; Devriendt, J.; Dubois, Y.; Eckert, D.; Elyiv, A.; Ettori, S.; Evrard, A.; Faccioli, L.; Farahi, A.; Ferrari, C.; Finet, F.; Fotopoulou, S.; Fourmanoit, N.; Gandhi, P.; Gastaldello, F.; Gastaud, R.; Georgantopoulos, I.; Giles, P.; Guennou, L.; Guglielmo, V.; Horellou, C.; Husband, K.; Huynh, M.; Iovino, A.; Kilbinger, M.; Koulouridis, E.; Lavoie, S.; Le Brun, A. M. C.; Le Fevre, J. P.; Lidman, C.; Lieu, M.; Lin, C. A.; Mantz, A.; Maughan, B. J.; Maurogordato, S.; McCarthy, I. G.; McGee, S.; Melin, J. B.; Melnyk, O.; Menanteau, F.; Novak, M.; Paltani, S.; Plionis, M.; Poggianti, B. M.; Pomarede, D.; Pompei, E.; Ponman, T. J.; Ramos-Ceja, M. E.; Ranalli, P.; Rapetti, D.; Raychaudury, S.; Reiprich, T. H.; Rottgering, H.; Rozo, E.; Rykoff, E.; Sadibekova, T.; Santos, J.; Sauvageot, J. L.; Schimd, C.; Sereno, M.; Smith, G. P.; Smolčić, V.; Snowden, S.; Spergel, D.; Stanford, S.; Surdej, J.; Valageas, P.; Valotti, A.; Valtchanov, I.; Vignali, C.; Willis, J.; Ziparo, F.

    2016-06-01

    Context. The quest for the cosmological parameters that describe our universe continues to motivate the scientific community to undertake very large survey initiatives across the electromagnetic spectrum. Over the past two decades, the Chandra and XMM-Newton observatories have supported numerous studies of X-ray-selected clusters of galaxies, active galactic nuclei (AGNs), and the X-ray background. The present paper is the first in a series reporting results of the XXL-XMM survey; it comes at a time when the Planck mission results are being finalised. Aims: We present the XXL Survey, the largest XMM programme totaling some 6.9 Ms to date and involving an international consortium of roughly 100 members. The XXL Survey covers two extragalactic areas of 25 deg2 each at a point-source sensitivity of ~5 × 10-15 erg s-1 cm-2 in the [0.5-2] keV band (completeness limit). The survey's main goals are to provide constraints on the dark energy equation of state from the space-time distribution of clusters of galaxies and to serve as a pathfinder for future, wide-area X-ray missions. We review science objectives, including cluster studies, AGN evolution, and large-scale structure, that are being conducted with the support of approximately 30 follow-up programmes. Methods: We describe the 542 XMM observations along with the associated multi-λ and numerical simulation programmes. We give a detailed account of the X-ray processing steps and describe innovative tools being developed for the cosmological analysis. Results: The paper provides a thorough evaluation of the X-ray data, including quality controls, photon statistics, exposure and background maps, and sky coverage. Source catalogue construction and multi-λ associations are briefly described. This material will be the basis for the calculation of the cluster and AGN selection functions, critical elements of the cosmological and science analyses. Conclusions: The XXL multi-λ data set will have a unique lasting legacy

  12. A Follow-up Investigation of the Later Development of Infants in Enriched Group Care.

    ERIC Educational Resources Information Center

    Fowler, William; Khan, Nasim

    An investigation of the continuing development of infants involved in a program of enriched group care is presented. The 30 advantaged infants had working mothers, and the 9 disadvantaged infants had nonworking mothers. In the original study, they were enrolled in private day care and involved in a program of total environmental care and parent…

  13. Enhancing the Validity of Foster Care Follow-Up Studies through Multiple Alumni Location Strategies

    ERIC Educational Resources Information Center

    Williams, Jason; McWilliams, Alisa; Mainieri, Tina; Pecora, Peter J.; La Belle, Karin

    2006-01-01

    While family-based placement prevention services, family reunification programs, subsidized guardianship, and aggressive adoption programs are reducing the numbers of children spending long periods of time in substitute care, a significant number of America's children will come of age in foster care. Agencies and policymakers should use research…

  14. Factors contributing to nonadherence to follow-up appointments in a resident glaucoma clinic versus primary eye care clinic

    PubMed Central

    Fudemberg, Scott J; Lee, Brian; Waisbourd, Michael; Murphy, Rachel A; Dai, Yang; Leiby, Benjamin E; Hark, Lisa A

    2016-01-01

    Purpose To determine the rate of adherence to follow-up appointment recommendations in a resident glaucoma clinic with no mechanism for reminders, compared to a resident cataract and primary eye care (CPEC) clinic in which telephone reminders were used, and to identify factors that contribute to adherence in each patient group. Methods This retrospective cohort study included subjects in the CPEC clinic who received telephone reminders and those in the glaucoma clinic who did not. Each sample was selected to have a similar proportion of follow-up recommendations for 1, 3, and 6 months. Subjects were considered adherent if they returned within a specified timeframe. Results A total of 144 subjects from the glaucoma clinic and 151 subjects from the CPEC clinic were included. There was no significant difference between follow-up adherence rates of patients who received telephone reminders and those who did not (odds ratio [OR] =1.35, 95% confidence interval [CI] 0.79–2.32, P=0.28). Patients who were on more than two ocular medications were more likely to return for follow-up (OR=3.11, 95% CI 1.53–6.35, P=0.0018). Subjects between the ages 50 and 80 years were more likely to be adherent compared to their younger and older peers (P=0.02). Conclusion The follow-up adherence of patients in a CPEC clinic who received telephone reminders was similar to patients in a glaucoma clinic who did not receive any intervention to increase their adherence. Younger (⩽50 years old) and elderly (⩾80 years old) subjects, as well as patients using less than two glaucoma medications, were less likely to adhere to their follow-up appointments. PMID:26811672

  15. Qualitative findings in a long-term disordered eating prevention programme follow-up with school-going girls.

    PubMed

    González, Marcela L; Mora, Marisol; Penelo, Eva; Goddard, Elizabeth; Treasure, Janet; Raich, Rosa M

    2013-04-01

    The assessment of eating disorder prevention-programmes has mainly been addressed quantitatively excluding complexity that may improve prevention. We compared perceptions of eating, female and male aesthetic-models, media influences, prevention-programmes and emerging topics among 12 young females who received a media literacy programme (N = 4), media literacy plus nutrition awareness programme (N = 4) or were assigned to a control condition (N = 4). Interpretative Phenomenological Analysis highlighted ego-syntonic eating-patterns and signs of internalization of the thin ideal. Findings provide invaluable and rich information to improve future iterations of the programme. PMID:22850973

  16. Factors associated with loss to follow-up among women in Option B+ PMTCT programme in northeast Ethiopia: a retrospective cohort study

    PubMed Central

    Mitiku, Israel; Arefayne, Mastewal; Mesfin, Yonatal; Gizaw, Muluken

    2016-01-01

    Introduction Ethiopia has recently adopted lifelong antiretroviral therapy (ART) for all HIV-positive pregnant and breastfeeding women (Option B+ strategy), regardless of CD4 count or clinical stage. However, the exact timing and predictors of loss to follow-up (LFU) are unknown. Thus, we examined the levels and determinants of LFU under Option B+ among pregnant and breastfeeding women initiated on lifelong ART for prevention of mother-to-child transmission (PMTCT) in Ethiopia. Methods We conducted a retrospective cohort study among 346 pregnant and breastfeeding women who started ART at 14 public health facilities in northeast Ethiopia from March 2013 to April 2015. We defined LFU as 90 days since the last clinic visit among those not known to have died or transferred out. We used Kaplan-Meier and Cox proportional hazards regression to estimate cumulative LFU and identify the predictors of LFU, respectively. Results Of the 346 women included, 88.4% were pregnant and the median follow-up was 13.7 months. Overall, 57 (16.5%) women were LFU. The cumulative proportions of LFU at 6, 12 and 24 months were 11.9, 15.7 and 22.6%, respectively. The risk of LFU was higher in younger women (adjusted hazard ratio (aHR) 18 to 24 years/30 to 40 years: 2.3; 95% confidence interval (CI): 1.2 to 4.5), in those attending hospitals compared to those attending health centres (aHR: 1.8; 95% CI: 1.1 to 3.2), in patients starting ART on the same day of diagnosis (aHR: 1.85; 95% CI: 1.1 to 3.2) and missing CD4 cell counts at ART initiation (aHR: 2.3; 95% CI: 1.2 to 4.4). Conclusions The level of LFU we found in this study is comparable with previous findings from other resource-limited settings. However, high early LFU shortly after ART initiation is still a major problem. LFU was high among younger women, those initiating ART on the day of HIV diagnosis, those missing baseline CD4 count and those attending hospitals. Thus, targeted HIV care and treatment programmes for these patients

  17. Home-Based Psychiatric Outpatient Care Through Videoconferencing for Depression: A Randomized Controlled Follow-Up Trial

    PubMed Central

    Rössler, Wulf

    2016-01-01

    Background There is a tremendous opportunity for innovative mental health care solutions such as psychiatric care through videoconferencing to increase the number of people who have access to quality care. However, studies are needed to generate empirical evidence on the use of psychiatric outpatient care via videoconferencing, particularly in low- and middle-income countries and clinically unsupervised settings. Objective The objective of this study was to evaluate the effectiveness and feasibility of home-based treatment for mild depression through psychiatric consultations via videoconferencing. Methods A randomized controlled trial with a 6- and 12-month follow-up including adults with mild depression treated in an ambulatory setting was conducted. In total, 107 participants were randomly allocated to the videoconferencing intervention group (n=53) or the face-to-face group (F2F; n=54). The groups did not differ with respect to demographic characteristics at baseline. The F2F group completed monthly follow-up consultations in person. The videoconferencing group received monthly follow-up consultations with a psychiatrist through videoconferencing at home. At baseline and after 6 and 12 months, in-person assessments were conducted with all participants. Clinical outcomes (severity of depression, mental health status, medication course, and relapses), satisfaction with treatment, therapeutic relationship, treatment adherence (appointment compliance and dropouts), and medication adherence were assessed. Results The severity of depression decreased significantly over the 12-month follow-up in both the groups. There was a significant difference between groups regarding treatment outcomes throughout the follow-up period, with better results in the videoconferencing group. There were 4 relapses in the F2F group and only 1 in the videoconferencing group. No significant differences between groups regarding mental health status, satisfaction with treatment, therapeutic

  18. The Development of Adopted Children after Institutional Care: A Follow-Up Study

    ERIC Educational Resources Information Center

    Vorria, Panayiota; Papaligoura, Zaira; Sarafidou, Jasmin; Kopakaki, Maria; Dunn, Judy; Van IJzendoorn, Marinus H.; Kontopoulou, Antigoni

    2006-01-01

    Background: Research suggests that institutional care has long-lasting effects on children. However, no study has longitudinally studied infants in an institution and their subsequent development at age four. Methods: Sixty-one adopted children aged four years who had spent their first two years of life in an institution were compared to 39…

  19. Discharged Elderly Nursing Home Care Unit Patients: A Follow-Up Study.

    ERIC Educational Resources Information Center

    Barnes, Lori; And Others

    The success of rehabilitative nursing homes has been measured by their ability to return patients to their homes. The rates of reinstitutionalization after discharge are less studied but are basic to the role of alternative levels of care. This research examines the relationship of predischarge factors with long term outcomes of patients…

  20. [Emergency care for women following sexual assault: characteristics of women and six-month post-aggression follow-up].

    PubMed

    Oshikata, Carlos Tadayuki; Bedone, Aloísio José; Faúndes, Anibal

    2005-01-01

    This study evaluated the process and results of treatment for women at a university hospital after sexual violence. A prospective study of 166 women (> or = 12 years of age) treated from October 1999 to February 2002 included six months follow-up after aggression. Half of the women were under 20 years of age, two were illiterate, 70.0% unmarried, 20.0% used contraceptives, and 80.0% received treatment within the first 24 hours post-aggression. Nearly 80.0% of aggressors were unknown to victims and 95.0% of the cases involved vaginal penetration. Emergency contraception was administered to 76.0%, antibiotics to 98.0%, hepatitis B immunoglobulin to 95.0%, and HIV anti-retroviral prophylaxis to 90.0%. The first follow-up consultation (at 14 days) was attended by 137 women, whereas 37.0% dropped out before the 45-day visit and only 29.0% complied with the six-month follow-up. During follow-up, hepatitis B and HPV were identified in 2.6%, pelvic inflammatory disease and Trichomonas vaginalis in 2.1%, and syphilis in 1.3%. Three pregnancies were observed among 127 women who received emergency contraception (2.6%). No cases of HIV seroconversion were observed. Emergency care for victims of sexual assault is effective in reducing unwanted pregnancies and infections. PMID:15692652

  1. Preterm newborns at Kangaroo Mother Care: a cohort follow-up from birth to six months

    PubMed Central

    Menezes, Maria Alexsandra da S.; Garcia, Daniela Cavalcante; de Melo, Enaldo Vieira; Cipolotti, Rosana

    2014-01-01

    OBJECTIVE: To evaluate clinical outcomes, growth and exclusive breastfeeding rates in premature infants assisted by Kangaroo Mother Care at birth, at discharge and at six months of life. METHODS: Prospective study of a premature infants cohort assisted by Kangaroo Mother Care in a tertiary public maternity in Northeast Brazil with birth weight ≤1750g and with clinical conditions for Kangaroo care. RESULTS: The sample was composed by 137 premature infants, being 62.8% female, with average birth weight of 1365±283g, average gestational age of 32±3 weeks and 26.2% were adequate for gestational age. They have been admitted in the Kangaroo Ward with a median of 13 days of life, weighing 1430±167g and, at this time, 57.7% were classified as small for corrected gestational age. They were discharged with 36.8±21.8 days of chronological age, weighing 1780±165g and 67.9% were small for corrected gestational age. At six months of life (n=76), they had an average weight of 5954±971g, and 68.4% presented corrected weight for gestational age between percentiles 15 and 85 of the World Health Organization (WHO) weight curve. Exclusive breastfeeding rate at discharge was 56.2% and, at six months of life, 14.4%. CONCLUSIONS: In the studied sample, almost two thirds of the children assisted by Kangaroo Mother Care were, at six months of life, between percentiles 15 and 85 of the WHO weight curves. The frequency of exclusive breastfeeding at six months was low. PMID:25119747

  2. Follow-up for cervical cancer: a Program in Evidence-Based Care systematic review and clinical practice guideline update

    PubMed Central

    Elit, L.; Kennedy, E.B.; Fyles, A.; Metser, U.

    2016-01-01

    Background In 2009, the Program in Evidence-based Care (pebc) of Cancer Care Ontario published a guideline on the follow-up of cervical cancer. In 2014, the pebc undertook an update of the systematic review and clinical practice guideline for women in this target population. Methods The literature from 2007 to August 2014 was searched using medline and embase [extended to 2000 for studies of human papillomavirus (hpv) dna testing]. Outcomes of interest were measures of survival, diagnostic accuracy, and quality of life. A working group evaluated the need for changes to the earlier guidelines and incorporated comments and feedback from internal and external reviewers. Results One systematic review and six individual studies were included. The working group concluded that the new evidence did not warrant changes to the 2009 recommendations, although hpv dna testing was added as a potentially more sensitive method of detecting recurrence in patients treated with radiotherapy. Comments from internal and external reviewers were incorporated. Recommendations Summary Follow-up care after primary treatment should be conducted and coordinated by a physician experienced in the surveillance of cancer patients. A reasonable follow-up strategy involves visits every 3–4 months within the first 2 years, and every 6–12 months during years 3–5. Visits should include a patient history and complete physical examination, with elicitation of relevant symptoms. Vaginal vault cytology examination should not be performed more frequently than annually. Combined positron-emission tomography and computed tomography, other imaging, and biomarker evaluation are not advocated; hpv dna testing could be useful as a method of detection of recurrence after radiotherapy. General recommendations for follow-up after 5 years are also provided. PMID:27122975

  3. A 6-month follow-up of the effects of an information and communication technology (ICT) training programme on people with intellectual disabilities.

    PubMed

    Li-Tsang, Cecilia W P; Lee, Maggie Y F; Yeung, Susanna S S; Siu, Andrew M H; Lam, C S

    2007-01-01

    We investigated the long-term effects of an information and communication technology (ICT) training programme for people with intellectual disabilities (ID). A community-based ICT training programme was designed to enhance the computer skills of people with ID and prepare them to make use of ICT in their daily life. Of the 100 who had participated in the original ICT training programme, 59 of them and their caregivers agreed to participate in the follow-up interview. A computer skills checklist was used to assess the ICT competence of the participants before training, after training, and at the 6-month follow-up assessment. All caregivers were interviewed at the 6-month follow-up session to explore the use of ICT by people with ID and their needs for further training. Results from repeated measures ANOVA showed that participants maintained at the 6-month follow-up the basic ICT skills that they acquired during training [F=13.86, p<0.001]. Caregivers reported that participants spent more time in using the computers, but still needed occasional guidance. They also reported a need to advance their ICT skills beyond the basic computer training. We concluded that ICT training for people with ID would help them in maximizing the benefits of information technology via computers. PMID:16979318

  4. Feasibility of a Team Approach to Complex Congenital Heart Defect Neurodevelopmental Follow-Up: Early Experience of a Combined Cardiology/Neonatal Intensive Care Unit Follow-Up Program.

    PubMed

    Chorna, Olena; Baldwin, H Scott; Neumaier, Jamie; Gogliotti, Shirley; Powers, Deborah; Mouvery, Amanda; Bichell, David; Maitre, Nathalie L

    2016-07-01

    Infants with complex congenital heart disease are at high risk for poor neurodevelopmental outcomes. However, implementation of dedicated congenital heart disease follow-up programs presents important infrastructure, personnel, and resource challenges. We present the development, implementation, and retrospective review of 1- and 2-year outcomes of a Complex Congenital Heart Defect Neurodevelopmental Follow-Up program. This program was a synergistic approach between the Pediatric Cardiology, Cardiothoracic Surgery, Pediatric Intensive Care, and Neonatal Intensive Care Unit Follow-Up teams to provide a feasible and responsible utilization of existing infrastructure and personnel, to develop and implement a program dedicated to children with congenital heart disease. Trained developmental testers administered the Ages and Stages Questionnaire-3 over the phone to the parents of all referred children at least once between 6 and 12 months' corrected age. At 18 months' corrected age, all children were scheduled in the Neonatal Intensive-Care Unit Follow-Up Clinic for a visit with standardized neurological exams, Bayley III, multidisciplinary therapy evaluations and continued follow-up. Of the 132 patients identified in the Cardiothoracic Surgery database and at discharge from the hospital, a total number of 106 infants were reviewed. A genetic syndrome was identified in 23.4% of the population. Neuroimaging abnormalities were identified in 21.7% of the cohort with 12.8% having visibly severe insults. As a result, 23 (26.7%) received first-time referrals for early intervention services, 16 (13.8%) received referrals for new services in addition to their existing ones. We concluded that utilization of existing resources in collaboration with established programs can ensure targeted neurodevelopmental follow-up for all children with complex congenital heart disease. PMID:27220370

  5. National screening program for transitional ages in Korea: a new screening for strengthening primary prevention and follow-up care.

    PubMed

    Kim, Hyun Su; Shin, Dong Wook; Lee, Won Chul; Kim, Young Taek; Cho, Belong

    2012-05-01

    Screening can effectively reduce mortality and morbidity in some diseases. In Korea, a practical national screening program for chronic disease was launched in 1995 and several problems were discussed. The program focused primarily on disease detection without follow-up care. In addition, the test items were uniform regardless of subject's age, sex, or risk factors; and people with low socioeconomic status were excluded. To improve the quality of program, a new national screening program called the "National Screening Program for Transitional Ages (NSPTA)" was initiated in 2007. It targeted two age groups, ages 40 and 66, because these ages are important transition periods in one's lifecycle. Follow-up care and education for lifestyle modification has been intensified; screening tests for mental health problems and osteoporosis have been introduced. The pool of eligible participants has been expanded to include people supported by Medicaid. This review aimed to describe the contents, process, and characteristics of the NSPTA and to compare it with the previous program. In addition, some preliminary results from 2007 to 2009 were presented. Lastly, we suggest several points that need to be considered to improve the program such as enhancement of participation rates, necessity of specialized committee and research for current screening program to be supported by evidence. PMID:22661875

  6. Views of family physicians about survivorship care plans to provide breast cancer follow-up care: exploration of results from a randomized controlled trial

    PubMed Central

    O’Brien, M.A.; Grunfeld, E.; Sussman, J.; Porter, G.; Mobilio, M. Hammond

    2015-01-01

    Background The U.S. Institute of Medicine recommends that cancer patients receive survivorship care plans, but evaluations to date have found little evidence of the effectiveness of such plans. We conducted a qualitative follow-on study to a randomized controlled trial (rct) to understand the experiences of family physicians using survivorship care plans to support the follow-up of breast cancer patients. Methods A subset of family physicians whose patients were enrolled in the parent rct in Ontario and Nova Scotia were eligible for this study. In interviews, the physicians discussed survivorship care plans (intervention) or usual discharge letters (control), and their confidence in providing follow-up cancer care. Results Of 123 eligible family physicians, 18 (10 intervention, 8 control) were interviewed. In general, physicians receiving a survivorship care plan found only the 1-page care record to be useful. Physicians who received only a discharge letter had variable views about the letter’s usefulness; several indicated that it lacked information about potential cancer- or treatment-related problems. Most physicians were comfortable providing care 3–5 years after diagnosis, but desired timely and informative communication with oncologists. Conclusions Although family physicians did not find extensive survivorship care plans useful, discharge letters might not be sufficiently comprehensive for follow-up breast cancer care. Effective strategies for two-way communication between family physicians and oncologists are still lacking. PMID:26300663

  7. After the diabetes care trial ends, now what? A 1-year follow-up of the RxING study

    PubMed Central

    Al Hamarneh, Yazid N; Sauriol, Luc; Tsuyuki, Ross T

    2015-01-01

    Introduction There is strong evidence that pharmacist care improves patients’ glycaemic control. However, the sustainability and durability of such interventions beyond the research period is not known. RxING was the first trial of pharmacist prescribing in diabetes and it showed an improvement in glycated haemoglobin (HbA1c) of 1.8% over 6 months. Objective 1° objective: To evaluate glycaemic control in the RxING study patients 12 months after the end of the formal study follow-up. 2° objective: To assess the patients’ risk of cardiovascular events in the next 10 years. Methods We contacted the participating pharmacists to check if the patients who participated in the RxING study are still taking insulin, the dose of insulin they are taking, and their HbA1c. There were no mandated follow-up visits with the pharmacist after the study completion. Results A total of 100 patients with poorly controlled type 2 diabetes were enrolled in the original RxING study; 93 of them completed the study, while 83 participated in the 12-month follow-up. Seventy-five patients were still taking insulin, with the average dose increasing from 31.1 units (SD 18.4) at study completion to 37.4 units (SD 30.8) (95% CI −13.3 to 0.88, p=0.085). HbA1c was reduced from 9.1% (SD 1) at baseline to 7.3% (SD 0.9) at study completion (95% CI 1.4 to 2, p <0.001), and increased to 8.1% (SD 1.3) 12 months later (95% CI −1.1 to −0.5, p <0.001 vs study completion). Conclusions Twelve months after completing the intervention, approximately half of the glycaemic control gains were lost. This highlights the importance of structured follow-up with the pharmacist in this patient population. Trial registration number clinicaltrials.gov; Identifier: NCT01335763. PMID:26270946

  8. The Effectiveness and Sustainability of a Universal School-Based Programme for Preventing Depression in Chinese Adolescents: A Follow-Up Study Using Quasi-Experimental Design

    PubMed Central

    Lai, Eliza S. Y.; Kwok, Chi-Leung; Wong, Paul W. C.; Fu, King-Wa; Law, Yik-Wa; Yip, Paul S. F.

    2016-01-01

    Background A pilot study about the effectiveness of a universal school-based programme, “The Little Prince is Depressed”, for preventing depression in Chinese adolescents in Hong Kong was conducted and reported previously. This study used a larger sample to examine the effectiveness and sustainability of the programme. Methods This study used quasi-experimental design. Twelve schools enrolled in “The Little Prince is Depressed” programme either as an intervention or a control condition. The intervention schools carried out the 12-session programme in two phases: the professional-led first phase and the teacher-led second phase. All participants were required to complete a questionnaire at three time points measuring their (1) depressive, anxiety, and stress levels; (2) knowledge of mental health; (3) attitudes towards mental illness; (4) perceived social support; and (5) help-seeking behaviours. Results A total of 3,391 students participated in the study. The level of depressive symptoms did not reduce significantly at post-intervention; however, a delayed effect was observed at follow-up assessment for the participants of the teacher-led group in reducing anxiety and stress levels. Also, the knowledge of mental health and attitudes towards mental illness of the intervention-group participants significantly improved at post-test, and the outcomes were maintained at 4 to 5 months after the intervention in both the professional-led and the teacher-led conditions (p<.05). A preference among schoolchildren for whom to seek help from was identified. Conclusions The universal depression prevention programme was effective in enhancing knowledge of mental health and promoting a more positive attitude towards mental illness among adolescents in Hong Kong. In particular, the teacher-led group showed better outcomes than the professional-led group in reducing students’ anxiety and stress at follow-up period. The programme can achieve sustainability in schools if

  9. Follow-up study of the regional quota system of Japanese medical schools and prefecture scholarship programmes: a study protocol

    PubMed Central

    Matsumoto, Masatoshi; Takeuchi, Keisuke; Tanaka, Junko; Tazuma, Susumu; Inoue, Kazuo; Owaki, Tetsuhiro; Iguchi, Seitaro; Maeda, Takahiro

    2016-01-01

    Introduction Given the shortage of physicians, particularly in rural areas, the Japanese government has rapidly expanded the number of medical school students by adding chiikiwaku (regional quotas) since 2008. Quota entrants now account for 17% of all medical school entrants. Quota entrants are usually local high school graduates who receive a scholarship from the prefecture government. In exchange, they temporarily practise in that prefecture, including its rural areas, after graduation. Many prefectures also have scholarship programmes for non-quota students in exchange for postgraduate in-prefecture practice. The objective of this cohort study, conducted by the Japanese Council for Community-based Medical Education, is to evaluate the outcomes of the quota admission system and prefecture scholarship programmes nationwide. Methods and analysis There are 3 groups of study participants: quota without scholarship, quota with scholarship and non-quota with scholarship. Under the support of government ministries and the Association of Japan Medical Colleges, and participation of all prefectures and medical schools, passing rate of the National Physician License Examination, scholarship buy-out rate, geographic distribution and specialties distribution of each group are analysed. Participants who voluntarily participated are followed by linking their baseline information to data in the government's biennial Physician Census. Results to date have shown that, despite medical schools' concerns about academic quality, the passing rate of the National Physician License Examination in each group was higher than that of all medical school graduates. Ethics and dissemination The Ethics Committee for Epidemiological Research of Hiroshima University and the Research Ethics Committee of Nagasaki University Graduate School of Biomedical Sciences permitted this study. No individually identifiable results will be presented in conferences or published in journals. The aggregated

  10. Evaluating outcomes of patients lost to follow-up in a large comprehensive care treatment program in western Kenya

    PubMed Central

    Rachlis, B; Ochieng, D; Geng, E; Rotich, E; Ochieng, V; Maritim, B; Ndege, S; Naanyu, V; Martin, J; Keter, A; Ayuo, P; Diero, L; Nyambura, M; Braitstein, P

    2014-01-01

    Background The Academic Model Providing Access To Healthcare (AMPATH) program provides comprehensive HIV care and treatment services. Approximately 30% of patients have become lost to follow-up (LTFU). We sought to actively trace and identify outcomes for a sample of these patients. Methods LTFU was defined as missing a scheduled visit by ≥ 3 months. A randomly selected sample of 17% of patients identified as LTFU between January 2009 and June 2011 was generated, with sample stratification on age, antiretroviral therapy (ART) status at last visit, and facility. Chart reviews were conducted followed by active tracing. Tracing was completed by trained HIV-positive outreach workers July 2011 to February 2012. Outcomes were compared between adults and children and by ART status. Results Of 14,811 LTFU patients, 2,540 were randomly selected for tracing (2,179 adults, 1,071 on ART). The chart reviews indicated that 326 (12.8%) patients were not actually LTFU. Outcomes for 71% of sampled patients were determined including 85% of those physically traced. Of those with known outcomes, 21% had died while 29% had disengaged from care for various reasons. The remaining patients had moved away (n=458, 25%) or were still receiving HIV care (n=443 total, 25%). Conclusions Our findings demonstrate the feasibility of a large scale sampling-based approach. A significant proportion of patients were found not to be LTFU and further, high numbers of patients who were LTFU could not be located. Over a quarter of patients disengaged from care for various reasons including access challenges and familial influences. PMID:25692336

  11. One year follow-up of a pragmatic multi-centre randomised controlled trial of a group-based fatigue management programme (FACETS) for people with multiple sclerosis

    PubMed Central

    2014-01-01

    Background Fatigue is one of the most common and debilitating symptoms of multiple sclerosis (MS). The aim was to evaluate the effectiveness at 1-year follow-up of a manualised group-based programme (‘FACETS’) for managing MS-fatigue. Methods One-year follow-up of a pragmatic multi-centre randomised controlled trial. People with MS and significant fatigue were randomised to FACETS plus current local practice (FACETS) or current local practice alone (CLP), using concealed computer-generated randomisation. Participant blinding was not possible. Primary outcome measures were fatigue severity (Global Fatigue Severity subscale of the Fatigue Assessment Instrument), self-efficacy (MS-Fatigue Self-Efficacy) and disease-specific quality of life (MS Impact Scale). Results Between May 2008 and November 2009, 164 participants were randomised. Primary outcome data were available at 1 year for 131 (80%). The benefits demonstrated at 4-months in the FACETS arm for fatigue severity and self-efficacy largely persisted, with a slight reduction in standardised effect sizes (SES) (−0.29, p = 0.06 and 0.34, p = 0.09, respectively). There was a significant difference on the MS Impact Scale favouring FACETS that had not been present at 4-months (SES −0.24, p = 0.046). No adverse events were reported. Conclusions Improvements in fatigue severity and self-efficacy at 4-months follow-up following attendance of FACETS were mostly sustained at 1 year with additional improvements in MS impact. The FACETS programme provides modest long-term benefits to people with MS-fatigue. Trial registration ISRCTN76517470 PMID:24886398

  12. Incident atrial fibrillation in the emergency department in Ontario: a population-based retrospective cohort study of follow-up care

    PubMed Central

    Yu, Bing; Ivers, Noah; Rochon, Paula; Lee, Douglas S.; Schull, Michael J.; Austin, Peter C.

    2015-01-01

    Background Continuity of care has been shown to be poor following in-hospital discharge, and there are substantially fewer resources to facilitate follow-up care arrangements after discharge from an emergency department. Our objective was to assess the frequency, timeliness and predictors for obtaining follow-up care following discharge from an emergency department in Ontario with a new diagnosis of atrial fibrillation. Methods We conducted a retrospective cohort study involving all patients discharged from the 157 nonpediatric emergency departments in Ontario, who received a new diagnosis of atrial fibrillation between 2007 and 2012. We determined the frequency of follow-up care with a family physician, cardiologist or internist within 7 (timely) and 30 days of the emergency department visit, and assessed the association of emergency and family physician characteristics, including primary care model type, with obtaining timely follow-up care. Results Among 14 907 patients discharged from Ontario emergency departments with a new, primary diagnosis of atrial fibrillation, half (n = 7473) had timely follow-up care. At 30 days, 2678 patients (18.0%) still had not obtained follow-up care. Among emergency and family physician factors, lack of a family physician had the largest independent association with acquiring timely follow-up care (odds ratio [OR] 0.58, 95% confidence interval [CI] 0.50–0.69). Using patients with a family physician belonging to a primarily fee-for-service remuneration model as the comparison group, patients with a family physician belonging to a capitation-based Family Health Network, as part of a Family Health Team, were less likely to receive timely follow-up care (OR 0.73, 95% CI 0.62–0.86), as were those whose family physician belonged to the same model type that was not part of a Family Health Team (OR 0.77, 95% CI 0.60–0.97). Interpretation Only half of the patients who were discharged from an emergency department in Ontario with a new

  13. Evaluating integrated headache care: a one-year follow-up observational study in patients treated at the Essen headache centre

    PubMed Central

    2011-01-01

    Background Outpatient integrated headache care was established in 2005 at the Essen Headache Centre in Germany. This paper reports outcome data for this approach. Methods Patients were seen by a neurologist for headache diagnosis and recommendation for drug treatment. Depending on clinical needs, patients were seen by a psychologist and/or physical therapist. A 5-day headache-specific multidisciplinary treatment programme (MTP) was provided for patients with frequent or chronic migraine, tension type headache (TTH) and medication overuse headache (MOH). Subsequent outpatient treatment was provided by neurologists in private practice. Results Follow-up data on headache frequency and burden of disease were prospectively obtained in 841 patients (mean age 41.5 years) after 3, 6 and 12 months. At baseline mean headache frequency was 18.1 (SD = 1.6) days per month, compared to measurement at 1 year follow-up a mean reduction of 5.8 (SD = 11.9) headache days per month was observed in 486 patients (57.8%) after one year (TTH patients mean: -8.5 days per month; migraine mean: -3.2 days per month, patients with migraine and TTH mean: -5.9 days per month). A reduction in headache days ≥ 50% was observed in 306 patients (36.4%) independent of diagnosis, while headache frequency remains unchanged in 20.9% and increase in 21.3% of the patient. Conclusion Multidisciplinary outpatient headache centres offer an effective way to establish a three-tier treatment offer for difficult headache patients depending on clinical needs. PMID:21985562

  14. Automated breast imaging-reporting and data system (BI-RADS) category 3 follow-up application: improving patient care and compliance

    NASA Astrophysics Data System (ADS)

    Kandula, Praveena; Cook, T. S.; Boonn, W. W.; Kim, W.

    2011-03-01

    With the current emphasis on healthcare reform and cost effectiveness, methods to increase healthcare efficiency while improving outcomes are paramount. With reference to breast cancer, delay in diagnosis can cause significant morbidity and mortality, as well as increased long term health care costs. Assessment with short interval mammographic follow-up of BI-RADS category 3 lesions has been shown to increase detection of a small number of breast cancers at an early stage. Because of the importance of timely follow-up for these patients, we propose a novel computer application that identifies patients due for short-term mammographic follow-up, thus reducing costly hours spent by personnel, reducing human error, and improving patient compliance. Our web-based application mines radiology reports and scheduling information to generate lists of patients due for short-term mammographic follow-up of BI-RADS category 3 results. The results can be placed in a worklist that can be used by a staff member to contact patients to schedule follow-up appointments. Additional analytic features of the application can identify referral characteristics that may serve as potential sources for improvement of patient follow-up. We believe that an automated system can be designed to improve patient care and compliance with follow-up of BI-RADS category 3 results.

  15. Observational Follow-up Study on a Cohort of Children with Severe Pneumonia after Discharge from a Day-care Clinic in Dhaka, Bangladesh

    PubMed Central

    Alam, Nur H.; Chisti, Mohammod J.; Salam, Mohammed A.; Ahmed, Tahmeed; Gyr, Niklaus

    2014-01-01

    ABSTRACT Compliance, morbidity, mortality, and hospitalization during fortnightly follow-up were evaluated by an observational study on a cohort of children with severe and very severe pneumonia after day-care treatment at an urban clinic. The primary outcome measures were proportions of success (compliance) and failure (non-compliance) of follow-up visits at the day-care clinic. In total, 251 children were followed up, with median (IQR) age of 5.0 (3.0-9.0) months, and their compliance dropped from 92% at the first to 85% at the sixth visit. Cough (28%), fever (20%), and rapid breathing (13%) were common morbidities. Successful follow-up visits were possible in 180 (95.2%) and 56 (90.3%) of the children with severe and very severe pneumonia respectively. Eleven (4.4%) needed hospitalization, and four (1.6%) died. Majority (≈90%) of the children could be successfully followed up; some failed to attend their scheduled follow-up visits due to hospitalization and death. The common morbidities indicate the importance of follow-up for detecting medical problems and early treatment, thus reducing risk of death. PMID:25076656

  16. Barriers and facilitators of adherence to medical advice on skin self-examination during melanoma follow-up care

    PubMed Central

    2013-01-01

    Background Melanoma is the fastest growing tumor of the skin, which disproportionately affects younger and middle-aged adults. As melanomas are visible, recognizable, and highly curable while in early stages, early diagnosis is one of the most effective measures to decrease melanoma-related mortality. Skin self-examination results in earlier detection and removal of the melanoma. Due to the elevated risk of survivors for developing subsequent melanomas, monthly self-exams are strongly recommended as part of follow-up care. Yet, only a minority of high-risk individuals practices systematic and regular self-exams. This can be improved through patient education. However, dermatological education is effective only in about 50% of the cases and little is known about those who do not respond. In the current literature, psychosocial variables like distress, coping with cancer, as well as partner and physician support are widely neglected in relation to the practice of skin self-examination, despite the fact that they have been shown to be essential for other health behaviors and for adherence to medical advice. Moreover, the current body of knowledge is compromised by the inconsistent conceptualization of SSE. The main objective of the current project is to examine psychosocial predictors of skin self-examination using on a rigorous and clinically sound methodology. Methods/Design The longitudinal, mixed-method study examines key psychosocial variables related to the acquisition and to the long-term maintenance of skin self-examination in 200 patients with melanoma. Practice of self-exam behaviors is assessed at 3 and 12 months after receiving an educational intervention designed based on best-practice standards. Examined predictors of skin self-exam behaviors include biological sex, perceived self-exam efficacy, distress, partner and physician support, and coping strategies. Qualitative analyses of semi-structured interviews will complement and enlighten the

  17. Dental auscultation for nursing personnel as a model of oral health care education: development, baseline, and 6-month follow-up assessments.

    PubMed

    Wårdh, Inger; Berggren, Ulf; Hallberg, Lillemor R M; Andersson, Lars; Sörensen, Stefan

    2002-01-01

    Oral health care has been shown to have low priority in nursing and has been only partly successful. To create more positive effects than those achieved through traditional oral health care education, this project tested an educational model for nursing staff personnel. In addition to traditional oral health care education, some of the nursing staff members passed an additional dental auscultation period and served as oral care aides. The aides were responsible for the oral health care of the residents at their nursing facilities (intervention group). The intervention nursing facilities were compared with facilities where nursing personnel only received a traditional oral health care education program. Assessments were made at baseline and at a 6-month follow-up. At follow-up it was shown that the nursing staff in the intervention group gave higher priority to the oral health care work than the nursing staff in the control group. PMID:11905448

  18. To be seen, confirmed and involved - a ten year follow-up of perceived health and cardiovascular risk factors in a Swedish community intervention programme

    PubMed Central

    Emmelin, Maria; Weinehall, Lars; Stenlund, Hans; Wall, Stig; Dahlgren, Lars

    2007-01-01

    Background Public health interventions are directed towards social systems and it is difficult to foresee all consequences. While targeted outcomes may be positively influenced, interventions may at worst be counterproductive. To include self-reported health in an evaluation is one way of addressing possible side-effects. This study is based on a 10 year follow-up of a cardiovascular community intervention programme in northern Sweden. Methods Both quantitative and qualitative approaches were used to address the interaction between changes in self-rated health and risk factor load. Qualitative interviews contributed to an analysis of how the outcome was influenced by health related norms and attitudes. Results Most people maintained a low risk factor load and a positive perception of health. However, more people improved than deteriorated their situation regarding both perceived health and risk factor load. "Ideal types" of attitude sets towards the programme, generated from the interviews, helped to interpret an observed polarisation for men and the lower educated. Conclusion Our observation of a socially and gender differentiated intervention effect suggests a need to test new intervention strategies. Future community interventions may benefit from targeting more directly those who in combination with high risk factor load perceive their health as bad and to make all participants feel seen, confirmed and involved. PMID:17672911

  19. Young Adult Cancer Survivors' Experience with Cancer Treatment and Follow-Up Care and Perceptions of Barriers to Engaging in Recommended Care.

    PubMed

    Berg, Carla J; Stratton, Erin; Esiashvili, Natia; Mertens, Ann

    2016-09-01

    We examined correlates of low engagement in the healthcare system, experiences with survivorship care, barriers to follow-up care, and potential resources for promoting follow-up care among young adult survivors of childhood cancers. We conducted a mixed-method study involving surveys of 106 survivors of childhood cancer aged 18-34 recruited from a university-affiliated children's hospital and an NCI-designated cancer center in the Southeastern USA. Phone-based semistructured interviews were then conducted in a subset of 26. Assessments included health factors, psychosocial factors, healthcare system interaction, and interest in resources to promote engagement in healthcare. Survey participants were on average 22.14 (SD = 3.16) years old, 50.0 % female, and 77.4 % White. Overall, 46.0 % had attended survivorship clinic, 47.2 % reported receiving a treatment summary, 68.9 % had a primary care provider, and 17.0 % reported no interaction with healthcare in the past 2 years. Correlates of less than annual healthcare provider visits included being older (p = 0.003), being male (p < 0.001), lack of insurance (p = 0.002), and having had chemotherapy (p = 0.05). Participants reported varied experiences in terms of how health and treatment information was presented, from none or too little to overwhelming or anxiety-provoking amounts. Barriers to engaging in survivorship care included no/limited insurance, time, or transportation; major life changes; anxiety; and difficulty transitioning from pediatrics to adult care. Participants highlighted the need for educational and psychosocial resources, particularly technology-based resources. Multilevel interventions are needed to increase engagement in survivorship care among young adult cancer survivors. Technology-based resources addressing social support and mental well-being are intervention possibilities. PMID:25948413

  20. Young Adult Cancer Survivors’ Experience with Cancer Treatment and Follow-Up Care and Perceptions of Barriers to Engaging in Recommended Care

    PubMed Central

    Stratton, Erin; Esiashvili, Natia; Mertens, Ann

    2016-01-01

    We examined correlates of low engagement in the healthcare system, experiences with survivorship care, barriers to follow-up care, and potential resources for promoting follow-up care among young adult survivors of childhood cancers. We conducted a mixed-method study involving surveys of 106 survivors of childhood cancer aged 18–34 recruited from a university-affiliated children’s hospital and an NCI-designated cancer center in the Southeastern USA. Phone-based semistructured interviews were then conducted in a subset of 26. Assessments included health factors, psychosocial factors, healthcare system interaction, and interest in resources to promote engagement in healthcare. Survey participants were on average 22.14(SD=3.16) years old, 50.0 % female, and 77.4 % White. Overall, 46.0 % had attended survivorship clinic, 47.2 % reported receiving a treatment summary, 68.9 % had a primary care provider, and 17.0 % reported no interaction with healthcare in the past 2 years. Correlates of less than annual healthcare provider visits included being older (p=0.003), being male (p<0.001), lack of insurance (p=0.002), and having had chemotherapy (p=0.05). Participants reported varied experiences in terms of how health and treatment information was presented, from none or too little to overwhelming or anxiety-provoking amounts. Barriers to engaging in survivorship care included no/limited insurance, time, or transportation; major life changes; anxiety; and difficulty transitioning from pediatrics to adult care. Participants highlighted the need for educational and psychosocial resources, particularly technology-based resources. Multilevel interventions are needed to increase engagement in survivor-ship care among young adult cancer survivors. Technology-based resources addressing social support and mental well-being are intervention possibilities. PMID:25948413

  1. A national survey of healthcare professionals' views on models of follow-up, holistic needs assessment and survivorship care for patients with head and neck cancer.

    PubMed

    Wells, M; Semple, C J; Lane, C

    2015-11-01

    Patterns of follow-up and survivorship care are changing in response to growing numbers of cancer survivors and an increasing recognition that traditional models are unsustainable and result in unmet needs. Clinicians have shown reluctance in changing conventional follow-up practices for patients with head and neck cancer. This study aimed to explore nurses' and allied health professionals' views and practices in relation to follow-up, holistic needs assessment and survivorship care in this patient group. An online survey of members of the British Association of Head and Neck Oncology Nurses was undertaken. The response rate was 43% (74 of 174). Findings revealed a range of existing models of follow-up, rehabilitation and support for people with head and neck cancer across the UK. Specialist staff were open to new models of care and to more responsibility, with adequate training and supervision. There were some gaps in the provision of comprehensive survivorship care and some specific areas of practice in which nurses lacked confidence, knowledge and skills, such as managing medications and complex symptoms. Further research is needed to develop and evaluate effective models of follow-up and support for a growing population of head and neck cancer survivors who have diverse and complex needs. PMID:25615418

  2. General anesthesia for dental care management of a patient with epidermolysis bullosa: 24-month follow-up.

    PubMed

    Mello, Bianca Zeponi Fernandes; Neto, Natalino Lourenço; Kobayashi, Tatiana Yuriko; Mello, Marina Barbosa Almeida; Ambrosio, Eloá Cristina Passucci; Yaedú, Renato Yassutaka Faria; Machado, Maria Aparecida Andrade Moreira; Oliveira, Thais Marchini

    2016-07-01

    Epidermolysis bullosa comprises a group of uncommon skin-related diseases, characterized by the formation of blisters on mucocutaneous regions occurring spontaneously, following a trauma, exposure to heat, or as a result of minimal mechanical trauma. The dental treatment of the patient with epidermolysis bullosa raises many questions and discussions, due to the difficulty of carrying out the procedures. This report aimed to detail the clinical considerations of the treatment under general anesthesia of a patient with epidermolysis bullosa. The extraction of all deciduous teeth under general anesthesia was recommended based on the clinical and radiographic examinations. At 24-month follow-up, the patient had great improvement in oral hygiene without new caries lesions. The patient has been followed-up at every month for caries lesion prevention and permanent tooth development. The treatment under general anesthesia provided the ideal safe conditions and was beneficial for the patient. PMID:26936632

  3. Management of kyphoscoliosis patients with respiratory failure in the intensive care unit and during long term follow up

    PubMed Central

    2012-01-01

    Background We aimed to evaluate the ICU management and long-term outcomes of kyphoscoliosis patients with respiratory failure. Methods A retrospective observational cohort study was performed in a respiratory ICU and outpatient clinic from 2002–2011. We enrolled all kyphoscoliosis patients admitted to the ICU and followed-up at regular intervals after discharge. Reasons for acute respiratory failure (ARF), ICU data, mortality, length of ICU stay and outpatient clinic data, non-invasive ventilation (NIV) device settings, and compliance were recorded. NIV failure in the ICU and the long term effect of NIV on pulmonary performance were analyzed. Results Sixty-two consecutive ICU kyphoscoliosis patients with ARF were enrolled in the study. NIV was initially applied to 55 patients, 11 (20%) patients were intubated, and the majority had sepsis and septic shock (p < 0.001). Mortality in the ICU was 14.5% (n = 9), reduced pH, IMV, and sepsis/septic shock were significantly higher in the non-survivors (p values 0.02, 0.02, 0.028, 0.012 respectively). Among 46 patients attending the outpatient clinic, 17 were lost to follow up and six were died. The six minute walk distance was significantly increased in the final follow up (306 m versus 419 m, p < 0.001). Conclusions We strongly discourage the use of NIV in the case of septic shock in ICU kyphoscoliosis patients with ARF. Pulmonary performance improved with NIV during long term follow up. PMID:22999093

  4. 77 FR 22001 - Proposed Collection of Follow-up Survey Information for Green Jobs and Health Care Impact...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-12

    ... Health Care Impact Evaluation of American Recovery and Reinvestment Act (ARRA)-Funded Grants; New... of the Green Jobs and Health Care ARRA-funded training grants. This evaluation is sponsored by ETA to... impacts of the Green Jobs and Health Care (GJHC) training grants. This evaluation is sponsored by ETA...

  5. A feasibility study of functional status and follow-up clinic preferences of patients at high risk of post intensive care syndrome.

    PubMed

    Farley, K J; Eastwood, G M; Bellomo, R

    2016-05-01

    After prolonged mechanical ventilation patients may experience the 'post intensive care syndrome' (PICS) and may be candidates for post-discharge follow-up clinics. We aimed to ascertain the incidence and severity of PICS symptoms in patients surviving prolonged mechanical ventilation and to describe their views regarding follow-up clinics. In a teaching hospital, we conducted a cohort study of all adult patients discharged alive after ventilation in ICU for ≥7 days during 2013. We administered the EuroQol-5D (EQ-5D) and Hospital Anxiety and Depression Scale (HADS) via telephone interview and asked patients their views about the possible utility of a follow-up clinic. We studied 48 patients. At follow-up (average 19.5 months), seven (15%) patients had died and 14 (29%) did not participate (eight declined; two were non-English speakers; four were non-contactable). Among the 27 responders, 16 (59%) reported at least moderate problems in ≥1 EQ-5D dimension; 10 (37%) in ≥2 dimensions, and 8 (30%) in ≥3 dimensions. Moreover, 10 (37%) patients reported marked psychological symptoms; six (22%) scored borderline or abnormal on the HADS for both anxiety and depression; and four (15%) scored borderline or abnormal for one component. Finally, 21/26 (81%) patients stated that an ICU follow-up clinic would have been beneficial. At long-term follow-up, the majority of survivors of prolonged mechanical ventilation reported impaired quality of life and significant psychological symptoms. Most believed that a follow-up clinic would have been beneficial. PMID:27246943

  6. Telemedicine Versus Standard Follow-Up Care for Diabetes-Related Foot Ulcers: Protocol for a Cluster Randomized Controlled Noninferiority Trial (DiaFOTo)

    PubMed Central

    Espehaug, Birgitte; Hausken, Marie F; Graue, Marit; Østbye, Truls; Skeie, Svein; Cooper, John G; Tell, Grethe S; Günther, Bodo Erhardt; Dale, Håvard; Smith-Strøm, Hilde; Kolltveit, Beate-Christin H; Kirkevold, Marit; Rokne, Berit

    2016-01-01

    Background This paper presents the protocol for an ongoing study to evaluate a telemedicine follow-up intervention for patients with diabetes-related foot ulcers. Diabetes-related foot ulcers represent challenges for patients and the health services. The large increase in the prevalence of diabetes, combined with the aging population, means that the absolute number of patients with diabetes-related foot ulcers is likely to continue to increase. Health care services therefore need to provide close clinical follow-up care for people with diabetes both in primary and specialist care. Information and communication technologies may enable more integrated treatment and care pathways across organizational boundaries. However, we lack knowledge about the effect of telemedicine follow-up and how such services can be optimally organized. Objective To present the design and methods of a study evaluating a telemedicine follow-up intervention for patients with diabetes-related foot ulcers. Methods The study is designed as a cluster randomized controlled trial (noninferiority trial) involving municipalities or municipality districts (clusters) belonging to one clinical site in Western Norway. The study includes patients with type 1 and type 2 diabetes presenting with a new foot ulcer at the initial visit to the clinic. Patients in the intervention group receive telemedicine follow-up care in the community. The key ingredient in the intervention is the close integration between health care levels. The intervention is facilitated by the use of an interactive wound platform consisting of a Web-based ulcer record combined with a mobile phone, enabling counseling and communication between nurses in the community and specialist health care. Patients in the control group receive standard hospital outpatient care. The primary endpoint in the trial is healing time; secondary outcomes include amputation and death, patient-reported outcome measures, and follow-up data on the recurrence of

  7. [The postoperative care and treatment in esophageal cancer (4). Postoperative follow up-(recurrence, nutritional management and after-care of IC)].

    PubMed

    Ide, H; Nakamura, H; Ohota, M; Tanigawa, K; Kobayashi, A; Yoshida, K; Hayashi, K; Nakamura, T; Eguchi, R

    1996-06-01

    The points of the postoperative care in radical operation of esophageal cancer are followings. 1) Postoperative nutritional management: In the reconstruction using gastric tube, we make Witzel's gastrostomy in antrum of regardless of the reconstructive routes and transfer to enteral tube-feeding to assist the oral food-taking amount. These management is not only attributing to assist early return to working but also effective to prevent the loss of postoperative physical strength in older patients. 2) Postoperative adjuvant therapy: The esophageal cancer is the diseases that react chemo- and radio-therapy, so most of advanced cases were treated with adjuvant therapy. Nowadays, it is essential for patients to explain the real diagnosis, treatment regimen, then to agree to the informed concent. After informed, the tender mental consult during treatment and outpatient service is required for mental burden. 3) Postoperative follow-up: The recognition of postoperative QOL, early detection of recurrence are mostly emphasized during 2 years after operation. The occurrence of secondary cancer (gastric cancer, cervico-pharyngeal cancer, colorectal cancer etc.) are seen in even 5-10 years after operation. Then the long-term periodical examination and life care are needed. PMID:8774815

  8. Predictors of default from follow-up care in a cervical cancer screening program using direct visual inspection in south-western Nigeria

    PubMed Central

    2014-01-01

    Background Increasingly evidence is emerging from south East Asia, southern and east Africa on the burden of default to follow up care after a positive cervical cancer screening/diagnosis, which impacts negatively on cervical cancer prevention and control. Unfortunately little or no information exists on the subject in the West Africa sub region. This study was designed to determine the proportion of and predictors and reasons for default from follow up care after positive cervical cancer screen. Method Women who screen positive at community cervical cancer screening using direct visual inspection were followed up to determine the proportion of default and associated factors. Multivariate logistic regression was used to determine independent predictors of default. Results One hundred and eight (16.1%) women who screened positive to direct visual inspection out of 673 were enrolled into the study. Fifty one (47.2%) out of the 108 women that screened positive defaulted from follow-up appointment. Women who were poorly educated (OR: 3.1, CI: 2.0 – 5.2), or lived more than 10 km from the clinic (OR: 2.0, CI: 1.0 – 4.1), or never screened for cervical cancer before (OR: 3.5, CI:3:1–8.4) were more likely to default from follow-up after screening positive for precancerous lesion of cervix . The main reasons for default were cost of transportation (48.6%) and time constraints (25.7%). Conclusion The rate of default was high (47.2%) as a result of unaffordable transportation cost and limited time to keep the scheduled appointment. A change from the present strategy that involves multiple visits to a “see and treat” strategy in which both testing and treatment are performed at a single visit is recommended. PMID:24678898

  9. Sickle Cell Disease Pain: 2. Predicting Health Care Use and Activity Level at 9-Month Follow-Up.

    ERIC Educational Resources Information Center

    Gil, Karen M.; And Others

    1992-01-01

    Studied adults with sickle cell disease (SCD) participating in longitudinal study of pain-coping strategies. Eighty-nine subjects completed baseline assessment of pain-coping strategies and structured pain interviews assessing health care use and activity reduction during painful episodes. Baseline Negative Thinking and Passive Adherence were…

  10. [The financial costs of health care: a follow-up survey of women having a high-risk delivery].

    PubMed

    Sondo, B; Testa, J; Kone, B

    1997-01-01

    Our aim was to analyze the financial costs of health care for women in labor transferred to primary referral maternity units in childbirth at risk. Another aim was to consider the willingness of women and their husbands to financially save and support the increasing costs of health care. For 15 consecutive days, medical students interviewed all women transferred for a risky delivery in 12 of the 17 primary referral maternity units in Burkina Faso. The median cost for transferring the women and their necessary health care was approximately 30,500 CFA. The median cost for the kit of surgical supplies was 15,000 CFA; the costs of medicine and transportation fare for the woman and her husband were 14,000 CFA and 9,800 CFA, respectively. The median cost for the health care of the newborn was 2,400 CFA. When the decision for the transfer was made, the necessary money to pay for the expenses was available for only 40 out of 79 women. Women and their husbands were willing to save for health care either through existing community institutions such as groups of villagers and popular savings developments (69 women and men); or through annuity schemes to be created (33 women and men); or through banks (4 women and men). Four women and 6 men refused to contribute because of previous experiences of poor management of collective funds. The average savings were low and insufficient to cover the expected expenses for the transfer and care of the women. The savings were reserved for payment of the transportation fare for the women and their husbands to the referral units (21 women and 20 men), prescriptions (9 women and 5 men), the medical consultation (1 woman), and to provide for both (37 women and 39 men). The costs of health care are expensive. The poverty of the couple facing an urgent problem of life or death made them discover new options for investing in their available community associations such as groups of villagers and popular savings developments and other options such

  11. Preventive Care for Women in Prison: A Qualitative Community Health Assessment of the Papanicolaou Test and Follow-Up Treatment at a California State Women’s Prison

    PubMed Central

    Magee, Catherine G.; Hult, Jen R.; Turalba, Ruby; McMillan, Shelby

    2005-01-01

    Growing evidence indicates that women in prison are particularly vulnerable to many negative health outcomes, including cervical cancer. The Papanicolaou (Pap) test is an effective tool to screen for this disease. To determine what is and is not working with the Pap test and follow-up treatment, we performed qualitative interviews with women prisoners and key informants at a California state women’s prison. Our assessment revealed that the process of administering Pap tests at this institution was not meeting the health care needs of the women interviewed. Women reported having negative experiences during the test and with their health care providers. Additionally the prison’s culture and infrastructure create obstacles that hinder prisoners from receiving quality care and providers from delivering that care. In response, women prisoners use self-and community advocacy to meet their health care needs and cope with these challenges. PMID:16186450

  12. Mother-to-Child Transmission of HIV Infection and Its Determinants among Exposed Infants on Care and Follow-Up in Dire Dawa City, Eastern Ethiopia.

    PubMed

    Wudineh, Fisseha; Damtew, Bereket

    2016-01-01

    Since the scale-up for prevention of mother-to-child transmission (PMTCT) services, rates of HIV infection among exposed infants have significantly declined. However, current achievements fell short of achieving the target sets. We investigated mother-to-child transmission (MTCT) of HIV infection and its determinants among HIV-exposed infants on care at Dilchora Referral Hospital in Dire Dawa City Administration. A retrospective institutional cohort study was conducted by reviewing follow-up records of HIV-exposed infants who were enrolled into care. Infants' HIV serostatus was the outcome measure of the study. Bivariate and multivariate logistic regressions were employed to identify significant determinants. Of the 382 HIV-exposed infants enrolled into care, 60 (15.7%) became HIV positive. Rural residence (AOR: 3.29; 95% CI: 1.40, 7.22), home delivery (AOR: 3.35; 95% CI: 1.58, 8.38), infant not receiving ARV prophylaxis at birth (AOR: 5.83; 95% CI: 2.84, 11.94), mixed feeding practices (AOR: 42.21; 95% CI: 8.31, 214.38), and mother-child pairs neither receiving ARV (AOR: 4.42; 95% CI: 2.01, 9.82) were significant independent determinants of MTCT of HIV infection. Our findings suggest additional efforts to intensify scale-up of PMTCT services in rural setting and improve institutional delivery and postnatal care for HIV positive mothers and proper follow-up for HIV-exposed infants. PMID:26989507

  13. Mother-to-Child Transmission of HIV Infection and Its Determinants among Exposed Infants on Care and Follow-Up in Dire Dawa City, Eastern Ethiopia

    PubMed Central

    Wudineh, Fisseha

    2016-01-01

    Since the scale-up for prevention of mother-to-child transmission (PMTCT) services, rates of HIV infection among exposed infants have significantly declined. However, current achievements fell short of achieving the target sets. We investigated mother-to-child transmission (MTCT) of HIV infection and its determinants among HIV-exposed infants on care at Dilchora Referral Hospital in Dire Dawa City Administration. A retrospective institutional cohort study was conducted by reviewing follow-up records of HIV-exposed infants who were enrolled into care. Infants' HIV serostatus was the outcome measure of the study. Bivariate and multivariate logistic regressions were employed to identify significant determinants. Of the 382 HIV-exposed infants enrolled into care, 60 (15.7%) became HIV positive. Rural residence (AOR: 3.29; 95% CI: 1.40, 7.22), home delivery (AOR: 3.35; 95% CI: 1.58, 8.38), infant not receiving ARV prophylaxis at birth (AOR: 5.83; 95% CI: 2.84, 11.94), mixed feeding practices (AOR: 42.21; 95% CI: 8.31, 214.38), and mother-child pairs neither receiving ARV (AOR: 4.42; 95% CI: 2.01, 9.82) were significant independent determinants of MTCT of HIV infection. Our findings suggest additional efforts to intensify scale-up of PMTCT services in rural setting and improve institutional delivery and postnatal care for HIV positive mothers and proper follow-up for HIV-exposed infants. PMID:26989507

  14. Effects of institutional rearing and foster care on psychopathology at age 12 years in Romania: follow-up of an open, randomised controlled trial

    PubMed Central

    Humphreys, Kathryn L; Gleason, Mary Margaret; Drury, Stacy S; Miron, Devi; Nelson, Charles A; Fox, Nathan A; Zeanah, Charles H

    2015-01-01

    Summary Background Early social deprivation can negatively affect domains of functioning. We examined psychopathology at age 12 years in a cohort of Romanian children who had been abandoned at birth and placed into institutional care, then assigned either to be placed in foster care or to care as usual. Methods We used follow-up data from the Bucharest Early Intervention Project (BEIP), a randomised controlled trial of abandoned children in all six institutions for young children in Bucharest, Romania. In the initial trial, 136 children, enrolled between ages 6–31 months, were randomly assigned to either care as usual or placement in foster care. In this study we followed up these children at age 12 years to assess psychiatric symptoms using the Diagnostic Interview Schedule for Children (4th edition; DISC-IV). We also recruited Romanian children who had never been placed in an institution from paediatric clinics and schools in Bucharest as a comparator group who had never been placed in an institution. The primary outcome measure was symptom counts assessed through DISC-IV scores for three domains of psychopathology: internalising symptoms, externalising symptoms, and attention-deficit hyperactivity disorder (ADHD). We compared mean DISC-IV scores between trial participants and comparators who had never been placed in an institution, and those assigned to care as usual or foster care. Analyses were done by modified intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00747396. Findings We followed up 110 children from the BEIP trial between Jan 27, 2011, and April 11, 2014, and 49 children as comparators who had never been placed in an institution. The 110 children who had ever been placed in an institution had higher symptom counts for internalising disorders (mean 0.93 [SD 1.68] vs 0.45 [0.84], difference 0.48 [95% CI 0.14–0.82]; p=0.0127), externalising disorders (2.31 [2.86] vs 0.65 [1.33], difference 1.66 [1.06–2.25]; p<0

  15. Brief Report: Does Most Mortality in Patients on ART Occur in Care or After Lost to Follow-Up? Evidence From the Themba Lethu Clinic, South Africa

    PubMed Central

    Maskew, Mhairi; Long, Lawrence; Sanne, Ian; Fox, Matthew P.

    2015-01-01

    Abstract: In resource-limited settings, early mortality on antiretroviral therapy (ART) is approximately 10%; yet, it is unclear how much of that mortality occurs in care or after lost to follow-up. We assessed mortality rates and predictors of death among 12,222 nonpregnant ART-naive adults initiating first-line ART between April 2004 and May 2012 in South Africa, stratified by person-years in care and lost. We found 14.6% of patients died and being lost accounted for a minority of deaths across multiple definitions of loss (population attributable-risk percent ranged from 10.4% to 42.5%). Although mortality rates in patients lost were much higher than in care, most ART-related mortality occurred on treatment. PMID:26181816

  16. An Education- and Telephone-Based Intervention to Improve Follow-up to Vision Care in Patients With Diabetes: A Prospective, Single-Blinded, Randomized Trial.

    PubMed

    Zangalli, Camila S; Murchison, Ann P; Hale, Nicole; Hark, Lisa A; Pizzi, Laura T; Dai, Yang; Leiby, Benjamin E; Haller, Julia A

    2016-01-01

    The aim was to evaluate the effectiveness of a multipronged intervention on diabetic dilated fundus examination (DFE) adherence. In a prospective trial, 521 patients with diabetes who were due for follow-up DFEs were randomized to usual care or the intervention group. Usual care received a form letter reminder to schedule and an automated reminder phone call prior to their appointment. Intervention participants received an educational brochure about diabetic eye disease and a personalized letter reminder to schedule. A research assistant called intervention participants to help schedule the appointment, and they received a reminder letter and an automated phone call prior to the scheduled visit. Patients in the intervention group were significantly more likely to schedule (63% vs 40%; P < .0001) and complete their appointment (48% vs 30%; P < .0001) compared with usual care. A multipronged intervention, including an educational mailing and telephone assistance with scheduling an appointment, significantly improved diabetic DFE adherence. PMID:25270737

  17. A 6-Month Follow-Up of the Effects of an Information and Communication Technology (ICT) Training Programme on People with Intellectual Disabilities

    ERIC Educational Resources Information Center

    Li-Tsang, Cecilia W. P.; Lee, Maggie Y. F.; Yeung, Susanna S. S.; Siu, Andrew M. H.; Lam, C. S.

    2007-01-01

    We investigated the long-term effects of an information and communication technology (ICT) training programme for people with intellectual disabilities (ID). A community-based ICT training programme was designed to enhance the computer skills of people with ID and prepare them to make use of ICT in their daily life. Of the 100 who had participated…

  18. Cost-Effectiveness of One Year Dementia Follow-Up Care by Memory Clinics or General Practitioners: Economic Evaluation of a Randomised Controlled Trial

    PubMed Central

    Meeuwsen, Els; Melis, René; van der Aa, Geert; Golüke-Willemse, Gertie; de Leest, Benoit; van Raak, Frank; Schölzel-Dorenbos, Carla; Verheijen, Desiree; Verhey, Frans; Visser, Marieke; Wolfs, Claire; Adang, Eddy; Olde Rikkert, Marcel

    2013-01-01

    Objective To evaluate the cost-effectiveness of post-diagnosis dementia treatment and coordination of care by memory clinics compared to general practitioners’ care. Methods A multicentre randomised trial with 175 community dwelling patients newly diagnosed with mild to moderate dementia, and their informal caregivers, with twelve months’ follow-up. Cost-effectiveness was evaluated from a societal point of view and presented as incremental cost per quality adjusted life year. To establish cost-effectiveness, a cost-utility analysis was conducted using utilities based on the EQ-5D. Uncertainty surrounding the incremental cost-effectiveness ratio (difference in costs divided by difference in effects) was calculated by bootstrapping from the original data. Results Compared to general practitioners’ care, treatment by the memory clinics was on average €1024 (95% CI: −€7723 to €5674) cheaper, and showed a non-significant decrease of 0.025 (95% CI: −0.114 to 0.064) quality adjusted life years. The incremental cost-effectiveness point estimate from the bootstrap simulation was € 41 442 per QALY lost if one would use memory clinic care instead of general practitioner care. Conclusion No evidence was found that memory clinics were more cost-effective compared to general practitioners with regard to post-diagnosis treatment and coordination of care of patients with dementia in the first year after diagnosis. Trial Registration ClinicalTrials.gov NCT00554047 PMID:24282511

  19. Breast cancer survivorship and South Asian women: understanding about the follow-up care plan and perspectives and preferences for information post treatment

    PubMed Central

    Singh–Carlson, S.; Wong, F.; Martin, L.; Nguyen, S.K.A.

    2013-01-01

    Background and Objectives As more treatment options become available and supportive care improves, a larger number of people will survive after treatment for breast cancer. In the present study, we explored the experiences and concerns of female South Asian (sa) breast cancer survivors (bcss) from various age groups after treatment to determine their understanding of follow-up care and to better understand their preferences for a survivorship care plan (scp). Methods Patients were identified by name recognition from BC Cancer Agency records for sa patients who were 3–60 months post treatment, had no evidence of recurrence, and had been discharged from the cancer centre to follow-up. Three focus groups and eleven face-to-face semistructured interviews were audio-recorded, transcribed verbatim, cross-checked for accuracy, and analyzed using thematic and content analysis. Participants were asked about their survivorship experiences and their preferences for the content and format of a scp. Results Fatigue, cognitive changes, fear of recurrence, and depression were the most universal effects after treatment. “Quiet acceptance” was the major theme unique to sa women, with a unique cross-influence between faith and acceptance. Emphasis on a generalized scp with individualized content echoed the wide variation in breast cancer impacts for sa women. Younger women preferred information on depression and peer support. Conclusions For sa bcss, many of the psychological and physical impacts of breast cancer diagnosis and treatment may be experienced in common with bcss of other ethnic backgrounds, but the present study also suggests the presence of unique cultural nuances such as spiritual and language-specific support resource needs. The results provide direction for designing key content and format of scps, and information about elements of care that can be customized to individual patient needs. PMID:23559888

  20. The disease management program for type 2 diabetes in Germany enhances process quality of diabetes care - a follow-up survey of patient's experiences

    PubMed Central

    2010-01-01

    Background In summer 2003 a disease management program (DMP) for type 2 diabetes was introduced on a nationwide basis in Germany. Patient participation and continuity of care within the DMP are important factors to achieve long-term improvements in clinical endpoints. Therefore it is of interest, if patients experience any positive or negative effects of the DMP on their treatment that would support or hamper further participation. The main objective of the study was to find out if the German Disease Management Program (DMP) for type 2 diabetes improves process and outcome quality of medical care for patients in the light of their subjective experiences over a period of one year. Methods Cohort study with a baseline interview and a follow-up after 10.4 ± 0.64 months. Data on process and outcome measures were collected by telephone interviews with 444 patients enrolled and 494 patients not enrolled in the German DMP for type 2 diabetes. Data were analyzed by multivariate logistic regression analyses. Results DMP enrolment was significantly associated with a higher process quality of care. At baseline enrolled patients more often reported that they had attended a diabetes education course (OR = 3.4), have ≥ 4 contacts/year with the attending physician (OR = 3.3), have at least one annual foot examination (OR = 3.1) and one referral to an ophthalmologist (OR = 3.4) and possess a diabetes passport (OR = 2.4). Except for the annual referral to an ophthalmologist these parameters were also statistically significant at follow-up. In contrast, no differences between enrolled and not enrolled patients were found concerning outcome quality indicators, e.g. self-rated health, Glycated hemoglobin (GHb) and blood pressure. However, 16-36% of the DMP participants reported improvements of body weight and/or GHb and/or blood pressure values due to enrolment - unchanged within one year of follow-up. Conclusions In the light of patient's experiences the DMP enhances the process

  1. Deriving Prostate Alpha-Beta Ratio Using Carefully Matched Groups, Long Follow-Up and the Phoenix Definition of Biochemical Failure

    SciTech Connect

    Shaffer, Richard; Pickles, Tom; Lee, Richard; Moiseenko, Vitali

    2011-03-15

    Purpose: Prior studies have derived low values of alpha-beta ratio (a/ss) for prostate cancer of approximately 1-2 Gy. These studies used poorly matched groups, differing definitions of biochemical failure, and insufficient follow-up. Methods and Materials: National Comprehensive Cancer Network low- or low-intermediate risk prostate cancer patients, treated with external beam radiotherapy or permanent prostate brachytherapy, were matched for prostate-specific antigen, Gleason score, T-stage, percentage of positive cores, androgen deprivation therapy, and era, yielding 118 patient pairs. The Phoenix definition of biochemical failure was used. The best-fitting value for a/ss was found for up to 90-month follow-up using maximum likelihood analysis, and the 95% confidence interval using the profile likelihood method. Linear quadratic formalism was applied with the radiobiological parameters of relative biological effectiveness = 1.0, potential doubling time = 45 days, and repair half-time = 1 hour. Bootstrap analysis was performed to estimate uncertainties in outcomes, and hence in a/ss. Sensitivity analysis was performed by varying the values of the radiobiological parameters to extreme values. Results: The value of a/ss best fitting the outcomes data was >30 Gy, with lower 95% confidence limit of 5.2 Gy. This was confirmed on bootstrap analysis. Varying parameters to extreme values still yielded best-fit a/ss of >30 Gy, although the lower 95% confidence interval limit was reduced to 0.6 Gy. Conclusions: Using carefully matched groups, long follow-up, the Phoenix definition of biochemical failure, and well-established statistical methods, the best estimate of a/ss for low and low-tier intermediate-risk prostate cancer is likely to be higher than that of normal tissues, although a low value cannot be excluded.

  2. Primary Prevention Programme for Burnout-Endangered Teachers: Follow-Up Effectiveness of a Combined Group and Individual Intervention of AFA Breathing Therapy.

    PubMed

    Goetz, Katja; Loew, Thomas; Hornung, Regina; Cojocaru, Laura; Lahmann, Claas; Tritt, Karin

    2013-01-01

    Background. Early retirement of teachers due to burnout is frequent in Germany. In this study short- and medium-term effects of AFA breathing therapy were evaluated. Methods. This study was designed as a longitudinal controlled intervention design with four points of measurements: before assessment (T1), after intervention (T2), three months (follow up 1) (T3) after intervention, and six months (follow up 2) after intervention (T4). The intervention lasted a total of 11 weeks (weekly group therapy for eight weeks and three weeks of individual breathing session). The effects of intervention were measured with the questionnaire "work-related behaviour and experience Patterns" (AVEM) at four times. Results. In the intervention group 64 teachers and in the self-selected control group 27 teachers were included. The AVEM scales "subjective significance of work" and "professional ambition" changed over time and within both groups (interaction effect). Significant improvements over the four measurements were observed in the intervention group in two AVEM scales: "emotional distancing" (F = 6.3; P < 0.01) and "balance and mental stability" (F = 4.4; P < 0.02). Conclusions. AFA breathing therapy showed short- and medium-term effects in the intervention group over four points of measurements. It may be assumed that breath therapy supports teachers in resisting occupational demand. PMID:24069056

  3. Effectiveness of Standardized Nursing Care Plans in Health Outcomes in Patients with Type 2 Diabetes Mellitus: A Two-Year Prospective Follow-Up Study

    PubMed Central

    Cárdenas-Valladolid, Juan; Salinero-Fort, Miguel A.; Gómez-Campelo, Paloma; de Burgos-Lunar, Carmen; Abánades-Herranz, Juan C.; Arnal-Selfa, Rosa; Andrés, Ana López-

    2012-01-01

    Background Implementation of a standardized language in Nursing Care Plans (SNCP) allows for increased efficiency in nursing data management. However, the potential relationship with patientś health outcomes remains uncertain. The aim of this study was to evaluate the effectiveness of SNCP implementation, based on North American Nursing Diagnosis Association (NANDA) and Nursing Interventions Classification (NIC), in the improvement of metabolic, weight, and blood pressure control of Type 2 Diabetes Mellitus (T2DM) patients. Methods A two-year prospective follow-up study, in routine clinical practice conditions. 31 primary health care centers (Spain) participated with 24,124 T2DM outpatients. Data was collected from Computerized Clinical Records; SNCP were identified using NANDA and NIC taxonomies. Descriptive and ANCOVA analyses were conducted. Results 18,320 patients were identified in the Usual Nursing Care (UNC) group and 5,168 in the SNCP group. At the two-year follow-up, the SNCP group improved all parameters except LDL cholesterol and diastolic blood pressure. We analyzed data adjustming by the baseline value for these variables and variables with statistically significant differences between groups at baseline visit. Results indicated a lowering of all parameters except HbA1c, but a statistically significant reduction was only observed with diastolic blood pressure results. However, the adjusted reduction of diastolic blood pressure is of little clinical relevance. Greater differences of control values for diastolic blood pressure, HbA1c, LDL-cholesterol and Body Mass Index were found in the SNCP group, but only reached statistical significance for HbA1c. A greater proportion of patients with baseline HbA1c ≥7 decreased to <7% at the two-year follow-up in the SNCP group than in the UNC group (16.9% vs. 15%; respectively; p = 0.01). Conclusions Utilization of SNCP was helpful in achieving glycemic control targets in poorly controlled patients with T2DM

  4. Longitudinal Follow-Up of Weight Change in the Context of a Community-Based Health Promotion Programme for Adults with an Intellectual Disability

    ERIC Educational Resources Information Center

    Thomas, G. R.; Kerr, M. P.

    2011-01-01

    Background: Obesity has been identified as a major health concern in adults with intellectual disabilities. This study evaluates a health promotion programme delivered by a NHS department for adults with intellectual disabilities. Method: Routine NHS data were collated and analysed descriptively. One hundred and ninety one adults with intellectual…

  5. Consensus statement on the care of the hyperglycaemic/diabetic patient during and in the immediate follow-up of acute coronary syndrome.

    PubMed

    Vergès, B; Avignon, A; Bonnet, F; Catargi, B; Cattan, S; Cosson, E; Ducrocq, G; Elbaz, M; Fredenrich, A; Gourdy, P; Henry, P; Lairez, O; Leguerrier, A M; Monpère, C; Moulin, P; Vergès-Patois, B; Roussel, R; Steg, G; Valensi, P

    2012-04-01

    The Diabetes and Cardiovascular Disease study group of the Société francophone du diabète (SFD, French Society of Diabetes) in collaboration with the Société française de cardiologie (SFC, French Society of Cardiology) have devised a consensus statement on the care of the hyperglycaemic/diabetic patient during and in the immediate follow-up of acute coronary syndrome (ACS); in particular, it includes the different phases of ACS [the intensive care unit (ICU) period, the post-ICU period and the short-term follow-up period after discharge, including cardiac rehabilitation] and also embraces all of the various diagnostic and therapeutic issues with a view to optimizing the collaboration between cardiologists and diabetologists. As regards diagnosis, subjects with HbA(1c) greater or equal to 6.5% on admission may be considered diabetic while, in those with no known diabetes and HbA(1c) less than 6.5%, it is recommended that an OGTT be performed 7 to 28 days after ACS. During hospitalization in the ICU, continuous insulin treatment should be initiated in all patients when admission blood glucose levels are greater or equal to 180 mg/dL (10.0 mmol/L) and, in those with previously known diabetes, when preprandial glucose levels are greater or equal to 140 mg/dL (7.77 mmol/L) during follow-up. The recommended blood glucose target is 140-180 mg/dL (7.7-10 mmol/L) for most patients. Following the ICU period, insulin treatment is not mandatory for every patient, and other antidiabetic treatments may be considered, with the choice of optimal treatment depending on the metabolic profile of the patient. Patients should be referred to a diabetologist before discharge from hospital in cases of unknown diabetes diagnosed during ACS hospitalization, of HbA(1c) greater or equal to 8% at the time of admission, or newly introduced insulin therapy or severe/repeated hypoglycaemia. Referral to a diabetologist after hospital discharge is recommended if diabetes is diagnosed by the

  6. Consensus statement on the care of the hyperglycaemic/diabetic patient during and in the immediate follow-up of acute coronary syndrome.

    PubMed

    Vergès, B; Avignon, A; Bonnet, F; Catargi, B; Cattan, S; Cosson, E; Ducrocq, G; Elbaz, M; Fredenrich, A; Gourdy, P; Henry, P; Lairez, O; Leguerrier, A M; Monpère, C; Moulin, P; Vergès-Patois, B; Roussel, R; Steg, G; Valensi, P

    2012-04-01

    The Diabetes and Cardiovascular Disease study group of the Société francophone du diabète (SFD, French Society of Diabetes) in collaboration with the Société française de cardiologie (SFC, French Society of Cardiology) have devised a consensus statement on the care of the hyperglycaemic/diabetic patient during and in the immediate follow-up of acute coronary syndrome (ACS); in particular, it includes the different phases of ACS [the intensive care unit (ICU) period, the post-ICU period and the short-term follow-up period after discharge, including cardiac rehabilitation] and also embraces all of the various diagnostic and therapeutic issues with a view to optimalizing the collaboration between cardiologists and diabetologists. As regards diagnosis, subjects with HbA(1c) greater or equal to 6.5% on admission may be considered diabetic while, in those with no known diabetes and HbA(1c) less than 6.5%, it is recommended that an OGTT be performed 7 to 28days after ACS. During hospitalization in the ICU, continuous insulin treatment should be initiated in all patients when admission blood glucose levels are greater or equal to 180mg/dL (10.0mmol/L) and, in those with previously known diabetes, when preprandial glucose levels are greater or equal to 140mg/dL (7.77mmol/L) during follow-up. The recommended blood glucose target is 140-180mg/dL (7.7-10mmol/L) for most patients. Following the ICU period, insulin treatment is not mandatory for every patient, and other antidiabetic treatments may be considered, with the choice of optimal treatment depending on the metabolic profile of the patient. Patients should be referred to a diabetologist before discharge from hospital in cases of unknown diabetes diagnosed during ACS hospitalization, of HbA(1c) greater or equal to 8% at the time of admission, or newly introduced insulin therapy or severe/repeated hypoglycaemia. Referral to a diabetologist after hospital discharge is recommended if diabetes is diagnosed by the OGTT

  7. Ensuring Quality Cancer Care: A Follow-Up Review of the Institute of Medicine’s Ten Recommendations for Improving the Quality of Cancer Care in America

    PubMed Central

    Spinks, Tracy; Albright, Heidi W.; Feeley, Thomas W.; Walters, Ron; Burke, Thomas W.; Aloia, Thomas; Bruera, Eduardo; Buzdar, Aman; Foxhall, Lewis; Hui, David; Summers, Barbara; Rodriguez, Alma; DuBois, Raymond; Shine, Kenneth I.

    2011-01-01

    Responding to growing concerns regarding the safety, quality, and efficacy of cancer care in the United States, the Institute of Medicine (IOM) of the National Academy of Sciences commissioned a comprehensive review of cancer care delivery in the US healthcare system in the late 1990s. The National Cancer Policy Board (NCPB), a twenty-member board with broad representation, performed this review. In its review, the NCPB focused on the state of cancer care delivery at that time, its shortcomings, and ways to measure and improve the quality of cancer care. The NCPB described an ideal cancer care system, where patients would have equitable access to coordinated, guideline-based care and novel therapies throughout the course of their disease. In 1999, the IOM published the results of this review in its influential report, Ensuring Quality Cancer Care. This report outlined ten recommendations, which, when implemented, would: 1) improve the quality of cancer care; 2) increase our understanding of quality cancer care; and, 3) reduce or eliminate access barriers to quality cancer care. Despite the fervor generated by this report, there are lingering doubts regarding the safety and quality of cancer care in the United States today. Increased awareness of medical errors and barriers to quality care, coupled with escalating healthcare costs, has prompted national efforts to reform the healthcare system. These efforts by healthcare providers and policymakers should bridge the gap between the ideal state described in Ensuring Quality Cancer Care and the current state of cancer care in the United States. PMID:22045610

  8. Mortality among adults transferred and lost to follow-up from antiretroviral therapy programmes in South Africa: a multicentre cohort study

    PubMed Central

    CORNELL, Morna; LESSELLS, Richard; FOX, Matthew P.; GARONE, Daniela Belen; GIDDY, Janet; FENNER, Lukas; MYER, Landon; BOULLE, Andrew

    2014-01-01

    Background & objectives Little is known about outcomes after transfer out (TFO) and loss to follow-up (LTF) and how differential outcomes might bias mortality estimates, as analyses generally censor or exclude TFOs/LTF. Using data linked to the National Population Register (NPR), we explored mortality among patients TFO and LTF compared with patients retained and investigated how linkage impacted on mortality estimates. Methods A cohort analysis of routine data on adults with civil-identification numbers starting ART 2004–2009 in four large South African ART cohorts. The number, proportion, timing and mortality of TFOs and LTF were reported. Mortality was compared using Kaplan-Meier curves, Cox’s proportional hazards and competing risks regression. Results Before linkage, 1207 patients (6%) had died, 2624 (13%) were LTF, 1067 (5%) were TFO and 14583 (75%) were retained. Compared with retained, mortality risk was three times higher among TFOs (aHR 3.11, 95% CI 2.42–3.99) and 20 times higher among LTF patients (aHR 22.03, 95% CI 20.05–24.21). Excluding early deaths after TFO or LTF, the risk was comparable among TFOs and retained (aHR 0.75, 95% CI 0.54–1.03) and higher among LTF (aHR 2.85, 95% CI 2.43–3.33). After linkage, corrected mortality was higher than site-reported mortality. Censoring did not however lead to substantial underestimation of mortality among TFOs. Conclusions While TFO and LTF predicted mortality, the lower incidence of TFO and subsequent death compared with LTF meant that censoring TFOs did not bias mortality estimates. Future cohort analyses should explicitly consider proportions TFO/LTF and mortality event rates. PMID:24977471

  9. Early Child Care and Children's Development in the Primary Grades: Follow-Up Results from the NICHD Study of Early Child Care

    ERIC Educational Resources Information Center

    American Educational Research Journal, 2005

    2005-01-01

    Associations between early child care and children's functioning though the end of third grade were examined. Some of the relations that had been detected before children's school entry were maintained. Higher-quality child care continued to be linked to higher scores in math, reading, and memory. More time spent in center care was associated with…

  10. Report recommends new 'customer care programme'.

    PubMed

    2014-07-15

    Nurses and other front line health workers in Wales should be sent on customer care training programmes to reduce the number of patient complaints, an independent review has recommended. PMID:25005374

  11. [Indicators of social functioning and social participation in mentally ill participants in a public health rehabilitation programme: a one year follow-up study].

    PubMed

    Kitajima, K; Kuroda, K; Tatara, K

    1996-02-01

    In order to investigate social functioning, a self-administered questionnaire was distributed to 66 participants (30 men and 36 women) in a group rehabilitation programme for the mentally ill at public health centers, and followed for 1 year to investigate their employability as an indicator of social participation. The survey included 20 items related to 5 aspects of daily life: diurnal routine, basic personal management, social activities, personal relationships, and management of illness. The major findings were as follows: 1. The group who had become employed showed significantly higher positive responses to questions concerning self-management such as conversation with others, consultation with others and when condition worsened than the unemployed group. Also the employed showed a tendency for higher positive responses to such items as cooking, keeping appointments, taking medicine, taking an active role in managing medications. 2. According to discriminant analysis by Hayashi's quantification method II, factors distinguishing 17 participants who had become employed within the year and those who remained unemployed included the following: ability to converse with others, taking an active role in managing medications, and ability to cook, male gender, co-residence with family, and a period of 3 years or less since hospital discharge. These results suggest that a public health rehabilitation program aimed at improving interpersonal skills, self-management of illness and other skills of daily living may be useful in helping the mentally ill participate socially. PMID:8901215

  12. Changes in health care utilisation following a reform involving choice and privatisation in Swedish primary care: a five-year follow-up of GP-visits

    PubMed Central

    2013-01-01

    Background The organisation of Swedish primary health care has changed following introduction of free choice of provider for the population in combination with freedom of establishment for private primary care providers. Our aim was to investigate changes in individual health care utilisation following choice and privatisation in Swedish primary care from an equity perspective, in subgroups defined by age, gender and family income. Methods The study is based on register data years 2007 – 2011 from the Skåne Regional Council (population 1.2 million) regarding individual health care utilisation in the form of visits to general practitioner (GP). Health utilisation data was matched with data about individual’s age, gender and family income provided by Statistics Sweden. Multilevel, logistic regression models were constructed to analyse changes in health utilisation in different subgroups and the probability of a GP-visit before and after reform. Results Health care utilisation in terms of both number of individuals that had visited a GP and number of GP-visits per capita increased in all defined subgroups, but to a varying degree. Multilevel logistic regression showed that individuals of both genders aged above 64 and belonging to a family with an income above median had more advantage of the reform, OR 1.25-1.29. Conclusions Reforms involving choice and privatisation in Swedish primary health care improved access to GP-visits generally, but more so for individuals belonging to a family with income above the median. PMID:24171894

  13. Long-Term Survival and Dialysis Dependency Following Acute Kidney Injury in Intensive Care: Extended Follow-up of a Randomized Controlled Trial

    PubMed Central

    Gallagher, Martin; Cass, Alan; Bellomo, Rinaldo; Finfer, Simon; Gattas, David; Lee, Joanne; Lo, Serigne; McGuinness, Shay; Myburgh, John; Parke, Rachael; Rajbhandari, Dorrilyn

    2014-01-01

    Background The incidence of acute kidney injury (AKI) is increasing globally and it is much more common than end-stage kidney disease. AKI is associated with high mortality and cost of hospitalisation. Studies of treatments to reduce this high mortality have used differing renal replacement therapy (RRT) modalities and have not shown improvement in the short term. The reported long-term outcomes of AKI are variable and the effect of differing RRT modalities upon them is not clear. We used the prolonged follow-up of a large clinical trial to prospectively examine the long-term outcomes and effect of RRT dosing in patients with AKI. Methods and Findings We extended the follow-up of participants in the Randomised Evaluation of Normal vs. Augmented Levels of RRT (RENAL) study from 90 days to 4 years after randomization. Primary and secondary outcomes were mortality and requirement for maintenance dialysis, respectively, assessed in 1,464 (97%) patients at a median of 43.9 months (interquartile range [IQR] 30.0–48.6 months) post randomization. A total of 468/743 (63%) and 444/721 (62%) patients died in the lower and higher intensity groups, respectively (risk ratio [RR] 1.04, 95% CI 0.96–1.12, p = 0.49). Amongst survivors to day 90, 21 of 411 (5.1%) and 23 of 399 (5.8%) in the respective groups were treated with maintenance dialysis (RR 1.12, 95% CI 0.63–2.00, p = 0.69). The prevalence of albuminuria among survivors was 40% and 44%, respectively (p = 0.48). Quality of life was not different between the two treatment groups. The generalizability of these findings to other populations with AKI requires further exploration. Conclusions Patients with AKI requiring RRT in intensive care have high long-term mortality but few require maintenance dialysis. Long-term survivors have a heavy burden of proteinuria. Increased intensity of RRT does not reduce mortality or subsequent treatment with dialysis. Trial registration www.ClinicalTrials.gov NCT00221013

  14. Measuring newborn foot length to identify small babies in need of extra care: a cross sectional hospital based study with community follow-up in Tanzania

    PubMed Central

    2010-01-01

    Background Neonatal mortality because of low birth weight or prematurity remains high in many developing country settings. This research aimed to estimate the sensitivity and specificity, and the positive and negative predictive values of newborn foot length to identify babies who are low birth weight or premature and in need of extra care in a rural African setting. Methods A cross-sectional study of newborn babies in hospital, with community follow-up on the fifth day of life, was carried out between 13 July and 16 October 2009 in southern Tanzania. Foot length, birth weight and gestational age were estimated on the first day and foot length remeasured on the fifth day of life. Results In hospital 529 babies were recruited and measured within 24 hours of birth, 183 of whom were also followed-up at home on the fifth day. Day one foot length <7 cm at birth was 75% sensitive (95%CI 36-100) and 99% specific (95%CI 97-99) to identify very small babies (birth weight <1500 grams); foot length <8 cm had sensitivity and specificity of 87% (95%CI 79-94) and 60% (95%CI 55-64) to identify those with low birth weight (<2500 grams), and 93% (95%CI 82-99) and 58% (95%CI 53-62) to identify those born premature (<37 weeks). Mean foot length on the first day was 7.8 cm (standard deviation 0.47); the mean difference between first and fifth day foot lengths was 0.1 cm (standard deviation 0.3): foot length measured on or before the fifth day of life identified more than three-quarters of babies who were born low birth weight. Conclusion Measurement of newborn foot length for home births in resource poor settings has the potential to be used by birth attendants, community volunteers or parents as a screening tool to identify low birth weight or premature newborns in order that they can receive targeted interventions for improved survival PMID:20959008

  15. Validation of 2 New Measures of Continuity of Care Based on Year-to-Year Follow-up With Known Providers of Health Care

    PubMed Central

    Tousignant, Pierre; Diop, Mamadou; Fournier, Michel; Roy, Yves; Haggerty, Jeannie; Hogg, William; Beaulieu, Marie-Dominique

    2014-01-01

    PURPOSE In a primary care context favoring group practices, we assessed the validity of 2 new continuity measures (both versions of known provider continuity, KPC) that capture the concentration of care over time from multiple physicians (multiple provider continuity, KPC-MP) or from the physician seen most often (personal provider continuity, KPC-PP). METHODS Patients with diabetes or cardiovascular disease (N = 765) were approached in the waiting rooms of 28 primary care clinics in 3 regions of the province of Quebec, Canada; answered a survey questionnaire measuring relational continuity, interpersonal communication, coordination within the clinic, coordination with specialists, and overall coordination; and gave permission for their medical records to be reviewed and their medical services utilization data for the previous 2 years to be accessed to measure KPC. Using generalized linear mixed models, we assessed the association between KPC and the patients’ responses. RESULTS Among the 5 different patient-reported measures or their combination, KPC-MP was significantly related with overall coordination of care: for high continuity, the odds ratio (OR) = 2.02 (95% CI, 1.33–3.07), and for moderate continuity, OR = 1.61 (95% CI, 1.06–2.46). KPC-MP was also related with the combined continuity score: for high continuity, OR = 1.52 (95% CI, 1.11–2.09), and for moderate continuity, OR = 1.48 (95% CI, 1.10–2.00). KPC-PP was not significantly associated with any of the survey measures. CONCLUSIONS The KPC-MP measure, based on readily available administrative data, is associated with patient-perceived overall coordination of care among multiple physicians. KPC measures are potentially a valuable and low-cost way to follow the effects of changes favoring group practice on continuity of care for entire populations. They are easy to replicate over time and across jurisdictions. PMID:25384820

  16. Mental health and functional impairment outcomes following a 6-week intensive treatment programme for UK military veterans with post-traumatic stress disorder (PTSD): a naturalistic study to explore dropout and health outcomes at follow-up

    PubMed Central

    Murphy, Dominic; Hodgman, Georgina; Carson, Carron; Spencer-Harper, Lucy; Hinton, Mark; Wessely, Simon; Busuttil, Walter

    2015-01-01

    Objective Combat Stress, a UK national charity for veterans with mental health problems, has been funded by the National Health Service (NHS) to provide a national specialist service to deliver treatment for post-traumatic stress disorder (PTSD). This paper reports the efficacy of a PTSD treatment programme for UK veterans at 6 months follow-up. Design A within subject design. Setting UK veterans with a diagnosis of PTSD who accessed Combat Stress. Participants 246 veterans who received treatment between late 2012 and early 2014. Intervention An intensive 6-week residential treatment programme, consisting of a mixture of individual and group sessions. Participants were offered a minimum of 15 individual trauma-focused cognitive behavioural therapy sessions. In addition, participants were offered 55 group sessions focusing on psychoeducational material and emotional regulation. Main outcome measures Clinicians completed measures of PTSD and functional impairment and participants completed measures of PTSD, depression, anger and functional impairment. Results We observed significant reductions in PTSD scores following treatment on both clinician completed measures (PSS-I: −13.0, 95% CI −14.5 to −11.5) and self-reported measures (Revised Impact of Events Scale (IES-R): −16.5, 95% CI −19.0 to −14.0). Significant improvements in functional impairment were also observed (eg, Health of the Nation Outcome Scales (HONOS): −6.85, 95% CI −7.98 to −5.72). There were no differences in baseline outcomes between those who completed and those who did not complete the programme, or post-treatment outcomes between those we were able to follow-up at 6 months and those lost to follow-up. Conclusions In a naturalistic study we observed a significant reduction in PTSD scores and functional impairment following treatment. These improvements were maintained at 6 month follow-up. Our findings suggest it may be helpful to take a closer look at combining individual

  17. Effect of Self Care Education with and without Telephone Follow-Up on the Level of Hope in Renal Dialysis Patients: A Single-Blind Randomized Controlled Clinical Trial

    PubMed Central

    Poorgholami, Farzad; Mansoori, Parisa; Montaseri, Zohreh; Najafi, Kazem

    2016-01-01

    Background: Various strategies such as teaching self care to hemodialysis patients have been employed to increase the level of their hope. This study aimed at examining the effects of a telephone follow-up program on the level of hope in a self care education program. Methods: In this single-blind randomized controlled clinical trial, 75 hemodialysis patients, selected by convenient sampling, were randomly assigned to 3 groups (n=25 each) including a control, a self care education, or a self care education with telephone follow-up. The control group received the routine care. The self care education group received 5 instruction sessions. The telephone follow-up group had similar instructional sessions followed by telephone calls during the subsequent 2 months. Data, collected using demographic information list and Miller’s hope questionnaire, were analyzed using Chi-Square, t-test, and one-way ANOVA followed by Scheffee test. Results: There was no significant difference among the scores of hope in the three groups before the intervention (P=0.40). However, after the intervention, the level of hope in the self care education group and self care education plus telephone follow-up groups were significantly higher than that of the control group (P=0.001). Moreover, the level of hope in the group with self care education plus telephone follow-up was significantly (P=0.001) more than that of the self care education group. Conclusion: Our findings indicated that teaching followed by telephone follow-up was associated with higher levels of hope. Therefore, such a strategy may be employed to improve the quality of life of patients with renal dialysis. Trial Registration Number: IRCT2014042617440N1 PMID:27382592

  18. Personalised long-term follow-up of cochlear implant patients using remote care, compared with those on the standard care pathway: study protocol for a feasibility randomised controlled trial

    PubMed Central

    Kitterick, Padraig; DeBold, Lisa; Weal, Mark; Clarke, Nicholas; Newberry, Eva; Aubert, Lisa

    2016-01-01

    Introduction Many resources are required to provide postoperative care to patients who receive a cochlear implant. The implant service commits to lifetime follow-up. The patient commits to regular adjustment and rehabilitation appointments in the first year and annual follow-up appointments thereafter. Offering remote follow-up may result in more stable hearing, reduced patient travel expense, time and disruption, more empowered patients, greater equality in service delivery and more freedom to optimise the allocation of clinic resources. Methods and analysis This will be a two-arm feasibility randomised controlled trial (RCT) involving 60 adults using cochlear implants with at least 6 months device experience in a 6-month clinical trial of remote care. This project will design, implement and evaluate a person-centred long-term follow-up pathway for people using cochlear implants offering a triple approach of remote and self-monitoring, self-adjustment of device and a personalised online support tool for home speech recognition testing, information, self-rehabilitation, advice, equipment training and troubleshooting. The main outcome measure is patient activation. Secondary outcomes are stability and quality of hearing, stability of quality of life, clinic resources, patient and clinician experience, and any adverse events associated with remote care. We will examine the acceptability of remote care to service users and clinicians, the willingness of participants to be randomised, and attrition rates. We will estimate numbers required to plan a fully powered RCT. Ethics and dissemination Ethical approval was received from North West—Greater Manchester South Research Ethics Committee (15/NW/0860) and the University of Southampton Research Governance Office (ERGO 15329). Results Results will be disseminated in the clinical and scientific communities and also to the patient population via peer-reviewed research publications both online and in print, conference and

  19. A comparative study of two various models of organising diabetes follow-up in public primary health care – the model influences the use of services, their quality and costs

    PubMed Central

    2014-01-01

    Background In Finland diabetologists have long been concerned about the level of diabetes care as the incidence of type 1 diabetes and complicated type 2 diabetes is exceeding the capacity of specialist clinics. We compared the outcome of diabetes care in two middle-sized Finnish municipalities with different models of diabetes care organisation in public primary health care. In Kouvola the primary health care of all diabetic patients is based on general practitioners, whereas in Nurmijärvi the follow-up of type 1 and most complicated type 2 diabetic patients is assigned to a general practitioner specialised in diabetes care. Methods Our study population consisted of all adult diabetic patients living in the municipalities under review. We compared the use and costs of public diabetes care, glycemic control, blood pressure, LDL-cholesterol level, the application of the national guidelines and patient satisfaction. The main outcome measures were the costs and use of health care services due to diabetes and its complications. Results In Nurmijärvi, where diabetes care was centralised, more type 1 diabetic patients were followed up in primary health care than in Kouvola, where general practitioners need more specialist consultations. The centralisation resulted in cost savings in the diabetes care of type 1 diabetic patients. Although the quality of care was similar, type 1 diabetic patients were more satisfied with their follow-up in the centralised system. In the care of type 2 diabetic patients the centralised system required fewer specialist consultations, but the quality and costs were similar in both models. Conclusions The follow-up of most diabetic patients – including type 1 diabetes – can be organised in primary health care with the same quality as in secondary care units. The centralised primary care of type 1 diabetes is less costly and requires fewer specialist consultations. PMID:24444378

  20. Why do some hospitals achieve better care of severely malnourished children than others? Five-year follow-up of rural hospitals in Eastern Cape, South Africa.

    PubMed

    Puoane, Thandi; Cuming, Katie; Sanders, David; Ashworth, Ann

    2008-11-01

    Staff at 11 rural hospitals in an under-resourced region of Eastern Cape Province, South Africa, participated in an intervention to improve the quality of care of severely malnourished children through training and support aimed at implementing the WHO case-management guidelines. Despite similar intervention inputs, some hospitals reduced their case-fatality rates by at least half, whereas others did not. The aim of this study was to investigate reasons for this disparity. Two successful and two poorly performing hospitals were purposively selected based on their case-fatality rates, which were <10% in the successful hospitals and >30% in those performing poorly. Comparative data were collected during June to October 2004 through structured observations of ward procedures, compilation of hospital data on case-loads and resources, and staff interviews and discussions related to attitudes, teamwork, training, supervision, managerial support and leadership. The four study hospitals had broadly similar resources, infrastructure and child:nurse ratios, and all had made changes to their clinical and dietary management following training. Case-management was broadly in line with WHO guidelines but the study revealed clear differences in institutional culture which influenced quality of care. Staff in the successful hospitals were more attentive and assiduous than staff in the poorly performing hospitals, especially in relation to rehydration procedures, feeding and the recording of vital signs. There was a strong emphasis on in-service training and induction of incoming staff in the successful hospitals and better supervision of junior staff and carers. Nurses had more positive attitudes towards malnourished children and their carers, and were less judgmental. Underlying factors were differences in leadership, teamwork, and managerial supervision and support. We conclude that unless there are supportive structures at managerial level, the potential benefits of efficacious

  1. Evaluation of a PICC care training programme.

    PubMed

    Purran, Ashutosh; Weller, Gordon; Kerr, Catherine

    2016-01-13

    An integrated care organisation requires a flexible workforce with a variable skill mix in all care settings. Organisations should ensure that education and training are maintained to support safe, high quality care that provides value for money, promotes flexibility, and increases workforce participation in achieving organisation objectives and the expansion of services. Peripherally inserted central catheter (PICC) care was identified as a challenging area for the nursing workforce in acute care and community services, following the integration and service enlargement of the Whittington Health NHS Trust. This article describes the evaluation of a new PICC care training programme that was developed and implemented to increase knowledge and awareness. The evaluation provides the clinical education team with information to help identify additional training needs to facilitate the integration of care. PMID:26758168

  2. Pain-related avoidance versus endurance in primary care patients with subacute back pain: psychological characteristics and outcome at a 6-month follow-up.

    PubMed

    Hasenbring, Monika I; Hallner, Dirk; Klasen, Bernhard; Streitlein-Böhme, Irmgard; Willburger, Roland; Rusche, Herbert

    2012-01-01

    Recent research has found individual differences in back pain patients due to behavioral avoidance vs persistence. However, there is a lack of prospective studies of nonspecific low back pain patients. The avoidance-endurance model (AEM) suggests at least 3 pathways leading to chronic pain: fear-avoidance response, distress-endurance response, and eustress-endurance response. We sought to compare these 3 maladaptive subgroups with an adaptive group using a classification tool that included the following scales: the thought suppression and behavioral endurance subscale of the Avoidance-Endurance Questionnaire and the Beck Depression Inventory. The psychological characteristics, and pain and disability of the AEM subgroups were investigated. We report results from 177 patients with subacute nonspecific low back pain at the start of outpatient treatment and at follow-up after 6 months. At baseline, a multivariate analysis of variance found that the fear-avoidance patients scored higher in pain catastrophizing than the other groups. The distress-endurance patients displayed elevated anxiety/depression and helplessness/hopelessness accompanied with the highest scores in the classification variables thought suppression and persistence behavior. The eustress-endurance patients had the highest humor/distraction scores, pain persistence, and positive mood despite pain. All 3 maladaptive groups revealed a higher pain intensity than the adaptive patients at follow-up after 6 months; however, disability at follow-up was elevated only in the fear-avoidance and distress-endurance patients. The study provides preliminary evidence for the construct and prospective validity of AEM-based subgroups of subacute, nonspecific back pain patients. The results suggest the need for individually targeted cognitive behavioral treatments in the maladaptive groups. PMID:22093816

  3. Attitudes towards mental illness among health care students at Swedish universities--a follow-up study after completed clinical placement.

    PubMed

    Markström, Urban; Gyllensten, Amanda Lundvik; Bejerholm, Ulrika; Björkman, Tommy; Brunt, David; Hansson, Lars; Leufstadius, Christel; Sandlund, Mikael; Svensson, Bengt; Ostman, Margareta; Eklund, Mona

    2009-08-01

    The aim of the study was to examine the changes in attitudes towards mental illness after theoretical education and clinical placement among students from university programmes preparing for different kinds of health professions. Three different questionnaires were used, measuring the level of familiarity with mental illness and attitudes towards mental illness in general and towards specific mental illnesses. The data were collected on two occasions, before the theoretical course and after the completed clinical placement. The result showed that the attitudes toward mental illness in general had changed in a less stigmatising direction after the clinical placement. On the other hand, attitudes toward specific mental illnesses did not show any major changes. A conclusion is that the clinical placement included in the university programmes to some extent could affect attitudes in a de-stigmatizing direction, possibly because of the interaction with persons suffering from mental illness and experienced supervisors. PMID:19286287

  4. A randomised clinical trial on a comprehensive geriatric assessment and intensive home follow-up after hospital discharge: the Transitional Care Bridge

    PubMed Central

    2010-01-01

    Background Older patients are at high risk for poor outcomes after acute hospital admission. The mortality rate in these patients is approximately 20%, whereas 30% of the survivors decline in their level of activities of daily living (ADL) functioning three months after hospital discharge. Most diseases and geriatric conditions that contribute to poor outcomes could be subject to pro-active intervention; not only during hospitalization, but also after discharge. This paper presents the design of a randomised controlled clinical trial concerning the effect of a pro-active, multi-component, nurse-led transitional care program following patients for six months after hospital admission. Methods/Design Three hospitals in the Netherlands will participate in the multi-centre, double-blind, randomised clinical trial comparing a pro-active multi-component nurse-led transitional care program to usual care after discharge. All patients acutely admitted to the Department of Internal Medicine who are 65 years and older, hospitalised for at least 48 hours and are at risk for functional decline are invited to participate in the study. All patients will receive integrated geriatric care by a geriatric consultation team during hospital admission. Randomization, which will be stratified by study site and cognitive impairment, will be conducted during admission. The intervention group will receive the transitional care bridge program, consisting of a handover moment with a community care Care Nurse (CN) during hospital admission and five home visits after discharge. The control group will receive 'care as usual' after discharge. The main outcome is the level of ADL functioning six months after discharge compared to premorbid functioning measured with the Katz ADL index. Secondary outcomes include; survival, cognitive functioning, quality of life, and health care utilization, satisfaction of the patient and primary care giver with the transitional care bridge program. All outcomes

  5. Mortality in eating disorders: a follow-up study of adult eating disorder patients treated in tertiary care, 1995-2010.

    PubMed

    Suokas, Jaana T; Suvisaari, Jaana M; Gissler, Mika; Löfman, Rasmus; Linna, Milla S; Raevuori, Anu; Haukka, Jari

    2013-12-30

    Elevated mortality risk in anorexia nervosa has been established, but less is known about the outcomes of bulimia nervosa and binge eating disorder. In this follow-up study we determined mortality in adults (N=2450, 95% women) admitted to the eating disorder clinic of the Helsinki University Central Hospital in the period 1995-2010. Most of the patients (80.7%) were outpatients. For each patient four controls were selected and matched for age, sex and place of residence. The matching was taken into account by modelling end-point events using Cox's proportional hazard model. The hazard ratio (HR) for all-cause mortality was 6.51 (95% CI 3.46-12.26) in broad anorexia nervosa (AN), 2.97 (95% CI 1.90-4.65) in broad bulimia nervosa (BN), and 1.77 (95% CI 0.60-5.27) in binge eating disorder (BED). Mortality risk in broad AN was highest during the first years after admission but declined thereafter, while in broad BN the mortality risk started to rise two years after the first admission. The HR for suicide was elevated both in broad AN (HR 5.07; 95% CI 1.37-18.84) and in broad BN (HR 6.07; 95% CI 2.47-14.89). Results show that eating disorders are associated with increased mortality risk even when specialised treatment is available. PMID:23958333

  6. Normalization of EEG activity among previously institutionalized children placed into foster care: A 12-year follow-up of the Bucharest Early Intervention Project.

    PubMed

    Vanderwert, Ross E; Zeanah, Charles H; Fox, Nathan A; Nelson, Charles A

    2016-02-01

    Extreme social and cognitive deprivation as a result of institutional care has profound effects on developmental outcomes across multiple domains for many abandoned or orphaned children. The Bucharest Early Intervention Project (BEIP) examines the outcomes for children originally placed in institutions who were assessed comprehensively and then randomized to foster care (FCG) or care as usual (CAUG) and followed longitudinally. Here we report on the brain electrical activity (electroencephalogram: EEG) of 12-year-old children enrolled in the BEIP. Previous reports suggested improvement in resting EEG activity for the group of children placed in the foster care intervention, particularly those placed before 24 months of age compared to children who were randomized to CAUG or those placed into families after this age. At 12 years, differences between those in the FCG and those in the CAUG persist in the alpha band (8-13 Hz), but not in higher frequency bands (i.e. in the beta band; 15-30 Hz), except in those children placed into the FCG who remained in high quality care environments over the course of the study. These findings highlight the importance of maintaining a stable high quality caregiving environment, particularly for children exposed to early psychosocial deprivation, for promoting healthy brain development. PMID:26724564

  7. A Five-year Follow-up of Quality of Life in Women with Breast Cancer in Anthroposophic and Conventional Care

    PubMed Central

    Carlsson, Marianne; Arman, Maria; Backman, Marie; Flatters, Ursula; Hatschek, Thomas; Hamrin, Elisabeth

    2006-01-01

    Complementary and alternative medicine is used by many cancer patients in most parts of the world, and its use is increasing. The aim of the present study was to examine, over 5 years, the perceived quality of life/life satisfaction in two samples of women with breast cancer who were treated with anthroposophic care or conventional medical treatment only. Data from admission, after 1 year and after 5 years are used for the comparisons. On admission to the study the women in anthroposophic care perceived their quality of life to be lower than that of the women in the conventional treatment group, especially for emotional, cognitive and social functioning and overall quality of life. Sixty women who actively chose treatment with anthroposophic medicine and 60 individually matched women treated with conventional medicine participated. Quality of life was measured by the EORTC QLQ-C30 and the Life Satisfaction Questionnaire. Twenty-six women within anthroposophic care and 31 women within conventional medicine survived the 5 years. Effect size (ES) estimation favored the anthroposophic group in seven of the subscales mostly measuring emotional functioning. The ES for four of the subscales favored the conventional treatment group, mostly concerning physical functioning. After 5 years there were improvements in overall quality of life and in emotional and social functioning compared to admission for the women in anthroposophic care. The improvements took place between admission and 1 year, but not further on. Only minor improvements were found in the matching group. PMID:17173117

  8. Effectiveness of Cognitive-Behavioral Treatment for Panic Disorder Versus Treatment as Usual in a Managed Care Setting: 2-Year Follow-Up

    ERIC Educational Resources Information Center

    Addis, Michael E.; Hatgis, Christina; Cardemil, Esteban; Jacob, Karen; Krasnow, Aaron D.; Mansfield, Abigail

    2006-01-01

    Eighty clients meeting criteria for panic disorder and receiving either panic control therapy (PCT; M. G. Craske, E. Meadows, & D. H. Barlow, 1994) or treatment as usual (TAU) in a managed care setting were assessed 1 and 2 years following acute treatment. PCT was provided by therapists with little or no previous exposure to cognitive-behavioral…

  9. A Follow Up Study of Children with Get Set Day Care and Prekindergarten Head Start Experience Who Enrolled in the School District of Philadelphia, Fall, 1978 & 1980.

    ERIC Educational Resources Information Center

    Asano, Mildred M.

    The subsequent school progress of children who attended the Get Set Day Care (GSDC) or Prekindergarten Head Start (PKHS) preschool programs compared to peers who had a different type or no preschool experience is examined in this document. The study corroborates the two major findings of the Consortium for Longitudinal Studies: that preschool…

  10. Substance Use and Delinquency among Middle School Girls in Foster Care: A Three-Year Follow-Up of a Randomized Controlled Trial

    ERIC Educational Resources Information Center

    Kim, Hyoun K.; Leve, Leslie D.

    2011-01-01

    Objective: The present study evaluated the efficacy of the Middle School Success intervention (MSS) for reducing substance use and delinquency among girls in foster care, using a randomized controlled trial design. The program was designed to fill a service gap during the summer prior to the middle school transition and to prevent delinquency,…

  11. Follow-up of permanent hearing impairment in childhood.

    PubMed

    Della Volpe, A; De Lucia, A; Pastore, V; Bracci Laudiero, L; Buonissimo, I; Ricci, G

    2016-02-01

    Programmes for early childhood childhood hearing impairment identification allows to quickly start the appropriate hearing aid fitting and rehabilitation process; nevertheless, a large number of patients do not join the treatment program. The goal of this article is to present the results of a strategic review of the strengths, weaknesses, opportunities and threats connected with the audiologic/prosthetic/language follow-up process of children with bilateral permanent hearing impairment. Involving small children, the follow-up includes the involvement of specialised professionals of a multidisciplinary team and a complex and prolonged multi-faced management. Within the framework of the Italian Ministry of Health project CCM 2013 "Preventing Communication Disorders: a Regional Program for Early Identification, Intervention and Care of Hearing Impaired Children", the purpose of this analysis was to propose recommendations that can harmonise criteria for outcome evaluation and provide guidance on the most appropriate assessment methods to be used in the follow-up course of children with permanent hearing impairment. PMID:27054392

  12. Sudan: national health programme and primary health care 1977/78-1983/84

    PubMed Central

    Idriss, A. A.; Lolik, P.; Khan, R. A.; Benyoussef, A.

    1976-01-01

    As a follow-up to the national health programming process developed in 1975 in Sudan, a primary health care programme for the whole country was formulated with assistance from WHO. In this article the methods used in the programming and formulation are described and discussed. These methods ensured an intersectoral approach on which technical, cultural, socioeconomic, financial, and political considerations were based. Areas in the field of health and rural development requiring government and community action during the period 1977/78-1983/84 are identified. Details on the strategies for population coverage of rural and nomadic communities with primary health care are given. Fundamental to these strategies is community participation in the development of primary health care within community development as a whole. The guiding principles of these strategies are their technical, political, social and financial feasibility. The social relevance of the primary health care programme for the community and the developmental sectors is emphasized. PMID:1086739

  13. From hospice to hospital: short-term follow-up study of hospice patient outcomes in a US acute care hospital surveillance system

    PubMed Central

    Pathak, Elizabeth Barnett; Wieten, Sarah; Djulbegovic, Benjamin

    2014-01-01

    Objectives In the USA, there is little systematic evidence about the real-world trajectories of patient medical care after hospice enrolment. The objective of this study was to analyse predictors of the length of stay for hospice patients who were admitted to hospital in a retrospective analysis of the mandatorily reported hospital discharge data. Setting All acute-care hospitals in Florida during 1 January 2010 to 30 June 2012. Participants All patients with source of admission coded as ‘hospice’ (n=2674). Primary outcome measures The length of stay and discharge status: (1) died in hospital; (2) discharged back to hospice; (3) discharged to another healthcare facility; and (4) discharged home. Results Patients were elderly (median age=81) with a high burden of disease. Almost half died (46%), while the majority of survivors were discharged to hospice (80% of survivors, 44% of total). A minority went to a healthcare facility (5.6%) or to home (5.2%). Only 9.2% received any procedure. Respiratory services were received by 29.4% and 16.8% were admitted to the intensive care unit. The median length of stay was 1 day for those who died. In an adjusted survival model, discharge to a healthcare facility resulted in a 74% longer hospital stay compared with discharge to hospice (event time ratio (ETR)=1.74, 95% CI 1.54 to 1.97 p<0.0001), with 61% longer hospital stays among patients discharged home (ETR=1.61, 95% CI 1.39 to 1.86 p<0.0001). Total financial charges for all patients exceeded $25 million; 10% of patients who appeared to exit hospice incurred 32% of the charges. Conclusions Our results raise significant questions about the ethics and pragmatics of end-of-life medical care, and the intentions and scope of hospices in the USA. Future studies should incorporate prospective linkage of subjective patient-centred data and objective healthcare encounter data. PMID:25052170

  14. Survivorship care planning and its influence on long-term patient-reported outcomes among colorectal and lung cancer survivors: The CanCORS disease-free survivor follow-up study

    PubMed Central

    Chrischilles, Elizabeth A.; McDowell, Bradley D.; Rubenstein, Linda; Charlton, Mary; Pendergast, Jane; Juarez, Grelda Yazmin; Arora, Neeraj K.

    2014-01-01

    PURPOSE Evaluate the relationship between survivorship care planning (SCP) and survivorship care and health outcomes reported by long-term lung and colorectal cancer survivors. METHODS Participants (n=832) were diagnosed and enrolled during 2003-2005. In 2012, patient-reported outcomes (survivorship care and health outcomes) and two patient-reported SCP measures (receipt of written summary of cancer treatment and receipt of instructions on who to see for routine cancer follow-up) were collected. Analyses controlled for SCP predictors collected from medical records and an interview 1 year after diagnosis. RESULTS One-in-four survivors reported receiving both SCP elements. Those receiving both were more certain which doctor was in charge (OR 7.0; 95% CI 3.9-12.5), more likely to report follow-up check-ups (OR 5.1; 95% CI 3.3-8.0) and had an MRI/PET/CT scan in the past 2 years (OR 2.8; 95% CI 1.7-4.7) compared to those receiving neither. Physician communication experiences were significantly more positive and having physical exams (OR 2.0; 95% CI 1.2-3.4) and meeting exercise guidelines (OR 1.6; 95% CI 1.004-2.4) more likely. Physical health (p=0.012) and good-to-excellent self-perceived health status (OR 2.2; 95% CI 1.3-3.9) were better for those receiving both elements. CONCLUSION SCP may lead to better cancer follow-up care, long-term physical health, and physician/patient communication experiences. IMPLICATIONS FOR CANCER SURVIVORS The positive association between outcomes and SCP suggest that efforts to implement SCP should be fruitful. PMID:25354481

  15. Five year report on the medical follow up of Marshallese receiving special medical care related to 1954 Bravo fallout radiation (January 1992--1996)

    SciTech Connect

    Vaswani, A.N.; Howard, J.E.

    1999-06-01

    This is the 17th and final report of the Marshall Islands Medical Program as carried out by the Brookhaven National Laboratory (BNL). The purpose of these publications has been to provide information on the medical status of 253 Marshallese exposed to radiation fallout in 1954. The medical program fulfills a commitment to disclose unique medical information relevant to public health. Details of the Bravo thermonuclear accident that caused the exposure have been published. A 1955 article in the Journal of the American Medical Association, which described the acute medical effects on the population that required special medical care, remains a definitive and relevant description of events. Marshallese participation in this Congressionally mandated program is voluntary. Throughout the 44 years of the program, each participating individual`s relevant medical findings, laboratory data, disease morbidity, and mortality have been published in the BNL reports in a manner preserving patient confidentiality. In each report, there has been an attempt to interpret these findings and to infer the role of radiation exposure in their development. An equally important aspect of the reports has been the presentation of data that allows for analyses of the medical consequences of the Marshallese exposure.

  16. Follow-Up Study of Complicated Grief among Parents Eighteen Months after a Child's Death in the Pediatric Intensive Care Unit

    PubMed Central

    Shear, Katherine; Newth, Christopher J.L.; Harrison, Rick; Berger, John; Zimmerman, Jerry; Anand, K.J.S.; Carcillo, Joseph; Donaldson, Amy E.; Dean, J. Michael; Willson, Douglas F.; Nicholson, Carol

    2011-01-01

    Abstract Objective We previously demonstrated that parents whose children die in a pediatric intensive care unit (PICU) have a high level of complicated grief symptoms 6 months after the death. In this study, we investigate the change in the extent of complicated grief symptoms among these parents between 6 and 18 months postdeath and identify factors predicting improvement. Methods One hundred thirty-eight parents of 106 children completed surveys at 6 and 18 months. Surveys included the Inventory of Complicated Grief (ICG), measures of grief avoidance, attachment, caregiving and social support, and demographics. Multivariable analysis was performed using generalized estimating equations to identify characteristics independently associated with improvement in ICG score. Results ICG scores were 33.4 ± 13.6 at 6 months and 28.0 ± 13.5 at 18 months, representing an improvement in ICG score of 5.4 + 8.0 (95% confidence interval [CI] 4.1–6.8, p < 0.001). Variables independently associated with greater improvement in ICG score included traumatic death and greater grief avoidance. Variables independently associated with less improvement included being the biological parent and having more responsive caregiving. Parents with one or two surviving children had more improvement in ICG score than those with no surviving children whereas parents with three or more surviving children had less improvement. Conclusion Complicated grief symptoms decrease among parents between 6 and 18 months after their child's death in the PICU; however, high symptom levels persists for some. Better understanding of the trajectory of complicated grief will allow parents at risk for persistent distress to receive professional support. PMID:21281122

  17. Hyper Cold Systems follow up

    NASA Astrophysics Data System (ADS)

    Berges, Jean Claude; Beltrando, Gerard; Cacault, Philippe

    2016-04-01

    The follow up of intense precipitation system is a key information for climate studies. Whereas some rainfall measurement series cover more than one century they cannot retrieve these phenomena in their spatial and temporal continuity. The geostationary satellite data offer a good trade-off between the length of data series and the retrieval accuracy. However a difficulty arise from ambiguous interpretation of the lone infrared signal in nephanalysis. Hence the tropopause temperature is used as a proxy to characterize extreme precipitation event. That does not mean that the more intense rain-rate will be always collocated with the coldest temperature but that most of these intense events is produced by systems whose a part is colder than tropopause. Computations have been carried out on 38 months of MSG and Meteosat/IODC. System follow up is achieved by a simple 3D connexity algorithm, the time being considered as the third dimension. This algorithm produce three dimension clusters from where the main system parameters can be easily extracted. Thus the systems can be classified trajectory characteristic (duration, speed ans size variation). A drawback of this simple threshold method relies is some over-segmentation. In most of case the bias is minor as unconnected clusters are small and short-lived. However an aggregating algorithm have been developed to retrieve the most complex system trajectories. To assess the efficiency of this method three regional studies are displayed: the North African Maghreb, the West African Sahel and the Indian Ocean. On Maghreb, the location of system initialization shows a dramatic difference between the eastern and western parts. Whereas in Tunisia a significant part of these systems are generated on sea and most have no clear relation with relief, the Morocco is mainly characterized with land initiated system with a strong orographic effect on system triggering. Another difference relies on the low level wind shear impact which

  18. Handgrip strength, quadriceps muscle power, and optimal shortening velocity roles in maintaining functional abilities in older adults living in a long-term care home: a 1-year follow-up study

    PubMed Central

    Kozicka, Izabela; Kostka, Tomasz

    2016-01-01

    Purpose To assess the relative role of handgrip strength (HGS), quadriceps muscle power (Pmax), and optimal shortening velocity (υopt) in maintaining functional abilities (FAs) in older adults living in a long-term care home over a 1-year follow-up. Subjects and methods Forty-one inactive older institutionalized adults aged 69.8±9.0 years participated in this study. HGS, Pmax, υopt, cognitive function using the Mini-Mental State Examination, depressive symptoms using the Geriatric Depression Scale, nutritional status using the Mini Nutritional Assessment (MNA), and physical activity (PA) using the Seven-Day Physical Activity Recall Questionnaire were assessed at baseline and at 1-year follow-up. FAs were assessed with activities of daily living (ADL), instrumental ADL, and Timed Up & Go test. Results Both at baseline and at follow-up, FAs were related to age, HGS, Pmax/kg, υopt, MNA, and PA. These associations were generally similar in both sexes. As revealed in multiple regression analysis, υopt was the strongest predictor of FA, followed by Pmax/kg, PA, and MNA. FA deteriorated after 1 year as measured by ADL and Timed Up & Go test. Pmax and υopt, but not HGS, also decreased significantly after 1 year. Nevertheless, 1-year changes in FAs were not related to changes in HGS, Pmax, υopt, or PA. Conclusion The 1-year period of physical inactivity among older institutionalized adults was found to have a negative effect on their FAs, Pmax, and υopt. The present study demonstrates that Pmax and, especially, υopt correlated with FAs of older adults more than HGS, both at baseline and at follow-up. Despite this, 1-year natural fluctuations of PA, Pmax, and υopt are not significant enough to influence FAs in inactive institutionalized older adults. PMID:27307720

  19. Follow-up Care After Cancer Treatment

    MedlinePlus

    ... Resources NCI Grants Management Legal Requirements NCI Grant Policies Grants Management Contacts Training Cancer Training at NCI Funding for ... Closeout NCI Grants Management Legal Requirements NCI Grant Policies Grant Management Contacts Other Funding Find NCI funding for small ...

  20. Long-term follow-up of moderately hypercholesterolemic hypertensive patients following randomization to pravastatin vs. usual care: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT)

    PubMed Central

    Margolis, Karen L.; Davis, Barry R.; Baimbridge, Charles; Ciocon, Jerry O.; Cuyjet, Aloysius B.; Dart, Richard A.; Einhorn, Paula T.; Ford, Charles E.; Gordon, David; Hartney, Thomas J; Haywood, L. Julian; Holtzman, Jordan; Mathis, David E.; Oparil, Suzanne; Probstfield, Jeffrey L.; Simpson, Lara M.; Stokes, John D.; Wiegmann, Thomas B.; Williamson, Jeff D.

    2015-01-01

    A randomized, controlled, multicenter trial assigned well-controlled hypertensive participants ≥55 years, with moderate hypercholesterolemia to receive pravastatin (n=5170) or usual care (n=5185) for 4-8 years, when trial therapy was discontinued. Passive surveillance using national databases to ascertain deaths and hospitalizations continued for total follow-up of 8-13 years to assess whether mortality and morbidity differences persisted or new differences developed. During the post-trial period, fatal and nonfatal outcomes were available for 98% and 64% of participants, respectively. Primary outcome was all-cause mortality; secondary outcomes included cardiovascular mortality, coronary heart disease (CHD), stroke, heart failure, cardiovascular disease, and end-stage renal disease. No significant differences appeared in mortality for pravastatin versus usual care (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.89-1.03), or other secondary outcomes. Similar to the previously reported in-trial result, there was a significant treatment effect for CHD in Blacks (HR, 0.79; 95% CI, 0.64-0.98). However, the in-trial result showing a significant treatment by race effect did not remain significant over the entire follow-up (P=.08). These findings are consistent with evidence from other large trials that show statins prevent CHD and add evidence that they are effective for CHD prevention in Blacks. PMID:23889716

  1. Operation: Migrant Follow-Up.

    ERIC Educational Resources Information Center

    Hamlin, Thomas M.

    In an effort to discover the number of migrant children that leave the migrant stream and enter the urban area of Rochester, New York, the State University College at Geneseo, New York, sponsored this 1968-69 study. The purpose was to determine if the migrant child is adequately cared for when he enters the urban area and if the educational…

  2. Predictive values and other quality criteria of the German version of the Nurse-Work Instability Scale (Nurse-WIS) – follow-up survey findings of a prospective study of a cohort of geriatric care workers

    PubMed Central

    2014-01-01

    Background Until now there has been a lack of effective screening instruments for health care workers at risk. To counteract the forecast shortage for health care workers, the offer of early interventions to maintain their work ability will become a central concern. The Nurse-Work Instability Scale (Nurse-WIS) seems to be suitable as a screening instrument and therefore a prospective study of a cohort of nursing staff from nursing homes was undertaken to validate the Nurse-Work Instability Scale (Nurse-WIS). Methods The follow-up data was used to test the sensitivity, specificity and the predictive values of the Nurse-WIS. The participants answered a questionnaire in the baseline investigation (T1) and in a follow-up 12 month after baseline. The hypothesis was that geriatric care workers with an increased risk according to the Nurse-WIS in T1 would be more likely to have taken long-term sick leave or drawn a pension for reduced work capacity in T2. Results 396 persons took part in T1 (21.3% response), 225 in T2 (42.3% loss-to-follow-up). In T1, 28.4% indicated an increased risk according to the Nurse-WIS. In T2, 10.2% had taken long-term sick leave or had drawn a pension for reduced work capacity. The sensitivity is 73.9% (95%-CI 55.7%–92.3%), the specificity is 76.7% (95%-CI 71.2%–82.8%). The ROC AUC indicated a moderate precision for the scale, at 0.74 (95%-CI 0.64–0.84). The PPV of the Nurse-WIS is 26.6%, and the NPV is 96.3%. For those with an increased risk according to the Nurse-WIS, the probability in T2 of long-term sick leave or a pension for reduced work capacity is around eight times higher (OR 8.3, 95%-CI 2.90–23.07). Persons who had indicated a long-term sick leave or made an application for a pension for reduced work capacity in T1 had a 17 times higher risk (OR 17.4, 95%-CI 3.34–90.55). Conclusion The German version of the Nurse-WIS appears to be a valid instrument with satisfactory predictive capabilities for recording an impending long

  3. The Majority of the Pre-Antiretroviral Population Who Were Lost to Follow-Up Stopped Their Care in Freetown, Sierra Leone: A 12-Month Prospective Cohort Study Starting with HIV Diagnosis

    PubMed Central

    Kelly, J. Daniel; Schlough, Gabriel Warren; Conteh, Sulaiman; Barrie, M. Bailor; Kargbo, Brima; Giordano, Thomas P.

    2016-01-01

    Background The heterogeneity of the pre-antiretroviral (pre-ART) population calls for more granular depictions of the cascade of HIV care. Methods We studied a prospective cohort of persons newly diagnosed with HIV infection from a single center in Freetown, Sierra Leone, over a 12-month period and then traced those persons who were lost to follow-up (LTFU) during pre-ART care (before ART initiation). ART eligibility was based on a CD4 cell count result of ≤ 350 mm/cells and/or WHO clinical stage 3 or 4. Persons who attended an appointment in the final three months were considered to be retained in care. Adherence to ART was measured using pharmacy refill dates. “Effective HIV care” was defined as completion of the cascade of care at 12-months regardless of whether patients are on ART. Tracing outcomes were obtained for those who were LTFU during pre-ART care. Results 408 persons newly diagnosed with HIV infection were screened, 338 were enrolled, and 255 persons were staged for ART. ART-ineligible persons had higher retention rates than ART-eligible persons (59.6% vs 41.8%, p = 0.03). 77 (22.8%) of 338 persons received effective HIV care. Most attrition (61.9%) occurred with persons during pre-ART care. 123 of 138 persons (89.1%) who were LTFU prior to ART initiation were found, and 91 of those 123 (74.0%) were alive. Of the 74 persons who were alive and described their engagement in care, 40 (54.1%) stopped care. Nearly half (42.5%) of those 40 stopped after assessment of ART-eligibility but before ART initiation. The main limitation of this study was the lack of tracing outcomes for those lost during ART care. Conclusions The majority of the pre-ART LTFU population stopped their care, particularly after ART-eligibility but before ART initiation. Interventions to hasten ART initiation and retain this at-risk group may have significant downstream impact on effective HIV care. PMID:26901765

  4. The magnitude of loss to follow-up of HIV-exposed infants along the prevention of mother-to-child HIV transmission continuum of care: a systematic review and meta-analysis

    PubMed Central

    Sibanda, Euphemia L.; Weller, Ian V.D.; Hakim, James G.; Cowan, Frances M.

    2013-01-01

    Introduction: Although prevention of mother-to-child HIV transmission (PMTCT) programs are widely implemented, many children do not benefit from them because of loss to follow-up (LTFU). We conducted a systematic review to determine the magnitude of infant/baby LTFU along the PMTCT cascade. Methods: Eligible publications reported infant LTFU outcomes from standard care PMTCT programs (not intervention studies) at any stage of the cascade. Literature searches were conducted in Medline, Embase, Web of Knowledge, CINAHL Plus, and Maternity and Infant Care. Extracted data included setting, methods of follow-up, PMTCT regimens, and proportion and timing of LTFU. For programs in sub-Saharan Africa, random-effects meta-analysis was done using Stata v10. Because of heterogeneity, predictive intervals (PrIs; approximate 95% confidence intervals of a future study based on extent of observed heterogeneity) were computed. Results: A total of 826 papers were identified; 25 publications were eligible. Studies were published from 2001 to 2012 and were mostly from sub-Saharan Africa (three were from India, one from UK and one from Ireland). There was extensive heterogeneity in findings. Eight studies reported on LTFU of pregnant HIV-positive women between antenatal care (ANC) registration and delivery, which ranged from 10.9 to 68.1%, pooled proportion 49.08% [95% confidence interval (CI) 39.6–60.9%], and PrI 22.0–100%. Fourteen studies reported LTFU of infants within 3 months of delivery, range 4.8–75%, pooled proportion 33.9% (27.6–41.5), and PrI 15.4–74.2. Children were also lost after HIV testing; this was reported in five studies, pooled estimate 45.5% (35.9–57.6), PrI 18.7–100%. Programs that actively tracked defaulters had better retention outcomes. Conclusion: There is unacceptable infant LTFU from PMTCT programs. Countries should incorporate defaulter-tracking as standard to improve retention. PMID:24056068

  5. The 'Walking for Wellbeing in the West' randomised controlled trial of a pedometer-based walking programme in combination with physical activity consultation with 12 month follow-up: rationale and study design

    PubMed Central

    Fitzsimons, Claire F; Baker, Graham; Wright, Annemarie; Nimmo, Myra A; Ward Thompson, Catharine; Lowry, Ruth; Millington, Catherine; Shaw, Rebecca; Fenwick, Elisabeth; Ogilvie, David; Inchley, Joanna; Foster, Charlie E; Mutrie, Nanette

    2008-01-01

    Background Scotland has a policy aimed at increasing physical activity levels in the population, but evidence on how to achieve this is still developing. Studies that focus on encouraging real world participants to start physical activity in their settings are needed. The Walking for Well-being in the West study was designed to assess the effectiveness of a pedometer-based walking programme in combination with physical activity consultation. The study was multi-disciplinary and based in the community. Walking for Well-being in the West investigated whether Scottish men and women, who were not achieving the current physical activity recommendation, increased and maintained walking behaviour over a 12 month period. This paper outlines the rationale and design of this innovative and pragmatic study. Methods Participants were randomised into two groups: Group 1: Intervention (pedometer-based walking programme combined with a series of physical activity consultations); Group 2: Waiting list control for 12 weeks (followed by minimal pedometer-based intervention). Physical activity (primary outcome) was measured using pedometer step counts (7 day) and the International Physical Activity Questionnaire (long version). Psychological processes were measured using questionnaires relating to the Transtheoretical Model of Behaviour Change, mood (Positive and Negative Affect Schedule) and quality of life (Euroqol EQ-5D instrument). Physiological measures included anthropometric and metabolic outcomes. Environmental influences were assessed subjectively (Neighbourhood Quality of Life Survey) and objectively (neighbourhood audit tool and GIS mapping). The qualitative evaluation employed observation, semi-structured interviews and focus groups. A supplementary study undertook an economic evaluation. Discussion Data analysis is on-going. Walking for Well-being in the West will demonstrate if a pedometer based walking programme, in combination with physical activity consultation

  6. Creating capacity through partnership: a palliative care skills development programme.

    PubMed

    Kelsall, Kay; Brennan, Ebony; Cole, Teresa

    2015-08-01

    This paper presents the development and implementation of a recurrently funded, rolling, 6-month palliative care secondment programme for NHS community staff nurses based in a rural health economy in Southwest England. The programme is a key tool in a wider development plan for improving access to, and the quality of, palliative and end-of-life care for a dispersed rural population. This is part of a much bigger programme of integration to meet the shared challenges of service capacity, equity, and sustainability that are presented by the geographical and demographical profile of the locality. The 'bigger picture' is defined and set in the context of the national drive and evidence base for integration in order to explain the reasons behind the secondment programme. This is followed by outlining the iterative process of design and implementation--the 'what?' and 'how?'--and key learning points to date are shared. PMID:26252232

  7. Implementation of Adolescent Family-Based Substance Use Prevention Programmes in Health Care Settings: Comparisons across Conditions and Programmes

    ERIC Educational Resources Information Center

    Aalborg, Annette E.; Miller, Brenda A.; Husson, Gail; Byrnes, Hilary F.; Bauman, Karl E.; Spoth, Richard L.

    2012-01-01

    Objective: To examine factors that influence the effectiveness and quality of implementation of evidence-based family-focused adolescent substance use prevention programmes delivered in health care settings and to assess the effects of programme choice versus programme assignment on programme delivery. Design: Strengthening Families Program: For…

  8. Follow-up Cost Study. TEX-SIS FOLLOW-UP SC5.

    ERIC Educational Resources Information Center

    Baugh, Ronald C.

    This report presents data on the costs of follow-up studies, based on 29 separate follow-up studies conducted by eight public community/junior colleges in Texas. The purpose of this study, conducted by Navarro College as a subcontractor of Project FOLLOW-UP, was to provide data and information regarding the cost of follow-up studies that would be…

  9. Francoise, a Fifteen-Year Follow Up.

    ERIC Educational Resources Information Center

    Rondal, J. A.; Elbouz, M.; Ylieff, M.; Docquier, L.

    2003-01-01

    This paper reports on a 15-year follow-up of the linguistic and cognitive profile of a woman with standard trisomy 21 (Down syndrome). The follow-up found recent rapid deterioration in receptive and productive language skills. However, basic phonological and morphosyntactic skills are preserved. Her changing profile mirrors that found in aging…

  10. Towards sustainability assessment follow-up

    SciTech Connect

    Morrison-Saunders, Angus; Pope, Jenny; Bond, Alan; Retief, Francois

    2014-02-15

    This paper conceptualises what sustainability assessment follow-up might entail for three models of sustainability assessment: EIA-driven integrated assessment, objectives-led integrated assessment and the contribution to sustainability model. The first two are characterised by proponent monitoring and evaluation of individual impacts and indicators while the latter takes a holistic view based around focused sustainability criteria relevant to the context. The implications of three sustainability challenges on follow-up are also examined: contested time horizons and value changes, trade-offs, and interdisciplinarity. We conclude that in order to meet these challenges some form of adaptive follow-up is necessary and that the contribution to sustainability approach is the best approach. -- Highlights: • We explore sustainability follow-up for three different sustainability models. • Long-time frames require adaptive follow-up and are a key follow-up challenge. • Other key challenges include interdisciplinarity, and trade-offs. • Sustainability follow-up should be a direction of travel and not an outcome. • Only the follow-up for contribution to sustainability model addresses sustainability challenges sufficiently.

  11. Neonatal Hearing Screening Programme (NHSP): At A Rural Based Tertiary Care Centre.

    PubMed

    Sharma, Yojana; Mishra, Girish; Bhatt, Sushen H; Nimbalkar, Somashekhar

    2015-12-01

    Deafness is the most common curable childhood handicap. It is a well recognised fact that unidentified hearing impairment can adversely affect optimal speech and language development and therefore academic, social and emotional development. Universal neonatal hearing screening programmes are implemented in many developed countries. However it is still in its early stage in India. The incidence of hearing impairment in India is 1-6 per thousand newborns screened (Paediatrics 19:155-165, 1998; Indian J Paediatr 74(6):545-549, 2007; Status of Disability in India, pp 172-185 2000). To determine the incidence of permanent hearing loss of moderate to evere variety in neonates taking care in a tertiary care rural based hospital in Gujarat. It was a non randomised observational study done for duration of 3 years. All neonates born in Shri Krishna Hospital underwent screening using two stage protocols with DPOAE test and final confirmation done with BERA. Total 2534 neonates were screened out of them 52 failed and 2482 (97.94 %) neonates passed in the 1st DPOAE test with 2.05 % refer rate. Total 7 (2 per 1000) neonates were detected with hearing impairment. 10 % neonates had one or other high risk factor. Out of high risk neonates, 1.8 % were diagnosed with hearing impairment in high risk group. Overall the follow-up rate was 72.7 %. Hospital based universal hearing screening of new born before discharge is feasible at a rural based tertiary care centre. Non specialist staff is invaluable in achieving a satisfactory referral rate with two stage hearing screening protocol. However, more efficacious tracking and follow up system is needed to improve the follow up rate for diagnosis. PMID:26693457

  12. Evaluating an outreach service for paediatric burns follow up.

    PubMed

    Cubitt, Jonathan J; Chesney, Amy; Brown, Liz; Nguyen, Dai Q

    2015-09-01

    Complications following paediatric burns are well documented and care needs to be taken to ensure the appropriate follow up of these patients. Historically this has meant follow up into adulthood however this is often not necessary. The centralisation of burns services in the UK means that patients and their parents may have to travel significant distances to receive this follow up care. To optimise our burns service we have introduced a burns outreach service to enable the patients to be treated closer to home. The aim of this study is to investigate the impact of the introduction of the burns outreach service and within this environment define the optimum length of time needed to follow up these patients. A retrospective analysis was carried out of 100 consecutive paediatric burns patients who underwent surgical management of their burn. During the follow up period there were 43 complications in 32 patients (32%). These included adverse scarring (either hypertrophic or keloid), delayed healing (taking >1 month to heal) and contractures (utilising either splinting or surgical correction). Fifty-nine percent of these complications occurred within 6 months of injury and all occurred within 18 months. Size of burn was directly correlated to the risk of developing a complication. The outreach service reduced the distance the patient needs to travel for follow up by more than 50%. There was also a significant financial benefit for the service as the follow up clinics were on average 50% cheaper with burns outreach than burns physician. Burns outreach is a feasible service that not only benefits the patients but also is cheaper for the burns service. The optimum length of follow up for paediatric burns in 18 months, after which if there have not been any complications they can be discharged. PMID:26036205

  13. Patient-centred care, health behaviours and cardiovascular risk factor levels in people with recently diagnosed type 2 diabetes: 5-year follow-up of the ADDITION-Plus trial cohort

    PubMed Central

    Dambha-Miller, Hajira; Cooper, Andrew J M; Simmons, Rebecca K; Kinmonth, Ann Louise; Griffin, Simon J

    2016-01-01

    Objective To examine the association between the experience of patient-centred care (PCC), health behaviours and cardiovascular disease (CVD) risk factor levels among people with type 2 diabetes. Design Population-based prospective cohort study. Setting 34 general practices in East Anglia, UK, delivering organised diabetes care. Participants 478 patients recently diagnosed with type 2 diabetes aged between 40 and 69 years enrolled in the ADDITION-Plus trial. Main outcome measures Self-reported and objectively measured health behaviours (diet, physical activity, smoking status), CVD risk factor levels (blood pressure, lipid levels, glycated haemoglobin, body mass index, waist circumference) and modelled 10-year CVD risk. Results Better experiences of PCC early in the course of living with diabetes were not associated with meaningful differences in self-reported physical activity levels including total activity energy expenditure (β-coefficient: 0.080 MET h/day (95% CI 0.017 to 0.143; p=0.01)), moderate-to-vigorous physical activity (β-coefficient: 5.328 min/day (95% CI 0.796 to 9.859; p=0.01)) and reduced sedentary time (β-coefficient: −1.633 min/day (95% CI −2.897 to −0.368; p=0.01)). PCC was not associated with clinically meaningful differences in levels of high-density lipoprotein cholesterol (β-coefficient: 0.002 mmol/L (95% CI 0.001 to 0.004; p=0.03)), systolic blood pressure (β-coefficient: −0.561 mm Hg (95% CI −0.653 to −0.468; p=0.01)) or diastolic blood pressure (β-coefficient: −0.565 mm Hg (95% CI −0.654 to −0.476; p=0.01)). Over an extended follow-up of 5 years, we observed no clear evidence that PCC was associated with self-reported, clinical or biochemical outcomes, except for waist circumference (β-coefficient: 0.085 cm (95% CI 0.015 to 0.155; p=0.02)). Conclusions We found little evidence that experience of PCC early in the course of diabetes was associated with clinically important changes in health

  14. African Primary Care Research: Performing a programme evaluation

    PubMed Central

    2014-01-01

    Abstract This article is part of a series on Primary Care Research in the African context and focuses on programme evaluation. Different types of programme evaluation are outlined: developmental, process, outcome and impact. Eight steps to follow in designing your programme evaluation are then described in some detail: engage stakeholders; establish what is known; describe the programme; define the evaluation and select a study design; define the indicators; plan and manage data collection and analysis; make judgements and recommendations; and disseminate the findings. Other articles in the series cover related topics such as writing your research proposal, performing a literature review, conducting surveys with questionnaires, qualitative interviewing and approaches to quantitative and qualitative data analysis. PMID:26245440

  15. [Follow-up of endometrial cancer].

    PubMed

    Gauthier, Tristan; Siegerth, François; Monteil, Jacques; Jammet, Isabelle; Saidi, Nadira; Tubiana-Mathieu, Nicole; Aubard, Yves

    2014-01-01

    Available data on appropriate follow-up in endometrial cancer highlight the need of well-conducted studies. Most recurrences tend to occur within three years and involve symptoms. Routine tests are not advocated without symptoms. In case of suspicious recurrence, TEP/CT seems to be the most sensitive and specific method. There is limited evidence to decide whether follow-up schedules with multiple visits result in survival benefits. An appropriate follow-up should be discussed based upon the risk of recurrence. Counselling on the potential symptoms of recurrence should be a major aim. PMID:25025796

  16. Robotic Follow-Up for Human Exploration

    NASA Technical Reports Server (NTRS)

    Fong, Terrence; Bualat, Maria; Deans, Matthew C.; Adams, Byron; Allan, Mark; Altobelli, Martha; Bouyssounouse, Xavier; Cohen, Tamar; Flueckiger, Lorenzo; Garber, Joshua; Palmer, Elizabeth; Heggy, Essam; Jurgens, Frank; Kennedy, Tim; Kobayashi, Linda; Lee, Pascal; Lee, Susan Y.; Lees, David; Lundy, Mike; Park, Eric; Pedersen, Liam; Smith, Trey; To, Vinh; Utz, Hans; Wheeler, Dawn

    2010-01-01

    We are studying how "robotic follow-up" can improve future planetary exploration. Robotic follow-up, which we define as augmenting human field work with subsequent robot activity, is a field exploration technique designed to increase human productivity and science return. To better understand the benefits, requirements, limitations and risks associated with this technique, we are conducting analog field tests with human and robot teams at the Haughton Crater impact structure on Devon Island, Canada. In this paper, we discuss the motivation for robotic follow-up, describe the scientific context and system design for our work, and present results and lessons learned from field testing.

  17. A randomized blinded controlled trial of mobile phone reminders on the follow-up medical care of HIV-exposed and HIV-infected children in Cameroon: study protocol (MORE CARE)

    PubMed Central

    2013-01-01

    Background In Cameroon, only two-thirds of children with HIV exposure or infection receive appropriate HIV-directed medical care. Mortality, antiretroviral therapy resistance and suboptimal virological response are strongly related to missed opportunities for treatment, and, more specifically, to skipped scheduled medical appointments. The present trial, MORE CARE (Mobile Reminders for Cameroonian Children Requiring HIV Care) seeks to determine if reminders sent by text message (SMS), phone call, or concomitant SMS and phone calls most increase the presence at medical appointments of HIV-infected or -exposed children (efficacy), and which is the most efficient related to working time and financial cost (efficiency). Methods/Design We will carry out a multicenter single-blind, randomized, factorial controlled trial. A randomization list will be electronically generated using random block sizes. Central allocation will be determined by sequentially numbered. A total of 224 subjects will be randomized into four groups (SMS, Call, SMS + Call, and Control) with an allocation ratio of 1:1:1:1. SMS and calls will be sent between 48 and 72 hours before the scheduled appointment. A medical assistant will send out text messages and will call participants. Our primary outcome is appointment measured by efficacy and efficiency of interventions. We hypothesize that two reminders (concomitant use of SMS and phone calls) as an appointment reminder is more effective to improve appointment compared to one reminder (only SMS or only call), and that the most efficient is use of only SMS. The analysis will be intention to treat. Discussion This trial investigates the potential of SMS and phone calls as motivational reminders to improve children’s adherence to medical appointments for HIV-related care in Cameroon. The intervention will act to end missed appointment due to forgetfulness. Trial registration Pan African Clinical Trials Registry: PACTR201304000528276 PMID:24066735

  18. Home Care Providers to the Rescue: A Novel First-Responder Programme

    PubMed Central

    Hansen, Steen M.; Brøndum, Stig; Thomas, Grethe; Rasmussen, Susanne R.; Kvist, Birgitte; Christensen, Anette; Lyng, Charlotte; Lindberg, Jan; Lauritsen, Torsten L. B.; Lippert, Freddy K.; Torp-Pedersen, Christian; Hansen, Poul A.

    2015-01-01

    Aim To describe the implementation of a novel first-responder programme in which home care providers equipped with automated external defibrillators (AEDs) were dispatched in parallel with existing emergency medical services in the event of a suspected out-of-hospital cardiac arrest (OHCA). Methods We evaluated a one-year prospective study that trained home care providers in performing cardiopulmonary resuscitation (CPR) and using an AED in cases of suspected OHCA. Data were collected from cardiac arrest case files, case files from each provider dispatch and a survey among dispatched providers. The study was conducted in a rural district in Denmark. Results Home care providers were dispatched to 28 of the 60 OHCAs that occurred in the study period. In ten cases the providers arrived before the ambulance service and subsequently performed CPR. AED analysis was executed in three cases and shock was delivered in one case. For 26 of the 28 cases, the cardiac arrest occurred in a private home. Ninety-five per cent of the providers who had been dispatched to a cardiac arrest reported feeling prepared for managing the initial resuscitation, including use of AED. Conclusion Home care providers are suited to act as first-responders in predominantly rural and residential districts. Future follow-up will allow further evaluation of home care provider arrivals and patient survival. PMID:26509532

  19. Experiences of a commercial weight-loss programme after primary care referral: a qualitative study

    PubMed Central

    Allen, Jodie T; Cohn, Simon R; Ahern, Amy L

    2015-01-01

    Background Referral to a commercial weight-loss programme is a cost-effective intervention that is already used within the NHS. Qualitative research suggests this community-based, non-medical intervention accords with participants’ view of weight management as a lifestyle issue. Aim To examine the ways in which participants’ attitudes and beliefs about accessing a commercial weight management programme via their doctor relate to their weight-loss experience, and to understand how these contextual factors influence motivation and adherence to the intervention. Design and setting A qualitative study embedded in a randomised controlled trial evaluating primary care referral to a commercial weight-loss programme in adults who are overweight or obese in England. The study took place from June–September 2013. Method Twenty-nine participants (body mass index [BMI] ≥28 kg/m2; age ≥18 years), who took part in the WRAP (Weight Loss Referrals for Adults in Primary Care) trial, were recruited at their 3-month assessment appointment to participate in a semi-structured interview about their experience of the intervention and weight management more generally. Interviews were audiorecorded, transcribed verbatim, and analysed inductively using a narrative approach. Results Although participants view the lifestyle-based, non-medical commercial programme as an appropriate intervention for weight management, the referral from the GP and subsequent clinical assessments frame their experience of the intervention as medically pertinent with clear health benefits. Conclusion Referral by the GP and follow-up assessment appointments were integral to participant experiences of the intervention, and could be adapted for use in general practice potentially to augment treatment effects. PMID:25824185

  20. A matched-group study protocol to evaluate the implementation of an Integrated Care Pathway programme for chronic obstructive pulmonary disease in Singapore

    PubMed Central

    Wu, Christine Xia; Tan, Woan Shin; See, Ryan Chor Kian; Yu, Weichang; Kwek, Lynette Siang Lim; Toh, Matthias Paul Han Sim; Chee, Thong Gan; Chua, Gerald Seng Wee

    2015-01-01

    Introduction The treatment of chronic obstructive pulmonary disease (COPD) involves different care providers across care sites. This fragmentation of care increases the morbidity and mortality burden, as well as acute health services use. The COPD-Integrated Care Pathway (ICP) was designed and implemented to integrate the care across different sites from primary care to acute hospital and home. It aims to reduce the prevalence of COPD among the population in the catchment, reduce risk of hospital admissions, delay or prevent the progression of the disease and reduce mortality rate by adopting a coordinated and multidisciplinary approach to the management of the patients’ medical conditions. This study on the COPD-ICP programme is undertaken to determine the impact on processes of care, clinical outcomes and acute care utilisation. Methods and analysis This will be a retrospective, pre-post, matched-groups study to evaluate the effectiveness of the COPD-ICP programme in improving clinical outcomes and reducing healthcare costs. Programme enrolees (intervention group) and non-enrolees (comparator group) will be matched using propensity scores. Administratively, we set 30% as our target for proportion admission difference between programme and non-programme patients. A sample size of 62 patients in each group will be needed for statistical comparisons to be made at 90% power. Adherence with recommended care elements will be measured at baseline and quarterly during 1-year follow-up. Risk of COPD-related hospitalisations as primary outcome, healthcare costs, disease progression and 1-year mortality during 1-year follow-up will be compared between the groups using generalised linear regression models. Ethics and dissemination This protocol describes the implementation and proposed evaluation of the COPD-ICP programme. The described study has received ethical approval from the NHG Domain Specific Review Board (DSRB Ref: 2013/01200). Results of the study will be

  1. Diabetic Amyotrophy: A Follow-up Study

    PubMed Central

    Casey, E. B.; Harrison, M. J. G.

    1972-01-01

    A clinical follow-up study of 12 patients with diabetic amyotrophy is reported. Re-examination after an interval indicated that improvement had occurred in all but one instance, and had been maintained over an average follow-up period of four and a half years. Improvement in the neurological syndrome appeared to follow improvement in diabetic control or institution of treatment in those whose diabetes had not previously been diagnosed. Seven patients made a good functional recovery, three no longer having any muscular weakness. Five showed significant residual disability. PMID:5015293

  2. Promoting culturally competent care: the Erasmus exchange programme.

    PubMed

    Milne, Avril; Cowie, Jean

    It is important to prepare nursing students for professional practice in a culturally diverse healthcare environment. The school of nursing and midwifery at Robert Gordon University in Aberdeen, has invested in promoting the Erasmus exchange programme to provide nursing students with the opportunity to undertake practice learning abroad and improve their ability to provide culturally competent care. This article describes the work done to increase the number of students who are able to take up this opportunity at the university. PMID:23617062

  3. Follow-Up Research on Agoraphobics.

    ERIC Educational Resources Information Center

    Chambless, Dianne L.

    In vivo exposure is the most commonly used and generally the most effective behavioral treatment for agoraphobia. Follow-up studies are difficult to interpret because additional treatment does not necessarily indicate relapse and non-treatment does not necessarily indicate non-relapse. Relapse rates are difficult to estimate because of lack of…

  4. Follow-up of differentiated thyroid carcinoma.

    PubMed

    Bournaud, C; Raverot, V

    2015-02-01

    The aim of follow-up of differentiated thyroid carcinoma (CTD) is the assessment of remission, and, in further steps, the early recognition of patients who develop a recurrence. Tools for the follow-up of CTD include the assessment of thyroglobulin and imaging procedures. Thyroglobulin (Tg) is a strong marker of persistent or recurrent disease, but it must be known that Tg antibodies may give falsely low Tg concentration. TSH stimulation, mainly by the mean of recombinant human TSH, improves the sensitivity of Tg determination. New highly sensitive assays may preclude the need for TSH stimulation, at least in some situations. In the last decades, (131)iodine whole body scan gave place to neck ultrasonography (US) as the most performing imaging procedure in the follow-up of CTD. Criteria to identify cervical lymph node suspect of metastasis have been described, and standardized procedures proposed. Finally, the proof of tumoral invasion is brought by cytological analysis of fine needle biopsies of suspicious lymph nodes. (18)FDG PET is a valuable tool for diagnosis and prognosis in metastatic patients, especially with negative (131)I WBS. Initial response to therapy, assessed by Tg determination and neck US, allows re-stratification of the risk of relapse. According to this "reassessed risk", adapted rhythms and modalities of follow-up have been recently proposed. PMID:26826480

  5. 1984 Graduate Follow-Up Study.

    ERIC Educational Resources Information Center

    John Tyler Community Coll., Chester, VA. Office of Institutional Research.

    A follow-up study is conducted of each graduating class of John Tyler Community College (JTCC) to document student successes in the job market and in pursuit of advanced studies, provide feedback to administrators and faculty for upgrading educational offerings and services, and provide a summary of student opinions to improve services. A…

  6. WCTC Graduate Follow-Up Report, 2002.

    ERIC Educational Resources Information Center

    Waukesha County Technical Coll., Pewaukee, WI.

    This paper reports on a survey of 2001-02 graduates of Waukesha County Technical College (WCTC), Wisconsin. The report indicates 1,257 students were awarded Associate's Degrees, technical diplomas, and apprenticeship certificates by WCTC in 2001-02. Of those graduates, 702 (56%) responded to the Graduate Follow-up Survey. Also, 84% of all…

  7. Employer Follow-Up Survey Report, 1997.

    ERIC Educational Resources Information Center

    Trident Technical Coll., Charleston, SC.

    In 1998, Trident Technical College conducted the 1997 Employer Follow-Up Survey to collect information from employers of 1997 graduates. A total of 373 employers of graduates were identified, of which 243 were contacted and interviewed. Findings indicate that employers rate graduates average or above average in most technical and personal skills.…

  8. PRM Programmes of Care and PRM Care Pathways: European Approach, Developments in France

    ERIC Educational Resources Information Center

    de Korvin, Georges; Yelnik, Alain P.; Ribinik, Patricia; Calmels, Paul; Le Moine, Francis; Delarque, Alain

    2013-01-01

    The development of European Union of Medical Specialists (UEMS) physical and rehabilitation medicine programmes of care (PRMPC) and physical and rehabilitation medicine care pathways (PRMCP) in France is a good example of the positive interaction between European and national organizations. PRMPC were defined at the European level to offer a…

  9. Effect of Health Literacy on Research Follow-Up.

    PubMed

    Leak, Cardella; Goggins, Kathryn; Schildcrout, Jonathan S; Theobald, Cecelia; Donato, Katharine M; Bell, Susan P; Schnelle, John; Kripalani, Sunil

    2015-01-01

    Previous research has not examined the effect of health literacy on research subjects' completion of scheduled research follow-up. This article evaluates patient factors associated with incomplete research follow-up at three time points after enrollment in a large, hospital-based prospective cohort study. Predictor variables included health literacy, age, race, gender, education, employment status, difficulty paying bills, hospital diagnosis, length of stay, self-reported global health status, depression, perceived health competence, medication adherence, and health care system distrust. In a sample of 2,042 patients, multivariable models demonstrated that lower health literacy and younger age were significantly associated with a lower likelihood of completing research follow-up interviews at 2-3 days, 30 days, and 90 days after hospital discharge. In addition, patients who had less education, were currently employed, and had moderate financial stress were less likely to complete 90-day follow-up. This study is the first to demonstrate that lower health literacy is a significant predictor of incomplete research follow-up. PMID:26513035

  10. Neonatal follow-up program: Where do we stand?

    PubMed Central

    H. Sobaih, Badr

    2012-01-01

    Neonatal follow-up program (NFP) is becoming the corner stone of standard, high quality care provided to newborns at risk of future neuorodevelopmental delay. Most of the recognized neonatal intensive care units in the developed countries are adopting NFP as part of their mandatory care for the best long term outcome of high risk infants, especially very low birth weight (VLBW) infants. Unfortunately, in the developing and in underdeveloped countries, such early detection and intervention programs are rarely existing, mainly because of the lack of awareness of and exposure to such programs in spite of the increasing numbers of surviving sick newborns due to advancement in neonatal care in these countries. This is a review article to explore the Neonatal follow-up programs looking at historical development, benefts and aims, and standard requirements for successful program development that can be adopted in our countries. In conclusion, proper Neonatal follow-up programs are needed to improve neonatal outcome. Therefore all professionals working in the feld of neonatal care in developing countries should cooperate to create such programs for early detection and hence early intervention for any adverse long term outcome in high-risk newborn infants

  11. KLENOT Project - Near Earth Objects Follow-up Program

    NASA Astrophysics Data System (ADS)

    Tichy, Milos; Ticha, Jana; Kocer, Michal; Tichy, Milos

    2015-08-01

    Near Earth Object (NEO) research is important not only as a great challenge for science but also as an important challenge for planetary defense. Therefore NEO discoveries, astrometric follow-up, orbit computations as well as physical studies are of high interest both to science community and humankind.The KLENOT Project of the Klet Observatory, South Bohemia, Czech Republic pursued the confirmation, early follow-up, long-arc follow-up and recovery of NEOs since 2002. Tens of thousands astrometric measurements helped to make inventory of NEOs as well as to understand the NEO distribution. It ranked among the world most prolific professional NEO follow-up programmes during its first phase from 2002 to 2008.The fundamental improvement of the 1.06-m KLENOT Telescope was started in autumn 2008. The new computer controlled paralactic mount was built to substantially increase telescope-time efficiency, the number of observations, their accuracy and limiting magnitude. The testing observations of the KLENOT Telescope Next Generation were started in October 2011. The new more efficient CCD camera FLI ProLine 230 was installed in summer 2013.The original Klet Software Package has been continually upgraded over the past two decades of operation.Both the system and strategy for the NEO follow-up observation used in the framework of the KLENOT Project are described here, including methods for selecting useful and important targets for NEO follow-up astrometry.The modernized KLENOT System was put into full operation in September 2013. More than 8000 of minor planet and comet astrometric positions including NEA measurements were published from September 2013 to February 2015.The 1.06-m KLENOT telescope is still the largest telescope in continental Europe used exclusively for observations of asteroids and comets. Full observing time is dedicated to the KLENOT team. Considering our results and long-time experience obtained at the Klet Observatory, we have the large potential to

  12. The LCOGT NEO Follow-up Network

    NASA Astrophysics Data System (ADS)

    Lister, Tim A.; Greenstreet, S.; Gomez, E.; Christensen, E.; Larson, S.

    2016-01-01

    Las Cumbres Observatory Global Telescope Network (LCOGT) has deployed a homogeneous telescope network of nine 1-meter telescopes to four locations in the northern and southern hemispheres, with a planned network size of twelve 1-meter telescopes at 6 locations. This network is very versatile and is designed to respond rapidly to target of opportunity events and also to perform long term monitoring of slowly changing astronomical phenomena. The global coverage of the network and the apertures of telescope available make LCOGT ideal for follow-up and characterization of Solar System objects (e.g. asteroids, Kuiper Belt Objects, comets, Near-Earth Objects (NEOs)) and additionally for the discovery of new objects. We are using the LCOGT network to confirm newly detected NEO candidates produced by the major sky surveys such as Catalina Sky Survey (CSS) and PanSTARRS (PS1&2) and several hundred targets are now being followed per year. An increasing amount of time is being spent to obtain follow-up astrometry and photometry for radar-targeted objects and those on the Near-Earth Object Human Space Flight Accessible Targets Study (NHATS) or Asteroid Retrieval Mission (ARM) lists in order to improve the orbits, determine the light curves and rotation periods and improve the characterization. This will be extended to obtain more light curves of other NEOs which could be targets. Recent results have included the first period determinations for several of the Goldstone-targeted NEOs. We are in the process of building a NEO follow-up portal which will allow professionals, amateurs and Citizen Scientists to plan, schedule and analyze NEO imaging and spectroscopy observations and data using the LCOGT Network and to act as a co-ordination hub for the NEO follow-up efforts.

  13. Prompt GRB optical follow-up experiments

    SciTech Connect

    Park, H-S; Williams, G; Ables, E; Band, D; Barthelmy, S; Bionta, R; Cline, T; Gehrels, N; Hartmann, D; Hurley, K; Kippen, M; Nemiroff, R; Pereira, W; Porrata, R

    2000-11-13

    Gamma Ray Bursts (GRBs) are brief, randomly located, releases of gamma-ray energy from unknown celestial sources that occur almost daily. The study of GRBs has undergone a revolution in the past three years due to an international effort of follow-up observations of coordinates provided by Beppo/SAX and IPN GRB. These follow-up observations have shown that GRBs are at cosmological distances and interact with surrounding material as described by the fireball model. However, prompt optical counterparts have only been seen in one case and are therefore very rare or much dimmer than the sensitivity of the current instruments. Unlike later time afterglows, prompt optical measurements would provide information on the GRB progenitor. LOTIS is the very first automated and dedicated telescope system that actively utilizes the GRB Coordinates Network (GCN) and it attempts to measure simultaneous optical light curve associated with GRBs. After 3 years of running, LOTIS has responded to 75 GRB triggers. The lack of any optical signal in any of the LOTIS images places numerical limits on the surrounding matter density, and other physical parameters in the environment of the GRB progenitor. This paper presents LOTIS results and describes other prompt GRB follow-up experiments including the Super-LOTIS at Kitt Peak in Arizona.

  14. Follow-up imaging after pediatric pyeloplasty

    PubMed Central

    Kumar, Manoj; Singh, Sanjeet Kumar; Arora, Sohrab; Mittal, Varun; Patidar, Nitesh; Sureka, Sanjoy Kumar; Ansari, M. S.

    2016-01-01

    Introduction: The duration, methods and frequency of radiographic follow-up after pediatric pyeloplasty is not well-defined. We prospectively evaluated a cohort of children undergoing pyeloplasty to determine the method for follow-up. Methods: Between 2000 and 2008, children undergoing pyeloplasty for unilateral ureteropelvic junction obstruction were evaluated for this study. All patients were evaluated preoperatively with protocol ultrasound (USG) and diuretic renal scan (RS). On the basis of preoperative split renal function (SRF), these patients were divided into four groups – Group I: SRF > 40%, Group II: SRF 30–39%, Group III: SRF 20–29%, and Group IV: SRF 10–19%. In follow-up, USG and RS were done at 3 months and repeated at 6 months, 1 year, and then yearly after surgery for a minimum period of 5 years. Improvement, stability, or worsening of hydronephrosis was based on the changes in anteroposterior (AP) diameter of pelvis and caliectasis on USG. Absolute increase in split renal function (SRF) >5% was considered significant. Failure was defined as increase in AP diameter of pelvis and decrease in cortical thickness on 3 consecutive USG, t½ >20 min with obstructive drainage on RS and/or symptomatic patient. Results: 145 children were included in the study. Their mean age was 3.26 years and mean follow-up was 7.5 years. Pre- and post-operative SRF remain unchanged within 5% range in 35 of 41 patients (85%) in Group I. While 9 of 20 patients (45%) in Group II, 23 of 50 patients (46%) in Group III, and 14 of 34 patients (41%) in Group IV exhibited changes >5% after surgery. 5 patients failed, 2 in Group III, and 3 in Group IV. None of the patients deteriorated in Group I and II. Conclusion: After pyeloplasty in children with a baseline split GFR >30%, if a diuretic renogram and USG performed 3 months postoperatively shows nonobstructive drainage with t½ <20 min and decreased hydronephrosis, no further follow-up is required. PMID:27555681

  15. [Follow-up of newborns with hypoxic-ischaemic encephalopathy].

    PubMed

    Martínez-Biarge, M; Blanco, D; García-Alix, A; Salas, S

    2014-07-01

    Hypothermia treatment for newborn infants with hypoxic-ischemic encephalopathy reduces the number of neonates who die or have permanent neurological deficits. Although this therapy is now standard of care, neonatal hypoxic-ischaemic encephalopathy still has a significant impact on the child's neurodevelopment and quality of life. Infants with hypoxic-ischaemic encephalopathy should be enrolled in multidisciplinary follow-up programs in order to detect impairments, to initiate early intervention, and to provide counselling and support for families. This article describes the main neurodevelopmental outcomes after term neonatal hypoxic-ischaemic encephalopathy. We offer recommendations for follow-up based on the infant's clinical condition and other prognostic indicators, mainly neonatal neuroimaging. Other aspects, such as palliative care and medico-legal issues, are also briefly discussed. PMID:24290154

  16. A GP's duty to follow up test results.

    PubMed

    Bird, Sara

    2003-01-01

    Medical negligence claims alleging 'failure to diagnose' are a common cause of claims against general practitioners. In these claims there is often an underlying weakness in the GP's test result and patient tracking systems. This article discusses the duty of care of a GP to follow up patients and their test results. Guidance is provided on how to establish an effective test result tracking system in order to minimise the possibility of a claim arising from 'failure to diagnose'. PMID:12647659

  17. The LCOGT NEO Follow-up Network

    NASA Astrophysics Data System (ADS)

    Lister, Tim; Gomez, Edward; Greenstreet, Sarah

    2015-08-01

    Las Cumbres Observatory Global Telescope Network (LCOGT) has deployed a homogeneous telescope network of nine 1-meter telescopes to four locations in the northern and southern hemispheres, with a planned network of twelve 1-meter telescopes at 6 locations. This network is very versatile and is designed to respond rapidly to target of opportunity events and also to perform long term monitoring of slowly changing astronomical phenomena. The global coverage of the network and the apertures of telescope available make LCOGT ideal for follow-up and characterization of Solar System objects (e.g. asteroids, Kuiper Belt Objects, comets, Near-Earth Objects (NEOs)) and ultimately for the discovery of new objects.LCOGT has completed the first phase of the deployment with the installation and commissioning of the nine 1-meter telescopes at McDonald Observatory (Texas), Cerro Tololo (Chile), SAAO (South Africa) and Siding Spring Observatory (Australia). The telescope network has been fully operational since 2014 May, and observations are being executed remotely and robotically. Future expansion to sites in the Canary Islands and Tibet is planned for 2016.I am using the LCOGT network to confirm newly detected NEO candidates produced by the major sky surveys such as Catalina Sky Survey (CSS) and PanSTARRS (PS1) and several hundred targets are now being followed-up per year. An increasing amount of time is being spent to obtain follow-up astrometry and photometry for radar-targeted objects and those on the Near-Earth Object Human Space Flight Accessible Targets Study (NHATS) or Asteroid Retrieval Mission (ARM) lists in order to improve the orbits, determine the light curves and rotation periods and improve the characterization. This will be extended to obtain more light curves of other NEOs which could be targets. Recent results have included the first period determinations for several of the Goldstone-targeted NEOs. We are in the process of building a NEO Portal which will allow

  18. Cost effectiveness of group follow-up after structured education for type 1 diabetes: a cluster randomised controlled trial

    PubMed Central

    2014-01-01

    Background This study examines the cost effectiveness of group follow-up after participation in the Dose Adjustment for Normal Eating (DAFNE) structured education programme for type 1 diabetes. Methods Economic evaluation conducted alongside a cluster randomised controlled trial involving 437 adults with type 1 diabetes in Ireland. Group follow-up involved two group education ‘booster’ sessions post-DAFNE. Individual follow-up involved two standard one-to-one hospital clinic visits. Incremental costs, quality-adjusted life years (QALYs) gained and cost effectiveness were estimated at 18 months. Uncertainty was explored using sensitivity analysis and by estimating cost effectiveness acceptability curves. Results Group follow-up was associated with a mean reduction in QALYs gained of 0.04 per patient (P value, 0.052; 95% CI, −0.08 to 0.01, intra-class correlation (ICC), 0.033) and a mean reduction in total healthcare costs of €772 (P value, 0.020; 95% CI, −1,415 to −128: ICC, 0.016) per patient. At alternative threshold values of €5,000, €15,000, €25,000, €35,000, and €45,000, the probability of group follow-up being cost effective was estimated to be 1.000, 0.762, 0.204, 0.078, and 0.033 respectively. Conclusions The results do not support implementation of group follow-up as the sole means of follow-up post-DAFNE. Given the reported cost savings, future studies should explore the cost effectiveness of alternative models of group care for diabetes. Trial registration Current Controlled Trials ISRCTN79759174 (assigned: 9 February 2007). PMID:24927851

  19. NASA Audit Follow-up Handbook

    NASA Technical Reports Server (NTRS)

    1990-01-01

    This NASA Audit Follow-up Handbook is issued pursuant to the requirements of the Office of Management and Budget (OMB) Circular A-50, Audit Follow-up, dated September 29, 1982. It sets forth policy, uniform performance standards, and procedural guidance to NASA personnel for use when considering reports issued by the Office of Inspector General (OIG), other executive branch audit organizations, the Defense Contract Audit Agency (DCAA), and the General Accounting Office (GAO). It is intended to: specify principal roles; strengthen the procedures for management decisions (resolution) on audit findings and corrective action on audit report recommendations; emphasize the importance of monitoring agreed upon corrective actions to assure actual accomplishment; and foster the use of audit reports as effective tools of management. A flow chart depicting the NASA audit and management decision process is in Appendix A. This handbook is a controlled handbook issued in loose-leaf form and will be revised by page changes. Additional copies for internal use may be obtained through normal distribution channels.

  20. Improving pediatric Inflammatory Bowel Disease (IBD) follow-up.

    PubMed

    Dykes, Dana; Williams, Elizabeth; Margolis, Peter; Ruschman, Jennifer; Bick, Julianne; Saeed, Shehzad; Opipari, Lisa

    2016-01-01

    Standardization of Inflammatory Bowel Disease (IBD) care through participation in the ImproveCareNow (ICN) Network has improved outcomes for pediatric patients with IBD, but under the current care model, our improvements have plateaued. Current ICN model care guidelines recommend health supervision visits every six months. We identified a gap in our practice's ability to ensure either a routine six month follow-up or a rapid follow-up after a disease flare, and a significant number of patients with active disease status during a six month period lacked timely reassessment after interventions or medication changes. Telemedicine provides an alternative method of care delivery to address these gaps, but has had limited use in patients with IBD. A multi-step approach to offer alternative follow-up care options via telemedicine was developed with potential impact on remission rates and quality of life. Short term goals of the pilot were to improve telemedicine access for patients with IBD were to 1) increase the percent of patients with active disease with a follow-up completed within two months of a visit from 40% to 70%, 2) increase the percent of patients with a visit scheduled within two months of their last sick visit from 20% to 70% (interim measure), 3) increase the number of eVisits from zero visits per month to two visits per month during pilot phase, 4) increase electronic communication with patients from zero messages per month to 200 messages per month, 5) no change in complications or adverse events (defined as an unplanned visit or ED (emergency department) encounter within 30 days of an eVisit. The expected outcomes of the e-visit model were to: maintain baseline care standards and health screening capabilities, improve access to care, and provide equivalent care delivery (no increase in the number of unplanned clinical encounters). Using the IHI model for improvement (Plan-Do-Study-Act) we have seen a progressive increase in the rate of patient signups

  1. Improving pediatric Inflammatory Bowel Disease (IBD) follow-up

    PubMed Central

    Dykes, Dana; Williams, Elizabeth; Margolis, Peter; Ruschman, Jennifer; Bick, Julianne; Saeed, Shehzad; Opipari, Lisa

    2016-01-01

    Standardization of Inflammatory Bowel Disease (IBD) care through participation in the ImproveCareNow (ICN) Network has improved outcomes for pediatric patients with IBD, but under the current care model, our improvements have plateaued. Current ICN model care guidelines recommend health supervision visits every six months. We identified a gap in our practice's ability to ensure either a routine six month follow-up or a rapid follow-up after a disease flare, and a significant number of patients with active disease status during a six month period lacked timely reassessment after interventions or medication changes. Telemedicine provides an alternative method of care delivery to address these gaps, but has had limited use in patients with IBD. A multi-step approach to offer alternative follow-up care options via telemedicine was developed with potential impact on remission rates and quality of life. Short term goals of the pilot were to improve telemedicine access for patients with IBD were to 1) increase the percent of patients with active disease with a follow-up completed within two months of a visit from 40% to 70%, 2) increase the percent of patients with a visit scheduled within two months of their last sick visit from 20% to 70% (interim measure), 3) increase the number of eVisits from zero visits per month to two visits per month during pilot phase, 4) increase electronic communication with patients from zero messages per month to 200 messages per month, 5) no change in complications or adverse events (defined as an unplanned visit or ED (emergency department) encounter within 30 days of an eVisit. The expected outcomes of the e-visit model were to: maintain baseline care standards and health screening capabilities, improve access to care, and provide equivalent care delivery (no increase in the number of unplanned clinical encounters). Using the IHI model for improvement (Plan-Do-Study-Act) we have seen a progressive increase in the rate of patient signups

  2. Implementing a quality improvement programme in palliative care in care homes: a qualitative study

    PubMed Central

    2011-01-01

    Background An increasing number of older people reach the end of life in care homes. The aim of this study is to explore the perceived benefits of, and barriers to, implementation of the Gold Standards Framework for Care Homes (GSFCH), a quality improvement programme in palliative care. Methods Nine care homes involved in the GSFCH took part. We conducted semi-structured interviews with nine care home managers, eight nurses, nine care assistants, eleven residents and seven of their family members. We used the Framework approach to qualitative analysis. The analysis was deductive based on the key tasks of the GSFCH, the 7Cs: communication, coordination, control of symptoms, continuity, continued learning, carer support, and care of the dying. This enabled us to consider benefits of, and barriers to, individual components of the programme, as well as of the programme as a whole. Results Perceived benefits of the GSFCH included: improved symptom control and team communication; finding helpful external support and expertise; increasing staff confidence; fostering residents' choice; and boosting the reputation of the home. Perceived barriers included: increased paperwork; lack of knowledge and understanding of end of life care; costs; and gaining the cooperation of GPs. Many of the tools and tasks in the GSFCH focus on improving communication. Participants described effective communication within the homes, and with external providers such as general practitioners and specialists in palliative care. However, many had experienced problems with general practitioners. Although staff described the benefits of supportive care registers, coding predicted stage of illness and advance care planning, which included improved communication, some felt the need for more experience of using these, and there were concerns about discussing death. Conclusions Most of the barriers described by participants are relevant to other interventions to improve end of life care in care homes

  3. Assessing Risk in Patients with Stable Coronary Disease: When Should We Intensify Care and Follow-Up? Results from a Meta-Analysis of Observational Studies of the COURAGE and FAME Era

    PubMed Central

    Barbero, Umberto; D'Ascenzo, Fabrizio; Nijhoff, Freek; Moretti, Claudio; Biondi-Zoccai, Giuseppe; Mennuni, Marco; Capodanno, Davide; Lococo, Marco; Lipinski, Michael J.; Gaita, Fiorenzo

    2016-01-01

    Background. A large number of clinical and laboratory markers have been appraised to predict prognosis in patients with stable angina, but uncertainty remains regarding which variables are the best predictors of prognosis. Therefore, we performed a meta-analysis of studies in patients with stable angina to assess which variables predict prognosis. Methods. MEDLINE and PubMed were searched for eligible studies published up to 2015, reporting multivariate predictors of major adverse cardiac events (MACE, a composite endpoint of death, myocardial infarction, and revascularization) in patients with stable angina. Study features, patient characteristics, and prevalence and predictors of such events were abstracted and pooled with random-effect methods (95% CIs). Major adverse cardiovascular event (MACE) was the primary endpoint. Results. 42 studies (104,559 patients) were included. After a median follow-up of 57 months, cardiovascular events occurred in 7.8% of patients with MI in 6.2% of patients and need for repeat revascularization (both surgical and percutaneous) in 19.5% of patients. Male sex, reduced EF, diabetes, prior MI, and high C-reactive protein were the most powerful predictors of cardiovascular events. Conclusions. We show that simple and low-cost clinical features may help clinicians in identifying the most appropriate diagnostic and therapeutic approaches within the broad range of outpatients presenting with stable coronary artery disease. PMID:27239372

  4. Assessing Risk in Patients with Stable Coronary Disease: When Should We Intensify Care and Follow-Up? Results from a Meta-Analysis of Observational Studies of the COURAGE and FAME Era.

    PubMed

    Barbero, Umberto; D'Ascenzo, Fabrizio; Nijhoff, Freek; Moretti, Claudio; Biondi-Zoccai, Giuseppe; Mennuni, Marco; Capodanno, Davide; Lococo, Marco; Lipinski, Michael J; Gaita, Fiorenzo

    2016-01-01

    Background. A large number of clinical and laboratory markers have been appraised to predict prognosis in patients with stable angina, but uncertainty remains regarding which variables are the best predictors of prognosis. Therefore, we performed a meta-analysis of studies in patients with stable angina to assess which variables predict prognosis. Methods. MEDLINE and PubMed were searched for eligible studies published up to 2015, reporting multivariate predictors of major adverse cardiac events (MACE, a composite endpoint of death, myocardial infarction, and revascularization) in patients with stable angina. Study features, patient characteristics, and prevalence and predictors of such events were abstracted and pooled with random-effect methods (95% CIs). Major adverse cardiovascular event (MACE) was the primary endpoint. Results. 42 studies (104,559 patients) were included. After a median follow-up of 57 months, cardiovascular events occurred in 7.8% of patients with MI in 6.2% of patients and need for repeat revascularization (both surgical and percutaneous) in 19.5% of patients. Male sex, reduced EF, diabetes, prior MI, and high C-reactive protein were the most powerful predictors of cardiovascular events. Conclusions. We show that simple and low-cost clinical features may help clinicians in identifying the most appropriate diagnostic and therapeutic approaches within the broad range of outpatients presenting with stable coronary artery disease. PMID:27239372

  5. Is follow-up capacity the current NHS bottleneck?

    PubMed

    Allder, Steven; Walley, Paul; Silvester, Kate

    2011-02-01

    Capacity and demand theory suggests that the presence of a queue is not necessarily an indication of a shortage of capacity in a system. It is much more likely that either there is a demand and capacity variation that creates queues or there is a delay designed into the system. A shortage of capacity is only really indicated where a backlog is not stable and continues to grow. In this article, data are taken from one NHS trust that provides evidence for a continually growing backlog for follow-up outpatient services. It is believed that these data are representative of most locations within the NHS in England and therefore suggest an immediate shortage in effective follow-up capacity. To avoid compromise to patient care, the problem will have to be addressed before the situation becomes unmanageable. The paper highlights options to reduce or deflect demand or to increase effective capacity. PMID:21404781

  6. ADATSA Follow-Up Study of Extended Outpatient Care: A Comparison of 90 Days versus 180 Days of Outpatient Treatment for Clients of Washington State's Alcoholism and Drug Addiction Treatment and Support Act.

    ERIC Educational Resources Information Center

    Van Der Hyde, Vincent A.; And Others

    This study was designed to compare outcomes for two groups of alcohol and substance abuse clients (N=230): a control group assigned to regular 90 days of outpatient treatment, and an experimental group assigned to 180 days of extended outpatient care. Outcomes were compared in the following nine categories: (1) relapse, measured as reported…

  7. Prevention, diagnosis, therapy and follow-up care of sepsis: 1st revision of S-2k guidelines of the German Sepsis Society (Deutsche Sepsis-Gesellschaft e.V. (DSG)) and the German Interdisciplinary Association of Intensive Care and Emergency Medicine (Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI))

    PubMed Central

    Reinhart, K.; Brunkhorst, F. M.; Bone, H.-G.; Bardutzky, J.; Dempfle, C.-E.; Forst, H.; Gastmeier, P.; Gerlach, H.; Gründling, M.; John, S.; Kern, W.; Kreymann, G.; Krüger, W.; Kujath, P.; Marggraf, G.; Martin, J.; Mayer, K.; Meier-Hellmann, A.; Oppert, M.; Putensen, C.; Quintel, M.; Ragaller, M.; Rossaint, R.; Seifert, H.; Spies, C.; Stüber, F.; Weiler, N.; Weimann, A.; Werdan, K.; Welte, T.

    2010-01-01

    Practice guidelines are systematically developed statements and recommendations that assist the physicians and patients in making decisions about appropriate health care measures for specific clinical circumstances taking into account specific national health care structures. The 1st revision of the S-2k guideline of the German Sepsis Society in collaboration with 17 German medical scientific societies and one self-help group provides state-of-the-art information (results of controlled clinical trials and expert knowledge) on the effective and appropriate medical care (prevention, diagnosis, therapy and follow-up care) of critically ill patients with severe sepsis or septic shock. The guideline had been developed according to the “German Instrument for Methodological Guideline Appraisal” of the Association of the Scientific Medical Societies (AWMF). In view of the inevitable advancements in scientific knowledge and technical expertise, revisions, updates and amendments must be periodically initiated. The guideline recommendations may not be applied under all circumstances. It rests with the clinician to decide whether a certain recommendation should be adopted or not, taking into consideration the unique set of clinical facts presented in connection with each individual patient as well as the available resources. PMID:20628653

  8. Patients' compliance with follow-up after treatment of gonococcal urethritis.

    PubMed Central

    Mitchell, R. W.; Robson, H. G.

    1977-01-01

    By means of telephone tracing 96% follow-up was achieved in men treated for gonococcal urethritis. A large proportion (34.8%) of patients required one or more calls before follow-up could be obtained. Frequency of sexual re-exposure, proportion with persistent gonorrhea or reinfection, and interval between initial therapy and follow-up were greater in those who required telephone contact for follow-up than in the group who returned for follow-up. Failure to reappear for follow-up does not imply either bacteriologic cure or disappearance of symptoms. Control of gonococcal infection still depends largely upon aggressive methods of case finding, appropriate therapy and careful follow-up. PMID:401673

  9. Vibration white finger: a follow up study.

    PubMed Central

    Ekenvall, L; Carlsson, A

    1987-01-01

    To study the course of vibration white finger (VWF) 55 men were re-examined three and a half to six years after the first examination. The patients were interviewed and finger systolic pressure after general body and local finger cooling was measured. The test results at the two examinations were compared. At the follow up examination some patients experienced a subjective improvement of VWF symptoms but not until more than three years had passed after they had stopped working with vibrating tools. To study the effect of diminished cold exposure on subjective symptoms, vibration exposed outdoor workers who changed to unexposed indoor work were studied separately. In this subgroup also improvement was reported only when more than three years has passed after the change of work, indicating that diminished cold exposure is not the primary explanation for the improvement. The cold provocation test, however, showed no tendency towards a diminished reaction of the vessels to cooling. Patients who continue to work with vibrating tools report a subjective increase in symptoms. This subjective impairment was reflected in an increased reaction to cold as measured in the cold provocation test. PMID:3620371

  10. [Guidelines for the follow up of patients with bronchopulmonary dysplasia].

    PubMed

    Pérez Tarazona, S; Rueda Esteban, S; Alfonso Diego, J; Barrio Gómez de Agüero, M I; Callejón Callejón, A; Cortell Aznar, I; de la Serna Blázquez, O; Domingo Miró, X; García García, M L; García Hernández, G; Luna Paredes, C; Mesa Medina, O; Moreno Galdó, A; Moreno Requena, L; Pérez Pérez, G; Salcedo Posadas, A; Sánchez Solís de Querol, M; Torrent Vernetta, A; Valdesoiro Navarrete, L; Vilella Sabaté, M

    2016-01-01

    Bronchopulmonary dysplasia (BPD) is the most common complication of preterm birth, and remains a major problem in pediatric pulmonology units. The decision of discharging from the Neonatal Unit should be based on a thorough assessment of the condition of the patient and compliance with certain requirements, including respiratory and nutritional stability, and caregiver education on disease management. For proper control of the disease, a schedule of visits and complementary tests should be established prior to discharge, and guidelines for prevention of exacerbations and appropriate treatment should be applied. In this paper, the Working Group in Perinatal Respiratory Diseases of the Spanish Society of Pediatric Pulmonology proposes a protocol to serve as a reference for the follow up of patients with BPD among different centers and health care settings. Key factors to consider when planning discharge from the Neonatal Unit and during follow up are reviewed. Recommendations on treatment and prevention of complications are then discussed. The final section of this guide aims to provide a specific schedule for follow-up and diagnostic interventions to be performed in patients with BPD. PMID:26089228

  11. Delivering a national programme of anticipatory care in primary care: a qualitative study

    PubMed Central

    O'Donnell, Catherine A; Mackenzie, Mhairi; Reid, Maggie; Turner, Fiona; Clark, Julia; Wang, Yinging; Sridharan, Sanjeev; Platt, Stephen

    2012-01-01

    Background Primary prevention often occurs against a background of inequalities in health and health care. Addressing this requires practitioners and systems to acknowledge the contribution of health-related and social determinants and to deal with the lack of interconnectedness between health and social service providers. Recognising this, the Scottish Government has implemented a national programme of anticipatory care targeting individuals aged 45–64 years living in areas of socioeconomic deprivation and at high risk of cardiovascular disease. This programme is called Keep Well. Aim To explore the issues and tensions underpinning the implementation of a national programme of anticipatory care. Design and setting A qualitative study in five Wave 1 Keep Well pilot sites, located in urban areas of Scotland, and involving 79 general practices. Method Annual semi-structured interviews were conducted with 74 key stakeholders operating at national government level, local pilot level and within general practices, resulting in 118 interviews. Interview transcripts were analysed using the framework approach. Results Four underlying tensions were identified. First, those between a patient-focused general-practice approach versus a population-level health-improvement approach, linking disparate health and social services; secondly, medical approaches versus wider social approaches; thirdly, a population-wide approach versus individual targeting; and finally, reactive versus anticipatory care. Conclusion Implementing an anticipatory care programme to address inequalities in cardiovascular disease identified several tensions, which need to be understood and resolved in order to inform the development of such approaches in general practice and to develop systems that reduce the degree of fragmentation across health and social services. PMID:22520917

  12. Why Are Spine Surgery Patients Lost to Follow-up?

    PubMed Central

    Daffner, Scott D.; Hilibrand, Alan S.; Riew, K. Daniel

    2013-01-01

    Long-term outcome studies are frequently hindered by a decreasing frequency of patient follow-up with the treating surgeon over time. Whether this attrition represents a “loss of faith” in their index surgeon or the realities of a geographically mobile society has never been assessed in a population of patients undergoing spinal surgery. The purpose of this article is to determine the frequency with which patients who have undergone prior surgery and develop new problems attempt to follow-up with their index spine surgeon. The study design was a population survey. All patients seen at two university-based spine centers over a 3-month period were surveyed regarding prior spine surgery. The questionnaire asked details of the previous operation, whether the patient had sought follow-up with their index surgeon, why the patient did not continue treatment with that surgeon, and whether the patient was satisfied with their prior treatment. Sixty-nine patients completed the survey. Prior operations were lumbar (53 patients) and cervical (16). When asked the reason for not seeing their prior surgeon, 10 patients (15%) stated that they (the patient) had moved and 16 (23%) responded that their surgeon no longer practiced in the area. Thirteen (19%) were unhappy with their previous care, 22 (32%) were seeking a second opinion, and 7 (10%) were told they needed more complex surgery. Thirty-seven (54%) discussed their symptoms with their original surgeon before seeking another surgeon. Although 32 patients (46%) had not discussed their new complaints with their index surgeon, only 3 patients (4%) chose not to return to their prior surgeon despite having the opportunity to do so. Forty-nine patients (71%) were satisfied with their prior surgical care, and 42 patients (61%) would undergo the index operation again. Most of the patients seen at the authors' practices after undergoing prior spine surgery elsewhere failed to follow up with their prior spine surgeon for

  13. Course Withdrawal Follow-Up. TEX-SIS Follow-Up, Volume 3, #1.

    ERIC Educational Resources Information Center

    Yavapai County Community Coll. District, Prescott, AZ.

    In spring 1982, a survey was conducted at Yavapai College to determine reasons for student course withdrawal. A TEX-SIS follow-up questionnaire was mailed to all 525 students who had dropped one or two courses, asking them to indicate their reasons for dropping the course(s) and if they felt discussion with a counselor would have been beneficial,…

  14. 29 CFR 99.315 - Audit findings follow-up.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 29 Labor 1 2014-07-01 2013-07-01 true Audit findings follow-up. 99.315 Section 99.315 Labor Office... § 99.315 Audit findings follow-up. (a) General. The auditee is responsible for follow-up and corrective... currently following up with the auditee on the audit finding; and (iii) A management decision was not...

  15. 7 CFR 3052.315 - Audit findings follow-up.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 15 2012-01-01 2012-01-01 false Audit findings follow-up. 3052.315 Section 3052.315....315 Audit findings follow-up. (a) General. The auditee is responsible for follow-up and corrective... currently following up with the auditee on the audit finding; and (iii) A management decision was not...

  16. 7 CFR 3052.315 - Audit findings follow-up.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 15 2010-01-01 2010-01-01 false Audit findings follow-up. 3052.315 Section 3052.315....315 Audit findings follow-up. (a) General. The auditee is responsible for follow-up and corrective... currently following up with the auditee on the audit finding; and (iii) A management decision was not...

  17. 7 CFR 3052.315 - Audit findings follow-up.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 15 2013-01-01 2013-01-01 false Audit findings follow-up. 3052.315 Section 3052.315....315 Audit findings follow-up. (a) General. The auditee is responsible for follow-up and corrective... currently following up with the auditee on the audit finding; and (iii) A management decision was not...

  18. 38 CFR 41.315 - Audit findings follow-up.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2014-07-01 2014-07-01 false Audit findings follow-up... findings follow-up. (a) General. The auditee is responsible for follow-up and corrective action on all... currently following up with the auditee on the audit finding; and (iii) A management decision was not...

  19. 29 CFR 99.315 - Audit findings follow-up.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 29 Labor 1 2011-07-01 2011-07-01 false Audit findings follow-up. 99.315 Section 99.315 Labor... Auditees § 99.315 Audit findings follow-up. (a) General. The auditee is responsible for follow-up and... currently following up with the auditee on the audit finding; and (iii) A management decision was not...

  20. 38 CFR 41.315 - Audit findings follow-up.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Audit findings follow-up... findings follow-up. (a) General. The auditee is responsible for follow-up and corrective action on all... currently following up with the auditee on the audit finding; and (iii) A management decision was not...

  1. 38 CFR 41.315 - Audit findings follow-up.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2013-07-01 2013-07-01 false Audit findings follow-up... findings follow-up. (a) General. The auditee is responsible for follow-up and corrective action on all... currently following up with the auditee on the audit finding; and (iii) A management decision was not...

  2. 7 CFR 3052.315 - Audit findings follow-up.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 15 2011-01-01 2011-01-01 false Audit findings follow-up. 3052.315 Section 3052.315....315 Audit findings follow-up. (a) General. The auditee is responsible for follow-up and corrective... currently following up with the auditee on the audit finding; and (iii) A management decision was not...

  3. 38 CFR 41.315 - Audit findings follow-up.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2011-07-01 2011-07-01 false Audit findings follow-up... findings follow-up. (a) General. The auditee is responsible for follow-up and corrective action on all... currently following up with the auditee on the audit finding; and (iii) A management decision was not...

  4. 29 CFR 99.315 - Audit findings follow-up.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 29 Labor 1 2012-07-01 2012-07-01 false Audit findings follow-up. 99.315 Section 99.315 Labor... Auditees § 99.315 Audit findings follow-up. (a) General. The auditee is responsible for follow-up and... currently following up with the auditee on the audit finding; and (iii) A management decision was not...

  5. 29 CFR 99.315 - Audit findings follow-up.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 1 2010-07-01 2010-07-01 true Audit findings follow-up. 99.315 Section 99.315 Labor Office... § 99.315 Audit findings follow-up. (a) General. The auditee is responsible for follow-up and corrective... currently following up with the auditee on the audit finding; and (iii) A management decision was not...

  6. 7 CFR 3052.315 - Audit findings follow-up.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 15 2014-01-01 2014-01-01 false Audit findings follow-up. 3052.315 Section 3052.315....315 Audit findings follow-up. (a) General. The auditee is responsible for follow-up and corrective... currently following up with the auditee on the audit finding; and (iii) A management decision was not...

  7. 29 CFR 99.315 - Audit findings follow-up.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 29 Labor 1 2013-07-01 2013-07-01 false Audit findings follow-up. 99.315 Section 99.315 Labor... Auditees § 99.315 Audit findings follow-up. (a) General. The auditee is responsible for follow-up and... currently following up with the auditee on the audit finding; and (iii) A management decision was not...

  8. 38 CFR 41.315 - Audit findings follow-up.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2012-07-01 2012-07-01 false Audit findings follow-up... findings follow-up. (a) General. The auditee is responsible for follow-up and corrective action on all... currently following up with the auditee on the audit finding; and (iii) A management decision was not...

  9. Discovery and follow up of asteroids

    NASA Technical Reports Server (NTRS)

    Bowell, E.; Chernykh, N. S.; Marsden, B. G.

    1989-01-01

    After a summary of the increasing activity in steroid discovery during the past few years, the importance of carefully thought out observing strategy is discussed, in particular with regard to target selection, observing frequency, and the time distribution of observations. Problems of cataloging and orbit linkage are outlined, inasmuch as they affect individual observers and orbit computers, as well as the work of the Minor Planet Center. There is some discussion of appropriate two-way communication between observers and the Minor Planet Center.

  10. Implantable cardioverter defibrillator clinic casualties: inadvertent reprogramming during routine implantable cardioverter defibrillator follow-up.

    PubMed

    Ozahowski, T P; Greenberg, M L; Mock, P; Holzberger, P T; Gerling, B; Zalinger, C; Perry, C

    1996-10-01

    On one occasion during a busy ICD follow-up clinic, the preceding patient's parameters for rate, PDF, and delay were inadvertently programmed into the subsequent patient's generator using the CPI Programmer Model 2035. This occurred after capacitor reformation, without pressing the "Program" button. The source of this reprogramming error was failure to clear the programmer memory of the previous patient's data, usually achieved by turning the programmer off between patients (or selecting "New Patient" from the menu). At our next ICD follow-up clinic, we purposely did not turn off the programmer between two sets of patients. On both occasions the above finding was repeated and confirmed. These observations indicate the potential for serious reprogramming errors that can occur simply by not clearing the programmer's memory between clinic patients. PMID:8904549

  11. Strategy and results of East Asian GRB FOllow-up Network (EAFON) follow-up observations

    NASA Astrophysics Data System (ADS)

    Urata, Y.; Eafon Team

    We have established Japan-Taiwan-China collaboration on GRBs study in the East-Asian region since 2004 This serves as valuable additions to the world-wide optical and infrared follow-up network because the East-Asia region is otherwise blank for the network We have been carrying out imaging and spectroscopic follow-up observations by Lulin Taiwan Kiso Japan WIDGET Japan and Xinglong China Using Xinglong and Kiso we can locate candidates and obtain early time spectra of afterglows While WIDGET provides early time observations before the burst the high-time resolution for multi-band light curves will be obtained by Lulin With the data from these sites we will obtain detailed information of light curve and redshift of GRBs which are important to understand the mechanism of afterglows Utilizing East Asian GRB Follow-up Observation Network EAFON we have observed 56 GRB optical afterglows and detected 15 early optical afterglow behavior including two short GRBs in multi-bands Based on these observations we have obtained 3 major results 1 first long term monitoring of short GRB afterglow from sim 0 1 days after the burst 2 two components in early optical afterglow 3 catch about 30 high redshift GRB candidates In this meeting we will present mainly report early a common feature of long GRB early afterglow We have found a common feature in long GRB early afterglow light curves These early light curves show re-brightening and or plateau phase around 0 1 days 2 4hours after bursts Combined with other prompt

  12. Klenot Project - Near Earth Objects Follow-Up Program

    NASA Astrophysics Data System (ADS)

    Tichý, Miloš; Tichá, Jana; Kočer, Michal

    2016-01-01

    NEO research is a great challenge just now - for science, for exploration and for planetary defence. Therefore NEO discoveries, astrometric follow-up, orbit computations as well as physical studies are of high interest both to science community and humankind. The KLENOT Project of the Klet Observatory, South Bohemia, Czech Republic pursued the confirmation, early follow-up, long-arc follow-up and recovery of Near Earth Objects since 2002. Tens of thousands astrometric measurements helped to make inventory of NEOs as well as to understand the NEO population. It ranked among the world most prolific professional NEO follow-up programmes during its first phase from 2002 to 2008. The fundamental improvement of the 1.06-m KLENOT Telescope was started in autumn 2008. The new computer controlled paralactic mount was built to substantially increase telescope-time efficiency, the number of observations, their accuracy and limiting magnitude. The testing observations of the KLENOT Telescope Next Generation (NG) were started in October 2011. The new more efficient CCD camera FLI ProLine 230 was installed in summer 2013. The original Klet Software Package has been continually upgraded over the past two decades of operation. Along with huge hardware changes we have decided for essential changes in software and the whole KLENOT work-flow. Using the current higher computing power available, enhancing and updating our databases and astrometry program, the core of our software package, will prove highly beneficial. Moreover, the UCAC4 as the more precise astrometric star catalog was implemented. The modernized KLENOT System was put into full operation in September 2013. This step opens new possibilities for the KLENOT Project, the long-term European Contribution to Monitoring and Cataloging Near Earth Objects. KLENOT Project Goals are confirmatory observations of newly discovered fainter NEO candidates, early follow-up of newly discovered NEOs, long-arc follow-up astrometry of NEOs

  13. Klenot Project - Near Earth Objects Follow-Up Program

    NASA Astrophysics Data System (ADS)

    Tichý, Miloš; Tichá, Jana; Kočer, Michal

    2016-01-01

    NEO research is a great challenge just now - for science, for exploration and for planetary defence. Therefore NEO discoveries, astrometric follow-up, orbit computations as well as physical studies are of high interest both to science community and humankind. The KLENOT Project of the Klet Observatory, South Bohemia, Czech Republic pursued the confirmation, early follow-up, long-arc follow-up and recovery of Near Earth Objects since 2002. Tens of thousands astrometric measurements helped to make inventory of NEOs as well as to understand the NEO population. It ranked among the world most prolific professional NEO follow-up programmes during its first phase from 2002 to 2008. The fundamental improvement of the 1.06-m KLENOT Telescope was started in autumn 2008. The new computer controlled paralactic mount was built to substantially increase telescope-time efficiency, the number of observations, their accuracy and limiting magnitude. The testing observations of the KLENOT Telescope Next Generation (NG) were started in October 2011. The new more efficient CCD camera FLI ProLine 230 was installed in summer 2013. The original Klet Software Package has been continually upgraded over the past two decades of operation. Along with huge hardware changes we have decided for essential changes in software and the whole KLENOT work-flow. Using the current higher computing power available, enhancing and updating our databases and astrometry program, the core of our software package, will prove highly beneficial. Moreover, the UCAC4 as the more precise astrometric star catalog was implemented. The modernized KLENOT System was put into full operation in September 2013. This step opens new possibilities for the KLENOT Project, the long-term European Contribution to Monitoring and Cataloging Near Earth Objects. KLENOT Project Goals are confirmatory observations of newly discovered fainter NEO candidates, early follow-up of newly discovered NEOs, long-arc follow-up astrometry of NEOs

  14. Endometrial cancer. Prevention, detection, management, and follow up.

    PubMed Central

    Elit, L.

    2000-01-01

    OBJECTIVE: To review risk factors for uterine cancer; to discuss strategies for detecting uterine cancer; to outline prognostic factors and treatment; and to review the role of follow up for patients who have completed primary therapy. QUALITY OF EVIDENCE: MEDLINE was searched from January 1996 to June 1998 using the terms endometrial neoplasms, estrogen replacement therapy, hormone replacement therapy, tamoxifen, and screening. Only English language articles were reviewed. Study types included reviews. Bibliographies of articles found were searched for further relevant titles. Causation literature is available from well conducted cohort trials. Treatment recommendations are based in part on prognostic information and a few randomized controlled trials. MAIN MESSAGE: Risk factors, both intrinsic and extrinsic, are associated with uterine cancer. Family physicians have a role in preventing disease by ensuring that all women with uteri in situ using hormone replacement therapy (HRT) have progesterone therapy as part of the HRT regimen. Detection is crucial; abnormal uterine bleeding or undiagnosed postmenopausal bleeding warrants investigation with endometrial biopsy. The goal of surgery is to remove the uterus and ovaries and identify factors that make the disease at high risk of recurrence. Although adjuvant radiation therapy does not prolong survival, it does alter the pattern of disease recurrence. The goal of follow up after primary therapy is to identify recurrent disease while it is still curable. CONCLUSIONS: Family physicians play an important role in preventing uterine cancer, initiating early diagnosis of disease, and in the future, might be more actively involved in caring for patients following primary therapy. PMID:10790821

  15. Longest follow-up of in situ working Bjork Shiley valve: 42-year follow-up.

    PubMed

    Soofi, Muhammad A; Ignaszewski, Maya T; Ashton, Thomas H; Miyagishima, Robert T

    2016-03-01

    The Bjork Shiley valve (BSV) is considered as the pioneer among modern disc valves, and eventually evolved into a reliable prosthesis after considerable research and multiple modifications. Various case reports have been published with follow-up of different types of BSV. We are reporting the longest follow-up ever published of a plano-convex type of BSV. Our patient's valve was implanted in 1973 due to a congenital bicuspid aortic valve with concomitant severe, symptomatic aortic stenosis, discovered at the age of 27. She presented with exertional dyspnoea, syncope and chest pain; however, her cardiovascular status remained stable and these symptoms abated after successful valve replacement at the age of 34. She is now 77 years old with no limitations in her activities and is able to walk a few miles most days of the week. Her echocardiograms throughout the decades have shown acceptable gradients across the aortic prosthesis without evidence of haemolysis. Our case report includes a summary of the patient with a discussion of the evidence that supports the durability of the original plano-convex BSV. PMID:26686528

  16. Follow-up and care of childhood cancer survivors

    SciTech Connect

    Meadows, A.T. )

    1991-02-15

    More children than ever before are being cured of cancer, thanks to aggressive use of multimodal therapy. Of prime concern are the potential long-term deleterious effects of such treatment. Sequelae may include impairment of growth or other aspects of development, damage to various organ systems, or a second cancer. Guidelines for surveillance and counseling are described.15 references.

  17. 77 FR 69896 - Agency Information Collection Activities; Submission for OMB Review; Comment Request; Follow-Up...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-21

    ...; Follow-Up Survey Information for Green Jobs and Health Care Impact Evaluation, American Recovery... Survey Information for Green Jobs and Health Care Impact Evaluation, American Recovery Reinvestment Act... Health Care Grants Impact Evaluation (OMB 1205-0486), and in March, 2012, the OMB approved a...

  18. Employer Follow-up Data Summary--1976-77. Tex-SIS FOLLOW-UP; Postsecondary Student Follow-up Management Information System. Monograph 8.

    ERIC Educational Resources Information Center

    Texas Education Agency, Austin. Dept. of Occupational Education and Technology.

    The Tex-SIS Follow-up system Employer Follow-up Survey involved four Texas community colleges, providing a statewide composite of employer data on the competency of occupational/technical graduates. The mailing list for prospective survey participants was derived from occupational/technical graduates' responses to a survey conducted in 1975-76. A…

  19. NHEXAS PHASE I MARYLAND STUDY--FOLLOW-UP QUESTIONNAIRE DATA

    EPA Science Inventory

    The Follow-up questionnaire data set contains information concerning the activities within the household during the sampling week. The information is from 402 follow-up questionnaires for 80 households across 6 cycles. The Follow-up Questionnaire specifically addressed the time ...

  20. 49 CFR 577.10 - Follow-up notification.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 7 2014-10-01 2014-10-01 false Follow-up notification. 577.10 Section 577.10... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) DEFECT AND NONCOMPLIANCE NOTIFICATION § 577.10 Follow-up... manufacturer to send a follow-up notification in accordance with this section. The scope, timing, form,...

  1. 49 CFR 382.311 - Follow-up testing.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... ALCOHOL USE AND TESTING Tests Required § 382.311 Follow-up testing. The requirements for follow-up testing must be performed in accordance with 49 CFR part 40, subpart O. ... 49 Transportation 5 2010-10-01 2010-10-01 false Follow-up testing. 382.311 Section...

  2. 49 CFR 382.311 - Follow-up testing.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... ALCOHOL USE AND TESTING Tests Required § 382.311 Follow-up testing. The requirements for follow-up testing must be performed in accordance with 49 CFR part 40, subpart O. ... 49 Transportation 5 2011-10-01 2011-10-01 false Follow-up testing. 382.311 Section...

  3. 49 CFR 382.311 - Follow-up testing.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... ALCOHOL USE AND TESTING Tests Required § 382.311 Follow-up testing. The requirements for follow-up testing must be performed in accordance with 49 CFR part 40, subpart O. ... 49 Transportation 5 2014-10-01 2014-10-01 false Follow-up testing. 382.311 Section...

  4. 33 CFR 179.15 - Follow-up report.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 33 Navigation and Navigable Waters 2 2013-07-01 2013-07-01 false Follow-up report. 179.15 Section...) BOATING SAFETY DEFECT NOTIFICATION § 179.15 Follow-up report. (a) Each manufacturer who makes an initial report required by § 179.13 shall submit a follow-up report to the Commandant by certified mail within...

  5. 33 CFR 179.15 - Follow-up report.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Follow-up report. 179.15 Section...) BOATING SAFETY DEFECT NOTIFICATION § 179.15 Follow-up report. (a) Each manufacturer who makes an initial report required by § 179.13 shall submit a follow-up report to the Commandant by certified mail within...

  6. 49 CFR 577.10 - Follow-up notification.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 7 2011-10-01 2011-10-01 false Follow-up notification. 577.10 Section 577.10... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) DEFECT AND NONCOMPLIANCE NOTIFICATION § 577.10 Follow-up... manufacturer to send a follow-up notification in accordance with this section. The scope, timing, form,...

  7. 49 CFR 577.10 - Follow-up notification.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 7 2013-10-01 2013-10-01 false Follow-up notification. 577.10 Section 577.10... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) DEFECT AND NONCOMPLIANCE NOTIFICATION § 577.10 Follow-up... manufacturer to send a follow-up notification in accordance with this section. The scope, timing, form,...

  8. 49 CFR 577.10 - Follow-up notification.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 7 2012-10-01 2012-10-01 false Follow-up notification. 577.10 Section 577.10... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) DEFECT AND NONCOMPLIANCE NOTIFICATION § 577.10 Follow-up... manufacturer to send a follow-up notification in accordance with this section. The scope, timing, form,...

  9. 49 CFR 382.311 - Follow-up testing.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... ALCOHOL USE AND TESTING Tests Required § 382.311 Follow-up testing. The requirements for follow-up testing must be performed in accordance with 49 CFR part 40, subpart O. ... 49 Transportation 5 2012-10-01 2012-10-01 false Follow-up testing. 382.311 Section...

  10. 33 CFR 179.15 - Follow-up report.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 33 Navigation and Navigable Waters 2 2012-07-01 2012-07-01 false Follow-up report. 179.15 Section...) BOATING SAFETY DEFECT NOTIFICATION § 179.15 Follow-up report. (a) Each manufacturer who makes an initial report required by § 179.13 shall submit a follow-up report to the Commandant by certified mail within...

  11. 49 CFR 382.311 - Follow-up testing.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... ALCOHOL USE AND TESTING Tests Required § 382.311 Follow-up testing. The requirements for follow-up testing must be performed in accordance with 49 CFR part 40, subpart O. ... 49 Transportation 5 2013-10-01 2013-10-01 false Follow-up testing. 382.311 Section...

  12. 33 CFR 179.15 - Follow-up report.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 33 Navigation and Navigable Waters 2 2011-07-01 2011-07-01 false Follow-up report. 179.15 Section...) BOATING SAFETY DEFECT NOTIFICATION § 179.15 Follow-up report. (a) Each manufacturer who makes an initial report required by § 179.13 shall submit a follow-up report to the Commandant by certified mail within...

  13. 2 CFR 200.511 - Audit findings follow-up.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 2 Grants and Agreements 1 2014-01-01 2014-01-01 false Audit findings follow-up. 200.511 Section...-up. (a) General. The auditee is responsible for follow-up and corrective action on all audit findings... submitted to the FAC; (ii) The Federal agency or pass-through entity is not currently following up with...

  14. 33 CFR 179.15 - Follow-up report.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 33 Navigation and Navigable Waters 2 2014-07-01 2014-07-01 false Follow-up report. 179.15 Section...) BOATING SAFETY DEFECT NOTIFICATION § 179.15 Follow-up report. (a) Each manufacturer who makes an initial report required by § 179.13 shall submit a follow-up report to the Commandant by certified mail within...

  15. 49 CFR 577.10 - Follow-up notification.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 7 2010-10-01 2010-10-01 false Follow-up notification. 577.10 Section 577.10... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) DEFECT AND NONCOMPLIANCE NOTIFICATION § 577.10 Follow-up... manufacturer to send a follow-up notification in accordance with this section. The scope, timing, form,...

  16. Implementation of the Care Programme Approach across Health and Social Services for Dual Diagnosis Clients

    ERIC Educational Resources Information Center

    Kelly, Michael; Humphrey, Charlotte

    2013-01-01

    Background: Care for clients with mental health problems and concurrent intellectual disability (dual diagnosis) is currently expected to be provided through the care programme approach (CPA), an approach to provide care to people with mental health problems in secondary mental health services. When CPA was originally introduced into UK mental…

  17. Primary care-based, targeted screening programme to promote sustained weight management

    PubMed Central

    Järvenpää, Salme; Kautiainen, Hannu

    2014-01-01

    Abstract Objective. To identify overweight and obese subjects at increased cardiovascular risk in the community, and provide them with lifestyle counselling that is possible to implement in real life. Design. Longitudinal cohort study. Setting. The communities of Harjavalta and Kokemäki in south-western Finland. Subjects. A tape for measurement of waist and a risk factor questionnaire was mailed to home-dwelling inhabitants aged 45–70 years (n = 6013). Of the 4421 respondents, 2752 with at least one cardiovascular risk factor were examined by a public health nurse. For the subjects with high cardiovascular risk (n = 1950), an appointment with a physician was scheduled. The main goal of lifestyle counselling for the 1608 high-risk subjects with BMI ≥ 25 kg/m2 was weight reduction of at least 5%. Among these, 906 had completed self-administrated questionnaires at baseline and form the present study population. Main outcome measure. Success in weight management. Results. At the three-year follow-up visit, 18% of subjects had lost ≥ 5% of their initial weight and 70% had stabilized their weight, while 12% had gained weight ≥ 5%. Newly diagnosed glucose disorder (OR 1.37 [95% CI 1.02–1.84]) predicted success in weight management, whereas depressive symptoms (OR 0.61 [95% CI 0.42–0.90]), excess alcohol use (OR 0.63 [95% CI 0.44–0.90]), and number of drugs used (OR 0.91 [95% CI 0.83–0.99]) at baseline predicted poor outcome. Conclusions. A primary care screening programme to identify overweight or obese individuals can promote sustained weight management. Psychological factors, especially depressive symptoms, are a critical component to consider before attempts to change the lifestyle of an individual. PMID:24592894

  18. Effectiveness of the palliative care ‘Availability, Current issues and Anticipation’ (ACA) communication training programme for general practitioners on patient outcomes: A controlled trial

    PubMed Central

    Blankenstein, Annette H; Schweitzer, Bart PM; Knol, Dirk L; van der Horst, Henriëtte E; Aaronson, Neil K; Deliens, Luc

    2014-01-01

    Background: Although communicating effectively with patients receiving palliative care can be difficult, it may contribute to maintaining or enhancing patients’ quality of life. Little is known about the effect of training general practitioners in palliative care–specific communication. We hypothesized that palliative care patients of general practitioners exposed to the ‘Availability, Current issues and Anticipation’ communication training programme would report better outcomes than patients of control general practitioners. Aim: To evaluate the effectiveness of the Availability, Current issues and Anticipation training programme for general practitioners on patient-reported outcomes. Design: In a controlled trial, general practitioners followed the Availability, Current issues and Anticipation programme or were part of the control group. Patients receiving palliative care of participating general practitioners completed the Palliative Care Outcome Scale, the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative, the Rest & Peace Scale, the Patient Satisfaction Questionnaire–III and the Availability, Current issues and Anticipation Scale, at baseline and 12 months follow-up. We analysed differences between groups using linear mixed models. Trial registration: ISRCTN56722368. Setting/participants: General practitioners who attended a 2-year Palliative Care Training Course in the Netherlands. Results: Questionnaire data were available for 145 patients (89 in intervention and 56 in control group). We found no significant differences over time between the intervention and control groups in any of the five outcome measures. Ceiling effects were observed for the Rest & Peace Scale, Patient Satisfaction Questionnaire–III and Availability, Current issues and Anticipation Scale. Conclusion: General practitioner participation in the Availability, Current issues and Anticipation training programme did not have

  19. The Irish DAFNE Study Protocol: A cluster randomised trial of group versus individual follow-up after structured education for Type 1 diabetes

    PubMed Central

    Dinneen, Seán F; O' Hara, Mary Clare; Byrne, Molly; Newell, John; Daly, Lisa; O' Shea, Donal; Smith, Diarmuid

    2009-01-01

    Background Structured education programmes for individuals with Type 1 diabetes have become a recognised means of delivering the knowledge and skills necessary for optimal self-management of the condition. The Dose Adjustment for Normal Eating (DAFNE) programme has been shown to improve biomedical (HbA1c and rates of severe hypoglycaemia) and psychosocial outcomes for up to 12 months following course delivery. The optimal way to support DAFNE graduates and maintain the benefits of the programme has not been established. We aimed to compare 2 different methods of follow-up of DAFNE graduates in a pragmatic clinical trial delivered in busy diabetes clinics on the island of Ireland. Methods Six participating centres were cluster randomised to deliver either group follow-up or a return to traditional one-to-one clinic visits. In the intervention arm group follow-up was delivered at 6 and 12 months post DAFNE training according to a curriculum developed for the study. In the control arm patients were seen individually in diabetes clinics as part of routine care. Study outcomes included HbA1c levels, self-reported rates of severe hypoglycaemia, body weight and measures of diabetes wellbeing and quality of life. These were measured at 6, 12 and 18 months after recruitment. Generalisability (external validity) was maximised by recruiting study participants from existing DAFNE waiting lists in each centre, by using broad inclusion criteria (including HbA1c values less than 13 percent with no lower limit) and by using existing clinic staff to deliver the training and follow-up. Internal validity and treatment fidelity were maximised by quality assuring the training of all DAFNE educators, by external peer review of the group follow-up sessions and by striving for full attendance at follow-up visits. Assays of HbA1c were undertaken in a central laboratory. Discussion This pragmatic clinical trial evaluating group follow-up after a structured education programme has been

  20. Asthma after childhood pneumonia: six year follow up study

    PubMed Central

    Clark, Christopher E; Coote, Jacqueline M; Silver, David A T; Halpin, David M G

    2000-01-01

    Objective To establish the long term cumulative prevalence of asthma in children admitted to hospital with pneumonia and to examine the hypothesis that some children admitted to hospital with pneumonia may be presenting with undiagnosed asthma. Design Prospective study of a cohort of children previously admitted to hospital with pneumonia, followed up by postal questionnaires to their general practitioners and the children or their parents. Setting General practices in southwest England. Participants 78 children admitted to the Royal Devon and Exeter Hospital between 1989 and 1991 with a diagnosis of pneumonia confirmed on independent review of x ray films. Main outcome measures Any diagnosis of asthma, use of any treatment for asthma, and asthma symptom scores. Results On the basis of a 100% response rate from general practitioners and 86% from patients or parents, the cumulative prevalence of asthma was 45%. A diagnosis of asthma was associated with a family history of asthma (odds ratio 11.23; 95% confidence interval 2.57 to 56.36; P=0.0002). Mean symptom scores were higher for all children with asthma (mean score 2.4; χ2=14.88; P=0.0001) and for children with asthma not being treated (mean 1.4; χ2=6.2; P=0.01) than for those without asthma (mean 0.2) . Conclusions A considerable proportion of children presenting to a district general hospital with pneumonia either already have unrecognised asthma or subsequently develop asthma. The high cumulative prevalence of asthma suggests that careful follow up of such children is worth while. Asthma is undertreated in these children; a structured symptom questionnaire may help to identify and reduce morbidity due to undertreatment. PMID:10834897

  1. Lack of Follow-Up Exams after Failed School Vision Screenings: An Investigation of Contributing Factors

    ERIC Educational Resources Information Center

    Kimel, Linda S.

    2006-01-01

    Programs to facilitate professional eye exams after failed school vision screenings often are based on the assumption that funding and access to services are major obstacles to care. Despite such programs, many children do not receive professional exams. The purpose of this study was to identify additional barriers to follow-up eye care. School…

  2. Gynaecological cancer follow-up: national survey of current practice in the UK

    PubMed Central

    Leeson, Simon; Stuart, Nick; Sylvestre, Yvonne; Hall, Liz; Whitaker, Rhiannon

    2013-01-01

    Objective To establish a baseline of national practice for follow-up after treatment for gynaecological cancer. Design Questionnaire survey. Setting Gynaecological cancer centres and units. Geographical location UK. Participants Members of the British Gynaecological Cancer Society and the National Forum of Gynaecological Oncology Nurses. Interventions A questionnaire survey. Outcome measures To determine schedules of follow-up, who provides it and what routine testing is used for patients who have had previous gynaecological cancer. Results A total of 117 responses were obtained; 115 (98%) reported hospital scheduled regular follow-up appointments. Two involved general practitioners. Follow-up was augmented or replaced by telephone follow-up in 29 responses (25%) and patient-initiated appointments in 38 responses (32%). A total of 80 (68%) cancer specialists also offered combined follow-up clinics with other specialties. Clinical examinations for hospital-based follow-up were mainly performed by doctors (67% for scheduled regular appointments and 63% for patient-initiated appointments) while telephone follow-up was provided in the majority by nurses (76%). Most respondents (76/117 (65%)) provided routine tests, of which 66/76 (87%) reported carrying out surveillance tests for ovarian cancer, 35/76 (46%) for cervical cancer, 8/76 (11%) for vulval cancer and 7/76 (9%) for endometrial cancer. Patients were usually discharged after 5 years (82/117 (70%)), whereas three (3%) were discharged after 4 years, nine (8%) after three years and one (1%) after 2 years. Conclusions Practice varied but most used a standard hospital-based protocol of appointments for 5 years and routine tests were performed usually for women with ovarian cancer. A minority utilised nurse-led or telephone follow-up. General practitioners were rarely involved in routine care. A randomised study comparing various models of follow-up could be considered. PMID:23883880

  3. PRM programmes of care and PRM care pathways: European approach, developments in France.

    PubMed

    de Korvin, Georges; Yelnik, Alain P; Ribinik, Patricia; Calmels, Paul; Le Moine, Francis; Delarque, Alain

    2013-03-01

    The development of European Union of Medical Specialists (UEMS) physical and rehabilitation medicine programmes of care (PRMPC) and physical and rehabilitation medicine care pathways (PRMCP) in France is a good example of the positive interaction between European and national organizations. PRMPC were defined at the European level to offer a robust template for the description and assessment of physical and rehabilitation medicine (PRM) clinical activity in various fields and contexts. An accreditation procedure was organized as a peer review. It has started to provide very informative documents. In France, discussions on this topic began in 2000. At the end of the same decade, the European approach fostered the interest of French PRM organizations in a period of negotiating with public authorities about two crucial issues: specifications required for reimbursement of functional instrumental assessments in PRM practice and funding of PRM care in postacute facilities. The French Society of PRM (SOFMER) decided to describe the PRM scope in a systematic way, emphasizing the best balance between patient needs, rehabilitation goals, relevant means and justified funding. Nine 'PRMCP' have been published since 2010 and others are in progress. PRMPC and PRMCP share the same concern about the best response offered by PRM to patients' needs. The first approach is the description of a local organization with respect to both scientific evidence and local conditions. The latter is an outline of PRM intervention related to a multidimensional pattern of patients' situations. Both enhance the role of PRM doctors, whose expertise is necessary for making a synthesis of medical diagnosis and functional assessment, for setting up a patient-centred care strategy and for supervising the rehabilitation team's intervention. PMID:23377230

  4. Developing a Work-Based Leadership Programme in the UK Social Care Sector

    ERIC Educational Resources Information Center

    McCray, Janet; Palmer, Adam

    2009-01-01

    Purpose: The purpose of this paper is to present a case study of the application of action research in the design of a degree-level leadership skills programme in the English social care sector. Design/methodology/approach: The action research study involved four formal semi-structured interviews with strategic leaders in the social care sector…

  5. The Refuge: An After-School Care Programme for African-American Children in Poverty

    ERIC Educational Resources Information Center

    Tuason, Ma. Teresa; Marcetic, Andjela; Roberts, Shavaun; Stuart, Karly; Rearick, Jessica

    2009-01-01

    The Refuge is an after-school care programme in the southeastern USA that caters to the academic and psychological needs of impoverished African-American children. This study evaluated the Refuge through interviews with staff, small group discussions with children and persistent observation. By evaluating the after-school care services they…

  6. Graduate Follow-Up Studies: How Useful Are They?

    ERIC Educational Resources Information Center

    Smedley, Rande H.; Olson, George H.

    Follow-up surveys may fall prey to several sources of bias and error, among them lack of control over independent variables, lack of item validity and reliability, sampling biases, and observation bias. Two follow-up studies have been dissected to expose inherent limitations: the Texas Education Product Study (TEPS) and Project TALENT. The…

  7. 49 CFR 219.211 - Analysis and follow-up.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Analysis and follow-up. 219.211 Section 219.211... Analysis and follow-up. (a) The laboratory designated in appendix B to this part undertakes prompt analysis... the railroad receives notification of the results of the toxicological analysis, any provision...

  8. 49 CFR 219.211 - Analysis and follow-up.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 4 2012-10-01 2012-10-01 false Analysis and follow-up. 219.211 Section 219.211 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION... Analysis and follow-up. (a) The laboratory designated in appendix B to this part undertakes prompt...

  9. 49 CFR 219.211 - Analysis and follow-up.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 4 2013-10-01 2013-10-01 false Analysis and follow-up. 219.211 Section 219.211 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION... Analysis and follow-up. (a) The laboratory designated in appendix B to this part undertakes prompt...

  10. 49 CFR 219.211 - Analysis and follow-up.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 4 2014-10-01 2014-10-01 false Analysis and follow-up. 219.211 Section 219.211 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION... Analysis and follow-up. (a) The laboratory designated in appendix B to this part undertakes prompt...

  11. 49 CFR 219.211 - Analysis and follow-up.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 4 2011-10-01 2011-10-01 false Analysis and follow-up. 219.211 Section 219.211 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION... Analysis and follow-up. (a) The laboratory designated in appendix B to this part undertakes prompt...

  12. Diagnosis, treatment and follow up of neonatal arrhythmias

    PubMed Central

    Binnetoğlu, Fatih Köksal; Babaoğlu, Kadir; Altun, Gürkan; Türker, Gülcan

    2014-01-01

    Summary Objective This study aimed to evaluate the aetiology, spectrum, course and outcomes of neonates with arrhythmias observed in a tertiary neonatal intensive care unit from 2007 to 2012. Methods Neonates with rhythm problems were included. The results of electrocardiography (ECG), Holter ECG, echocardiography and biochemical analysis were evaluated. The long-term results of follow up were reviewed. Results Forty-five patients were male (68%) and 21 (32%) were female. Fifty-five patients (83.3%) were term, 11 (16.6%) were preterm, and 34% were diagnosed in the prenatal period. Twenty cases (30.3%) had congenital heart disease. Twenty-three patients (34.8%) were diagnosed during the foetal period. The most common arrhythmias were supraventricular ectopic beats and supraventricular tachycardia (SVT) at 39.3 and 22.7%, respectively. SVT recurred in five patients after the neonatal period. Conclusion Supraventricular ectopic beats and SVT were the most common arrhythmias during the neonatal period. Although the prognosis of arrhythmias in the neonatal period is relatively good, regular monitoring is required. PMID:24844549

  13. Follow-up of children of diabetic mothers.

    PubMed

    Cummins, M; Norrish, M

    1980-04-01

    The results of a follow-up study of infants of diabetic mothers are presented. The antenatal care of all such mothers was supervised in a combined clinic by obstetricians and physicians, and good diabetic control was achieved in most of them. 51 mothers delivered 73 infants, all liveborn, between the years 1964 and 1972 inclusive at Hammersmith Hospital. There were no fetal deaths. 66 infants survived the neonatal period, and 63 the first 2 years of life. 51 children, including all those seriously ill in the neonatal period, could be traced. Detailed neurological and general examinations including skinfold measurements were made, and the IQ measured. Four children were found to have major handicaps. These were severe deafness, epilepsy, low IQ, and myopia. No other neurological abnormalities were detected, and the distribution of full-scale IQs was normal. The distribution of height and head circumference centiles was near normal, but an increased number of children had weights above the 90th centile. No significant congenital malformations were found in these 51 survivors, and none has so far developed diabetes. PMID:7416774

  14. Studying large-scale programmes to improve patient safety in whole care systems: challenges for research.

    PubMed

    Benn, Jonathan; Burnett, Susan; Parand, Anam; Pinto, Anna; Iskander, Sandra; Vincent, Charles

    2009-12-01

    Large-scale national and multi-institutional patient safety improvement programmes are being developed in the health care systems of several countries to address problems in the reliability of care delivered to patients. Drawing upon popular collaborative improvement models, these campaigns are ambitious in their aims to improve patient safety in macro-level systems such as whole health care organisations. This article considers the methodological issues involved in conducting research and evaluation of these programmes. Several specific research challenges are outlined, which result from the complexity of longitudinal, multi-level intervention programmes and the variable, highly sociotechnical care systems, with which they interact. Organisational-level improvement programmes are often underspecified due to local variations in context and organisational readiness for improvement work. The result is variable implementation patterns and local adaptations. Programme effects span levels and other boundaries within a system, vary dynamically or are cumulative over time and are problematic to understand in terms of cause and effect, where concurrent external influences exist and the impact upon study endpoints may be mediated by a range of organisational and social factors. We outline the methodological approach to research in the United Kingdom Safer Patients Initiative, to exemplify how some of the challenges for research in this area can be met through a multi-method, longitudinal research design. Specifically, effective research designs must be sensitive to complex variation, through employing multiple qualitative and quantitative measures, collect data over time to understand change and utilise descriptive techniques to capture specific interactions between programme and context for implementation. When considering the long-term, sustained impact of an improvement programme, researchers must consider how to define and measure the capability for continuous safe and

  15. A programme to reduce acquired pressure ulcers in care homes.

    PubMed

    Thompson, Trish Morris; Marks-Maran, Di

    Prevention of pressure ulcers is a major health concern, especially for older people. Much of the literature related to prevention of pressure ulcers focuses on hospital-acquired pressure ulcers. There is less literature related to prevention of pressure ulcers in care homes. This article presents a review of the literature related to prevention of pressure ulcers in care homes and an ambitious project undertaken by one care home provider to raise awareness of pressure ulcers, provide training in prevention and monitor and evaluate pressure ulcers in over 200 care home across the UK. Known as MI SKIN, the project involves ongoing training to all levels of care staff, a robust system of monitoring pressure ulcers and a mechanism to investigate and learn from any incident of pressure ulcer using root cause analysis. PMID:26110989

  16. Current State of Inclusion of Children with Special Needs in Child Care Programmes in One Canadian Province

    ERIC Educational Resources Information Center

    Wiart, Lesley; Kehler, Heather; Rempel, Gwen; Tough, Suzanne

    2014-01-01

    Background: Access to quality child care is an important support for families with children with disabilities. The objectives of this study were to determine: (1) the current state of inclusion of children with special needs in child care programmes, and (2) the presence of child care staff practices and programme characteristics that support…

  17. Changes in physical activity during a weight loss intervention and follow-up: a randomized controlled trial

    PubMed Central

    Fuller, N R; Williams, K; Shrestha, R; Ahern, A L; Holzapfel, C; Hauner, H; Jebb, S A; Caterson, I D

    2014-01-01

    Summary Physical activity is an important component in weight loss treatment and weight maintenance. We evaluated the physical activity component of two weight loss programmes, either standard care (SC) as defined by national guidelines, or a commercial programme (CP; Weight Watchers) over the period of weight loss and follow-up. 772 adults (mean body mass index: 31.4 ± 2.6 kg m−2) were recruited by primary care practices in Australia, the United Kingdom, and Germany, and randomly assigned to 12 months SC, or the CP. They were then followed up at 24 months. Change in physical activity levels were assessed by the International Physical Activity Questionnaire (IPAQ)-short form, and pedometer recordings. Both groups reported increases in physical activity using the IPAQ from baseline to 12 months and 24 months (within groups P < 0.0001) and in pedometer steps from baseline to 12 months only (within groups P < 0.0001). Differences between groups with both methods of assessment were not significant. There was a significant difference in weight loss between the groups at 12 months favouring the CP group; however, this statistical difference was not maintained at 24 months. In conclusion, despite similar increases in reported activity, there were significant differences in weight loss and regain between groups. Therefore, greater weight loss seen with the CP is unlikely to be due to increases in physical activity. Trends in pedometer steps mirrored changes in weight over time more closely than the IPAQ; however, both assessment tools have limitations. Better activity assessment measures are needed to more accurately gauge changes in physical activity during weight loss interventions. PMID:25826767

  18. The cost-effectiveness of primary care referral to a UK commercial weight loss programme.

    PubMed

    Meads, D M; Hulme, C T; Hall, P; Hill, A J

    2014-12-01

    Primary care referral to commercial weight loss programmes that follow best practice is included in current UK guidance on the management of adult obesity. This study investigated whether such a programme was cost-effective compared with usual care. A decision-analytical Markov model was developed to estimate the lifetime costs and benefits of the referral programme compared with usual care and enable a cost-utility analysis. The model cohort transited between body mass index classifications and type 2 diabetes, stroke and myocardial infarction (MI) with risk, cost and effect parameter values taken from published literature. The cost per incremental quality-adjusted life year (QALY) was calculated. Extensive deterministic and scenario sensitivity analyses and probabilistic sensitivity analyses (PSA) were conducted. At 12 months, the incremental cost-effectiveness ratio was £6906, indicating that programme referral was cost-effective. Over a lifetime, referral to the commercial programme was dominant as it led to a cost saving of £924 and conferred incremental benefit (0.22 QALY) over usual care. Model simulations estimated lower lifetime rates of type 2 diabetes, stroke and MI as a result of the weight loss achieved. The results were robust to extensive sensitivity analyses. The PSA indicated that programme referral had a 68% chance of being cost-effective at a willingness to pay per incremental QALY threshold of £20,000. Referral to the programme dominated usual care, being both cheaper and more effective. These results compare favourably with economic evaluations of other obesity interventions and add to a growing evidence base on the cost-effectiveness of commercial weight loss providers and practices. PMID:25826162

  19. Determining the rate of follow-up after hospital emergency department visits for dental conditions

    PubMed Central

    Meyer, Beau; Adkins, Eric; Finnerty, Nathan M; Robinson, Fonda G

    2016-01-01

    Background Emergency department (ED) visits for dental reasons continue to impact EDs nationwide. This investigation determined the rate of follow-up in an emergency dental clinic (EDC) after hospital ED visits for nontraumatic dental conditions. Methods This prospective investigation reports the number of patients who presented to an ED for nontraumatic dental conditions and the rate of follow-up at an EDC. Upon ED discharge, patients were provided instructions to follow-up for low-cost care at the EDC. Telephone contact was attempted following failed referrals. Descriptive statistics were reported for comparing referral sources and demographic trends. Results Two hundred and forty-seven referrals were made and 31% followed up for definitive treatment at the EDC. More referrals were made on weekends than on weekdays. Failed referrals were unreachable by telephone in 75% of cases. Tooth extraction was the most common treatment rendered in the EDC. Of the ED patients who accessed EDC care, 14% became comprehensive patients in the EDC’s regular dental clinic. Conclusion Less than one-third of ED referrals to the EDC followed up for definitive care when provided an opportunity to do so, and 75% of referrals were unreachable by telephone in the week following the ED dental visit. PMID:27099530

  20. Guidelines for the follow-up of patients undergoing bariatric surgery.

    PubMed

    O'Kane, Mary; Parretti, Helen M; Hughes, Carly A; Sharma, Manisha; Woodcock, Sean; Puplampu, Tamara; Blakemore, Alexandra I; Clare, Kenneth; MacMillan, Iris; Joyce, Jacqueline; Sethi, Su; Barth, Julian H

    2016-06-01

    Bariatric surgery can facilitate weight loss and improvement in medical comorbidities. It has a profound impact on nutrition, and patients need access to follow-up and aftercare. NICE CG189 Obesity emphasized the importance of a minimum of 2 years follow-up in the bariatric surgical service and recommended that following discharge from the surgical service, there should be annual monitoring as part of a shared care model of chronic disease management. NHS England Obesity Clinical Reference Group commissioned a multi-professional subgroup, which included patient representatives, to develop bariatric surgery follow-up guidelines. Terms of reference and scope were agreed upon. The group members took responsibility for different sections of the guidelines depending on their areas of expertise and experience. The quality of the evidence was rated and strength graded. Four different shared care models were proposed, taking into account the variation in access to bariatric surgical services and specialist teams across the country. The common features include annual review, ability for a GP to refer back to specialist centre, submission of follow-up data to the national data base to NBSR. Clinical commissioning groups need to ensure that a shared care model is implemented as patient safety and long-term follow-up are important. PMID:27166136

  1. Managing high-risk patients: the Mass General care management programme

    PubMed Central

    Kodner, Dennis L.

    2015-01-01

    The Massachusetts General Care Management Program (Mass General CMP or CMP) was designed as a federally supported demonstration to test the impact of intensive, practice-based care management on high-cost Medicare fee-for-service (FFS) beneficiaries—primarily older persons—with multiple hospitalisations and multiple chronic conditions. The Massachusetts General Care Management Program operated over a 6-year period in two phases (3 years each). It started during the first phase at Massachusetts General Hospital, a major academic medical centre in Boston, Massachusetts in collaboration with Massachusetts General Physicians Organisation. During the second phase, the programme expanded to two more affiliated sites in and around the Boston area, including a community hospital, as well as incorporated several modifications primarily focused on the management of transitions to post-acute care in skilled nursing facilities. At the close of the demonstration in July 2012, Mass General Massachusetts General Care Management Program became a component of a new Pioneer accountable care organisation (ACO). The Massachusetts General Care Management Program is focused on individuals meeting defined eligibility criteria who are offered care that is integrated by a case manager embedded in a primary care practice. The demonstration project showed substantial cost savings compared to fee-for-service patients served in the traditional Medicare system but no impact on hospital readmissions. The Massachusetts General Care Management Program does not rest upon a “whole systems” approach to integrated care. It is an excellent example of how an innovative care co-ordination programme can be implemented in an existing health-care organisation without making fundamental changes in its underlying structure or the way in which direct patient care services are paid for. The accountable care organisation version of the Massachusetts General Care Management Program includes the staffing

  2. Managing high-risk patients: the Mass General care management programme.

    PubMed

    Kodner, Dennis L

    2015-01-01

    The Massachusetts General Care Management Program (Mass General CMP or CMP) was designed as a federally supported demonstration to test the impact of intensive, practice-based care management on high-cost Medicare fee-for-service (FFS) beneficiaries-primarily older persons-with multiple hospitalisations and multiple chronic conditions. The Massachusetts General Care Management Program operated over a 6-year period in two phases (3 years each). It started during the first phase at Massachusetts General Hospital, a major academic medical centre in Boston, Massachusetts in collaboration with Massachusetts General Physicians Organisation. During the second phase, the programme expanded to two more affiliated sites in and around the Boston area, including a community hospital, as well as incorporated several modifications primarily focused on the management of transitions to post-acute care in skilled nursing facilities. At the close of the demonstration in July 2012, Mass General Massachusetts General Care Management Program became a component of a new Pioneer accountable care organisation (ACO). The Massachusetts General Care Management Program is focused on individuals meeting defined eligibility criteria who are offered care that is integrated by a case manager embedded in a primary care practice. The demonstration project showed substantial cost savings compared to fee-for-service patients served in the traditional Medicare system but no impact on hospital readmissions. The Massachusetts General Care Management Program does not rest upon a "whole systems" approach to integrated care. It is an excellent example of how an innovative care co-ordination programme can be implemented in an existing health-care organisation without making fundamental changes in its underlying structure or the way in which direct patient care services are paid for. The accountable care organisation version of the Massachusetts General Care Management Program includes the staffing structure

  3. Quality Indicator Development for Positive Screen Follow-up for Sickle Cell Disease and Trait.

    PubMed

    Faro, Elissa Z; Wang, C Jason; Oyeku, Suzette O

    2016-07-01

    Extensive variation exists in the follow-up of positive screens for sickle cell disease. Limited quality indicators exist to measure if the public health goals of screening-early initiation of treatment and enrollment to care-are being achieved. This manuscript focuses on the development of quality indicators related to the follow-up care for individuals identified with sickle cell disease and trait through screening processes. The authors used a modified Delphi method to develop the indicators. The process included a comprehensive literature review with rating of the evidence followed by ratings of draft indicators by an expert panel held in September 2012. The expert panel was nominated by leaders of various professional societies, the Health Resources and Services Administration, and the National Heart, Lung, and Blood Institute and met face to face to discuss and rate each indicator. The panel recommended nine quality indicators focused on key aspects of follow-up care for individuals with positive screens for sickle cell disease and trait. Public health programs and healthcare institutions can use these indicators to assess the quality of follow-up care and provide a basis for improvement efforts to ensure appropriate family education, early initiation of treatment, and appropriate referral to care for individuals identified with sickle cell disease and trait. PMID:27320465

  4. Short-Term Follow-Up of Narcotic Addicts

    ERIC Educational Resources Information Center

    Swartz, June; Jabara, Raymond

    1974-01-01

    A follow-up questionnaire was mailed to 144 narcotic addict veterans approximately six months after termination from treatment at a multimodality drug program. It was found that 75 percent continued to use drugs, and 38 percent became readdicted. (Author)

  5. Follow-Up and Feed-Back Materials.

    ERIC Educational Resources Information Center

    Cripwell, Kenneth R.

    1968-01-01

    Presented and discussed are a series of suggestions and examples concerned with improving ETV and ITV programs through feedback and increasing their effectiveness through the use of follow-up materials in the classroom. (LS)

  6. Follow-up of an Exercise-Based Treatment for Children with Reading Difficulties

    ERIC Educational Resources Information Center

    Reynolds, David; Nicolson, Roderick I.

    2007-01-01

    This study reports the results of a long-term follow-up of an exercise-based approach to dyslexia-related disorders (Reynolds, Nicolson, & Hambly, "Dyslexia," 2003; 9(1): 48-71). In the initial study, children at risk of dyslexia were identified in 3 years of a junior school. One half then undertook a 6 month, home-based exercise programme.…

  7. Women with abnormal screening mammography lost to follow-up

    PubMed Central

    Kuo, Chia-Sheng; Chen, Guan-Ru; Hung, Shou-Hung; Liu, Yi-Lien; Huang, Kuo-Chin; Cheng, Shao-Yi

    2016-01-01

    Abstract Breast cancer has the highest incidence among all cancers for women in Taiwan. The current screening policy in Taiwan suggested a biennial mammography for all women 40 to 69 years of age. A recommendation for additional testing is recommended for women with a BI-RADS result of 0 or 4; a request made via postal mail. Approximately 20% of high-risk patients do not receive additional follow-up. Therefore, we aimed to explore the causes of these patients being lost to follow-up, despite an abnormal mammogram. Two questionnaires were designed separately according to the conceptual framework of the Health Belief Model. Study participants, women who received a screening mammography at the National Taiwan University Hospital in 2011 with a BI-RAD of 0 or 4, were interviewed via telephone. The dependent variable was receipt of follow-up or not. The analyses were performed by using χ2 tests and logistic regression models. In total, 528 women were enrolled in the study: 51.2% in BI-RADS 0 group and 56.6% in BI-RADS 4, respectively. In the BI-RADS 0 group, those patients who received a follow-up examination cited the most likely causes to be physician suggestion, health implications, and concerns regarding breast cancer. Patients who did not receive a follow-up examination cited a lack of time and a perception of good personal health as primary reasons. In the BI-RADS 4 group, those patients who received a follow-up examination cited the physician's recommendation and a recognition of the importance of follow-up examinations. Patients who did not receive a follow-up examination cited having received follow-up at another hospital and a desire for a second opinion. In the BI-RADS 0 group, multivariate analysis showed that patients with higher scores in the “perceived benefits” domain were statistically more likely to receive a follow-up examination. There was no significant difference in perceived threats, perceived barriers, action cues, or self-efficacy between

  8. Obesity in preschool children: an intervention programme in primary health care in Singapore.

    PubMed

    Ray, R; Lim, L H; Ling, S L

    1994-05-01

    The Programme on Prevention and Management of Obesity in Preschool Children, aged three to six years, was implemented in 17 Primary Health Clinics in November 1991. The study sample comprised 1128 preschool children who qualified to enter the obesity register, using the defined criteria for obesity of 2 standard deviations above the normal weight for height and age. This group was divided into three categories, namely, mildly overweight (120% to below 140%), moderately overweight (140% to below 160%), and severely overweight (above 160%). The severely overweight category was referred to dietitians for follow-up management, while the other two categories were managed by the clinic staff through pre-planned nurse-conducted counselling sessions. In this paper, we analysed the first 1128 preschool children aged three to six years on the Programme with respect to their demographic characteristics; medical conditions; family history of obesity, diabetes, hypertension and ischaemic heart disease; number of siblings and parents' educational and occupational status. The Malay children showed significantly more severe grades of obesity compared to the Chinese and Indian children. A family history of obesity and hypertension among the three groups were significant (P < 0.001). After one year of follow-up with the intervention programme, the following were found: 40.4% (456) of the children improved in their obesity status and 20.2% (228) reached normal status. The severe, moderate and mild categories reduced from 6.3% to 5.9%, 29.3% to 23.2% and 64.4% to 50.7% respectively and was found to be statistically significant (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7944246

  9. Feasibility and benefits of group-based exercise in residential aged care adults: a pilot study for the GrACE programme

    PubMed Central

    Henwood, Timothy; Climstein, Mike; Keogh, Justin William Leslie

    2016-01-01

    The objective of the study was to examine the feasibility and benefits of a group resistance training exercise programme for improving muscle function in institutionalised older adults. A feasibility and acceptability study was designed for a residential aged care (RAC) facility, based on the Gold Coast, Australia. Thirty-seven adults, mean age 86.8 ± 6.1 years (30 females) living in a RAC facility. Participants were allocated into an exercise (n = 20) or control (n = 17) group. The exercise group, the Group Aged Care Exercise (GrACE) programme, performed 12 weeks of twice weekly resistance exercises. Feasibility was measured via recruitment rate, measurement (physiological and surveys) completion rate, loss-to-follow-up, exercise session adherence, adverse events, and ratings of burden and acceptability. Muscle function was assessed using gait speed, sit-to-stand and handgrip strength assessments. All intervention participants completed pre- and post-assessments, and the exercise intervention, with 85% (n = 17) of the group attending ≥ 18 of the 24 sessions and 15% (n = 3) attending all sessions. Acceptability was 100% with exercise participants, and staff who had been involved with the programme strongly agreed that the participants “Benefited from the programme.” There were no adverse events reported by any participants during the exercise sessions. When compared to the control group, the exercise group experienced significant improvements in gait speed (F(4.078) = 8.265, p = 0.007), sit to stand performance (F(3.24) = 11.033, p = 0.002) and handgrip strength (F(3.697) = 26.359, p < 0.001). Resistance training via the GrACE programme is feasible, safe and significantly improves gait speed, sit-to-stand performance and handgrip strength in RAC adults. PMID:27231652

  10. The UPBEAT depression and coronary heart disease programme: using the UK medical research council framework to design a nurse-led complex intervention for use in primary care

    PubMed Central

    2012-01-01

    Background Depression is common in coronary heart disease (CHD) and increases the incidence of coronary symptoms and death in CHD patients. Interventions feasible for use in primary care are needed to improve both mood and cardiac outcomes. The UPBEAT-UK programme of research has been funded by the NHS National Institute for Health Research (NIHR) to explore the relationship between CHD and depression and to develop a new intervention for use in primary care. Methods Using the Medical Research Council (MRC) guidelines for developing and evaluating complex interventions, we conducted a systematic review and qualitative research to develop a primary care-based nurse-led intervention to improve mood and cardiac outcomes in patients with CHD and depression. Iterative literature review was used to synthesise our empirical work and to identify evidence and theory to inform the intervention. Results We developed a primary care-based nurse-led personalised care intervention which utilises elements of case management to promote self management. Following biopsychosocial assessment, a personalised care plan is devised. Nurses trained in behaviour change techniques facilitate patients to address the problems important to them. Identification and utilisation of existing resources is promoted. Nurse time is conserved through telephone follow up. Conclusions Application of the MRC framework for complex interventions has allowed us to develop an evidence based intervention informed by patient and clinician preferences and established theory. The feasibility and acceptability of this intervention is now being tested further in an exploratory trial. PMID:23234253