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Sample records for patient case-mix follow-up

  1. Gastroscopic follow up of pernicious anaemia patients.

    PubMed Central

    Sjöblom, S M; Sipponen, P; Järvinen, H

    1993-01-01

    To assess the value of gastroscopic cancer surveillance of patients with pernicious anaemia, 56 patients were re-endoscoped and biopsied after three years. In addition, changes in the density of fundic mucosal endocrine cells were evaluated morphometrically. Two cases (3.6%) of early gastric cancer and two cases of small gastric carcinoid tumours (3.6%) were detected in addition to the five carcinoids that had been found at the initial endoscopic screening. Nodular argyrophil cell hyperplasia and morphometric density of argyrophil cells were not stable phenomena: nodular hyperplasias regressed in five patients, remained similar in six, and progressed to a small carcinoid tumour in one. Serum gastrin concentrations did not correlate well with changes in the endocrine cell density. Regular endoscopic surveillance for gastric cancer may be beneficial and realistic in young patients with pernicious anaemia while the importance of fundic endocrine cell hyperplasia and that of small gastric carcinoids need further study. PMID:8432447

  2. Acromegalic patients lost to follow-up: a pilot study.

    PubMed

    Kasuki, Leandro; Marques, Nelma Verônica; Nuez, Maria José Braga La; Leal, Vera Lucia Gomes; Chinen, Renata N; Gadelha, Mônica R

    2013-06-01

    Approximately 50 % of all acromegalic patients will require lifelong medical treatment to normalize mortality rates and reduce morbidity. Thus, adherence to therapy is essential to achieve treatment goals. To date, no study has evaluated the frequency and reasons for loss to follow-up in the acromegalic population. The current study aimed at evaluating the frequency of acromegalic patient loss to follow-up in three reference centers and the reasons responsible for their low compliance with treatment. All of the files for the acromegalic patients in the three centers were reviewed. Those patients, who had not followed up with the hospital for more than a year, were contacted via phone and/or mail and invited to participate. Patients who agreed to participate were interviewed, and blood samples were collected. A total of 239 files were reviewed; from these 42 patients (17.6 %) were identified who were lost to follow-up. It was possible to contact 27 of these patients, 10 of whom did not attend the appointments for more than one time and 17 of whom agreed to participate in the study. Fifteen of these 17 patients had active disease (88.2 %), and all of the patients restarted treatment in the original centers. The main reason for loss to follow-up was an absence of symptoms. High-quality follow-up is important in acromegaly to successfully achieve the aims of the treatment. An active search for patients may allow the resumption of treatment in a significant proportion of these cases, contributing to reduced morbidity and mortality in this patient population.

  3. Patients' expectations and preferences regarding cancer follow-up care.

    PubMed

    Brandenbarg, D; Berendsen, A J; de Bock, G H

    2017-07-05

    Most survivors of cancer enter a follow-up routine after their treatment, the aim of which is to detect recurrence, provide psychological support, monitor treatment-related side-effects, and to evaluate care. Due to rising numbers of people with cancer and better survival of these patients, current follow-up routines are under pressure. We reviewed the literature on patients' expectations and preferences regarding this care. We systematically searched the databases of Pubmed, CINAHL, and PsychInfo. Studies were screened and data extraction was double performed by three authors. Data were collected from quantitative and qualitative studies and described thematically. After screening, 12 full-text articles were included, comprising 849 patients aged from 28 to 90 years. Patients expect follow-up visits to detect recurrence of cancer. They want to undergo extensive testing to get reassurance. Furthermore, patients expect relevant information to be provided and to get advice about different aspects of their illness. Psychosocial support is also expected. Patients express a desire for consistency of care as well as continuity of care, and prefer long and intensive follow-up. After cancer, patients appear to lose confidence in their bodies and fear cancer recurrence after the end of treatment, which may lead to intensive screening wishes. This is not desirable, since care for cancer is already under pressure due to rising numbers of survivors. We have to ensure that follow-up routines are sustainable and effective. Patients should receive good information about the need for follow-up tests. Doctors should be trained to give this information. Copyright © 2017 Elsevier B.V. All rights reserved.

  4. Outpatient Follow-up and Secondary Prevention for Melanoma Patients

    PubMed Central

    Gamble, Ryan G.; Jensen, Daniel; Suarez, Andrea L.; Hanson, Anne H.; McLaughlin, Lauren; Duke, Jodi; Dellavalle, Robert P.

    2010-01-01

    Health care providers and their patients jointly participate in melanoma prevention, surveillance, diagnosis, and treatment. This paper reviews screening and follow-up strategies for patients who have been diagnosed with melanoma, based on current available evidence, and focuses on methods to assess disease recurrence and second primary occurrence. Secondary prevention, including the roles of behavioral modification and chemoprevention are also reviewed. The role of follow-up dermatologist consultation, with focused physical examinations complemented by dermatoscopy, reflectance confocal microscopy, and/or full-body mapping is discussed. Furthermore, we address the inclusion of routine imaging and laboratory assessment as components of follow-up and monitoring of advanced stage melanoma. The role of physicians in addressing the psychosocial stresses associated with a diagnosis of melanoma is reviewed. PMID:24281112

  5. Outpatient follow-up of patients hospitalized for acute leptospirosis

    PubMed Central

    Spichler, Anne; Athanazio, Daniel; Seguro, Antonio C.; Vinetz, Joseph M.

    2011-01-01

    Summary Objective The outcome of leptospirosis after the resolution of acute disease, either spontaneously or after treatment, is not well described. The aim of this study was to assess the possible sequelae of acute leptospirosis after hospital discharge. Methods We report here a prospective study carried out in São Paulo, Brazil in which patients hospitalized for leptospirosis were followed in the outpatient setting. Results Forty-seven patients were serially assessed: 32 severe and 15 mild cases. Early and late complications were not common in either group, but subjective complaints were common in the first few weeks after hospital discharge (53% of severe cases, 40% of mild cases). Two patients had continuing complaints: one had profound general malaise and the other developed new onset panic disorder. The sample analyzed represented 26% of the patients hospitalized with leptospirosis in the city of São Paulo during the study period. The duration of follow-up was an average of approximately 20 days at the first visit, and approximately 40 days at the second visit. Forty-seven patients came for one follow-up visit and 22 of the same patients had two follow-up visits. Conclusions While two of 47 patients reported continuing symptoms after hospitalization for acute leptospirosis, no definitive, objective evidence of chronic sequelae due to this infection was proven. While preliminary, these observations point to the need for a prospective, rigorous and systematic study to definitively determine and characterize late complications and chronic disease after acute leptospirosis. PMID:21616696

  6. Longitudinal follow-up of occupational status in tinnitus patients.

    PubMed

    Andersson, G

    2000-01-01

    In this study, the long-term outcome of tinnitus patients was studied in terms of changes in occupational status from admission to follow-up for an average duration of 5 years. A consecutive series of 189 tinnitus patients seen between the years 1988 and 1995 were sent a postal questionnaire booklet; 146 provided usable responses (a 77% response rate). Results showed a significant change in occupational status, which was explained partly by retirement because of old age. Few were unemployed at follow-up, and relatively few were on sick leave. These data suggest that tinnitus patients may be less of a demand for the sickness benefit system in Sweden, but it may reflect also that tinnitus is not accepted as a cause for sick absenteeism.

  7. [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.

  8. Detailed Follow-up Study of Pediatric Orofacial Granulomatosis Patients.

    PubMed

    Haaramo, Anu; Alapulli, Heikki; Aine, Liisa; Saarnisto, Ulla; Tuokkola, Jetta; Ruuska, Tarja; Sipponen, Taina; Pitkäranta, Anne; Kolho, Kaija-Leena

    2017-10-01

    Orofacial granulomatosis (OFG) is a chronic inflammatory condition affecting the orofacial area. Its connection to Crohn disease (CD) is debated. Our aim was to describe a cohort of pediatric patients with OFG in detail, study the long-term behavior of OFG, and evaluate factors predicting CD in patients with OFG. We invited patients diagnosed with OFG at 2 university hospitals, Finland for a follow-up appointment. Patients (n = 29) were examined by a dentist and an otorhinolaryngologist using a structural schema. Orofacial findings were also recorded using digital photographing. Patients filled in questionnaires about general health and special diets. Patients' nutrition was evaluated from food records. The findings were compared between patients with OFG only and OFG with CD. Patients with CD had more findings in the orofacial area (total score for orofacial findings median 11) compared to patients with OFG only (total score median 7.5). There was no statistically significant difference in the type of lesions between these groups, except the upper lip was more often affected in patients with CD (n = 11) than in patients with OFG only (n = 0). Most of the patients had normal otorhinolaryngological findings. All patients with elevated anti-Saccharomyces cerevisiae antibody A levels had CD (n = 6) and they presented with more orofacial findings (total score) than patients with normal levels of anti-S cerevisiae antibody A (P = 0.0311). Long-term follow-up of pediatric-onset patients with OFG shows good prognosis. Patients with OFG do not seem to have otorhinolaryngological comorbidity. Anti-S cerevisiae antibody A may serve as a factor to indicate the possible presence of underlying CD in patients with OFG, but further studies are requested.

  9. Outpatient follow-up of patients hospitalized for acute leptospirosis.

    PubMed

    Spichler, Anne; Athanazio, Daniel; Seguro, Antonio C; Vinetz, Joseph M

    2011-07-01

    The outcome of leptospirosis after the resolution of acute disease, either spontaneously or after treatment, is not well described. The aim of this study was to assess the possible sequelae of acute leptospirosis after hospital discharge. We report here a prospective study carried out in São Paulo, Brazil in which patients hospitalized for leptospirosis were followed in the outpatient setting. Forty-seven patients were serially assessed: 32 severe and 15 mild cases. Early and late complications were not common in either group, but subjective complaints were common in the first few weeks after hospital discharge (53% of severe cases, 40% of mild cases). Two patients had continuing complaints: one had profound general malaise and the other developed new onset panic disorder. The sample analyzed represented 26% of the patients hospitalized with leptospirosis in the city of São Paulo during the study period. The duration of follow-up was an average of approximately 20 days at the first visit, and approximately 40 days at the second visit. Forty-seven patients came for one follow-up visit and 22 of the same patients had two follow-up visits. While two of 47 patients reported continuing symptoms after hospitalization for acute leptospirosis, no definitive, objective evidence of chronic sequelae due to this infection was proven. While preliminary, these observations point to the need for a prospective, rigorous and systematic study to definitively determine and characterize late complications and chronic disease after acute leptospirosis. Copyright © 2011 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  10. [Intracranial stenosis. Study and follow-up of 38 patients].

    PubMed

    Palomeras Soler, E; Fossas Felip, P; Cano Orgaz, A; Sanz Cartagena, P

    2004-06-01

    To describe vascular risk factors of patients harboring intracranial arterial stenosis (IAS) as well their final outcome. We reviewed clinical reports of all patients admitted to our Institution from April 1, 1999 to November 30, 2001 with the diagnosis of IAS. Diagnosis was made by means of magnetic resonance angiography (MRA) or four-vessels digital subtraction angiography. Thirty-eight patients harboring 56 IAS were identified. Mean follow-up was 18 months. Two control groups were selected: one was a group of 44 patients with stroke and embolic cardiopathy (EC) and the other was a group of 67 patients with stroke and extracranial stenosis without IAS. Mean age was 69.7 years, with male preponderance (76.3 %). Seventeen cases (44.7 %) had associated extracranial carotid stenosis greater than 50 %. Multiple IAS were found in 12 patients. Diabetes mellitus was significantly more frequent in the IAS group than in both control groups. On the other hand, cigarette smoking was more common in the IAS group with respect to the EC group. IAS was symptomatic in 25 cases, whereas in 13 patients IAS was found in the work-up for cerebral ischemia in another territory. From the group of symptomatic patients, 22 (88 %) had a Rankin scale 2 or lower on discharge and, in the long term follow-up, their incidence rate of recurrent ischemic stroke was 15 per 100 patients/year. Diabetes mellitus was the most specific risk factor for IAS. IAS was multiple in 32% of patients and in extracranial stenosis from moderate to severe degree was found in 44.7% of the cases. Stroke secondary to IAS caused a low dependency level at discharge. Incidence rate of recurrent ischemic stroke was 15 % patients/ year.

  11. Comparing cancer detection rates of patients undergoing short term follow-up vs routine follow-up after benign breast biopsies, is follow-up needed?

    PubMed

    Plecha, Donna M; Garlick, Courtney; Dubchuck, Christina; Thompson, Cheryl; Constantinou, Niki

    To compare cancer rates after benign breast biopsies between patients with short term imaging follow-up (STFU) and those with routine follow-up (RFU). Retrospective review of benign stereotactic, US or DCE-MRI breast biopsies. Of 580 lesions, 192 (33%) had STFU, and 388 (67%) had RFU. For US and mammographic detected lesions, there is no difference in cancer rates between the STFU (1 cancer, n=148) and the RFU group (0 cancer, n=365) (p=0.29). There were 2 cancers in the STFU group versus 0 in the RFU DCE-MRI group (p=0.54). Our results support RFU after benign ultrasound and stereotactic breast biopsies. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. [Follow-up of patients with inflammatory bowel disease].

    PubMed

    García-López, Santiago

    2013-10-01

    Multiple data were presented on inflammatory bowel disease (IBD) in Digestive Disease Week (DDW). Of particular interest to gastroenterologists were those on novel treatments and information on safety. Other data, such as those relating to disease "follow-up", were possibly of lesser interest. However, the information reported this year was, in my opinion, highly important, because it could lead to significant changes in clinical practice. Thus, results presented strongly suggest that patients with asymptomatic IBD, specifically Crohn's disease (CD), often develop complications during their clinical course. Moreover, this is especially true in patients with CD and biological signs of inflammation, despite being asymptomatic. In addition, it seems clear that the absence of symptoms does not imply an absence of inflammation. These observations indicate a dual practical message: patients should be followed-up and objectively evaluated. Multiple data were presented on how to objectively evaluate disease activity in IBD. The prognostic value and objectivity of endoscopy has been reaffirmed, specifically with new data on the only validated index, the UCEIS, in ulcerative colitis. Together with endoscopy, the role of less invasive techniques such as imaging tests (magnetic resonance enterography, computed tomography enterography and even echography, with and without contrast agent) and fecal markers has been reaffirmed in several conditions and these techniques have a certain predictive value. Finally, many studies were reported that confirm the therapeutic activity of levels of anti-TNF and its antibodies in certain conditions and with some limitations. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  13. [Patient education: the way for long-term follow up].

    PubMed

    Ruiz, J

    2008-06-04

    Therapeutic education is now perfectly integrated in caring and medicine. Its field of application is primarily in chronic diseases for the acquisition of competences in the management of treatments, in co-operation with health professionals. In ambulatory medicine, patients and health professionals are currently running up against the difficulties of the long-term follow-up with its part of uncertainty, lassitude and economic pressure. EBM and the various models of health psychology light us only partially the way. A new type of reflexive step is emerging. This way of thinking should place in its center the concept of therapeutic relation: between science and being. We summarize here our reflexive process in the course of an interdisciplinary team gathering social sciences, art and medicine.

  14. Orthopedics management of acromicric dysplasia: follow up of nine patients.

    PubMed

    Klein, Céline; Le Goff, Carine; Topouchian, Vicken; Odent, Sylvie; Violas, Philippe; Glorion, Christophe; Cormier-Daire, Valérie

    2014-02-01

    Acromicric dysplasia (AD) is an autosomal dominant disorder characterized by short stature, short extremities, stiff joint and skeleton features including brachymetacarpia, cone-shaped epiphyses, internal notch of the femoral head, and delayed bone age. Recently, we identified fibrillin 1 (FBN1) as the disease gene of AD. The aim of our study was to further describe the long-term follow up of AD patients with an emphasis on orthopedic management. Nine patients with FBN1 mutations were included in the study ranging in age from 5.5 to 64 years. For all, detailed clinical and radiological data were available. Birth parameters were always normal and patients progressively developed short stature <-3 SD. Carpal tunnel syndrome was observed in four patients. We found discrepancy between the carpal bone age and the radius and ulna epiphysis bone ages, a variable severity of hip dysplasia with acetabular dysplasia, epiphyseal and metaphyseal femoral dysplasia resembling Legg-Perthes-Calvé disease and variable pelvic anteversion and hyperlordosis. Orthopedic surgery was required in two patients for hip dysplasia, in one for limb lengthening and in three for carpal tunnel syndrome. Our observations expand the AD phenotype and emphasize the importance of regular orthopedic survey. © 2013 Wiley Periodicals, Inc.

  15. [Cardiological follow-up in patients with Fabry disease].

    PubMed

    Pieruzzi, Federico; Pieroni, Maurizio; Chimenti, Cristina; Frustaci, Andrea; Sarais, Cristiano; Cecchi, Franco

    2010-01-01

    Fabry disease is a rare tesaurismosis due to a deficit of the lysosomal enzyme activity of alpha-galactosidase, needed for the normal catabolism of globotriaosylceramides (GL3). Fabry cardiac involvement has several clinical manifestations: concentric left ventricular hypertrophy without left ventricular dilation and severe loss of left ventricular systolic function, mitral and aortic valvulopathy, disorders of the atrioventricular conduction or repolarization, and compromised diastolic function. Differentiating Fabry disease from similar conditions is often quite straightforward, e.g., cardiac amyloidosis is often associated with low electrocardiographic voltages, and systemic symptoms are usually associated with hemochromatosis and sarcoidosis. However, sometimes second-level (genetic analysis, alpha-galactosidase levels) or invasive investigations are required, which can include endomyocardial biopsy. Diagnostic imaging techniques have been described, but they lack specificity. Echocardiographic imaging with tissue Doppler analysis and/or strain rate analysis can allow diagnosis of Fabry disease even before left ventricular hypertrophy becomes apparent. This review illustrates the techniques for staging cardiac involvement and damage in Fabry disease and for the long-term follow-up of Fabry patients with or without cardiac involvement. Careful cardiac monitoring is especially important in elderly female carriers, who often develop renal disorders and/or left ventricular hypertrophy as the only manifestations of their late Fabry disease. In some clinical series, Fabry disease was diagnosed in 12% of women with adult-onset hypertrophic cardiomyopathy. Cardiological problems and outcomes of enzyme replacement therapy, associated with or without other cardiological treatments, are also discussed.

  16. [Long-term follow up of patients with pernicious anemia].

    PubMed

    Horváth, K; Laub, W M

    1990-05-13

    The authors give several data of 357 patients with megaloblastic anaemia diagnosed, treated and controlled between 1958-1988. 334 of the patients had anaemia perniciosa and 23 of them had postresectional megaloblastic anaemia. After listing the criteria of the diagnosis the authors detail the mean age of the patients at the time of diagnosis, the distribution of sexes, age and blood groups among the patients, the number of new cases per year, the frequency of relapsus of the disease and its association with other autoimmune diseases. They also deal with the characteristic seasonal fluctuation and the accumulated cases in families. Its association with malignant tumours, especially with stomach carcinoma was examined.

  17. Nurse-led follow-up at home vs. conventional medical outpatient clinic follow-up in patients with incurable upper gastrointestinal cancer: a randomized study.

    PubMed

    Uitdehaag, Madeleen J; van Putten, Paul G; van Eijck, Casper H J; Verschuur, Els M L; van der Gaast, Ate; Pek, Chulja J; van der Rijt, Carin C D; de Man, Rob A; Steyerberg, Ewout W; Laheij, Robert J F; Siersema, Peter D; Spaander, Manon C W; Kuipers, Ernst J

    2014-03-01

    Upper gastrointestinal cancer is associated with a poor prognosis. The multidimensional problems of incurable patients require close monitoring and frequent support, which cannot sufficiently be provided during conventional one to two month follow-up visits to the outpatient clinic. To compare nurse-led follow-up at home with conventional medical follow-up in the outpatient clinic for patients with incurable primary or recurrent esophageal, pancreatic, or hepatobiliary cancer. Patients were randomized to nurse-led follow-up at home or conventional medical follow-up in the outpatient clinic. Outcome parameters were quality of life (QoL), patient satisfaction, and health care consumption, measured by different questionnaires at one and a half and four months after randomization. As well, cost analyses were done for both follow-up strategies in the first four months. In total, 138 patients were randomized, of which 66 (48%) were evaluable. At baseline, both groups were similar with respect to clinical and sociodemographic characteristics and health-related QoL. Patients in the nurse-led follow-up group were significantly more satisfied with the visits, whereas QoL and health care consumption within the first four months were comparable between the two groups. Nurse-led follow-up was less expensive than conventional medical follow-up. However, the total costs for the first four months of follow-up in this study were higher in the nurse-led follow-up group because of a higher frequency of visits. The results suggest that conventional medical follow-up is interchangeable with nurse-led follow-up. A cost utility study is necessary to determine the preferred frequency and duration of the home visits. Copyright © 2014 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

  18. Case mix, quality and high-cost kidney transplant patients.

    PubMed

    Englesbe, M J; Dimick, J B; Fan, Z; Baser, O; Birkmeyer, J D

    2009-05-01

    A better understanding of high-cost kidney transplant patients would be useful for informing value-based purchasing strategies by payers. This retrospective cohort study was based on the Medicare Provider Analysis and Review (MEDPAR) files from 2003 to 2006. The focus of this analysis was high-cost kidney transplant patients (patients that qualified for Medicare outlier payments and 30-day readmission payments). Using regression techniques, we explored relationships between high-cost kidney transplant patients, center-specific case mix, and center quality. Among 43 393 kidney transplants in Medicare recipients, 35.2% were categorized as high-cost patients. These payments represented 20% of total Medicare payments for kidney transplantation and exceeded $200 million over the study period. Case mix was associated with these payments and was an important factor underlying variation in hospital payments high-cost patients. Hospital quality was also a strong determinant of future Medicare payments for high-cost patients. Compared to high-quality centers, low-quality centers cost Medicare an additional $1185 per kidney transplant. Payments for high-cost patients represent a significant proportion of the total costs of kidney transplant surgical care. Quality improvement may be an important strategy for reducing the costs of kidney transplantation.

  19. Patients' recovery after critical illness at early follow-up.

    PubMed

    Kelly, Michelle A; McKinley, Sharon

    2010-03-01

    To determine the quality of life, particularly physical function, of intensive care survivors during the early recovery process. Survivors of critical illness face ongoing challenges after discharge from the intensive care unit and on returning home. Knowledge about health issues during early phases of recovery after hospital discharge is emerging, yet still limited. Descriptive study where the former critically ill patients completed instruments on general health and quality of life (SF-36) in the first six months of recovery. Participants responded to the SF-36 questionnaire and questions about problems, one to six months after intensive care, either face-to-face or by telephone. Thirty-nine participants had a mean age of 60 years; of them, 59% were men and had been in intensive care for 1-69 days (median = 5). Most participants (69%) rated their health as good or fair, but 54% rated general health as worse than a year ago. Mean quality of life scores for all scales ranged from 25-65.5%, with particularly low scores for Role-Physical (25) and Pain (45.1). Half the participants reported difficulty with mobility, sleep and concentration, and 72% that their responsibilities at home had changed. No relationships were found between SF-36 scores and admission diagnosis, gender, age or length of intensive care stay. These survivors of critical illness and hospitalisation in an intensive care unit perceive their general health to be good despite experiencing significant physical limitations and disturbed sleep during recovery. Knowledge of issues in these early phases of recovery and discussion and resolution of patient problems could normalise the experience for the patient and help to facilitate better quality of life.

  20. Follow-up Study of Patients With Cerebral Palsy

    PubMed Central

    Cohen, Peter; Kohn, Jean G.

    1979-01-01

    Of 319 patients with cerebral palsy recalled for reevaluation 15 years after the initial visit, 10 percent had died. Of the living, 55 percent had spasticity, 32 percent had athetosis, 4 percent had ataxia and 9 percent had mixed spasticity and athetosis; 38 percent had an intelligence quotient (IQ) less than 50, 24 percent between 50 and 79, and 38 percent had IQ above 80. There was a high correlation between overall functional outcome and intellectual level. Severity of physical disability, as measured by hand use, mobility and speech, also correlated with dependence, in part because increased severity of the disability was associated with decreased intellectual capacity generally. Twenty-five years after the initial visit, parental attitudes and personality intactness were evaluated (using the Minnesota Multiphasic Personality Inventory [MMPI]) and were correlated with satisfaction with status in life in 28 persons predicted to be independent on the 15-year study. Twenty (72 percent) of the 28 were satisfied with their status in life and of these, 16 were evaluated (with the MMPI) with 70 percent scoring in the normal range; 13 (65 percent) had parents with a positive attitude. Positive attitude was defined as parental feelings that the handicapped child was a worthy, valuable person, to be encouraged and assisted but not isolated from the world of nonhandicapped people. Careful serial assessment by professional teams combined with repeated long-term counseling of families can result in optimal outcome for the disability level involved, due to the primary role parents play in the development of a child's character and behavior. PMID:154207

  1. Patients lost to follow-up in acromegaly: results of the ACROSPECT study.

    PubMed

    Delemer, B; Chanson, Ph; Foubert, L; Borson-Chazot, F; Chabre, O; Tabarin, A; Weryha, G; Cortet-Rudelli, C; Raingeard, I; Reznik, Y; Reines, C; Bisot-Locard, S; Castinetti, F

    2014-05-01

    The complex management of acromegaly has transformed this disease into a chronic condition, with the risk of patients being lost to follow-up. The objective of this study was to estimate the proportion of acromegalic patients lost to follow-up in France and to determine the impact that abandoning follow-up has on the disease and its management. ACROSPECT was a French national, multicentre, cross-sectional, observational study. Acromegalic patients were considered lost to follow-up if no new information had been entered in their hospital records during the previous 2 years. They were traced where possible, and data were collected by means of a recall visit or questionnaire. In the study population, 21% of the 2392 acromegalic patients initially followed in 25 tertiary endocrinology centres were lost to follow-up. At their last follow-up visit, 30% were uncontrolled, 33% were receiving medical therapy and 53% had residual tumour. Of the 362 traced, 62 had died and 77% were receiving follow-up elsewhere; the leading reason for abandoning follow-up was that they had not been informed that it was necessary. Our analysis of the questionnaires suggests that they were not receiving optimal follow-up. This study underlines the need to better inform acromegalic patients of the need for long-term follow-up, the absence of which could be detrimental to patients' health, and to develop shared care for what must now be regarded as a chronic disease.

  2. Patient satisfaction with nurse-led telephone follow-up after curative treatment for breast cancer

    PubMed Central

    2010-01-01

    Background Current frequent follow-up after treatment for breast cancer does not meet its intended aims, but does depend on expensive and scarce specialized knowledge for routine history taking and physical examinations. The study described in this paper compared patient satisfaction with a reduced follow-up strategy, i.e. nurse-led telephone follow-up, to satisfaction with traditional hospital follow-up. Methods Patient satisfaction was assessed among patients (n = 299) who were participants of a randomized controlled trial investigating the cost-effectiveness of several follow-up strategies in the first year after treatment for breast cancer. Data on patient satisfaction were collected at baseline, three, six and 12 months after treatment, using the Dutch version of Ware's Patient Satisfaction Questionnaire III (PSQ III). In addition to general satisfaction, the PSQ III reports on satisfaction scores for technical competence, interpersonal aspects, and access of care. Regression analysis was used to predict satisfaction scores from whether or not nurse-led telephone follow-up was received. Results Nurse-led telephone follow-up had no statistically significant influence on general patient satisfaction (p = 0.379), satisfaction with technical competence (p = 0.249), and satisfaction with interpersonal aspects (p = 0.662). Regarding access of care, patient satisfaction scores were significantly higher for patients receiving telephone follow-up (p = 0.015). However, a mean difference at 12 months of 3.1 points was judged to be not clinically relevant. Conclusions No meaningful differences were found in satisfaction scores between nurse-led telephone and hospital follow-up in the first year after breast cancer treatment. With high satisfaction scores and the potential to substantially reduce clinic visits, nurse-led telephone follow-up may be an acceptable alternative to traditional hospital follow-up. Trial registration number ISRCTN 74071417. PMID:20429948

  3. Feasibility of tailored follow-up for patients with early breast cancer.

    PubMed

    van Hezewijk, Marjan; Smit, Dennis J F; Bastiaannet, Esther; Scholten, Astrid N; Ranke, Gemma M C; Kroep, Judith R; Marijnen, Corrie A M; van de Velde, Cornelis J H

    2014-12-01

    As the number of breast cancer survivors increases, this study prospectively examined whether tailored follow-up with differentiated number of visits per risk group, based on a prognostic index for local recurrence, is feasible and acceptable for patients and professionals. Between March 2007 and March 2010, 180 breast cancer patients (pT1-2N0-2cM0) were included. Primary endpoint was feasibility of tailored follow-up, based on the number of follow-up visits, patient satisfaction, anxiety and attitude towards follow-up. Secondary endpoints were reasons for visits, incidence, time to detection of local recurrences and the use of alternative care. In the second and third year of follow-up, the results show a 22% reduction in visits per patient in the low-risk group compared to the intermediate-risk group; 2.8 versus 3.6 visits. The majority of interval visits in both groups was initiated by the professional. No significant differences were found in attitude towards follow-up, patient satisfaction, anxiety and depression, alternative health care use or local recurrences between the risk groups. In conclusion, implementation of a tailored follow-up programme with decreased number of visits for low-risk patients is feasible and acceptable to patients. Appointing one coordinating professional, possibly a nurse practitioner, could further reduce the number of follow-up visits.

  4. Testicular Microlithiasis: Patient Compliance in a Two-Year Follow-Up Program

    PubMed Central

    Pedersen, M. R.; Osther, P. J. S.; Soerensen, F. B.; Rafaelsen, S. R.

    2016-01-01

    Introduction: We present a retrospective 2-year follow-up cohort of 103 men with testicular microlithiasis (TML) and discuss patient compliance and the value of surveillance. Methods: A retrospective analysis of patients examined with scrotal ultrasonography (US) in the period from 2008 through 2010 was performed. A total of 103 men with TML were diagnosed and offered US follow-up every 6 months for 2 years. They were retrospectively analyzed regarding demographics and follow-up details, including the development of any kind of malignancy until March 2015, using the Danish Electronic Pathology Registry. Results: The prevalence of TML was 10.3%. Of the 103 men with TML, 23 (22.3%) had TML in the left testicle, 38 (36.9%) in the right (p=0.002), and 42 (40.8%) had bilateral TML. Patient compliance was low with 11.7% participating in all US follow-up examinations. 5 men presented risk factors (testicular atrophy (N=1) and previous testicular cancer (N=4)), but no cases of testicular malignancy were found in the follow-up period. Conclusion: The low patient compliance conflicts with the ESUR Scrotal Imaging Subcommittee guidelines that recommend scrotal US follow-up annually for TML until the age of 55 years. The fact that no cancers were found during follow-up using the pathology registry calls the value of follow-up into question. PMID:27921092

  5. [Secondary ambulatory prophylaxis of venous thromboembolism: outcome of patients who were lost to follow-up].

    PubMed

    Wawrzyńska, L; Hajduk, B; Kober, J; Filipecki, S

    1998-01-01

    We have attempted to determine the outcome of 87 out-patients who were lost from follow-up. Several factors have been assessed: causes of lost from follow-up duration of oral anticoagulation, recurrent venous thromboembolic events, cause of death (if applicable).

  6. Large Regional Differences in Serological Follow-Up of Q Fever Patients in The Netherlands

    PubMed Central

    Morroy, Gabriëlla; Wielders, Cornelia C. H.; Kruisbergen, Mandy J. B.; van der Hoek, Wim; Marcelis, Jan H.; Wegdam-Blans, Marjolijn C. A.; Wijkmans, Clementine J.; Schneeberger, Peter M.

    2013-01-01

    Background During the Dutch Q fever epidemic more than 4,000 Q fever cases were notified. This provided logistical challenges for the organisation of serological follow-up, which is considered mandatory for early detection of chronic infection. The aim of this study was to investigate the proportion of acute Q fever patients that received serological follow-up, and to identify regional differences in follow-up rates and contributing factors, such as knowledge of medical practitioners. Methods Serological datasets of Q fever patients diagnosed between 2007 and 2009 (N = 3,198) were obtained from three Laboratories of Medical Microbiology (LMM) in the province of Noord-Brabant. One LMM offered an active follow-up service by approaching patients; the other two only tested on physician's request. The medical microbiologist in charge of each LMM was interviewed. In December 2011, 240 general practices and 112 medical specialists received questionnaires on their knowledge and practices regarding the serological follow-up of Q fever patients. Results Ninety-five percent (2,226/2,346) of the Q fever patients diagnosed at the LMM with a follow-up service received at least one serological follow-up within 15 months of diagnosis. For those diagnosed at a LMM without this service, this was 25% (218/852) (OR 54, 95% CI 43–67). Although 80% (162/203) of all medical practitioners with Q fever patients reported informing patients of the importance of serological follow-up, 33% (67/203) never requested it. Conclusions Regional differences in follow-up are substantial and range from 25% to 95%. In areas with a low follow-up rate the proportion of missed chronic Q fever is potentially higher than in areas with a high follow-up rate. Medical practitioners lack knowledge regarding the need, timing and implementation of serological follow-up, which contributes to patients receiving incorrect or no follow-up. Therefore, this information should be incorporated in national guidelines

  7. The clinical value and the cost-effectiveness of follow-up in endometrial cancer patients.

    PubMed

    Tjalma, W A A; van Dam, P A; Makar, A P; Cruickshank, D J

    2004-01-01

    The aim of the present article was to evaluate the cost-effectiveness of follow-up in endometrial cancer patients. A literature review was performed regarding the studies that addressed routine follow-up of endometrial cancer. For each published study, the costs of the follow-up program were calculated according to Belgium standards. A mean total of 13% relapsed. Symptomatology and clinical examination detected over 83% of the recurrences. The follow-up cost in euro after 5 and 10 years ranged between 127.68 and 2,028.78 and between 207.48 and 2,353.48, respectively. Based on the available data, there is little evidence of routine follow-up improving survival rates. Multiple protocols are used in practice without an evidence base. There is an urgent need for prospective randomized studies to evaluate the value of the current so-called 'standard medical practice of follow-up.' It is to be expected that the cost of follow-up could be reduced considerably, for instance, by tailoring to low- and high-risk groups, or by abandoning routine follow-up. Symptomatic patients, however, should be evaluated immediately. A reduction in the number of visits and examinations would mean an enormous reduction in costs. This economic benefit would be warmly welcomed in the times of increased health costs and decreased budgets.

  8. [Predictors of participation in medical rehabilitation follow-up in working patients with chronic back pain].

    PubMed

    Sibold, M; Mittag, O; Kulick, B; Müller, E; Opitz, U; Jäckel, W H

    2011-12-01

    Outpatient follow-up programmes aim to increase the sustainability of rehabilitation. However, the factors influencing participation in follow-up programmes are still unclear. The aim of this study was to examine participation in the MERENA follow-up programme of the Rhineland-Palatinate German Pension Fund. The study was conducted in 12 outpatient rehabilitation centres with 192 working patients who were being treated for chronic back pain at the time the survey was conducted. Both patients and physicians completed a written survey at the outset of rehabilitation, on completion, and again (if applicable) at the end of the follow-up programme. The data collected mainly concerned the patients' health and factors related to their occupational situation (e. g. functional capacity, working capacity) and reasons for refusing to participate in the MERENA follow-up programme. Predictors for participation in the follow-up programme were determined using binary logistic regression analysis. On completion of rehabilitation, nearly all patients were given the recommendation to participate in the follow-up programme. Half of these patients took advantage of the programme. The most frequently given reason for refusal to participate was that participation in the programme was not compatible with their duties at work. Low functional capacity and continued work disability increased the probability that a patient would take part in a follow-up programme after rehabilitation. In contrast, a longer commute to the centre was an obstacle to participation. Women were more likely to participate in the programme than men. The results indicate that participation in a follow-up programme is often not compatible with employment. We could not satisfactorily explain why women were more likely to participate in the programme. This result could have been related to women's more flexible time schedules. An improvement of the current situation could be achieved by having follow-up programmes

  9. Electronic Detection of Delayed Test Result Follow-Up in Patients with Hypothyroidism.

    PubMed

    Meyer, Ashley N D; Murphy, Daniel R; Al-Mutairi, Aymer; Sittig, Dean F; Wei, Li; Russo, Elise; Singh, Hardeep

    2017-07-01

    Delays in following up abnormal test results are a common problem in outpatient settings. Surveillance systems that use trigger tools to identify delayed follow-up can help reduce missed opportunities in care. To develop and test an electronic health record (EHR)-based trigger algorithm to identify instances of delayed follow-up of abnormal thyroid-stimulating hormone (TSH) results in patients being treated for hypothyroidism. We developed an algorithm using structured EHR data to identify patients with hypothyroidism who had delayed follow-up (>60 days) after an abnormal TSH. We then retrospectively applied the algorithm to a large EHR data warehouse within the Department of Veterans Affairs (VA), on patient records from two large VA networks for the period from January 1, 2011, to December 31, 2011. Identified records were reviewed to confirm the presence of delays in follow-up. During the study period, 645,555 patients were seen in the outpatient setting within the two networks. Of 293,554 patients with at least one TSH test result, the trigger identified 1250 patients on treatment for hypothyroidism with elevated TSH. Of these patients, 271 were flagged as potentially having delayed follow-up of their test result. Chart reviews confirmed delays in 163 of the 271 flagged patients (PPV = 60.1%). An automated trigger algorithm applied to records in a large EHR data warehouse identified patients with hypothyroidism with potential delays in thyroid function test results follow-up. Future prospective application of the TSH trigger algorithm can be used by clinical teams as a surveillance and quality improvement technique to monitor and improve follow-up.

  10. Post-discharge follow-up visits and hospital utilization by Medicare patients, 2007-2010.

    PubMed

    DeLia, Derek; Tong, Jian; Gaboda, Dorothy; Casalino, Lawrence P

    2014-01-01

    Document trends in time to post-discharge follow-up visit for Medicare patients with an index admission for heart failure (HF), acute myocardial infarction (AMI), or community-acquired pneumonia (CAP). Determine factors predicting whether the first post-discharge utilization event is a follow-up visit, treat-and-release emergency department (ED) visit, or readmission. Using Medicare claims data from 2007-2010, we plotted annual cumulative incidence functions for the time frame post-discharge to follow-up visit, accounting for competing risks with censoring at 30 days. We used multinomial probit regression to determine factors predicting the probability of first-occurring post-discharge utilization events within 30 days. For each cohort, the cumulative incidence of follow-up visits increased during the study period. For example, in 2010, 54.6% of HF patients had a follow-up visit within 10 days of discharge compared to 47.9% in 2007. Within each cohort, the largest increase in follow-up visits took place between 2008 and 2009. Follow-up visits were less likely for patients who were Black, Hispanic, and enrolled in Medicaid or Medicare Advantage, and they were more likely for patients with greater comorbidities and prior procedures as well as those with private or supplemental Medicare coverage. There were no changes in 30-day readmission rates. Although increases in follow-up visits may have been influenced by the introduction of publicly reported readmission rates in 2009, these increases did not continue in 2010 and were not associated with a change in readmissions. Patients who were Black, Hispanic, and/or enrolled in Medicaid or Medicare Advantage were less likely to have follow-up visits.

  11. Post-Discharge Follow-Up Visits and Hospital Utilization by Medicare Patients, 2007–2010

    PubMed Central

    DeLia, Derek; Tong, Jian; Gaboda, Dorothy; Casalino, Lawrence P

    2014-01-01

    Objective Document trends in time to post-discharge follow-up visit for Medicare patients with an index admission for heart failure (HF), acute myocardial infarction (AMI), or community-acquired pneumonia (CAP). Determine factors predicting whether the first post-discharge utilization event is a follow-up visit, treat-and-release emergency department (ED) visit, or readmission. Methods Using Medicare claims data from 2007–2010, we plotted annual cumulative incidence functions for the time frame post-discharge to follow-up visit, accounting for competing risks with censoring at 30 days. We used multinomial probit regression to determine factors predicting the probability of first-occurring post-discharge utilization events within 30 days. Results For each cohort, the cumulative incidence of follow-up visits increased during the study period. For example, in 2010, 54.6% of HF patients had a follow-up visit within 10 days of discharge compared to 47.9% in 2007. Within each cohort, the largest increase in follow-up visits took place between 2008 and 2009. Follow-up visits were less likely for patients who were Black, Hispanic, and enrolled in Medicaid or Medicare Advantage, and they were more likely for patients with greater comorbidities and prior procedures as well as those with private or supplemental Medicare coverage. There were no changes in 30-day readmission rates. Discussion Although increases in follow-up visits may have been inf luenced by the introduction of publicly reported readmission rates in 2009, these increases did not continue in 2010 and were not associated with a change in readmissions. Patients who were Black, Hispanic, and/or enrolled in Medicaid or Medicare Advantage were less likely to have follow-up visits. PMID:24949226

  12. Establishment of an inferior vena cava filter database and interventional radiology led follow-up - retrieval rates and patients lost to follow-up.

    PubMed

    Klinken, Sven; Humphries, Charlotte; Ferguson, John

    2017-10-01

    To evaluate the rates of inferior vena cava (IVC) filter retrieval and the number of patient's lost to follow-up, before and after the establishment of an IVC filter database and interventional radiology (inserting physician) led follow-up. On the 1st of June 2012, an electronic interventional radiology database was established at our Institution. In addition, the interventional radiology team took responsibility for follow-up of IVC filters. Data were prospectively collected from the database for all patients who had an IVC filter inserted between the 1st June 2012 and the 31st May 2014. Data on patients who had an IVC filter inserted between the 1st of June 2009 to the 31st of May 2012 were retrospectively reviewed. Patient demographics, insertion indications, filter types, retrieval status, documented retrieval decisions, time in situ, trackable events and complications were obtained in the pre-database (n = 136) and post-database (n = 118) cohorts. Attempted IVC filter retrieval rates were improved from 52.9% to 72.9% (P = 0.001) following the establishment of the database. The number of patients with no documented decision (lost to follow-up) regarding their IVC filter reduced from 31 of 136 (23%) to 0 of 118 patients (P = < 0.001). There was a non-significant reduction in IVC filter dwell time in the post-database group (113 as compared to 137 days, P = 0.129). Following the establishment of an IVC filter database and interventional radiology led follow-up, we demonstrate a significant improvement in the attempted retrieval rates of IVC filters and the number of patient's lost to follow-up. © 2017 The Royal Australian and New Zealand College of Radiologists.

  13. Rehabilitation of the institutionalized patient: description of a programme and follow-up of 60 patients.

    PubMed

    Baker, G H; Woods, T J; Anderson, J A

    1977-05-01

    The programme in an intensive rehabilitation unit in a large psychiatric hospital is described. Features include the use of non-medical staff as primary therapists, the use of a mini-bus to facilitate regular visits by patients to their home areas, the inclusion of the mini-bus driver on weekly staff conferences, the use of sociodrama, the re-organization of hospital money payments to patients, the promotion of relations with community-based facilities through occasional "teach-in" days, and a special liaison social worker providing intensive follow-up after discharge. Rehabilitation was prolonged (average stay about one year) and about half of those selected for rehabilitation from the long-stay wards were discharged. Follow-up showed that these patients benefited from discharge, in spite of a relatively high incidence of psychopathology and of social problems. Those transferred back to long-stay wards showed increased institutionalization.

  14. Did successfully treated pulmonary tuberculosis patients undergo all follow-up sputum smear examinations?

    PubMed

    Satyanarayana, S; Nagaraja, S B; Kelamane, S; Jaju, J; Chadha, S S; Chander, K; Vishnu, H; Wilson, N C; Harries, A D

    2011-12-21

    To assess response to anti-tuberculosis treatment as per national guidelines, a retrospective record review was undertaken in four districts of Andhra Pradesh, India, in December 2009 to determine whether pulmonary tuberculosis (PTB) patients reported as successfully treated (cured or treatment completed) underwent all scheduled follow-up sputum smear examinations. In a quarterly cohort of 3000 PTB patients reported as successfully treated, 1847 (61.5%) underwent all follow-up sputum examinations, with a higher proportion of new cases (65%) than retreatment cases (45%). The mid-continuation phase follow-up sputum examinations were commonly missed, and 11% patients had not undergone end-of-treatment follow-up sputum examinations.

  15. What is the best way to schedule patient follow-up appointments?

    PubMed

    Saine, Patrick J; Baker, Suzanne M

    2003-06-01

    What is the best way to schedule follow-up appointments? The most popular model requires the patient to negotiate a follow-up appointment time on leaving the office. This process accounts for the majority of follow-up patient scheduling. There are circumstances when this immediate appointment arrangement is not possible, however. The two common processes used to contact patients for follow-up appointments after they have left the office are the postcard reminder method and the prescheduled appointment method. In 2001 the two methods used to contact patients for follow-up appointments after they had left the clinic were used for all 2,116 reappointment patients at an ophthalmology practice at Dartmouth-Hitchcock Medical Center. The number of completed successful appointments, the no-show rate, and patient satisfaction for each method were calculated. A larger number of patient reappointments were completed using the prescheduled appointment procedure than the postcard reminder system (74% vs 54%). The difference between completed and pending appointments (minus no-shows) of the two methods equaled 163 patients per quarter, or 652 patients per year. Additional revenues associated with use of the prescheduled appointment letter method were estimated at $594,600 for 3 years. Using the prescheduled appointment method with a patient notification letter is advised when patients do not schedule their appointments on the way out of the office.

  16. Treatment summaries, follow-up care instructions, and patient navigation: could they be combined to improve cancer survivor's receipt of follow-up care?

    PubMed

    Jabson, Jennifer M

    2015-12-01

    Cancer survivors require follow-up care to ensure early detection of recurrence, management of late/long term effects, preventive screening for early detection of second primary malignancies, as well as other forms of preventive care. But not all survivors receive necessary follow-up care. Combining survivorship care plans and patient navigation may be a successful strategy to improve survivor's receipt of necessary follow-up care. Using data from the 2010 LIVESTRONG online survey of cancer survivors (N = 3854), this study tested associations between receipt of follow-up care instructions (FCI) and treatment summaries (TS) paired with patient navigation (PN), and survivor's receipt of cancer surveillance, preventive cancer screening, and attendance at regular medical appointments. Survivors who received FCI, TS, and patient navigation were the most likely to report attendance at all medical appointments (aOR 4.17, 95% CI 2.30, 7.57, p ≤ .001) and receipt of preventive cancer screening (aOR 3.56, 95% CI 2.28, 5.55, p ≤ .001). Likelihood of receiving follow-up care was greatest when survivors received FCI, TS, and PN. This pairing appeared to be most beneficial for survivor's attendance at medical appointments and receipt of preventive cancer screening. By improving attendance at medical appointments and prevention cancer screening, pairing SCP and PN could benefit survivors through reduced recurrence, earlier recurrence detection, and prevention of second primaries.

  17. Failure to follow-up test results for ambulatory patients: a systematic review.

    PubMed

    Callen, Joanne L; Westbrook, Johanna I; Georgiou, Andrew; Li, Julie

    2012-10-01

    Serious lapses in patient care result from failure to follow-up test results. To systematically review evidence quantifying the extent of failure to follow-up test results and the impact for ambulatory patients. Medline, CINAHL, Embase, Inspec and the Cochrane Database were searched for English-language literature from 1995 to 2010. Studies which provided documented quantitative evidence of the number of tests not followed up for patients attending ambulatory settings including: outpatient clinics, academic medical or community health centres, or primary care practices. Four reviewers independently screened 768 articles. Nineteen studies met the inclusion criteria and reported wide variation in the extent of tests not followed-up: 6.8% (79/1163) to 62% (125/202) for laboratory tests; 1.0% (4/395) to 35.7% (45/126) for radiology. The impact on patient outcomes included missed cancer diagnoses. Test management practices varied between settings with many individuals involved in the process. There were few guidelines regarding responsibility for patient notification and follow-up. Quantitative evidence of the effectiveness of electronic test management systems was limited although there was a general trend towards improved test follow-up when electronic systems were used. Most studies used medical record reviews; hence evidence of follow-up action relied upon documentation in the medical record. All studies were conducted in the US so care should be taken in generalising findings to other countries. Failure to follow-up test results is an important safety concern which requires urgent attention. Solutions should be multifaceted and include: policies relating to responsibility, timing and process of notification; integrated information and communication technologies facilitating communication; and consideration of the multidisciplinary nature of the process and the role of the patient. It is essential that evaluations of interventions are undertaken and solutions

  18. Patient attendance in a recall program after prosthodontic rehabilitation: a 5-year follow-up.

    PubMed

    Wolfart, Stefan; Weyer, Nils; Kern, Matthias

    2012-01-01

    This study evaluated the recall attendance and maintenance for a patient population after prosthodontic treatment in undergraduate student courses. Four hundred ninety-three patients who received fixed restorations (FRs; crowns or fixed partial dentures) or removable partial dentures (RPDs; conical crown-retained or precision attachment-retained dental prostheses) were included in a recall program. The number of patients attending regularly scheduled follow-up visits every 6 months was recorded. On the basis of the complexity of the performed treatment, all follow-up interventions were assigned to the categories minimal, moderate, or extensive. After 60 months, a cumulative follow-up attendance rate between 63% (RPD) and 74% (FR) was evident and not gender related. Altogether, 399 patients (193 FR, 206 RPD) regularly attended the follow-up visits. Between 61.9% (RPD) and 93.8% (FR) of these patients did not need any extensive treatment; however, only 19.2% (RPD) to 85.6% (FR) did not need any moderate or extensive treatment between follow-up visits. Patients treated with FRs showed a higher recall attendance than patients treated with RPDs. Further, patients with RPDs needed more extensive and moderate treatments than patients with FRs. This difference should be taken into consideration during prosthetic planning and patient consultation.

  19. Does routine ultrasound change management in the follow-up of patients with vesicoureteral reflux?

    PubMed

    Rudzinski, Jan K; Weber, Bryce; Wildgoose, Petra; Lorenzo, Armando; Bagli, Darius; Farhat, Walid; Harvey, Elizabeth; Salle, Joao Luiz Pippi

    2013-01-01

    Children with vesicoureteral reflux (VUR) usually need a renal ultrasound (RUS). There is little data on the role of follow-up RUS in VUR. We evaluated the impact of follow-up RUS on the change in clinical management in patients with VUR. We prospectively analyzed children with a previous diagnosis of VUR seen in the outpatient clinic with a routine follow-up RUS within 4 months. Variables collected included: demographic data, VUR history, dysfunctional voiding symptoms and concurrent ultrasound findings. Change in management was defined as addition of new medication, nurse counselling, surgery or further investigations. The study included 114 consecutive patients. The mean patient age was 4.5 years old, mean age of VUR diagnosis was 1.7 years, with average follow-up of 2.8 years. A change in management with stable RUS occurred in 14 patients, in which the change included ordering a DMSA in 9, nurse counselling for dysfunctional voiding in 3, and booking surgery in 2 patients. Change on RUS was seen in 4 patients. Multivariable analysis showed that history of urinary tract infection (UTI) since the last follow-up visit was more significant than RUS findings. The RUS findings in most patients followed for VUR remain stable or with minimal changes. The variable showing a significant effect on change in management in our study was history of UTI since the last follow-up visit rather than RUS findings. The value of follow-up RUS for children with VUR may need to be revisited.

  20. What patients think about ICU follow-up services: a qualitative study

    PubMed Central

    Prinjha, Suman; Field, Kate; Rowan, Kathy

    2009-01-01

    Introduction UK policy recommendations advocate the use of intensive care unit (ICU) follow-up services to help detect and treat patients' physical and emotional problems after hospital discharge and as a means of service evaluation. This study explores patients' perceptions and experiences of these services. Methods Thirty-four former ICU patients were recruited throughout the UK, using maximum variation sampling to achieve as broad a range of experiences of the ICU as possible. Participants were interviewed at home by a qualitative researcher unconnected to their hospital care. Interviews were recorded and transcribed for analysis. We report a qualitative thematic analysis of patients' experiences of ICU follow up. Results Former patients said they valued ICU follow-up services, which had made an important contribution to their physical, emotional and psychological recovery in terms of continuity of care, receiving information, gaining expert reassurance and giving feedback to ICU staff. Continuity of care included having tests and being monitored, referrals to other specialists and ICU follow-up appointments soon after hospital discharge. Information about physical, emotional and psychological recovery was particularly important to patients, as was information that helped them make sense of their ICU experience. Those without access to ICU follow-up care often felt abandoned or disappointed because they had no opportunity to be monitored, referred or get more information. Conclusions Former patients value having ICU follow-up services but many found that their healthcare needs were unmet because hospitals were unable to provide the aftercare they required. Most participants were aware of the financial constraints on the health system. Although they valued ICU follow-up care, they did not want it to continue indefinitely, with many of them declining appointment invitations when they themselves felt they no longer needed them. PMID:19338653

  1. What patients think about ICU follow-up services: a qualitative study.

    PubMed

    Prinjha, Suman; Field, Kate; Rowan, Kathy

    2009-01-01

    UK policy recommendations advocate the use of intensive care unit (ICU) follow-up services to help detect and treat patients' physical and emotional problems after hospital discharge and as a means of service evaluation. This study explores patients' perceptions and experiences of these services. Thirty-four former ICU patients were recruited throughout the UK, using maximum variation sampling to achieve as broad a range of experiences of the ICU as possible. Participants were interviewed at home by a qualitative researcher unconnected to their hospital care. Interviews were recorded and transcribed for analysis. We report a qualitative thematic analysis of patients' experiences of ICU follow up. Former patients said they valued ICU follow-up services, which had made an important contribution to their physical, emotional and psychological recovery in terms of continuity of care, receiving information, gaining expert reassurance and giving feedback to ICU staff. Continuity of care included having tests and being monitored, referrals to other specialists and ICU follow-up appointments soon after hospital discharge. Information about physical, emotional and psychological recovery was particularly important to patients, as was information that helped them make sense of their ICU experience. Those without access to ICU follow-up care often felt abandoned or disappointed because they had no opportunity to be monitored, referred or get more information. Former patients value having ICU follow-up services but many found that their healthcare needs were unmet because hospitals were unable to provide the aftercare they required. Most participants were aware of the financial constraints on the health system. Although they valued ICU follow-up care, they did not want it to continue indefinitely, with many of them declining appointment invitations when they themselves felt they no longer needed them.

  2. How to shorten patient follow-up after treatment for Trypanosoma brucei gambiense sleeping sickness.

    PubMed

    Mumba Ngoyi, Dieudonné; Lejon, Veerle; Pyana, Pati; Boelaert, Marleen; Ilunga, Médard; Menten, Joris; Mulunda, Jean Pierre; Van Nieuwenhove, Simon; Muyembe Tamfum, Jean Jacques; Büscher, Philippe

    2010-02-01

    BACKGROUND. Clinical management of human African trypanosomiasis requires patient follow-up of 2 years' duration. At each follow-up visit, cerebrospinal fluid (CSF) is examined for trypanosomes and white blood cells (WBCs). Shortening follow-up would improve patient comfort and facilitate control of human African trypanosomiasis. METHODS. A prospective study of 360 patients was performed in the Democratic Republic of the Congo. The primary outcomes of the study were cure, relapse, and death. The WBC count, immunoglobulin M level, and specific antibody levels in CSF samples were evaluated to detect treatment failure. The sensitivity and specificity of shortened follow-up algorithms were calculated. RESULTS. The treatment failure rate was 37%. Trypanosomes, a WBC count of > or = 100 cells/microL, and a LATEX/immunoglobulin M titer of 1:16 in CSF before treatment were risk factors for treatment failure, whereas human immunodeficiency virus infection status was not a risk factor. The following algorithm, which had 97.8% specificity and 94.4% sensitivity, is proposed for shortening the duration of follow-up: at 6 months, patients with trypanosomes or a WBC count of > or = 50 cells/microL in CSF are considered to have treatment failure, whereas patients with a CSF WBC count of > or = 5 cells/microL are considered to be cured and can discontinue follow-up. At 12 months, the remaining patients (those with a WBC count of > or = 6-49 cells/microL) need a test of cure, based on trypanosome presence and WBC count, applying a cutoff value of > or = 20 cells/microL. CONCLUSION. Combining criteria for failure and cure allows follow-up of patients with second-stage human African trypanosomiasis to be shortened to a maximum duration of 12 months.

  3. Cardiac surgery patients' evaluation of the quality of theatre nurse postoperative follow-up visit.

    PubMed

    Falk-Brynhildsen, Karin; Nilsson, Ulrica

    2009-06-01

    Theatre nurses at the Department of Cardiothoracic Surgery in Orebro, Sweden, have since 2001 routinely conducted a follow-up visit to postoperative cardiac patients. A model with a standardized information part and an individual-caring conversation including both a retrospective and a prospective part designed the visit. The purpose of this study was to evaluate the quality of the postoperative follow-up visit conducted by the theatre nurses and find out if the quality was related to gender or type of admission. The method was prospective and explorative, including 74 cardiac surgery patients who had had a postoperative follow-up visit by a theatre nurse in Sweden. The instrument measuring quality, from the patient's perspective, measured the quality of the visit, and consisted of 16 items modified to suit the study. The results showed an overall high quality rating, with statistically significant higher scores for six items between patients who had undergone emergency surgery, in comparison with elective patients. When comparing gender, women had statistically significant higher scores in two items. In conclusion, this postoperative follow-up visit by the theatre nurse was a valuable and useful tool especially for the patients who had undergone emergency surgery. In the follow-up visit the theatre nurse creates a caring relationship by meeting the patient as an individual with his/her own experience and needs for information about the surgery, intra and postoperative care, and recovery.

  4. Patients with computed tomography-proven acute diverticulitis require follow-up to exclude colorectal cancer

    PubMed Central

    Zaman, Shafquat; Chapman, Warren; Mohammed, Imtiyaz; Gill, Kathryn

    2017-01-01

    Background/Aims Traditionally, patients with acute diverticulitis undergo follow-up endoscopy to exclude colorectal cancer (CRC). However, its usefulness has been debated in this era of high-resolution computed tomography (CT) diagnosis. We assessed the frequency and outcome of endoscopic follow-up for patients with CT-proven acute diverticulitis, according to the confidence in the CT diagnosis. Methods Records of patients with CT-proven acute diverticulitis between October 2007 and March 2014 at Sandwell & West Birmingham Hospitals NHS Trust were retrieved. The National Cancer Registry confirmed the cases of CRC. Endoscopy quality indicators were compared between these patients and other patients undergoing the same endoscopic examination over the same period. Results We identified 235 patients with CT-proven acute diverticulitis, of which, 187 were managed conservatively. The CT report was confident of the diagnosis of acute diverticulitis in 75% cases. Five of the 235 patients were subsequently diagnosed with CRC (2.1%). Three cases of CRC were detected in the 187 patients managed conservatively (1.6%). Forty-eight percent of the conservatively managed patients underwent follow-up endoscopy; one case of CRC was identified. Endoscopies were often incomplete and caused more discomfort for patients with diverticulitis compared with controls. Conclusions CRC was diagnosed in patients with CT-proven diverticulitis at a higher rate than in screened asymptomatic populations, necessitating follow-up. CT reports contained statements regarding diagnostic uncertainty in 25% cases, associated with an increased risk of CRC. Follow-up endoscopy in patients with CT-proven diverticulitis is associated with increased discomfort and high rates of incompletion. The use of other follow-up modalities should be considered. PMID:28522949

  5. Under-utilization of controller medications and poor follow-up rates among hospitalized asthma patients.

    PubMed

    Lintzenich, Annie; Teufel, Ronald J; Basco, William T

    2011-07-01

    Recommended preventive care following an asthma admission includes prescribing controller medications and encouraging outpatient follow-up. We sought to determine (1) the proportion of patients who receive controller medications or attend follow-up after asthma admission and (2) what factors predict these outcomes. South Carolina Medicaid data from 2007-2009 were analyzed. Patients who were included were 2 to 18 years old, and had at least one admission for asthma. Variables examined were: age, gender, race, and rural location. Outcome variables were controller medication prescription and follow-up appointment. Any claim for an inhaled corticosteroid (ICS) or ICS/long-acting beta-agonist in the 2 months after admission was considered appropriate. Any outpatient visit for asthma in the 2 months after admission was considered appropriate. Bivariate analyses used chi-square tests. Logistic regression models identified factors that predict controller medications and follow-up. Five hundred five patients were included, of whom 60% were male, 79% minority race/ethnicity, and 58% urban. Rates of receiving controller medications and attending follow-up appointments were low, and an even lower proportion received both. Overall, 52% received a controller medication, 49% attended follow-up, and 32% had both. Multivariable analyses demonstrated that patients not of minority race or ethnicity were more likely to receive controller medications (odds ratio, 1.7; 95% confidence interval, 1.1-2.6). Patients with asthma admitted for acute exacerbations in South Carolina have low rates of controller medication initiation and follow-up attendance. Minority race/ethnicity patients are less likely to receive controller medications. To decrease rates of future exacerbations, inpatient providers must improve the rates of preventive care delivery in the acute care setting with a focus on racial/ethnic minority populations.

  6. Current organisation of follow-up does not meet cancer patients' needs.

    PubMed

    Sperling, Cecilie; Sandager, Mette; Jensen, Henry; Knudsen, Janne Lehmann

    2014-06-01

    For cancer patients, traditional follow-up care is considered unsuitable and unsustainable. The patient perspective seems often to be absent in the ongoing debate about alternative strategies for follow-up care. Based on a national survey from 2012, the objective of this study was to examine cancer patients' support needs regarding physiological and emotional problems during follow-up and to identify factors associated with their needs and any unmet needs. Patients diagnosed with cancer in the period from April to September 2010 were invited to participate. A total of 4,401 patients responded (response rate = 64%). The risks in terms of prevalence rate ratios of having needs and unmet needs for both physiological and emotional problems were estimated using the Poisson regression. The study showed that 60% of the patients had needs for support regarding physiological and emotional problems, and half of the patients reported unmet needs. Younger patients and patients with co-morbidity were more likely to report needs and unmet needs for physiological and emotional support. Treatment complexity and setting of follow-up were not associated with unmet needs. The study underlines that the current organisation of follow-up does not meet cancer patients' needs. Several factors are associated with both needs and unmet needs. Hence, a more sustainable approach for follow-up care may consist in stratification tailored to the patients' different needs. In such an approach, more focus should be on age-specific needs and the impact of co-morbidity. The study is funded by the Danish Cancer Society. The study was approved by the Danish Data Protection Agency (J. no. 2010-41-4694). According to the Danish Act on Research Ethics Review of Health Research Projects (S. 8(3) of Act No. 402 of 28 May 2003), no ethical approval was needed.

  7. Pemphigus with characteristics of dermatitis herpetiformis. A long-term follow-up of five patients.

    PubMed

    Ingber, A; Feuerman, E J

    1986-11-01

    Five patients had a form of pemphigus which in its early stages resembled dermatitis herpetiform, although the immunofluorescent findings were typical of pemphigus. Potassium iodide tests, performed for the first time in such patients, showed positive results in two patients. Follow-ups ranging from 5 to 14 years have shown a benign course with low to absent dosages of steroids.

  8. Results of remote follow-up and monitoring in young patients with cardiac implantable electronic devices.

    PubMed

    Silvetti, Massimo S; Saputo, Fabio A; Palmieri, Rosalinda; Placidi, Silvia; Santucci, Lorenzo; Di Mambro, Corrado; Righi, Daniela; Drago, Fabrizio

    2016-01-01

    Remote monitoring is increasingly used in the follow-up of patients with cardiac implantable electronic devices. Data on paediatric populations are still lacking. The aim of our study was to follow-up young patients both in-hospital and remotely to enhance device surveillance. This is an observational registry collecting data on consecutive patients followed-up with the CareLink system. Inclusion criteria were a Medtronic device implanted and patient's willingness to receive CareLink. Patients were stratified according to age and presence of congenital/structural heart defects (CHD). A total of 221 patients with a device - 200 pacemakers, 19 implantable cardioverter defibrillators, and two loop recorders--were enrolled (median age of 17 years, range 1-40); 58% of patients were younger than 18 years of age and 73% had CHD. During a follow-up of 12 months (range 4-18), 1361 transmissions (8.9% unscheduled) were reviewed by technicians. Time for review was 6 ± 2 minutes (mean ± standard deviation). Missed transmissions were 10.1%. Events were documented in 45% of transmissions, with 2.7% yellow alerts and 0.6% red alerts sent by wireless devices. No significant differences were found in transmission results according to age or presence of CHD. Physicians reviewed 6.3% of transmissions, 29 patients were contacted by phone, and 12 patients underwent unscheduled in-hospital visits. The event recognition with remote monitoring occurred 76 days (range 16-150) earlier than the next scheduled in-office follow-up. Remote follow-up/monitoring with the CareLink system is useful to enhance device surveillance in young patients. The majority of events were not clinically relevant, and the remaining led to timely management of problems.

  9. Lost to follow up: contributing factors and challenges in South African patients on antiretroviral therapy.

    PubMed

    Maskew, M; MacPhail, P; Menezes, C; Rubel, D

    2007-09-01

    Patients who do not return for follow-up at clinics providing comprehensive HIV/AIDS care require special attention. This is particularly true where resources are limited and clinic loads are high. Themba Lethu Clinic at Helen Joseph Hospital in Johannesburg is a facility supported by PEPFAR funding through Right to Care (Grant CA-574-A-00-02-00018); more than 800 HIV/AIDS patients are seen there each week. Data on a sample of patients who failed to return for follow-up were analysed to identify the causes and to plan strategies to overcome the problem. A group of 182 patients who missed follow-up appointments at the clinic were identified. Their files were examined to identify possible contributing factors. The patients were then contacted telephonically and asked their reasons for non-attendance. Results show that the leading cause of failure to follow up was financial (34% of patients). Patients cited transport costs and having to pay to open a file at each visit as the biggest monetary obstacles to obtaining treatment. Fifty-five per cent of patients lost to follow-up showed an improvement in CD4 count on treatment. Death accounted for 27% of the patients lost to follow-up and the mean ( +/- standard deviation (SD)) duration of treatment in this group was only 8 ( +/- 6) weeks. Of the patients in this group who had been seen at 4 months, 60% had failed to respond to treatment. The mean duration of ARV treatment before being lost to follow-up was 21 ( +/- 28) weeks. The mean CD4+ count was 92 ( +/- 74.5) cells/ microl and the mean number of visits was 3.33 ( +/- 2.17). Seventy-four per cent of the patients were on regimen 1A, and only 1 cited side-effects of medication as a reason for not returning. This study highlighted financial difficulty as the major obstacle to obtaining treatment. There is evidence in support of providing ARV treatment free of charge to HIVpositive patients who qualify, as occurs in other provinces in South Africa. It is also suggested

  10. The Experience of Melanoma Follow-Up Care: An Online Survey of Patients in Australia

    PubMed Central

    Street, Jackie; Neuhaus, Susan; Bessen, Taryn

    2014-01-01

    Investigating patients' reports on the quality and consistency of melanoma follow-up care in Australia would assist in evaluating if this care is effective and meeting patients' needs. The objective of this study was to obtain and explore the patients' account of the technical and interpersonal aspects of melanoma follow-up care received. An online survey was conducted to acquire details of patients' experience. Participants were patients treated in Australia for primary melanoma. Qualitative and quantitative data about patient perceptions of the nature and quality of their follow-up care were collected, including provision of melanoma specific information, psychosocial support, and imaging tests received. Inconsistencies were reported in the provision and quality of care received. Patient satisfaction was generally low and provision of reassurance from health professionals was construed as an essential element of quality of care. “Gaps” in follow-up care for melanoma patients were identified, particularly provision of adequate psychosocial support and patient education. Focus on strategies for greater consistency in the provision of support, information, and investigations received, may generate a cost dividend which could be reinvested in preventive and supportive care and benefit patient well-being. PMID:25535589

  11. A review of 145 234 ophthalmic patient episodes lost to follow-up.

    PubMed

    Davis, A; Baldwin, A; Hingorani, M; Dwyer, A; Flanagan, D

    2017-03-01

    PurposeLost to follow-up and delays in follow-up care are a major problem in chronic diseases, particularly when irreversible progression precedes symptoms. The NPSA Glaucoma Safety Alert in 2009 highlighted the risk and requirements for consistent robust review systems in ophthalmology. In response, Moorfields Eye Hospital reviewed the records of all patients in all subspecialties without review appointments booked. The purpose of this study was to determine whether ophthalmic patients lost to follow-up had come to harm and develop investigation techniques to optimise safety, which do not put excessive demands on clinical staff time.MethodsThe health records of all patients lost to follow-up (LTFU) between July 2007 and November 2012 were reviewed for evidence of clinical harm using a risk-based strategy involving an initial administrative review, then a clinician led electronic patient record review, followed by a review of paper records by clinicians. The final stage was a clinical outpatient review where required determined by clinical risk.ResultsPatients identified as lost to follow-up were 145 234; 79 562 episodes were closed following administrative review; 50 519 were discharged following clinician examination of paper records; 12 316 patients required clinical review; and 16 serious incidents were identified, of which 14 patients had glaucoma, 1 a medical retinal condition with secondary glaucoma, and 1 an oculoplastic condition. A number of actions implemented hospital wide are described which minimise future risk.ConclusionRisk from delays or lost to follow-up care continue and require better capacity and more accurate data nationally.

  12. A multidisciplinary follow-up clinic after patients' discharge from ITU.

    PubMed

    Crocker, Cheryl

    Follow-up clinics following discharge from intensive care are not a new phenomenon - Whiston Hospital in Liverpool has been running a clinic since 1990. Its pioneering work has set a precedent and has inspired Nottingham City Hospital to set up its own clinic. The Department of Health (2000) recommended that all NHS trusts 'review the provision of follow-up services and ensure there is appropriate provision for those patients who will benefit'. Nottingham City Hospital set up a multidisciplinary follow-up clinic without funding, with great success, over a year ago. This service has been extremely valuable to patients and their carers and has helped staff understand the needs of patients once they have left intensive care. This article will describe the clinic's work and case studies are utilized in order to illustrate key points.

  13. [Follow-up study of HIV-infected patients with prior cerebral toxoplasmosis].

    PubMed

    Ermak, T N; Peregudova, A B

    2015-01-01

    To assess follow-up study results in human immunodeficiency virus (HIV)-infected patients with prior cerebral toxoplasmosis (CT). Follow-up study results were assessed in HIV-infected patients with prior CT. The fate of only 97 out of 137 (66% of the hospitalized) patients discharged from hospital is known, as 40 convalescents have been lost to follow up. Thereafter, relapses developed in 19 patients, of whom 6 died. Eleven more patients with HIV infection died due to its progression and development of other secondary lesions. Five more patients died from narcotic overdose, staphylococcal sepsis, and acute pancreatic necrosis. The main peak of fatal outcomes was within the first 2 years after discharge. 3.5-year survival rates after TC were 75%. The causes of recurrent and progressive HIV infection were non-compliance with secondary prevention of CT and low adherence to an antiretroviral therapy regimen, the blame of which fell not only on the patients, but also their attending physicians and specialists who had advised how to enhance treatment motivation. Further follow-up of convalescent CT patients calls for closer attention to the possible development of recurrences within the first three years after discharge in particular, regardless of CD4 cell counts.

  14. 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. © 2016 World Obesity.

  15. Referral of discharged emergency department patients to primary and specialty care follow-up.

    PubMed

    Ginde, Adit A; Talley, Brad E; Trent, Stacy A; Raja, Ali S; Sullivan, Ashley F; Camargo, Carlos A

    2012-08-01

    Emergency department (ED) patients often need urgent primary or specialty care follow-up, but access is particularly difficult for those without insurance. To characterize follow-up options for uninsured ED patients and to evaluate differences based on ED characteristics. We mailed a survey to all ED Directors in Colorado, Georgia, Massachusetts, and Oregon (n = 351 EDs). Typical referrals for urgent primary and specialty care follow-up for uninsured patients were classified as: a) private physician or clinic affiliated with the same hospital; b) external public clinic or university hospital; or c) no referral system/policy. Of the 298 (85%) responding EDs, 215 (72%) reported primary care referral to private physicians or clinics at the same hospital and 231 (78%) for specialty care. Twenty (7%) and 27 (9%) EDs had no referral system for primary and specialty care, respectively. Factors associated with typical referral to primary care follow-up at the same hospital were: lower visit volume (85% for EDs with < 1 patient per hour vs. 67% for EDs with ≥ 3 patients per hour); rural area (79% for rural vs. 68% for urban areas), and critical access hospital status (81% critical access vs. 69% non-critical access). Conversely, higher visit volume (87% vs. 58%), urban (81% vs. 72%), and non-critical access hospitals (83% vs. 53%) were more likely to refer for specialty care follow-up at the same hospital. Referral of uninsured ED patients to local follow-up was high for primary and specialty care. Smaller, rural EDs referred within their own hospital more often for primary care but less often for specialty care. Copyright © 2012 Elsevier Inc. All rights reserved.

  16. Evaluation of an education and follow-up programme for implantable cardioverter defibrillator-implanted patients.

    PubMed

    Cinar, Fatma I; Tosun, Nuran; Kose, Sedat

    2013-09-01

    To determine the experiences, problems and the need for care and education of implantable cardioverter defibrillator-implanted patients and to assess the effects of an education and nurse follow-up programme on their quality of life, anxiety, depression and knowledge level. Although implantable cardioverter defibrillator has become a well-established therapy for people experiencing potentially lethal dysrhythmias, implantable cardioverter defibrillator patients may have physical and psychosocial problems due to the implantation. Applying a planning education and follow-up programme to implantable cardioverter defibrillator-implanted patients may prevent the need for more intensive treatment during the postimplantation period. A mixed methods design that used both qualitative and quantitative data collections and analysis was used for this study. The study was performed in the cardiology department in Turkey between 2009-2010. The data were collected using the 'Semi-Structured Interview Form', 'Form for Assessment of Patients' Knowledge Level about implantable cardioverter defibrillator', 'Spielberger's State-Trait Anxiety Inventory', 'Beck Depression Inventory II' and 'The Short-Form 36 Health Survey'. All forms were completed at the beginning of the study and at six months. The study included 27 patients in the experimental group and 27 patients in the control group. The results showed that the patients were living with various physical and psychosocial problems and insufficient knowledge regarding the implantable cardioverter defibrillator. Education and follow-up programme increased knowledge levels, decreased anxiety and depression scores and improved several subscales of quality of life in the experimental group patients. It was recommended that education and follow-up programme be used for patients scheduled to undergo implantable cardioverter defibrillator implantation, starting before implantation and continuing thereafter, to help patients adapt to a life

  17. Long-term follow-up study of patients with refractory obsessive-compulsive disorder.

    PubMed

    Ross, Stephen; Fallon, Brian A; Petkova, Eva; Feinstein, Suzanne; Liebowitz, Michael R

    2008-01-01

    The authors prospectively followed patients with treatment-resistant obsessive-compulsive disorder (OCD). Between 1988 and 1995, 56 patients with a history of inadequate response to oral clomipramine received 14 infusions of intravenous clomipramine. The follow-up period ranged from 4 to 11 years after treatment. Of the 44 subjects interviewed at follow-up, 70.5% had current OCD and 29.5% had sub-threshold OCD. Almost half reported feeling much improved or very much improved compared to their state prior to treatment with intravenous clomipramine.

  18. Five-year follow-up of carpal tunnel release in patients over age 65.

    PubMed

    Weber, Robert A; DeSalvo, Daniel J; Rude, Malcolm J

    2010-02-01

    In 2005, a prospective clinical trial with a 6-month follow-up demonstrated the efficacy of carpal tunnel release in patients 65 years and older and showed that age is not a contraindication to surgery. The purpose of this study was to determine whether there was any further improvement, maintenance of results, or recurrence of carpal tunnel symptoms 5 years after surgery. We contacted all 66 patients (with a total of 92 hands involved) from the original study to be enrolled for re-evaluation. Of the original cohort, 12 were unavailable because of death or severe neurologic impairment. Of the remaining 54 patients, 19 agreed to participate in this follow-up study of their 29 hands. For the 5-year follow-up, patients underwent a repeat history and physical examination with particular emphasis on the status of their hands over the past 5 years. The Michigan Hand Outcome Questionnaire was again used to determine overall hand function, activities of daily living, work performance, pain, aesthetics, and satisfaction with hand function. The mean age of patients available for 5-year follow-up was 78 +/- 3 years. The patients maintained their symptom improvement, demonstrating no significant difference between the 6-month and 5-year follow-up data; their physical findings, except for grip strength, were likewise unchanged. The patients also retained their improved 2-point discrimination. Scar tenderness decreased over the 5 years. The Michigan Hand Outcome Questionnaire confirmed the fact that initial postoperative improvement in all parameters persisted at least 5 years. One patient underwent repeat carpal tunnel release of 1 hand for recurrent symptoms. Overall, 94% of patients were either very or completely satisfied with their results. Patients who were 65 years of age or older at the time of surgery maintained their clinical improvement for at least 5 years after surgery. Therapeutic IV. Copyright 2010. Published by Elsevier Inc.

  19. Effect of follow-up endoscopy on the outcomes of patients with inflammatory bowel disease.

    PubMed

    Kim, Duk Hwan; Park, Soo Jung; Park, Jae Jun; Yun, Young Hoon; Hong, Sung Pil; Kim, Tae Il; Kim, Won Ho; Cheon, Jae Hee

    2014-10-01

    Little is known about the role of follow-up endoscopy in patients with inflammatory bowel disease (IBD). The present study aimed to evaluate whether repeated endoscopies would be beneficial in improving outcomes of patients with IBD. Patients who had been initially confirmed to have IBD at two tertiary hospitals in Korea were regularly followed and included in this study. The clinical impact as assessed by the presence or absence of a change in management after endoscopy and cumulative hospitalization rate was compared between two groups classified according to the presence or absence of indications. A total of 188 patients with IBD were enrolled [69 patients with Crohn's disease (CD) and 119 with ulcerative colitis (UC)]. Of these patients, 130 underwent follow-up endoscopy (48 with CD and 82 with UC). The rate of management change was significantly higher in the group with indications for follow-up endoscopy (p = 0.001 in CD and <0.001 in UC). The presence of any indications for follow-up endoscopy was found to be a significant predictor of hospitalization risk in patients with UC (p = 0.015), but not in those with CD. However, there was no significant difference in cumulative hospitalization hazard with respect to treatment change in patients without any endoscopic indications (p = 0.561 in CD and 0.423 in UC). Follow-up endoscopy might not have a significant impact on the overall clinical course and outcomes in patients with IBD. However, the presence of endoscopic indications predicts a poor clinical outcome in UC.

  20. Proliferative retinopathy predicts nephropathy: a 25-year follow-up study of type 1 diabetic patients.

    PubMed

    Karlberg, Charlotte; Falk, Christine; Green, Anders; Sjølie, Anne Katrin; Grauslund, Jakob

    2012-08-01

    We wanted to examine proliferative retinopathy as a marker of incident nephropathy in a 25-year follow-up study of a population-based cohort of Danish type 1 diabetic patients and to examine cross-sectional associations between nephropathy and retinopathy in long-term surviving patients of the same cohort. All type 1 diabetic patients from Fyn County, Denmark, were identified as of 1 July 1973. One hundred and eighty four patients were examined in 1981-1982 (baseline) and in 2007-2008 (follow-up). The level of retinopathy was graded by ophthalmoscopy at baseline and nine-field digital colour fundus photographs at follow-up. Single spot urine was used to evaluate nephropathy at both examinations. Proliferative retinopathy was present in 29 patients (15.8%) at baseline. At follow-up, these patients were more likely to macroalbuminuria (20.7% vs. 6.5%) than patients without proliferative retinopathy at baseline. In a multivariate logistic regression adjusted for baseline age, sex, duration of diabetes, smoking, HbA(1,) systolic and diastolic blood pressure, odds ratio of nephropathy (micro- and macroalbuminuria combined) was 2.98 (95% confidence interval 1.18-7.51, p = 0.02) for patients with proliferative retinopathy at baseline as compared to those without. At follow-up, there was a close relation between retinopathy and nephropathy. The level of macroalbuminuria was 4.3, 4.6 and 13.0% for patients with no or mild non-proliferative retinopathy, moderate non-proliferative retinopathy and proliferative retinopathy, respectively. In conclusion, proliferative retinopathy is an independent marker of long-term nephropathy in type 1 diabetes. Upcoming studies should examine whether these microvascular complications are also causally linked in type 1 diabetes.

  1. Patient relationship management: an overview and study of a follow-up system.

    PubMed

    Oinas-Kukkonen, Harri; Räisänen, Teppo; Hummastenniemi, Niko

    2008-01-01

    Customer relationship management research is utilized to explain the need for a more patient-oriented support in patient care. This article presents a European study on how various hospital units of a single healthcare organization have utilized a patient relationship management system--in particular a patient treatment follow-up system--and how it affects patient care and the knowledge work performed by the medical staff. Eight physicians were interviewed at a university hospital on whether patient treatment was improved through a follow-up system that had been in use in the case organization for three years. The interviewees represented various hospital units, and all of them had used the system at their own unit. The results indicate that it is possible to improve patient care through more personalized treatment. The follow-up treatment system seems to be a tool to create and maintain better communication with the patients rather than just a technological solution. It may help better understand and analyze both individual patients and patient groups. For individual physicians it provides a way to reflect professional skills. The system was lacking in its support for one-to-one communication with patients. Nevertheless, the system is an example of patient relationship management which may help healthcare units to move towards a more patient-oriented care.

  2. Percutaneous transhepatic lithotripsy using a choledochoscope: long-term follow-up in 14 patients.

    PubMed

    Hayashi, N; Sakai, T; Yamamoto, T; Inagaki, R; Ishii, Y

    1998-11-01

    The purpose of our study was to estimate the long-term prognosis of patients with bile duct stones who undergo electrohydraulic lithotripsy guided by choledochoscopy. Since 1987, at our institution, 14 patients with bile duct stones have been treated using percutaneous electrohydraulic lithotripsy guided by choledochoscopy. The procedure was performed 5-7 days after biliary drainage using a 5-mm choledochoscope placed through an 18- to 20-French sheath. All patients underwent follow-up CT, sonography, or both every 6-12 months after treatment. No complications occurred in the 14 patients who underwent treatment. During a mean follow-up period of 4.8 years (range, 2-9 years), two (14%) of the 14 patients developed recurrent common bile duct stones, and another two (14%) developed recurrent small intrahepatic stones; all patients remained asymptomatic. Percutaneous electrohydraulic lithotripsy can be safely performed using a 5-mm choledochoscope. Recurrent calculi may be seen in 28% of patients.

  3. Patients visiting the emergency room for seizures: insurance status and clinic follow-up.

    PubMed

    Farhidvash, Fariba; Singh, Pradumna; Abou-Khalil, Bassel; Arain, Amir

    2009-11-01

    Epilepsy is a chronic condition that is best treated in the outpatient clinic setting. However, many epilepsy patients use the hospital emergency room (ER) as a primary resource for seizure management. We studied characteristics of these patients in comparison with patients attending an epilepsy clinic. We reviewed ER data of patients seen in 2002 and 2003 for seizures, in Vanderbilt University Hospital (VUH) and Metro Nashville General Hospital (MNGH), seeking to identify patients who had visited the emergency room more than once. We collected demographic and insurance information on these patients and identified those who followed up in the epilepsy clinic. There were 1005 patients who visited the VUH ER and 205 the MNGH ER for seizures. Patients visiting the ER for seizures were less likely to be insured than epilepsy patients followed in the clinic, in both institutions. The proportion of patients visiting the ER more than once was 15.2% at VUH and 29.2% at MNGH. Among these patients, 3.2% at VUH and 26.7% at MNGH were uninsured. Clinic follow-up occurred in 68.6% of VUH and 13.3% of MNGH repeat ER visitors. Combining institutions, insured patients were much more likely to follow-up in the clinic. Repeated use of the ER for seizures was more common in the county hospital, where the proportion of uninsured patients was also higher. Patients visiting the county hospital ER repeatedly tend not to follow-up in the neurology clinic. This element of disparity of care requires further attention.

  4. Outpatient follow-up does not prevent emergency department utilization by trauma patients.

    PubMed

    Dalton, Michael K; Fox, Nicole M; Porter, John M; Hazelton, Joshua P

    2017-10-01

    Although most trauma centers have a regularly scheduled trauma clinic, research demonstrates that trauma patients do not consistently attend follow-up appointments and often use the emergency department (ED) for outpatient care. A retrospective review of outpatient follow-up of adult patients admitted to the trauma service (January 2014-December 2014) at an urban level I trauma center was conducted (n = 2134). A total of 219 patients (10%) were evaluated in trauma clinic after discharge from the hospital. Twenty-one percent of patients seen in trauma clinic visited the ED within 30 d compared with 12% of those not seen in clinic (P < 0.001). A total of 104 patients were readmitted within 30 d of discharge; no difference existed in the rate of hospital readmission between patients seen in clinic and those not seen in clinic (P = 0.25). Stepwise logistic regression showed that clinic follow-up was not a significant predictor of decreased ED utilization (adjusted odds ratio [OR] 1.16 [95% confidence interval 0.78-1.72], P = 0.461) and also showed that while ED use was a significant predictor of readmission (adjusted OR 216 [93-500], P < 0.001), clinic visits were not (adjusted OR 0.74 [0.33-1.69], P = 0.48). Outpatient follow-up in the trauma clinic does not decrease ED utilization or hospital readmissions indicating that interventions aimed at improving access to a conventional outpatient clinic will not impact ED utilization rates. Further study is necessary to determine the best system for providing clinically appropriate and cost-effective outpatient follow-up for trauma patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Follow-up study using iodine-131 metaiodobenzylguanidine imaging in a patient with neuroblastoma

    SciTech Connect

    Ikekubo, K.; Habuchi, Y.; Jeong, S.; Yamaguchi, H.; Saiki, Y.; Ito, H.; Hino, M.; Higa, T.

    1986-11-01

    A new radiopharmaceutical, I-131 metaiodobenzylguanidine (I-131 MIBG) was used to determine the location and to follow-up tumors in a 13-month-old girl with neuroblastoma. I-131 MIBG imaging revealed both a primary abdominal tumor and a distant metastatic orbital tumor. Follow-up study with I-131 MIBG imaging demonstrated significant resolution of tumors after external radiotherapy and chemotherapy. I-131 MIBG imaging is a simple, safe, and specific method of determining the location of tumors and also is clinically useful in the evaluation and management of patients with neuroblastoma.

  6. [A cooperation protocol for the follow-up of patients after bariatric surgery].

    PubMed

    Barbelanne, Alexia; Wolf, Sylvie; Foiry, Anne-Françoise; Guillot, Caroline; Aron Wisnewsky, Judith

    2016-12-01

    Professional cooperation protocols have recently been developed by the French national health authority and regional health agencies. They enable paramedical staff to perform procedures usually carried out by doctors. In the framework of bariatric surgery, the follow-up of patients after surgery is thereby assured by specialist nurses. They can make a diagnosis and prescribe vitamins, minerals and tests.

  7. Sixty-year follow-up in an untreated patient with Kienböck disease.

    PubMed

    Meek, Marcel F; Lunn, Peter G

    2011-12-01

    Kienböck disease can be treated either conservatively or by various operations. We describe the findings of the progression of Kienböck disease over 60 years in an 84-year-old man who had had no surgical treatment. This is the longest follow-up ever reported to our knowledge of a patient with avascular necrosis of the lunate.

  8. European Laryngological Society: ELS recommendations for the follow-up of patients treated for laryngeal cancer.

    PubMed

    Simo, Ricard; Bradley, Patrick; Chevalier, Dominique; Dikkers, Frederik; Eckel, Hans; Matar, Nayla; Peretti, Giorgio; Piazza, Cesare; Remacle, Mark; Quer, Miquel

    2014-09-01

    It is accepted that the follow-up of patients who had treatment for laryngeal cancer is a fundamental part of their care. The reasons of post-treatment follow-up include evaluation of treatment response, early identification of recurrence, early detection of new primary tumours, monitoring and management of complications, optimisation of rehabilitation, promotion smoking and excessive alcohol cessation, provision of support to patients and their families, patient counselling and education. Controversies exist in how these aims are achieved. Increasing efforts are being made to rationalise the structure and timing of head and neck cancer follow-up clinics. The aim of this document is to analyse the current evidence for the need to follow up patients who have been treated for LC and provide an up to date, evidence-based statement which is meaningful and applicable to all European Health Care Systems. A working group of the Head and Neck Cancer Committee of the ELS was constituted in 2009. A review of the current published literature on the management and follow-up of laryngeal cancer was undertaken and statements are made based on critical appraisal of the literature and best current evidence. Category recommendations were based on the Oxford Centre for Evidence-Based Medicine. Statements include: length, frequency, setting, type of health professional, clinical assessment, screening investigations, patient's education, second primary tumours, and mode of treatment considerations including radiotherapy, chemo-radiation therapy, transoral surgery and open surgery. It also addresses specific recommendations regarding patients with persistent pain, new imaging techniques, tumour markers and narrow band imaging.

  9. One-Year Follow-Up of Patients Undergoing Transvenous Extraction of Pacemaker and Defibrillator Leads

    PubMed Central

    Kempa, Maciej; Budrejko, Szymon; Piepiorka-Broniecka, Marta; Rogowski, Jan; Kozlowski, Dariusz; Raczak, Grzegorz

    2015-01-01

    Introduction The number of pacemaker and ICD implantations has increased substantially in the recent years. Therefore, complications are also observed in a greater number. In many cases, transvenous extraction of the previously implanted device (pacemaker or ICD) is the only solution. One may find in the literature information about the efficacy and safety of that procedure, but data concerning the results of long-term follow up are still limited. Aim The aim of the study was to assess the one-year mortality in the cohort of patients undergoing transvenous lead extraction procedures in our centre. Methods Records of the patients undergoing transvenous lead removal in the Department of Cardiology and Electrotherapy of the Medical University of Gdańsk were analyzed. We collected detailed information about 192 patients that had undergone the procedure from January 2003 until June 2012. Data were collected from medical and surgical records. We analyzed concomitant diseases, indications, and possible complications. Long-term follow-up data were gathered in the follow-up ambulatory records and over-the-phone interviews with patients or families. In several cases, we consulted the database of the Polish National Health Fund. Results During the early post-operative period 5 patients died, although none of those deaths was associated with the procedure itself. No other major complications were observed. During one-year follow-up other 5 patients died, which gave the overall one-year survival rate of 92.7%. Heart failure, renal failure and an infective indication showed significant association with increased mortality. Conclusion Results of transvenous lead extraction, a relatively safe procedure, should be assessed over time extending beyond the sole perioperative period. Some complications may be delayed in their nature, and may be observed only during the long-term follow up. PMID:26694032

  10. How initial tumor stage affects rectal cancer patient follow-up.

    PubMed

    Ode, Kenichi; Patel, Uday; Virgo, Katherine S; Audisio, Riccardo A; Johnson, Frank E

    2009-06-01

    Many believe that follow-up testing for rectal carcinoma patients after primary curative-intent therapy should be rather intensive for high-stage lesions and less intensive for low-stage lesions. We recently carried out a survey of the American Society of Colon and Rectal Surgeons (ASCRS) to quantify the strategies they use after primary treatment for their own patients. Considerable variability in surveillance exists. Here we report how initial TNM stage affects follow-up intensity. We devised vignettes succinctly describing otherwise healthy patients with rectal carcinoma (stages I-III). We mailed a questionnaire based on the vignettes to the 1,795 ASCRS members. Responses deemed evaluable were entered into a computer database. The effect of TNM stage on follow-up intensity for patients with stage I, II, or III rectal carcinoma treated with radical surgery was assessed by repeated-measures ANOVA. The surveillance modality most frequently utilized was the office visit. In year 1 following surgery for patients with stage I lesions, 3.8+/-2.7 office visits (mean +/- SD) were recommended, decreasing to 1.5+/-1.0 in year 5. For patients with stage III lesions treated with radical surgery +/- adjuvant therapy, 4.0+/-2.8 office visits were recommended in year 1, decreasing to 1.7+/-1.2 in year 5. Similar results were generated for all commonly used surveillance modalities. The intensity of follow-up after curative-intent treatment for rectal carcinoma varies minimally across TNM stages. This suggests that a controlled trial comparing high-intensity versus low-intensity follow-up testing could be carried out without stratification by TNM stage.

  11. Teaching patient-centered communication skills: a telephone follow-up curriculum for medical students

    PubMed Central

    Saba, George W.; Chou, Calvin L.; Satterfield, Jason; Teherani, Arianne; Hauer, Karen; Poncelet, Ann; Chen, Huiju Carrie

    2014-01-01

    Background To encourage medical students’ use of patient-centered skills in core clerkships, we implemented and evaluated a Telephone Follow-up Curriculum focusing on three communication behaviors: tailoring education to patients’ level of understanding, promoting adherence by anticipating obstacles, and ensuring comprehension by having patients repeat the plans. Methods The intervention group consisted of two different cohorts of third-year medical students in longitudinal clerkships (n=41); traditional clerkship students comprised the comparison group (n=185). Intervention students telephoned one to four patients 1 week after seeing them in outpatient clinics or inpatient care to follow up on recommendations. We used surveys, focus groups, and clinical performance examinations to assess student perception, knowledge and skills, and behavior change. Results Students found that the curriculum had a positive impact on patient care, although some found the number of calls excessive. Students and faculty reported improvement in students’ understanding of patients’ health behaviors, knowledge of patient education, and attitudes toward telephone follow-up. Few students changed patient education behaviors or called additional patients. Intervention students scored higher in some communication skills on objective assessments. Conclusion A patient-centered communication curriculum can improve student knowledge and skills. While some intervention students perceived that they made too many calls, our data suggest that more calls, an increased sense of patient ownership, and role modeling by clerkship faculty may ensure incorporation and application of skills. PMID:24767705

  12. Five- to 10-Year Prospective Follow-Up of Wrist Arthroplasty in 56 Nonrheumatoid Patients.

    PubMed

    Reigstad, Ole; Holm-Glad, Trygve; Bolstad, Bjørg; Grimsgaard, Christian; Thorkildsen, Rasmus; Røkkum, Magne

    2017-08-24

    The goal of the study was to evaluate the clinical and radiological outcomes of a cementless wrist arthroplasty with minimum 5-year follow-up in nonrheumatoid patients. Fifty-seven (40 male) patients with end-stage arthritis changes received an uncemented ball-and-socket total wrist arthroplasty (Motec Wrist). Function was evaluated before surgery and at yearly follow-ups. Visual analog scale at rest and activity, quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), active range of motion (AROM), and grip-strength were recorded. Standardized radiographs were taken to assess osteolysis, loosening, and subsidence. Fifty-six patients were followed for a mean of 8 years (SD, 2 years). Eight wrists were reoperated with arthrodesis (4) or a new arthroplasty (4) owing to distal component loosening (3), infection (2), pain/fixed malposition (2), or proximal and distal component loosening (1). One radiocarpal dislocation was reduced closed and remained stable. Improved QuickDASH score and visual analog scale pain score both at rest and during activity were found at the last follow-up, as well as increased AROM (97° vs 126°) and grip strength (21 kg vs 24 kg). The radiological follow-up demonstrated loosening in 2 wrists. Thirty-five patients were working at surgery (17 manual labor) and 27 (11 manual labor) at follow-up. The 10-year Kaplan-Meyer survival of the implants was 86% for revision any cause, 2 additional arthroplasties are loose (but not revised), giving a survival rate of 82% if these are revised prior to 10 years of observation. An uncemented total wrist arthroplasty can provide long-lasting unrestricted hand function in young and active patients. Therapeutic IV. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  13. Is Every Patient Followed up as a Papillary Thyroid Cancer Patient Really That?

    PubMed Central

    Abdulrezzak, Ummuhan; Tutus, Ahmet; Kula, Mustafa; Öztürk, Figen; Soyuer, Işın

    2012-01-01

    We report the case of a 64-year-old man followed up for two years as suffering from differentiated thyroid cancer (DTC). In the patient’s follow up, despite thyroglobulin level and I-131 whole body scan results being normal, metastases were identified at the 4th thoracic vertebra corpus by MR. Histopathological findings were carcinoma metastases. F-18 FDG PET/CT showed increased metabolic activity in the right renal mass, bilaterally in the surrenal gland, multiple lymph nodes in the thoracic and abdominal para-aortic region and in multiple vertebral and pelvic bones. An excisional biopsy of the right renal mass was reported as renal cell carcinoma. Immunohistochemical staining performed retrospectively to the first thyroid preparation showed renal cell carcinoma metastases. Consequently, any patient who presents with a thyroid nodule can also be considered as possibly suffering from metastatic disease. F-18 FDG PET/CT can provide valuable information in finding the primary focus and metastases. Conflict of interest:None declared. PMID:23487501

  14. Follow-up of patients with pseudotumoral chronic pancreatitis: Outcome and surveillance

    PubMed Central

    Téllez-Ávila, Félix Ignacio; Villalobos-Garita, Álvaro; Giovannini, Marc; Chan, Carlos; Hernández-Calleros, Jorge; Uscanga, Luis; Ramírez-Luna, Miguel Ángel

    2014-01-01

    AIM: To follow up patients with pseudotumoral chronic pancreatitis (PCP) to assess their outcome and identify an optimal surveillance interval. METHODS: Data obtained prospectively were analyzed in a retrospective manner. Patients with clinical evidence of chronic pancreatitis (abdominal pain in the epigastrium, steatorrhea, and diabetes mellitus), endoscopic ultrasound (EUS) criteria > 4, and EUS-fine needle aspiration (FNA) were included. A pseudotumor was defined as a non-neoplastic space-occupying lesion, a cause of chronic pancreatitis that may mimic changes typical of pancreatic cancer on CT or endoscopic ultrasound but without histological evidence. A real tumor was defined as a neoplastic space-occupying lesion because of pancreatic cancer confirmed by histology. RESULTS: Thirty-five patients with chronic pancreatitis were included, 26 (74.2%) of whom were men. Nine (25.7%) patients were diagnosed with pseudotumoral chronic pancreatitis and two (2/35; 5.7%) patients with pseudotumoral chronic pancreatitis were diagnosed with pancreatic cancer on follow-up. The time between the diagnosis of pseudotumoral chronic pancreatitis and pancreatic adenocarcinoma was 35 and 30 d in the two patients. Definitive diagnosis of pancreatic adenocarcinoma was made by surgery. In the remaining six patients with pseudotumoral chronic pancreatitis, the median of follow-up was 11 mo (range 1-22 mo) and they showed no evidence of malignancy on surveillance. In the follow-up of patients without pseudotumoral chronic pancreatitis but with chronic pancreatitis, none were diagnosed with pancreatic cancer. According to our data, older patients with chronic pancreatitis are at risk of pseudotumoral chronic pancreatitis. CONCLUSION: According to characteristics of patient, detection of PCP should lead a surveillance program for pancreatic cancer with EUS-FNA in < 1 mo or directly to surgical resection. PMID:25024616

  15. Long-term follow-up of incidental intracranial aneurysms in patients with acute ischemic stroke.

    PubMed

    Oh, Yoon-Sang; Shon, Young-Min; Kim, Beum Saeng; Cho, A-Hyun

    2013-05-01

    The natural history of incidental intracranial aneurysms in patients with acute ischemic stroke is not well known. Therefore, we performed a 2-year follow-up of clinical outcomes and computed tomographic angiography (CTA) findings of incidentally found aneurysm in acute ischemic stroke patients. We included acute ischemic stroke patients who presented within 7 days of stroke onset. Patients underwent magnetic resonance imaging and CTA. Demographics, clinical outcome, presence of aneurysm, aneurysm type, location, and diameter of aneurysm were identified. CTA was performed at least 2 years after the initial examination. The development of all cases of hemorrhage related to aneurysmal rupture and long-term clinical outcome were checked. Incidental intracranial aneurysms were found in 19 (6.1%) of the 314 patients. The sex (female) and old age were associated with the presence of incidental intracranial aneurysms. Favorable outcome (modified Rankin scale score 0-2) at 3 months showed no difference between the patients with aneurysm and those without (72.2% v 75.2%; P = .78). No aneurysm rupture or subarachnoid hemorrhage has occurred during the 2-year follow-up period. Follow-up CTA could be performed in 10 out of the 19 patients with aneurysm. Nine of them showed no change regarding to aneurysm shape and size, and the aneurysm disappeared in 1 patient. In our study, the prevalence of incidental aneurysm among acute ischemic stroke patients was 6.1%. After 2 years of follow-up, there was no aneurysm rupture or subarachnoid hemorrhage, and the diameter and shape of aneurysms did not change except for 1 patient in whom the aneurysm disappeared. Copyright © 2013 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  16. Engaging patients via mobile phone technology to assist follow-up after hospitalization in Quito, Ecuador.

    PubMed

    Maslowsky, Julie; Valsangkar, Bina; Chung, Jennifer; Rasanathan, Jennifer; Cruz, Freddy Trujillo; Ochoa, Marco; Chiriboga, Monica; Astudillo, Fernando; Heisler, Michele; Merajver, Sofia

    2012-05-01

    Disease management following hospital discharge is difficult in most low-resourced areas, posing a major obstacle to health equity. Although mobile phones are a ubiquitous and promising technology to facilitate healthcare access, few studies have tested the acceptability and feasibility of patients themselves using the devices for assisting linkages to healthcare services. We hypothesized that patients would use mobile phones to help manage postdischarge problems, if given a communication protocol. We developed a mobile phone-based program and investigated its acceptability and feasibility as a method of delivering posthospitalization care. A consecutive cohort of adult patients in a public hospital in Quito, Ecuador was enrolled over a 1-month period. A hospital-based nurse relayed patients' discharge instructions to a community-based nurse. Patients corresponded with this nurse via text messaging and phone calls according to a protocol to initiate and participate in follow-up. Eighty-nine percent of eligible patients participated. Ninety-seven percent of participants completed at least one contact with the nurse; 81% initiated contact themselves. Nurses completed 262 contacts with 32 patients, clarifying discharge instructions, providing preventive education, and facilitating clinic appointments. By this method, 87% of patients were successfully linked to follow-up appointments. High levels of patient participation and successful delivery of follow-up services indicate the mobile phone program's acceptability and feasibility for facilitating posthospitalization follow-up. Patients actively used mobile phones to interact with nurses, enabling the provision of posthospitalization medical advice and facilitate community-based care via mobile phone.

  17. Effective follow-up consultations: the importance of patient-centered communication and shared decision making.

    PubMed

    Brand, Paul L P; Stiggelbout, Anne M

    2013-12-01

    Paediatricians spend a considerable proportion of their time performing follow-up visits for children with chronic conditions, but they rarely receive specific training on how best to perform such consultations. The traditional method of running a follow-up consultation is based on the doctor's agenda, and is problem-oriented. Patients and parents, however, prefer a patient-centered, and solution-focused approach. Although many physicians now recognize the importance of addressing the patient's perspective in a follow-up consultation, a number of barriers hamper its implementation in practice, including time constraints, lack of appropriate training, and a strong tradition of the biomedical, doctor-centered approach. Addressing the patient's perspective successfully can be achieved through shared decision making, clinicians and patients making decisions together based on the best clinical evidence. Research shows that shared decision making not only increases patient, parent, and physician satisfaction with the consultation, but also may improve health outcomes. Shared decision making involves building a physician-patient-parent partnership, agreeing on the problem at hand, laying out the available options with their benefits and risks, eliciting the patient's views and preferences on these options, and agreeing on a course of action. Shared decision making requires specific communication skills, which can be learned, and should be mastered through deliberate practice. Copyright © 2013 Elsevier Ltd. All rights reserved.

  18. Remote Monitoring for Follow-up of Patients with Cardiac Implantable Electronic Devices

    PubMed Central

    Morichelli, Loredana; Varma, Niraj

    2014-01-01

    Follow-up of patients with cardiac implantable electronic devices is challenging due to the increasing number and technical complexity of devices coupled to increasing clinical complexity of patients. Remote monitoring (RM) offers the opportunity to optimise clinic workflow and to improve device monitoring and patient management. Several randomised clinical trials and registries have demonstrated that RM may reduce number of hospital visits, time required for patient follow-up, physician and nurse time, hospital and social costs. Furthermore, patient retention and adherence to follow-up schedule are significantly improved by RM. Continuous wireless monitoring of data stored in the device memory with automatic alerts allows early detection of device malfunctions and of events requiring clinical reaction, such as atrial fibrillation, ventricular arrhythmias and heart failure. Early reaction may improve patient outcome. RM is easy to use and patients showed a high level of acceptance and satisfaction. Implementing RM in daily practice may require changes in clinic workflow. To this purpose, new organisational models have been introduced. In spite of a favourable cost:benefit ratio, RM reimbursement still represents an issue in several European countries. PMID:26835079

  19. Experience from multidisciplinary follow-up on critically ill patients treated in an intensive care unit.

    PubMed

    Fonsmark, Lise; Rosendahl-Nielsen, Mette

    2015-05-01

    International literature describes that former intensive care unit (ICU) patients suffer considerable physical and neuropsychological complications. Systematic data on Danish ICU survivors are scarce as standardised follow-up after intensive care has yet to be described. This article describes and evaluates the knowledge gained from outpatient follow-up at a tertiary intensive care unit at Rigshospitalet, Copenhagen, during a three-year period. A total of 101 adult former ICU patients attended the outpatient clinic over a three-year period. Patients included were medical and surgical patients with a length of stay exceeding four days. Patients attended the clinic after discharge from hospital and for a minimum of two months from their discharge from the ICU. The patients were assessed for physical, neuropsychological and psychological problems and, if necessary, further treatment or rehabilitation was initiated. Reduced physical ability was seen in 82%. A total of 89% suffered a substantial weight loss. 83.2% had signs indicating acute brain dysfunction during the ICU stay, and approximately half of the patients still had cognitive problems. A total of 66 interventions were initiated. Our data confirmed that a large proportion of ICU survivors suffer considerable long-term physical and neuropsychological sequelae. Intensive care follow-up may contribute to address these specific problems and to initiate the needed interventions. Research is needed to determine whether specialised rehabilitation is required. not relevant. not relevant.

  20. [Key points of the follow-up plan in the care of Alzheimer's disease patients].

    PubMed

    Hein, C; Sourdet, S; Piau, A; Villars, H; Nourhashemi, F; Vellas, B

    2011-03-01

    The following article presents the main points of the follow-up plan of Alzheimer's disease (AD) and related syndromes patients. The general objective of this follow-up plan is to improve the quality of live of these subjects and their family. The key points are assessments of cognitive decline, functional decline and complications such as behavioural and psychological symptoms of dementia (BPSD), malnutrition and gait and balance disorders. In clinical practice, different tools are available, but frequency of evaluation is not consensual. However, the aim of this follow-up is to detect, prevent and treat complications and to improve the use of residual functional abilities in basic activities of daily living. The physician also needs to detect and prevent caregiver's exhaustion and to consider the ethical issues raised by the disease. The care plan is based on non pharmacological and pharmacological measures. The non pharmacological approach must be implemented first. The place of anti-dementia drugs is considered. Lastly, this follow-up plan aims to limit iterative admissions to emergency room and to increase the access to geriatric units. Communication and collaboration between specialist, family practitioner and caregivers are needed in order to reach the objective of quality of life improvement in AD patients.

  1. [A long-term follow-up of a patient with DIDMOAD (Wolfram) syndrome].

    PubMed

    Shiono, T; Noro, M; Abe, S

    1991-03-01

    A 19-year-old Japanese woman developed diabetes mellitus, diabetes insipidus and optic atrophy. Other abnormal ocular findings included color blindness, elevated dark adaptation threshold and constriction of visual fields. Diabetic retinopathy, which is considered to be rare in this syndrome, also was found in the fundi of this patient. During the nine-year follow-up period, diabetic retinopathy deteriorated despite treatment by photocoagulation and vitrectomy, suggesting the importance of ophthalmological examinations in patients with DIDMOAD syndrome.

  2. Diagnostic evaluation and follow-up of patients with atrial fibrillation.

    PubMed

    Dillon, Patrick; Ghanbari, Hamid

    2014-11-01

    In this article, a review of the diagnostic evaluation and outpatient follow-up of patients with atrial fibrillation is presented. After exploring details of symptoms, past medical history, quality of life, and physical exam findings, diagnostic tools are then discussed. Furthermore, important considerations after the initial diagnosis and treatment of patients with atrial fibrillation are discussed. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. A prospective ten-year follow-up of patients with chronic urticaria.

    PubMed

    Dionigi, P C L; Menezes, M C S; Forte, W C N

    2016-01-01

    Chronic urticaria can be the initial clinical presentation of a number of different diseases. The objective of the present study was to report the associated diseases during a ten-year clinical-laboratory follow-up in patients with an initial diagnosis of chronic spontaneous urticaria (CSU) of unknown cause. A prospective, longitudinal cohort study with a ten-year clinical-laboratory follow-up was conducted. Patients with a history of urticarial plaques of over six weeks presenting as the only clinical symptom were selected. Individuals with other clinical conditions, urticaria of known causes or chronic physical urticaria were excluded. The following tests were initially performed: haemogram, urine type I, stool parasite exam and sedimentation rate. The following exams were ordered during follow-up: PPD; urine culture; serology tests; antithyroid and antinuclear antibodies, rheumatoid factor, lupus anticoagulant; thyroid hormones; serum immunoglobulin; paranasal sinus and thorax radiographs; testing for BK and Helicobacter pylori; and prick tests. Infections were diagnosed in 29% of patients (syphilis, parasitosis, H. pylori, urinary infection, tuberculosis, hepatitis B and C); autoimmune diseases in 21% (thyroiditis, rheumatoid arthritis and antiphospholipid antibody syndrome); primary immunodeficiencies in 4% (IgA and IgG2 deficiencies); and chronic myeloid leukaemia in 1%. At ten-years of follow-up, the urticaria diagnosis was CSU of unknown cause in 45% of the cases. This ten-year clinical-laboratory follow-up of 100 individuals with chronic urticaria as the initial diagnosis revealed the presence of associated diseases in over half of the cases. The most prevalent diseases were infections and autoimmune diseases besides primary immunodeficiencies and blood diseases. Copyright © 2016 SEICAP. Published by Elsevier España, S.L.U. All rights reserved.

  4. Feasibility of epilepsy follow-up care through telemedicine: a pilot study on the patient's perspective.

    PubMed

    Ahmed, Syed Nizamuddin; Mann, Carly; Sinclair, D Barry; Heino, Angela; Iskiw, Blayne; Quigley, Daphne; Ohinmaa, Arto

    2008-04-01

    Cost analysis and patient satisfaction with telemedicine in epilepsy care. This controlled study included out-of-town epilepsy patients coming to follow-up at the University of Alberta hospital epilepsy clinic. After an informed consent, patients were randomized to either conventional (n = 18) or telemedicine (n = 23) clinics. Patients or caregivers filled patient satisfaction and travel cost questionnaires in both alternatives. Cost per visit analysis included costs of traveling, lodging, and lost productivity. Average age of the population was 41 years (range 19-73; 45% women). Eighty-three percent of patients preferred their next visit through telemedicine. About 90% of patients indicated a need for companion travel (mainly by car) to conventional clinic. For the conventional group patients the value of lost productivity was CAD $201, hotel cost CAD $8.50, and the value of car mileage CAD $256.50, totaling about CAD $466.00. Patient costs for telemedicine were CAD $35.85. Telemedicine production costs are similar to the patients' savings in traveling and lost productivity. About 90% of patients in both groups were satisfied with the quality of the service. Telemedicine can play a role in follow-up care of epilepsy patients, reduce patient costs, and improve patient satisfaction. This is the first full-time epilepsy telemedicine clinic in Western Canada.

  5. Following up adult patients with tetralogy of fallot: The role of echocardiography.

    PubMed

    Daraban, Ana Maria; Jurcuţ, Ruxandra; Bădilă, Elisabeta; Bartoş, Daniela; Dan, Gheorghe Andrei

    2017-02-01

    Tetralogy of Fallot (TOF) is one of the most common cyanotic congenital heart diseases. With surgical repair and the advances in postoperative care, contemporary mortality has dramatically improved and an increasing number of patients survive into adulthood, leading to a growing number of adult TOF. However, residual anatomic and hemodynamic abnormalities are encountered in nearly all patients, making follow-up mandatory. Furthermore, mortality starts to increase 25 years after surgery, emphasizing that, in adult TOF, closer monitoring is necessary. We review here the role of echocardiography in the follow-up of the TOF patients, emphasizing the role of multiple echocardiographic techniques. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:79-95, 2017. © 2016 Wiley Periodicals, Inc.

  6. MRI in adult patients with aortic coarctation: diagnosis and follow-up.

    PubMed

    Shepherd, B; Abbas, A; McParland, P; Fitzsimmons, S; Shambrook, J; Peebles, C; Brown, I; Harden, S

    2015-04-01

    Aortic coarctation is a disease that usually presents in infancy; however, a proportion of patients present for the first time in adulthood. These lesions generally require repair with either surgery or interventional techniques. The success of these techniques means that increasing numbers of patients are presenting for follow-up imaging in adulthood, whether their coarctation was initially repaired in infancy or as adults. Thus, the adult presenting to the radiologist for assessment of possible coarctation or follow-up of coarctation repair is not an uncommon scenario. In this review, we present details of the MRI protocols and MRI findings in these patients so that a confident and accurate assessment can be made.

  7. 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.

  8. Is cytoimmunological monitoring a safe follow-up method for heart transplantation patients?

    PubMed Central

    Gunay, Celalettin; Oz, Bilgehan Savas; Arslan, Mehmet

    2014-01-01

    The aim of the study The aim of the study is to show the effects of cytoimmunological monitoring and its role in the patient's follow-up period after heart transplantation. Material and methods Between 2002 and 2009, 8 patients underwent heart transplantation at Gulhane Military Medical Academy Hospital. Seven patients were male. The average age was 43 ± 12 years. Donor hearts were implanted orthotopically in all patients. The patients were then subjected to cytoimmunological monitoring and endomyocardial biopsy. 431 laboratory blood tests were carried out for all patients to analyze their cytoimmunological profiles and diagnose a possible infection or rejection. Results The total and average follow-up periods were 17.5 patient years and 30 ± 36 months (1-120 months), respectively. The first patient had two rejection episodes in 3 months. A viral infection was diagnosed in the third patient, who had painful muscle spasms in both lower limbs and the CD4/CD8 ratio was below 0.4. In the fourth patient, the CD4/CD8 ratio suddenly increased and a urinary infection was diagnosed. Only one patient passed away in the early period (less than 30 days). Four patients died because of an infection or hemodynamic deterioration within three months. Conclusions Cytoimmunological monitoring is a simple and effective technique of evaluating the patient's immunological profile. It may provide an adjunctive laboratory test and may decrease the number of endomyocardial biopsies. PMID:26336394

  9. Midterm Follow-Up of the Stentless Freedom Solo Bioprosthesis in 350 Patients.

    PubMed

    Wollersheim, Laurens W; Li, Wilson W; Bouma, Berto J; Kaya, Abdullah; van Boven, Wim J; van der Meulen, Jan; de Mol, Bas A

    2016-07-01

    The stentless Freedom Solo aortic bioprosthesis is implanted supraannularly using one running suture line in the sinuses of Valsalva. We report our 9-year experience with this bioprosthesis. From April 2005 to July 2014, 350 consecutive patients at our institution underwent aortic valve replacement with the Freedom Solo bioprosthesis. Follow-up and echocardiographic data were collected retrospectively from referring cardiology centers. The mean age was 76 ± 6 years, 48% were male, and 46% underwent a concomitant procedure. Median EuroSCORE II was 3.0 (interquartile range, 1.9 to 4.9). Operative mortality was 5.1% for all procedures and 2.1% for isolated aortic valve replacement. The 1-, 5-, and 9-year overall survival was 92%, 74%, and 47%, respectively. At 6 years, freedom from structural valve deterioration and freedom from aortic valve reoperation were 98% and 96%, respectively. Prosthetic valve endocarditis occurred at a rate of 0.8% per patient-year. Permanent pacemaker implantation was necessary in 2.3% (n = 8), and moderate and severe prosthesis-patient mismatch occurred in 30 patients overall (9.6%). Postoperative maximum and mean valvular gradients were 17 mm Hg and 10 mm Hg, respectively, and remained stable during follow-up. Aortic valve replacement with the Freedom Solo is safe and has a low rate of permanent pacemaker implantations and prosthesis-patient mismatch. Survival is comparable to that with other aortic bioprostheses, and structural valve deterioration and aortic valve reoperation are infrequent during midterm follow-up. Hemodynamic performance is excellent, with low valvular gradients that remain stable during follow-up. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  10. Follow-up of patients with celiac disease: achieving compliance with treatment.

    PubMed

    Pietzak, Michelle Maria

    2005-04-01

    Celiac disease is the only autoimmune condition for which we know the environmental trigger: gluten. Complete removal of gluten from the diet in a patient with celiac disease should result in symptomatic, serologic, and histologic remission. However, compliance with the gluten-free diet, especially in the United States, is extremely challenging. Compliance can be measured both noninvasively, by dietary history and measurement of serum antibodies, and invasively, by using endoscopic and histologic criteria. The advantages and disadvantages of these various modalities are discussed. The highest rates of compliance are reported in patients who are diagnosed as young children, whereas adolescents and those diagnosed via mass serologic screening have the most transgressions. Barriers to compliance include the poor palatability of gluten-free foods, confusing food-labeling practices, and common comorbid psychologic burdens such as anxiety and depression. Because celiac disease is a multisystemic disorder, physicians need to be aware of the potential autoimmune, nutritional, and malignant complications. An algorithm for the follow-up and management of the newly diagnosed celiac disease patient is presented, which includes regular follow-up; measurement of serum antibodies; eliciting a detailed dietary history; and examination for signs and symptoms of nutritional deficiencies, malignancy, and other autoimmune diseases. Ideally, a team approach to the follow-up of the newly diagnosed patient should include regular supervision by an interested physician, medical nutritional counseling by a registered dietician, and access to local and national support groups knowledgeable about this condition.

  11. Follow-up evaluation of 105 patients with myofascial pain-dysfunction syndrome.

    PubMed

    Cohen, S R

    1978-11-01

    A follow-up study of 118 patients was performed to determine the effect of various conservative treatments for MPD after six months to 12 years. Of the patients, 82% were females; 62 were females younger than 40 years old. During treatment, patients were made aware of muscle spasm, and consciousness of the role of muscles in MPD was raised. Of 105 patients who were contacted, 65 had no further problems, 26 thought the problem was improved and under control, and 14 had not improved or had sought treatment elsewhere. Musculature and psychological factors play major roles in the MPD syndrome.

  12. Obesity paradox disappears in coronary artery bypass graft patients during 20-year follow-up.

    PubMed

    Hällberg, Ville; Kataja, Matti; Lahtela, Jorma; Tarkka, Matti; Inamaa, Tapio; Palomäki, Ari

    2016-02-24

    Although obesity is a risk factor for coronary heart disease (CHD), it might be associated with a favourable prognosis in patients with CHD. The aim of the study was to evaluate this so called 'obesity paradox' during a follow-up period of 20 years in patients who had undergone coronary artery bypass grafting (CABG). The study population consisted of 922 CHD patients who had undergone CABG between 1993 and 1994. Pre and perioperative data was collected from patient records and supplemented with patient questionnaires, telephone contacts and data from national archives. The 10-year postoperative prognosis of normal-weight patients (body mass index (BMI) 18.5-24.9 kg/m(2)) was inferior to that of overweight (BMI 25.0-29.9 kg/m(2)) and obese patients (BMI⩾30.0 kg/m(2)) and to the background population. Beyond 10 years the prognosis of obese patients deteriorated when compared with the overweight group. At the end of the 20-year follow-up, survival of the normal weight group was 0.68 (95% confidence interval (CI), 0.49-0.87; p<0.001), the overweight group 0.82 (95% CI, 0.71-0.92; p<0.001), and the obese group 0.67 (95% CI, 0.49-0.85; p<0.001), when compared with their background populations (=1.00). Obese patients developed diabetes more frequently and died more frequently of cardiovascular disease than patients in the two other study groups during the second postoperative decade (p<0.01). During long-term follow-up the obesity paradox seems to disappear due to progression of cardiometabolic disease in patients who have undergone CABG. © The European Society of Cardiology 2016.

  13. Telephone follow-up of patients after radical prostatectomy: a systematic review1

    PubMed Central

    da Mata, Luciana Regina Ferreira; da Silva, Ana Cristina; Pereira, Maria da Graça; de Carvalho, Emilia Campos

    2014-01-01

    Objective to assess and summarize the best scientific evidence from randomized controlled clinical trials about telephone follow-up of patients after radical prostatectomy, based on information about how the phone calls are made and the clinical and psychological effects for the individuals who received this intervention. Method the search was undertaken in the electronic databases Medline, Web of Science, Embase, Cinahl, Lilacs and Cochrane. Among the 368 references found, five were selected. Results two studies tested interventions focused on psychological support and three tested interventions focused on the physical effects of treatment. The psychoeducative intervention to manage the uncertainty about the disease and the treatment revealed statistically significant evidences and reduced the level of uncertainty and anguish it causes. Conclusion the beneficial effects of telephone follow-up could be determined, as a useful tool for the monitoring of post-prostatectomy patients. PMID:26107844

  14. Cartilage-hair hypoplasia: follow-up of immunodeficiency in two patients.

    PubMed

    Kainulainen, Leena; Lassila, Olli; Ruuskanen, Olli

    2014-02-01

    To study the changes in the immunological status in 2 children with cartilage hair hypoplasia (CHH). A 4-6 year immunological follow-up from infancy. In infancy the children presented a combined T cell and B cell immunodeficiency which partly resolved in time. Mitogen-induced T cell proliferation values fluctuated but lymphopenia has remained constant. Both patients had no recent thymic emigrants (TREC). Both children have suffered from a prolonged viral infection. Hypogammaglobulinemia normalized during the first years of life but both children have a specific antibody deficiency (SAD). The changes in the immunological status in CHH patients emphasize the importance of a regular follow-up. SAD should be searched for in CHH. The absence of TRECs supports combined immunodeficiency and possible need of hematopoietic stem cell transplantation.

  15. Vasoactive peptides during long-term follow-up of patients after cardiac transplantation.

    PubMed

    Kirchhoff, Wiebke Ch; Gradaus, Rainer; Stypmann, Joerg; Deng, Mario C; Tian, Tonny D T; Scheld, Hans H; Breithardt, Günter; Brisse, Betty

    2004-03-01

    Vasoactive peptides are accepted indicators of the degree of heart failure and its progression or improvement following medical therapy. Normalization of cardiac hemodynamics by cardiac transplantation (HTx) may lead to normalization of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) plasma levels shortly after the procedure. Long-term follow-up was done for 14 consecutive patients, 12 men and 2 women, 49 years of age (range 24 to 64 years). ANP and BNP were measured by radioimmunoassay (RIA) in central venous plasma samples (before breakfast, at steady state) at the following intervals after HTx: 7 to 30 (1), 31 to 60 (2), 61 to 90 (3), 120 to 180 (4) and 210 to 365 (5) days. During follow-up, ANP decreased significantly within 2 months after HTx and continued of this level, whereas BNP decreased continuously without reaching normal values. The mean ratio of ANP:BNP increased from 3.23 to 8.01 during follow-up. Whereas right atrial pressure (RAP), right ventricular pressure (RVP), right ventricular end-diastolic pressure (RVEDP) and pulmonary capillary wedge pressure (PCWP) did not change during follow-up, cardiac output (CO) improved slightly, but significantly from 5.21 liters/min to 5.9 liters/min (p = 0.035). Normalization of left ventricular function after orthotopic HTx does not induce an early diminution of ANP and BNP plasma levels to normal concentrations. Although elevated ANP concentrations showed only minimal changes within 1 year, BNP decreased significantly as early as 2 months after HTx, without reaching normal values during the year of follow-up. Also, the ratio of ANP and BNP increased significantly from 3.23 to 8.01. These results demonstrate the contribution of other factors beyond cardiac function that determine the levels of these peptides.

  16. Five to Ten Years Follow-up after Coiling of 241 Patients with Acutely Ruptured Aneurysms

    PubMed Central

    Consoli, A.; Renieri, L.; Mura, R.; Nappini, S.; Ricciardi, F.; Pecchioli, G.; Ammannati, F.; Mangiafico, S.

    2012-01-01

    Summary Endovascular treatment has assumed a role of first choice in the management of ruptured intracranial aneurysms. We describe the clinical and morphological data after the treatment of 258 ruptured intracranial aneurysms in 241 patients, in order to evaluate the safety and the efficacy of the endovascular treatment. Two hundred and forty-one patients with saccular ruptured aneurysms were treated at our institution between 2000 and 2005. After the endovascular treatment a clinical and angiographic follow-up was conducted. The clinical follow-up was carried out with a medical examination and telephonic interviews and mRS was used for evaluation. Two hundred and forty-nine acutely ruptured aneurysms were successfully treated and immediately after the endovascular procedure 81.9% of the aneurysms resulted completely occluded, 12.1% had a residual neck and 6% revealed a residual sac. The evolution of each grade was evaluated at six months and two years. During the follow-up we observed five early and one late re-bleedings. Twenty-four patients underwent a second procedure. After the discharge and up to ten years 73.1% of patients had a good clinical outcome (mRS0-1), 8.9% died and the remainder showed moderate-severe disability (mRS2-3). The long-term stability of the anatomical result is a critical issue of this approach because eventual re-bleedings may occur even after several months or years. A careful clinical and radiological follow-up for up to two years after the embolization may prevent recurrences but may not be sufficient. PMID:22440595

  17. Percutaneous treatment of patients with heart diseases: selection, guidance and follow-up. A review

    PubMed Central

    2012-01-01

    Aortic stenosis and mitral regurgitation, patent foramen ovale, interatrial septal defect, atrial fibrillation and perivalvular leak, are now amenable to percutaneous treatment. These percutaneous procedures require the use of Transthoracic (TTE), Transesophageal (TEE) and/or Intracardiac echocardiography (ICE). This paper provides an overview of the different percutaneous interventions, trying to provide a systematic and comprehensive approach for selection, guidance and follow-up of patients undergoing these procedures, illustrating the key role of 2D echocardiography. PMID:22452829

  18. Study of 2 years follow-up of referral patients with abnormal Pap smear

    PubMed Central

    Behnamfar, Fariba; Zafarbakhsh, Azam; Allameh, Taj-Alsadat

    2015-01-01

    Background: Abnormal Pap smear consists of premalignant or malignant cervical lesions. Many of premalignant cervical lesions will never progress to invasive malignancy, or even may regress over the time. Thus, there is always a risk of overtreatment of patients with an abnormal Pap smear. A long-term follow-up of these patients can reveal final events associated with each subtype of abnormal Pap smear, and, therefore, help us to prevent unnecessary interventions. The aim of our study was to present 2 years follow-up of referral patients with abnormal Pap smear. Materials and Methods: A total of 334 consecutive women aged more than 16 who were referred with an abnormal Pap smear were entered into the study. Patients were followed with biannual Pap smear and annual colposcopy and biopsy for 2 years. Results: At baseline, the majority of patients with abnormal Pap smear were normal on colposcopy and biopsy (68% and 86%, respectively). Six months after first abnormal Pap smear majority of patients in each group showed a significant regress to normal or less invasive lesion (P < 0.001). Twelve patients (4%) had no change in Pap smear, whereas 313 (94%) had at least one stage improvement. Only nine (3%) patients had deteriorated Pap smear after 6 months. All 308 patients who underwent colposcopy and biopsy had normal Pap smear 24 months after the first abnormal Pap smear. Conclusion: Pap smear is associated with a high rate of false-positive results. In addition, the majority of low-grade cervical lesions can spontaneously regress. A long-term follow-up of a patient with abnormal Pap smear can help us to avoid needless interventions. PMID:26958048

  19. Long-term virological follow up of patients with occult hepatitis C virus infection.

    PubMed

    Castillo, Inmaculada; Bartolomé, Javier; Quiroga, Juan A; Barril, Guillermina; Carreño, Vicente

    2011-11-01

    Patients with occult hepatitis C virus (HCV) infection (HCV-RNA in liver without detectable anti-HCV and serum HCV-RNA) may have viral RNA in peripheral blood mononuclear cells (PBMCs) and in serum after ultracentrifugation, and may present HCV-specific T-cell responses, but it is unknown whether these markers persist to be detectable over time. To perform a prospective virological long-term follow up of patients with occult HCV. Viral markers were tested every 3-4 months during 55.7 ± 20.3 months in 37 patients with occult HCV who were under ursodeoxycholic acid treatment. Viral RNA was detectable in PBMCs of 31 patients during the follow up. In 23 of them, viral RNA in PBMCs was detected intermittently and in the other eight patients HCV-RNA was positive in a single sample. After ultracentrifugation, serum HCV-RNA was detected in 33 patients, being the viraemia intermittently detectable in 28, whereas in the remaining five patients, serum HCV-RNA was positive only once. Only one patient tested always HCV-RNA negative in PBMCs and in ultracentrifuged serum during follow up. Specific Core, NS3, and/or NS4 T-cell responses were found in 31 of the patients. The patient who was always HCV-RNA negative in PBMCs and in ultracentrifuged serum had specific HCV-T-cell responses. Occult HCV infection persists over time with fluctuating viraemia levels that induce and maintain specific T-cell responses against viral proteins. © 2011 John Wiley & Sons A/S.

  20. Remote follow-up of pacemakers in a selected population of debilitated elderly patients.

    PubMed

    Folino, Antonio Franco; Breda, Roberto; Calzavara, Patrizia; Borghetti, Francesca; Comisso, Jennifer; Iliceto, Sabino; Buja, Gianfranco

    2013-03-01

    The majority of patients with pacemakers are very elderly, many being >85-years old. They often suffer from serious illnesses and have great difficulty in walking. The aim of our study was to compare remote pacemaker monitoring with in-home checks of pacemakers, in terms of applicability, efficacy, and cost in a selected population of debilitated elderly patients. We selected 72 subjects (mean age 87 ± 8 years) among elderly debilitated patients with Medtronic pacemakers, compatible with the Carelink(®) remote monitoring system (13 patients with DDD pacemaker; 59 patients with single-lead VDD pacemaker). Remote follow-up was compared with in-home checks performed by nurses in 326 patients in similar clinical conditions. A total of 190 transmissions were received by remote monitoring (mean transmissions per month: 7.0; mean per patient: 2.6; range 1-6) during 27 months of follow-up. In this period, seven pacemakers were replaced owing to battery exhaustion, after a mean of 6.7 years from implantation. The occurrence of atrial or ventricular high-rate episodes was reported in 98 transmissions (53%). Nineteen patients died (annual mortality: 11.7%). On comparing the costs borne by the hospital for in-home checks, both for medical personnel and transportation, the estimated average saving was €32 per year per patient. Our study shows that the remote follow-up of pacemakers is a reliable, effective, and cost-saving procedure in elderly, debilitated patients. Moreover, remote controls provided an accurate and early diagnosis of arrhythmia occurrence.

  1. Patient location strategies for pediatric long-term follow-up studies.

    PubMed

    Lovell, Matthew E; Morcuende, Jose A

    2006-01-01

    Poor follow-up rates greatly diminish the validity of prospective and long-term studies. Therefore, locating patients is of critical importance. This is especially true in populations treated during childhood because addresses will change several times in intervening years. Recent publications have reported new strategies for patient location. The purpose of this study is to test an algorithm proposed by King et al., as well as other search methods, using a cohort of patients treated for clubfoot in childhood The study population included 126 patients with clubfeet treated between 1950 and 1967. We followed the search algorithm proposed by King et al. In addition, we used state driver's license records, Reunitetonight.com, and Intelius.com. Patients were considered to be found when they returned a postage-paid reply letter or were contacted by phone. Using web pages recommended by King et al. we located 26 of 126 (21 percent) patients. Operator directory assistance failed to locate any patients not located by free internet sources. Additional websites had varied results. State driver's license records found 25 patients. Reunitetonight.com found none with thirty attempted. The best search engine was Intelius.com which located 68 out of 126 (54 percent) patients. The algorithm proposed by King et al. is not effective for long-term follow-up studies of pediatric populations. Intelius.com is worth the small fee charged (dollar 22.45) as it was the most effective method of locating patients.

  2. Long-term follow-up of patients after retinal detachment surgery.

    PubMed

    Coakes, R L; Ramsay, J H; Tarbuck, D T

    1978-04-01

    The value of long-term follow-up of patients after retinal detachment surgery depends on the number of further detachments prevented. This in turn depends on the frequency with which predisposing lesions are found and treated and also the risk of leaving them untreated. In a retrospective study of 128 patients who had attended the Retina Clinic at Moorfields, High Holborn, for at least 10 years, the frequency with which asymptomatic retinal breaks were detected was less than two per hundred patients per year of follow-up. The risk of such lesions progressing to detachment if left untreated is estimated to be no more than 12 per cent and on this basis it is likely that no more than four or five detachments were prevented in our series. During the same period 66 new or re-detachments occurred, in spite of regular examination and treatment of predisposing lesions found, and it is concluded that long-term follow-up is of doubtful value in the prevention of further detachments.

  3. Extended follow-up of patients suspected of having joint sepsis after total joint replacement.

    PubMed Central

    Lidwell, O. M.; Lowbury, E. J.; Whyte, W.; Blowers, R.; Lowe, D.

    1985-01-01

    During an average follow-up time of about 2 1/2 years after total hip or knee-joint replacement in 8052 patients, suspected joint infection was recorded in 85 patients whose joints had not been re-operated during that period. The hospital records of 72 of these patients were examined after a further period, averaging about 5 years. Thirty-five of these had suffered continuing major problems with the joint, 18 of which had been revised, and a further 9 joints needed such treatment. Infection was confirmed in 17 of the 35. These numbers are proportionately about three times greater than those observed among a set of matched controls followed-up for a similar period. The evidence from the extended follow-up suggests that the failure rate, unassociated with infection, reached about 5% by 7 years after operation and that late infections, manifested between about 2 1/2 and 7 years after operation, were about as frequent as those confirmed during the first 2 1/2 years. PMID:4093608

  4. The role of alexithymia: An 8-year follow-up study of chronic pain patients.

    PubMed

    Saariaho, Anita S; Saariaho, Tom H; Mattila, Aino K; Joukamaa, Matti I; Karukivi, Max

    2016-08-01

    The aim of this 8-year follow-up study was to ascertain changes in alexithymia, depressiveness and pain situation in a sample of chronic pain patients and to explore the impact of alexithymia and depression on the outcome. Participants (n=83) were chronic non-malignant pain patients who completed self-report study questionnaires before their first visit to the pain clinic and again 8years later. Study variables consisted of pain intensity measured by the Visual Analogous Scale, the Pain Disability Scale, the Toronto Alexithymia Scale and the Beck Depression Inventory. The moderate improvement in the pain situation was estimated as a decrease of 30% or more in pain intensity or pain disability. In the whole sample there was a significant decrease in pain intensity, pain disability and depressiveness, but only some of the patients achieved moderate improvement in their pain situation. Alexithymia remained stable during the 8-year period. The alexithymic patients had poorer pain situation and more depressiveness both at baseline and at follow-up. Unfavorable outcome in the pain situation was connected with male gender and alexithymia at baseline but not with depressiveness. Alexithymia and depressiveness were closely related to each other and the connection strengthened during the follow-up period. Alexithymic depressive chronic pain patients represent a special, more disabled subgroup among chronic pain patients. The authors recommend screening for and identifying alexithymia and depression in chronic pain patients. Structural treatment protocols such as cognitive-behavioral therapy may benefit these patients. More research is needed to develop treatment interventions for alexithymic patients. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Long-term follow-up of functioning after spinal surgery in patients with Rett syndrome.

    PubMed

    Larsson, Eva-Lena; Aaro, Stig; Ahlinder, Peter; Normelli, Helena; Tropp, Hans; Oberg, Birgitta

    2009-04-01

    In a prospective study, 23 consecutive girls with Rett syndrome and neuromuscular scoliosis were evaluated for functioning at a long-term follow-up. The patients had mostly improved, which was confirmed by their parents. Rett syndrome is associated with neuromuscular scoliosis and has a typically long C-shaped thoracolumbar kyphoscoliosis. Prospective long-term follow-up studies related to these patients' total situation are sparse. Most studies focus on the Cobb angle of the scoliosis, whereas parents are mainly concerned about the girls' continued functioning. Twenty-three patients with Rett syndrome and neuromuscular scoliosis were evaluated preoperatively from 1993 to 2002. At follow-up, 19 patients remained in the study. Three patients died (not due to surgery), and one patient could not participate because it was too far to travel. Mean follow-up time was 74 months (range 49-99 months). The assessments comprised the sitting balance, seating supports in wheelchair, weight distribution, time used for rest, care given, and angle of scoliosis. Follow-up questionnaires and two-open-ended questions about the positive and negative effects of surgery were sent to parents. Sitting balance, number of seating supports in wheelchair, weight distribution, time used for rest, and the Cobb angle had all improved after surgery. The parents assessed improvement in seating position, daily activities, time used for rest, and cosmetic appearance. We can conclude that the stabilized spine resulted in sufficient strength to keep the body upright with the possibility of looking around at the surroundings more easily. The girls got better seating position with less need for seating adaptations in the wheelchair and with reduced time needed for resting during the day. Finally we can conclude that the indication for surgery is to get a better posture which lead to less risk of pressure sores, and that un upright position lead to better possibility to easily breath with fewer episodes

  6. Self-inflicted injury: a follow-up study of 43 patients.

    PubMed Central

    Sneddon, I; Sneddon, J

    1975-01-01

    Forty-three patients, 38 women and 5 men, with self-inflicted skin lesions were studied. Thirty-three were followed up for up to 22 years. In most cases dermatitis artefacta was only one incident in a long history of psychogenic illness. Of the 43 patients, 13 (30%), 12 women and one man, continued to produce lesions or were disabled with other psychiatric disorders more than 12 years after the onset of symptoms. Prognosis was difficult but recovery seemed to occur when the patient's life circumstances changed rather than as a result of treatment. Images FIG. 1 FIG. 2 FIG. 3 PMID:1164617

  7. Transcatheter aortic valve implantation in very elderly patients: immediate results and medium term follow-up

    PubMed Central

    Pascual, Isaac; Muñoz-García, Antonio J; López-Otero, Diego; Avanzas, Pablo; Jimenez-Navarro, Manuel F; Cid-Alvarez, Belén; del Valle, Raquel; Alonso-Briales, Juan H; Ocaranza-Sanchez, Raimundo; Hernández, José M; Trillo-Nouche, Ramiro; Morís, César

    2015-01-01

    Objective To evaluate immediate transcatheter aortic valve implantation (TAVI) results and medium-term follow-up in very elderly patients with severe and symptomatic aortic stenosis (AS). Methods This multicenter, observational and prospective study was carried out in three hospitals. We included consecutive very elderly (> 85 years) patients with severe AS treated by TAVI. The primary endpoint was to evaluate death rates from any cause at two years. Results The study included 160 consecutive patients with a mean age of 87 ± 2.1 years (range from 85 to 94 years) and a mean logistic EuroSCORE of 18.8% ± 11.2% with 57 (35.6%) patients scoring ≥ 20%. Procedural success rate was 97.5%, with 25 (15.6%) patients experiencing acute complications with major bleeding (the most frequent). Global mortality rate during hospitalization was 8.8% (n = 14) and 30-day mortality rate was 10% (n = 16). Median follow up period was 252.24 ± 232.17 days. During the follow-up period, 28 (17.5%) patients died (17 of them due to cardiac causes). The estimated two year overall and cardiac survival rates using the Kaplan-Meier method were 71% and 86.4%, respectively. Cox proportional hazard regression showed that the variable EuroSCORE ≥ 20 was the unique variable associated with overall mortality. Conclusions TAVI is safe and effective in a selected population of very elderly patients. Our findings support the adoption of this new procedure in this complex group of patients. PMID:26345138

  8. Muscle strength in patients with acromegaly at diagnosis and during long-term follow-up.

    PubMed

    Füchtbauer, Laila; Olsson, Daniel S; Bengtsson, Bengt-Åke; Norrman, Lise-Lott; Sunnerhagen, Katharina S; Johannsson, Gudmundur

    2017-08-01

    Patients with acromegaly have decreased body fat (BF) and increased extracellular water (ECW) and muscle mass. Although there is a lack of systematic studies on muscle function, it is believed that patients with acromegaly may suffer from proximal muscle weakness despite their increased muscle mass. We studied body composition and muscle function in untreated acromegaly and after biochemical remission. Prospective observational study. Patients with acromegaly underwent measurements of muscle strength (dynamometers) and body composition (four-compartment model) at diagnosis (n = 48), 1 year after surgery (n = 29) and after long-term follow-up (median 11 years) (n = 24). Results were compared to healthy subjects. Untreated patients had increased body cell mass (113 ± 9% of predicted) and ECW (110 ± 20%) and decreased BF (67 ± 7.6%). At one-year follow-up, serum concentration of IGF-I was reduced and body composition had normalized. At baseline, isometric muscle strength in knee flexors and extensors was normal and concentric strength was modestly increased whereas grip strength and endurance was reduced. After one year, muscle strength was normal in both patients with still active disease and patients in remission. At long-term follow-up, all patients were in remission. Most muscle function tests remained normal, but isometric flexion and the fatigue index were increased to 153 ± 42% and 139 ± 28% of predicted values, respectively. Patients with untreated acromegaly had increased body cell mass and normal or modestly increased proximal muscle strength, whereas their grip strength was reduced. After biochemical improvement and remission, body composition was normalized, hand grip strength was increased, whereas proximal muscle fatigue increased. © 2017 European Society of Endocrinology.

  9. Long-term follow-up of patients with choroidal neovascularization due to angioid streaks

    PubMed Central

    Martinez-Serrano, Maria Guadalupe; Rodriguez-Reyes, Abelardo; Guerrero-Naranjo, Jose Luis; Salcedo-Villanueva, Guillermo; Fromow-Guerra, Jans; García-Aguirre, Gerardo; Morales-Canton, Virgilio; Velez-Montoya, Raul

    2017-01-01

    Background The following case series describes the long-term anatomical and functional outcome of a group of seven patients with choroidal neovascularization (CNV), secondary to angioid streaks (AS), who were treated with antiangiogenic drugs in a pro re nata (PRN) regimen. After the 4-year mark, visual acuity tends to return to pretreatment level. Treatment delays and lack of awareness and self-referral by the patients are believed to be the cause of the PRN regimen failure. Purpose To assess the long-term outcomes (>4 years) of patients with CNV due to AS treated with a PRN regimen of antiangiogenic. Methods This was a retrospective, case series, single-center study. We reviewed the electronic medical records from patients with CNV due to AS. From each record, we noted general demographic data and relevant medical history; clinical presentation, changes in best-corrected visual acuity (BCVA) over time, optical coherent tomography parameters, treatment and retreatment details, and systemic associations. Changes in BCVA and central macular thickness were assessed with a Wilcoxon two-sample test, with an alpha value of ≤0.05 for statistical significance. Results The mean follow-up time was 53.8±26.8 months. BCVA at baseline was: 1.001±0.62 logMAR; at the end of follow-up: 0.996±0.56 logMAR (P=0.9). Central macular thickness at baseline was: 360.85±173.82 μm; at the end of follow-up: 323.85±100.34 μm (P=0.6). Mean number of intravitreal angiogenic drugs: 6±4.16 injections (range 4–15). Mean time between injections was 3.8±2.7 months (range 1.9–5.8 months). Conclusion Despite initial anatomical and functional improvement, patients at the end of the follow-up had no visual improvement after a pro re nata regimen of antiangiogenic drugs. The amount of retreatments, number of recurrences, and time between intravitreal injections were similar to previous reports with shorter follow-up. PMID:28031699

  10. [Treatment strategy in tuberculous spondylitis: long-term follow-up results of 55 patients].

    PubMed

    Güven, Osman; Bezer, Murat; Aydin, Nuri; Ketenci, Ismail Emre

    2008-01-01

    We evaluated our treatment algorithm used in adult patients with tuberculous spondylitis together with long-term treatment results. The study included 55 adult patients (26 males, 29 females; mean age 50 years; range 23 to 71 years) with tuberculous spondylitis. The patients underwent four different treatment methods including non-operative treatment (NO, 6 patients), posterior debridement, fusion and instrumentation (PDFI, 21 patients), anterior debridement, instrumentation and fusion (ADIF, 21 patients), and finally, urgent radical debridement (RD, 11 patients) due to financial limitations of the patients. All the patients received antituberculous therapy for 12 months. On presentation, 17 patients (30.9%) had neurologic deficits (ADIF, 6 patients; RD, 11 patients). Neurologic assessment was made according to the Frankel grading system. The results were evaluated with respect to kyphosis, sagittal balance, neurologic recovery, and patient satisfaction. The mean follow-up period was 95.3 months (range 66 to 114 months). Radiographically, successful bone fusion was achieved in all the patients. Following treatment, all surgically treated groups exhibited decreases in the kyphotic angle. The mean correction was significantly greater in ADIF (17.5 degrees ) and PDFI (12.1 degrees ) groups compared to the RD group (4.9 degrees ) (p<0.05). Final increases in the kyphotic angle were 0.7 degrees , 1.2 degrees , 1.4 degrees , and 1.6 degrees in NO, PDFI, ADIF, and RD groups, respectively. The mean sagittal deviations in the first postoperative month were +2 mm, +11 mm, +12 mm, and +14 mm in NO, PDFI, ADIF, and RD groups, respectively, which remained unchanged till the end of follow-up. Complete neurologic recovery was obtained in all but one patient. All the patients expressed satisfaction with the treatment. No recurrences or reactivation of disease were observed. This study showed that, with appropriate patient selection, the results of NO, PDFI, and ADIF were

  11. Cognitive evolution in hypertensive patients: a six-year follow-up

    PubMed Central

    Vicario, Augusto; del Sueldo, Mildren A; Zilberman, Judith M; Cerezo, Gustavo H

    2011-01-01

    Background: Several studies have examined the links between hypertension, vascular damage, and cognitive impairment. The functions most commonly involved seem to be those associated with memory and executive function. Aims: 1) to report the cognitive evolution in a cohort of hypertensive patients, 2) to identify the affected domains, and 3) to correlate the results obtained with blood pressure measurements. Materials and Methods: Observational 6-year follow-up cohort study including both males and females aged ≥65 and ≤80 years, and hypertensive patients under treatment. Patients with a history of any of the following conditions were excluded: stroke, transient ischemic attack, diabetes mellitus, atrial fibrillation, cardiac surgery, dementia, or depression. Four neurocognitive evaluations were performed (at baseline and every 2 years). The tests used evaluated memory and executive function domain. Blood pressure was measured on every cognitive evaluation. Results: Sixty patients were followed for 76.4 ± 2.8 months. The average age at baseline was 72.5 ± 4.2 and 77.9 ± 4.6 at 6 years (65% were women). Two patients were lost to follow up (3.3%) and 8 patients died (13.3%).The density incidence for dementia was 0.6% patients per year (pt/y) (n = 3) and for depression was 1.6% pt/y (n = 12). No changes were observed in either memory impairment or the Mini Mental State Examination (MMSE) results (p = ns) during follow-up. A progressive impairment of the executive function was shown regardless of the blood pressure measurements. Conclusion: 1) the incidence of dementia doubled to general population, 2) the initial memory impairment did not change during the evaluation period, 3) cognitive impairment worsened in the areas related to executive function (prefrontal cortex) regardless of the adequacy of anti-hypertensive treatment and blood pressure values. PMID:21603597

  12. Profile and follow-up of patients with tuberculosis in a priority city in Brazil

    PubMed Central

    Pereira, Jisleny da Cruz; Silva, Marcio Roberto; da Costa, Ronaldo Rodrigues; Guimarães, Mark Drew Crosland; Leite, Isabel Cristina Gonçalves

    2015-01-01

    OBJECTIVE To analyze the cases of tuberculosis and the impact of direct follow-up on the assessment of treatment outcomes. METHODS This open prospective cohort study evaluated 504 cases of tuberculosis reported in the Sistema de Informação de Agravos de Notificação (SINAN – Notifiable Diseases Information System) in Juiz de Fora, MG, Southeastern Brazil, between 2008 and 2009. The incidence of treatment outcomes was compared between a group of patients diagnosed with tuberculosis and directly followed up by monthly consultations during return visits (287) and a patient group for which the information was indirectly collected (217) through the city’s surveillance system. The Chi-square test was used to compare the percentages, with a significance level of 0.05. The relative risk (RR) was used to evaluate the differences in the incidence rate of each type of treatment outcome between the two groups. RESULTS Of the outcomes directly and indirectly evaluated, 18.5% and 3.2% corresponded to treatment default and 3.8% and 0.5% corresponded to treatment failure, respectively. The incidence of treatment default and failure was higher in the group with direct follow-up (p < 0.05) (RR = 5.72, 95%CI 2.65;12.34, and RR = 8.31, 95%CI 1.08;63.92, respectively). CONCLUSIONS A higher incidence of treatment default and failure was observed in the directly followed up group, and most of these cases were neglected by the disease reporting system. Therefore, effective measures are needed to improve the control of tuberculosis and data quality. PMID:25741659

  13. Treatment adherence in heart failure patients followed up by nurses in two specialized clinics

    PubMed Central

    da Silva, Andressa Freitas; Cavalcanti, Ana Carla Dantas; Malta, Mauricio; Arruda, Cristina Silva; Gandin, Thamires; da Fé, Adriana; Rabelo-Silva, Eneida Rejane

    2015-01-01

    Objectives: to analyze treatment adherence in heart failure (HF) patients followed up by the nursing staff at specialized clinics and its association with patients' characteristics such as number of previous appointments, family structure, and comorbidities. Methods: a cross-sectional study was conducted at two reference clinics for the treatment of HF patients (center 1 and center 2). Data were obtained using a 10-item questionnaire with scores ranging from 0 to 26 points; adherence was considered adequate if the score was ≥ 18 points, or 70% of adherence. Results: a total of 340 patients were included. Mean adherence score was 16 (±4) points. Additionally, 124 (36.5%) patients showed an adherence rate ≥ 70%. It was demonstrated that patients who lived with their family had higher adherence scores, that three or more previous nursing appointments was significantly associated with higher adherence (p<0.001), and that hypertension was associated with low adherence (p=0.023). Conclusions: treatment adherence was considered satisfactory in less than a half of the patients followed up at the two clinics specialized in HF. Living with the family and attending to a great number of nursing appointments improved adherence, while the presence of hypertension led to worse adherence. PMID:26487139

  14. VLCAD deficiency: Follow-up and outcome of patients diagnosed through newborn screening in Victoria.

    PubMed

    Evans, Maureen; Andresen, Brage S; Nation, Judy; Boneh, Avihu

    2016-08-01

    Very long chain acyl-CoA dehydrogenase (VLCAD) deficiency is an inherited metabolic disorder of fatty acid oxidation. Treatment practices of the disorder have changed over the past 10-15years since this disorder was included in newborn screening programs and patients were diagnosed pre-symptomatically. A genotype-phenotype correlation has been suggested but the discovery of novel mutations make this knowledge limited. Herein, we describe our experience in treating patients (n=22) diagnosed through newborn screening and mutational confirmation and followed up over a median period of 104months. We report five novel mutations. In 2013 we formalised our treatment protocol, which essentially follows a European consensus paper from 2009 and our own experience. The prescribed low natural fat diet is relaxed for patients who are asymptomatic when reaching age 5years but medium-chain triglyceride oil is recommended before and after physical activity regardless of age. Metabolic stability, growth, development and cardiac function are satisfactory in all patients. There were no episodes of encephalopathy or hypoglycaemia but three patients had episodes of muscle pain with our without rhabdomyolysis. Body composition studies showed a negative association between dietary protein intake and percent body fat. Larger patient cohort and longer follow up time are required for further elucidation of genotype-phenotype correlations and for establishing the role of dietary protein in metabolic stability and long-term healthier body composition in patients with VLCAD deficiency.

  15. Risk Factors for Mortality in Hemodialysis Patients: Two-Year Follow-Up Study

    PubMed Central

    do Sameiro-Faria, Maria; Costa, Elísio; Mendonça, Denisa; Teixeira, Laetitia; Rocha-Pereira, Petronila; Fernandes, João; Kohlova, Michaela; Reis, Flávio; Amado, Leonilde; Bronze-da-Rocha, Elsa; Miranda, Vasco; Quintanilha, Alexandre; Belo, Luís; Santos-Silva, Alice

    2013-01-01

    Background. End-stage renal disease (ESRD) patients under hemodialysis (HD) have high mortality rate. Inflammation, dyslipidemia, disturbances in erythropoiesis, iron metabolism, endothelial function, and nutritional status have been reported in these patients. Our aim was to identify any significant association of death with these disturbances, by performing a two-year follow-up study. Methods and Results. A large set of data was obtained from 189 HD patients (55.0% male; 66.4 ± 13.9 years old), including hematological data, lipid profile, iron metabolism, nutritional, inflammatory, and endothelial (dys)function markers, and dialysis adequacy. Results. 35 patients (18.5%) died along the follow-up period. Our data showed that the type of vascular access, C-reactive protein (CRP), and triglycerides (TG) are significant predictors of death. The risk of death was higher in patients using central venous catheter (CVC) (Hazard ratio [HR] =3.03, 95% CI = 1.49–6.13), with higher CRP levels (fourth quartile), compared with those with lower levels (first quartile) (HR = 17.3, 95% CI = 2.40–124.9). Patients with higher TG levels (fourth quartile) presented a lower risk of death, compared with those with the lower TG levels (first quartile) (HR = 0.18, 95% CI = 0.05–0.58). Conclusions. The use of CVC, high CRP, and low TG values seem to be independent risk factors for mortality in HD patients. PMID:24347799

  16. Patients with n-hexane induced polyneuropathy: a clinical follow up.

    PubMed Central

    Chang, Y C

    1990-01-01

    The prognosis of hexacarbon induced polyneuropathy is usually good, though its clinical course after the cessation of exposure has not been described in detail. Eleven patients with moderate to severe n-hexane induced polyneuropathy due to occupational exposure were regularly followed up for a period of four years at the neurological department of the National Taiwan University Hospital. Sensorimotor neuropathy was diagnosed in nine patients and motor neuropathy in two. All were removed from further exposure to n-hexane after aetiological confirmation, but motor disturbance continued to worsen in five cases. Sensory functions were regained earlier than motor functions. All the patients, including one who was tetraplegic and confined to a wheelchair in the early stages, regained their full motor capabilities within one to four years. Three patients with severe neuropathy had residual muscle atrophy in the intrinsic foot and hand muscles. Signs of damage to the central nervous system, including increased tendon reflexes in two patients and leg tightness in six patients, emerged as muscle power was nearing complete recovery. The tightness of the legs gradually disappeared, but muscle cramps of the calves developed and these were still present at the end of follow up. Two patients had mild abnormal colour vision, and the abnormality was still detectable four years later. It is concluded that n-hexane induced neuropathy has a good prognosis, and that spasticity due to damage to the central nervous system is functionally reversible; muscle cramps and dyschromatopsia persist much longer. PMID:2166555

  17. Patients with n-hexane induced polyneuropathy: a clinical follow up.

    PubMed

    Chang, Y C

    1990-07-01

    The prognosis of hexacarbon induced polyneuropathy is usually good, though its clinical course after the cessation of exposure has not been described in detail. Eleven patients with moderate to severe n-hexane induced polyneuropathy due to occupational exposure were regularly followed up for a period of four years at the neurological department of the National Taiwan University Hospital. Sensorimotor neuropathy was diagnosed in nine patients and motor neuropathy in two. All were removed from further exposure to n-hexane after aetiological confirmation, but motor disturbance continued to worsen in five cases. Sensory functions were regained earlier than motor functions. All the patients, including one who was tetraplegic and confined to a wheelchair in the early stages, regained their full motor capabilities within one to four years. Three patients with severe neuropathy had residual muscle atrophy in the intrinsic foot and hand muscles. Signs of damage to the central nervous system, including increased tendon reflexes in two patients and leg tightness in six patients, emerged as muscle power was nearing complete recovery. The tightness of the legs gradually disappeared, but muscle cramps of the calves developed and these were still present at the end of follow up. Two patients had mild abnormal colour vision, and the abnormality was still detectable four years later. It is concluded that n-hexane induced neuropathy has a good prognosis, and that spasticity due to damage to the central nervous system is functionally reversible; muscle cramps and dyschromatopsia persist much longer.

  18. Corneal Astigmatism in Patients After Cataract Surgery: A 10-Year Follow-up Study.

    PubMed

    Kim, Hyojin; Whang, Woong-Joo; Joo, Choun-Ki

    2016-06-01

    To report the long-term outcomes of corneal astigmatism after cataract surgery. The study included 55 eyes of 46 patients who underwent cataract surgery with temporal 3-mm clear corneal incisions from January 2001 to December 2003. All patients underwent complete ophthalmological examination including keratometry at the preoperative visit and at 2 months and 10 years after surgery. Only those eyes that underwent a follow-up of 10 years or longer from the time of cataract surgery were enrolled. Arithmetic and vector analyses were performed to obtain the change in corneal astigmatism with advancing age. The mean age of the patients was 59.11 ± 12.33 years (range: 18 to 75 years), and 58.7% of the patients were women. The mean follow-up period was 131.28 ± 14.36 months. The average magnitudes of surgically induced astigmatism and long-term astigmatism change were 0.66 ± 0.42 and 0.57 ± 0.47 diopters (D), respectively. The vector difference was 0.56 ± 0.55 D at 90° ± 0° between the preoperative and 2-month visits. However, there was no difference in vector values between postoperative 2 months and 10 years (0.00 ± 0.74 D at 0° ± 0°). Patients with corneal astigmatism who underwent cataract surgery did not show a long-term against-the-rule change in corneal astigmatism during a 10-year follow-up. These results provide useful information when planning toric intraocular lens implantation in patients with corneal astigmatism. [J Refract Surg. 2016;32(6):404-409.]. Copyright 2016, SLACK Incorporated.

  19. 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

  20. Follow-up after tricuspid valve surgery in adult patients with systemic right ventricles.

    PubMed

    Koolbergen, David R; Ahmed, Yunus; Bouma, Berto J; Scherptong, Roderick W C; Bruggemans, Eline F; Vliegen, Hubert W; Holman, Eduard R; Mulder, Barbara J M; Hazekamp, Mark G

    2016-09-01

    In patients with congenitally corrected transposition of the great arteries (ccTGA) or after atrial (Mustard or Senning) correction for transposition of the great arteries (acTGA), the right ventricle (RV) supports the systemic circulation. The tricuspid valve (TV) (systemic atrioventricular valve) is prone to regurgitation in these patients and this is associated with impending RV failure and decreased survival. This study evaluates mid-term functional improvements, echocardiographic findings and survival after TV surgery in this patient group. From July 1999 to November 2014, 26 patients (mean age 37.1 ± 12.3 years, 14 females) with ccTGA (n = 15) or acTGA (n = 11) had TV surgery. All patients had RV dysfunction and more-than-moderate TV regurgitation (TR); 14 underwent TV replacement (TVR) and 12 had valvuloplasty (TVP). Main outcomes were New York Heart Association (NYHA) functional class, TR and RV dysfunction at 1 year postoperatively and at latest follow-up. Complications and freedom from the composite end-point of death or recurrent TR were analysed. The median follow-up time was 5.9 years (range, 0-16.1 years). Mean NYHA functional class significantly improved to 1.7 [95% confidence interval (CI): 1.3-2.1] at 1 year (P= 0.004) and was 2.1 (95% CI: 1.7-2.6) at latest follow-up (P= 0.14). TV competence significantly improved to a mean TR grade of 1.1 (95% CI: 0.5-1.7) at latest follow-up (P< 0.001). The mean grade for RV function at latest follow-up was 2.7 (95% CI: 2.3-3.0). Most encountered postoperative complications were arrhythmias and temporary haemodynamic instability due to low cardiac output. Early mortality was 11.5% (n = 3); late mortality was 15.4% (n = 4). Estimated freedom from the composite end-point of death or recurrent TR was 76.9% (95% CI: 55.7-88.9%) at 1 year and 64.8% (95% CI: 43.2-79.9%) at 5 years. In TVP patients, TV function at 1 year and at latest follow-up was significantly worse than in TVR patients (P< 0.001 and P= 0

  1. Simple Analysis Used in Diagnosis and Follow-up of Schizophrenic Patients (Patent)

    PubMed Central

    Nour El-Dien, Faten A.; El-Nahas, Reham G.; El-Nahas, Ahmed G.

    2006-01-01

    Dopamine acts as neurotransmitter in the central and peripheral sympathetic nervous system. Determination of dopamine (DO) was performed by spectrophotometric analysis depending on the formation of new colored compound. The proposed procedure was efficient in quantitative determination of DO as pure material in pharmaceutical preparations and in urine samples. DO concentration in urine sample of patient confirms the affection with schizophrenia and the proposed procedure was used to facilitate diagnosis and followup of schizophrenic patients. It is recommended to apply the proposed procedures as routine analysis in pharmaceutical companies for quality control and in analytical laboratories to diagnose and follow up schizophrenia. PMID:17671624

  2. [Evaluation of depressive symptoms and resilience in patients on pharmacotherapeutic follow-up].

    PubMed

    Gomes, N C; Abrão, P H O; Fernandes, M R; Beijo, L A; Marques, L A M

    This study aimed to carry out the pharmacotherapeutic follow-up of patients with depression and to assess its impact on the resilience of the patients. Patients were followed-up for 8 months. The pharmacist evaluated depressive symptoms, resilience, and the need for pharmaceutical intervention. The measurement tools used were the Dader method, PHQ-9, and a resilience scale. Data were analysed using BioStat 5.0 software and the performing of the Wilcoxon and Pearson correlation tests. There was a reduction in the rate of depressive symptoms from 12.9 to 5.2 (P<.0001), and an increase in the resilience score from 112.4 to 149.0 (P<.0001). Pharmaceutical interventions were made to resolve the drug related problems in the form of oral communication between pharmacist-patient or pharmacist-patient-doctor. The pharmaceutical care was effective in decreasing depression and contributed to the increased resilience of patients. Copyright © 2017 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. How Can Follow-Up of Patients with Raynaud Phenomenon be Optimized?

    PubMed Central

    Kadan, Murat; Erol, Gökhan; Karabacak, Kubilay; Kaya, Erkan; Arslan, Gökhan; Doğancı, Suat; Demirkılıç, Ufuk

    2015-01-01

    Background Raynaud phenomenon (RP) is common worldwide and presents diagnostic and therapeutic difficulties. We aimed to share our experience with optimizing of patient follow-up by using the cold-stimulation test (CST). Material/Methods Data of 81 patients admitted with RP symptomatology were collected. Demographic data and symptoms were recorded. A scale was used for determining the severity of disease at pre-treatment and post-treatment. CST was performed to all patients at pre-treatment and post-treatment for assessment of treatment efficiency in follow-up. Results were analyzed with the SPSS for Mac 20.0 program. Results All the patients were male. Mean age was 22.3±2.14 (19–29). Mean duration of symptoms from onset to present was 4.59±2.85 years. There were statistically significant differences between pre-treatment and post-treatment hand temperatures measured by CST (p<0.001). However, there were no statistically significant differences between pre-treatment and post-treatment severity scores of patients (p=0.135). Conclusions To quantitatively determine the treatment efficacy, CST may be used instead of asking simple questions of patients. PMID:25847811

  4. EVALUATION OF A TELEMEDICINE MODEL TO FOLLOW UP PATIENTS WITH EXUDATIVE AGE-RELATED MACULAR DEGENERATION.

    PubMed

    Andonegui, Jose; Aliseda, Daniel; Serrano, Luis; Eguzkiza, Aitor; Arruti, Natalia; Arias, Luis; Alcaine, Araceli

    2016-02-01

    To evaluate a telemedicine model to follow up patients with exudative age-related macular degeneration and compare the time spent using this model with the time spent conducting office examinations. Results of office and telemedicine evaluations were compared to determine whether patients with exudative age-related macular degeneration previously treated with intravitreal injections needed additional treatment. The office examinations included visual acuity measurement, fundus examination, and optical coherence tomography. The telemedicine evaluation included evaluation of retinography images, optical coherence tomography images, and visual acuity data obtained in the office. We also measured the time spent on telemedicine evaluations and compared it with the time spent on office examinations. Twenty-one patients were included. A comparison of office and remote diagnostic decisions showed the same results in 181 cases. Among the 20 remaining patients and considering office diagnostic decisions as the gold standard, 17 (8%) patients had false-positive diagnoses and 3 (1%) had false-negative diagnoses. The sensitivity and specificity of the telemedicine evaluations were 96% and 85%, respectively. The average time spent on remote evaluations was 1 minute 21 seconds compared with 10 minutes spent on office examination (P < 0.001). The telemedicine model can be a useful alternative for following up patients with age-related macular degeneration.

  5. Three-Year Follow-up of Conservative Treatments of Shoulder Osteoarthritis in Older Patients.

    PubMed

    Guo, Jiong Jiong; Wu, Kailun; Guan, Huaqing; Zhang, Lei; Ji, Cheng; Yang, Huilin; Tang, Tiansi

    2016-07-01

    Little is known about the mid-term results of nonsurgical treatment for shoulder osteoarthritis (OA), especially in a Chinese population. This study sought to determine the efficacy of nonsurgical management in older patients with shoulder OA. A total of 129 conservatively treated unilateral shoulder OA patients who were older than 65 years were evaluated prospectively at the initial office visit and then subsequently at 3, 6, 12, 18, 24, and 36 months later. During the 36-month follow-up period, all patients could receive conventional therapy, such as nonsteroidal anti-inflammatory medication, corticosteroid injection, sodium hyaluronate, and education, at the discretion of treating physicians. Some patients received physiotherapy, rehabilitation training, and a shoulder strap to improve the range of motion and muscular strength training from a physical therapist. Parameters measured included comparative effectiveness of each therapeutic method, visual analog scale (VAS), Simple Shoulder Test (SST), and Short Form (36) Health Survey (SF-36) scores. At 3-year follow-up, most patients had a significant increase from their pretreatment values in pain, self-assessed shoulder function, mental health, and 5 of 8 SF-36 domains. The study showed a decline in SST and VAS at 6 and 12 months after an initial ascent at 3 months, and then it was rescued and continued at 3-year follow-up. Combined therapy could improve symptoms significantly. This study suggests that a conservative approach may be more appropriate and can produce satisfactory mid-term outcomes in selected cases. The findings of this study suggest that conservative treatments should be extended for longer than 12 months before the decision regarding shoulder arthroplasty is made. [Orthopedics. 2016; 39(4):e634-e641.].

  6. Breathing retraining - a five-year follow-up of patients with dysfunctional breathing.

    PubMed

    Hagman, Carina; Janson, Christer; Emtner, Margareta

    2011-08-01

    The term dysfunctional breathing (DB) has been introduced to describe patients who display divergent breathing patterns and have breathing problems that cannot be attributed to a specific medical diagnosis. Patients with DB are often misdiagnosed as having asthma. To describe patients with DB, five years after a breathing retraining intervention. Out of initially 25 patients with DB and 25 age and sex-matched patients with asthma, 22 patients with DB and 23 patients with asthma (ages 25-78 years) were followed up after five years. Data were collected from posted self-report questionnaires. Only patients with DB had received breathing retraining, consisting of information, advice and diaphragmatic breathing. Patients were evaluated regarding quality of life (SF-36), anxiety, depression, sense of coherence, hyperventilation, influence on daily life, emergency room (ER) visits, and symptoms associated with DB. Quality of life (SF-36), physical component summary scale (PCS), had improved in patients with DB from 43 to 47 (p = 0.03). The number of ER visits had decreased from 18 to 2 in patients with DB (p = 0.02). Symptoms associated with DB had decreased extensively, from a mean score of 6.9 to 2.7, on a DB criterion list (p < 0.001). Patients with DB were less impaired by their breathing problems both in daily life and when exercising (p < 0.001). The only difference found over time in the asthma group concerned quality of health, bodily pain, which had deteriorated, from 77 to 68 (p = 0.049). This five-year follow-up study indicates that patients with dysfunctional breathing benefit from breathing retraining. Copyright © 2011 Elsevier Ltd. All rights reserved.

  7. Periodontitis in patients with coronary artery disease: an 8-year follow-up.

    PubMed

    Johansson, Carin Starkhammar; Ravald, Nils; Pagonis, Christos; Richter, Arina

    2014-03-01

    This study examines whether preceding assessment of periodontal status in patients with established coronary artery disease (CAD) can predict future CAD endpoints (myocardial infarction, new revascularization procedure, or CAD-related death) during 8-year follow-up and whether the changes in periodontal status over time differ in patients with CAD compared with healthy controls. In 2003, periodontal status was examined in 161 patients with CAD who underwent percutaneous coronary intervention or coronary artery bypass graft due to significant stenosis in the coronary arteries and 162 controls without CAD. Eight years later, 126 patients with CAD (102 males and 24 females, mean age: 68 ± 8.9 years) and 121 controls (101 males and 20 females, mean age: 69 ± 9.0 years) were reexamined periodontally. A standard classification of periodontal disease in three groups (mild, moderate, and severe) was used. CAD endpoints during follow-up were obtained by review of medical records. CAD as cause of death was confirmed from the Swedish Cause of Death Register. No significant differences were found among patients with CAD, with or without CAD-related endpoints at 8-year follow-up, and severity of periodontitis at baseline (P = 0.7). CAD did not influence the incidence or severity of periodontitis. Significant differences were found at the final examination in periodontitis prevalence and severity (P = 0.001), number of teeth (P = 0.006), probing depth 4 to 6 mm (P = 0.016), bleeding on probing (P = 0.001), and radiographic bone level (P = 0.042) between CAD patients and controls, all in favor of controls. The study results did not show a significant association during 8 years among CAD endpoints and periodontal status at baseline. The progression of periodontitis was low in both groups, although the higher proportion of individuals with severe periodontitis among patients with CAD compared with controls remained unchanged over the 8-year follow-up. Further long

  8. Audiological follow-up of 24 patients affected by Williams syndrome.

    PubMed

    Barozzi, Stefania; Soi, Daniela; Spreafico, Emanuela; Borghi, Anna; Comiotto, Elisabetta; Gagliardi, Chiara; Selicorni, Angelo; Forti, Stella; Cesarani, Antonio; Brambilla, Daniele

    2013-09-01

    Williams syndrome is a neurodevelopmental disorder associated with cardiovascular problems, facial abnormalities and several behavioural and neurological disabilities. It is also characterized by some typical audiological features including abnormal sensitivity to sounds, cochlear impairment related to the outer hair cells of the basal turn of the cochlea, and sensorineural or mixed hearing loss, predominantly in the high frequency range. The aim of this report is to describe a follow-up study of auditory function in a cohort of children affected by this syndrome. 24 patients, aged 5-14 years, were tested by means of air/bone conduction pure-tone audiometry, immittance test and transient evoked otoacoustic emissions. They were evaluated again 5 years after the first assessment, and 10 of them underwent a second follow-up examination after a further 5 years. The audiometric results showed hearing loss, defined by a pure tone average >15 dB HL, in 12.5% of the participants. The incidence of hearing loss did not change over the 5-year period and increased to 30% in the patients who underwent the 10-year follow-up. Progressive sensorineural hearing loss was detected in 20% of the patients. A remarkable finding of our study regarded sensorineural hearing impairment in the high frequency range, which increased significantly from 25% to 50% of the participants over the 5-year period. The increase became even more significant in the group of patients who underwent the 10-year follow-up, by which time the majority of them (80%) had developed sensorineural hearing loss. Otoacoustic emissions were found to be absent in a high percentage of patients, thus confirming the cochlear fragility of individuals with Williams syndrome. Our study verified that most of the young Williams syndrome patients had normal hearing sensitivity within the low-middle frequency range, but showed a weakness regarding the high frequencies, the threshold of which worsened significantly over time in

  9. A four-year follow-up of duodenal ulcer patients after Helicobacter pylori eradication.

    PubMed

    Tepes, B; Kavcic, B; Gubina, M; Krizman, I

    1999-01-01

    The aim of our study was to evaluate the clinical course of disease in 63 duodenal ulcer (DU) patients during a 4-year follow-up after Helicobacter pylori (H. pylori) eradication. Upper gastrointestinal endoscopy and a clinical interview were performed before antimicrobial therapy, 2 months after, yearly and when symptoms recurred. Two antral and two corporal specimens were taken for histology, and one additional specimen from antrum was taken for rapid urease test at the first endoscopy and for culture at the following endoscopies. All patients received triple antimicrobial regimens based on colloidal bismuth subcitrate, amoxycillin and metronidazole for at least 2 weeks. Patients with a negative histology and culture 2 months after antimicrobial therapy were included in the study. After H. pylori eradication, ulcer recurrence dropped from 84.1% per year in the year before H. pylori eradication to a mean value of 5.2% per year during 2076 patient months (p<0.01). The increased incidence of gastroesophageal reflux disease (GERD) was found only in the first year of the follow-up period. The average percentage of anti-ulcer drug users per year was 30.8% because of GERD, reflux symptoms, ulcer recurrence or non-ulcer dyspepsia. Ulcers or acute erosions recurred in 9 H. pylori-negative patients; recurrences were attributable to non-steroidal anti-inflammatory drugs (NSAID) in 4 out of 9 cases (44.4%). H. pylori eradication changed the long-term course of DU disease.

  10. Subjective assessment of visual verticality in follow-up of patients with acute vestibular disease.

    PubMed

    Gómez García, Angélica; Jáuregui-Renaud, Kathrine

    2003-06-01

    We conducted a study of 10 patients with acute unilateral peripheral vestibular failure in order to assess their ability to perceive visual verticality during the acute stage of their disease and during recovery. We also evaluated 31 healthy volunteers to test the reproducibility of our assessment methods. The 10 patients were first evaluated within 4 days of the onset of their vestibular failure, and follow-up tests were conducted 2 and 4 weeks later. The healthy subjects were similarly tested at 2 and 4 weeks following their baseline evaluation. All patients and subjects were tested 10 times during each evaluation session, and results from each as well as from the groups as a whole were calculated as a mean of all responses. The mean visual vertical tilt (the amount of deviation from true verticality) among the 10 patients declined from 8.4 degrees (+/- 2.4 degrees) at the first examination to 3.2 degrees (+/- 1.6 degrees) at week 2 and to 1.4 degrees (+/- 0.7 degree) at week 4. These decreases coincided with the pace of the resolution of their vestibular symptoms. The rates of reproducibility among the 31 healthy volunteers at 2 and 4 weeks following their initial assessment were 95 and 97%, respectively. We concluded that repeated measurements of the static visual vertical can be useful as a follow-up tool for patients with vestibular neuritis.

  11. [Model of a prospective follow-up study of patients managed in intensive care].

    PubMed

    Ritz, R

    1988-04-30

    For ethical and economic reasons, follow-up--especially after intensive care--is important as a form of quality control which could serve as a basis for more differentiated indications for patient admission. A follow-up model, involving questionnaires 3 months, 1 year and 3 years after intensive care, and preliminary results of patients in 1985 are presented. Only a few patients described their present health situation as bad, but unstable situations showed little improvement between 3 months and 1 year after intensive care. There was a rather high percentage of rehospitalization and/or need for continued medical care. Only 10% of respondent patients were unable to work 1 year after intensive care, and 12% still depended on help from others. 15-35% described their quality of life as restricted; only 4% had negative memories of intensive care (fear, pain), and only 0.6% of respondent patients thought their previous admission to the intensive care unit had been a wrong decision.

  12. Vertebral Augmentation with Nitinol Endoprosthesis: Clinical Experience in 40 Patients with 1-Year Follow-up

    SciTech Connect

    Anselmetti, Giovanni Carlo; Manca, Antonio; Marcia, Stefano; Chiara, Gabriele; Marini, Stefano; Baroud, Gamal; Regge, Daniele; Montemurro, Filippo

    2013-05-08

    PurposeThis study was designed to assess the clinical outcomes of patients treated by vertebral augmentation with nitinol endoprosthesis (VNE) to treat painful vertebral compression fractures.MethodsForty patients with one or more painful osteoporotic VCF, confirmed by MRI and accompanied by back-pain unresponsive to a minimum 2 months of conservative medical treatment, underwent VNE at 42 levels. Preoperative and postoperative pain measured with Visual Analog Scale (VAS), disability measured by Oswestry Disability Index (ODI), and vertebral height restoration (measured with 2-dimensional reconstruction CT) were compared at last follow-up (average follow-up 15 months). Cement extravasation, subsequent fractures, and implant migration were recorded.ResultsLong-term follow-up was obtained in 38 of 40 patients. Both VAS and ODI significantly improved from a median of 8.0 (range 5–10) and 66 % (range 44–88 %) to 0.5 (range 0–8) and 6 % (range 6–66 %), respectively, at 1 year (p < 0.0001). Vertebral height measurements comparing time points increased in a statistically significant manner (ANOVA, p < 0.001). Overall cement extravasation rate was 9.5 %. Discal and venous leakage rates were 7.1 and 0 % respectively. No symptomatic extravasations occurred. Five of 38 (13.1 %) patients experienced new spontaneous, osteoporotic fractures. No device change or migration was observed.ConclusionsVNE is a safe and effective procedure that is able to provide long-lasting pain relief and durable vertebral height gain with a low rate of new fractures and cement leakages.

  13. Quality of life in patients with progressive supranuclear palsy: one-year follow-up.

    PubMed

    Pekmezović, Tatjana; Ječmenica-Lukić, Milica; Petrović, Igor; Špica, Vladana; Tomić, Aleksandra; Kostić, Vladimir S

    2015-09-01

    The aim of this prospective cohort study that included 46 patients with progressive supranuclear palsy (PSP) was to estimate which demographic and clinical factors were the main contributors to the health-related quality of life (HRQoL) and how did the HRQoL change over a follow-up period of 1 year in these patients. The hierarchical regression analyses showed that the final models demonstrated that gender, included clinical variables and psychiatric/neuropsychological scales, accounted for 68% of the variance in the Physical Composite Score and 73% of the variance of the Mental Composite Score of the 36-item Short Form Health Survey (SF-36). Among variables in both final models, only the score of the Apathy Evaluation Scale showed statistically significant negative predictive value (p < 0.05). Changes in the HRQoL scores were assessed in 28 PSP patients who completed 1-year follow-up period after the baseline examination. Statistically significant decline in the HRQoL was detected for the following scales of the SF-36: physical functioning, vitality, social functioning, and role emotional, as well as in both composite scores (Physical Composite Score and Mental Composite Score). The analyses of magnitude of changes in the HRQoL during 1-year follow-up period showed large effect size (≥0.80) for total scores, as well as for the physical functioning, vitality, and social functioning. In conclusion, despite certain limitations, our study provided some new insights into potential predictors of the HRQoL and its longitudinal changes in patients with PSP.

  14. Consensus statement on the diagnosis, treatment and follow-up of patients with primary adrenal insufficiency.

    PubMed

    Husebye, E S; Allolio, B; Arlt, W; Badenhoop, K; Bensing, S; Betterle, C; Falorni, A; Gan, E H; Hulting, A-L; Kasperlik-Zaluska, A; Kämpe, O; Løvås, K; Meyer, G; Pearce, S H

    2014-02-01

    Primary adrenal insufficiency (PAI), or Addison's disease, is a rare, potentially deadly, but treatable disease. Most cases of PAI are caused by autoimmune destruction of the adrenal cortex. Consequently, patients with PAI are at higher risk of developing other autoimmune diseases. The diagnosis of PAI is often delayed by many months, and most patients present with symptoms of acute adrenal insufficiency. Because PAI is rare, even medical specialists in this therapeutic area rarely manage more than a few patients. Currently, the procedures for diagnosis, treatment and follow-up of this rare disease vary greatly within Europe. The common autoimmune form of PAI is characterized by the presence of 21-hydroxylase autoantibodies; other causes should be sought if no autoantibodies are detected. Acute adrenal crisis is a life-threatening condition that requires immediate treatment. Standard replacement therapy consists of multiple daily doses of hydrocortisone or cortisone acetate combined with fludrocortisone. Annual follow-up by an endocrinologist is recommended with the focus on optimization of replacement therapy and detection of new autoimmune diseases. Patient education to enable self-adjustment of dosages of replacement therapy and crisis prevention is particularly important in this disease. The authors of this document have collaborated within an EU project (Euadrenal) to study the pathogenesis, describe the natural course and improve the treatment for Addison's disease. Based on a synthesis of this research, the available literature, and the views and experiences of the consortium's investigators and key experts, we now attempt to provide a European Expert Consensus Statement for diagnosis, treatment and follow-up. © 2013 The Association for the Publication of the Journal of Internal Medicine.

  15. Outpatient Follow-Up versus 30-day Readmission among General and Vascular Surgery Patients: A Case for Redesigning Transitional Care

    PubMed Central

    Saunders, Richard Scott; Fernandes-Taylor, Sara; Rathouz, Paul J.; Saha, Sandeep; Wiseman, Jason T.; Havlena, Jeffrey; Matsumura, Jon; Kent, K. Craig

    2014-01-01

    Background The association between early outpatient follow-up and 30-day readmission has not been evaluated in any surgical population. Our study characterizes the relationship between outpatient follow-up and early readmissions among surgical patients. Methods We queried the medical record at a large, tertiary care institution (July 2008-December 2012) to determine rates of 30-day outpatient follow-up and readmission for general or vascular surgical procedures. Results The majority of discharges for general (84% of 7552) and vascular (75% of 2362) surgery had a follow-up visit before readmission or within 30 days of discharge. General surgery patients who were not readmitted had high rates of follow-up (88%) and received follow-up at approximately 2-weeks post-discharge (median time 11 days after discharge). In contrast, readmitted general surgery patients received first follow-up at one week (a median time of 8 days); 49% had follow-up. Vascular surgery patients showed a similar trend. Over half of patients readmitted after follow-up were readmitted within 24 hours of their most recent outpatient visit. Conclusions Current routine follow-up does not occur early enough to detect adverse events and prevent readmission. Early outpatient care may prevent readmission in some patients, but often serves as a conduit for readmission among patients already experiencing complications. PMID:25239351

  16. Surveillance strategies in the follow-up of melanoma patients: too much or not enough?

    PubMed

    Kurtz, James; Beasley, Georgia M; Agnese, Doreen; Kendra, Kari; Olencki, Thomas E; Terando, Alicia; Howard, J Harrison

    2017-06-15

    After appropriate initial therapy for patients with stage II-III melanoma, there is no consensus regarding surveillance. Thus, follow-up is highly variable among institutions and individual providers. The National Comprehensive Cancer Network recommends routine clinical examination and consideration of imaging for stage IIB-IIIC every 3-12 mo with no distinction between stages. Detection of recurrence is important as novel systemic therapies and surgical resection of recurrence may provide survival benefits. We retrospectively reviewed 369 patients with stage II and III melanoma treated at Ohio State University from 2009-2015, who underwent surgery as primary therapy. Two hundred forty-seven patients who were followed for a minimum of 6 mo after surgical resection to achieve no evidence of disease status (NED) were included in this analysis. One hundred twenty-two were lost to follow-up after surgery and were excluded. The rate of recurrence for stage IIA/IIB patients was 11% (14/125). Eleven of the 14 (79%) recurrences were detected by clinical symptoms or physical examination. Thirty-nine percent (49/125) of stage IIA or IIB patients were followed by clinical examination only, whereas 61% (76/125) were followed with at least two serial chest x-rays. The median time to first chest x-ray after NED status was 4.7 mo (n = 76), median time to second chest x-ray after NED status was 12.7 mo (n = 76), and 66% (50/76) continued to have additional serial chest x-rays. At median follow-up of 35 mo for the 125 patients with stage IIA/IIB, there was no difference in survival between those followed clinically (95% [95% CI: 0.88-0.99]) versus those followed with at least two serial x-rays (96% [95% CI: 0.89-0.98]). For stage IIC/IIIA-C patients, recurrence was detected in 23% (28/122) at median follow-up 31.2 mo. Fifty percent of recurrences were detected by imaging in asymptomatic patients, whereas 50% (14/28) had recurrence detected on imaging associated clinical

  17. Impact of the priority follow-up system on quality of life in Chinese schizophrenia patients.

    PubMed

    Xiang, Yu-Tao; Leung, Chi-Ming; Tang, Wai-Kwong; Ungvari, Gabor Sandor

    2008-02-01

    Priority follow up (PFU) is a particular aspect of mental health care in Hong Kong whereby psychiatric patients with a history of violence or suspected proclivity to violence are identified and their management is closely monitored. The aim of the present study was to determine the impact of a PFU system on quality of life (QOL) in schizophrenia patients. Two hundred and sixty-seven clinically stable outpatients with schizophrenia were randomly selected and interviewed in Hong Kong using standardized assessment instruments that covered their clinical condition and QOL. Patients with PFU status constituted 8.2% of the sample. PFU patients were more likely to be men, have a history of violence, and were poorer in the physical, psychological, social and environmental QOL domains than their non-PFU counterparts even after controlling for the effects of potential confounding variables. More effective measures should be taken to improve QOL in PFU schizophrenia patients who are prone to violent behavior.

  18. Long-term follow-up of radiation accident patients in Peru: review of two cases.

    PubMed

    Barriga, L E; Zaharia, M; Pinillos, L; Moscol, A; Heredia, A; Sarria, G; Marquina, J; Barriga, O; Picon, C

    2012-10-01

    Overexposure to radioactive sources used in radiotherapy or industrial radiography may result in severe health consequences. This report assesses the initial clinical status and the medical and psychological long-term follow-up of two radiation accident patients from Peru during the mid-to-late 1990s: one patient exposed to a radiotherapy (60)Co source in Arequipa, the other patient to a (192)Ir source in Yanango. Commonalities and differences are described. The main causes in both accidents were human error and the failure to apply appropriate safety guidelines and standard operating procedures. Education and training of the personnel working with radiation sources are essential to prevent accidents. The experience gained from the medical management of the two patients is valuable for future treatment of such patients.

  19. A 3-year follow-up of sun behavior in patients with cutaneous malignant melanoma.

    PubMed

    Idorn, Luise Winkel; Datta, Pameli; Heydenreich, Jakob; Philipsen, Peter Alshede; Wulf, Hans Christian

    2014-02-01

    IMPORTANCE UV radiation (UVR) exposure is the primary environmental risk factor for developing cutaneous malignant melanoma (CMM). OBJECTIVE To measure changes in sun behavior from the first until the third summer after the diagnosis of CMM using matched controls as a reference. DESIGN, SETTING, AND PARTICIPANTS Three-year follow-up, observational, case-control study performed from May 7 to September 22, 2009, April 17 to September 15, 2010, and May 6 to July 31, 2011, at a university hospital in Denmark of 21 patients with CMM and 21 controls matched to patients by sex, age, occupation, and constitutive skin type participated in the study. Exposure to UVR was assessed the first and second summers (n=20) and the first and third summers (n=22) after diagnosis. Data from 40 participants were analyzed. MAIN OUTCOMES AND MEASURES Exposure to UVR was assessed by personal electronic UVR dosimeters that measured time-related UVR in standard erythema dose (SED) and corresponding sun diaries (mean, 74 days per participant each participation year). RESULTS Patients' daily UVR dose and UVR dose in connection with various behaviors increased during follow-up (quantified as an increase in daily UVR dose each year; all days: mean, 0.3 SED; 95% CI, 0.05-0.5 SED; days with body exposure: mean, 0.6 SED; 95% CI, 0.07-1.2 SED; holidays: mean, 1.2 SED; 95% CI, 0.3-2.1 SED; days abroad: 1.9 SED; 95% CI, 0.4-3.4 SED; and holidays with body exposure: mean, 2.3 SED; 95% CI, 1.1-3.4 SED). After the second year of follow-up, patients' UVR dose was higher than that of controls, who maintained a stable UVR dose. No difference was found between groups in the number of days with body exposure or the number of days using sunscreen in the second and third years of follow-up. CONCLUSIONS AND RELEVANCE Our findings suggest that patients with CMM do not maintain a cautious sun behavior in connection with an increase in UVR exposure, especially on days with body exposure, when abroad, and on holidays.

  20. Characteristics of patients in an eating disorder sample who dropped out: 2-year follow-up.

    PubMed

    Gómez Del Barrio, Andrés; Vellisca Gonzalez, María Yolanda; González Gómez, Jana; Latorre Marín, José Ignacio; Carral-Fernández, Laura; Orejudo Hernandez, Santos; Madrazo Río-Hortega, Inés; Moreno Malfaz, Laura

    2017-07-17

    This manuscript explores the characteristics of individuals diagnosed with an eating disorder who dropped out of treatment, compared with those who completed it. The participants were 196 patients diagnosed with eating disorders (according to DSM-IV-TR criteria) who consecutively began treatment for the first time in an eating disorders unit. They were assessed at baseline with a set of questionnaires evaluating eating habits, temperament, and general psychopathology. During the follow-up period, patients who dropped out were re-assessed via a telephone interview. In the course of a 2-year follow-up, a total of 80 (40.8%) patients were labeled as dropouts, and 116 (59.2%) remaining subjects were considered completers. High TCI scores in the character dimensions of Disorderliness (NS4) (p < .01) and total Novelty Seeking (NST), along with low scores in Dependency (RD4), were significantly associated with dropout in the course of 2 years. Once the results were submitted to logistic regression analysis, dropout only remained associated with high scores in Disorderliness (NS4) and, inversely, with an initial Anorexia Nervosa (AN) diagnosis (p < .05). Reasons for dropout stated by the patients included logistic difficulties, subjective improvement of their condition, and lack of motivation. Clinicians should handle the first therapeutic intervention with particular care in order to enhance their understanding of clients and their ability to rapidly identify those who are at risk of dropping out of treatment. Level III: Cohort Study.

  1. 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

  2. Underuse of long-term routine hospital follow-up care in patients with a history of breast cancer?

    PubMed Central

    2011-01-01

    Background After primary treatment for breast cancer, patients are recommended to use hospital follow-up care routinely. Long-term data on the utilization of this follow-up care are relatively rare. Methods Information regarding the utilization of routine hospital follow-up care was retrieved from hospital documents of 662 patients treated for breast cancer. Utilization of hospital follow-up care was defined as the use of follow-up care according to the guidelines in that period of time. Determinants of hospital follow up care were evaluated with multivariate analysis by generalized estimating equations (GEE). Results The median follow-up time was 9.0 (0.3-18.1) years. At fifth and tenth year after diagnosis, 16.1% and 33.5% of the patients had less follow-up visits than recommended in the national guideline, and 33.1% and 40.4% had less frequent mammography than recommended. Less frequent mammography was found in older patients (age > 70; OR: 2.10; 95%CI: 1.62-2.74), patients with comorbidity (OR: 1.26; 95%CI: 1.05-1.52) and patients using hormonal therapy (OR: 1.51; 95%CI: 1.01-2.25). Conclusions Most patients with a history of breast cancer use hospital follow-up care according to the guidelines. In older patients, patients with comorbidity and patients receiving hormonal therapy yearly mammography is performed much less than recommended. PMID:21708039

  3. Ultrasonographic follow-up of patients with choroidal melanoma following conservative treatment.

    PubMed

    Ravozzoni, L; Mosci, C; Polizzi, A; Schenome, M; Soldati, M R; Buono, C

    1998-01-01

    The authors assessed the regression of choroidal tumors, following irradiation treatment, by means of B scan sonography (Sonomed B 3000). Thirty-two patients were studied, 12 of whom underwent brachytherapy with 106Ru plaques and 20 of whom were treated with accelerated protons. After a follow-up period of 12 months, the following was observed: reduction of the thickness of the tumor (significantly greater in the tumors which underwent brachytherapy) and morphological and structural changes which consisted in a thinning of the tumor and an increased reflectivity.

  4. Driving safety after brain damage: follow-up of twenty-two patients with matched controls.

    PubMed

    Katz, R T; Golden, R S; Butter, J; Tepper, D; Rothke, S; Holmes, J; Sahgal, V

    1990-02-01

    Driving after brain damage is a vital issue, considering the large number of patients who suffer from cerebrovascular and traumatic encephalopathy. The ability to operate a motor vehicle is an integral part of independence for most adults and so should be preserved whenever possible. The physician may estimate a patient's ability to drive safely based on his own examination, the evaluation of a neuropsychologist, and a comprehensive driving evaluation--testing, driving simulation, behind-the-wheel observation--with a driving specialist. This study sought to evaluate the ability of brain-damaged individuals to operate a motor vehicle safely at follow-up. These patients had been evaluated (by a physician, a neuropsychologist, and a driving specialist) and were judged able to operate a motor vehicle safely after their cognitive insult. Twenty-two brain-damaged patients who were evaluated at our institution were successfully followed up to five years (mean interval of 2.67 years). Patients were interviewed by telephone. Their driving safely was compared with a control group consisting of a close friend or spouse of each patient. Statistical analysis revealed no difference between patient and control groups in the type of driving, the incidence of speeding tickets, near accidents, and accidents, and the cost of vehicle damage when accidents occurred. The patient group was further divided into those who had, and those who had not experienced driving difficulties so that initial neuropsychologic testing could be compared. No significant differences were noted in any aspect of the neuropsychologic test battery. We conclude that selected brain-damaged patients who have passed a comprehensive driving assessment as outlined were as fit to drive as were their normal matched controls.(ABSTRACT TRUNCATED AT 250 WORDS)

  5. Lexical access changes in patients with multiple sclerosis: a two-year follow-up study.

    PubMed

    Sepulcre, Jorge; Peraita, Herminia; Goni, Joaquin; Arrondo, Gonzalo; Martincorena, Inigo; Duque, Beatriz; Velez de Mendizabal, Nieves; Masdeu, Joseph C; Villoslada, Pablo

    2011-02-01

    The aim of the study was to analyze lexical access strategies in patients with multiple sclerosis (MS) and their changes over time. We studied lexical access strategies during semantic and phonemic verbal fluency tests and also confrontation naming in a 2-year prospective cohort of 45 MS patients and 20 healthy controls. At baseline, switching lexical access strategy (both in semantic and in phonemic verbal fluency tests) and confrontation naming were significantly impaired in MS patients compared with controls. After 2 years follow-up, switching score decreased, and cluster size increased over time in semantic verbal fluency tasks, suggesting a failure in the retrieval of lexical information rather than an impairment of the lexical pool. In conclusion, these findings underline the significant presence of lexical access problems in patients with MS and could point out their key role in the alterations of high-level communications abilities in MS.

  6. The trabecular bypass stent in a pseudophakic glaucoma patient: A 1-year follow-up.

    PubMed

    Fea, Antonio M; Dogliani, Monica; Machetta, Federica; Lale-Lacroix, Gabriella; Brogliatti, Beatrice; Grignolo, Federico M

    2008-12-01

    To describe the 1-year success of a trabecular stent implant in a pseudophakic glaucoma patient. The stent is implanted through a small corneal incision under gonioscopic control. Intraocular pressure control was reported in cultured human anterior segment. Observational case report. We report the case of a patient who was implanted and followed-up for 1 year at the Dipartimento di Fisiopatologia Clinica. The main outcome measures were intraocular pressure and visual field. The patient's intraocular pressure was controlled with topical beta-blockers for 6 months and without therapy for 6 months. Two diurnal curves demonstrated achievement of target pressure during the day. The 1-year visual field was unchanged. We are not aware of previous reports of trabecular stent implantation in pseudophakic patients. The trabecular stent had minimal peri-operative morbidity. Identification of the implantation site is challenging and reduction of efficacy over time may occur.

  7. Should we follow-up serum testosterone in patients with advanced prostate cancer?

    PubMed

    Perachino, Massimo

    2010-07-01

    Agonistic analogs of luteinizing hormone-releasing hormones are indicated for the palliative treatment of metastatic prostate cancer. While the prognostic role of prostate-specific antigen in patients submitted to androgen-deprivation therapy has been extensively investigated in these patients, there is no consensus about the utility of serum testosterone measurements during follow-up and about their possible prognostic value. Recent reports have shown that testosterone levels might be directly related to survival and risk of death. These results need to be confirmed by further prospective studies. Given this concept, lowering testosterone as much as possible should be the goal of androgen-deprivation therapy in patients with metastatic prostate cancer, as this may have an impact on patient survival.

  8. Follow-up status of patients with angiographically normal coronary arteries and panic disorder

    SciTech Connect

    Beitman, B.D.; Kushner, M.G.; Basha, I.; Lamberti, J.; Mukerji, V.; Bartels, K. )

    1991-03-27

    Cardiology patients with normal coronary angiography demonstrate continuing and substantial social, health, and work disability. The authors hypothesized that the diagnosis of panic disorder would mark those for whom continuing disability is most likely. They interviewed 72 such patients at the time of their normal angiogram, and then again an average of 38 months later. Those with panic disorder (n=36) demonstrated significantly more disability at follow-up than did the other study patients. They conclude that those patients with normal angiograms who have panic disorder are more disabled than those who do not have panic disorder. Panic disorder in psychiatric samples has been shown to be highly treatable. Therefore, early identification and treatment of panic disorder in this group is likely to minimize the suffering associated with this condition.

  9. Two Patients with Dry Eye Disease Followed Up Using an Expression Assay of Ocular Surface Mucin

    PubMed Central

    Machida, Yumiko; Shoji, Jun; Harada, Natsuko; Inada, Noriko

    2016-01-01

    Purpose We report 2 patients with dry eye disease followed up using the expression levels of ocular surface mucin. Case Reports Patient 1: a 57-year-old woman with Sjögren's syndrome-associated dry eyes experienced severe dryness and foreign body sensation in both her eyes, and instilled sodium hyaluronate ophthalmic solution 0.3% about 10–15 times daily. We measured the expression levels of MUC5AC mRNA (MUC5AC) and MUC16 mRNA (MUC16) by using real-time reversed transcription polymerase chain reaction for the specimens of modified impression cytology. Expression levels of MUC5AC and MUC16 on her ocular surface were very low. Subjective symptoms and expression levels of ocular surface mucin improved after combined treatment of rebamipide (4 times daily) and fluorometholone (once daily) ophthalmic suspension. Patient 2: a 62-year-old man with chronic graft-versus-host disease-associated dry eye experienced severe foreign body sensation and developed superficial punctate keratopathy with mucous thread and filamentary keratitis. Expression level of MUC5AC was very high at baseline. Subjective symptoms and expression levels of ocular surface mucin improved by combined treatment of rebamipide (4 times daily) and fluorometholone (once daily) ophthalmic suspension. Conclusion Clinical test for MUC gene expression on the ocular surface was found to be useful in the follow-up of dry eye treatment. PMID:27194990

  10. [Dynamic renal echography versus urography in the follow-up of patients who have undergone ureterosigmoidostomy].

    PubMed

    Montanari, E; Tzoumas, S; Deiana, G; Cogni, M; Guarneri, A; Zanetti, G; Austoni, E

    1994-09-01

    The main post uretero-sigmoidostomy complications are stricture of the anastomosis, chronic infection and urolithiasis. In our institution the patients with ureterosigmodostomy undergo a follow-up protocol in which blood chemistry, ultrasonography, intravenous pyelography and C.T. are periodically performed. The aim of the present paper is to compare the accuracy of kidney sonography after diuretic stimulation with intravenous pyelography in the diagnosis of ureteral stenosis. Out of 91 patient with ureterosigmoidostomy 18 patients (34 kidneys) underwent intravenous pyelography, a basal U.S. and then a dynamic one at 5, 10, 15, 30, 45, 60, 90, 120 minutes after administration of furosemide 20 mg i.v. At basal U.S. 27 kidneys were normal and 7 showed a dilations. After diuretic stimulation we observed 16 normal kidneys, 16 dilated units and 2 intermittent hydronephrosis. Out of 16 dilated kidneys 6 became normal in 60 minutes. Out of 10 dilated units 3 were normal in 90 minutes (hipotonic), 2 were normal before 120 minutes (low grade obstruction) and 5 were dilated after 120 minutes (high grade obstruction). With intravenous pyelography we observed 27 normal kidneys and seven dilated units. Dynamic sonography have shown high sensibility (100%), specificity (88.8%) and accuracy (91%) in diagnosis of ureteral obstruction in to I.V.P. in the follow-up of this kind of divesion.

  11. One-year follow-up study of psychotic patients treated with blonanserin: a case series.

    PubMed

    Takahashi, Sakae; Suzuki, Masahiro; Uchiyama, Makoto

    2013-09-01

    Blonanserin is a relatively new atypical antipsychotic drug, and has been used in Korea and Japan for 1 and 3 years, respectively. Therefore, the clinical characteristics of blonanserin remain unclear. In this study, to clarify the features of blonanserin, we performed prospective and long-term comparative investigations of patients treated with blonanserin. We followed 10 psychiatric patients who were switched to blonanserin from other antipsychotics for 1 year (schizophrenia: 8; mental retardation: 2). In the light of quality of life, we focused on adverse effects of patients during the follow-up. In the long-term follow-up, (i) hyperprolactinemia is more frequently in risperidone than in blonanserin; however, it is more often in blonanserin than in olanzapine; and (ii) weight gain is more common in olanzapine than in blonanserin. We switched to blonanserin from other antipsychotic drugs within the same case, and then followed the case for 1 year. We consider that long-term observations within the same case lead to obvious comparisons among drugs. On the basis of our findings, we conclude that blonanserin may be useful for the maintenance treatment of schizophrenia without inducing hyperprolactinemia and weight gain. Copyright © 2012 Wiley Publishing Asia Pty Ltd.

  12. An electrophysiological follow up of patients with n-hexane polyneuropathy.

    PubMed Central

    Chang, Y C

    1991-01-01

    Electroneurographic (ENeG) and evoked potential (EP) studies were regularly performed on 11 printing workers with n-hexane polyneuropathy after cessation of exposure. At the initial examination, the ENeG studies simulated a demyelinative process. Further slowing of nerve conduction velocity, or further decreasing of action potential amplitude, or both in the follow up ENeG study were found in about half the patients. The motor distal latency did not worsen. Nerve conduction returned to normal earlier in the sensory than in the motor nerves. After the patients had regained full motor capability, conduction velocities in motor nerves were still significantly slowed. These ENeG characteristics correlate with the pathological and pathophysiological changes in experimental hexa-carbon neuropathies. The initial findings from the EP studies indicated a conduction abnormality in the central nervous system (CNS). Delayed worsening occurred in the amplitude of visual EPs in three patients. On serial follow up, the interpeak latency and interpeak amplitude of visual EPs improved little. Residual abnormalities were also found in the interpeak latency of auditory EPs in the brainstem and in the absolute latency of scalp somatosensory EPs from the peroneal nerve. Astroglial proliferation in the CNS probably impedes recovery of the abnormalities in EP. PMID:1993154

  13. Median arcuate ligament syndrome: vascular surgical therapy and follow-up of 18 patients.

    PubMed

    Grotemeyer, Dirk; Duran, Mansur; Iskandar, Franziska; Blondin, Dirk; Nguyen, Kim; Sandmann, Wilhelm

    2009-11-01

    The median arcuate ligament syndrome (MALS) or celiac artery compression syndrome is a rare vascular disorder caused by an extrinsic compression of the celiac artery from the median arcuate ligament, prominent fibrous bands, and ganglionic periaortic tissue. Clinical symptoms are postprandial abdominal pain, nausea, vomiting, unintentional weight loss, and sometimes, abdominal pain during body exercise caused by an intermittent visceral ischemia. The aim of this study was to evaluate the operative management of patients with MALS in our institution, especially in consideration of various vascular reconstructive techniques. Between June 2000 and January 2009, a total of 341 patients were treated in our department for vascular pathologies of the visceral arteries (225 chronic visceral ischaemia, 84 acute visceral ischaemia, and 14 visceral artery aneurysms). In a retrospective study of 18 patients with MALS, the records, clinical symptoms, diagnostic evaluation, and surgical procedures were compiled. This was completed by a reassessment for a follow-up. A MALS was diagnosed in 15 female (83.3%) and three male (16.7%) patients. The mean patient age was 46.2 years (range 20-68 years). The diagnosis of MALS was based on a radiological analysis in all patients by a digitally subtracted angiogram, but duplex ultrasound was used lately more frequently to study the influence of respiration on the stenotic degree of the celiac trunk. All 18 patients were treated with open surgery in an elective situation. Due to the local and specific pathology of the celiac trunk with a fixed stricture or stenosis, out of 18 cases beside decompression, 11 (primary, seven; secondary, four patients) further procedures were performed on the celiac artery (aorto-celiac vein interposition n = 6, aorto-hepatic vein interposition n = 1, resection of the celiac artery and end-to-end anastomosis n = 2, patchplasty of the celiac artery with vein n = 1, and transaortic removal of a stent of the celiac

  14. Long-term follow-up of coronary angioplasty in patients with diabetes compared with nondiabetics.

    PubMed

    Brueren, B R G; Ten Berg, J M; Kelder, J C; Suttorp, M J; Mast, E G; Bal, E; Ernst, S M P G; Plokker, H W T

    2004-04-01

    Some reports have indicated that in patients with diabetes mellitus and multivessel disease, coronary artery bypass surgery is preferred over percutaneous coronary intervention (PCI). We retrospectively compared outcome PCI in diabetic and nondiabetic patients. Ninety-seven diabetics and 971 nondiabetics were included and randomised before PCI to aspirin alone or aspirin plus coumadin. Fifty diabetics and 481 nondiabetics underwent follow-up angiography. The primary endpoint comprised all-cause mortality, myocardial infarction or targetvessel revascularisation. Baseline characteristics were similar between the groups except for significantly more males and smokers among the nondiabetics. The diabetics had significantly more previous strokes, more left anterior descending coronary artery disease as well as more restenotic lesions and multivessel disease. At 30 days, the primary endpoint had occurred in five diabetics (5.2%) and 47 nondiabetics (4.9%), (p=0.8) and at one year in 17 (17.5%) and in 165 (17.1%), respectively (p=0.9). Event-free survival remained comparable during long-term follow-up (four years). Multivariate analysis showed no differences for the occurrence of any event (p=0.9, 95% CI 0.6-1.7). At six months, the minimal luminal diameter was significantly smaller in the diabetics (1.55±0.76 mm vs. 1.78±0.66 mm, p=0.01). Diabetics also had more restenosis (41% vs. 23%, p=0.003). Despite angiographical differences at six months between the diabetics and nondiabetics, both short-term and long-term clinical follow-up appeared to be similar.

  15. Long-term follow-up of coronary angioplasty in patients with diabetes compared with nondiabetics

    PubMed Central

    Brueren, B.R.G.; ten Berg, J.M.; Kelder, J.C.; Suttorp, M.J.; Mast, E.G.; Bal, E.; Ernst, S.M.P.G.; Plokker, H.W.T.

    2004-01-01

    Background Some reports have indicated that in patients with diabetes mellitus and multivessel disease, coronary artery bypass surgery is preferred over percutaneous coronary intervention (PCI). We retrospectively compared outcome PCI in diabetic and nondiabetic patients. Methods Ninety-seven diabetics and 971 nondiabetics were included and randomised before PCI to aspirin alone or aspirin plus coumadin. Fifty diabetics and 481 nondiabetics underwent follow-up angiography. The primary endpoint comprised all-cause mortality, myocardial infarction or targetvessel revascularisation. Results Baseline characteristics were similar between the groups except for significantly more males and smokers among the nondiabetics. The diabetics had significantly more previous strokes, more left anterior descending coronary artery disease as well as more restenotic lesions and multivessel disease. At 30 days, the primary endpoint had occurred in five diabetics (5.2%) and 47 nondiabetics (4.9%), (p=0.8) and at one year in 17 (17.5%) and in 165 (17.1%), respectively (p=0.9). Event-free survival remained comparable during long-term follow-up (four years). Multivariate analysis showed no differences for the occurrence of any event (p=0.9, 95% CI 0.6-1.7). At six months, the minimal luminal diameter was significantly smaller in the diabetics (1.55±0.76 mm vs. 1.78±0.66 mm, p=0.01). Diabetics also had more restenosis (41% vs. 23%, p=0.003). Conclusion Despite angiographical differences at six months between the diabetics and nondiabetics, both short-term and long-term clinical follow-up appeared to be similar. PMID:25696315

  16. Positron emission tomography in the follow-up of cutaneous malignant melanoma patients: a systematic review

    PubMed Central

    Danielsen, Maria; Højgaard, Liselotte; Kjær, Andreas; Fischer, Barbara MB

    2014-01-01

    Cutaneous malignant melanoma (CMM) has a high risk of dissemination to regional lymph nodes and visceral organs. Recurrences are most frequently seen within the first 2-3 years after initial treatment, but these patients have a life-long risk of relapse. The prognosis is highly dependent on lymph node involvement and distant metastases, accentuating the importance of close surveillance to identify disease progression at an early stage, and thereby detect recurrences amenable to treatment. Positron emission tomography (PET) has already been proven useful in the staging of CMM, but the utility of PET in follow-up programs for asymptomatic patients in high risk of relapse to detect systemic recurrences has yet to be investigated. We performed a systematic literature search in PUBMED, EMBASE and the Cochrane Controlled Trials Register, and identified 7 original studies on the diagnostic value of FDG-PET in the follow-up of CMM. Sensitivity, specificity, positive and negative predictive values were calculated to examine PET’s diagnostic value in detecting relapse. The mean sensitivity of PET was 96% and the specificity was 92%. The positive and negative predictive values were, respectively, 92% and 95%. Overall, PET has a high diagnostic value and the many advantages of PET indicate utility in the routine follow-up program of CMM. However, the number of prospective studies of high quality is scarce, and as the use of PET and PET/CT is becoming more widespread and the technology is expensive, there is an urgent need for systematic assessment of the diagnostic value. PMID:24380042

  17. Follow up study of 70 patients with renal artery stenosis treated by percutaneous transluminal dilatation.

    PubMed Central

    Geyskes, G G; Puylaert, C B; Oei, H Y; Mees, E J

    1983-01-01

    Between April 1978 and April 1981, 70 patients with hypertension and renal artery stenosis were treated by percutaneous transluminal arterial dilatation. Selection of the patients was based solely on arteriographic criteria. Arteriography after dilatation showed considerable widening of the stenosed area in all patients. In 65 patients the effect of treatment on the blood pressure was assessed during follow up periods of one to four years. In 14 of these patients the hypertension was cured, in 29 it was improved, and in 22 there was no change. Patients with fibromuscular lesions benefited distinctly more than did those with atheromatous stenosis, only one of the 21 patients with fibromuscular lesions showing no change as compared with 21 of the 44 patients with atheromatous lesions. The only serious complication encountered was microcholesterol emboli, which developed in two patients with severe atheromatous lesions of the aorta. In the atheromatous group age and overall renal function had no influence on the blood pressure response. In the subgroup of patients with a unilateral lesion the renal vein renin ratios and asymmetrical curves obtained by renography had only a very limited predictive value. In experienced hands percutaneous transluminal arterial dilatation is relatively safe, and this study suggests that it should be attempted in all patients with renal artery stenosis. Only in patients with severe atheromatosis of the aorta should the risk associated with the catheterisation be weighed against the 50% or so chance of benefit from the procedure. PMID:6223685

  18. A long term follow up of 15 patients with arrhythmogenic right ventricular dysplasia.

    PubMed Central

    Blomström-Lundqvist, C; Sabel, K G; Olsson, S B

    1987-01-01

    The clinical course in 15 patients with features consistent with arrhythmogenic right ventricular dysplasia is described. At referral seven patients had abnormal physical findings, nine had abnormal electrocardiograms with non-specific right-sided abnormalities, and seven patients had increased heart size or prominent right ventricles on chest x ray. During long term follow up (mean 8.8 years, range 1.5 to 28 years) 11 patients had abnormal physical findings, 11 had electrocardiographic changes, and nine had increased heart size. Recurrent sustained right ventricular tachycardia was the most common arrhythmia (10 patients). Two patients experienced ventricular fibrillation. Seven patients suffered from over 10 episodes of ventricular tachycardia, nine required cardioversions, and 10 patients had associated serious symptoms such as syncope, severe hypotension, or cardiac arrest. Four patients required operation to correct the arrhythmia and three patients developed right heart failure. Two out of three deaths were sudden. These data suggest that in arrhythmogenic right ventricular dysplasia right ventricular abnormalities may be progressive and that the condition may affect the left ventricle. The course of the ventricular arrhythmias was highly variable and could not be predicted in individual patients. The potential for lethal ventricular arrhythmias is evident and warrants intensive diagnostic efforts to identify patients with adverse prognostic features. PMID:3676037

  19. Achieving optimal delivery of follow-up care for prostate cancer survivors: improving patient outcomes

    PubMed Central

    Hudson, Shawna V; O’Malley, Denalee M; Miller, Suzanne M

    2015-01-01

    Background Prostate cancer is the most commonly diagnosed cancer in men in the US, and the second most prevalent cancer in men worldwide. High incidence and survival rates for prostate cancer have resulted in a large and growing population of long-term prostate cancer survivors. Long-term follow-up guidelines have only recently been developed to inform approaches to this phase of care for the prostate cancer population. Methods A PubMed search of English literature through August 2014 was performed. Articles were retrieved and reviewed to confirm their relevance. Patient-reported measures that were used in studies of long-term prostate cancer survivors (ie, at least 2 years posttreatment) were reviewed and included in the review. Results A total of 343 abstracts were initially identified from the database search. After abstract review, 105 full-text articles were reviewed of which seven met inclusion criteria. An additional 22 articles were identified from the references of the included articles, and 29 were retained. From the 29 articles, 68 patient-reported outcome measures were identified. The majority (75%) were multi-item scales that had been previously validated in existing literature. We identified four main areas of assessment: 1) physical health; 2) quality of life – general, physical, and psychosocial; 3) health promotion – physical activity, diet, and tobacco cessation; and 4) care quality outcomes. Conclusion There are a number of well-validated measures that assess patient-reported outcomes that document key aspects of long-term follow-up with respect to patient symptoms and quality of life. However, there are fewer patient-reported outcomes related to health promotion and care quality within the prevention, surveillance, and care coordination components of cancer survivorship. Future research should focus on development of additional patient-centered and patient-related outcomes that enlarge the assessment portfolio. PMID:25834471

  20. Achieving optimal delivery of follow-up care for prostate cancer survivors: improving patient outcomes.

    PubMed

    Hudson, Shawna V; O'Malley, Denalee M; Miller, Suzanne M

    2015-01-01

    Prostate cancer is the most commonly diagnosed cancer in men in the US, and the second most prevalent cancer in men worldwide. High incidence and survival rates for prostate cancer have resulted in a large and growing population of long-term prostate cancer survivors. Long-term follow-up guidelines have only recently been developed to inform approaches to this phase of care for the prostate cancer population. A PubMed search of English literature through August 2014 was performed. Articles were retrieved and reviewed to confirm their relevance. Patient-reported measures that were used in studies of long-term prostate cancer survivors (ie, at least 2 years posttreatment) were reviewed and included in the review. A total of 343 abstracts were initially identified from the database search. After abstract review, 105 full-text articles were reviewed of which seven met inclusion criteria. An additional 22 articles were identified from the references of the included articles, and 29 were retained. From the 29 articles, 68 patient-reported outcome measures were identified. The majority (75%) were multi-item scales that had been previously validated in existing literature. We identified four main areas of assessment: 1) physical health; 2) quality of life - general, physical, and psychosocial; 3) health promotion - physical activity, diet, and tobacco cessation; and 4) care quality outcomes. There are a number of well-validated measures that assess patient-reported outcomes that document key aspects of long-term follow-up with respect to patient symptoms and quality of life. However, there are fewer patient-reported outcomes related to health promotion and care quality within the prevention, surveillance, and care coordination components of cancer survivorship. Future research should focus on development of additional patient-centered and patient-related outcomes that enlarge the assessment portfolio.

  1. Long-term follow-up in patients with CCFDN syndrome.

    PubMed

    Walter, Maggie C; Bernert, Günther; Zimmermann, Uta; Müllner-Eidenböck, Andrea; Moser, Elisabeth; Kalaydjieva, Luba; Lochmüller, Hanns; Müller-Felber, Wolfgang

    2014-10-07

    We describe the 10-year follow-up in a cohort of 16 patients with genetically confirmed congenital cataracts, facial dysmorphism, and neuropathy (CCFDN) syndrome, providing new insights in the clinical course of the disease. We performed a detailed clinical and paraclinical characterization and 10-year follow-up study in 16 patients with molecularly defined CCFDN syndrome, illustrating that CCFDN is a severe disabling disorder. All patients initially presented with congenital cataracts along with strabismus, facial dysmorphism, short stature, and demyelinating neuropathy. In all patients, paresis of small hand muscles and foot extensors worsened with disease progression, while ataxia scores remained stable or improved. Nerve conduction velocity was normal in early infancy up to 18 months, decreased to approximately 20 m/s around age 10 years, and then remained stable; distal motor latency was prolonged. Sensory nerve conduction velocities were slowed, and initially of normal amplitude. With disease progression, both sensory and motor nerves showed reduction of amplitudes indicating axonal loss. In 6 patients, acute severe proximal weakness and myalgia after febrile infections, along with rhabdomyolysis, myoglobinuria, and hyperCKemia, led to a less favorable outcome and permanent loss of ambulation in 3 patients. CCFDN should be classified as a recessive demyelinating sensory-motor neuropathy, and axonal loss is a major determinant of long-term outcomes and disability. Patients benefit from early and ongoing physiotherapy, and should be thoroughly counseled regarding virus-triggered rhabdomyolysis and the risk of malignant hyperthermia. Whether supplementation with liposoluble vitamins results in a therapeutic benefit should be evaluated in further studies. © 2014 American Academy of Neurology.

  2. Is social inequality related to different patient concerns in routine oral cancer follow-up clinics?

    PubMed

    Allen, Sarah; Lowe, Derek; Harris, Rebecca V; Brown, Steve; Rogers, Simon N

    2017-01-01

    Oral cancer has a higher incidence in the lower social strata, and these patients are less likely to engage in supportive interventions and report a poorer quality of life (QoL). The aim of this paper is to compare the Patient Concerns Inventory (PCI) responses across social groups attending routine oral cancer follow-up clinics with particular focus on the deprivation lower quartile. The PCI package is completed by patients as part of their routine review consultation with SNR. Patients were those diagnosed between 2008 and 2012. Deprivation was stratified using the IMD 2010 from postcode. Of the 106 eligible patients, 85 % used the PCI. Just over half (54 %) were living in the most deprived quartile, with two-thirds (68 %) of males in the most deprived quartile, compared with 35 % of females (p = 0.004). In regard to number and type of PCI items selected by patients at their first PCI clinic, there were no notable differences in respect of IMD classification. The two commonest concerns were fear of recurrence (43 %) and sore mouth (43 %). The most deprived quartile reported significant problems in regard to mood (p = 0.004) and recreation (p = 0.02), and a non-significant trend (36 vs 18 %, p = 0.09) in stating their overall QoL as being less than good. It is possible to identify the concerns of patients from lower socioeconomic strata as part of routine follow-up clinics. This allows for targeted multi-professional intervention and supports to improve the outcome in this hard to reach group.

  3. [Clinical follow up and histological findings of patients with MEN2 treated with prophylactic thyroidectomy].

    PubMed

    Roldán Pérez, S; Cabello Laureano, R; Fernández-Pineda, I; Aspiazu Salinas, D; Martínez Criado, Y; De Agustín Asensio, J C

    2012-07-01

    To present our experience in the prophylactic management of the medullary thyroid carcinoma (MTC), reviewing the correlation between clinical, analytical, histopathological, and genetic findings on subjects with type 2A multiple endocrine neoplasia (MEN 2A) and familial MTC. A retrospective study was done by reviewing the medical records of patients diagnosed with MEN 2A or familial MTC, between 1997 and 2011. The variables studied were sex, age at the time of diagnosis, age at the time of surgery, pre and post operative Calcitonin levels, pre and post op Metanephrine levels in patients with MEN 2A, histopathological findings, follow up and overall survival. Thirteen patients were identified with family history of MTC, 9 females and 4 males. Eleven carriers of mutation on RET proto-oncongene for MEN 2A and no carriers for Familial MTC. The median age at the time of diagnosis was 4.2 years (range: 1.8 to 8.2). All patients were treated with total thyroidectomy, with a median age of 6 years (range: 4.08 to 8.5). The histopathological findings demonstrated 7 cases of C-Cells nodular hyperplasia, 2 micro-carcinomas, 1 multicentric carcinoma, 1 lymphocytic thyroiditis and 2 without evidence of disease. Elevated pre operative Calcitonin levels were found in 3 cases, correlated with one histopathological finding of micro-carcinoma. All patients are disease free. In patients with genetic predisposition to suffer the disease, early prophylactic thyroidectomy is the only current available approach to prevent and cure MTC. The creation of a multidisciplinary team (Endocrinology, clinical genetics, and pediatric surgery), is necessary to study, manage and follow up patients with MEN 2A and their families.

  4. Blood pressure outcomes of dental patients screened chronobiologically: a seven-year follow-up.

    PubMed

    Schaffer, E M; Cornélissen, G; Rhodus, N; Halhuber, M; Watanabe, Y; Halberg, F

    2001-07-01

    This article is a follow-up on a 1998 article in JADA. The blood pressure, or BP, of 23 of 24 normotensive patients was monitored at 15-minute intervals for a total of nine days, in three consecutive sessions of four, two and three days, respectively, separated by a few weeks. Twelve patients were reached by phone seven years after the prior chronobiologically interpreted monitoring to ascertain their cardiovascular status since the initial monitoring. Only two of the 12 patients reached in follow-up had abnormalities in all three sessions, and only these two patients reported having experienced an adverse vascular event (one a myocardial infarction, the other coronary artery bypass graft surgery). The difference in outcome between the patients with chronobiological abnormality in all three sessions vs. the pool of those with abnormality in only two, one or none of the sessions is statistically significant. Even a five-day (and sometimes a longer) profile, while greatly preferred to single measurements, may not suffice for a definitive diagnosis of certain patients. Retrospectively, the 864 measurements, on the average, on each person in our study could have served for a recommendation to each person. Chronobiologically interpreted BP and heart rate monitoring for a week or longer as a start detects high-risk states that may be missed by conventional casual measurements that are rarely accompanied by one-day profiles. The dentist has an important opportunity for conveying the importance of monitoring BP and heart rate for a week to detect an abnormal variability, and for implementing this monitoring. Dentists can educate patients regarding the need for screening and for interpreting the results for variability, and contribute to their overall health by referring them to their physicians when treatment is indicated.

  5. The trabecular bypass stent in a pseudophakic glaucoma patient: A 1-year follow-up

    PubMed Central

    Fea, Antonio M; Dogliani, Monica; Machetta, Federica; Lale-Lacroix, Gabriella; Brogliatti, Beatrice; Grignolo, Federico M

    2008-01-01

    Purpose To describe the 1-year success of a trabecular stent implant in a pseudophakic glaucoma patient. The stent is implanted through a small corneal incision under gonioscopic control. Intraocular pressure control was reported in cultured human anterior segment. Design Observational case report. Methods We report the case of a patient who was implanted and followed-up for 1 year at the Dipartimento di Fisiopatologia Clinica. The main outcome measures were intraocular pressure and visual field. Results The patient’s intraocular pressure was controlled with topical beta-blockers for 6 months and without therapy for 6 months. Two diurnal curves demonstrated achievement of target pressure during the day. The 1-year visual field was unchanged. Conclusions We are not aware of previous reports of trabecular stent implantation in pseudophakic patients. The trabecular stent had minimal peri-operative morbidity. Identification of the implantation site is challenging and reduction of efficacy over time may occur. PMID:19668446

  6. Mitochondrial Myopathy in Follow-up of a Patient With Chronic Fatigue Syndrome

    PubMed Central

    Galán, Fernando; de Lavera, Isabel; Cotán, David; Sánchez-Alcázar, José A.

    2015-01-01

    Introduction. Symptoms of mitochondrial diseases and chronic fatigue syndrome (CFS) frequently overlap and can easily be mistaken. Methods. We report the case of a patient diagnosed with CFS and during follow-up was finally diagnosed with mitochondrial myopathy by histochemical study of muscle biopsy, spectrophotometric analysis of the complexes of the mitochondrial respiratory chain, and genetic studies. Results. The results revealed 3% fiber-ragged blue and a severe deficiency of complexes I and IV and several mtDNA variants. Mother, sisters, and nephews showed similar symptoms, which strongly suggests a possible maternal inheritance. The patient and his family responded to treatment with high doses of riboflavin and thiamine with a remarkable and sustained fatigue and muscle symptoms improvement. Conclusions. This case illustrates that initial symptoms of mitochondrial disease in adults can easily be mistaken with CFS, and in these patients a regular reassessment and monitoring of symptoms is recommended to reconfirm or change the diagnosis. PMID:26904705

  7. Radiofrequency ablation of benign thyroid nodules: safety and imaging follow-up in 236 patients.

    PubMed

    Jeong, Woo Kyoung; Baek, Jung Hwan; Rhim, Hyunchul; Kim, Yoon Suk; Kwak, Min Sook; Jeong, Hyun Jo; Lee, Ducky

    2008-06-01

    This study evaluated the safety and volume reduction of ultrasonography (US)-guided radiofrequency ablation (RFA) for benign thyroid nodules, and the factors affecting the results obtained. A total of 302 benign thyroid nodules in 236 euthyroid patients underwent RFA between June 2002 and January 2005. RFA was carried out using an internally cooled electrode under local anesthesia. The volume-reduction ratio (VRR) was assessed by US and safety was determined by observing the complications during the follow-up period (1-41 months). The correlation between the VRR and several factors (patient age, volume and composition of the index nodule) was evaluated. The volume of index nodules was 0.11-95.61 ml (mean, 6.13 +/- 9.59 ml). After ablation, the volume of index nodules decreased to 0.00-26.07 ml (mean, 1.12 +/- 2.92 ml) and the VRR was 12.52-100% (mean, 84.11 +/- 14.93%) at the last follow-up. A VRR greater than 50% was observed in 91.06% of nodules, and 27.81% of index nodules disappeared. The complications encountered were pain, hematoma and transient voice changes. In conclusion, RFA is a safe modality effective at reducing volume in benign thyroid nodules.

  8. HPV-Testing in Follow-up of Patients Treated for CIN2+ Lesions.

    PubMed

    Mariani, Luciano; Sandri, Maria Teresa; Preti, Mario; Origoni, Massimo; Costa, Silvano; Cristoforoni, Paolo; Bottari, Fabio; Sideri, Mario

    2016-01-01

    Persistent positivity of HPV-DNA testing is considered a prognostic index of recurrent disease in patients treated for CIN2+. HPV detection, and particularly genotyping, has an adequate high rate of sensitivity and specificity (along with an optimal reproducibility), for accurately predicting treatment failure, allowing for an intensified monitoring activity. Conversely, women with a negative HPV-test 6 months after therapy have a very low risk for residual/recurrent disease, which leads to a more individualized follow-up schedule, allowing for a gradual return to the normal screening scheme. HPV testing should be routinely included (with or without cytology) in post-treatment follow-up of CIN2+ patients for early detection of recurrence and cancer progression. HPV genotyping methods, as a biological indicator of persistent disease, could be more suitable for a predictive role and risk stratification (particularly in the case of HPV 16/18 persistence) than pooled HPV-based testing. However, it is necessary to be aware of the performance of the system, adhering to strict standardization of the process and quality assurance criteria.

  9. HPV-Testing in Follow-up of Patients Treated for CIN2+ Lesions

    PubMed Central

    Mariani, Luciano; Sandri, Maria Teresa; Preti, Mario; Origoni, Massimo; Costa, Silvano; Cristoforoni, Paolo; Bottari, Fabio; Sideri, Mario

    2016-01-01

    Persistent positivity of HPV-DNA testing is considered a prognostic index of recurrent disease in patients treated for CIN2+. HPV detection, and particularly genotyping, has an adequate high rate of sensitivity and specificity (along with an optimal reproducibility), for accurately predicting treatment failure, allowing for an intensified monitoring activity. Conversely, women with a negative HPV-test 6 months after therapy have a very low risk for residual/recurrent disease, which leads to a more individualized follow-up schedule, allowing for a gradual return to the normal screening scheme. HPV testing should be routinely included (with or without cytology) in post-treatment follow-up of CIN2+ patients for early detection of recurrence and cancer progression. HPV genotyping methods, as a biological indicator of persistent disease, could be more suitable for a predictive role and risk stratification (particularly in the case of HPV 16/18 persistence) than pooled HPV-based testing. However, it is necessary to be aware of the performance of the system, adhering to strict standardization of the process and quality assurance criteria. PMID:26722366

  10. Effects of Self-management Education Through Telephone Follow-up in Diabetic Patients.

    PubMed

    Namjoo Nasab, Mahmood; Ghavam, Abbas; Yazdanpanah, Abbas; Jahangir, Fereidoun; Shokrpour, Nasrin

    It is expected that the number of people living with diabetes rise especially in low- and middle-income countries. In Iran, more than four million adults have diabetes mellitus, and self-management education is essential for effective diabetes self-care. This study aimed to investigate the effect of self-management education with telephone follow-up in diabetic patients of rural areas of Fars province in Lamerd city, Iran. In this experimental study, 64 participants were randomly assigned to intervention and control groups (32 patients for each group). In the intervention group, the participants attended four educational sessions, each lasting 90 minutes. The control group received the usual care. Outcome measures were clinical variables and the patients' scores in Diabetes Self-Management Questionnaire (DSMQ) in the preintervention and postintervention phases. Effects of the intervention were analyzed using Mann-Whitney U test and analysis of covariance. Data of 60 patients (30 in each group) were analyzed. There were significant differences between the two groups in fasting blood sugar after 3 months of intervention. There was a significant difference between the intervention and control groups in DSMQ sum scale after adjusting for baseline value. In subscales of DSMQ, there were significant differences between the intervention and control groups in glucose management, dietary control, and physical activity, whereas no significant difference was found in health care use between the intervention and control groups. Self-management education with telephone follow-up in diabetic patients in rural areas is effective, especially in improving fasting blood sugar level and increasing scores of patients based on DSMQ.

  11. Neurocysticercosis: HP10 Antigen Detection Is Useful for the Follow-up of the Severe Patients

    PubMed Central

    Fleury, Agnès; Garcia, Esperanza; Hernández, Marisela; Carrillo, Roger; Govezensky, Tzipe; Fragoso, Gladis; Sciutto, Edda; Harrison, Leslie J. S.; Parkhouse, R. Michael Evans

    2013-01-01

    Background The most severe clinical form of neurocysticercosis (NC) occurs when cysticerci are located in the subarachnoid space at the base of the brain (SaB). The diagnosis, monitoring and treatment of NC-SaB, constitutes a severe clinical challenge. Herein we evaluate the potential of the HP10 antigen detection enzyme-linked immunosorbent assay (HP10 Ag-ELISA) in the long term follow-up of NC-SaB cases. Assay performance was compared with that of Magnetic Resonance Imaging (MRI). In addition, the robustness of the HP10 Ag-ELISA was evaluated independently at two different institutions. Methodology/Principal Findings A double-blind prospective cohort trial was conducted involving 38 NC-SaB cases and a total of 108 paired serum and cerebrospinal fluid (CSF) samples taken at intervals of 4 to 8 months for up to 43 months. At each medical visit, results of sera and CSF HP10 Ag-ELISA and MRI obtained at last visit were compared and their accuracy was evaluated retrospectively, considering radiological evolution between appointments. In the long-term follow-up study, HP10 Ag-ELISA had a better agreement than MRI with retrospective radiological evaluation. High reproducibility of HP10 Ag-ELISA between laboratories was also demonstrated. Conclusions Results reported in this study establish for the first time the usefulness of the comparatively low cost HP10 Ag-ELISA for long term follow-up of NC-SaB patients. PMID:23505587

  12. Long term follow-up of a tobacco prevention and cessation program in cystic fibrosis patients.

    PubMed

    Ortega-García, Juan Antonio; Perales, Joseph E; Cárceles-Álvarez, Alberto; Sánchez-Sauco, Miguel Felipe; Villalona, Seiichi; Mondejar-López, Pedro; Pastor-Vivero, María Dolores; Mira Escolano, Pilar; James-Vega, Diana Carolina; Sánchez-Solís, Manuel

    2016-03-02

    This study evaluates the impact over time of a telephone-based intervention in tobacco cessation and prevention targeting patients with cystic fibrosis (CF) in the Mediterranean region of Murcia, Spain. We conducted an experimental prospective study with a cohort of CF patients using an integrative smoking cessation programme, between 2008 and 2013. The target population included family members and patients from the Regional CF unit. The study included an initial tobacco exposure questionnaire, measurement of lung function, urinary cotinine levels, anthropomorphic measures and the administered intervention at specific time intervals. Of the 88 patients tracked through follow-up, active smoking rates were reduced from 10.23% to 4.55% (p = 0.06). Environmental tobacco exposure was reduced in non-smoker patients from 62.03% to 36.90% (p < 0.01) during the five year follow-up. Significant reductions in the gradient of household tobacco smoke exposure were also observed with a decrease of 12.60%, from 31.65% (n = 25/79) to 19.05% (n = 16/84) in 2013 (p = <0.01). Cotinine was significantly correlated with both active and passive exposure (p<0.01) with a significant reduction of cotinine levels from 63.13 (28.58-97.69) to 20.56 (0.86-40.27) ng/ml (p<0.01). The intervention to significantly increase the likelihood of family quitting (smoke-free home) was 1.26 (1.05-1.54). Telephone based interventions for tobacco cessation and prevention is a useful tool when applied over time. Trained intervention professionals in this area are needed in the environmental health approach for the treatment of CF.

  13. Long term follow-up of a tobacco prevention and cessation program in cystic fibrosis patients

    PubMed Central

    Ortega-García, Juan Antonio; Perales, Joseph E.; Cárceles-Álvarez, Alberto; Sánchez-Sauco, Miguel Felipe; Villalona, Seiichi; Mondejar-López, Pedro; Pastor-Vivero, María Dolores; Escolano, Pilar Mira; Jaimes-Vega, Diana Carolina; Sánchez-Solís, Manuel

    2016-01-01

    This study evaluates the impact over time of a telephone-based intervention in tobacco cessation and prevention targeting patients with cystic fibrosis (CF) in the Mediterranean region of Murcia, Spain. We conducted an experimental prospective study with a cohort of CF patients using an integrative smoking cessation programme, between 2008 and 2013. The target population included family members and patients from the Regional CF unit. The study included an initial tobacco exposure questionnaire, measurement of lung function, urinary cotinine levels, anthropomorphic measures and the administered intervention at specific time intervals. Of the 88 patients tracked through follow-up, active smoking rates were reduced from 10.23% to 4.55% (p = 0.06). Environmental tobacco exposure was reduced in non-smoker patients from 62.03% to 36.90% (p < 0.01) during the five year follow-up. Significant reductions in the gradient of household tobacco smoke exposure were also observed with a decrease of 12.60%, from 31.65% (n = 25/79) to 19.05% (n = 16/84) in 2013 (p = <0.01). Cotinine was significantly correlated with both active and passive exposure (p<0.01) with a significant reduction of cotinine levels from 63.13 (28.58–97.69) to 20.56 (0.86–40.27) ng/ml (p<0.01). The intervention to significantly increase the likelihood of family quitting (smoke-free home) was 1.26 (1.05–1.54). Telephone based interventions for tobacco cessation and prevention is a useful tool when applied over time. Trained intervention professionals in this area are needed in the environmental health approach for the treatment of CF. PMID:26990263

  14. [A seven-year follow-up analysis on prognosis factors of stroke patients].

    PubMed

    Li, Hai-xin; Wang, Pei-shan; Tian, Gui-ling; Xu, Wei-li; Liu, Dong; Wu, Jing

    2005-09-01

    To describe survival conditions of patients with stroke and to analyze the factors associated with survival, a seven-year follow-up study was carried out. From Nov. 1995 to Dec. 1996, 189 stroke patients were selected in the Department of Neurology, General Hospital, Tianjin Medical University. Cases were followed up since the onset of stroke. Data collected would include case history, illness and survival conditions. Kaplan-Meier methods were used for survival description. Cox regression was used for prognostic factors analyses. A total number of 82 patients had been dead during the period of study and among them,58 cases died from stroke. The survival rate was 79.86% in one year, 65.46% in three years and 57.46% in seven years. Factors with statistical significance that associated with survival would include: age (RR = 1.065, P < 0.001), physical exercises before stroke (RR = 0.308, P<0.001), hypertension history (RR = 1.785, P < 0.05) and stroke history (RR =2.493, P < 0.001) while factors associated with severity of the illness were: area of cerebral lesion, conditions when discharged from the hospital, rehabilitative treatment of post-discharge and recurrence. We also found that social-psychical factors as rehabilitative confidence, repression, negative event, support from relatives and friends were related to survival of stroke. Histories on hypertension, stroke and brain injury condition were related to the rate survival on stroke. Patients persisting physical exercises before stroke had better prognosis. The survival rate of patients with recurrence was lower than those without while social psychic factors might be related to survival.

  15. Serum ostase in the follow-up of breast cancer patients.

    PubMed

    Marchei, P; Santini, D; Bianco, V; Chiodini, S; Reale, M G; Simeoni, F; Marchei, G G; Vecchione, A

    1995-01-01

    The present study was carried out on 152 patients divided into three groups: A) 73 underwent radical surgery for breast carcinoma without signs of metastases; B) 31 patients with radiologic and scintigraphic evidence of bone metastases originating from malignant mammary neoplasia (14 with only one and 17 with two or more localizations); C) 48 affected by simple mammary cysts. No patients had a previous history of primary or secondary bone pathologies or renal, hepatic or endocrine ones. Besides this, no patient took drugs influencing the metabolic turnover of the bony tissue in the three months preceding the study. After surgery all patients underwent standard clinical and laboratory follow-up, the latter including, every 3 months, the evaluation of serum CA 15.3, CA 27.29 MCA, and ostase. The ostase cut-off, obtained by the statistical elaboration of the serum values of the 48 patients with benign mammary cysts and the 73 disease free patients, was 17 microg./L. The mean concentration in the three groups and two subgroups was: 13.76 microg./L (patients without metastases), 31.84 (patients with metastases), 18.4 (limited bony metastases), 40.04 (diffused bony metastases) and 5.36 (mammary cists). The diagnostic sensitivity of ostase proved superior to that of CA 15.3 (84% vs 75%) except when considering the subgroup with limited metastases (71.4% vs 72.7%), while the specificity was similar (around 78%). CA 27.29 and MCA were not useful as markers of metastasis. In a longitudinal-perspective study it was possible periodically to test these markers in 13 patients, at first, disease free and then with signs of bone progression evidence by skeletal scintigraphy. In 11 of these patients ostase and CA 15.3 showed increased values, an average 136 and 131 days respectively, before instrumental evidence of progression. None of the 13 patients, at the time of bone progression diagnosis, showed clinical, laboratory or instrumental signs of disease in other organs. The

  16. Testicular cancer patients: considerations in long-term follow-up.

    PubMed

    Gospodarowicz, Mary

    2008-04-01

    Over the past 30 years, testicular tumors have become the paradigm for a curable adult cancer. Numerous factors have contributed to this success, including the introduction of newer treatment approaches, such as cisplatin-based combination chemotherapy and curative retroperitoneal lymph node dissection. Moreover, the last three decades have witnessed the evolution of newer diagnostic methods, improvements in staging, the evaluation of patient response, and the monitoring of relapse. These treatment successes have been accompanied by the emergence of the late effects of testicular cancer and its treatment, including second primary cancers, cardiovascular sequelae, the metabolic syndrome, gonadal toxicity, neurotoxicity, and pulmonary sequelae. An overview of these late effects and recommendations for patient follow-up are presented in this article.

  17. Course and moderators of emotional eating in anorectic and bulimic patients: a follow-up study.

    PubMed

    Fioravanti, Giulia; Castellini, Giovanni; Lo Sauro, Carolina; Ianni, Sirio; Montanelli, Luca; Rotella, Francesco; Faravelli, Carlo; Ricca, Valdo

    2014-04-01

    Emotion dysregulation has been found to be associated with specific eating attitudes and behavior in Eating Disorder (ED) patients. The present study evaluated whether emotional eating profile of ED patients changes over time and the possible effects of a psychotherapeutic intervention on the emotional eating dimension. One hundred and two ED patients (28 with Anorexia Nervosa restricting type [AN-R], 35 with Anorexia Nervosa binge/purging subtype [AN-B/P] and 39 with Bulimia Nervosa [BN]) were evaluated at baseline, at the end of a Cognitive Behavioral Therapy, at 3 and 6 year follow-up. The Structured Clinical Interview for DSM IV Axis I Disorders, the Emotional Eating Scale (EES) and several self-reported questionnaires for eating specific and general psychopathology were applied. A control group of 86 healthy subjects was also studied, in order to compare psychopathological variables at baseline. A significant EES total score reduction was observed among AN-B/P and BN patients, whereas no significant change was found in the AN-R group. Mixed Models analyses showed that a significant effect on EES total score variation was found for cocaine or amphetamine abuse (b = .25; p < .01). Patients who assumed these substances reported no significant EES reduction across time, unlike other patients. The present results suggest that ED patients with a history of cocaine or amphetamine abuse represent a sub-population of patients with lasting dysfunctional mood modulatory mechanisms.

  18. Long term follow-up of patients with Cushing's disease treated by interstitial irradiation

    SciTech Connect

    Sandler, L.M.; Richards, N.T.; Carr, D.H.; Mashiter, K.; Joplin, G.F.

    1987-09-01

    The first 86 patients with Cushing's disease treated with interstitial irradiation (by needle implantation) as the sole therapy were reviewed. In the 82 patients who were reassessed 1 yr after treatment 63 (77%) achieved remission. This study comprises the outcome and complications in the 54 patients who had a remission and whom we were able to follow. The follow-up period ranged from 3-26 yr (mean, 10.5) from the time of remission. No instance of clinical or radiological relapse has occurred. Of these 54 patients, yttrium-90 alone was used in 32, of whom 12 (37%) required corticosteroid or T4 replacement therapy in a mean time of 3.5 months; in 7 of these 12 we elected to give an ablative dose. Gold-198 alone was used in 15 patients, of whom 7 (47%) developed hypopituitarism in a mean time of 76 months. Both isotopes were used in 7 patients. A diurnal serum cortisol rhythm was found in 28 of the 31 patients who were not receiving corticosteroid therapy. In 5 of the 7 patients with an initially abnormal pituitary fossa, serial radiological studies revealed remodelling in 3. There have been no complications in the last 17 years. Pituitary implantation with yttrium-90 is an effective alternative to transsphenoidal hypophysectomy, with a high remission rate, no recurrence (as yet), no operative complications, and avoidance of hormone replacement in the majority.

  19. Information needs and sources of information for patients during cancer follow-up

    PubMed Central

    Shea–Budgell, M.A.; Kostaras, X.; Myhill, K.P.; Hagen, N.A.

    2014-01-01

    Background Now more than ever, cancer patients want health information. Little has been published to characterize the information needs and preferred sources of that information for patients who have completed cancer treatment. Methods We used a nationally validated instrument to prospectively survey patients attending a cancer clinic for a post-treatment follow-up visit. All patients who came to the designated clinics between December 2011 and June 2012 were approached (N = 648), and information was collected only from those who agreed to proceed. Results The 411 patients who completed the instrument included individuals with a wide range of primary malignancies. Their doctor or health professional was overwhelmingly the most trusted source of cancer information, followed by the Internet, family, and friends. The least trusted sources of information included radio, newspaper, and television. Patients most preferred to receive personalized written information from their health care provider. Conclusions Cancer survivors are keenly interested in receiving information about cancer, despite having undergone or finished active therapy. The data indicate that, for patients, their health care provider is the most trusted source of cancer information. Cancer providers should ask patients about the information they want and should direct them to trusted sources. PMID:25089098

  20. Genetic Analysis and Follow-Up of 25 Neonatal Diabetes Mellitus Patients in China

    PubMed Central

    Cao, Bingyan; Gong, Chunxiu; Wu, Di; Lu, Chaoxia; Liu, Fang; Liu, Xiaojing; Zhang, Yingxian; Gu, Yi; Qi, Zhan; Li, Xiaoqiao; Liu, Min; Li, Wenjing; Su, Chang; Liang, Xuejun; Feng, Mei

    2016-01-01

    Aims. To study the clinical features, genetic etiology, and the correlation between phenotype and genotype of neonatal diabetes mellitus (NDM) in Chinese patients. Methods. We reviewed the medical records of 25 NDM patients along with their follow-up details. Molecular genetic analysis was performed. We compared the HbA1c levels between PNDM group and infantile-onset T1DM patients. Results. Of 25 NDM patients, 18 (72.0%) were PNDM and 7 (28.0%) were TNDM. Among 18 PNDM cases, 6 (33.3%) had known KATP channel mutations (KATP-PNDM). There were six non-KATP mutations, five novel mutations, including INS, EIF2AK3 (n = 2), GLIS3, and SLC19A2, one known EIF2AK3 mutation. There are two ABCC8 mutations in TNDM cases and one paternal UPD6q24. Five of the six KATP-PNDM patients were tried for glyburide transition, and 3 were successfully switched to glyburide. Mean HbA1c of PNDM was not significantly different from infantile onset T1DM (7.2% versus 7.4%, P = 0.41). Conclusion. PNDM accounted for 72% of NDM patients. About one-third of PNDM and TNDM patients had KATP mutations. The genetic etiology could be determined in 50% of PNDM and 43% of TNDM cases. PNDM patients achieved good glycemic control with insulin or glyburide therapy. The etiology of NDM suggests polygenic inheritance. PMID:26839896

  1. Long-term cognitive follow-up of Parkinson's disease patients with impulse control disorders.

    PubMed

    Siri, Chiara; Cilia, Roberto; Reali, Elisa; Pozzi, Beatrice; Cereda, Emanuele; Colombo, Aurora; Meucci, Nicoletta; Canesi, Margherita; Zecchinelli, Anna L; Tesei, Silvana; Mariani, Claudio B; Sacilotto, Giorgio; Zini, Michela; Pezzoli, Gianni

    2015-04-15

    This study investigated cognitive functions in Parkinson's disease (PD) patients with impulse control disorders (ICDs) and aimed to identify possible predictors of behavioral outcome. In this longitudinal cohort study, 40 PD outpatients with ICDs and 40 without, were matched for sex, age at PD onset, age and disease duration at cognitive assessment. All patients had two neuropsychological assessments at least 2 years apart (mean, 3.5 years). Multivariate logistic regression analysis was performed to identify predictors of ICDs remission at follow-up. The PD patients with and without ICDs had overall comparable cognitive performance at baseline. When evaluating changes between baseline and follow-up, we found significant group × time interactions in several frontal lobe-related tests, with the ICDs group showing a less pronounced worsening over time. ICDs remission was associated with better performance at baseline in working memory-related tasks, such as digit span (odds ratio [OR] = 2.69 [95% confidence interval (CI), 1.09-6.66]) and attentive matrices (OR=1.19 [95%CI, 1.03-1.37]). ICDs remitters and non-remitters had no remarkable differences in baseline PD-related features and therapy management strategies (including the extent of dopamine agonist dose reduction). In conclusion, ICDs in PD patients are not related to greater cognitive impairment or executive dysfunction, but rather show relatively lower cognitive decline over time. The impaired top-down inhibitory control characterizing ICDs is likely attributable to a drug-induced overstimulation of relatively preserved prefrontal cognitive functions. Full behavioral remission in the long term was predicted by better working memory abilities. © 2015 International Parkinson and Movement Disorder Society. © 2015 International Parkinson and Movement Disorder Society.

  2. Follow-up of multiple sclerosis patients treated with Endotherapia (GEMSP)

    PubMed Central

    Geffard, Michel; Mangas, Arturo; Coveñas, Rafael

    2017-01-01

    Endotherapia (GEMSP) is a novel therapeutic approach for multiple sclerosis (MS). The aim of the present study was to demonstrate the efficiency of Endotherapia in the follow-up of 193 patients with MS. The efficiency coefficient that was evaluated was the Expanded Disability Status Scale (EDSS) score, which is a functional scale of MS progression. The evaluated score of each patient during follow-up visits was compared with the theoretical score of the disease progression without GEMSP. The evolution of the EDSS score was evaluated according to the inclusion score. The quantitative global study of the EDSS score highlighted a statistically significant difference between the final average scores of the treatment with GEMSP (M) and worldwide reference (R) groups. The improvement of the M group compared with the R group was 24.5%. According to the final EDSS scores, the study highlighted a difference in favor of the M group with 62.0% for scores ≤3, 7.8% for scores between 3 and 6 and 19.6% for scores ≥6. According to the qualitative evolution of the EDSS scores, the improvements in favor of group M were 49.3% for scores ≤3, 79.1% for scores between 3 and 6 and 19.5% for scores ≥6. The qualitative study of the EDSS score showed a statistically significant success percentage; the success percentages were between 59.1 and 90.0%. In a larger population of MS patients, the data confirm the beneficial effects of GEMSP that were previously reported in pre-clinical and clinical studies. In addition, 78% of patients showed an improvement or deceleration of the disease. PMID:28451391

  3. Apathy in first episode psychosis patients: a ten year longitudinal follow-up study.

    PubMed

    Evensen, Julie; Røssberg, Jan Ivar; Barder, Helene; Haahr, Ulrik; Hegelstad, Wenche ten Velden; Joa, Inge; Johannessen, Jan Olav; Larsen, T K; Melle, Ingrid; Opjordsmoen, Stein; Rund, Bjørn Rishovd; Simonsen, Erik; Sundet, Kjetil; Vaglum, Per; Friis, Svein; McGlashan, Thomas

    2012-04-01

    Apathy is a common symptom in first episode psychosis (FEP), and is associated with poor functioning. Prevalence and correlates of apathy 10 years after the first psychotic episode remain unexplored. The aims of the study were twofold: 1) to examine prevalence and predictors of apathy at 10 years, and 2) to examine the relationship between apathy at 10 years and concurrent symptoms, functioning and outcome, including subjective quality of life. Three-hundred-and-one patients with FEP were included at baseline, 186 participated in the 10 year follow-up. Of these, 178 patients completed the Apathy Evaluation Scale (AES-S-Apathy). Patients were classified as having apathy (AES-S-Apathy≥27) or not. The relationship between apathy and baseline variables (Demographics, Diagnosis, Duration of Untreated Psychosis), measures of symptomatology (Positive and Negative Syndrome Scale, Calgary Depression Scale for Schizophrenia), functioning (Global Assessment of Functioning Scale, Strauss Carpenter Level of Functioning Scale) and subjective quality of life (Lehman's Quality of Life Interview) were estimated through correlation analyses and blockwise multiple hierarchical regression analysis. Nearly 30% of patients met the threshold for being apathetic at follow-up. No baseline variables predicted apathy significantly at 10 years. Apathy was found to contribute independently to functioning and subjective quality of life, even when controlling for other significant correlates. Apathy is a common symptom in a FEP cohort 10 years after illness debut, and its presence relates to impaired functioning and poorer subjective quality of life. Copyright © 2011 Elsevier B.V. All rights reserved.

  4. Case-Mix Adjustment and the Comparison of Community Health Center Performance on Patient Experience Measures

    PubMed Central

    Johnson, M Laura; Rodriguez, Hector P; Solorio, M Rosa

    2010-01-01

    Objective To assess the effect of case-mix adjustment on community health center (CHC) performance on patient experience measures. Data Sources A Medicaid-managed care plan in Washington State collected patient survey data from 33 CHCs over three fiscal quarters during 2007–2008. The survey included three composite patient experience measures (6-month reports) and two overall ratings of care. The analytic sample includes 2,247 adult patients and 2,859 adults reporting for child patients. Study Design We compared the relative importance of patient case-mix adjusters by calculating each adjuster's predictive power and variability across CHCs. We then evaluated the impact of case-mix adjustment on the relative ranking of CHCs. Principal Findings Important case-mix adjusters included adult self-reported health status or parent-reported child health status, adult age, and educational attainment. The effects of case-mix adjustment on patient reports and ratings were different in the adult and child samples. Adjusting for race/ethnicity and language had a greater impact on parent reports than adult reports, but it impacted ratings similarly across the samples. The impact of adjustment on composites and ratings was modest, but it affected the relative ranking of CHCs. Conclusions To ensure equitable comparison of CHC performance on patient experience measures, reports and ratings should be adjusted for adult self-reported health status or parent-reported child health status, adult age, education, race/ethnicity, and survey language. Because of the differential impact of case-mix adjusters for child and adult surveys, initiatives should consider measuring and reporting adult and child scores separately. PMID:20337738

  5. Case-mix adjustment and the comparison of community health center performance on patient experience measures.

    PubMed

    Johnson, M Laura; Rodriguez, Hector P; Solorio, M Rosa

    2010-06-01

    To assess the effect of case-mix adjustment on community health center (CHC) performance on patient experience measures. A Medicaid-managed care plan in Washington State collected patient survey data from 33 CHCs over three fiscal quarters during 2007-2008. The survey included three composite patient experience measures (6-month reports) and two overall ratings of care. The analytic sample includes 2,247 adult patients and 2,859 adults reporting for child patients. We compared the relative importance of patient case-mix adjusters by calculating each adjuster's predictive power and variability across CHCs. We then evaluated the impact of case-mix adjustment on the relative ranking of CHCs. Important case-mix adjusters included adult self-reported health status or parent-reported child health status, adult age, and educational attainment. The effects of case-mix adjustment on patient reports and ratings were different in the adult and child samples. Adjusting for race/ethnicity and language had a greater impact on parent reports than adult reports, but it impacted ratings similarly across the samples. The impact of adjustment on composites and ratings was modest, but it affected the relative ranking of CHCs. To ensure equitable comparison of CHC performance on patient experience measures, reports and ratings should be adjusted for adult self-reported health status or parent-reported child health status, adult age, education, race/ethnicity, and survey language. Because of the differential impact of case-mix adjusters for child and adult surveys, initiatives should consider measuring and reporting adult and child scores separately.

  6. The Bandung neurosurgery patient outcomes project, Indonesia (Part II): Patient pathways and feasibility and acceptability of telephone follow-up.

    PubMed

    Sutiono, Agung Budi; Faried, Ahmad; McAllister, Susan; Ganefianty, Amelia; Sarjono, Kalih; Arifin, Muhammad Zafrullah; Derrett, Sarah

    2017-03-02

    Support of neurosurgery patients following discharge from hospital is important. Currently, little is known about patients' in low- and middle-income countries before and after their hospital treatment. This companion paper reports patients' pathways before and after hospital admission and the feasibility of following up this ill-patient population by telephone. Eligible patients were aged ≥18 years admitted to the Neurosurgery Department in Dr. Hasan Sadikin Hospital-a regional referral hospital in Bandung City, Indonesia. Clinical data were collected on admission by clinicians. In-person interviews were undertaken with a clinical research nurse 1 to 2 days pre-discharge, and telephone follow-up interviews at 1, 2, and 3 months post-discharge. Information was also collected on pathways prior to admission and following discharge. The number of contact attempts for each patient interview was documented, as was the overall acceptability of undertaking a telephone interview. Of 178 patients discharged from hospital, 12 later died. Of the remaining 166 patients, 95% were able to be followed up to 3 months. Two-thirds of patients had been referred from another hospital. Patients came from, and were discharged to, locations throughout the West Java region. At the 1-month interview, 84% participants reported that they had had a follow-up consultation with a health professional-mostly with a neurosurgeon. This study has shown that, with a neurosurgery nurse delegated to the role, it is feasible to conduct follow-up telephone interviews with patients after discharge from a neurosurgery ward and that in fact such follow-up was appreciated by patients. Copyright © 2017 John Wiley & Sons, Ltd.

  7. Long-term follow-up of patients with silent ischemia during exercise radionuclide angiography

    SciTech Connect

    Breitenbuecher, A.P.; Pfisterer, M.; Hoffmann, A.; Burckhardt, D. )

    1990-04-01

    A retrospective 5 year follow-up study was performed in 140 patients with unequivocal ischemia during exercise radionuclide angiography (greater than or equal to 10% decrease in left ventricular ejection fraction or greater than or equal to 5% decrease in ejection fraction together with a distinct regional wall motion abnormality). In 84 patients (60%), ischemia during radionuclide angiography was silent (silent ischemia group), whereas 56 patients experienced angina during the test (symptomatic group). Work load and antianginal medication were similar in both groups. Critical cardiac events (unstable angina, myocardial infarction, cardiac death) occurred in 27% of patients in the silent ischemia group and 16% of those in the symptomatic group (p = NS); however, myocardial infarction or death was more frequent in patients with silent ischemia (22% versus 9%; p less than 0.05). If there was additional exercise-induced ST segment depression, the rate of critical events was further increased (p less than 0.05). The difference in critical cardiac events seemed to be influenced by the higher incidence of revascularization procedures in symptomatic patients, whereas medical therapy had no similar effect. Thus, these findings suggest that patients with documented severe ischemia should undergo left heart catheterization and revascularization irrespective of symptoms to improve their prognosis.

  8. A follow up study of patients with paraneoplastic neurological disease in the United Kingdom

    PubMed Central

    Candler, P; Hart, P; Barnett, M; Weil, R; Rees, J

    2004-01-01

    Objectives: To examine the range of clinical phenotypes, tumour associations, relevant investigations, response to therapy and outcome in a large series of non-selected patients with paraneoplastic neurological disease (PND) affecting the central nervous system (CNS) in the United Kingdom. Methods: Data were obtained on patients either through direct referral or through the British Neurological Surveillance Unit (BNSU) from February 2000 to January 2001. Physicians were asked to supply information about age and sex of patients, presenting neurological syndromes, the basis of the diagnosis of PND, any associated malignancy, and treatment. Case notes were reviewed and follow up data obtained where possible one year after notification. Results: A total of 63 patients (48 females, 15 males) were identified, 48 through the BNSU and 15 through direct referral. Of these 52 were diagnosed as having definite PND, 10 probable PND, and 1 possible PND. The median age of onset of PND was 66 years (range 30–80 years) and only 7 patients (11%) were less than 50 years at presentation. In 53 patients (84%) the PND preceded the diagnosis of cancer. Paraneoplastic sensory neuronopathy, paraneoplastic encephalomyelitis, and paraneoplastic cerebellar degeneration (PCD) were the most common syndromes reported. The benefit of magnetic resonance imaging in the diagnosis of the disease was limited, while fluorodeoxyglucose positron emission tomography was shown to be useful for the detection of an occult malignancy in 10 out of 14 patients. Antineuronal antibodies were positive in 44/57 (77%) of cases. The following tumours were diagnosed: small cell lung cancer (30%), breast cancer (14%), ovarian cancer (8%), non-small cell lung cancer (8%), Hodgkin's lymphoma (6%), other (16%). With the exception of PCD associated with mesothelioma all other tumours diagnosed in these patients had been previously documented as being associated with PND. Only treatment of the tumour was found to be

  9. A follow-up study of family burden in patients with bipolar affective disorder.

    PubMed

    Maji, K R; Sood, Mamta; Sagar, Rajesh; Khandelwal, Sudhir K

    2012-03-01

    Research in the last two decades has documented a high level of burden in caregivers of bipolar disorder. The present study is aimed at studying family burden among relatives of patients with bipolar affective disorder. Thirty four consecutive hospitalized patients with bipolar affective disorder currently in mania and their relatives were assessed twice: at the time of admission and during follow-up four weeks after discharge. A semi-structured performa designed for the study was completed. Patients were assessed on Young's Mania Rating Scale and relatives were assessed on Family Burden Assessment Scale. More than 90% of family members reported severe subjective (rated by relative) and objective burden (rated by interviewer) at admission; none of them was free of burden. At the time of follow-up, about one quarter (23.5%) and two thirds (64.7%) of family members did not experience any objective and subjective burden respectively; subjective and objective family burden was moderate in about one third (35.3%) and a half (52.9%), respectively. None of the family members reported severe burden subjectively, while the objective burden was rated to be severe in a quarter (23.5%) of family members. The study was limited by the lack of a control group from an outpatient setting as hospitalization increases family burden. Also, the rater at the second assessment was not blind to ratings at the first assessment. Almost all the family members experienced severe burden initially. Even when symptoms subsided, family members continued to experience burden specifically related to finances. burden was significantly higher than subjective burden.

  10. Prospective Follow-Up of Patients with Acute Hepatitis C Virus Infection in Brazil

    PubMed Central

    Lewis-Ximenez, Lia L.; Lauer, Georg M.; zur Wiesch, Julian Schulze; de Sousa, Paulo Sergio Fonseca; Ginuino, Cleber F.; Paranhos-Baccalá, Gláucia; Ulmer, Hanno; Pfeiffer, Karl P.; Goebel, Georg; Pereira, João Luiz; de Oliveira, Jaqueline Mendes; Yoshida, Clara Fumiko Tachibana; Lampe, Elisabeth; Velloso, Carlos Eduardo; Pinto, Marcelo Alves; Coelho, Henrique Sergio; Almeida, Adilson José; Fernandes, Carlos Augusto; Kim, Arthur Y.; Strasak, Alexander M.

    2013-01-01

    Background The natural outcome of infection with hepatitis C virus (HCV) varies substantially among individuals. However, little is known about host and viral factors associated with a self-limiting or chronic evolution of HCV infection. Methods From 1 January 2001 through 31 December 2008, a consecutive series of 65 patients from Rio de Janeiro, Brazil, with a well-documented diagnosis of acute HCV infection, acquired via various routes, were enrolled in this study. Patients were prospectively followed up for a median of 40 months after the estimated date of HCV infection with serial measurements of serum alanine aminotransferase, HCV RNA, and anti-HCV antibodies. Spontaneous viral clearance (SVC) was defined as undetectable levels of HCV RNA in serum, in the absence of treatment, for 3 consecutive HCV polymerase chain reaction tests within the first 6 months of follow-up. Cox proportional hazards regression was used to identify host and viral predictors of SVC. Results The cumulative rate of SVC was 44.6% (95% confidence interval, 32.3%–57.5%). Compared with chronic HCV evolution, patients with self-limiting disease had significantly lower peak levels of anti-HCV antibodies (median, 109.0 vs 86.7 optical density–to–cutoff ratio [od/co]; P < .02), experienced disease symptoms more frequently (69.4% vs 100%; P < .001), and had lower viral load at first clinical presentation (median, 4.3 vs 0.0 log copies; P =.01). In multivariate analyses, low peak anti-HCV level (<93.5 od/co) was the only independent predictor for SVC; the hazard ratio compared with high anti-HCV levels (≥93.5 od/co) was 2.62 (95% confidence interval, 1.11–6.19; P =.03). Conclusion Our data suggest that low levels of anti-HCV antibodies during the acute phase of HCV infection are independently related to spontaneous viral clearance. PMID:20235831

  11. Long-term follow-up of vitrectomy in patients with pathologic myopic foveoschisis

    PubMed Central

    Zhang, Ting; Zhu, Ying; Jiang, Chun-Hui; Xu, Ge-Zhi

    2017-01-01

    AIM To report the long-term surgical outcomes of pathologic myopic foveoschisis (MF) following vitrectomy. METHODS We performed a retrospective case series analysis of 50 consecutive patients diagnosed with MF who experienced vision loss due to progression of foveoschisis. The 50 patients (67 eyes) were treated in our hospital with vitrectomy with internal limiting membrane (ILM) peeling from December 2004 to September 2010. Best corrected visual acuity (BCVA), refractive error, optical coherence tomography (OCT), and routine examination results were analysed. The changes of BCVA, foveal anatomical features on OCT scan, and complications were the main outcome measures. RESULTS The mean follow-up duration was 42±17mo (range 24 to 93mo). BCVA improved significantly postoperatively (0.76±0.65 logMAR) compared with preoperative baselines (1.31±0.78 logMAR, P<0.0001), and in 53 eyes (79%) including 3 lines gain in 44 eyes (66%) at the last follow-up visit. OCT scans showed that central retinal thickness decreased from 580.0±270.0 µm preoperatively (n=67) to 179.7±84.7 µm postoperatively (n=58, P<0.0001). Total resolution of foveoschisis occurred in 41 eyes (61%). Preoperative BCVA correlated well with postoperative BCVA, whereas other factors such as age, axial length, and refractive error were not correlated. The most common complications were cataract and full-thickness macular hole formation in 14 and 9 cases, respectively. CONCLUSION Patients with progressive vision loss due to MF who were treated with vitrectomy with ILM peeling show favourable outcomes. In most eyes, visual acuity and foveal structure remain stable during long-term observation. PMID:28251089

  12. One-year follow-up of patients with long-lasting post-herpetic neuralgia.

    PubMed

    Pica, Francesca; Gatti, Antonio; Divizia, Marco; Lazzari, Marzia; Ciotti, Marco; Sabato, Alessandro Fabrizio; Volpi, Antonio

    2014-11-01

    Recent information on epidemiology and management of post-herpetic neuralgia (PHN), a painful complication of zoster, is scarce. This study was conducted at the Pain Clinic of the Policlinico Tor Vergata, Rome, Italy, on eighty-five immunocompetent patients with a clinical diagnosis of PHN. At enrollment (time 0, T0), the patients were interviewed by physicians to obtain demographic data and information about their zoster clinical history and underwent a blood test for VZV-DNA research. DN4 and SF-12 questionnaires were used to assess the neuropathic nature of pain and the overall health status, respectively. A one-year follow-up was planned for enrolled cases, who were visited at regular intervals of at least 3 months. At T0 all the patients were at least 6 months from the episode of acute zoster and still presented with intense pain (mean VAS =6.7; mean DN4 = 5.7). Using antivirals within 72 hours from the rash onset was associated to a significant reduction of pain at T0 (p = 0.006 vs untreated patients). Only 2.6% of patients treated with antivirals during acute zoster but 18.6% of the untreated ones presented with neuropathic pain at T12 (p =0.007), even though the two groups were similar at T0. VZV-DNA was found in 5 out of the 50 available blood samples. At the last follow-up visit, PCS and MCS scores of the PHN patients were found to be recovered over those of the historical age-matched healthy controls. Undesirable side effects of analgesic therapies were observed in 15.3 to 28.8% of the patients. Patients who six months after acute zoster still have significant neuropathic pain, have a high probability of suffering from chronic pain in the subsequent months/years. The initial antiviral treatment has a significant impact on the pain. Current strategies of analgesic therapy are effective to achieve relief of pain in PHN patients, but they are burdened with heavy and undesirable side effects.

  13. Transduodenal sphincteroplasty. 5-25 year follow-up of 89 patients.

    PubMed Central

    Nardi, G L; Michelassi, F; Zannini, P

    1983-01-01

    Between 1957 and 1977, 95 patients underwent transduodenal pancreatic sphincteroplasty (TPS) for a diagnosis of recurrent pancreatitis. Five to twenty-five year follow-up was obtained for 89 patients (94%) and was analyzed by life-table method. Short-term successful outcome was defined as relief of symptoms (e.g., pain) for one to three years; long-term successful outcome was defined as those patients who remained symptom-free at time of last follow-up. Operative mortality was 4.2% (4 patients). Fifty-six patients (66%) had a successful short-term outcome. Of these, 13 patients had recurrence of symptoms: 7 occurred at 4 years, 5 at 5 years and 1 at 6 years. Preoperative factors associated with poor short-term outcome were previous upper abdominal surgery (X2 = 5.67, p less than 0.05) and frequent diarrhea (X2 = 6.18, p less than 0.05). Preoperative factors associated with poor long-term outcome were previous upper abdominal surgery (X2 = 7.82, p less than 0.01), heavy alcohol intake (X2 = 4.71, p less than 0.05), narcotic use (X2 = 5.68, p less than 0.05) and frequent diarrhea (X2 = 4.8, p less than 0.05). Morphine Prostigmin Test (MPT) was performed preoperatively in 78 patients (82%). A significantly greater proportion of patients with a rise in serum pancreatic enzymes secondary to MPT (MPT+) had a successful long-term outcome compared with those without such a rise (MPT-) (61% v 41%, X2 = 5.13, p less than 0.05). Furthermore, of the patients with a successful short-term outcome, 88% with MPT+ remained long-term symptom-free compared to 38.5% with MPT- (X2 = 8.36, p less than 0.01). We conclude that TPS can be a successful operation for acute recurrent pancreatitis. Previous upper abdominal operations, signs of more advanced pancreatic disease, preoperative narcotic use and alcohol abuse, were associated with a worse outcome and probably associated with chronic recurrent pancreatitis. Preoperative use of MPT, coupled with accurate clinical history, defined

  14. Predictors of and barriers associated with poor follow-up in patients with glaucoma in South India.

    PubMed

    Lee, Bradford W; Sathyan, Parthasarathi; John, Rajesh K; Singh, Kuldev; Robin, Alan L

    2008-10-01

    To determine predictors of and reasons for poor longitudinal glaucoma follow-up in South India. This 1-to-1, matched, case-control study enrolled 300 patients with established glaucoma. We defined cases (poor follow-up) and controls (good follow-up) based on number of and maximum interval between glaucoma follow-up visits attended in the preceding year. We collected data by oral questionnaire and used stepwise multivariate logistic regression to calculate odds ratios (ORs) for poor follow-up. Adjusting for age and sex, independent predictors of poor follow-up included lack of formal education (adjusted OR, 4.13; 95% confidence interval [CI], 1.44-11.90), no use of prescribed glaucoma medications (adjusted OR, 2.17; 95% CI, 1.06-4.43), and belief that follow-up is less important if one uses glaucoma medications and has no noticeable visual changes (adjusted OR, 10.59; 95% CI, 3.74-29.97). Age, sex, and disease severity were not significant predictors. The most prevalent barriers to follow-up were belief that there was no problem with one's eyes (44.4%) and lack of escort (19.7%). Knowing predictors of poor follow-up can help identify patients who need individualized strategies to improve follow-up. Because believing one's eyes are problem-free and lacking escorts are significant barriers to follow-up, novel strategies in patient education (eg, intensive counseling, audiovisual aides, and patient support groups) and escort provision may improve longitudinal glaucoma follow-up and disease management.

  15. Ultrasound elastography in diagnosis and follow-up for patients with chronic recurrent parotitis.

    PubMed

    Zengel, Pamela; Reichel, Christoph A; Vincek, Teresa; Clevert, Dirk André

    2017-09-04

    Chronic recurrent parotitis (CRP) is a non-obstructive disease with episodes characterized by painful swelling of the parotid gland. It presents in both a juvenile and an adult form, with no clear information on its actual origin. Diagnosis is based on patient medical history and ultrasound examination but is frequently not correctly identified. Acoustic Radiation Force Impulse Imaging (ARFI) is a novel ultrasound elastography technology that has recently been implemented in the diagnostic work-up of patients with malignancies. This study aimed to answer whether ARFI can reasonably be employed in the initial examination and follow-up during therapy in patients with CRP. Mechanical tissue properties of the salivary glands were analyzed by ARFI in 37 parotid glands of patients with CRP. Having integrated ARFI into our diagnostic protocol for CRP, affected parotid glands were found to exhibit lower tissue elasticity compared to both healthy contralateral glands in the same individuals as well as those of healthy individuals. Most importantly, this method enabled us to quantitatively assess the patient benefit of therapy regarding the recovery of the glands' diseased parenchyma. ARFI provides a quick, easy, and reliable diagnostic tool for the assessment of disease severity and progression in patients with CRP that can be seamlessly implemented into preexisting ultrasound protocols.

  16. Follow-up of patients with systemic lupus erythematosus: what is not found in the guidelines.

    PubMed

    Jiménez-Alonso, J; Vargas-Hitos, J A; Navarrete-Navarrete, N; Zamora-Pasadas, M; Aguilar-Huergo, S; Jáimez, L; Sabio, J M

    2013-12-01

    A series of measures in the management of patients with systemic lupus erythematosus (SLE) which usually are not found in the lupus guidelines are discussed. In the lupus patient who has been well-controlled in the long term, the dose of hydroxychloroquine should be progressively reduced, without decreasing more than approximately 600 mg per week. We recommend taking this drug in the morning in patients with insomnia, at night in those with dyspepsia and to separate the intake of the drug from the shower (and the water should be as cool as possible) in those patients with aquagenic pruritus. We do not use prednisone on alternate days and exceptionally divide the dose into ¾ before breakfast and ¼ before dinner. Twenty to 30 min should be used per patient in every scheduled visit to assure a good clinical and human practice. We analyzed the follow-up of 112 consecutive patients from our systemic disease unit and found that 71.4% of them had symptoms that were unexplained by lupus and we only referred 8.9% of them to other specialists, probably because of our general training as internal medicine doctors. We suggest that knowing the views of SLE specialists might be of interest since, well-designed studies that would allow to progress in the understanding of this disease could be performed based on their experience.

  17. [Assessment of nutritional status in renal transplant patients during 5 years of follow-up].

    PubMed

    Fernández Castillo, Rafael; Fernandez Gallegos, Ruth; Alvarez Serrano, Maria Adelaida; Nuñez Negrillo, Ana María; Navarro Perez, Carmen Flores; Quero Alfonso, Angel I

    2014-11-01

    Weight gain and malnutrition after kidney transplantation is common and the resulting overweight and obesity is associated with serious health complications. By contrast, the prevalence of malnutrition in patients with renal transplantation and its impact on the outcome of kidney transplantation is underestimated. The aim of this study was to evaluate the nutritional status of renal transplant patients and determine if the five-year follow-up, these patients undergo alterations that suggest nutritional deterioration. The sample consisted of 119 renal transplant patients who attended for five years post-transplant consultation. All patients measurements of total cholesterol, low density lipoprotein (LDL), high density lipoprotein (HDL), triglycerides and ferritin (Ft) were performed. and anthropometric measurements were made of weight, height and BMI. Patients were divided into three groups according to GFR Group 1: <60 mL/min, Group 2: 89-60 mL/min Group 3: ≥ 90 mL/min. The weight and BMI tended to decrease in group 3 while increasing in the other groups. A decrease in total cholesterol, HDL, LDL, Triglycerides and Ferritin less pronounced in group 3 occurs. After five years you can see a significant reduction in nutritional biochemical parameters in general, likewise the nutritional status is closely related, and is directly proportional to the function of the graft. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

  18. Hypofractionation in post-mastectomy breast cancer patients: seven-year follow-up.

    PubMed

    Eldeeb, Hany; Awad, Iman; Elhanafy, Osman

    2012-12-01

    To compare three fractionation schedules in post-mastectomy patients treated with radiotherapy as regard acute and early late effects as well as local recurrence rates. One hundred and seven breast cancer patients treated with modified radical mastectomy and adjuvant radiotherapy±adjuvant systemic treatments between November 2001 and July 2004 were enrolled in this study. Patients were categorized into three groups. Group A (41 patients) received conventional fractionation 50 Gy over 25 fractions. Group B (36 patients) received other fractionation regimen 45 Gy over 17 fractions. Group C (30 patients) received 40 Gy over 15 fractions. The median follow-up period was 23 months. There has been no statistical significant difference in local control (P=0.88), pain (P=0.98), telangectasis (P=0.23), fibrosis (P=0.13), arm oedema (P=0.96) or pigmentation (P=0.80) between the three groups. GII-III Erythema was significantly higher in the two hypofractionation arms compared to the control arm (P=0.001). Although acute skin reactions were higher in the hypofractionated arms, there was no significant difference in the local recurrence rates or late radiation effects. A national randomized multicentre study is recommended to explore this further.

  19. Counselling for Patients and Family Members: A Follow-Up Study in the Emergency Department

    PubMed Central

    Paavilainen, Eija; Salminen-Tuomaala, Mari; Leikkola, Päivi

    2012-01-01

    Although the research indicates that patients and family members are not fully satisfied with the counselling they receive, little is known about the quality of counselling in more detail. The purpose of the study was to describe patients' and their family members' experiences about counselling in emergency department, and follow how these experiences possibly change after the educational intervention for the whole nursing staff of the ED ward. The pre-test-post-test follow-up design was implemented including online continuing education for ED staff. The data were collected via questionnaires from patients and their family members in two phases and analyzed statistically. After online education of staff, experiences of patients and family members concerning counselling were better than before the education. Especially, family members' satisfaction had increased. However, our results also indicated that patients and family members desire more information for example, regarding medications. Care practices had developed towards family-centeredness, which patients and family members appreciate. Online education proved also in some degree its usefulness in educating ED staff, by offering the same education to a staff which works in shifts. Furthermore, family presence and participation practices should be developed by offering possibilities for families to stay with each other on ED ward. PMID:23008782

  20. [Antibodies against smooth muscle in the detection and follow-up of the celiac disease patient].

    PubMed

    Cueto Rúa, E; Menna, M E; Morales, V; Drut, R

    1987-01-01

    The presence of smooth muscle antibodies (SMA) as determined by indirect immunofluorescence was investigated in the serum of 40 patients, 36 out of which were children. Group I included patients having celiac disease (diagnosed by three biopsies). 7/7 (Group Ia) showed no SMA on gluten-free diet while antibodies were present after challenge. 4/6 (Group Ib) were positive also after challenge (these had not had previous determination). Group II was composed by patients presumed to have celiac disease for they had only one biopsy showing grade IV villous atrophy. 5 patients were of recent diagnosis (group IIa) and showed SMA. 4/5 (Group IIb) who admitted not to had been able to follow the gluten-free diet were also positive for SMA. 6/6 (Group IIc) patients on strict gluten-free diet and showing good clinical response had no detectable SMA. Group III included relatives of patients having celiac disease. 5/6 with SMA showed pathologic small bowel biopsies; only 1/4 with no SMA had mucosal alterations. It is concluded that the presence of serum SMA can be considered a useful marker in the follow-up of cases of celiac disease already diagnosed and to investigate presumed cases of such disease.

  1. Evaluation of nurse-led follow up for patients undergoing pelvic radiotherapy

    PubMed Central

    Faithfull, S; Corner, J; Meyer, L; Huddart, R; Dearnaley, D

    2001-01-01

    This study reports results from a randomised controlled trial of nurse-led care and was designed to determine whether nurse-led follow up improved patients morbidity and satisfaction with care in men treated with radical radiotherapy for prostate and bladder cancer. The aim was to compare outcomes in terms of toxicity, symptoms experienced, quality of life, satisfaction with care and health care costs, between those receiving nurse-led care and a group receiving standard care. The study population was of men prescribed radical radiotherapy (greater than 60 Gy). Participants completed self-assessment questionnaires for symptoms and quality of life within the first week of radiotherapy treatment, at week 3, 6 and 12 weeks from start of radiotherapy. Satisfaction with clinical care was also assessed at 12 weeks post-treatment. Observer-rated RTOG toxicity scores were recorded pre-treatment, weeks 1, 3, 6 and 12 weeks from start of radiotherapy. The results presented in this paper are on 115 of 132 (87%) of eligible men who agreed to enter the randomised trial. 6 men (4%) refused and 11 (8%) were missed for inclusion in the study. Data were analysed as a comparison at cross-sectional time points and as a general linear model using multiple regression. There was no significant difference in maximum symptom scores over the time of the trial between nurse-led follow-up care and conventional medical care. Differences were seen in scores in the initial self assessment of symptoms (week 1) that may have been as a result of early nursing intervention. Those men who had received nurse-led care were significantly more satisfied (P < 0.002) at 12 weeks and valued the continuity of the service provided. There were also significant (P < 0.001) cost benefits, with a 31% reduction in costs with nurse-led, compared to medically led care. Evidence from this study suggests that a specialist nurse is able to provide safe follow up for men undergoing radiotherapy. The intervention

  2. Suicide intent among parasuicide patients in Nicaragua: a surveillance and follow-up study.

    PubMed

    Caldera, Trinidad; Herrera, Andrés; Kullgren, Gunnar; Renberg, Ellinor Salander

    2007-01-01

    This study examines suicide intent among parasuicide patients in a low-income country, Nicaragua, with special reference to gender patterns and future suicidal behavior. Using the Suicide Intent Scale (SIS), suicide intent was assessed in 204 persons presenting to hospital after parasuicide. Repetition was checked after a mean follow-up period of three years. The total SIS scores did not differ between women and men. However, a higher SIS score among women was significantly associated with older age, having children and use of pesticide as the parasuicide method. The overall method of suicide intent was low in Nicaragua compared to other countries, as was the nonfatal repetition rate (4.8% after three years). Subsequent suicides were found only in three men. Factor structures within the SIS disclosed supported the cross-cultural validity of the instrument. The level of suicide intent at the index attempt did not show any association with future suicidal behavior.

  3. [One year follow up of successful coronary angioplasty in non selected patients].

    PubMed

    Dighero T, Humberto; Wajner A, Jacobo; Puentes R, Angel; Zepeda M, Flavio; Bellet P, Augusto; Donoso P, Hernán; Guillem V, Arturo; Aranda C, Waldo

    2006-11-01

    Re-stenosis after percutaneous coronary angioplasty (PTCA) is related to clinical and angiographic features. To describe the clinical and angiographic characteristic of our patients with coronary cardiopathy subjected to PTCA and the predictor factors for re-stenosis. We gathered the clinical and angiographic characteristics of all patients who underwent a successful PTCA of a native coronary artery. All patients had a clinical assessment one year after the procedure. Patients were classified in Group 1, if they did not have angina or coronary events after the angioplasty or Group 2, if they had angina or a coronary event after the procedure. Only Group 2 patients were subjected to a coronary angiogram. We collected 383 PTCA procedures. Follow up information was obtained in 92.2%. Three hundred forty two patients (89.3%) were assessed one year the procedure. Nine patients (2.3%) died of a cardiovascular cause. Ninety patients (26.3%) were classified in Group 2. In 65 patients, angiographic re-stenosis was demonstrated (19%). Re-stenosis occurred in 36 and 13% of patients with an without Diabetes Mellitus, respectively (p <0.01). The other clinical predictor variables were a history of myocardial infarction (p =0.007), obesity (p =0.041) and hypercholesterolemia (p =0.050). None of the angiographic characteristics predicted restenosis. Stents were protective factors against restenosis (15.6% in stented lesions vs 25.4% in nonstented; p =0.01). Re-stenosis after angioplasty occurred in 19% of our patients with angina or coronary events. The clinical variables associated with a higher risk of re-stenosis were diabetes (the main risk factor), previous myocardial infarction, obesity and hypercholesterolemia. Angiographic variables were not associated with re-stenosis. The use of stents decreases the incidence of re-stenosis in all groups).

  4. What Facilitates "Patient Empowerment" in Cancer Patients During Follow-Up: A Qualitative Systematic Review of the Literature.

    PubMed

    Jørgensen, Clara R; Thomsen, Thora G; Ross, Lone; Dietz, Susanne M; Therkildsen, Signe; Groenvold, Mogens; Rasmussen, Charlotte L; Johnsen, Anna T

    2017-07-01

    Empowerment is a concept of growing importance in cancer care, but little is known about cancer patients' experiences of empowerment during follow-up. To explore this area, a qualitative systematic literature review was conducted in PubMed, CINAHL, and PsycINFO. A total of 2,292 papers were identified and 38 articles selected and included in the review. The thematic synthesis of the papers resulted in seven analytical themes being identified: empowerment as an ongoing process, knowledge is power, having an active role, communication and interaction between patients and health care professionals, support from being in a group, religion and spirituality, and gender. Very few articles explicitly explored the empowerment of cancer patients during follow-up, and the review identified a lack of attention to patients' own understandings of empowerment, a lack of specific focus on empowerment during follow-up, and insufficient attention to collective empowerment, as well as ethnic, social, and gender differences.

  5. Determinants of mortality in elderly patients with tuberculosis: a population-based follow-up study.

    PubMed

    Yen, Y-F; Feng, J-Y; Pan, S-W; Chuang, P-H; Su, V Y-F; Su, W-J

    2017-05-01

    Elderly individuals with tuberculosis (TB) are more likely to have a non-specific clinical presentation of TB and high mortality. However, factors associated with mortality in elderly TB patients have not been extensively studied. This retrospective cohort study aimed to identify factors associated with death among elderly Taiwanese with TB. All elderly patients with TB from 2006 to 2014 in Taipei, Taiwan, were included in a study. Multiple logistic regression was used to identify the factors associated with death in elderly TB patients. The mean age of the 5011 patients was 79·7 years; 74·1% were men; 32·7% had mortality during the study follow-up period. After controlling for potential confounders, age ⩾75 years (reference: 65-74 years), male sex, end-stage renal disease (ESRD), malignancy, acid-fast bacilli-smear positivity, TB-culture positivity, pleural effusion on chest radiograph and notification by an ordinary ward or intensive care unit were associated with a higher risk of all-cause death; while high school, and university or higher education, cavity on chest radiograph and directly observed therapy were associated with a lower risk of all-cause death. This study found that the proportion of death among elderly patients with TB in Taipei, Taiwan, was high. To improve TB treatment outcomes, future control programmes should particularly target individuals with comorbidities (e.g. ESRD and malignancy) and those with a lower socio-economic status (e.g. not educated).

  6. Long-Term Follow-Up of Patients at High Risk for Nephropathy After Contrast Exposure.

    PubMed

    Abaci, Okay; Harmankaya, Ozlem; Kocas, Betul; Kocas, Cuneyt; Bostan, Cem; Coskun, Ugur; Yildiz, Ahmet; Ersanli, Murat

    2015-07-01

    Contrast medium-induced acute kidney injury (CI-AKI) is associated with morbidity and mortality, but the long-term outcomes of patients who do not develop CI-AKI remain unknown. We assessed clinical end points during long-term follow-up in patients at high risk for nephropathy who did not develop CI-AKI. Patients (n = 135) with impaired renal function (estimated glomerular filtration rate: 30-60 mL/min/1.73 m(2)) were divided into 2 groups according to contrast media (CM) exposure. The primary end point of this study was a composite outcome measure of death or renal failure requiring dialysis. Multivariate analyses identified CM exposure to be independently associated with major adverse long-term outcomes (hazard ratio: 2.3; 95% confidence interval, 1.34-6.52; P = .018). Even when CM exposure does not cause CI-AKI in patients with impaired renal function, in the long term, primary end points occur more frequently in patients exposed to CM than in those with no CM exposure.

  7. Melanoma patients under vemurafenib: prospective follow-up of melanocytic lesions by digital dermoscopy.

    PubMed

    Perier-Muzet, Marie; Thomas, Luc; Poulalhon, Nicolas; Debarbieux, Sébastien; Bringuier, Pierre-Paul; Duru, Gerard; Depaepe, Lauriane; Balme, Brigitte; Dalle, Stephane

    2014-05-01

    Second primary melanomas (SPMs) induced by vemurafenib have been recently described. The aim of this study was to define the dermoscopical signs of melanoma in this context. Patients underwent a total body examination before receiving vemurafenib. Each single melanocytic lesion was registered before therapy by digital dermoscopy (DD), and then repeated monthly until therapy disruption. Forty-two patients were included, the mean duration of follow-up was 6.7 months, and a mean number of 51 lesions per patients were captured and followed. A total number of 2,155 lesions were recorded, of which 56.1% presented at least one change during the study. More common changes concerned the color of the lesions (up to 15%) and appearance or disappearance of globules (14.6%). Thirty-six of the melanocytic lesions were surgically excised, 21 were classified as a nevus, 1 was a lentigo, and 14 as a second new primary melanoma (occurring in 21% of our patients). DD allowed us to excise only 36/2,155 (1.6%) of the lesions and permitted us to detect 14 SPM in the 42 patients with a highly efficient malignant/benign ratio of 63.6%. Although vemurafenib is now tested in an adjuvant setting DD should be systematically used in order to accurately detect SPM and reduce the number of unnecessary excisions.

  8. Longitudinal Transient Elastography Measurements Used in Follow-up for Patients with Cystic Fibrosis.

    PubMed

    Van Biervliet, Stephanie; Verdievel, Hugo; Vande Velde, Saskia; De Bruyne, Ruth; De Looze, Danny; Verhelst, Xavier; Geerts, Anja; Robberecht, Eddy; Van Vlierberghe, Hans

    2016-04-01

    Cystic fibrosis-related liver disease (CFLD) is diagnosed using a combination of criteria. Transient elastography (TE), an ultrasonographic method to evaluate liver stiffness, can differentiate patients with and without liver disease. This retrospective study (2007-2013) aimed to detect developing CFLD using consequent TE measurements. All cystic fibrosis patients with TE measurements between 2007 and 2013 (n = 150, median age 17 (9-24) y) were included, of which 118 had a median of three (range, 2-4) measurements with an interval of 1 (1-2) y. Twenty (14%) had CFLD at the first TE measurement; five (3%) developed CFLD during follow-up. The median TE value in CFLD was 14 kPa (8.7-32.2) compared with 5.3 (4.9-5.7) in cystic fibrosis patients without liver disease (CFnoLD; p = 0.0001). In CFnoLD, TE was correlated with age (p = 0.031). A TE result >6.8 kPa had a sensitivity of 91.5% and a specificity of 91.7% in predicting CFLD, according to the receiver operating characteristics analysis. It also has a positive predictive value of 88.6% and a negative predictive value of 86.9%, increasing to 91.7% and 98%, respectively, in patients at risk (<14 y) for developing CFLD. Patients with developing CFLD had progressively increasing consecutive TE measurements.

  9. Patient-based outcomes following clubfoot surgery: a 16-year follow-up study.

    PubMed

    Vitale, Michael G; Choe, Julie C; Vitale, Mark A; Lee, Francis Y; Hyman, Joshua E; Roye, David P

    2005-01-01

    The ongoing controversy regarding the appropriate treatment of clubfoot has resulted in much variability in practice patterns, making the assessment of long-term outcomes a difficult one. Recently, new patient-based measures of outcomes have allowed for improved methods of assessing health outcomes in children. The purpose of this study was to follow up on a cohort of adolescents who underwent surgical repair at the authors' institution. Traditional (radiographs) and patient-based measures were obtained from 24 patients. The Child Health Questionnaire showed that the quality of life of these patients was relatively high after surgery, and these scores were comparable to those of age-matched young athletes with healthy feet. The disease-specific instrument, which was also administered, showed similar results. The role of radiographic measures was limited, as they did not reflect patient-based outcomes after clubfoot surgery. Both generic and disease-specific measures should be used as primary endpoints in evaluating treatment results in this area.

  10. Prosthetic rehabilitation of geriatric amputee patients: a follow-up study.

    PubMed

    Steinberg, F U; Sunwoo, I; Roettger, R F

    1985-11-01

    During a four-year period, 116 lower extremity amputee patients older than 65 years were evaluated and treated by our department. Fifty-nine patients with below-knee (BK) amputations, 22 with above-knee (AK) amputations, and 15 with bilateral amputations were fitted with prostheses and trained in their use. A follow-up study on all patients was done at an average of 22 months after they had completed their training program but not earlier than after 6 months. Of all BK amputees who had been fitted with a prosthesis, 73% were using it fulltime and as their main mode of locomotion; 25% were using it part of the time. The results were less favorable for AK and for bilateral amputee patients: 50% of AK amputees and 33% of the bilateral amputees had become fulltime users of their prostheses. Age alone was not a major determining factor in success or failure of prosthetic rehabilitation. Failures usually were due to concurrent medical disease or mental deterioration. The study indicates that the effort and expense of fitting and training geriatric patients with prostheses may be well worthwhile.

  11. Clinical, imaging, and follow-up observations of patients with anti-GABAB receptor encephalitis.

    PubMed

    Qiao, Song; Zhang, Yin-Xi; Zhang, Bi-Jun; Lu, Ru-Yi; Lai, Qi-Lun; Chen, Lin-Hui; Wu, Jiong

    2017-05-01

    Anti-gamma-aminobutyric acid B (anti-GABAB) receptor encephalitis is a newly described type of autoimmune encephalitis. We report a case series of patients diagnosed with anti-GABAB receptor encephalitis in China, focusing on their presentations, laboratory and imaging results, and outcomes, as well as the treatment strategies which were employed. Data from patients diagnosed with anti-GABAB receptor encephalitis in the Second Affiliated Hospital, School of Medicine, Zhejiang University, from January 2014 to June 2015 were retrospectively collected and analyzed. Based on specific diagnostic criteria, seven cases were included. Six of the seven patients were males, and a median age at presentation of 56 years (range: 4-71 years). Seizures were the most common initial symptom, and all patients developed symptoms of typical limbic encephalitis during their disease course. Additional types of autoantibodies were identified in four patients. After presentation, three patients were found to have small cell lung cancer and one patient was eventually diagnosed with thymoma. All patients accepted first-line immune therapy, but only one chose tumor treatment. The three tumor-free patients had a good outcome, whereas those with tumors had a poor one. Finally, there were no relapses during follow-up. Anti-GABAB receptor encephalitis is a rare, unique autoimmune disease, and is often associated with tumors. It should be considered in the differential diagnosis for middle and senior-aged patients who present with predominantly limbic encephalitis symptoms. Importantly, earlier recognition of this potentially treatable condition could improve its overall prognosis.

  12. Outcomes of Hepatic Resection in Intrahepatic Cholangiocarcinoma Patients with Diabetes, Hypertension, and Dyslipidemia: Significance of Routine Follow-Up

    PubMed Central

    Nishioka, Takayoshi; Kubo, Shoji; Tanaka, Shogo; Wakasa, Kenichi; Takemura, Shigekazu; Kinoshita, Masahiko; Hamano, Genya; Kuwae, Yuko; Shibata, Toshihiko; Suehiro, Shigefumi

    2016-01-01

    Background The outcomes of hepatic resection in intrahepatic cholangiocarcinoma (ICC) patients with diabetes mellitus (DM), hypertension (HT), and dyslipidemia (DL) (metabolic components) remain unclear. Methods The outcomes of 43 ICC patients without known risk factors for ICC who underwent hepatic resection were retrospectively reviewed. These patients were divided into three groups: those followed-up for metabolic components at least every 6 months (follow-up group, n=16), those not followed-up for metabolic components (no follow-up group, n=14), and those without metabolic components (control group, n=13). Results In the follow-up group, 13 (81%) patients were further examined for ICC during follow-up because of abnormal screening results, such as elevated serum gamma-glutamyl transpeptidase and carbohydrate antigen 19-9 (CA19-9) concentrations or detection of hepatic tumor on ultrasonography and/or computed tomography, whereas most patients in the other two groups exhibited ICC-related symptoms. No patient in the follow-up group exhibited lymph node metastasis, whereas 43% of those in the no follow-up group and 46% in the control group had lymph node metastasis (p=0.005 and 0.004 vs. the follow-up group, respectively). All 16 patients in the follow-up group were diagnosed as International Union Against Cancer pathologic stage I or II (early stage). There were no significant differences in the incidence of postoperative recurrence between the three groups; however, the incidence of extrahepatic recurrence was lower in the follow-up group than in the no follow-up group and the control group (13% vs. 78% vs. 63%, p=0.0232). The 1-, 3-, and 5-year overall survivalrates in the follow-up group were better than those in the no follow-up and control groups (93/93/66% vs. 77/34/34% and 85/24/0%, p=0.034 and 0.001, respectively). Conclusions Routine measurement of serum gamma-glutamyl transpeptidase and/or CA19-9 levels and imaging examinations every 12 months (or 6

  13. 10-year follow-up of laparoscopic vertical banded gastroplasty: good results in selected patients.

    PubMed

    Scozzari, Gitana; Toppino, Mauro; Famiglietti, Federico; Bonnet, Gisella; Morino, Mario

    2010-11-01

    To evaluate the long-term results of laparoscopic vertical banded gastroplasty (VBG) for morbid obesity. Laparoscopic VBG, a safe and straightforward bariatric procedure characterized by good short-term results, has been progressively replaced by other more complex procedures on the basis of a presumed high rate of long-term failure. Nevertheless, some authors have recently reported long-term efficacy in selected patients. All patients who underwent laparoscopic VBG were included in a prospective database. Patients reaching 10-year follow-up received a complete evaluation including clinical, endoscopic, and biochemical examinations. Between January 1996 and March 1999, 266 morbidly obese patients underwent bariatric procedures. Among them, 213 were selected for laparoscopic VBG; exclusion criteria were as follows: contraindications to pneumoperitoneum, gastroesophageal reflux disease, and psychological contraindications to restrictive procedures. Mean age, preoperative weight, and body mass index were 36.9 years, 123.6 kg, and 45.4 kg/m, respectively. Intraoperative complication rate and conversion rate were 0.9% and 0.9%, respectively. Early postoperative complication rate was 4.2% and early reoperation rate was 0.5%. Mean hospital length of stay was 6.3 days. Mortality was nil. The 10-year follow-up rate was 70.4% (150 patients). Late postoperative complication rate was 14.7%, and 10-year revisional surgery rate was 10.0%. The excess weight loss percentages at 3, 5, and 10 years were 65.0%, 59.9%, and 59.8%, respectively. The resolution and/or improvement rate for comorbidity were 47.5% for hypertension, 55.6% for diabetes, 75% for sleep apnea, and 47.4% for arthritis. Mean Moorehead-Ardelt Quality of Life Questionnaire and BAROS values were 1.4 and 3.8, respectively. The present study demonstrates that laparoscopic VBG in carefully selected patients leads to long-term results comparable with more complex and invasive procedures. Given the low postoperative

  14. Pleurodesis in follow-up and treatment of malignant pleural mesothelioma patients.

    PubMed

    Ak, Güntülü; Metintaş, Muzaffer; Yildirim, Hüseyin; Metintaş, Selma; Dündar, Emine; Erginel, Sinan; Alataş, Füsun

    2009-01-01

    We analyzed the necessity of pleurodesis in the follow-up of the patients with malignant pleural mesothelioma (MPM), and how much it contributes to the survival period by determining the indications, efficiency, and reliability of the pleurodesis application. 191 patients were assessed retrospectively and 69 (36%) of them were established with a pleurodesis indication. In 42 patients accepting pleurodesis, the pleurodesis success was evaluated. Factors affecting the success of pleurodesis and the effect of pleurodesis on survival were assessed. Pleurodesis was a success in 26 (62%) of the 42 patients. In the group in which the pleurodesis process was a success, it was observed that KPS and pleural fluid pH were higher (p= 0.030, p= 0.032, respectively). In case of KPS > or = 80, the sensitivity was: 76.9%, specificity: 50.0%, PPV: 71.4%, and NPV was established as 57.1%. In case of pleural fluid pH > 7.27, the sensitivity was: 92.9%, specificity: 50.0%, PPV: 76.5%, and NPV was observed as 80.0%. In the group in which pleurodesis was a success, the median survival was longer (Log-rank: 11.2; p= 0.0008). Independently from chemotherapy, the chance of living longer for patients whose pleurodesis was a success was 2.6 times higher. A severe complication concerning the process was not observed. Pleurodesis is performed less frequently than it is assumed on patients with MPM. In patients with KPS > or = 80, pleural fluid pH > 7.27, and with indication, pleurodesis must be administered. In feasible patients, a successful pleurodesis with talc increases the survival of patients with MPM, and it can be safely administered.

  15. QTC TENDENCY IN PACEMAKER DEPENDENT PATIENTS - PROGNOSTIC MEANING OF LONG QTC DURING 5 YEAR FOLLOW UP.

    PubMed

    Tsetskhladze, E; Khintibidze, I

    2016-04-01

    Prolongation of ventricular repolarization, which is represented by QTc prolongation on the standard ECG can be considered as increased risk for fatal arrhythmia. However, in pacemaker dependency (with ventricular pacing from the right apex) Ventricular Pacemaker causes abnormal steps of ventricular activation and therefore widens QRS complex and alters ventricular repolarization. It is still questionable whether QTc prolongation in right ventricular-paced patients is associated with increased risk of fatal arrhythmia or other cardiac complications. The other important question is whether the pacemaker dependent patient with long QTc interval may safely receive medications with known potential to prolong ventricular repolarization. The aim of the study was to determine whether QTc prolongation in VP (ventricular pacemaker) patients is associated with increased risk of fatal arrhythmia or other cardiac complications and whether these patients can safely receive medications with known potential to prolong ventricular repolarization. The study is based on retrospective analysis of the QTc interval prior and after pacemaker insertion; dynamic changes of QTc interval and possible influence of the medications, with known potential to prolong ventricular repolarization. Study population consisted 76 patients with narrow native QRS complexes and QTcF/QTcB <500 ms for both male and female patients. QTc prolongation in VP patients most likely does not represent true repolarization abnormalities and is not associated with risk of fatal arrhythmia. While analysis of group receiving medications with known potency of QTc increase we found no additional tendency of QTc increase. Based on our data receiving the medications with known potency of QTc prolongation in VP patients should be considered as safe approach. Long-term follow up data (5 years) assessed retrospectively shows that in patients with widened QRS after VP are at increased risk of development of HF and HF

  16. Evaluation of a follow-up protocol for patients on chloroquine and hydroxychloroquine treatment.

    PubMed

    Sanabria, M R; Toledo-Lucho, S C

    2016-01-01

    To review the problems found after a new follow-up protocol for patients on chloroquine and hydroxychloroquine treatment. Retrospective study was conducted between May 2012 and January 2013 on the clinical files, retinographies, fundus auto-fluorescence (FAF) images, and central-10 degree visual fields (VF) of patients who were referred to the Ophthalmology Department as they had started treatment with hydroxychloroquine. One hundred twenty-six patients were included; 94.4% were referred from the Rheumatology Department and 5.6% from Dermatology. Mean age was 59.7 years, and 73.8% were women. All of them were on hydroxychloroquine treatment, and 300mg was the most frequent daily dose. Rheumatoid arthritis was the most common diagnosis (40.5%), followed by systemic lupus erythematosus (15.9%). The mean Snellen visual acuity was 0.76, and 26 patients had lens opacities. The VF were normal in 97 patients, 8 had mild to moderate defects with no definite pattern, and in 9 the results were unreliable. Of the 51 patients older than 65years, 16 (31.4%) had altered or unreliable VF. The FAF was normal in 104 patients (82.5%), and abnormal, but consistent with ophthalmoscopic features, in 12 patients (pathological myopia, age related changes, early, middle or late age-related macular degeneration). Visual fields as a reference test for the diagnosis of AP toxicity are not quite reliable for patients over 65. Therefore, the FAF is recommended as primary test, perhaps combined with another objective test, such as SD-OCT instead of VF. Copyright © 2015 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.

  17. Cu isotopic signature in blood serum of liver transplant patients: a follow-up study

    PubMed Central

    Lauwens, Sara; Costas-Rodríguez, Marta; Van Vlierberghe, Hans; Vanhaecke, Frank

    2016-01-01

    End-stage liver disease (ESLD) is life-threatening and liver transplantation (LTx) is the definitive treatment with good outcomes. Given the essential role of hepatocytes in Cu homeostasis, the potential of the serum Cu isotopic composition for monitoring a patient’s condition post-LTx was evaluated. For this purpose, high-precision Cu isotopic analysis of blood serum of ESLD patients pre- and post-LTx was accomplished via multi-collector ICP-mass spectrometry (MC-ICP-MS). The Cu isotopic composition of the ESLD patients was fractionated in favour of the lighter isotope (by about −0.50‰). Post-LTx, a generalized normalization of the Cu isotopic composition was observed for the patients with normal liver function, while it remained light when this condition was not reached. A strong decrease in the δ65Cu value a longer term post-LTx seems to indicate the recurrence of liver failure or cancer. The observed trend in favour of the heavier Cu isotopic composition post-LTx seems to be related with the restored biosynthetic capacity of the liver, the restored hepatic metabolism and/or the restored biliary secretion pathways. Thus, Cu isotopic analysis could be a valuable tool for the follow-up of liver transplant patients and for establishing the potential recurrence of liver failure. PMID:27468898

  18. Cu isotopic signature in blood serum of liver transplant patients: a follow-up study

    NASA Astrophysics Data System (ADS)

    Lauwens, Sara; Costas-Rodríguez, Marta; van Vlierberghe, Hans; Vanhaecke, Frank

    2016-07-01

    End-stage liver disease (ESLD) is life-threatening and liver transplantation (LTx) is the definitive treatment with good outcomes. Given the essential role of hepatocytes in Cu homeostasis, the potential of the serum Cu isotopic composition for monitoring a patient’s condition post-LTx was evaluated. For this purpose, high-precision Cu isotopic analysis of blood serum of ESLD patients pre- and post-LTx was accomplished via multi-collector ICP-mass spectrometry (MC-ICP-MS). The Cu isotopic composition of the ESLD patients was fractionated in favour of the lighter isotope (by about ‑0.50‰). Post-LTx, a generalized normalization of the Cu isotopic composition was observed for the patients with normal liver function, while it remained light when this condition was not reached. A strong decrease in the δ65Cu value a longer term post-LTx seems to indicate the recurrence of liver failure or cancer. The observed trend in favour of the heavier Cu isotopic composition post-LTx seems to be related with the restored biosynthetic capacity of the liver, the restored hepatic metabolism and/or the restored biliary secretion pathways. Thus, Cu isotopic analysis could be a valuable tool for the follow-up of liver transplant patients and for establishing the potential recurrence of liver failure.

  19. [Follow-up of patients with osteoarthritis. Coordinated management and criteria for referral between healthcare levels].

    PubMed

    Nieto Pol, Enrique

    2014-01-01

    The correct management of osteoarthritis requires an accurate diagnosis, evaluation of its spread and functional repercussions, and the application of comprehensive and effective individually-tailored treatment aimed at relieving pain and improving physical function with a consequent improvement in quality of life; treatment should also aim to prevent or delay disease progression and its effects. In the National Health Service, primary care is the basic level and the first point of access to healthcare; this level guarantees the continuity of care, coordinates patients, and regulates clinical workflow. Family physicians coordinate the healthcare processes related to chronic diseases and are responsible for the management, diagnosis, evaluation, treatment, and follow-up of patients with osteoarthritis. The clinical practice guidelines internationally accepted as the standard of care for the management of osteoarthritis should be adapted by both Spanish health planning strategies and clinical practice guidelines to the Spanish healthcare setting. The comprehensive assessment of osteoarthritis includes evaluation of its effects on the patient's physical function and quality of life; formulating a treatment plan in collaboration with the patient and adapted to his or her comorbidities; providing advice on basic treatments and their risks and benefits; and carrying out an individually-tailored periodic review. Referral criteria are based on diagnostic confirmation, poor treatment response, and surgical evaluation. Copyright © 2014 Elsevier España, S.L. All rights reserved.

  20. Impact of involuntary out-patient commitment on reducing hospital services: 2-year follow-up.

    PubMed

    Castells-Aulet, Laura; Hernández-Viadel, Miguel; Jiménez-Martos, Jesús; Cañete-Nicolás, Carlos; Bellido-Rodríguez, Carmen; Calabuig-Crespo, Roman; Asensio-Pascual, Pedro; Lera-Calatayud, Guillem

    2015-08-01

    Aims and method To evaluate whether involuntary out-patient commitment (OPC) in patients with severe mental disorder reduces their use of hospital services. This is a retrospective case-control study comparing a group of patients on OPC (n = 75) and a control group (n = 75) which was composed of patients whose sociodemographic variables and clinical characteristics were similar to those of the OPC group. Each control case is paired with an OPC case, so the control case must have an involuntary admission in the month that the index OPC case admission occurred. Emergency room visits, admissions and average length of hospital stay over a 2-year follow-up after the initiation of OPC were compared. Results No statistically significant evidence was found in the use of mental healthcare services between the two groups. Different reasons for admission found between the groups limit similarity when comparing the two. Clinical implications The findings cast doubt over the effectiveness of this legal measure to reduce emergency visits, the number of admissions and the length of stay in the hospital.

  1. Thyroglobulin levels to follow-up patients with treated differentiated thyroid carcinoma

    SciTech Connect

    Moser, E.; Braun, S.; Bueell, U.; Kirsch, C.M.; Tosch, U.; Wendt, T.

    1984-01-01

    Serum thyroglobulin (hTg) measurements by commercial radioimmunoassay were performed in the follow-up of 118 patients with differentiated thyroid carcinoma undergoing I-131 local and whole-body scans following surgery and I-131 therapy. Patients with positive anti-hTg antibodies (23% of cases) were excluded. In all remaining I-131 accumulating residual, recurrent, or metastatic tumors, hTg levels were elevated (greater than 6.25 ng/ml, minimum detectable value). Twelve patients with neither recurrence nor metastases had elevate hTg levels. Sensitivity and specificity depended on the threshold used for elevate hTg levels. At an hTg-threshold of 6.25 ng/ml sensitivity has 100%, specificity has 82%. As hTg levels were reported to depend on endogenous TSH stimulation, it is not yet advisable to replace I-131 scans totally by hTg determination. After having determined an hTg ''baseline'' below detectable values (less than 6.25 ng/ml), we reduced the number of I-131 scans by half. However, elevated hTg levels were an indication for an I-131 scan. Therefore, on the basis of 23% of our patients who had anti-hTg antibodies the need exists to develop a commercial assay which is independent from antibodies.

  2. Nutritional follow-up of patients after obesity surgery: best practice.

    PubMed

    O'Kane, Mary; Barth, Julian H

    2016-05-01

    Obesity surgery is an appropriate treatment option for patients with severe and complex obesity and helps in the improvement of comorbidities. In the first 2 years following surgery, follow-up is provided by the obesity surgery centre. Ongoing care is then usually returned to the general practitioner. Patients need access to ongoing support and monitoring otherwise may be at risk of developing nutritional deficiencies such as anaemia or protein malnutrition. The British Obesity and Metabolic Surgery Society have developed guidelines on nutritional monitoring and nutritional supplements to support both bariatric centres and general practitioners. The Royal College of General Practitioners and BOMSS have worked collaboratively to develop Ten Top Tips for the management of obesity surgery patients to aid with the long-term management in primary care. Women, planning to get pregnant, need access to preconception advice and additional monitoring during pregnancy. It is essential that long-term data are collected and inputted into the National Bariatric Surgery Register. Obesity surgery improves comorbidities; however, patients must have access to long-term nutritional monitoring. © 2016 John Wiley & Sons Ltd.

  3. [Prognosis of patients with irritable intestine syndrome. A prospective study with 1 year follow-up].

    PubMed

    Linares Rodríguez, A; Rodrigo Sáez, L; Pérez Alvarez, R; Sánchez Lombraña, J L; Rodríguez Pérez, A; Arribas Castrillo, J M

    1990-01-01

    An analysis was made of the prognosis over a one-year follow-up period of a consecutive series of 86 out patients with irritable bowel syndrome (SII) who were treated randomly with an antispasmodic (otilonium) or a tranquilizer (clobazam), and the existence of factors, mainly psychological, that could worsen it was determined with the Zung anxiety test and the Hamilton depression scale. We confirmed that irritable intestine syndrome is a chronic disease, with a mean course of 13 +/- 12.5 years at the time of consultation. A large proportion of patients had permanent problems (58.1%) and did not experience important changes in the intensity of symptoms throughout evolution (68.6%). Although most improved initially with the treatment instated (76.7%), the improvement was rarely complete (11.8%). A year after beginning treatment, 61.6% were the same or worse than before the index consultation. In the group of patients with a good course, the proportion of those that correctly followed medical treatment and of those who had experienced more or less lengthy asymptomatic periods before consultation was significantly larger. In the group of patients with poor evolution, the scores on the Zung anxiety test and Hamilton depression scale were significantly higher than in those who evolved favorably. Neither consultation of a specialist nor the treatment used in this study seem to have contributed to an evident improvement in the prognosis.

  4. Coping of cancer patients during and after radiotherapy--a follow-up of 2 years.

    PubMed

    Sehlen, S; Song, R; Fahmüller, H; Herschbach, P; Lenk, M; Hollenhorst, H; Schymura, B; Aydemir, U; Dühmke, E

    2003-12-01

    We wanted to understand coping strategies specific to different phases up to two years after radiotherapy, to identify patients who are at higher risk of mood disturbances and to characterise the association between coping strategies and psychosocial adaptation. From 1997 to 2001, 2,169 patients with different diagnoses were screened (27.8% refused to participate). Data of 276 patients from the beginning of radiotherapy (ti1) and 5 follow-up investigations (ti6/2 years) could be analysed. With the FKV (Freiburg Questionnaire Coping with Disease) cancer-specific coping aspects were assessed. The association between coping styles and psychosocial adaptation was evaluated using the Questionnaire on Stress in Cancer Patients (QSC) and the questionnaire on Functional Assessment of Cancer Treatment (FACT-G). 'Active problem-orientated' coping and 'distractions' are the most important coping strategies. Only 'active problem-orientated' and 'depressive' coping showed a significant decrease. We observed higher means on the scales of the FKV in women. Marital status (single, married, divorced/widowed) had a significant influence on active problem-orientated coping and spirituality. Age, children, education, T/M status and curative/ palliative intention of treatment had no influence on coping styles. Breast cancer patients and lymphoma patients demonstrated the highest use of coping strategies after radiotherapy with a significant decrease of 'active problem-orientated coping'. Depressive coping and minimizing importance at ti1 were associated with high psychosocial distress and low quality of life (QoL) at ti6. The correlation of coping mechanisms at the beginning of radiotherapy with low QoL and high psychosocial stress at 2 years could help to identify patients at risk for low psychosocial adaptation. Psycho-oncologically trained teams of physicians would best correspond to this profile of needs and would contribute significantly to an ameliorated adaptation of patients to

  5. Follow-up of ischaemic heart disease in patients with coeliac disease.

    PubMed

    Emilsson, Louise; Carlsson, Roland; James, Stefan; Hambraeus, Kristina; Ludvigsson, Jonas F

    2015-01-01

    Patients with coeliac disease and myocardial infarction have a more favourable atherosclerotic risk factor profile than controls with myocardial infarction (MI). Therefore, MI prognosis and treatment may differ according to coeliac status. This paper reports on the study of Swedish MI patients with and without coeliac disease (equal to villous atrophy; Marsh histopathology stage 3) based on duodenal or jejunal biopsy data. We used the Swedish Quality Register (SWEDEHEART) to identify individuals with a record of MI from 2005 to 2008 and to obtain data on medication, coronary interventions, and clinical and laboratory parameters at 6-10 weeks and one year after first MI. One-year mortality and coronary interventions were assessed for 430 coeliac patients and 1988 controls. For other outcome variables, we compared 42 coeliac patients with MI and 201 general population controls with MI. Odds ratios (ORs) were calculated by logistic regression. The results showed that compared with controls with MI, coeliac individuals with MI had significantly higher one-year all-cause mortality (OR = 1.43; 95% confidence interval (CI) = 1.04-1.95) but less often underwent a percutaneous coronary intervention (OR = 0.77; 95% CI = 0.61-0.96). Coeliac patients were more often prescribed warfarin but less often aspirin and statins. The readmission rate due to cardiac events in coeliac patients was 15.2% vs. 12.6% in controls (p-value = 0.69). Other clinical and laboratory parameters were similar. We conclude that the follow up of MI does not seem to differ between coeliac patients and controls, and is unlikely to explain the excess mortality from cardiovascular disease noted in Swedish patients with CD. © The European Society of Cardiology 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  6. Patient Satisfaction with Pharmacist-Led Collaborative Follow-Up Care in an Ambulatory Rheumatology Clinic.

    PubMed

    Hall, Jill J; Katz, Steven J; Cor, M Ken

    2017-09-01

    Patient satisfaction is known to increase with pharmacist intervention in general outpatient clinics and with nurse-led care in rheumatology clinics. The aim of the present study was to describe and compare patient satisfaction with two different types of care: a pharmacist physician collaborative model and a traditional physician model in a rheumatology clinic setting. A cross-sectional survey of inflammatory arthritis patients seen during a follow-up visit in Edmonton, Alberta, Canada, was conducted over a ten-week period. Patient satisfaction was measured using a modified version of the validated Leeds Satisfaction Questionnaire, which uses a five-point Likert scale to measure six dimensions of satisfaction, and compared between the collaborative care and traditional physician models. A total of 62 patients completed the questionnaire (21 collaborative care and 41 traditional physician model). The average age of respondents was 52 years and the majority were female. The mean score for satisfaction across the six dimensions was 4.56 in the collaborative care group and 4.30 in the traditional physician group (p = 0.02). Patient satisfaction in the collaborative care group was consistently higher across all dimensions. No difference was noted between participants seen for the first time compared with those seen two or more times by the pharmacist. A collaborative care model can exceed the already high expectations for care of patients with inflammatory arthritis. Our findings support the role of pharmacists using a collaborative care approach to care for patients in rheumatology clinics. Copyright © 2016 John Wiley & Sons, Ltd.

  7. Adding Doppler Ultrasonography to the Follow-Up of Patients with Vasospastic Disorder Improves Objectivity

    PubMed Central

    Karabacak, Kubilay; Kadan, Murat; Kaya, Erkan; Erol, Gokhan; Arslan, Gokhan; Celik, Murat; Doğanci, Suat; Demirkilic, Ufuk

    2015-01-01

    Background Assessing therapeutic efficacy and patient satisfaction objectively and quantitatively has always been a problem in patients with vasospastic disorders. We aimed to present the additive value of ultrasonographic assessment of peripheral arteries secondary to cold stimulation, as a test for treatment efficacy during follow-up. Material/Methods Arterial blood flow rates were measured from radial artery with Doppler USG in patients who presented to our department with vasospastic disorders. Ultrasonography was performed at the following intervals; before cold stimulation and at 5th, 10th, 15th, 20th minutes of cold stimulation. Patients were controlled by repeat cold stimulation test and Doppler US at the 2nd month of the treatment. Results were analyzed with SPSS for Mac 20.0 package program. Results We enrolled 46 patients in the study. All patients were male and mean age was 22.3±2.17 years. Most common symptoms were cyanosis and coldness. There were statistically significant differences between pre-treatment and post-treatment arterial blood flow rates at each measurement time point (p<0.001) except initial measurement (p>0.05). On post-treatment values, there were 10.04±0.78 cm/s increase in 5th minute, 6.25±1.39 cm/s in 10th minute, 6.43±2.13 cm/s in 15th minute, and 6.38±1.86 cm/s in 20th minute measurements. All increases at the 5 time points were statistically meaningful when compared to their pre-treatment corresponding time points (p<0.001). Conclusions Doppler flowmetry added to standard cold stimulation test for evaluating the patients with vasospastic disorders provides better and more objective results when compared to the patient-oriented subjective scoring systems. PMID:25639947

  8. Surgical follow-up costs disproportionately impact low-income patients.

    PubMed

    Scott, Aaron R; Rush, Augustus J; Naik, Aanand D; Berger, David H; Suliburk, James W

    2015-11-01

    Surgical procedures have significant costs at the national level, but the financial burden on patients is equally important. Patients' out-of-pocket costs for surgery and surgical care include not only direct medical costs but also the indirect cost of lost wages and direct nonmedical costs including transportation and childcare. We hypothesized that the nonmedical costs of routine postoperative clinic visits disproportionately impact low-income patients. This was a cross-sectional study performed in the postoperative acute care surgery clinic at a large, urban county hospital. A survey containing items about social, demographic, and financial data was collected from ambulatory patients. Nonmedical costs were calculated as the sum of transportation, childcare, and lost wages. Costs and cost to income ratios were compared between income strata. Ninety-seven patients responded to the survey of which 59 reported all items needed for cost calculations. The median calculated cost of a clinic visit was $27 (interquartile range $18-59). Components of this cost were $16 ($14-$20) for travel, $22 ($17-$50) for childcare among patients requiring childcare, and $0 ($0-$30) in lost wages. Low-income patients had significantly higher (P = 0.0001) calculated cost to income ratios, spending nearly 10% of their monthly income on these costs. The financial burden of routine postoperative clinic visits is significant. Consistent with our hypothesis, the lowest income patients are disproportionately impacted, spending nearly 10% of their monthly income on costs associated with the clinic visit. Future cost-containment efforts should examine alternative, lower cost methods of follow-up, which reduce financial burden. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Non-systemic vasculitic neuropathy: single-center follow-up of 60 patients.

    PubMed

    Üçeyler, Nurcan; Geng, Anna; Reiners, Karlheinz; Toyka, Klaus V; Sommer, Claudia

    2015-09-01

    The objective of this study is to report the clinical presentation and long-term outcome of patients with non-systemic vasculitic neuropathy (NSVN) seen at our neuromuscular center. In this retrospective analysis, we assessed medical records of 60 patients with biopsy-proven NSVN (39 men, 21 women; median age: 64 years, 24-80), who were seen at our department between 1999 and 2008 and were followed up until 2014. The initial neurological findings, laboratory and neurophysiological data, treatment regimens, and outcome were analyzed in all patients. NSVN was mostly asymmetric (48/60, 80%), sensorimotor (45/60, 75%), and painful (38/60, 63%), with walking impairment as one major sign (51/60, 85%). No compound action potentials could be recorded in 29/60 (48%) sural nerves (later biopsied side) and in 6/60 (10%) tibial (motor) nerves. Pathology of sural nerve was informative in all cases irrespective of neurophysiological findings and prior immunosuppression. After initial treatment with i.v. methylprednisolone, all patients reported overall improvement. Of the 46 patients who were followed for >1 year, those with mild to moderate affliction were stable with azathioprine (19/46, 41%), while 18/46 (39%) patients were treated with cyclophosphamide and other immunosuppressants due to progression or relapse. At 4 years, 24/46 (52%) patients had either discontinued (n = 21) or had primarily refused immunosuppressive treatment (n = 3) without relapse. Age younger than the group median of 64 years was associated with better outcome. No patient evolved to systemic vasculitis. NSVN is a potentially treatable disorder of the peripheral nervous system.

  10. Follow-up of patients with functional bowel symptoms treated with a low FODMAP diet

    PubMed Central

    Maagaard, Louise; Ankersen, Dorit V; Végh, Zsuzsanna; Burisch, Johan; Jensen, Lisbeth; Pedersen, Natalia; Munkholm, Pia

    2016-01-01

    AIM: To investigate patient-reported outcomes from, and adherence to, a low FODMAP diet among patients suffering from irritable bowel syndrome and inflammatory bowel disease. METHODS: Consecutive patients with irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD) and co-existing IBS fulfilling the ROME III criteria, who previously attended an outpatient clinic for low FODMAP diet (LFD) dietary management and assessment by a gastroenterologist, were invited to participate in a retrospective questionnaire analysis. The questionnaires were sent and returned by regular mail and gathered information on recall of dietary treatment, efficacy, symptoms, adherence, satisfaction, change in disease course and stool type, and quality of life. Before study enrolment all patients had to sign an informed written consent. RESULTS: One hundred and eighty patients were included, 131 (73%) IBS and 49 (27%) IBD patients. Median age was 43 years (range: 18-85) and 147 (82%) were females. Median follow-up time was 16 mo (range: 2-80). Eighty-six percent reported either partial (54%) or full (32%) efficacy with greatest improvement of bloating (82%) and abdominal pain (71%). The proportion of patients with full efficacy tended to be greater in the IBD group than in the IBS group (42% vs 29%, P = 0.08). There was a significant reduction in patients with a chronic continuous disease course in both the IBS group (25%, P < 0.001) and IBD group (23%, P = 0.002) along with a significant increase in patients with a mild indolent disease course of 37% (P < 0.001) and 23% (P = 0.002), respectively. The proportion of patients having normal stools increased with 41% in the IBS group (P < 0.001) and 66% in the IBD group (P < 0.001). One-third of patients adhered to the diet and high adherence was associated with longer duration of dietary course (P < 0.001). Satisfaction with dietary management was seen in 83 (70%) IBS patients and 24 (55%) IBD patients. Eighty-four percent of patients

  11. Primary staging and follow-up in melanoma patients – monocenter evaluation of methods, costs and patient survival

    PubMed Central

    Hofmann, U; Szedlak, M; Rittgen, W; Jung, E G; Schadendorf, D

    2002-01-01

    In a German cohort of 661 melanoma patients the performance, costs and survival benefits of staging methods (history and physical examination; chest X-ray; ultrasonography of the abdomen; high resolution sonography of the peripheral lymph nodes) were assessed at initial staging and during follow-up of stage I/II+III disease. At initial staging, 74% (23 out of 31) of synchronous metastases were first detected by physical examination followed by sonography of the lymph nodes revealing 16% (5 out of 31). Other imaging methods were less efficient (Chest X-ray: one out of 31; sonography of abdomen: two out of 31). Nearly 24% of all 127 first recurrences and 18% of 73 second recurrences developed in patients not participating in the follow-up programme. In follow-up patients detection of first or second recurrence were attributed to history and physical examination on a routine visit in 47 and 52% recurrences, respectively, and to routine imaging procedures in 21 and 17% of cases, respectively. Lymph node sonography was the most successful technical staging procedure indicating 13% of first relapses, but comprised 24% of total costs of follow-up in stage I/II. Routine imaging comprised nearly 50% of total costs for follow-up in stage I/II and in stage III. The mode of detecting a relapse (‘patient vs. doctor-diagnosed’ or ‘symptomatic vs asymptomatic’) did not significantly influence patients overall survival. Taken together, imaging procedures for routine follow-up in stage I/II and stage III melanoma patients were inefficient and not cost-efficient. British Journal of Cancer (2002) 87, 151–157. doi:10.1038/sj.bjc.6600428 www.bjcancer.com © 2002 Cancer Research UK PMID:12107834

  12. Laboratory guidelines for the diagnosis and follow-up of patients with monoclonal gammopathies.

    PubMed

    Bravo García-Morato, M; Padilla-Merlano, B; Nozal, P; Espiño, M; Juárez, C; Villar, L M; López-Trascasa, M

    2016-04-01

    We present guidelines from the Immunochemistry group of the Spanish Society for Immunology that are designed to provide a practical tool for the diagnosis and follow-up of monoclonal gammopathies. We review the clinical and analytical features of various monoclonal gammopathies, international consensus guidelines and techniques used to detect and follow-up monoclonal components.

  13. Pharmacotherapy and group cognitive behavioral therapy enhance follow-up treatment duration in gambling disorder patients.

    PubMed

    Choi, Sam-Wook; Shin, Young-Chul; Youn, HyunChul; Lim, Se-Won; Ha, Juwon

    2016-01-01

    Longer treatment duration is important for the successful treatment of gambling disorder (GD). This retrospective study investigated the factors and interventions that might enhance treatment duration in GD patients in South Korea. A total of 758 outpatients with a primary diagnosis of GD, who were treated in a clinical practice from 2002 to 2011, were assessed by retrospective chart review. We compared the treatment duration according to pharmacotherapy and group cognitive behavioral therapy (CBT). Pharmacotherapy contributed to a longer duration of treatment maintenance, despite the patients' gambling severity (p < 0.001). Participation in group CBT (p < 0.001) and antidepressants (p = 0.009) were associated with a longer treatment duration after adjusting for age, depression, and gambling severity. The treatment maintenance duration was the longest in those receiving combined antidepressant pharmacotherapy and group CBT (F = 35.79, p < 0.001). Group CBT and antidepressants seem to enhance treatment follow-up duration in GD patients. Additional studies are needed to advance GD prevention and treatment strategies.

  14. Improvement of sleep architecture in the follow up of a patient with bilateral paramedian thalamic stroke.

    PubMed

    Fonseca, Ana Catarina; Geraldes, Ruth; Pires, Joana; Falcão, Filipa; Bentes, Carla; Melo, Teresa Pinho E

    2011-12-01

    Normal sleep architecture and arousal require an intact thalamus. Thalamic vascular lesions, particularly in the paramedian region may cause arousal disturbances and hypersomnolence. Although hypersomnolence is one of the main characteristics of acute bilateral paramedian thalamic infarcts, there are only scarce reports in literature concerning polysomnographic follow-up of these patients. The few reported cases in literature show that sleep stages do not significantly change from the acute to chronic phase. We present a case report of a patient with a bilateral paramedian thalamic infarct in which a polysomnographic evaluation of sleep was performed four days and five months after stroke. In the acute phase, polysomnography showed an impairment of phase 2 NREM and absence of phase 3 and 4 NREM with absent sleep spindles. After the acute stroke phase, hypersomnolence improved and sleep spindles reappeared as well as phase 3 and 4 of NREM sleep. Our patient clear clinical and polysomnographic improvement makes us suppose that in this case the initial impairment could have been essentially due to a functional transitory impairment of the thalamocortical and corticothalamic connections. This case report is peculiar because it discloses a marked improvement of sleep architecture which to the best of our knowledge has not been clearly described before. Copyright © 2011 Elsevier B.V. All rights reserved.

  15. [Protocol for the diagnosis and follow up of patients with cystic fibrosis].

    PubMed

    Barrio Gómez de Agüero, M I; García Hernández, G; Gartner, S

    2009-09-01

    Cystic fibrosis (CF) is the most common severe recessive genetic disease in Caucasians. During the last years, new therapies and aggressive management of the lung disease have contributed significantly to the increased life expectancy in CF patients. A review and update of CF diagnosis and management of lung disease are included. The sweat chloride test (SCT) remains the gold standard for CF diagnosis and should be performed properly. However, in a few patients SCT results may not be conclusive to clarify the CF diagnosis. Patients with CF should be followed up in specialist Units by an expert multidisciplinary expert applying standard clinical protocols and using lung function tests, and microbiological and imaging studies. An overview with the recommendations for treatment of early onset and chronic infections due to Pseudomonas aeruginosa, Staphylococcus aureus and other uncommon pathogens is included. Furthermore, the management of other aspects of CF lung disease and complications is provided, as well as the indications for lung transplantation. This document has been prepared by the members of the CF working group of the Spanish Paediatrics Pulmonary Society to provide an update to the earlier documents published in this Journal in 1999.

  16. Follow-up study and response to treatment in 23 patients with Lewis-Sumner syndrome.

    PubMed

    Viala, K; Renié, L; Maisonobe, T; Béhin, A; Neil, J; Léger, J M; Bouche, P

    2004-09-01

    Lewis-Sumner syndrome (LSS) is a dysimmune peripheral nerve disorder, characterized by a predominantly distal, asymmetric weakness mostly affecting the upper limbs with sensory impairment, and by the presence of multifocal persistent conduction blocks. The nosological position of this neuropathy in relation to multifocal motor neuropathy (MMN) and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is still debated. We report the clinical, biological and electrophysiological features, the course and the response to treatment in 23 LSS patients. The initial symptoms started in the distal part of an upper limb in 70% of patients. They were sensorimotor in 65% and purely sensory in 35% of patients. A cranial nerve involvement was observed in 26% of patients and a distal limb amyotrophy in 52%. The CSF protein level was normal in 67% of patients and mildly elevated in the remainder. None had serum anti-GM1 antibodies. There were multiple motor conduction blocks (average of 2.87/patient), predominantly located in the forearm, whereas demyelinating features outside the blocked nerves were rare. Abnormal distal sensory potentials were found in 87% of patients. The electrophysiological pattern suggests a very focal motor fibre demyelination sparing the nerve endings, whereas sensory fibre involvement was widespread. The course was chronic progressive in 71% of patients and relapsing-remitting in the others. During the follow-up study (median duration of 4 years), half of the patients progressed with a multifocal pattern and the distribution of the motor deficit remained similar to the initial presentation. The other patients showed a progression to the other limbs, suggesting a more diffuse process. Fifty-four percent of the patients treated with intravenous immunoglobulin showed an improvement, compared with 33% of the patients treated with oral steroids. Overall, 73% of patients had a positive response to immune-mediated therapy. LSS may be distinguished

  17. Use of nurse-led telephone follow-up as a sole method of assessing patients after nasal surgery

    PubMed Central

    Sooby, Paul; Kirkland, Paul

    2015-01-01

    Patients undergoing nasal surgery have historically been routinely followed up in consultant led clinics some months after surgery. It has been noted that a significant proportion of these patients either did not attend these appointments or did not require them, impacting on the efficiency of ENT outpatient clinics. A quality improvement project was undertaken to assess this problem and to propose a new patient pathway whereby patients are contacted by ENT nursing staff by telephone three months following surgery. During these telephone conversations only 9.5% of patients requested outpatient follow-up and all of these patients were discharged upon their follow-up. The project demonstrates that nurse-led follow up is an efficient, effective and safe way of managing patient care post-nasal surgery. PMID:26734352

  18. Benefit of follow-up CT in emergency department patients with persistent non-traumatic abdominal pain.

    PubMed

    Asrani, Ashwin V; Johnson, Jamlik-Omari F; Novelline, Robert A

    2011-01-01

    To determine the benefit of a short-term follow-up abdominopelvic computed tomography (APCT) examination among emergency department (ED) patients with persistent abdominal pain and an initially negative CT. During a 5-year period from January 2004 to December 2008, our institution's radiology department performed approximately 56,000 APCTs examinations in the ED. Sixty-eight percent of the APCT examinations used intravenous contrast. Nine hundred fifty-seven patients received two APCTs within 1 week for non-traumatic abdominal pain in the ED. Sixty-four patients with initially negative APCTs presented to the ED within 1 week with persistent abdominal pain and received follow-up APCT imaging. The mean follow-up period was 2.6 days. The mean interval period in which the second APCT yielded a positive result was 2.0 days. Seventy-five percent of follow-up examinations were performed with intravenous contrast. Twenty-three percent of patients had positive findings on the follow-up examination. Seventy-three percent of the follow-up positive findings were referable to bowel pathology. The cause of abdominal pain remained elusive at 1 week in 23% of patients. Short-term follow-up APCT examinations in patients with persistent, unexplained abdominal pain may be of benefit if the second APCT is performed with intravenous contrast in patients suspected of having bowel pathology.

  19. Methodological Challenges Associated with Patient Responses to Follow-up Longitudinal Surveys Regarding Quality of Care

    PubMed Central

    Kahn, Katherine L; Liu, Honghu; Adams, John L; Chen, Wen-Pin; Tisnado, Diana M; Carlisle, David M; Hays, Ron D; Mangione, Carol M; Damberg, Cheryl L

    2003-01-01

    Objective To illustrate, using empirical data, methodological challenges associated with patient responses to longitudinal surveys regarding the quality of process of care and health status, including overall response rate, differential response rate, and stability of responses with time. Data Sources/Study Setting Primary patient self-report data were collected from 30,308 patients in 1996 and 13,438 patients in 1998 as part of a two-year longitudinal study of quality of care and health status of patients receiving care delivered by 63 physician organizations (physician groups) across three West Coast states. Study Design We analyzed longitudinal, observational data collected by Pacific Business Group on Health (PBGH) from patients aged 18–70 using a four-page survey in 1996 and a similar survey in 1998 to assess health status, satisfaction, use of services, and self-reported process of care. A subset of patients with self-reported chronic disease in the 1996 study received an enriched survey in 1998 to more fully detail processes of care for patients with chronic disease. Data Collection/Extraction Methods We measured response rate overall and separately for patients with chronic disease. Logistic regression was used to assess the impact of 1996 predictors on response to the follow-up 1998 survey. We compared process of care scores without and with nonresponse weights. Additionally, we measured stability of patient responses over time using percent agreement and kappa statistics, and examined rates of gender inconsistencies reported across the 1996 and 1998 surveys. Principal Findings In 1998, response rates were 54 percent overall and 63 percent for patients with chronic disease. Patient demographics, health status, use of services, and satisfaction with care in 1996 were all significant predictors of response in 1998, highlighting the importance of analytic strategies (i.e., application of nonresponse weights) to minimize bias in estimates of care and

  20. Patients' experiences of an open access follow up arrangement in managing inflammatory bowel disease.

    PubMed

    Rogers, A; Kennedy, A; Nelson, E; Robinson, A

    2004-10-01

    Improving access is a key policy issue in improving quality of care and extending patient choice and participation. People's experience of changing from fixed outpatient appointments to more flexible direct access arrangements for chronic disease has been underexplored. To examine patients' views on using an open system of access compared with fixed outpatient appointments as part of a guided self-management intervention for inflammatory bowel disease (IBD). Embedded qualitative study undertaken alongside a randomised controlled trial. Semi-structured interviews were undertaken to obtain an in depth understanding of patients' experience of the change in access arrangements. A purposive sample (n = 30) was drawn from the intervention group (n = 700) according to a range of responses to the trial baseline and follow up quantitative measures. 28 interviews were included in the analysis. Compared with the previous system of fixed appointments, preference for the new open access system was based on enhanced personal control in contacting services and the view that it fitted better with everyday routine management and the requirement for urgent medical contact when symptoms fail to respond to medication. Preference for retaining fixed appointments was based on a sense of security from gaining access which did not require the individual to initiate the request for medical help. Open access may fit better with patients' self-management of their condition and everyday routines, roles and responsibilities. Ensuring that outpatient organisational arrangements and personnel are responsive to patient initiated requests for appointments is likely to impact on the acceptability of this type of access arrangement. Some people may continue to prefer the fixed appointment system which should be retained if patient choice is to be respected.

  1. Six-year follow-up of the treatment of patients with dissociative disorders study.

    PubMed

    Myrick, Amie C; Webermann, Aliya R; Loewenstein, Richard J; Lanius, Ruth; Putnam, Frank W; Brand, Bethany L

    2017-01-01

    Objective: Literature on the treatment of dissociative disorders (DDs) suggests that these individuals require long-term and specialized treatment to achieve stabilization and functionality. There is considerable empirical support for specialized phasic, dissociation-focused treatment in reducing a myriad of psychological symptoms and self-harm in this population. However, until recently, there has been a paucity of longitudinal treatment research on DD patients. Method: In the present six-year follow-up study, 61 therapists who participated in the initial phase of the Treatment of Patients with Dissociative Disorders (TOP DD) study answered questionnaires about their study patient's stressors, quality of life, global functioning, victimization, and safety. These results provided a view of patients' progress six years since the beginning of the TOP DD study. Results: Longitudinal analyses demonstrated patients had significantly fewer stressors (Χ(2) (6) = 18.76, p < .01, canonical r = .48, N = 76), instances of sexual revictimization (X(2)(1) = 107.05, p < .001) and psychiatric hospitalizations (t(54) = 2.57, p < .05, Cohen's d = .43), as well as higher global functioning (Χ(2) (2) = 59.27, p < .001, canonical r = .65, N = 111). Conclusions: These findings continue to support the initial results of the TOP DD study that, despite marked initial difficulties and functional impairment, DD patients benefit from specialized treatment.

  2. Patients' experiences of an open access follow up arrangement in managing inflammatory bowel disease

    PubMed Central

    Rogers, A; Kennedy, A; Nelson, E; Robinson, A

    2004-01-01

    Background: Improving access is a key policy issue in improving quality of care and extending patient choice and participation. People's experience of changing from fixed outpatient appointments to more flexible direct access arrangements for chronic disease has been underexplored. Objectives: To examine patients' views on using an open system of access compared with fixed outpatient appointments as part of a guided self-management intervention for inflammatory bowel disease (IBD). Design: Embedded qualitative study undertaken alongside a randomised controlled trial. Semi-structured interviews were undertaken to obtain an in depth understanding of patients' experience of the change in access arrangements. Participants: A purposive sample (n = 30) was drawn from the intervention group (n = 700) according to a range of responses to the trial baseline and follow up quantitative measures. Results: 28 interviews were included in the analysis. Compared with the previous system of fixed appointments, preference for the new open access system was based on enhanced personal control in contacting services and the view that it fitted better with everyday routine management and the requirement for urgent medical contact when symptoms fail to respond to medication. Preference for retaining fixed appointments was based on a sense of security from gaining access which did not require the individual to initiate the request for medical help. Conclusions: Open access may fit better with patients' self-management of their condition and everyday routines, roles and responsibilities. Ensuring that outpatient organisational arrangements and personnel are responsive to patient initiated requests for appointments is likely to impact on the acceptability of this type of access arrangement. Some people may continue to prefer the fixed appointment system which should be retained if patient choice is to be respected. PMID:15465941

  3. Flat affect and social functioning: a 10 year follow-up study of first episode psychosis patients.

    PubMed

    Evensen, Julie; Røssberg, Jan Ivar; Barder, Helene; Haahr, Ulrik; Hegelstad, Wenche Ten Velden; Joa, Inge; Johannessen, Jan Olav; Larsen, T K; Melle, Ingrid; Opjordsmoen, Stein; Rund, Bjørn Rishovd; Simonsen, Erik; Vaglum, Per; McGlashan, Thomas; Friis, Svein

    2012-08-01

    Affective flattening has been described as enduring, but long term follow-up studies of first episode psychosis patients are lacking. The aim of this study was to follow the symptom development of flat affect (FA), over a 10 year follow-up period, with focus on prevalence, predictors and outcome factors including social functioning. Three-hundred-and-one patients with FEP were included at baseline, 186 participated in the 10 year follow-up. These were followed on PANSS item N1 (FA) from baseline through 5 follow-up assessments over 10 years. Patients were grouped as having never-present, improving, deteriorating, fluctuating or enduring FA. The groups were compared on baseline variables, variables at 10 year follow-up, and social functioning throughout the follow-up period. Twenty nine percent never displayed FA, 66% had improving, deteriorating or fluctuating FA, while 5% of patients had enduring FA. Premorbid social function predicted enduring FA. The patients with enduring, fluctuating and deteriorating FA did poorer on all outcome variables, including remission and recovery rates. The enduring FA group did significantly poorer in social functioning over the 10 year period. FA is expressed at some point of time in the majority of FEP patients in a 10 year follow-up period, and appears more fluctuant than expected from the relevant literature. FA is associated with poorer outcome after 10 years, and enduring FA to poorer social function at all points of assessment. Copyright © 2012 Elsevier B.V. All rights reserved.

  4. ANMCO Position Paper: long-term follow-up of patients with pulmonary thromboembolism

    PubMed Central

    Zonzin, Pietro; Enea, Iolanda; Gulizia, Michele Massimo; Ageno, Walter; Agostoni, Piergiuseppe; Azzarito, Michele; Becattini, Cecilia; Bongarzoni, Amedeo; Bux, Francesca; Casazza, Franco; Corrieri, Nicoletta; D’Alto, Michele; D’Amato, Nicola; D’Armini, Andrea Maria; De Natale, Maria Grazia; Di Minno, Giovanni; Favretto, Giuseppe; Filippi, Lucia; Grazioli, Valentina; Palareti, Gualtiero; Pesavento, Raffaele; Roncon, Loris; Scelsi, Laura; Tufano, Antonella

    2017-01-01

    Abstract Venous thromboembolism (VTE), including pulmonary embolism and deep venous thrombosis, is the third most common cause of cardiovascular death. The management of the acute phase of VTE has already been described in several guidelines. However, the management of the follow-up (FU) of these patients has been poorly defined. This consensus document, created by the Italian cardiologists, wants to clarify this issue using the currently available evidence in VTE. Clinical and instrumental data acquired during the acute phase of the disease are the cornerstone for planning the FU. Acquired or congenital thrombophilic disorders could be identified in apparently unprovoked VTE during the FU. In other cases, an occult cancer could be discovered after a VTE. The main targets of the post-acute management are to prevent recurrence of VTE and to identify the patients who can develop a chronic thromboembolic pulmonary hypertension. Knowledge of pathophysiology and therapeutic approaches is fundamental to decide the most appropriate long-term treatment. Moreover, prognostic stratification during the FU should be constantly updated on the basis of the new evidence acquired. Currently, the cornerstone of VTE treatment is represented by both the oral and the parenteral anticoagulation. Novel oral anticoagulants should be an interesting alternative in the long-term treatment. PMID:28751848

  5. Percutaneous Vertebroplasty in Multiple Myeloma: Prospective Long-Term Follow-Up in 106 Consecutive Patients

    SciTech Connect

    Anselmetti, Giovanni Carlo Manca, Antonio; Montemurro, Filippo; Hirsch, Joshua; Chiara, Gabriele; Grignani, Giovanni Carnevale Schianca, Fabrizio Capaldi, Antonio Rota Scalabrini, Delia; Sardo, Elena Debernardi, Felicino; Iussich, Gabriella; Regge, Daniele

    2012-02-15

    Purpose: Percutaneous vertebroplasty (PV) is a minimally invasive procedure involving the injection of bone cement within a collapsed vertebral body. Although this procedure was demonstrated to be effective in osteoporosis and metastases, few studies have been reported in cases of multiple myeloma (MM). We prospectively evaluated the safety and efficacy of PV in the treatment of vertebral compression fractures (VCFs) resulting from MM. Materials and Methods: PV was performed in 106 consecutive MM patients who had back pain due to VCFs, the treatment of which had failed conservative therapies. Follow-up (28.2 {+-} 12.1 months) was evaluated at 7 and 15 days as well as at 1, 3, 6, 12, 18, and every 6 months after PV. Visual analog scale (VAS) pain score, opioid use, external brace support, and Oswestry Disability Index (ODI) score were recorded. Results: The median pretreatment VAS score of 9 (range 4-10) significantly (P < 0.001) decreased to 1 (range 0-9) after PV. Median pre-ODI values of 82% (range 36-89%) significantly improved to 7% (range 0-82%) (P < 0.001). Differences in pretreatment and posttreatment use of analgesic drug were statistically significant (P < 0.001). The majority of patients (70 of 81; 86%) did not use an external brace after PV (P < 0.001). Conclusion: PV is a safe, effective, and long-lasting procedure for the treatment of vertebral compression pain resulting from MM.

  6. Pallidal stimulation for segmental dystonia: long term follow up of 11 consecutive patients.

    PubMed

    Sensi, Mariachiara; Cavallo, Michele A; Quatrale, Rocco; Sarubbo, Silvio; Biguzzi, Sara; Lettieri, Cristian; Capone, Jay G; Tugnoli, Valeria; Tola, Maria Rosaria; Eleopra, Roberto

    2009-09-15

    Pallidal stimulation is a convincing and valid alternative for primary generalized dystonia refractory to medical therapy or botulinum toxin. However, the clinical outcome reported in literature is variable most likely because of heterogeneity DBS techniques employed and /or to clinical dystonic pattern of the patients who undergo surgery. In this study, we report the long term follow up of a homogeneous group of eleven subjects affected by segmental dystonia who were treated with bilateral stimulation of the Globus Pallidus pars interna (GPi) from the years 2000 to 2008. All the patients were evaluated, before surgery and at 6-12-24-36 months after the treatment, in accordance with the Burke Fahn Marsden Dystonia Rating Scale (BFMDRS). Our study indicates that DBS promotes an early and significant improvement at 6 months with an even and a better outcome later on. The analysis of specific sub items of the BFMDRS revealed an earlier and striking benefit not only as far as segmental motor function of the limbs but also for the complex cranial functions like face, (eyes and mouth), speech and swallowing, differently from results reported in primary generalized dystonia. Deep Brain Stimulation of GPi should be considered a valid indication for both generalized and segmental dystonia when other therapies appear ineffective.

  7. An implantable neuroprosthesis for standing and walking in paraplegia: 5-year patient follow-up

    NASA Astrophysics Data System (ADS)

    Guiraud, David; Stieglitz, Thomas; Koch, Klaus Peter; Divoux, Jean-Louis; Rabischong, Pierre

    2006-12-01

    We present the results of a 5-year patient follow-up after implantation of an original neuroprosthesis. The system is able to stimulate both epimysial and neural electrodes in such a way that the complete flexor-extensor chain of the lower limb can be activated without using the withdrawal reflex. We demonstrate that standing and assisted walking are possible, and the results have remained stable for 5 years. Nevertheless, some problems were noted, particularly regarding the muscle response on the epimysial channels. Analysis of the electrical behaviour and thresholds indicated that the surgical phase is crucial because of the sensitivity of the functional responses to electrode placement. Neural stimulation proved to be more efficient and more stable over time. This mode requires less energy and provides more selective stimulation. This FES system can be improved to enable balanced standing and less fatiguing gait, but this will require feedback on event detection to trigger transitions between stimulation sequences, as well as feedback to the patient about the state of his lower limbs.

  8. Intracorneal ring segment depth in keratoconus patients: a long-term follow-up study.

    PubMed

    Shahhoseini, Saied; Hashemi, Hassan; Asgari, Soheila

    2017-06-12

    To compare the actual depth of the tunnel created with femtosecond laser for intracorneal ring segment (ICRS) implantation with the target depth in keratoconus patients. In this mix design study, eligible keratoconus patients were identified through chart review. The inclusion criterion was a history of ICRS implantation with femtosecond laser more than 6 months prior to enrollment. Participants underwent anterior segment optical coherence tomography using Spectralis (Heidelberg Engineering GmbH, Heidelberg, Germany) for depth measurement defined as the distance from the anterior corneal surface to anterior rim of the ring. The mean age of the 30 participants was 31.4 ± 7.9 years, and 58.6% were male. Mean follow-up time after ring implantation was 25.8 ± 10.0 (range 7-41) months. Mean actual depth was 59.9% (42.4-86.8%), and the target depth was 85.0% (74.8-90.0%) (P < 0.001). The ring was at a depth of less than 70% in 25 eyes of the 30 (83.3%) studied eyes. The mean 26 months after implantation, ring segments are placed at a shallower depth than originally intended. Therefore, although femtosecond laser technology is an acceptable method for the surgeon, it is necessary to revisit the depth calculator of the device.

  9. Regular aquatic exercise for chronic kidney disease patients: a 10-year follow-up study.

    PubMed

    Pechter, Ülle; Raag, Mait; Ots-Rosenberg, Mai

    2014-09-01

    Chronic kidney disease (CKD) patients not yet in dialysis can benefit from increased physical activity; however, the safety and outcomes of aquatic exercise have not been investigated in observational studies. The aim of this study was to analyze association of 10 years of regularly performed aquatic exercise with the study endpoint--that is, all-cause death or start of dialysis. Consecutive CKD patients were included in the study in January 2002. The exercise group (n=7) exercised regularly under the supervision of physiotherapist for 10 years; the control group (n=9), matched in terms of age and clinical parameters, remained sedentary. Low-intensity aerobic aquatic exercise was performed regularly twice a week; 32 weeks or more of exercise therapy sessions were conducted annually. None of the members of the aquatic exercise group reached dialysis or died in 10 years. In the sedentary control group, 55% reached the study endpoint--renal replacement therapy (n=2) or all-cause death (n=3). Occurrence of the study endpoint, compared using the exact multinomial test with unconditional margins, was statistically significantly different (P-value: 0.037) between the study groups. Regular supervised aquatic exercise arrested CKD progression. There was a statistically significant difference between the sedentary group and the exercise group in reaching renal replacement therapy or all-cause death in a follow-up time of 10 years.

  10. Prosthetic Rehabilitation of a Patient With Gastroesophageal Reflux Disease: Five-Year Follow-up.

    PubMed

    Moretto, G; Pupo, Y M; Bueno, A L N; Araujo, F O

    2016-01-01

    Tooth wear is a multifactorial process that is a growing concern in dentistry. This phenomenon can be caused by mechanical (attrition, abrasion, or abfraction) or chemical (erosion) processes. Etiologic factors in dental erosion can be due to changes in behavior, an unbalanced diet, or gastrointestinal disorders such as acid regurgitation, which may influence the salivary flow rate and buffering capacity of saliva. This case report describes an esthetic rehabilitation of a patient with gastroesophageal reflux and dental erosion, with a treatment rationale that includes the use of a diagnostic template and five-year follow-up. This technique, presented here in a clinical case with moderate enamel loss, integrates an additive wax-up and a direct intraoral bis-acryl resin mock-up. Lithium disilicate glass-ceramic (IPS e.max Press, Ivoclar Vivadent) laminate veneers were fabricated with the heatpress technique. They were veneered with a layering ceramic (IPS e.max Ceram, Ivoclar Vivadent) to improve the appearance of the incisal edge. The case demonstrated the success of veneers as an effective, conservative, and esthetic treatment for patients with this pathology.

  11. Stainless steel wire mesh cranioplasty: ten years' experience with 183 patients (100 followed up).

    PubMed

    Datti, R; Cavagnaro, G; Camici, S

    1985-01-01

    We have executed 183 cranioplasties in order to repair cranial defects using stainless steel wire mesh over a period of a decade, using Gardner's technique with minor modifications. The follow-up was possible in 100 patients and it ranged from 4 to 134 months, with an average of 64.1 months (5.3 years). Among these, 8 patients developed postoperative complications (8%): 7 needed cranioplasty remotion (7%) and 1 needed cranioplasty revision without remotion (1%). The causes of morbidity were due to: infection (3%), CSF leak (1%), haematoma (1%), skin local soaking (1%), posttraumatic plastic dislodgement (2%). Our total morbidity rate (8%) may compare with that resulting from the use of different materials such as alloplastics (6-12%), osteoplastics (until 40%) and miscellaneous (5.5%). The group in which cranioplasty was done within six months following the first operation had our highest complication rate (18.2%). In our experience the stainless steel wire mesh was shown to be an effective material to repair cranial defects.

  12. Accelerated Corneal Collagen Cross-Linking in Pediatric Patients: Two-Year Follow-Up Results

    PubMed Central

    Shetty, Rohit; Nagaraja, Harsha; Jayadev, Chaitra; Pahuja, Natasha Kishore; Kurian Kummelil, Mathew; Nuijts, Rudy M. M. A.

    2014-01-01

    Purpose. To evaluate the effectiveness and safety of accelerated corneal collagen cross-linking (ACXL) in patients below 14 years of age with progressive keratoconus. Materials and Methods. Thirty eyes of 18 patients with established progressive keratoconus underwent preoperative and postoperative visual acuity assessment, topography, and specular microscopy prior to ACXL and were followed up for 24 months. Results. Mean age of the patients was 12.7 years with ten males and eight females. There was an improvement in the mean postoperative uncorrected distant visual acuity (from 0.76 ± 0.26 to 0.61 ± 0.25; P = 0.005), mean corrected distant visual acuity (from 0.24 ± 0.19 to 0.12 ± 0.12; P < 0.001), mean spherical refraction (from −3.04 DS ± 3.60 to −2.38 DS ± 3.37; P = 0.28), mean cylinder (from −3.63 DC ± 1.82 to −2.80 DC ± 1.48; P = 0.008), and spherical equivalent (from −4.70 D ± 3.86 to −3.75 D ± 3.49; P = 0.15). Three eyes of two patients with vernal keratoconjunctivitis (VKC) showed progression. There were no intra- or postoperative complications. Conclusion. In pediatric patients ACXL is an effective and safe procedure for the management of keratoconus. Optimal management of VKC is important to arrest the progression of keratoconus. PMID:25295278

  13. A 6-month follow-up of nutritional status in institutionalized patients with Alzheimer's disease.

    PubMed

    Van Wymelbeke, V; Guédon, A; Maniere, D; Manckoundia, P; Pfitzenmeyer, P

    2004-01-01

    A follow up of nutritional status in institutionalized patients with Alzheimer's disease. Observational study. Specialized unit for patients with Alzheimer's disease in Dijon hospital, France. Fourteen women, aged 72-92 years. On admission of patients to the specialized unit for dementia, body weight, body mass index, arm muscle circumference (AMC) and triceps skin fold (TSF) were measured. Serum concentrations of albumin, prealbumin, homocysteine, orosomucoide, calcium, folates, vitamins B12 and B6 and C-reactive protein were recorded. The same clinical and biological measurements were repeated at day 30, 90 and 180. Both mean weight and mean BMI increased throughout the study with significant differences between day 0 and day 90, and day 180 (p<0.01). The weight gain was associated with a significant increase in AMC and TSF (p<0.01 and p<0.001, respectively). There was no significant difference for values of both mean serum levels of albumin and prealbumin between day 0 and day 180. Whatever the period, serum concentrations of folates and vitamin B12 were in the normal range, while mean levels of vitamin B6 were lower than the normal range; For all these values, there was no significant difference between day 0, 30, 90, 180. Mean levels of C-reactive protein and orosomucoide and lymphocyte counts were in the normal range both at admission and day 180. No significant difference was noted between value of homocysteine at admission and at day 180. In this special care unit, the patients with Alzheimer's disease who take part in daily activities and particularly preparation of the meal don't lose weight. It is certain that future studies recording food intake and energy expenditure are necessary to explain the benefits in the nutritional status observed in patients showing dementia when they are institutionalized in a special unit.

  14. Using case-mix information in strategic hospital marketing. Deriving market research from patient data.

    PubMed

    Little, A

    1992-01-01

    Hospital survival requires adaptation, adaptation requires understanding, and understanding requires information. These are the basic equations behind hospital strategic marketing, and one of the answers may lie in hospitals' own patient-data systems. Marketers' and administrators' enlightened application of case-mix information could become one more hospital survival tool.

  15. The effects of traumatic brain injury on patients and their families. A follow-up study.

    PubMed

    Inzaghi, M G; De Tanti, A; Sozzi, M

    2005-12-01

    With this study we wanted to verify whether the same uneasiness elements as those described by numerous previous studies also existed in an Italian sample of traumatic brain-injured (TBI) patients. A follow-up investigation was conducted on a sample of 16 subjects who had suffered severe TBI 5 to 10 years earlier. Based on series of neuropsychological tests, the patients' levels of remaining autonomous function were assessed. For each patient, a family reference person was identified with a semistructured interview to define how they dealt with the consequences of the trauma within the familial nucleus, what motivated their choices, the social outcome of the familial nucleus, the behavioral outcome, and the social- and work-related outcomes of the patient. The caregiver's current emotions were also analyzed. The study results confirmed that the family felt isolated from the social groups it used to belong to, and that few patients had fully achieved reinsertion into their social and/or work environments. Only 50% of subjects had returned to their job, most of them finding work at a lower level. The closest relatives reported experiencing a state of hardship. Many (70%) care-givers expressed by a steady feeling of worry but had devised effective compensatory strategies over the course of the study period to deal with depression. Such compensation appeared to be the result of the care-givers' awareness of the need to cope with situations where the patients very often depended on them. The hardship level the patient's familial nucleus experienced was not correlated with the patient's social- and work-related outcome, and elements of difficulty were evident among the relatives of patients who had returned to a productive life and those who were close to the family. The presence of severe cognitive and/or behavioral disability was a major factor in generating concern and worry about the future. In cases where the patient was severely disabled, the happiness level

  16. Follow up of patients who start treatment with antidepressants: treatment satisfaction, treatment compliance, efficacy and safety

    PubMed Central

    2013-01-01

    Background Measuring satisfaction with treatment has proved useful to ascertain the treatment features that are most important to the patients, and to explain increased treatment compliance. However, there are few studies that relate satisfaction to other clinical or self-perceived health status indicators. Recent studies have shown the close relationship between satisfaction with treatment, treatment compliance, and effectiveness. This study attempts to design and validate a scale to evaluate satisfaction with antidepressant drug therapy, assess treatment compliance (self-reported, validated questionnaire, drug accountability and electronic monitorization system), assess efficacy in reducing depressive symptoms and safety in patients who initiate antidepressant drug therapy, as well as to establish predictors of satisfaction, compliance and effectiveness with these drugs. Methods/design This is an observational longitudinal study with a cohort of adults initiating treatment with antidepressant drugs. A multi-centre study will be performed in which 20 Primary Care practices from Castilla-La Mancha are expected to participate. An initial interview and follow-up visits at 15 days, 1, 3, 6, 9 and 12 months will be conducted with all study participants. 706 subjects will be studied (95% confidence interval, precision ± 3%, expected rate of non-compliance 50%, expected non-responders and lost to follow up rate 15%). The following measurements will be performed: development and validation of a scale of satisfaction with antidepressant therapy, participant and antidepressant characteristics, treatment compliance evaluation (Haynes-Sackett Test, Morisky-Green Test, drug accountability and Medication Event Monitoring System), depression symptom reduction (Hamilton Depression Rating Scale and Montgomery-Asberg Depression Rating Scale), observation of adverse effects, and beliefs about treatment (The Beliefs about Medicines Questionnaire). Discussion Antidepressant drugs are

  17. The health status of Q-fever patients after long-term follow-up

    PubMed Central

    2011-01-01

    Background In the Netherlands, from 2007 to 2009, 3,522 Q-fever cases were notified from three outbreaks. These are the largest documented outbreaks in the world. Previous studies suggest that symptoms can persist for a long period of time, resulting in a reduced quality of life (QoL). The aim of this study was to qualify and quantify the health status of Q-fever patients after long-term follow-up. Methods 870 Q-fever patients of the 2007 and 2008 outbreaks were mailed a questionnaire 12 to 26 months after the onset of illness. We assessed demographic data and measured health status with the Nijmegen Clinical Screening Instrument (NCSI). The NCSI consists of three main domains of functional impairment, symptoms and QoL that are divided into eight sub-domains. The NCSI scores of Q-fever patients older than 50 years (N = 277) were compared with patients younger than 50 years (N = 238) and with norm data from healthy individuals (N = 65) and patients with chronic obstructive pulmonary disease (N = 128). Results The response rate was 65.7%. After applying exclusion criteria 515 Q-fever patients were included in this study. The long-term health status of two thirds of Q-fever patients (both younger and older than 50 years) was severely affected for at least one sub-domain. Patients scores were most severely affected on the sub-domains general QoL (44.9%) and fatigue (43.5%). Hospitalisation in the acute phase was significantly related to long-term behavioural impairment (OR 2.8, CI 1.5-5.1), poor health related QoL (OR 2.3,CI 1.5-4.0) and subjective symptoms (OR 1.9, CI 1.1-3.6). Lung or heart disease, depression and arthritis significantly affected the long-term health status of Q-fever patients. Conclusions Q-fever patients presented 12 to 26 months after the onset of illness severe -clinically relevant- subjective symptoms, functional impairment and impaired QoL. All measured sub-domains of the health status were impaired. Hospitalisation and co-morbidity were

  18. [Cardiac rehabilitation in patients with myocardial infarction: a 10-year follow-up study].

    PubMed

    Maroto Montero, José M; Artigao Ramírez, Rosario; Morales Durán, María D; de Pablo Zarzosa, Carmen; Abraira, Víctor

    2005-10-01

    Very little information is available on the effect of cardiac rehabilitation programs on long-term survival. The primary aim of this study was to assess the effect of a structured cardiac rehabilitation program on mortality in patients who had suffered acute myocardial infarction. The secondary endpoint was the effect on morbidity. The study included 180 low-risk male patients aged under 65 years. Patients were randomly assigned to one of 2 groups: 90 entered into a comprehensive cardiac rehabilitation program, and 90 served as a control group. The mean follow-up period was 10 years. All-cause mortality was significantly lower in the intervention group: the 10-year survival rate was 91.8% in the intervention group compared with 81.7% in the control group (P=.04). There was also a decrease in cardiovascular mortality, though it was not statistically significant: the 10-year survival rate was 91.8% in the intervention group compared with 83.8% in the control group (P=.10). The incidence of non-fatal complications was lower in the intervention group (35.2% vs 63.2%, P=.03), as was the incidence of unstable angina (15.7% vs 33.9%, P =.02) and cardiac heart failure (3.0% vs 14.4%, P=.02), and the need for coronary intervention (8.4% vs 22.9%, P=.02). The application of a comprehensive cardiac rehabilitation program significantly decreased long-term mortality and morbidity in low-risk patients after acute myocardial infarction.

  19. Six-year follow-up of the treatment of patients with dissociative disorders study*

    PubMed Central

    Myrick, Amie C.; Webermann, Aliya R.; Loewenstein, Richard J.; Lanius, Ruth; Putnam, Frank W.; Brand, Bethany L.

    2017-01-01

    ABSTRACT Objective: Literature on the treatment of dissociative disorders (DDs) suggests that these individuals require long-term and specialized treatment to achieve stabilization and functionality. There is considerable empirical support for specialized phasic, dissociation-focused treatment in reducing a myriad of psychological symptoms and self-harm in this population. However, until recently, there has been a paucity of longitudinal treatment research on DD patients. Method: In the present six-year follow-up study, 61 therapists who participated in the initial phase of the Treatment of Patients with Dissociative Disorders (TOP DD) study answered questionnaires about their study patient’s stressors, quality of life, global functioning, victimization, and safety. These results provided a view of patients’ progress six years since the beginning of the TOP DD study. Results: Longitudinal analyses demonstrated patients had significantly fewer stressors (Χ2(6) = 18.76, p < .01, canonical r = .48, N = 76), instances of sexual revictimization (X 2(1) = 107.05, p < .001) and psychiatric hospitalizations (t(54) = 2.57, p < .05, Cohen’s d = .43), as well as higher global functioning (Χ2(2) = 59.27, p < .001, canonical r = .65, N = 111). Conclusions: These findings continue to support the initial results of the TOP DD study that, despite marked initial difficulties and functional impairment, DD patients benefit from specialized treatment. PMID:28680542

  20. Transdisciplinary approach to the follow-up of patients after myocardial infarction.

    PubMed

    Costa e Silva, Rosana; Pellanda, Lucia; Portal, Vera; Maciel, Patricia; Furquim, Aline; Schaan, Beatriz

    2008-08-01

    To compare conventional and transdisciplinary care in a tertiary outpatient clinic for patients after their first acute myocardial infarction. One hundred fifty-three patients with acute myocardial infarction were randomized at hospital discharge and followed-up to compare conventional (n=75) and transdisciplinary care (n=78). They were submitted to a clinical evaluation, received a dietary plan, and were re-evaluated twice in 60-180 days by a nurse, dietitian and physician, when new clinical and laboratory data were collected. The primary outcome was clinical improvement, as evaluated by an index including reduction of body weight, lowering of blood pressure, smoking cessation, increase in physical activity and compliance with medication. The groups were similar at baseline: 63.4% were men, 89.9% had an acute myocardial infarction with ST-segment-elevation, 32.7% were diabetic, and 72.2% were hypertensive. The clinical improvement index was similar between the studied groups: in 33.3 % (transdisciplinary care) vs. 30.4 % (conventional care) of patients, the improvement was very good (P=1.000). Rates of re-hospitalization and death (p=0.127) were similar between transdisciplinary and conventional care. Compliance with diet was higher for transdisciplinary care (50.0%) vs. conventional care (26.1%) (p=0.007), as was compliance with visits (73.3 vs. 40.3%, respectively, p<0.001). Compliance with diet and visits was higher for transdisciplinary care vs. conventional care; however, the transdisciplinary approach did not provide more clinical benefits than the conventional approach after patients' first acute myocardial infarction in this setting.

  1. Long-term follow-up on Cushing disease patient after transsphenoidal surgery.

    PubMed

    Jeong, Insook; Oh, Moonyeon; Kim, Ja Hye; Cho, Ja Hyang; Choi, Jin-Ho; Yoo, Han-Wook

    2014-09-01

    Cushing disease is caused by excessive adrenocorticotropic hormone (ACTH) production by the pituitary adenoma. Transsphenoidal surgery is its first-line treatment. The incidence of Cushing disease in children and adolescents is so rare that long-term prognoses have yet to be made in most cases. We followed-up on a 16-year-old male Cushing disease patient who presented with rapid weight gain and growth retardation. The laboratory findings showed increased 24-hour urine free cortisol and lack of overnight cortisol suppression by low-dose dexamethasone test. The serum cortisol and 24-hour urine free cortisol, by high-dose dexamethasone test, also showed a lack of suppression, and a bilateral inferior petrosal sinus sampling suggested lateralization of ACTH secretion from the right-side pituitary gland. However, after a right hemihypophysectomy by the transsphenoidal approach, the 24-hour urine free cortisol levels were persistently high. Thus the patient underwent a total hypophysectomy, since which time he has been treated with hydrocortisone, levothyroxine, recombinant human growth hormone, and testosterone enanthate. Intravenous bisphosphonate for osteoporosis had been administered for three years. At his current age of 26 years, his final height had attained the target level range; his bone mineral density was normal, and his pubic hair was Tanner stage 4. This report describes the long-term treatment course of a Cushing disease patient according to growth profile, pubertal status, and responses to hormone replacement therapy. The clinical results serve to emphasize the importance of growth optimization, puberty, and bone health in the treatment management of Cushing disease patients who have undergone transsphenoidal surgery.

  2. Cervical muscle area measurements in whiplash patients: Acute, 3, and 6 months of follow-up.

    PubMed

    Ulbrich, Erika J; Aeberhard, Ramon; Wetli, Sylvia; Busato, Andre; Boesch, Chris; Zimmermann, Heinz; Hodler, Juerg; Anderson, Suzanne E; Sturzenegger, Matthias

    2012-12-01

    To investigate the role of the cervical spine muscles in whiplash injury. We hypothesized that (i) cervical muscle hypotrophy would be evident after a 6-month follow-up and, (ii) cervical muscle hypotrophy would correlate with symptom persistence probably related to pain or inactivity. Ninety symptomatic patients (48 females) were recruited from our emergency department and examined within 48 h, and at 3, and 6 months after a motor vehicle accident. MRI cross-sectional muscle area (CSA) measurements were performed bilaterally of the cervical extensor and sternocleidomastoid muscles using transverse STIR (Short Tau inversion Recovery) sequences at the C2 (deep and total dorsal cervical extensor muscles), C4 (sternocleidomastoid muscles) and C5 (deep and total dorsal cervical extensor muscles) levels. Two blinded raters independently performed the measurements at each time point. First, CSA changes over time were analyzed and, second, CSAs were correlated with clinical outcomes (EuroQuol, Whiplash Disability Score, neck pain intensity [VAS], cervical spine mobility). There was a high agreement of CSA measurements between the two raters. Women consistently had smaller CSAs than men. There were no significant changes of CSAs over time at any of the three levels. There were no consistent significant correlations of CSA values with the clinical scores at all time points except with the body mass index. Our results do not support a major role of cervical muscle volume in the genesis of symptoms after whiplash injury. Copyright © 2012 Wiley Periodicals, Inc.

  3. Personality as a predictor of depression symptoms in burn patients: a follow-up study.

    PubMed

    Giannoni-Pastor, A; Gomà-i-Freixanet, M; Valero, S; Fidel Kinori, S G; Tasqué-Cebrián, R; Arguello, J M; Casas, M

    2015-02-01

    There is empirical evidence that having some personality characteristics increases the risk of developing depression. This is the first study which analyses the role of personality dimensions, assessed by the Alternative Five Factor Model, in the development of depressive symptoms in adult burn survivors across time. Participants were 109 adult burn survivors admitted to a Burns Unit. Personality was assessed by the Zuckerman-Kuhlman Personality Questionnaire and depression symptoms by the Beck Depression Inventory. After adjusting by age, gender and burn size, results showed that high Neuroticism-Anxiety (N-Anx) and Aggression-Hostility (Agg-Host) were related to higher depression scores when compared with low N-Anx and Agg-Host groups along the six months follow-up. Moreover, Activity and Impulsive-Sensation Seeking factors were involved in statistically significant different depressive symptom development trajectories during the six months after burn. These findings suggest that personality factors could be used to identify the most vulnerable patients, who could develop severe mood symptoms at different points in their recovery. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  4. Multi-observation PET image analysis for patient follow-up quantitation and therapy assessment.

    PubMed

    David, S; Visvikis, D; Roux, C; Hatt, M

    2011-09-21

    In positron emission tomography (PET) imaging, an early therapeutic response is usually characterized by variations of semi-quantitative parameters restricted to maximum SUV measured in PET scans during the treatment. Such measurements do not reflect overall tumor volume and radiotracer uptake variations. The proposed approach is based on multi-observation image analysis for merging several PET acquisitions to assess tumor metabolic volume and uptake variations. The fusion algorithm is based on iterative estimation using a stochastic expectation maximization (SEM) algorithm. The proposed method was applied to simulated and clinical follow-up PET images. We compared the multi-observation fusion performance to threshold-based methods, proposed for the assessment of the therapeutic response based on functional volumes. On simulated datasets the adaptive threshold applied independently on both images led to higher errors than the ASEM fusion and on clinical datasets it failed to provide coherent measurements for four patients out of seven due to aberrant delineations. The ASEM method demonstrated improved and more robust estimation of the evaluation leading to more pertinent measurements. Future work will consist in extending the methodology and applying it to clinical multi-tracer datasets in order to evaluate its potential impact on the biological tumor volume definition for radiotherapy applications.

  5. Multi-observation PET image analysis for patient follow-up quantitation and therapy assessment

    PubMed Central

    David, Simon; Visvikis, Dimitris; Roux, Christian; Hatt, Mathieu

    2011-01-01

    In Positron Emission Tomography (PET) imaging, an early therapeutic response is usually characterized by variations of semi-quantitative parameters restricted to maximum SUV measured in PET scans during the treatment. Such measurements do not reflect overall tumour volume and radiotracer uptake variations. The proposed approach is based on multi-observation image analysis for merging several PET acquisitions to assess tumour metabolic volume and uptake variations. The fusion algorithm is based on iterative estimation using stochastic expectation maximization (SEM) algorithm. The proposed method was applied to simulated and clinical follow-up PET images. We compared the multi-observation fusion performance to threshold-based methods, proposed for the assessment of the therapeutic response based on functional volumes. On simulated datasets, the adaptive threshold applied independently on both images led to higher errors than the ASEM fusion and on the clinical datasets, it failed to provide coherent measurements for four patients out of seven due to aberrant delineations. The ASEM method demonstrated improved and more robust estimation of the evaluation leading to more pertinent measurements. Future work will consist in extending the methodology and applying it to clinical multi-tracers datasets in order to evaluate its potential impact on the biological tumour volume definition for radiotherapy applications. PMID:21846937

  6. Use of an extended INR follow-up interval for Veteran patients in an anticoagulation clinic.

    PubMed

    Porter, Andrea L; Margolis, Amanda R; Schoen, Rebecca R; Staresinic, Carla E; Ray, Cheryl A; Fletcher, Christopher D

    2017-04-01

    A prospective, single-arm study of 50 participants evaluated an extended INR follow-up interval to determine the implementation feasibility and safety of an extended interval in Veterans on a stable dose of warfarin. A protocol was designed to allow for a rigorous, yet pragmatic evaluation of a 12-week INR follow-up interval. Feasibility was determined by study enrollment, retention, and participant achievement rates for the extended INR interval. Safety was determined by bleeding and thromboembolism rates. Participants were monitored for 6 months. Despite the long-term stability of participants prior to enrollment, only 56% achieved a 12-week follow-up interval and only 34% of enrolled participants maintained a 12-week interval. Sixteen percent of participants were never eligible for an extension of their INR follow-up interval despite meeting initial enrollment criteria. There were two major bleeding events and one participant who experienced a thromboembolic event. Implementation of an extended interval of INR follow-up appears feasible as participant enrollment goals were met and pharmacists were able to follow the study protocol. However, a lower than expected proportion of participants were able to achieve and maintain an extended INR follow-up interval. Future evaluations are needed to confirm the safety of an extended INR interval.

  7. [Satisfaction of principal caregivers of patients followed-up by palliative care teams].

    PubMed

    Fernández-Isla, L E; Conde-Valvis-Fraga, S; Fernández-Ruíz, J S

    2016-10-01

    To determine the satisfaction of main caregivers of deceased patients followed-up by palliative care teams. Web research on electronic data bases: PubMed and MEDES, using "Palliative Care" and "Patient Satisfaction" as main descriptors, and "Family", "Professional-Family Relations", "Quality of Health Care" and "Quality Assurance, Health Care" as secondary descriptors. Studies written in Spanish and English were included. Profile of principal caregiver: a woman between her mid-forties and her mid-fifties, usually related with the patient as a daughter, and of primary educational level. The items that the main caregivers valued the most were: a kind manner, feeling free to ask questions about problems during the process, tactful explanations, receiving information, pain management, time for answering questions, interest for emotional problems, and information about treatment. The worse valued items were: symptoms control, lack of psychological support after death, preparation for a death of a relative, keeping in touch after death, help to resolve outstanding issues, and help during grief. In general, a great majority of palliative care teams achieved excellent results. In spite of the good results obtained in satisfaction surveys from caregivers with regard to palliative care teams, it is essential to improve the quality of scientific-technical training (both from the medical and the psychological point of view), as well as to improve communicational skills among palliative care staff. Copyright © 2016 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  8. MRI as outcome measure in facioscapulohumeral muscular dystrophy: 1-year follow-up of 45 patients.

    PubMed

    Andersen, Grete; Dahlqvist, Julia R; Vissing, Christoffer R; Heje, Karen; Thomsen, Carsten; Vissing, John

    2017-03-01

    There is no effective treatment available for facioscapulohumeral muscular dystrophy type 1 (FSHD1), but emerging therapies are under way that call for a better understanding of natural history in this condition. In this prospective, longitudinal study, we used quantitative MRI to assess yearly disease progression in patients with FSHD1. Ambulatory patients with confirmed diagnosis of FSHD1 (25/20 men/women, age 20-75 years, FSHD score: 0-12) were tested with 359-560-day interval between tests. Using the MRI Dixon technique, muscle fat replacement was evaluated in paraspinal, thigh, and calf muscles. Changes were compared with those in FSHD score, muscle strength (hand-held dynamometry), 6-minute-walk-distance, 14-step-stair-test, and 5-time-sit-to-stand-test. Composite absolute fat fraction of all assessed muscles increased by 0.036 (CI 0.026-0.046, P < 0.001), with increases in all measured muscle groups. The clinical severity FSHD score worsened (10%, P < 0.05), muscle strength decreased over the hip (8%), neck (8%), and back (17%) (P < 0.05), but other strength measures, 6-minute-walk-distance, 5-times-sit-to-stand-test, and 14-step-stair-test were unchanged. Changes in muscle strength, FSHD score, and fat fraction did not correlate. This first study to systemically monitor quantitative fat replacement longitudinally in FSHD1 shows that MRI provides an objective measure of disease progression, often before changes can be appreciated in strength and functional tests. The study indicates that quantitative MRI can be a helpful end-point in follow-up and therapeutic trials of patients with FSHD1.

  9. [Long-term Follow-up of Patients with Hepatitis-Associated Aplastic Anemia].

    PubMed

    You, Ya-Hong; Meng, Xian-Bin; Li, Xing-Xin; Ge, Mei-Li; Nie, Neng; Huang, Jin-Bo; Zhang, Jing; Huang, Zhen-Dong; Shao, Ying-Qi; Shi, Jun; Zheng, Yi-Zhou

    2017-08-01

    To explore the clinical characteristic, therapeutic efficacy and prognosis of patients with hepatitis-associated aplasitc anemia (HAAA). the clinical data and labrotatory examination results of 30 cases of HAAA were analyzed retrospectively, the 6-month response ratio and overall survival (OS) were assessed. HAAA most commonly occured in males, with the occurence rate of males and females was 4:1, the median onset age was 16 (4-43) years old, HAAA oriented focus on sever aplastic anemia (SAA)(4 cases,13%) and very sever aplastic anemia (VSAA)(22 cases,73%). Aplastic anemia (AA) could be seen on occurence of hepatitis (accompanied aplastic anemia) (7 cases,23%), or after the onset of hepatits (delayed aplastic anemia) (23 cases,77%), but more often occured in the latter. Statistical analysis showed that when compared with the patients of delayed aplastic anemia, patients accompanied aplastic anemia possesses lower levels of glutamic-pyruvic transaminase(ALT), aspertate aminotransferase (AST) and total bilirubin (TBIL)(P=0.042,0.012,0.001), and possessed a more obvious lymphoid cell disorder when AA occured, with more lower peripheral blood CD19(+) B cells proportion (P=0.046) and more obvious imbalance of CD4(+)/CD8(+) ratio, but the difference was no statistical significant (P=0538). Factors affecting the 6-month respose were the severity of AA (P=0.044), the peak level of bilirubin of hepatitis (P=0.006) and the propotion of mature monocyte in bone marrow (P=0.034). The long-term follow-up showed that the 2-year OS of HAAA was 64.3±9.2%, the 6-month curative efficacy significantly affect the prognosis (P<0.001). HAAA more often occur in young male, HAAA is mainly SAA and VSAA and mostly non-A-C hepatitis associated aplastic anemia, patients usually have a high incidence of early infection. Patients acompanied with aplastic anemia possess more obvious immunological derangement; the treatment efficacy for HAAA is poor, patients who haven't obtained 6-month response

  10. Are too many septal deviations operated on? A retrospective patient`s satisfaction questionnaire with 11 years follow-up.

    PubMed

    Toyserkani, N M; Frisch, T

    2012-06-01

    Not much is known about long-term satisfaction of septoplasty. The goal of this study was to assess disease specific quality of life outcomes as well as satisfaction at more than 10 years follow-up after septoplasty. The study was conducted as a retrospective questionnaire study (based on the NOSE scale) in which a questionnaire was sent to every patient and followed up by a telephone interview conducted in a tertiary otorhinolaryngologic clinic. 238 out of 369 patients who underwent septoplasty accepted to participate of which 222 were eligible. We found a significant reduction in NOSE score from 56.9 before surgery to 31.9 at follow-up. 68.0% experienced improved nasal breathing and 55.9% were satisfied with the overall outcome. Predictive analysis showed that only severity of symptoms before surgery was predictive of all final outcome parameters. Long-term outcome of septoplasty appears to be in line with shorter follow-up. Surprisingly a sizable difference was noted between rate of satisfaction and improvement in nasal breathing. It is important that the surgeon and patient have the same expectations to septoplasty as to avoid any inappropriate disappointment, which is more likely to occur if symptoms are not severe.

  11. Outcomes of HIV-positive patients lost to follow-up in African treatment programmes.

    PubMed

    Zürcher, Kathrin; Mooser, Anne; Anderegg, Nanina; Tymejczyk, Olga; Couvillon, Margaret J; Nash, Denis; Egger, Matthias

    2017-04-01

    The retention of patients on antiretroviral therapy (ART) is key to achieving global targets in response to the HIV epidemic. Loss to follow-up (LTFU) can be substantial, with unknown outcomes for patients lost to ART programmes. We examined changes in outcomes of patients LTFU over calendar time, assessed associations with other study and programme characteristics and investigated the relative success of different tracing methods. We performed a systematic review and logistic random-effects meta-regression analysis of studies that traced adults or children who started ART and were LTFU in sub-Saharan African treatment programmes. The primary outcome was mortality, and secondary outcomes were undocumented transfer to another programme, treatment interruption and the success of tracing attempts. We included 32 eligible studies from 12 countries in sub-Saharan Africa: 20 365 patients LTFU were traced, and 15 708 patients (77.1%) were found. Compared to telephone calls, tracing that included home visits increased the probability of success: the adjusted odds ratio (aOR) was 9.35 (95% confidence interval [CI] 1.85-47.31). The risk of death declined over calendar time (aOR per 1-year increase 0.86, 95% CI 0.78-0.95), whereas undocumented transfers (aOR 1.13, 95% CI 0.96-1.34) and treatment interruptions (aOR 1.31, 95% CI 1.18-1.45) tended to increase. Mortality was lower in urban than in rural areas (aOR 0.59, 95% CI 0.36-0.98), but there was no difference in mortality between adults and children. The CD4 cell count at the start of ART increased over time. Mortality among HIV-positive patients who started ART in sub-Saharan Africa, were lost to programmes and were successfully traced has declined substantially during the scale-up of ART, probably driven by less severe immunodeficiency at the start of therapy. © 2017 John Wiley & Sons Ltd.

  12. [Metabolic Control, Evaluation and Follow-up Interventions in Patients With Schizophrenia].

    PubMed

    Oviedo, Gabriel Fernando; Gómez Restrepo, Carlos; Bohórquez Peñaranda, Adriana; García Valencia, Jenny; Jaramillo, Luis Eduardo; Tamayo, Nathalie; Arenas, María Luisa; Vélez Fernández, Carolina

    2015-01-01

    To determine the laboratory tests, related to metabolic risk that should be practiced to adult patients diagnosed with schizophrenia. To assist the clinician decision-making process about complementary diagnostic evaluation strategies in adult diagnosed with schizophrenia. A clinical practice guideline was elaborated under the parameters of the Methodological Guide of the Ministerio de Salud y Protección Social to identify, synthesize and evaluate the evidence and make recommendations about the treatment and follow-up of adult patients with schizophrenia. The evidence of NICE guide 82 was adopted and updated. The evidence was presented to the Guideline Developing Group and recommendations, employing the GRADE system, were produced. The risk of overall mortality in schizophrenia is higher than in the general population excluding suicide. Results related with mortality associated to antipsychotics showed contradictory results. Metabolic outcomes showed a higher incidence and association with schizophrenia and treatment with antipsychotics (AP). The diagnosis of dyslipidemia in men with schizophrenia appears to be lower in comparison with the general population. However, changes in weight, blood sugar levels, HDL cholesterol and triglycerides are influenced by the use of antipsychotics in general there is a higher risk of developing diabetes mellitus in adults with schizophrenia. Based on the evidence found a plan was formulated for the evaluation of physiological and paraclinical variables during and before the management with AP in adult diagnosed with schizophrenia. The overall quality of evidence is low considering that most of the reports come from observational studies that have risk of bias and some designs have methodological limitations. Copyright © 2014 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  13. A retrospective clinical study on 37 subtalar arthrodesis patients of nine years follow-up.

    PubMed

    Xu, Xiangyang; Yang, Chonglin; Zhu, Yuan; Liu, Jinhao; Wei, Baofu

    2015-08-04

    Subtalar arthrodesis is a common therapy for subtalar joint disorders. In this article, we evaluate the effect of subtalar arthrodesis on the ankle and hindfoot joints. Fifty patients (33 men and 17 women) underwent subtalar arthrodesis between January 1, 1996, and August 31, 2011. The 36-item Short-Form Health Survey and American Orthopaedic Foot and Ankle Society ankle hindfoot scores were used for clinical evaluation. Radiographic analysis included assessment of degenerative changes and ankle and hindfoot joint function in the frontal and sagittal planes. Thirty-seven patients (27 men and 10 women; mean age, 42.6 years) were followed up for an average of 9.2 years (range, 2-17 years). The mean ± SD 36-item Short-Form Health Survey score improved from 30.21 ± 7.19 before surgery to 78.50 ± 12.23, and the American Orthopaedic Foot and Ankle Society ankle hindfoot score increased from 50.32 ± 12.39 to 73.14 ± 15.44. Degenerative changes in the talonavicular, calcaneocuboid, metatarsocuboid, and ankle joints occurred. The talar-vertical angle was positively related to the tibial-plantar minimal angle (affected side: r = 0.56; P < .01; healthy side: r = 0.46; P < .01). The difference in hindfoot height is positively related to the difference in tibial-plantar minimal angle (r = 0.54; P < .01). Subtalar arthrodesis is effective treatment for subtalar joint disease but could induce joint degeneration and ankle joint motion limitation related to talar declination and hindfoot height.

  14. Long-term follow-up of retinitis pigmentosa patients with multifocal electroretinography.

    PubMed

    Nagy, Ditta; Schönfisch, Birgitt; Zrenner, Eberhart; Jägle, Herbert

    2008-10-01

    To study the rate of multifocal electroretinographic (mfERG) response amplitude changes and their relation to other parameters of disease development in retinitis pigmentosa (RP). Twenty-three patients (9 men and 14 women) with clinically defined RP were included in the study. Disease progression was monitored during a period of up to 10 years by psychophysical techniques and Ganzfeld electroretinography. In addition, ERGs were recorded with a mfERG imaging system (VERIS; Electro-Diagnostic Imaging, Inc., Redwood City, CA). The black and white stimulus consisted of 61 hexagons covering a visual field of approximately 60 degrees x 55 degrees . Responses were analyzed according to concentric ring averages. The progression of visual field loss for target III4e was approximately 14.5%. Using the same type of regression model, the yearly progression according to the mfERG values was found to be approximately 6% to 10% in the outer three rings. Visual acuity (median 0.8) correlated well with the amplitude of the central segment of the mfERGs, ring 5 amplitudes of the mfERG strongly correlated with the scotopic Ganzfeld ERG mixed cone-rod response amplitude. However, in advanced cases, reliable mfERG responses could still be recorded, even if the ISCEV scotopic Ganzfeld ERG was not reproducible. MfERG ring 5 amplitudes as well as the Ganzfeld ERG mixed cone-rod response amplitude showed only a mild correlation with visual field area. The mfERG allows long-term follow-up of disease progression in retinitis pigmentosa. It does not replace, but complements psychophysical methods and could be used as an objective outcome measure in upcoming treatment studies involving patients with advanced retinal diseases.

  15. Nelfinavir in HIV-HCV coinfected patients: a 24-month follow-up in a cohort of 82 patients.

    PubMed

    Poizot-Martin, I; Marimoutou, C; Drogoul-Vey, M P; Vion-Dury, F; Frixon-Marin, V; Benhaim, S; Poggi, P; Gastaut, J A

    2005-10-01

    This retrospective and longitudinal study evaluated the long-term hepatic tolerance of a nelfinavir (NFV)-antiretroviral combined regimen in 82 patients of the HCV-HIV Cohort of CISIH-Sud of Marseilles. Follow-up data (liver enzyme levels, CD4 cell count, HIV viral load, and metabolic parameters) of patients treated with NFV on inclusion or during the follow-up of the cohort were analyzed under treatment over 24 months. Comparisons were performed with X2 or Kruskal-Wallis tests. At baseline (n = 82), the median exposure to NFV was 4.1 months; 58 patients received NFV combined with NRTI and 24 with NNRTI. The median CD4 cell count was 337/mm3 [interquartile range (IR): 216-480) and 39.7% had an undetectable HIV RNA level. Qualitative HCV PCR was positive in 91% of the patients and 19/51 patients with liver biopsy were F3-F4. Median alanine and aspartate aminotransferase (ALAT, ASAT), gamma-glutamyltransferase (GT), and alkaline phosphatase (ALP) were 46 UI/liter (IR: 36-76), 55 UI/liter (IR: 32-97), 97 UI/liter (IR: 50-194), and 88 UI/liter (IR: 72-104), respectively, with 76% of the patients with ALAT/ASAT grade <2. Median follow-up was 23 months (IR: 13.8-37). No significant difference was observed in the distribution of ALAT, ASAT, GT, and ALP as well as of ALAT/ASAT grades over the 24-month study period. Patients treated with NFV + NNRTI had significantly higher GT and ALP levels at baseline with no significant increase during follow-up. Cholesterol, triglyceride, and glycemia distributions remained stable over time. In conclusion, this study showed a good hepatic and metabolic tolerance of a long-term NFV-combined regimen in HIV-HCV coinfected patients.

  16. Preoperative radiotherapy in breast cancer patients: 32 years of follow-up.

    PubMed

    Riet, F G; Fayard, F; Arriagada, R; Santos, M A; Bourgier, C; Ferchiou, M; Heymann, S; Delaloge, S; Mazouni, C; Dunant, A; Rivera, S

    2017-05-01

    This study evaluates the long-term outcomes of a retrospective cohort of breast cancer (BC) patients who had received curatively intended premastectomy radiation therapy (RT). We analysed locoregional control, disease-free survival (DFS) and overall survival (OS), pathological complete remission (pCR), predictors thereof, and immediate safety. The series consisted of 187 patients with a median age of 49 years [43-60] and T2-T4 or N2 tumours. Between 1970 and 1984, they had received slightly hypofractionated RT to the whole breast, ipsilateral supraclavicular fossa and axilla ± the internal mammary chain (45-55 Gy/18 fractions of 2.5 Gy/34 days) systematically followed by a modified radical mastectomy with an axillary dissection. No other preoperative treatment was given. Among the 166 centrally reviewed tumour biopsy specimens, 22% had a triple-negative (TN) phenotype, 17% were HER2 3 + or amplified and 61% were ER+. The median follow-up was 32 years [23-35]. The 25-year locoregional control rate was 89% [93%-82%] and the 25-year DFS and OS rates were identical, 30% [24%-37%]. A pCR in the tumour and lymph nodes had been achieved in 18 among all patients (10%), but in 26% with TN disease. In the multivariate analysis, the TN status was the only predictive factor of pCR (OR = 5.49, 95% confidence interval [CI] 1.87-16.1, p = 0.002). Also, the pN status (HR = 1.69, [1.28-2.22], p = 0.0002) and TN subtype (HR = 1.80, [1.00-3.26], p = 0.05) exerted a significant prognostic impact on OS. The postoperative complication rate (grade >2) was 19% with 4.3% of localized skin necrosis. Preoperative RT followed by radical surgery is feasible and associated with good long-term locoregional control. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Interventions to improve continuity of care in the follow-up of patients with cancer.

    PubMed

    Aubin, Michèle; Giguère, Anik; Martin, Mélanie; Verreault, René; Fitch, Margaret I; Kazanjian, Arminée; Carmichael, Pierre-Hugues

    2012-07-11

    usual care. Given the expected clinical and methodological diversity, median changes in outcomes (and bootstrap confidence intervals) among groups of studies that shared specific features of interest were chosen to analyse the effectiveness of included interventions. Fifty-one studies were included. They used three different models, namely case management, shared care, and interdisciplinary teams. Six additional interventional strategies were used besides these models: (1) patient-held record, (2) telephone follow-up, (3) communication and case discussion between distant healthcare professionals, (4) change in medical record system, (5) care protocols, directives and guidelines, and (6) coordination of assessments and treatment.Based on the median effect size estimates, no significant difference in patient health-related outcomes was found between patients assigned to interventions and those assigned to usual care. A limited number of studies reported psychological health, satisfaction of providers, or process of care measures. However, they could not be regrouped to calculate median effect size estimates because of a high heterogeneity among studies. Results from this Cochrane review do not allow us to conclude on the effectiveness of included interventions to improve continuity of care on patient, healthcare provider or process of care outcomes. Future research should evaluate interventions that target an improvement in continuity as their primary objective and describe these interventions with the categories proposed in this review. Also of importance, continuity measures should be validated with persons with cancer who have been followed in various settings.

  18. Follow-up of Disabled Patients Discharged from a Rehabilitation Center

    ERIC Educational Resources Information Center

    Brodwin, Martin G.

    1976-01-01

    This article reports on a follow-up survey of disabled individuals discharged from an aftercare hospital residence program, who had begun a program for independent living to support their vocational development. Measures of independent behavior were related to client independence after discharge from the rehabilitation setting. (Author)

  19. The Sexual Adjustment of Coronary Bypass Surgery Patients: A 4-Year Follow-Up.

    ERIC Educational Resources Information Center

    Thurer, Shari; Thurer, Robert L.

    1983-01-01

    Measured the sexual adjustment of 14 individuals before coronary bypass surgery and both four months and four years afterwards. Results showed that sexual adjustment worsened with the onset of symptomatic coronary artery disease and did not improve at either follow-up interval. (LLL)

  20. [Results of follow-up of operations in pediatric patients with indirect inguinal hernia].

    PubMed

    Hecker, W C; Ring-Mrozik, E

    1987-01-01

    This paper present the results of follow-up examinations of 2801 operated inguinal hernias. In comparison with the high excision of the hernial sac plus "crude suture", the standard Bassini technique produces poorer results as regards recurrence, testicular atrophy and secondary maldescent. The mortality of elective herniotomy was 0.016% in this series.

  1. The Sexual Adjustment of Coronary Bypass Surgery Patients: A 4-Year Follow-Up.

    ERIC Educational Resources Information Center

    Thurer, Shari; Thurer, Robert L.

    1983-01-01

    Measured the sexual adjustment of 14 individuals before coronary bypass surgery and both four months and four years afterwards. Results showed that sexual adjustment worsened with the onset of symptomatic coronary artery disease and did not improve at either follow-up interval. (LLL)

  2. Follow-up of Disabled Patients Discharged from a Rehabilitation Center

    ERIC Educational Resources Information Center

    Brodwin, Martin G.

    1976-01-01

    This article reports on a follow-up survey of disabled individuals discharged from an aftercare hospital residence program, who had begun a program for independent living to support their vocational development. Measures of independent behavior were related to client independence after discharge from the rehabilitation setting. (Author)

  3. Availability of mobile phones for discharge follow-up of pediatric Emergency Department patients in western Kenya.

    PubMed

    House, Darlene R; Cheptinga, Philip; Rusyniak, Daniel E

    2015-01-01

    Objective. Mobile phones have been successfully used for Emergency Department (ED) patient follow-up in developed countries. Mobile phones are widely available in developing countries and may offer a similar potential for follow-up and continued care of ED patients in low and middle-income countries. The goal of this study was to determine the percentage of families with mobile phones presenting to a pediatric ED in western Kenya and rate of response to a follow-up phone call after discharge. Methods. A prospective, cross-sectional observational study of children presenting to the emergency department of a government referral hospital in Eldoret, Kenya was performed. Documentation of mobile phone access, including phone number, was recorded. If families had access, consent was obtained and families were contacted 7 days after discharge for follow-up. Results. Of 788 families, 704 (89.3%) had mobile phone access. Of those families discharged from the ED, successful follow-up was made in 83.6% of cases. Conclusions. Mobile phones are an available technology for follow-up of patients discharged from a pediatric emergency department in resource-limited western Kenya.

  4. Application of Regent mechanical valve in patients with small aortic annulus: 3-year follow-up

    PubMed Central

    2012-01-01

    Background Aortic valve replacement (AVR) with a small aortic annulus is always challenging for the cardiac surgeon. In this study, we sought to evaluate the midterm performance of implantation with a 17-mm or 19-mm St. Jude Medical Regent (SJM Regent) mechanical valve in retrospective consecutive cohort of patients with small aortic annulus (diameter ≤ 19 mm). Methods From January 2008 to April 2011, 40 patients (31 female, mean age = 47.2 ± 5.8 years) with small aortic annulus (≤19 mm in diameter) underwent aortic valve replacement with a 17-mm or 19-mm St. Jude Medical Regent (SJM Regent) mechanical valve. Preoperative mean body surface area, New York Heart Association class, and mean aortic annulus were 1.61 ± 0.26 m2, 3.2 ± 0.4, and 18 ± 1.4 mm respectively. Patients were divided into two groups, according to the implantation of 17 mm SJM Regent mechanical valve (group 1, n = 18) or 19 mm SJM Regent valve (group 2, n = 22). All patients underwent echocardiography examination preoperatively and at one year post-operation. Results There were no early deaths in either group. Follow-up time averaged 36 ± 17.6 months. The mean postoperative New York Heart Association class was 1.3 ± 0.6 (p < 0.001). By echocardiography, in group 1, the left ventricular ejection fraction (LVEF), left ventricular fraction shortening (LVFS), and the indexed effective orifice area (EOAI) increased from 43.7% ± 11.6%, 27.3% ± 7.6%, and 0.70 ± 0.06 cm2/m2 to 69.8 ± 9.3%, 41.4 ± 8.3%, and 0.92 ± 0.10 cm2/m2 respectively (P < 0.05), while the left ventricular mass index (LVMI), and the aortic transvalvular pressure gradient decreased from 116.4 ± 25.4 g/m2, 46.1 ± 8.5 mmHg to 86.7 ± 18.2 g/m2 , 13.7 ± 5.2 mmHg respectively. In group 2, the LVEF, LVFS and EOAI increased from 45.9% ± 9.7%, 30.7% ± 8.0%, and 0.81 ± 0.09 cm2/m2 to 77.4%

  5. Risk factors for loss to follow-up during active surveillance of patients with Stage I seminoma.

    PubMed

    Endo, Tsuyoshi; Kawai, Koji; Kamba, Tomomi; Inai, Hiromu; Uchida, Kazunori; Miyazaki, Jun; Kamoto, Toshiyuki; Ogawa, Osamu; Nishiyama, Hiroyuki

    2014-04-01

    To elucidate the patterns and risk factors for loss to follow-up during active surveillance for Stage I seminoma. A total of 425 cases with Stage I seminoma underwent radical orchiectomy from 1985 to 2006 at 25 Japanese institutions, including 22 community hospitals and 3 university hospitals. The post-orchiectomy management selected was active surveillance for 186 patients, adjuvant radiotherapy for 182 patients and chemotherapy for 57 patients. The Kaplan-Meier method was used to estimate the recurrence-free survival and loss to follow-up rate. The risk factors for loss to follow-up were examined using Cox's proportional hazards model with multiple variables. The 2-, 5- and 10-year loss to follow-up rates in the active surveillance group were 14.2, 37.8 and 71.3%, respectively, which were not significantly different in comparison with those in the active surveillance and adjuvant radiotherapy or chemotherapy groups. With regard to the active surveillance group, the multivariate analysis demonstrated that patients younger than 36 years at diagnosis, patients diagnosed since 2000 and patients treated at hospitals that enrolled more than 10 cases had a significant risk for loss to follow-up. No significant correlation between the loss to follow-up rate and pathological risk factors such as tumor size (≤4 versus >4 cm) and rete testis invasion (presence versus absence) was shown. The loss to follow-up rates beyond 5 years were unsatisfactorily high during active surveillance. Further approaches to improve the quality of active surveillance are needed, especially for high-risk patients such as those of younger age.

  6. Overgeneral autobiographical memory at baseline predicts depressive symptoms at follow-up in patients with first-episode depression.

    PubMed

    Liu, Yansong; Zhang, Fuquan; Wang, Zhiqiang; Cao, Leiming; Wang, Jun; Na, Aiguo; Sun, Yujun; Zhao, Xudong

    2016-09-30

    Previous studies have shown that overgeneral autobiographical memory (OGM) is a characteristic of depression. However, there are no studies to explore the association between baseline OGM and depressive symptoms at follow-up in patients with first-episode depression (FE). This study investigated whether baseline OGM predicts depressive symptoms at follow-up in patients with FE. We recruited 125 patients with FE. The participants were divided into remitted group and non-remitted group according to the severity of their depression at 12 months follow-up. The measures consisted of the 17-item Hamilton Depression Rating Scale, Ruminative Response Scale, and Autobiographical Memory Test. Hierarchical linear regression analyses and bootstrap mediation analyses were conducted. The results showed that non-remitted patients had more OGM at baseline. Baseline OGM predicted depressive symptoms at follow-up in patients with FE. Rumination mediated the relationship between baseline OGM and depressive symptoms at follow-up. Our findings highlight OGM as a vulnerability factor involved in the maintenance of depression in patients with FE.

  7. Quality of Follow-Up After Hospitalization for Mental Illness Among Patients From Racial-Ethnic Minority Groups

    PubMed Central

    Carson, Nicholas J.; Vesper, Andrew; Chen, Chih-nan; Cook, Benjamin Lê

    2014-01-01

    Objective Outpatient follow-up after hospitalization for mental health reasons is an important indicator of quality of health systems. Differences among racial-ethnic minority groups in the quality of service use during this period are understudied. This study assessed the quality of out-patient treatment episodes following inpatient psychiatric treatment among blacks, whites, and Latinos in the United States. Methods The Medical Expenditure Panel Survey (2004–2010) was used to identify adults with any inpatient psychiatric treatment (N=339). Logistic regression models were used to estimate predictors of any outpatient follow-up or the beginning of adequate outpatient follow-up within seven or 30 days following discharge. Predicted disparities were calculated after adjustment for clinical need variables but not for socioeconomic characteristics, consistent with the Institute of Medicine definition of health care disparities as differences that are unrelated to clinical appropriateness, need, or patient preference. Results Rates of follow-up were generally low, particularly rates of adequate treatment (<26%). Outpatient treatment prior to inpatient care was a strong predictor of all measures of follow-up. After adjustment for need and socioeconomic status, the analyses showed that blacks were less likely than whites to receive any treatment or begin adequate follow-up within 30 days of discharge. Conclusions Poor integration of follow-up treatment in the continuum of psychiatric care leaves many individuals, particularly blacks, with poor-quality treatment. Culturally appropriate interventions that link individuals in inpatient settings to outpatient follow-up are needed to reduce racial-ethnic disparities in outpatient mental health treatment following acute treatment. PMID:24686538

  8. Exercise and Pharmacotherapy in Patients With Major Depression: One-Year Follow-Up of the SMILE Study

    PubMed Central

    Hoffman, Benson M.; Babyak, Michael A.; Craighead, W. Edward; Sherwood, Andrew; Doraiswamy, P. Murali; Coons, Michael J.; Blumenthal, James A.

    2013-01-01

    Objective To examine a 1-year follow-up of a 4-month, controlled clinical trial of exercise and antidepressant medication in patients with major depressive disorder (MDD). Methods In the original study, 202 sedentary adults with MDD were randomized to: a) supervised exercise; b) home-based exercise; c) sertraline; or d) placebo pill. We examined two outcomes measured at 1-year follow-up (i.e., 16 months post randomization): 1) continuous Hamilton Depression Rating Scale score; and 2) MDD status (depressed; partial remission; full remission) in 172 available participants (85% of the original cohort). Regression analyses were performed to examine the effects of treatment group assignment, as well as follow-up antidepressant medication use and self-reported exercise (Godin Leisure-Time Exercise Questionnaire), on the two outcomes. Results In the original study, patients receiving exercise achieved similar benefits compared with those receiving sertraline. At the time of the 1-year follow-up, rates of MDD remission increased from 46% at post treatment to 66% for participants available for follow-up. Neither initial treatment group assignment nor antidepressant medication use during the follow-up period were significant predictors of MDD remission at 1 year. However, regular exercise during the follow-up period predicted both Hamilton Depression Rating Scale scores and MDD diagnosis at 1 year. This relationship was curvilinear, with the association concentrated between 0 minute and 180 minutes of weekly exercise. Conclusion The effects of aerobic exercise on MDD remission seem to be similar to sertraline after 4 months of treatment; exercise during the follow-up period seems to extend the short-term benefits of exercise and may augment the benefits of antidepressant use. PMID:21148807

  9. Case mix, outcome and activity for patients admitted to intensive care units requiring chronic renal dialysis: a secondary analysis of the ICNARC Case Mix Programme Database

    PubMed Central

    Hutchison, Colin A; Crowe, Alex V; Stevens, Paul E; Harrison, David A; Lipkin, Graham W

    2007-01-01

    Introduction This report describes the case mix, outcome and activity for admissions to intensive care units (ICUs) of patients who require prior chronic renal dialysis for end-stage renal failure (ESRF), and investigates the effect of case mix factors on outcome. Methods This was a secondary analysis of a high-quality clinical database, namely the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme Database, which includes 276,731 admissions to 170 adult ICUs across England, Wales and Northern Ireland from 1995 to 2004. Results During the eight year study period, 1.3% (n = 3,420) of all patients admitted to ICU were receiving chronic renal dialysis before ICU admission. This represents an estimated ICU utilization of six admissions (32 bed-days) per 100 dialysis patient-years. The ESRF group was younger (mean age 57.3 years versus 59.5 years) and more likely to be male (60.2% versus 57.9%) than those without ESRF. Acute Physiology and Chronic Health Evaluation II score and Acute Physiology Score revealed greater severity of illness on admission in patients with ESRF (mean 24.7 versus 16.6 and 17.2 versus 12.6, respectively). Length of stay in ICU was comparable between groups (median 1.9 days versus 1.8 days) and ICU mortality was only slightly elevated in the ESRF group (26.3% versus 20.8%). However, the ESRF group had protracted overall hospital stay (median 25 days versus 17 days), and increased hospital mortality (45.3% versus 31.2%) and ICU readmission (9.0% vs. 4.7%). Multiple logistic regression analysis adjusted for case mix identified the increased hospital mortality to be associated with increasing age, emergency surgery and nonsurgical cases, cardiopulmonary resuscitation before ICU admission and extremes of physiological norms. The adjusted odds ratio for ultimate hospital mortality associated with chronic renal dialysis was 1.24 (95% confidence interval 1.13 to 1.37). Conclusion Patients with ESRF admitted to UK ICUs are more

  10. Methadone treatment for opiate dependent patients in general practice and specialist clinic settings: Outcomes at 2-year follow-up.

    PubMed

    Gossop, Michael; Stewart, Duncan; Browne, Nadine; Marsden, John

    2003-06-01

    Few studies have investigated methadone treatment of opiate dependent patients in primary health care settings. Using a prospective cohort design, the study investigated outcomes at 1 and 2 years for 240 patients treated by general practitioners (n = 79) or drug clinics (n = 161) at sites across England. Mean daily methadone dose for both groups was 50 mg. Reductions in illicit drug use, injecting, sharing injecting equipment, psychological and physical health problems, and crime, were found in both groups at follow-up. Patients treated in general practitioner (GP) settings reported less frequent benzodiazepine and stimulant use, and fewer psychological health problems at follow-up. Alcohol use outcomes were poor for both groups. Differences in treatment practices were found for GPs and clinics. Results show substantial reductions in a range of problems behaviours, among unselected samples of opiate dependent patients treated in GP and in clinic settings, which are sustained to 1-year and 2-year follow-up.

  11. Long-term follow-up data may help manage patient and parent expectations for pediatric patients undergoing thyroidectomy.

    PubMed

    Morris, Lilah F; Waguespack, Steven G; Warneke, Carla L; Ryu, Haengrang; Ying, Anita K; Anderson, Barbara J; Sturgis, Erich M; Clayman, Gary L; Lee, Jeffrey E; Evans, Douglas B; Grubbs, Elizabeth G; Perrier, Nancy D

    2012-12-01

    We investigated the incidence and impact of postoperative complications in children who underwent total thyroidectomy (TTx). The records of all pediatric patients undergoing TTx (2001-2011) at our institution were retrospectively reviewed for the occurrence of biochemical hypothyroidism (thyroid-stimulating hormone >10 mIU/mL), laboratory assessments, and medication nonadherence. The 74 patients (median age, 12.5 years) had thyroid cancer (differentiated, n = 39; medullary, n = 16) or benign pathology (n = 19; 16 with multiple endocrine neoplasia type 2A). The median postoperative follow-up was 3.2 years; 46 patients (62%) had ≥ 1 year follow-up. Forty-one percent had ≥ 1 period of medication nonadherence; this was not associated with age at TTx (P = .30). Non-treatment-related hypothyroidism occurred in 33% of patients during postoperative year (POY) 1. The number of POY1 laboratory assessments among the 30% of patients with parathyroid dysfunction was more than twice that among patients with normal parathyroid function (median assessments per year 8 vs 3; P < .0001). Forty-four percent of patients/families reported behavioral or physiologic changes; 40% were concomitant with abnormal thyroid function. More than 40% of pediatric patients were unable to fully adhere to postoperative medication regimens, and non-treatment-related hypothyroidism was common. Postoperative hypoparathyroidism doubled the number of laboratory assessments obtained. These data may help families better prepare for TTx sequelae. Copyright © 2012 Mosby, Inc. All rights reserved.

  12. Mortality and functional status at one-year of follow-up in elderly patients with prolonged ICU stay.

    PubMed

    Pintado, M C; Villa, P; Luján, J; Trascasa, M; Molina, R; González-García, N; de Pablo, R

    2016-01-01

    To evaluate mortality and functional status at one year of follow-up in patients>75 years of age who survive Intensive Care Unit (ICU) admission of over 14 days. A prospective observational study was carried out. A Spanish medical-surgical ICU. Patients over 75 years of age admitted to the ICU. ICU admission: demographic data, baseline functional status (Barthel index), baseline mental status (Red Cross scale of mental incapacity), severity of illness (APACHE II and SOFA), stay and mortality. One-year follow-up: hospital stay and mortality, functional and mental status, and one-year follow-up mortality. A total of 176 patients were included, of which 22 had a stay of over 14 days. Patients with prolonged stay did not show more ICU mortality than those with a shorter stay in the ICU (40.9% vs 25.3% respectively, P=.12), although their hospital (63.6% vs 33.8%, P<.01) and one-year follow-up mortality were higher (68.2% vs 41.2%, P=.02). Among the survivors, one-year mortality proved similar (87.5% vs 90.6%, P=.57). These patients presented significantly greater impairment of functional status at hospital discharge than the patients with a shorter ICU stay, and this difference persisted after three months. The levels of independence at one-year follow-up were never similar to baseline. No such findings were observed in relation to mental status. Patients over 75 years of age with a ICU stay of more than 14 days have high hospital and one-year follow-up mortality. Patients who survive to hospital admission did not show greater mortality, though their functional dependency was greater. Copyright © 2015 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  13. Survival outcome of radioiodine therapy in post thyroidectomy thyroid carcinoma patients: Outcome of long term follow up

    NASA Astrophysics Data System (ADS)

    Haque, F.; Nahar, N.; Sultana, S.; Nasreen, F.; Jabin, Z.; Alam, A. S. M. M.

    2016-03-01

    The overall prognosis of patients with thyroid carcinoma is excellent whenever managed following best practice guidelines. Objective: To calculate sex and age group affected by thyroid cancer; to compare between single or multiple dose of radio ablation needed after thyroidectomy and to determine the percentage of patients become disease free during their follow up. Methods: This was a retrospective study done in NINMAS, Bangladesh on 687 patients from 1984 to 2004. In all cases total or near total thyroidectomy was done before commencing radioiodine therapy. Patients TG level, neck ultrasonography, thyroid scan, whole body I131 scans, neck examination were done every six monthly/yearly. Results: Among 687 patients, female were more sufferers (68.1%) and female to male ratio was 2:1. Age group 19-40 years was mostly affected (57.8%). Most common type seen was papillary carcinoma (81.8%). After ablation 100 patients did not follow-up. Total 237 patients discontinued within 4 years. Remaining 450 patients undergone regular follow-up for 5 years and more, 394 were disease free (87.6%). Total recurrence of metastasis was 23 and 12 patients expired at different times. Conclusions: Long-term regular follow-up is necessary after radioiodine ablation to become free of disease.

  14. Lead Time to Appointment and No-Show Rates for New and Follow-up Patients in an Ambulatory Clinic.

    PubMed

    Drewek, Rupali; Mirea, Lucia; Adelson, P David

    High rates of no-shows in outpatient clinics are problematic for revenue and for quality of patient care. Longer lead time to appointment has variably been implicated as a risk factor for no-shows, but the evidence within pediatric clinics is inconclusive. The goal of this study was to estimate no-show rates and test for association between appointment lead time and no-show rates for new and follow-up patients. Analyses included 534 new and 1920 follow-up patients from pulmonology and gastroenterology clinics at a freestanding children's hospital. The overall rate of no-shows was lower for visits scheduled within 0 to 30 days compared with 30 days or more (23% compared with 47%, P < .0001). Patient type significantly modified the association of appointment lead time; the rate of no-shows was higher (30%) among new patients compared with (21%) follow-up patients with appointments scheduled within 30 days (P = .004). For appointments scheduled 30 or more days' lead time, no-show rates were statistically similar for new patients (46%) and follow-up patients (0.48%). Time to appointment is a risk factor associated with no-shows, and further study is needed to identify and implement effective approaches to reduce appointment lead time, especially for new patients in pediatric subspecialties.

  15. An ontology-based approach to patient follow-up assessment for continuous and personalized chronic disease management.

    PubMed

    Zhang, Yi-Fan; Gou, Ling; Zhou, Tian-Shu; Lin, De-Nan; Zheng, Jing; Li, Ye; Li, Jing-Song

    2017-08-01

    Chronic diseases are complex and persistent clinical conditions that require close collaboration among patients and health care providers in the implementation of long-term and integrated care programs. However, current solutions focus partially on intensive interventions at hospitals rather than on continuous and personalized chronic disease management. This study aims to fill this gap by providing computerized clinical decision support during follow-up assessments of chronically ill patients at home. We proposed an ontology-based framework to integrate patient data, medical domain knowledge, and patient assessment criteria for chronic disease patient follow-up assessments. A clinical decision support system was developed to implement this framework for automatic selection and adaptation of standard assessment protocols to suit patient personal conditions. We evaluated our method in the case study of type 2 diabetic patient follow-up assessments. The proposed framework was instantiated using real data from 115,477 follow-up assessment records of 36,162 type 2 diabetic patients. Standard evaluation criteria were automatically selected and adapted to the particularities of each patient. Assessment results were generated as a general typing of patient overall condition and detailed scoring for each criterion, providing important indicators to the case manager about possible inappropriate judgments, in addition to raising patient awareness of their disease control outcomes. Using historical data as the gold standard, our system achieved a rate of accuracy of 99.93% and completeness of 95.00%. This study contributes to improving the accessibility, efficiency and quality of current patient follow-up services. It also provides a generic approach to knowledge sharing and reuse for patient-centered chronic disease management. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Radiofrequency ablation of numerous premature ventricular contractions in a cardiac resynchronisation therapy patient: a long-term follow-up.

    PubMed

    Farkowski, Michał Mirosław; Chwyczko, Tomasz; Sterliński, Maciej; Syska, Paweł; Szwed, Hanna; Pytkowski, Mariusz

    2013-01-01

    We present a case study of a patient with dilated cardiomyopathy and a cardiac resynchronisation therapy (CRT) device who was repeatedly hospitalised due to heart failure (HF) exacerbations. A successful radiofrequency ablation of numerous premature ventricular contractions enabled the proper action of CRT and stabilised the patient's condition in NYHA II without HF subsequent hospitalisations during a 30 month follow-up.

  17. Long-Term Serological Follow-Up of Acute Q-Fever Patients after a Large Epidemic

    PubMed Central

    Wielders, Cornelia C. H.; van Loenhout, Joris A. F.; Morroy, Gabriëlla; Rietveld, Ariene; Notermans, Daan W.; Wever, Peter C.; Renders, Nicole H. M.; Leenders, Alexander C. A. P.; van der Hoek, Wim; Schneeberger, Peter M.

    2015-01-01

    Background Serological follow-up of acute Q-fever patients is important for detection of chronic infection but there is no consensus on its frequency and duration. The 2007–2009 Q-fever epidemic in the Netherlands allowed for long-term follow-up of a large cohort of acute Q-fever patients. The aim of this study was to validate the current follow-up strategy targeted to identify patients with chronic Q-fever. Methods A cohort of adult acute Q-fever patients, diagnosed between 2007 and 2009, for whom a twelve-month follow-up sample was available, was invited to complete a questionnaire and provide a blood sample, four years after the acute episode. Antibody profiles, determined by immunofluorescence assay in serum, were investigated with a special focus on high titres of IgG antibodies against phase I of Coxiella burnetii, as these are considered indicative for possible chronic Q-fever. Results Of the invited 1,907 patients fulfilling inclusion criteria, 1,289 (67.6%) were included in the analysis. At any time during the four-year follow-up period, 58 (4.5%) patients were classified as possible, probable, or proven chronic Q-fever according to the Dutch Q-fever Consensus Group criteria (which uses IgG phase I ≥1:1,024 to as serologic criterion for chronic Q-fever). Fifty-two (89.7%) of these were identified within the first year after the acute episode. Of the six patients that were detected for the first time at four-year follow-up, five had an IgG phase I titre of 1:512 at twelve months. Conclusions A twelve-month follow-up check after acute Q-fever is recommended as it adequately detects chronic Q-fever in patients without known risk factors. Additional serological and clinical follow-up is recommended for patients with IgG phase I ≥1:512, as they showed the highest risk to progress to chronic Q-fever. PMID:26161658

  18. Long-Term Serological Follow-Up of Acute Q-Fever Patients after a Large Epidemic.

    PubMed

    Wielders, Cornelia C H; van Loenhout, Joris A F; Morroy, Gabriëlla; Rietveld, Ariene; Notermans, Daan W; Wever, Peter C; Renders, Nicole H M; Leenders, Alexander C A P; van der Hoek, Wim; Schneeberger, Peter M

    2015-01-01

    Serological follow-up of acute Q-fever patients is important for detection of chronic infection but there is no consensus on its frequency and duration. The 2007-2009 Q-fever epidemic in the Netherlands allowed for long-term follow-up of a large cohort of acute Q-fever patients. The aim of this study was to validate the current follow-up strategy targeted to identify patients with chronic Q-fever. A cohort of adult acute Q-fever patients, diagnosed between 2007 and 2009, for whom a twelve-month follow-up sample was available, was invited to complete a questionnaire and provide a blood sample, four years after the acute episode. Antibody profiles, determined by immunofluorescence assay in serum, were investigated with a special focus on high titres of IgG antibodies against phase I of Coxiella burnetii, as these are considered indicative for possible chronic Q-fever. Of the invited 1,907 patients fulfilling inclusion criteria, 1,289 (67.6%) were included in the analysis. At any time during the four-year follow-up period, 58 (4.5%) patients were classified as possible, probable, or proven chronic Q-fever according to the Dutch Q-fever Consensus Group criteria (which uses IgG phase I ≥1:1,024 to as serologic criterion for chronic Q-fever). Fifty-two (89.7%) of these were identified within the first year after the acute episode. Of the six patients that were detected for the first time at four-year follow-up, five had an IgG phase I titre of 1:512 at twelve months. A twelve-month follow-up check after acute Q-fever is recommended as it adequately detects chronic Q-fever in patients without known risk factors. Additional serological and clinical follow-up is recommended for patients with IgG phase I ≥1:512, as they showed the highest risk to progress to chronic Q-fever.

  19. Pretreatment sputum smear grade and smear positivity during follow-up of TB patients in Ahmedabad, India.

    PubMed

    Patel, J; Dave, P; Satyanarayana, S; Kumar, A M V; Shah, A; Ananthakrishnan, R; Ratnu, A

    2013-12-21

    In Ahmedabad, India, a retrospective record review was undertaken among 2842 sputum smear-positive tuberculosis patients registered for treatment from April to September 2011 to assess the association of pretreatment sputum smear grade with sputum positivity and the additional yield of a second sputum sample during each follow-up examination. Respectively 39%, 26%, 28% and 7% of patients had pretreatment sputum grade 3+, 2+, 1+ and scanty. The higher the pretreatment sputum grade, the higher the proportion found positive during various follow-up periods. Overall, the additional yield of the second sputum sample was <2%; it did not vary with pretreatment smear grading.

  20. Six Month Follow-Up of a Patient With a Retained Fascia Iliaca Catheter: A Case Report.

    PubMed

    Borg, Lindsay K; Kumar, Gunjan; Funck, Natasha; Tamm-Daniels, Inge; Giori, Nicholas J; Mariano, Edward R

    2017-10-05

    Retained catheters are a rare but known complication of continuous peripheral nerve block. To date there have been several case reports of retained catheters but none that include longer-term follow-up of the patient experience and outcomes. Here, we present the case of a retained fascia iliaca catheter used for analgesia after total hip arthroplasty that fractured during removal and was ultimately never retrieved. The patient initially experienced paresthesias emanating from the site of continuous peripheral nerve block catheter placement, but these issues resolved completely over several weeks. No infectious or serious sequelae were encountered during 6 months of follow-up.

  1. A short-term follow-up of treatment outcome in groups of uncooperative child dental patients.

    PubMed

    Arnrup, K; Berggren, U; Broberg, A G; Bodin, L

    2004-12-01

    To evaluate the short-term follow-up outcome in four subgroups of uncooperative child dental patients referred to a specialist paediatric dental clinic in Sweden. Seventy children, classified into four groups (based on fear, temperament, behaviour and verbal intelligence), were followed-up at their public dental clinics after termination of specialist dental treatment. Questionnaire assessments of children's dental and general fear, parental dental fear, emotional stress, locus of control and parenting efficacy were made by parents pre and post treatment and at follow-up and were analysed within and between groups. At follow-up, parents rated their children's coping and procedure stress, while treatment acceptance was rated by the dentists. Decreases in child dental fear were maintained at follow-up, although a third of children still had moderate or high dental fear. For those children who had been classified into the externalising, impulsive group, an increased risk of non-acceptance (RR=3.7) was indicated. The risk of dental fear at follow-up was increased for the group of fearful, inhibited children (RR=3.8). For the study group as a whole a poorer follow-up outcome could be predicted by avoidance behaviour (OR 12.9-16.6) and moderate or high post treatment dental fear (OR 6.5- 21.3). Fearful, inhibited child dental patients may need, due to dental fear, extra attention even after successful dental treatment at a specialist clinic. Externalising, impulsive children constitute a special challenge for dentistry. The continued need for adjusted management after termination of specialist treatment can be predicted from avoidance behaviour and post treatment dental fear scores.

  2. Follow-up intervals in patients with Cushing's disease: recommendations from a panel of experienced pituitary clinicians.

    PubMed

    Geer, Eliza B; Ayala, Alejandro; Bonert, Vivien; Carmichael, John D; Gordon, Murray B; Katznelson, Laurence; Manuylova, Ekaterina; Shafiq, Ismat; Surampudi, Vijaya; Swerdloff, Ronald S; Broder, Michael S; Cherepanov, Dasha; Eagan, Marianne; Lee, Jackie; Said, Qayyim; Neary, Maureen P; Biller, Beverly M K

    2017-08-01

    Follow-up guidelines are needed to assess quality of care and to ensure best long-term outcomes for patients with Cushing's disease (CD). The purpose of this study was to assess agreement by experts on recommended follow-up intervals for CD patients at different phases in their treatment course. The RAND/UCLA modified Delphi process was used to assess expert consensus. Eleven clinicians who regularly manage CD patients rated 79 hypothetical patient scenarios before and after ("second round") an in-person panel discussion to clarify definitions. Scenarios described CD patients at various time points after treatment. For each scenario, panelists recommended follow-up intervals in weeks. Panel consensus was assigned as follows: "agreement" if no more than two responses were outside a 2 week window around the median response; "disagreement" if more than two responses were outside a 2 week window around the median response. Recommendations were developed based on second round results. Panel agreement was 65.9% before and 88.6% after the in-person discussion. The panel recommended follow-up within 8 weeks for patients in remission on glucocorticoid replacement and within 1 year of surgery; within 4 weeks for patients with uncontrolled persistent or recurrent disease; within 8-24 weeks in post-radiotherapy patients controlled on medical therapy; and within 24 weeks in asymptomatic patients with stable plasma ACTH concentrations after bilateral adrenalectomy. With a high level of consensus using the Delphi process, panelists recommended regular follow-up in most patient scenarios for this chronic condition. These recommendations may be useful for assessment of CD care both in research and clinical practice.

  3. Contraception and postpartum follow-up in patients with gestational diabetes.

    PubMed

    Rosenthal, Emily W; Easter, Sarah Rae; Morton-Eggleston, Emma; Dutton, Caryn; Zera, Chloe

    2017-04-01

    We sought to review the effect of immediate provision of postpartum contraception on postpartum follow-up and screening for type 2 diabetes in women with gestational diabetes mellitus (GDM). We performed multivariate logistic regression to identify the association between immediate provision of postpartum contraception and attendance at the 6-week postpartum visit and performance of a 6- to 12-week oral glucose tolerance test, controlling for age, type of insurance, parity and race. Women who received contraception prior to hospital discharge were less likely to attend their postpartum visit [adjusted odds ratio (aOR) 0.59, 95% confidence interval (CI) 0.39-0.88], but just as likely to participate in postpartum diabetes screening (adjusted odds ratio (aOR) 1.27, 95% confidence interval (CI) 0.78-2.06). Attendance at the postpartum visit was associated with private insurance (OR 1.93, 95% CI 1.31-2.99). Receiving contraception while admitted postpartum did not affect follow-up for diabetes screening for women with GDM. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Following up infant bronchiolitis patients provided new evidence for and against the united airway disease hypothesis.

    PubMed

    Lauhkonen, Eero; Koponen, Petri; Nuolivirta, Kirsi; Helminen, Merja; Paassilta, Marita; Toikka, Jyri; Korppi, Matti

    2016-11-01

    The united airway disease (UAD) hypothesis suggests that allergic rhinitis and asthma develop together. We evaluated the evidence for and against the UAD hypothesis at five to seven years of age after hospitalisation for bronchiolitis at less than six months. This study used prospective follow-up data for 102 children hospitalised for bronchiolitis under the age of six months. We included the presence of previous and current asthma, prolonged rhinitis and skin prick tests (SPT) to common inhaled allergens and lung function by impulse oscillometry (IOS) at five to seven years of age. Bronchial hyper-reactivity (BHR) was assessed using the exercise challenge test and bronchodilation test. Current asthma, but not previous transient asthma, was associated with prolonged rhinitis and a positive SPT. BHR, which reflected reactive airways, but not lung function, was associated with respiratory allergy, namely the combination of current asthma, prolonged rhinitis and a positive SPT. This post-bronchiolitis follow-up study suggested an association between respiratory allergy and reactive airways at five to seven years of age, which supported the UAD hypothesis. However, previous transient asthma and a reduction in lung function reduction did not support the hypothesis. ©2016 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  5. [The mobile application of patient management in education and follow-up for patients following total knee arthroplasty].

    PubMed

    Huang, P; He, J; Zhang, Y M

    2017-05-30

    Objective: To apply themobile application of patient management in education and follow-up for patients following total knee arthroplasty, and evaluate the clinical outcomes. Methods: A total of 150 patients following total knee arthroplasty were chosen from May to October 2016 in orthopaedics department of our hospital, and they were randomly divided into two groups. On the basis of the traditional education, the observation group combined with the APP education, guidance of functional exercise and follow-up. While traditional face-to-face and telephone education were combined to control group. The activity, compliance and satisfaction score of the two groups were observed. Results: Finally, 132 patients were included in the study. The postoperative range of motion of the two groups in February were respectively (110.83±6.83)°and (105.45±7.53)°, the difference was statistically significant (P<0.05); the range of motion in March were respectively (110±6.33)°and (103.26±7.57)°, the difference was statistically significant too (P<0.05); Patients's compliance and satisfaction score in observation group were significantly better than control group(P<0.05). Conclusion: Combination of traditional face-to-face education with mobile application will improve effects of functional training, compliance, and hospital-discharge satisfaction, it will also both shorten the education time and increase the education efficiency. To sum up, it's worth being widely applied clinically.

  6. The use of long leg calipers for paraplegic patients: a follow-up study of patients discharged 1973-82.

    PubMed

    Hawran, S; Biering-Sørensen, F

    1996-11-01

    We reviewed the medical records of 45 paraplegic patients discharged with long leg calipers, during the 10 year period 1973-82, from the Rehabilitation Hospital in Hornbaek, Denmark. A follow-up interview was carried out during 1993-94 for all 40 patients who were still alive. Thirty had complete paraplegia (seven women) and 10 had incomplete paraplegia (two women). At the follow-up interview only three were still using their calipers. The main reasons for giving up the use of calipers was, in 38%, that it was too time consuming to put them on and take them off. For 22% the main reason was a fear of falling, while 19% reported that the calipers were impractical, as their hands had to be occupied in keeping balance and therefore could not be used for other purposes, including carrying items. The three paraplegic patients who did not totally give up the use of long leg calipers used them very little, at a maximum once a week. In contrast all 10 paraplegic patients who had been provided with a standing frame made use of this at least once a month. The majority of the remaining subjects were interested in having a standing frame. We therefore believe that a standing frame could be a good alternative to long leg calipers to facilitate standing for spinal cord injured patients.

  7. Three year follow up of patients with raised blood pressure identified at health checks in general practice.

    PubMed Central

    Mant, D.; McKinlay, C.; Fuller, A.; Randall, T.; Fullard, E. M.; Muir, J.

    1989-01-01

    OBJECTIVE--To assess the extent of three year follow up of blood pressure, weight, and smoking habit in patients with raised blood pressure identified at health checks. DESIGN--Retrospective audit of medical and nursing records. SETTING--Three general practices in Oxfordshire. PATIENTS--386 of 448 patients with raised blood pressure (diastolic greater than or equal to 90 or systolic greater than or equal to 160 mm Hg) identified from 2935 patients aged 35-64 attending health checks in 1982-4. MEASUREMENTS and MAIN RESULTS--All records of blood pressure, weight, and smoking habit in the medical record were abstracted for three years after the initial health check. All 42 patients with an initial diastolic blood pressure greater than or equal to 105 mm Hg and 316 of 344 patients with an initial pressure of 90-104 mm Hg had at least one further measurement of their blood pressure. Follow up of smoking habit and of weight was less complete with only half of the 100 smokers and 67 of the 87 obese patients (body mass index greater than or equal to 30) having any documented follow up of these risk factors. Annual follow up in the second and third years occurred in 228/297 (76.8%) and 232/320 (72.5%) in patients with blood pressure greater than 95 mm Hg at the beginning of each year. For patients who smoked annual follow up in these years occurred in fewer than a third and for those who were obese in just over half. On the assumption that those not followed up had not changed, at the end of three years the proportion of patients with diastolic blood pressure greater than or equal to 100 mm Hg had fallen from 61 patients (15.8%) to 31 (8.1%); the proportion of smokers had fallen from 103 (26.7%) to 94 (24.4%); and the proportion of obese patients had fallen from 87 (22.5%) to 79 (20.5%). CONCLUSIONS--These changes were modest and in the absence of a control group cannot be attributed necessarily to health checks. Although the standard of follow up was better than in

  8. Ultrasound-based follow-up does not increase survival in early-stage melanoma patients: A comparative cohort study.

    PubMed

    Ribero, S; Podlipnik, S; Osella-Abate, S; Sportoletti-Baduel, E; Manubens, E; Barreiro, A; Caliendo, V; Chavez-Bourgeois, M; Carrera, C; Cassoni, P; Malvehy, J; Fierro, M T; Puig, S

    2017-09-07

    Different protocols have been used to follow up melanoma patients in stage I-II. However, there is no consensus on the complementary tests that should be requested or the appropriate intervals between visits. Our aim is to compare an ultrasound-based follow-up with a clinical follow-up. Analysis of two prospectively collected cohorts of melanoma patients in stage IB-IIA from two tertiary referral centres in Barcelona (clinical-based follow-up [C-FU]) and Turin (ultrasound-based follow-up [US-FU]). Kaplan-Meier curves were used to evaluate distant metastases-free survival (DMFS), disease-free interval (DFI), nodal metastases-free survival (NMFS) and melanoma-specific survival (MSS). A total of 1149 patients in the American Joint Committee on Cancer stage IB and IIA were included in this study, of which 554 subjects (48%) were enrolled for a C-FU, and 595 patients (52%) received a protocolised US-FU. The median age was 53.8 years (interquartile range [IQR] 41.5-65.2) with a median follow-up time of 4.14 years (IQR 1.2-7.6). During follow-up, 69 patients (12.5%) in C-FU and 72 patients (12.1%) in US-FU developed disease progression. Median time to relapse for the first metastatic site was 2.11 years (IQR 1.14-4.04) for skin metastases, 1.32 (IQR 0.57-3.29) for lymph node metastases and 2.84 (IQR 1.32-4.60) for distant metastases. The pattern of progression and the total proportion of metastases were not significantly different (P = .44) in the two centres. No difference in DFI, DMFS, NMFS and MSS was found between the two cohorts. Ultrasound-based follow-up does not increase the survival of melanoma patients in stage IB-IIA. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. Treatment of Visceral Aneurysm Using Multilayer Stent: Two-Year Follow-Up Results in Five Consecutive Patients

    SciTech Connect

    Balderi, Alberto Antonietti, Alberto Pedrazzini, Fulvio Sortino, Davide Vinay, Claudia Grosso, Maurizio

    2013-10-15

    Purpose: The present study was performed to analyze the midterm results (five consecutive patients, 2-year follow-up) of the endovascular management of visceral artery aneurysms using the Cardiatis Multilayer Flow Modulator (CMFM) (Cardiatis, Isnes, Belgium), a self-expandable stent. Materials and Methods: From August 2009 to January 2011, we implanted five CMFMs in five patients (all men; mean age 73 years) to treat two common hepatic artery aneurysms, one celiac trunk aneurysm, one splenic artery aneurysm, and one superior mesenteric artery aneurysm (diameter 25-81 mm). The primary end point was technical success. The secondary end point was stent patency, absence of aneurysm rupture or reperfusion, and shrinking of the sac at 6-, 12-, and 24-month follow-up using computed tomography angiography. Follow-up ranged from 24 to 48 months (mean 31.2). Results: Technical success was achieved in all patients. Complete exclusion of the aneurysm with sac shrinking was achieved in two patients. Two stents became occluded at 6- and 24-month follow-up, respectively; both patients were asymptomatic and were not retreated. One patient developed sac reperfusion due to incomplete aneurysm exclusion. Conclusion: Long-term results in a wider population are needed to validate the effectiveness of the CMFM.

  10. Association of survival time with transthoracic echocardiography in stable patients with heart failure: Is routine follow-up ever appropriate?

    PubMed

    Fonseca, Ricardo; Otahal, Petr; Galligan, John; Neilson, Samuel; Huynh, Quan; Saito, Makoto; Negishi, Kazuaki; Marwick, Thomas H

    2017-03-01

    The appropriateness of repeat transthoracic echocardiography (TTE) for stable heart failure (HF) is based on timing of the follow-up examination, but this lacks scientific support. We sought the association of routine follow-up TTE on survival and readmission in stable HF. Patients with HF were selected from consecutive HF admissions from 2008 to 2012. Groups were divided into: no follow-up TTE; routine <1year with no change in status ("rarely appropriate"), ≥1year follow-up with no change in status ("maybe appropriate") and TTE due to change in clinical status ("appropriate"). Survival analysis was performed for the combined endpoint of HF readmission and death, and a separate analysis was performed for HF readmission, with death as a competing risk. Of 550 HF patients, 141 had a follow-up TTE, including 41 (29%) within 1year. The event-free time in years was similar between no TTE (1.10years [95%CI: 0.69, 1.49], routine TTE <1year (2.61years [95% CI: 1.08, 3.04], routine >1year (2.45years [95% CI: 1.37, 5.78]); all were greater than symptomatic patients (0.09years [95% CI: 0.02, 1.80]). HF readmission was independently associated with statins, renal disease, coronary angiography and NYHA class, but not follow-up TTE timing. There were no differences in the cumulative incidence for death between groups. There were no differences in change in management in routine TTE <1year and ≥1year. The distinction of appropriateness of routine repeat TTE in stable HF patients, based on testing <1 or ≥1year after index admission appears unjustified. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  11. [Long-term follow up of patients surgically treated for pyelo-ureteral disease by the Anderson-Hynes technique].

    PubMed

    Polito, M; Galosi, A B; Minardi, D; Nonni, M; Cinti, P; Riccardi, A

    1997-02-01

    A series of 48 patients with hydronephrosis (mean age 31 yrs.) underwent on Anderson-Hynes pyeloplasty. Assessment was carried out in 30 pts. after a mean observation time of 90 months, with a minimum 5 years follow-up. Clinical examination, laboratory investigations, renal ultrasonography, urography and renal scan were performed pre-operatively and at follow-up. There was one patient with evidence of stenosis in the ureteropelvic junction; one patient developed urinary leakage post-operatively and required surgical correction. All patients had symptoms pre-operatively and no one had symptoms post-operatively. Four patients had calcolosis associated, postoperatively all pts. were stone free; four years later one patient developed litiasis. We observed that the results of surgical intervention in hydronephrosis are excellent especially in patients aged less than 30 years.

  12. Effect of Remote Internet Follow-Up on Postradiotherapy Compliance Among Patients with Esophageal Cancer: A Randomized Controlled Study.

    PubMed

    Wang, Ping; Yang, Lin; Hua, Zhongsheng

    2015-11-01

    To explore the effects of using remote Internet follow-up on postradiotherapy compliance with medical advice provided to patients with esophageal cancer. Between January 1 and August 1, 2013, in total, 128 patients with esophageal squamous cell cancer treated with radiotherapy were randomly assigned to either an observation group (n=64) or a control group (n=64). The control group received routine outpatient follow-up, whereas the observation group received additional remote Internet follow-up for 6 months after discharge from the hospital. The treatment effects and compliance were investigated using a questionnaire. At 3 months and 6 months after discharge, patients in the observation group had sought significantly more consultations and undergone more periodic re-examinations than patients in the control group (all p<0.001). Furthermore, both the disease-free survival rate and the symptom reduction rate were significantly higher in the observation group compared with the control group (all p<0.001). Remote Internet follow-up is an easy and fast method for improving postradiotherapy compliance with medical instructions and promoting normalization among patients with esophageal cancer.

  13. General practice vs surgical-based follow-up for patients with colon cancer: randomised controlled trial

    PubMed Central

    Wattchow, D A; Weller, D P; Esterman, A; Pilotto, L S; McGorm, K; Hammett, Z; Platell, C; Silagy, C

    2006-01-01

    This trial examined the optimal setting for follow-up of patients after treatment for colon cancer by either general practitioners or surgeons. In all, 203 consenting patients who had undergone potentially curative treatment for colon cancer were randomised to follow-up by general practitioners or surgeons. Follow-up guidance recommended three monthly clinical review and annual faecal occult blood tests (FOBT) and were identical in both study arms. Primary outcome measures (measured at baseline, 12 and 24 months were (1) quality of life, SF-12; physical and mental component scores, (2) anxiety and depression: Hospital Anxiety and Depression Scale and (3) patient satisfaction: Patient Visit-Specific Questionnaire. Secondary outcomes (at 24 months) were: investigations, number and timing of recurrences and deaths. In all, 170 patients were available for follow-up at 12 months and 157 at 24 months. At 12 and 24 months there were no differences in scores for quality of life (physical component score, P=0.88 at 12 months; P=0.28 at 24 months: mental component score, P=0.51, P=0.47; adjusted), anxiety (P=0.72; P=0.11) depression (P=0.28; P=0.80) or patient satisfaction (P=0.06, 24 months). General practitioners ordered more FOBTs than surgeons (rate ratio 2.4, 95% CI 1.4–4.4), whereas more colonoscopies (rate ratio 0.7, 95% CI 0.5–1.0), and ultrasounds (rate ratio 0.5, 95% CI 0.3–1.0) were undertaken in the surgeon-led group. Results suggest similar recurrence, time to detection and death rates in each group. Colon cancer patients with follow-up led by surgeons or general practitioners experience similar outcomes, although patterns of investigation vary. PMID:16622437

  14. Discharge huddle outfitted with mobile technology improves efficiency of transitioning stroke patients into follow-up care.

    PubMed

    Tielbur, Brittany R; Rice Cella, Donna E; Currie, Amanda; Roach, Jonathan D; Mattingly, Bryan; Boone, Jack; Watwood, Christina; McGauran, Ann; Kirshner, Howard S; Charles, P David

    2015-01-01

    Disjointed patient care is a well-documented problem in health care systems, often stemming from poor communication between providers, services, and follow-up care resources. A multidisciplinary discharge huddle, augmented with cellular and tablet technology, was implemented on the Neurology Stroke Service to facilitate multidisciplinary communication, improve transition of patients, and increase referrals into affiliated follow-up care. After initiating the huddle, patient length of stay decreased by 1.4 days (25%), patient flow into continuum partners increased by 10%, and the number of patients going without services after their hospital stay decreased by more than 12%. Huddle members reported that the technology was helpful, heavily utilized, and made their work more efficient. This pilot suggests that utilizing modern mobile technologies can help improve efficiency and referrals within the health care system and reduce patient length of stay.

  15. Higher ambulatory blood pressure relates to new cerebral microbleeds: 2-year follow-up study in lacunar stroke patients.

    PubMed

    Klarenbeek, Pim; van Oostenbrugge, Robert J; Rouhl, Rob P W; Knottnerus, Iris L H; Staals, Julie

    2013-04-01

    Elevated blood pressure (BP) is associated with the presence of cerebral microbleeds (CMBs) in cross-sectional studies. However, longitudinal studies did not show a convincing relationship. We aimed to determine the association between elevated BP levels and the occurrence of new CMBs after a 2-year follow-up in first-ever lacunar stroke patients using ambulatory BP monitoring. Ninety-six first-ever lacunar stroke patients underwent brain MRI and ambulatory BP monitoring at baseline and after 2-year follow-up. We used logistic regression analyses to assess the association of BP levels with new CMBs. We found new CMBs in 17 patients (18%). Higher 24-hour, day and night systolic BP (odds ratio, 2.69; 95% confidence interval, 1.40-5.21 per SD increase for 24-hour BP) and diastolic BP (odds ratio, 2.13; 95% confidence interval, 1.15-3.90 per SD increase for 24-hour BP) at baseline were associated with the development of new CMBs independent of age and sex. BP levels decreased during follow-up in both patients with and without new CMBs. Unlike BP levels at baseline, there was no difference in BP levels at follow-up between patients with and without new CMBs. Both higher systolic and diastolic BP levels were associated with the development of new CMBs in a population of lacunar stroke patients. Decrease of BP levels during follow-up did not halt progression of CMBs; however, it remains to be determined whether (early) intervention with antihypertensive drugs can slow down progression of CMBs.

  16. Follow-up bone scan in breast cancer patients: what is the appropriate interpretation of purely rib uptake?

    PubMed

    Seo, Minjung; Ko, Byung Kyun; Tae, Soon Young; Koh, Su-Jin; Noh, Young Ju; Choi, Hye-Jeong; Bae, Kyungkyg; Bang, Minseo; Jun, Sungmin; Park, Seol Hoon

    2016-12-01

    Although rib uptake is frequently detected in follow-up bone scans of breast cancer patients, few studies have assessed its clinical significance. Among 1208 breast cancer patients who underwent a bone scan between 2011 and 2014, 157 patients presented with newly detected rib uptake at follow-up. Patients who had underlying bone metastases (n=8) or had simultaneous new uptake in sites other than the rib (n=13) were excluded. The patients enrolled finally were those who had purely rib uptakes. The location, intensity, and final diagnosis of the uptake were evaluated by nuclear medicine physicians. A total of 275 new instances of rib uptake were detected in follow-up bone scans of 136 patients. These were more frequently located on the ipsilateral side of the breast cancer (61.1%) and the anterior arc (65.1%), and they presented as moderate to intense (93.1%) uptakes. Among these, 265 lesions in 130 patients turned out to be benign fractures (96.4%), whereas only 10 lesions in six patients were metastases. The proportion of metastases was significantly higher if the uptake was linear or if the patient had recurrence. It was marginally higher if the uptake was located in the posterior arc. The proportion of metastases within the radiation field was significantly lower in patients with a history of irradiation. Newly detected purely rib uptake on a follow-up bone scan in patients who have been treated for breast cancer is mostly because of fractures and rarely signals metastasis. However, if the patient has disease recurrence, metastasis should strongly be suspected, particularly when uptake is linear or located in the posterior arc.

  17. Proposal for management and dermoscopy follow-up of nevi in patients affected by oculocutaneous albinism type Ia

    PubMed Central

    Peralta, Rosario; Sabban, Emilia Cohen; Friedman, Paula; Marcucci, Carolina; Bollea Garlatti, Luis A.; Galimberti, Gastón; Cabo, Horacio

    2017-01-01

    Albino patients are at great risk for developing cutaneous neoplasms, including melanomas. In this paper we describe the dermatoscopic findings of nevi in two patients with oculocutaneous albinism type Ia (OCA-Ia) highlighting that they manifest a vascular pattern similar to that described for amelanotic melanoma. We propose managing these patients with dermoscopy, using the comparative approach, digital follow up (DFU), and reflectance confocal microscopy as a complementary tool for difficult cases. PMID:28243493

  18. The frequency of bone fractures among patients with chronic kidney disease not on dialysis: two-year follow-up.

    PubMed

    Figurek, Andreja; Vlatkovic, Vlastimir; Vojvodic, Dragan; Gasic, Branislav; Grujicic, Milorad

    2017-05-22

    Renal osteodystrophy is a severe complication of chronic kidney disease (CKD) that increases morbidity and mortality in these patients. Mineral and bone disorder starts early in CKD and affects the incidence of bone fractures. The aim of this study was to observe the frequency of diverse bone fractures in patients with CKD not on dialysis. This cohort study included 68 patients, that were followed during the two-year period. The patients were divided in two cohorts: one that developed bone fractures and the other that did not. There were 35 (51.5%) men and 33 (48.5%) women. The mean age of patients ranged 62.88±11.60 years. During follow-up serum values of chronic kidney disease - mineral and bone indicators were measured. The methods of descriptive and analytical statistics were used in order to analyze obtained data. During this two-year follow-up seven patients developed bone fractures. Among them, females dominated (6 patients) compared to males (only 1 patient). The most common were fractures of forearm. The mean level of parathyroid hormone (PTH) at the beginning of the monitoring was higher in the group of patients with bone fractures (165.25±47.69 pg/ml) in regard to other group (103.96±81.55 pg/ml). After two-year follow-up, this difference became statistically significant at the level p<0.05. Patients that developed bone fractures had higher FRAX (Fracture Risk Assessment) score compared to other group. In our study, about 10% of patients had bone fractures in two-year follow-up period. Patients who developed fractures had a higher PTH level and FRAX score.

  19. Long-term follow-up of mobile-bearing total ankle replacement in patients with inflammatory joint disease.

    PubMed

    Kraal, T; van der Heide, H J L; van Poppel, B J; Fiocco, M; Nelissen, R G H H; Doets, H C

    2013-12-01

    Little is known about the long-term outcome of mobile-bearing total ankle replacement (TAR) in the treatment of end-stage arthritis of the ankle, and in particular for patients with inflammatory joint disease. The aim of this study was to assess the minimum ten-year outcome of TAR in this group of patients. We prospectively followed 76 patients (93 TARs) who underwent surgery between 1988 and 1999. No patients were lost to follow-up. At latest follow-up at a mean of 14.8 years (10.7 to 22.8), 30 patients (39 TARs) had died and the original TAR remained in situ in 28 patients (31 TARs). The cumulative incidence of failure at 15 years was 20% (95% confidence interval (CI) 11 to 28). The mean American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score of the surviving patients at latest follow-up was 80.4 (95% CI 72 to 88). In total, 21 patients (23 TARs) underwent subsequent surgery: three implant exchanges, three bearing exchanges and 17 arthrodeses. Neither design of TAR described in this study, the LCS and the Buechel-Pappas, remains currently available. However, based both on this study and on other reports, we believe that TAR using current mobile-bearing designs for patients with end-stage arthritis of the ankle due to inflammatory joint disease remains justified.

  20. Systemic and pulmonary screening of patients with Behçet's disease during periodic follow-up.

    PubMed

    Bilgin, Gulden; Sungur, Gulten; Kucukterzi, Vildan

    2013-03-01

    Behçet's disease (BD) is a multisystemic disease that may involve all systems, the most common symptoms being oral and genital ulcerations and ocular involvement. Pulmonary involvement is not usually investigated in BD unless there is a specific complaint. In this study, pulmonary parameters and findings were investigated in BD patients at periodic follow-ups. A total of 112 subjects with a definitive diagnosis of BD from the Ocular Diseases Polyclinic, Behçet Disease Center, Ankara Training and Research Hospital and who had been referred to the Thoracic Diseases Polyclinic between January-October 2010 were evaluated. In the patients, the absence of active smoking, pregnancy, lactation and systemic steroid use were especially considered. A total of 112 patients between 14 and 61 years-old (53 male, 59 female) were enrolled in the study. The duration of follow-up varied between 1 and 22 years. The most commonly encountered symptom was hemoptysis observed in 18 subjects. 43 patients had mild obstruction, 9 patients had moderate obstruction, 4 patients had advanced obstruction and 4 patients showed restrictive alterations. Thoracic CT was normal for 83 subjects. Pulmonary involvement was observed as a pulmonary artery aneurysm in 4 patients and was treated. In BD, although anyone of PFT and CT values is normal, others may show pathological values. We believe that it would be useful in the follow-up to keep a regular record of the patient data and to perform PFT and, if possible, CT periodically.

  1. Role of the nurse in patient education and follow-up of people receiving oral chemotherapy treatment: an international survey.

    PubMed

    Kav, Sultan; Johnson, Judi; Rittenberg, Cynthia; Fernadez-Ortega, Paz; Suominen, Tarja; Olsen, Pia Riis; Patiraki, Elisabeth; Porock, Davina; Dahler, Annette; Toliusiene, Jolanta; Tadic, Dusanka; Pittayapan, Pongpak; Roy, Vijay; Wang, Qi; Colak, Meric; Saca-Hazboun, Hanan; Makumi, David; Kadmon, Ilana; Ami, Sarah Ben; Anderson, Elsie; Clark-Snow, Rebecca

    2008-09-01

    The aim of this study was to explore the nursing role in education and follow-up of patients who were taking oral chemotherapy (CT) and to identify the worldwide gap in patient education about oral CT. Multinational Association of Supportive Care in Cancer members were invited to participate in a survey on oral CT. Nurse coordinators collected data via a 16-item questionnaire. Respondents totaled 1115 oncology nurses from 15 countries. Findings showed that about half of subjects work in outpatient/ambulatory clinics and had given at least two or more oral CT drugs. Although 52% had some type of guidelines/protocols, 47% reported not having received any education about oral CT drugs. While 64% report being involved in patient education, 58% of subjects indicated lack of patient education materials that are specific for oral CT agents. Only 27% stated that they gave all necessary information such as when and how to take the drugs, drug safety and storage, side effects, and symptom management. Reasons for not being involved in oral CT education and follow-up included beliefs that the physician plans the oral CT and gives patients necessary instructions (34%), that nurses only see patients who receive intravenous chemotherapy (16%), that nurses have lack of knowledge about oral agents (15%), and belief that physicians are responsible for patient follow-up. The nurses suggested better education and follow-up of patients to include the written patient education materials (33%) and professional education for nurses (30%). Findings revealed the need for professional education for nurses to ensure comprehensive, consistent patient education and development of written materials for patients receiving oral CT treatment.

  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. © 2016 Special Care Dentistry Association and Wiley Periodicals, Inc.

  3. Open Surgical Treatment for Femoroacetabular Impingement in Patients over Thirty Years: Two Years Follow-up Results

    PubMed Central

    2015-01-01

    Purpose We report short term results of open surgical treatment for symptomatic femoroacetabular impingement (FAI) in patients over the age of 30 years. Materials and Methods Between May 2011 and June 2012, thirteen FAI hips (11 patients) with hip pain persisting longer than 6 months were treated by either surgical hip dislocation (SHD) or anterior mini-open. They were followed up for longer than 2 years. The 11 patients included 7 females and 4 males with a mean age of 45 (range, 33-60) years. They were clinically evaluated for modified Harris hip score (MHHS) and University of California at Los Angeles (UCLA) activity level. Their lateral center-edge angle, acetabular index, and alpha angle were measured and compared. Results Acetabuloplasties were performed for seven cases. Femoral osteochondroplasty was performed for all thirteen cases. At minimum follow-up of two year (range, 24-29 months), all patients had substantial relief in preoperative pain with improvement in range of motion. The median MHHS was significantly (P<0.05) improved from 61 points preoperatively to 87 points at the last follow-up. The median UCLA activity level was 7 (range, 5-8) at last follow-up. Radiological indices improved. Two cases showed mild residual pain attributable to adhesion between capsule and reshaped femoral head-neck area. Conclusion Open surgical treatment of FAI was a reliable and effective treatment method in symptomatic FAIs for patients over the age of 30 years without advanced arthritic change of hip joint at short term follow-up. PMID:27536632

  4. Long-Term Follow-Up of Patients after Percutaneous Coronary Intervention with Everolimus-Eluting Bioresorbable Vascular Scaffold

    PubMed Central

    Meneguz-Moreno, Rafael Alexandre; Costa Junior, José de Ribamar; Moscoso, Freddy Antônio Britto; Staico, Rodolfo; Tanajura, Luiz Fernando Leite; Centemero, Marinella Patrizia; Chaves, Auréa Jacob; Abizaid, Andrea Claudia Leão de Sousa; Sousa, Amanda Guerra de Moraes Rego e; Abizaid, Alexandre Antonio Cunha

    2017-01-01

    Background Bioresorbable vascular scaffolds (BVS) were developed to improve the long-term results of percutaneous coronary intervention, restoring vasomotion. Objectives To report very late follow-up of everolimus-eluting Absorb BVS (Abbott Vascular, Santa Clara, USA) in our center. Methods Observational retrospective study, in a single Brazilian center, from August 2011 to October 2013, including 49 patients submitted to Absorb BVS implantation. Safety and efficacy outcomes were analyzed in the in-hospital and very late follow-up phases (> 2 years). Results All 49 patients underwent a minimum follow-up of 2.5 years and a maximum of 4.6 years. Mean age was 56.8 ± 7.6 years, 71.4% of the patients were men, and 26.5% were diabetic. Regarding clinical presentation, the majority (94%) had stable angina or silent ischemia. Device success was achieved in 100% of cases with 96% overall procedure success rate. Major adverse cardiovascular events rate was 4% at 30 days, 8.2% at 1 year, and 12.2% at 2 years, and there were no more events until 4.6 years. There were 2 cases of thrombosis (1 subacute and 1 late). Conclusions In this preliminary analysis, Absorb BVS showed to be a safe and effective device in the very late follow-up. Establishing the efficacy and safety profiles of these devices in more complex scenarios is necessary. PMID:28076449

  5. Penile plication for Peyronie's disease: our results with mean follow-up of 103 months on 89 patients.

    PubMed

    Cantoro, U; Polito, M; Catanzariti, F; Montesi, L; Lacetera, V; Muzzonigro, G

    2014-01-01

    To evaluate the outcome of the long-term follow-up in patients who underwent corporoplasty-straightening treatment for Peyronie's disease. Between 1990 and 2012, a total of 89 patients underwent corporoplasty-straightening surgery using penile plication for Peyronie's disease. We followed up on all the patients for the following: (a) the correction of the curvature; (b) any penile shortening; (c) sexual function; and (d) complications. The mean follow-up period was 103 months. Complete correction of the curvature was obtained in 81 patients (91%). Shortening of the penis (1.5 to <3 cm) occurred in 20 patients (22.5%) and 79 patients (88.7%) had good erectile function (International Index of Erectile Function (IIEF) 5> 21). The most frequent complication was the sensitivity reduction of the glans in eight patients (8.9%), which was resolved within about a year after surgery (mean 11 months) and the shortening of the penis in 20 patients (22.5%), which, however, did not result in problems during sexual intercourse. Corporoplasty using penile straightening plication is a safe procedure whose results are maintained for even many years after surgery. It is a procedure that can be applied to any type of curvature. Any reduction in the length of the penis, as a result of the surgery procedure, does not lead to difficulties in sexual intercourse.

  6. Improving the Blood Pressure Control With the ProActive Attitude of Hypertensive Patients Seeking Follow-up Services

    PubMed Central

    Tang, Shangfeng; Bishwajit, Ghose; Ji, Lu; Feng, Da; Fang, Haiqing; Fu, Hang; Shao, Tian; Shao, Piaopiao; Liu, Chunyan; Feng, Zhanchun; Luba, Tegene R.

    2016-01-01

    Abstract Proactive attitude of hypertensive patients seeking follow-up services (FUS) lies at the core of self-efficacy. However, few evidence have shown the activeness of seeking FUS in the context of blood pressure control among hypertensive patients. Improvements in follow-up visits may not just by services itself cause better control of blood pressure among hypertensive patients, rather due to the patient's pro-active attitude of the patient in seeking FUS. A cross-sectional study was carried out in selected rural regions of China to explore the association between blood pressure control and sociodemographic and economic variables and activeness of hypertensive patients in seeking FUS. The primary clinical outcome for this study was blood pressure control (systolic blood pressure <140 mmHg or diastolic blood pressure <90 mmHg) Out of the total 2321 participants with hypertension aged 35 years or older participated in this survey. Number of proactive FUS seekers were 3.17 times greater than those of passive seekers (odds ratio [OR] = 3.17, 95% confidence interval [CI] = 2.56–3.93, P < 0.001). In all subgroups, hypertensive patients who were seeking FUS actively were more likely to control blood pressure better than those seeking FUS passively. Proactive attitude of seeking follow-up services can improve blood pressure control among hypertensive patients. PMID:27057859

  7. Would loss to follow-up bias the outcome evaluation of patients operated for degenerative disorders of the lumbar spine?

    PubMed Central

    2011-01-01

    Background and purpose Loss to follow-up may bias the outcome assessments of clinical registries. In this study, we wanted to determine whether outcomes were different in responding and non-responding patients who were included in a clinical spine surgery registry, at two years of follow-up. In addition, we wanted to identify risk factors for failure to respond. Methods 633 patients who were operated for degenerative disorders of the lumbar spine were followed for 2 years using a local clinical spine registry. Those who did not attend the clinic and those who did not answer a postal questionnaire—for whom 2 years of outcome data were missing—and who would be lost to follow-up according to the standard procedures of the registry protocols, were defined as non-respondents. They were traced and interviewed by telephone. Outcome measures were: improvement in health-related quality of life (EQ-5D), leg pain, and back pain; and also general state of health, employment status, and perceived benefits of the operation. Results We found no statistically significant differences in outcome between respondents (78% of the patients) and non-respondents (22%). Receipt of postal questionnaires (not being summoned for a follow-up visit) was the strongest risk factor for failure to respond. Forgetfulness appeared to be an important cause. Older patients and those who had complications were more likely to respond. Interpretation A loss to follow-up of 22% would not bias conclusions about overall treatment effects and, importantly, there were no indications of worse outcomes in non-respondents. PMID:21189113

  8. Mobile phone-based telemedicine system for the home follow-up of patients undergoing ambulatory surgery.

    PubMed

    Martínez-Ramos, Carlos; Cerdán, María Teresa; López, Rodrigo S

    2009-01-01

    A pilot study was done to address the efficacy of a General Packet Radio Service mobile phone-based telemedicine system used to improve follow-up after ambulatory surgery. The method involves sending images of surgical wounds or other areas from the patient's home, to assess local complications and avoid unnecessary hospital visits. Ninety-six (N = 96) patients were enrolled in the study. The phone used was a Nokia 6600, which provides images in Joint Photographic Experts Group format. These images were sent via e-mail and visualized on a standard 17-inch screen of a personal computer. After the follow-up period, self-reported patient satisfaction was assessed by analyzing the replies to a 9-item questionnaire. Thirty of the 96 patients (31.3%) reported local problems including: hematoma in 20 (66.7%) patients, surgical bandage blood-stained in 7 (23.3%), exudates in 1 (3.3%), allergic skin reactions in 1 (3.3%), and bandage too tight in 1 (3.3%). In total, 225 photographs were evaluated by 3 physicians. In all cases, it was possible to identify and assess the postoperative problem with consensus among the 3 physicians. Images served to resolve patients' concerns in 20 individuals (66.7%). In 10 patients (33.3%), concerns were satisfied but it was suggested that follow-up images be sent in the following days. Only 1 patient (3.3%) was asked to visit the hospital. The telemedicine system proposed increases the efficiency of home follow-up to ambulatory surgery, avoids unnecessary hospital visits, and clearly improves patient satisfaction.

  9. Interdisciplinary evidence-based recommendations for the follow-up of early stage seminomatous testicular germ cell cancer patients.

    PubMed

    Souchon, Rainer; Hartmann, Michael; Krege, Susanne; Lorch, Anja; Mayer, Frank; De Santis, Maria; Gillessen, Silke; Beyer, Jörg; Cathomas, Richard

    2011-03-01

    To provide guidance regarding follow-up procedures after initial treatment of early stage testicular seminoma (clinical stages (CS) I-II A/B) based on current published evidence complemented by expert opinion. An interdisciplinary, multinational working group consisting of urologists, medical oncologists, and radiation oncologists analyzed the published evidence regarding follow-up procedures in various stages of seminomatous and nonseminomatous testicular cancers. Focusing on radiooncological aspects, the recommendations contained herein are restricted to early stage seminoma (with radiotherapy being a standard treatment option). In particular, extent, frequency, and duration of imaging at follow-up were analyzed concerning relapse patterns, risk factors, and mode of relapse detection. Active surveillance, adjuvant carboplatin or radiotherapy are equally accepted options for CS I seminoma but they result in different relapse rates and patterns. Usually relapses occur within the first 2(-6) years. Routinely performed follow-up using computerized tomography (CT) after adjuvant treatment yield only low detection rates of recurrences. Therefore, there is no evidence to maintain routine examinations every 3-4 months. After treatment of stage IIA/B, detection rates of relapses or progression identified solely by routinely performed CT during follow-up are low. Considering lifelong cure rates of up to 99% for patients treated for seminoma CS I-IIA/B, the negative impact of unnecessary ionizing radiation exposure has to be considered. The presented recommendations for various follow-up scenarios for early stage seminoma strongly promote the restrictive use of imaging procedures that utilize ionizing radiation (especially CT), due to its potential to induce secondary malignancies.

  10. [Second primary tumors in patients treated at an early age for Hodgkin's disease; consequences for the follow-up].

    PubMed

    Aleman, B M; Klokman, W J; van Leeuwen, F E

    2000-08-05

    As curative treatment is now available for a substantial group of cancer patients, it is increasingly important to evaluate how late complications of treatment affect their long-term survival. Two recent publications summarize the second malignancies in survivors of Hodgkin's disease treated during adolescence or young adulthood. After more than 20 years' follow-up, the risk of solid tumours is still much greater in survivors of Hodgkin's disease than in the population at large. Age at treatment has a major effect on the occurrence of second malignancy. Reassuringly, the increased risk of solid tumours in patients who were less than 20 years of age seems to decrease as these patients grow older. The data of these studies suggest that chemotherapy may increase the risk of solid tumours from radiotherapy. Special alertness to symptoms of second malignancies is advised during follow-up after treatment for Hodgkin's disease, especially in patients treated below the age of 20.

  11. Pre-treatment loss to follow-up among smear-positive TB patients in tertiary hospitals, Quetta, Pakistan

    PubMed Central

    Kumar, A. M. V.; Hinderaker, S. G.; Heldal, E.; Qadeer, E.; Fatima, R.; Ullah, A.; Safdar, N.; Yaqoob, A.; Anwar, K.; Ul Haq, M.

    2017-01-01

    Setting: Three public sector tertiary care hospitals in Quetta, Balochistan, Pakistan, with anecdotal evidence of gaps between the diagnosis and treatment of patients with tuberculosis (TB). Objectives: To assess the proportion of pre-treatment loss to follow-up (LTFU), defined as no documented evidence of treatment initiation or referral in TB registers, among smear-positive pulmonary TB patients diagnosed in 2015, and the associated sociodemographic factors. Design: A retrospective cohort study involving the review of laboratory and TB registers. Results: Of 1110 smear-positive TB patients diagnosed (58% female, median age 40 years, 5% from outside the province or the country), 235 (21.2%) were lost to follow-up before starting treatment. Pre-treatment LTFU was higher among males; in patients residing far away, in rural areas, outside the province or the country; and in those without a mobile phone number. Conclusion: About one fifth of the smear-positive TB patients were lost to follow-up before starting treatment. Strengthening the referral and feedback mechanisms and using information technology to improve the tracing of patients is urgently required. Further qualitative research is needed to understand the reasons for pre-treatment LTFU from the patient's perspective. PMID:28775939

  12. Pre-treatment loss to follow-up among smear-positive TB patients in tertiary hospitals, Quetta, Pakistan.

    PubMed

    Wali, A; Kumar, A M V; Hinderaker, S G; Heldal, E; Qadeer, E; Fatima, R; Ullah, A; Safdar, N; Yaqoob, A; Anwar, K; Ul Haq, M

    2017-03-21

    Setting: Three public sector tertiary care hospitals in Quetta, Balochistan, Pakistan, with anecdotal evidence of gaps between the diagnosis and treatment of patients with tuberculosis (TB). Objectives: To assess the proportion of pre-treatment loss to follow-up (LTFU), defined as no documented evidence of treatment initiation or referral in TB registers, among smear-positive pulmonary TB patients diagnosed in 2015, and the associated sociodemographic factors. Design: A retrospective cohort study involving the review of laboratory and TB registers. Results: Of 1110 smear-positive TB patients diagnosed (58% female, median age 40 years, 5% from outside the province or the country), 235 (21.2%) were lost to follow-up before starting treatment. Pre-treatment LTFU was higher among males; in patients residing far away, in rural areas, outside the province or the country; and in those without a mobile phone number. Conclusion: About one fifth of the smear-positive TB patients were lost to follow-up before starting treatment. Strengthening the referral and feedback mechanisms and using information technology to improve the tracing of patients is urgently required. Further qualitative research is needed to understand the reasons for pre-treatment LTFU from the patient's perspective.

  13. Randomized Trial Comparing a Web-Mediated Follow-up With Routine Surveillance in Lung Cancer Patients.

    PubMed

    Denis, Fabrice; Lethrosne, Claire; Pourel, Nicolas; Molinier, Olivier; Pointreau, Yoann; Domont, Julien; Bourgeois, Hugues; Senellart, Hélène; Trémolières, Pierre; Lizée, Thibaut; Bennouna, Jaafar; Urban, Thierry; El Khouri, Claude; Charron, Alexandre; Septans, Anne-Lise; Balavoine, Magali; Landry, Sébastien; Solal-Céligny, Philippe; Letellier, Christophe

    2017-09-01

    The use of web-based monitoring for lung cancer patients is growing in interest because of promising recent results suggesting improvement in cancer and resource utilization outcomes. It remains an open question whether the overall survival (OS) in these patients could be improved by using a web-mediated follow-up rather than classical scheduled follow-up and imaging. Advanced-stage lung cancer patients without evidence of disease progression after or during initial treatment were randomly assigned in a multicenter phase III trial to compare a web-mediated follow-up algorithm (experimental arm), based on weekly self-scored patient symptoms, with routine follow-up with CT scans scheduled every three to six months according to the disease stage (control arm). In the experimental arm, an alert email was automatically sent to the oncologist when self-scored symptoms matched predefined criteria. The primary outcome was OS. From June 2014 to January 2016, 133 patients were enrolled and 121 were retained in the intent-to-treat analysis; 12 deemed ineligible after random assignment were not subsequently followed. Most of the patients (95.1%) had stage III or IV disease. The median follow-up was nine months. The median OS was 19.0 months (95% confidence interval [CI] = 12.5 to noncalculable) in the experimental and 12.0 months (95% CI = 8.6 to 16.4) in the control arm (one-sided P = .001) (hazard ratio = 0.32, 95% CI = 0.15 to 0.67, one-sided P = .002). The performance status at first detected relapse was 0 to 1 for 75.9% of the patients in the experimental arm and for 32.5% of those in the control arm (two-sided P < .001). Optimal treatment was initiated in 72.4% of the patients in the experimental arm and in 32.5% of those in the control arm (two-sided P < .001). A web-mediated follow-up algorithm based on self-reported symptoms improved OS due to early relapse detection and better performance status at relapse.

  14. Detection rate of lung cancer among chronic obstructive pulmonary disease patients regularly followed up by pulmonary physicians.

    PubMed

    Laisaar, Tanel; Lill, Hille; Kullamaa, Anneli; Jõgi, Rain

    2011-11-01

      Chronic obstructive pulmonary disease (COPD) has been found to be an independent risk factor for lung cancer. The aim of this study was to evaluate whether regular follow up of COPD patients increases the diagnosis of lung cancer at an early stage.   Case reports of 105 male moderate to severe COPD patients who participated in a clinical study were analyzed retrospectively. Throughout the 3-year study period patients regularly visited a pulmonary physician. Investigations to detect lung cancer were ordered only with the presence of symptoms. The lung cancer incidence in the study group was compared to that of general male population matched by age.   At the beginning of the study the mean age was 67 (range 55-81) years, mean smoking history 36.2 (range 11-102) years and mean forced expiratory volume in 1 s (FEV1 ) 43.3% (range 22.7-59.7). During the study six lung cancers and five other cancers were diagnosed per 287 person-years of observation. Only one lung cancer was operable, others were locally advanced or had distant metastases.   Despite the patients being followed up regularly by a pulmonary physician, most cancers were diagnosed at an advanced stage. The relative risk of getting lung cancer was 6.0 times higher (95% CI 2.7-13.3) among COPD patients than among the general population. The current study confirms that COPD patients have an increased risk of lung cancer. Moreover simple regular follow up of patients without special lung cancer screening investigations do not help to detect the cancer in its early stage. This study stresses the need to establish a more detailed follow-up program for COPD patients to detect early lung cancer in this high risk population. © Tianjin Lung Cancer Institute and Blackwell Publishing Asia Pty. Ltd.

  15. Family Physician Involvement in Cancer Care Follow-up: The Experience of a Cohort of Patients With Lung Cancer

    PubMed Central

    Aubin, Michèle; Vézina, Lucie; Verreault, René; Fillion, Lise; Hudon, Éveline; Lehmann, François; Leduc, Yvan; Bergeron, Rénald; Reinharz, Daniel; Morin, Diane

    2010-01-01

    PURPOSE There has been little research describing the involvement of family physicians in the follow-up of patients with cancer, especially during the primary treatment phase. We undertook a prospective longitudinal study of patients with lung cancer to assess their family physician’s involvement in their follow-up at the different phases of cancer. METHODS In 5 hospitals in the province of Quebec, Canada, patients with a recent diagnosis of lung cancer were surveyed every 3 to 6 months, whether they had metastasis or not, for a maximum of 18 months, to assess aspects of their family physician’s involvement in cancer care. RESULTS Of the 395 participating patients, 92% had a regular family physician but only 60% had been referred to a specialist by him/her or a colleague for the diagnosis of their lung cancer. A majority of patients identified the oncology team or oncologists as mainly responsible for their cancer care throughout their cancer journey, except at the advanced phase, where a majority attributed this role to their family physician. At baseline, only 16% of patients perceived a shared care pattern between their family physician and oncologists, but this proportion increased with cancer progression. Most patients would have liked their family physician to be more involved in all aspects of cancer care. CONCLUSIONS Although patients perceive that the oncology team is the main party responsible for the follow-up of their lung cancer, they also wish their family physicians to be involved. Better communication and collaboration between family physicians and the oncology team are needed to facilitate shared care in cancer follow-up. PMID:21060123

  16. Ross procedure is a safe treatment option for aortic valve endocarditis: Long-term follow-up of 42 patients.

    PubMed

    Ringle, A; Richardson, M; Juthier, F; Rousse, N; Polge, A S; Coisne, A; Duva-Pentiah, A; Ben Abda, A; Banfi, C; Montaigne, D; Vincentelli, A; Prat, A

    2016-01-15

    Aortic root replacement with a pulmonary autograft (Ross procedure) can be performed as a treatment of aortic valve endocarditis, avoiding prosthetic valve implantation in septic context. We sought to assess long-term outcomes of the Ross procedure in this indication. From April 1992 to March 2009, the intervention was performed in 42 patients (mean age 34 ± 8 years) suffering from an active or ancient aortic valve endocarditis. 36% of the patients had extensive perivalvular involvement, and surgery was urgent in 18 patients (43%). We performed a prospective clinical and echocardiographic follow-up of this population. Median follow-up was 10 years (4-21 years). Overall survival at 10 and 15 years was respectively 87 ± 5% and 81 ± 8%. Perioperative mortality was 4.7% (2 patients) and no late cardiac death was reported. Eight patients (19%) underwent repeat surgery for autograft and/or homograft dysfunction at a median time of 8.4 years (3 months-18 years). Rate of recurrent endocarditis was low (7%-3 patients), including 1 in a context of persistent intravenous drug abuse. Clinical follow-up showed good functional status for all patients with NYHA ≤ II, and less than 25% of patients requiring cardiovascular medication. Late echocardiographic follow-up demonstrated well-functioning autograft and homograft, with only one severe aortic regurgitation, and one significant increase in pulmonary mean gradient. The Ross procedure in aortic valve endocarditis is an interesting alternative to prosthetic valvular replacement in a selected population, with a high rate of survival free from any cardiovascular event or medication requirement. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  17. Adherence to follow-up and treatment recommendations in Greek and immigrant patients with chronic hepatitis B in Greece.

    PubMed

    Voulgaris, Theodoros; Vlachogiannakos, John; Ioannidou, Panagiota; Papageorgiou, Maria-Vasiliki; Zampeli, Evi; Karagiannakis, Dimitrios; Georgiou, Anastasia; Papazoglou, Afroditi; Karamanolis, George; Papatheodoridis, George V

    2017-03-01

    Immigrants have multiple barriers to access to health care systems. We evaluated the adherence to follow-up and treatment recommendations of chronic hepatitis B virus (HBV) Greek and immigrant patients. In total, 1001 consecutive adult patients with chronic HBV infection who visited our clinics for the first time between 2002 and 2011 were included. All patients born outside Greece were considered immigrants. Diagnosis was considered to be complete if patients could be classified into HBeAg-positive chronic hepatitis B (CHB), inactive carriers, HBeAg-negative CHB, or decompensated cirrhosis. Of the patients, 56% were Greeks and 44% were immigrants. Greeks visited our clinics at a significantly older mean age (50 vs. 35 years, P<0.001) and more frequently with advanced liver disease (11.4 vs. 6.4%, P=0.007). During the first year, Greeks more frequently had several tests and eventually a complete diagnosis (68 vs. 55%, P<0.001). Greeks were more frequently in the phase of HBeAg-negative CHB and less frequently in the phase of inactive carrier or HBeAg-positive CHB, but age was the main determinant for these differences in multivariate analysis. Treatment was initiated more frequently by Greeks than immigrants with treatment indications (86 vs. 65%, P<0.001). Only 30-33% of treated and 4-10% of untreated patients remained under follow-up at year 5, without significant differences between Greeks and immigrants. Adherence to follow-up recommendations is rather poor for all chronic HBV patients. Immigrants are lost more frequently during the first year, but only small proportions of treated and particularly untreated Greek or immigrant patients remain under long-term follow-up.

  18. Predictors of loss to follow-up in antiretroviral treatment for adult patients in the Oromia region, Ethiopia

    PubMed Central

    Megerso, Abebe; Garoma, Sileshi; Eticha, Tolosa; Workineh, Tilaye; Daba, Shallo; Tarekegn, Mihretu; Habtamu, Zelalem

    2016-01-01

    Purpose It is known that antiretroviral treatment (ART) reduces mortality from acquired immunodeficiency syndrome related causes. Patient’s lost to follow-up (LTFU) in this treatment poses a paramount problem to the public and health care services. Information on predictors of loss to follow-up is scarce in this study area and similar settings. Therefore, this study aimed at identifying correlates of loss to follow-up in ART among adult patients in the Oromia region of Ethiopia. Methods A case–control study was conducted between February 2015 and April 2015 using medical records. The stratified sampling technique was used to select health facilities. The number of patient records to be included in the study was proportionally allocated to each stratum based on their patient proportion in the regional data. Specific health facilities from which to include the records were randomly selected from a list of the health facilities per stratum. All adult patient records registered as LTFU (416) in the selected health facilities during the 12-month period prior to the data collection date, and 832 patients with good adherence to ART were included. Data were double-entered into Epi Info 7 and analyzed using SPSS 20. Descriptive statistics and binary logistic regression were used to report the results. Qualitative data were thematically analyzed using open code computer software. Results Age 15–24 years (adjusted odds ratio [AOR], 19.82 95% CI: 6.80, 57.73); day laborers (AOR, 5.36; 95% confidence interval [CI]: 3.23, 8.89), rural residents (AOR, 2.35; 95% CI: 1.45, 3.89), World Health Organization clinical stage IV (AOR, 2.29; 95% CI: 1.45, 3.62), baseline CD4 <350 cells/mL (AOR, 2.06; 95% CI: 1.36, 3.13), suboptimal adherence to ART (AOR, 7.42; 95% CI: 1.87, 29.41), were factors which increased the risk of loss to follow-up in ART. Conclusion Multiple risk factors, both socioeconomic and clinical, were associated with loss to follow-up. Attention is required to

  19. [Follow-up with the assistance of TB-info software of 208 tuberculosis patients who were treated in 2004].

    PubMed

    Bourgarit, A; Mallet, H-P; Keshtmand, H; De Castro, N; Rambeloarisoa, J; Fain, O; Antoun, F; Picard, C; Rocher, G; Che, D; Farge, D

    2009-10-01

    The impact of the TB-info software was assessed on the care of patients treated with antituberculosis regimen (ATT). Cohort study of patients with tuberculosis who received an ATT in 2004 in two hospitals and five medical centres in Paris. Follow-up was implemented with the TB-info software. Data were compared to those of the 1999-2003 cohort. Two hundred and nine ATT were initiated in 2004, with a mean duration of 7.2 months. Demographic and clinical data reflected this population precariousness: 79% were foreign-born, 25% lived in institutions and half of them had no or unusual health insurance. Compared to the previous cohort, viral co-infections were tested in more than 80% cases and showed association with HIV, HBV or HCV in 11, 10 and 5% of the patients, respectively. Twenty-one patients were lost for follow-up (11%) and 76% of the smear-positive pulmonary tuberculosis therapies were declared successful but only 34% were declared cured with the WHO criteria. Analysis of the data obtained with TB-info software showed an improvement of tuberculosis patients care with more co-infection tested and less lost for follow-up. These results confirm the usefulness of this software for patients care and assessment of physicians practice in France.

  20. Long-term Follow-up of MDD Patients Who Respond to Deep rTMS: A Brief Report.

    PubMed

    Rosenberg, Oded; Dinur Klein, Limor; Gersner, Roman; Kotler, Moshe; Zangen, Abraham; Dannon, Pinhas

    2015-01-01

    Deep transcranial magnetic stimulation (dTMS) is effective in treatment of Major Depressive Disorder (MDD), and in re-treatment in case of relapse. Our study evaluates the long-term durability of dTMS in MDD. Seventeen patients that responded to dTMS treatment evaluated. Follow-up period was 9.3 months. Patients were considered as relapsed if: HDRS (Hamilton Depression Rating Scale) score was 16 points or more, in case of change in antidepressants, hospitalization due to exacerbation, referral to ECT. Six months after last treatment three patients relapsed (17.6%). During the follow-up of 9.3 months, nine relapsed. Relapse rate was 5.6 per 100 person-months. Patients continued to improve in HDRS following the treatment. We have found number of treatment sessions, stimulation, age, age of depressive disorder onset, length of depressive episode prior to the first treatment, as well as number of depressive episodes to have no predictive value regarding propensity to relapse in these patients. The study's main limitations are the relatively small sample size, patients differing in follow-up periods and the lack of a control group. Relapse rates after dTMS are comparable to pharmacotherapy and ECT.

  1. What Women Want: Patient Recommendations for Improving Access to Breast and Cervical Cancer Screening and Follow-up

    PubMed Central

    Ragas, Daiva M.; Nonzee, Narissa J.; Tom, Laura S.; Phisuthikul, Ava M.; Luu, Thanh Ha; Dong, XinQi

    2016-01-01

    BACKGROUND The patient voice remains underrepresented in clinical and public health interventions. To inform interventions that strive to improve access to breast and cervical cancer screening and follow-up among low-income populations, we explored recommendations from low-income women pursuing health care in the safety net. METHODS Semi-structured interviews were conducted among women receiving follow-up care for an abnormal breast or cervical cancer screening result or a positive cancer diagnosis in federally qualified health centers (FQHCs), free clinics, or an academic cancer center in the Chicago metropolitan area. FINDINGS Of the 138 women interviewed in the parent study, 52 women provided recommendations for improving access to screening and follow-up care. Most were between 41 and 65 years old (62%) and African American (60%) or White (25%). Recommendations included strengthening community-based health education with more urgent messaging, strategic partnerships, and active learning experiences to increase patient engagement, which women regarded as a key driver of access. Women also suggested increasing access by way of changes to health care delivery systems and policy, including more direct patient-provider and patient-clinic communications, addressing delays caused by high patient volume, combining preventive services, expanding insurance coverage, and adjusting screening guidelines. CONCLUSIONS This exploratory study demonstrates important insights from the patient lens that may help to increase the acceptability and efficacy of community and clinical interventions aimed at improving access to breast and cervical cancer screening and follow-up. Further research is needed to identify appropriate integration of patient input into interventions, practice, and policy change. PMID:25213744

  2. Psychosocial conditions in adults with Crouzon syndrome: a follow-up study of 31 Swedish patients.

    PubMed

    Fischer, Sara; Tovetjärn, Robert; Maltese, Giovanni; Sahlin, Per-Erik; Tarnow, Peter; Kölby, Lars

    2014-08-01

    Crouzon syndrome presents with craniosynostosis, maxillary hypoplasia, exophtalmus, and sometimes hampered neuropsychological development. The aim of the present study was to evaluate the quality of life for adult patients with Crouzon syndrome. Forty patients with Crouzon syndrome born before 1990 could be identified. A questionnaire addressing education, employment, social relations, and quality-of-life was used. A matched control group was created for comparison. Logistic regression, correcting for the influence of age and sex, was used to compare patients and controls. Thirty-one patients and 285 controls answered the questionnaire. The level of education was lower in patients than in controls (p < 0.015). Patients were less often married or had a partner (p = 0.059), had fewer children of their own (p = 0.004), and had less experience of a sexual relationship (p < 0.001). The difference in housing was not significant, and only one patient lived in a care centre and three patients required a personal assistant to manage activities of daily living. The patients' estimation of their somatic health was equal to that of the controls, but the patients more often used anti-epileptic medication (p = 0.003). Periods of depressive mood were more common in patients (p = 0.001), but there was no difference between the groups regarding a general positive attitude to life. In conclusion, patients with Crouzon syndrome often have intellectual and social shortcomings that negatively affect their lives. However, the range of abilities is wide in this group.

  3. Splenectomy in Massive Tropical Splenomegaly: Two to Six-Year Follow-Up in 14 Patients

    DTIC Science & Technology

    1988-06-01

    grade [9], liver size, presence of ascites, and presence of abdominal varices were specifically noted. Patients were graded as to general condition...outlined in table l. Ten of the 14 patients had multiple indications for surgery (see Methods). Six patients had ascites and one had abdominal varices

  4. Multiple copies of RUNX1: description of 14 new patients, follow-up, and a review of the literature.

    PubMed

    Pérez-Vera, Patricia; Montero-Ruíz, Oreth; Frías, Sara; Rivera-Luna, Roberto; Valladares, Adán; Arenas, Diego; Paredes-Aguilera, Rogelio; Carnevale, Alessandra

    2008-01-15

    RUNX1 over-representation is present in children with acute lymphoblastic leukemia. Although these cases have been related with poor outcome, not all reports describe patient follow-up. To understand its associated clinical features and prognosis, we report on 14 children with ALL and RUNX1 over-representation with laboratory data and outcomes compared to previous reports. Eighty-six children with RUNX1 over-representation have been described, including the 14 patients of this study. Most of them are between 6 and 15 years of age, have low leukocyte counts, pre-B immunophenotype, and three to eight RUNX1 copies. Of the 69 patients with follow-up data, 21 of them relapsed or died, suggesting that RUNX1 over-representation is associated to a poor outcome.

  5. New cerebral microbleeds in ischemic stroke patients on warfarin treatment: two-year follow-up.

    PubMed

    Orken, D Necioglu; Uysal, E; Timer, E; Kuloglu-Pazarcı, N; Mumcu, S; Forta, H

    2013-09-01

    Cerebral microbleeds (CMBs) are known to be indicative of bleeding-prone microangiopathy. Little is known about the significance of CMBs in anticoagulated patients. We determined the frequency of new CMBs in ischemic stroke patients who had been receiving warfarin treatment for 2 years. A total of 204 ischemic stroke patients on warfarin therapy for 2 years underwent a repeat MRI. We compared demographic features, vascular risk factors, and radiological findings of patients with and without new CMBs. New CMBs on gradient-echo MRI were found in 29 of 204 patients (10%). Of 35 patients who had CMBs in the original study, 9 developed new CMBs after 2 years (26%), compared with 20 of the 169 patients (12%) who did not have CMBs at baseline (p=0.03). Patients with new CMBs were older than patients without CMBs (p=0.04), and the frequency of leukoaraiosis was significantly higher (p=0.02). The mean duration of warfarin treatment was not significantly different between the patients with and without new CMBs (p=0.28). This longitudinal study suggested that the presence of CMBs at baseline increased the frequency of new CMBs in patients on warfarin therapy. Copyright © 2013 Elsevier B.V. All rights reserved.

  6. Correlation of baseline hormonal disorders with immunological failure and mortality in male HIV patients during follow-up

    PubMed Central

    Wen, Ying; Ding, Hai bo; Chen, Wei; Zhou, Ying; Wang, Wen; Wang, Yu; Lu, Xu; Liu, Jing; Kang, Jing; Geng, Wenqing; Shang, Hong; Liu, Pei

    2016-01-01

    Abstract To assess the effect that hormonal disturbances have on HIV prognosis in male patients. A prospective follow-up study was conducted among male HIV patients who started antiretroviral therapy (ART) between July 1, 2011 and June 30, 2014. The final follow-up session occurred before December 31, 2014. We examined the correlation between pre-ART hormone levels and disease prognosis. The Kaplan–Meier method and the multivariate Cox proportional hazard model were used to identify hormone-related predictors of immunological failure and mortality. During the follow-up of 163 male HIV patients, mortality rate occurred at a rate of 16.0% (26/163). Of these deaths, 84.6% (22/26) were acquired immunodeficiency syndrome–related. Furthermore, 53 patients were found to have suffered from immunological failure. Both pre-ART CD4+ T cell counts and the clinical stage assigned to the patients correlated strongly with dehydroepiandrosterone sulfate levels. Hyponatremia, high cortisol levels, tuberculosis, and being at World Health Organization (WHO)-defined clinical stage 4 were characteristics that associated significantly with mortality. Being at WHO clinical stage 4 was, itself, a factor that significantly associated with immunological failure. High cortisol levels were found to be an important hormonal disorder that associated with mortality. None of the hormones examined in this study had a strong correlation with immunological failure. PMID:28033281

  7. The value of serum tumour markers in the prediction of aetiology and follow up of patients with pericardial effusion.

    PubMed

    Bildirici, U; Celikyurt, U; Acar, E; Bulut, O; Sahin, T; Kozdag, G; Ural, D

    2012-04-01

    The aim of this study was to evaluate the value of tumour markers in the differential diagnosis of pericardial effusions and to assess their changing levels during follow up. Sixty-nine patients who were admitted to hospital with a diagnosis of pericardial effusion were included in the study. Serum tumour markers were measured on admission and after a mean of 18 ± 7 months' follow up. An aetiological diagnosis was made on clinical evaluation, imaging techniques and biochemical, microbiological and pathological analysis. The patients were divided into five groups according to the aetiology of their pericardial effusions. Carbohydrate antigen (CA) 12-5 and CA 15-3, and carcinoembryonic antigen (CEA) levels were significantly higher in patients with malignancies than in those with viral/idiopathic pericarditis. With multivariate analysis, CA 15-3 levels were found to be the most significant determinant (p = 0.027). In the ROC curve analysis, CA 15-3 values above 25 U/ml predicted a malignancy with 71% sensitivity and 78% specificity. Tumour markers, particularly CA 15-3, may be useful in the differential diagnosis and prediction of malignancies in patients with pericardial effusion. In patients with viral/idiopathic aetiology, these serum tumour markers were slightly elevated in the acute phase, but after a mean of one year of follow up, their levels returned to normal, contrary to those with malignancies.

  8. Perioperative hemodynamics and risk for delirium and new onset dementia in hip fracture patients; A prospective follow-up study.

    PubMed

    Neerland, Bjørn Erik; Krogseth, Maria; Juliebø, Vibeke; Hylen Ranhoff, Anette; Engedal, Knut; Frihagen, Frede; Ræder, Johan; Bruun Wyller, Torgeir; Watne, Leiv Otto

    2017-01-01

    Delirium is common in hip fracture patients and many risk factors have been identified. Controversy exists regarding the possible impact of intraoperative control of blood pressure upon acute (delirium) and long term (dementia) cognitive decline. We explored possible associations between perioperative hemodynamic changes, use of vasopressor drugs, risk of delirium and risk of new-onset dementia. Prospective follow-up study of 696 hip fracture patients, assessed for delirium pre- and postoperatively, using the Confusion Assessment Method. Pre-fracture cognitive function was assessed using the Informant Questionnaire of Cognitive Decline in the Elderly and by consensus diagnosis. The presence of new-onset dementia was determined at follow-up evaluation at six or twelve months after surgery. Blood pressure was recorded at admission, perioperatively and postoperatively. Preoperative delirium was present in 149 of 536 (28%) assessable patients, and 124 of 387 (32%) developed delirium postoperatively (incident delirium). The following risk factors for incident delirium in patients without pre-fracture cognitive impairment were identified: low body mass index, low level of functioning, severity of physical illness, and receipt of ≥ 2 blood transfusions. New-onset dementia was diagnosed at follow-up in 26 of 213 (12%) patients, associated with severity of physical illness, delirium, receipt of vasopressor drugs perioperatively and high mean arterial pressure postoperatively. Risk factors for incident delirium seem to differ according to pre-fracture cognitive status. The use of vasopressors during surgery and/or postoperative hypertension is associated with new-onset dementia after hip fracture.

  9. Ultrathin Skin Grafting in Resistant Stable Vitiligo: A Follow-up Study of 8 Years in 370 Patients.

    PubMed

    Majid, Imran; Imran, Saher

    2017-02-01

    Ultrathin skin grafting (UTSG) is a tissue grafting technique used in resistant stable vitiligo. To assess long-term follow-up results achieved with UTSG in vitiligo. Over a span of 8 years, a total of 415 patients with stable vitiligo were treated with UTSG at the authors' institute. Retrospective analysis of results achieved in these patients was performed, and primary end points assessed included the extent and quality of repigmentation achieved and adverse effects from the procedure. Results were correlated with the site, morphological type of vitiligo, duration of stability, postprocedure treatment used, and the age and sex of the patient. Follow-up results were available with 554 lesions in 370 patients. Excellent response (≥90% repigmentation) was documented in 78.9% (437/554) lesions whereas 8.67% (48/554) lesions demonstrated poor results. Pigmentation was retained in >98% (112/114) cases over 4-year follow-up. The commonest adverse effect noted was "perigraft halo" in 12.3% (68/554) lesions. Site and morphological type of vitiligo as well as the postoperative use of phototherapy showed statistically significant correlation with response. Age and sex of the patient and duration of stability beyond 1 year did not influence the outcome. Ultrathin skin grafting provides long-term beneficial results in stable resistant vitiligo.

  10. A large prospective European cohort study of patients treated with strontium ranelate and followed up over 3 years.

    PubMed

    Audran, M; Jakob, F J; Palacios, S; Brandi, M-L; Bröll, H; Hamdy, N A T; McCloskey, E V

    2013-09-01

    Strontium ranelate has been available as an osteoporosis treatment in Europe since 2004. This article describes a large European observational survey of the use of strontium ranelate in clinical daily practice. A retrospective observational registry included 32,446 women consulting for postmenopausal osteoporosis in seven countries. Within the registry, 12,046 women were receiving strontium ranelate and were followed up over 3 years. The baseline characteristics of the follow-up cohort were similar to those of the whole registry cohort (age, 68.9 ± 10.3 years; body mass index, 25.6 ± 4.3 kg/m(2); lumbar spine T-score, -2.57 ± 0.85 SD; femoral neck T-score, -2.11 ± 0.86 SD). At baseline, 77 % of patients had at least one risk factor for osteoporosis, and 46 % had a previous history of osteoporotic fracture. Mean duration of follow-up was 32.0 ± 9.7 months, and treatment duration was 25.2 ± 13.7 months (24,956 patient-years of treatment). Persistence with strontium ranelate was 80 % at 1 year, 68 % at 2 years, and 64 % at 32 months; most patients (about 80 %) reported rarely omitting a dose. At least one emergent adverse event was reported in 2,674 (22 %) patients, most frequently gastrointestinal side effects. The crude incidence of venous thromboembolic events was 2.1/1,000 patient-years. No cases of hypersensitivity reactions, such as drug rash with eosinophilia and systemic symptoms (DRESS), Steven-Johnson syndrome, or toxic epidermal necrolysis, were reported. During follow-up, a fracture occurred in 890 patients (7 %); 429 of the fractures were nonvertebral fractures. Our observational survey over 32 months indicated good rates of adherence with strontium ranelate and confirmed its good safety profile in the management of postmenopausal osteoporosis.

  11. Acute fatty liver of pregnancy: Over six months follow-up study of twenty-five patients

    PubMed Central

    Xiong, Hao-Feng; Liu, Jing-Yuan; Guo, Li-Min; Li, Xing-Wang

    2015-01-01

    AIM: To evaluate the prognosis of patients with acute fatty liver of pregnancy (AFLP) 6 mo or longer after discharge. METHODS: The records of pregnant patients diagnosed with AFLP at Beijing Ditan Hospital over a 16-year period were reviewed in November 2012. Patients were monitored using abdominal ultrasound, liver and kidney functions, and routine blood examination. RESULTS: A total of 42 patients were diagnosed with AFLP during the study period, and 25 were followed. The mean follow-up duration was 54.5 mo (range: 6.5-181 mo). All patients were in good physical condition, but one patient had gestational diabetes. The renal and liver functions normalized in all patients after recovery, including in those with pre-existing liver or kidney failure. The ultrasound findings were normal in 12 patients, an increasingly coarsened echo-pattern and increased echogenicity of the liver in 10 patients, and mild to moderate fatty liver infiltration in 3 patients. Cirrhosis or liver nodules were not observed in any patient. CONCLUSION: Acute liver failure and acute renal failure in AFLP patients is reversible. Patients do not require any specific long-term follow-up after recovery from AFLP if their liver function tests have normalized and they remain well. PMID:25684961

  12. Glycosylated hemoglobin as a screening test for hyperglycemia in antipsychotic-treated patients: a follow-up study

    PubMed Central

    Steylen, Pauline MJ; van der Heijden, Frank MMA; Hoogendijk, Witte JG; Verhoeven, Willem MA

    2015-01-01

    Purpose To assess the point prevalence of undetected prediabetes (preDM) and diabetes mellitus (DM) in patients treated with antipsychotics and to compare metabolic parameters between patients with normoglycemia (NG), preDM, and DM. Furthermore, conversion rates for preDM and DM were determined in a 1-year follow-up. Patients and methods In a naturalistic cohort of 169 patients, fasting glucose (FG) and hemoglobin A1c (HbA1c) criteria were applied at baseline and at follow-up after 1 year. A distinction was made between baseline patients diagnosed according to FG (B-FG) and those diagnosed according to HbA1c (B-HbA1c). Conversion rates in the 1-year follow-up were compared between B-FG and B-HbA1c. Results At baseline, preDM and DM were present in 39% and 8%, respectively. As compared to patients with NG, metabolic syndrome was significantly more prevalent in patients with preDM (62% vs 31%). Although the majority of patients were identified by the FG criterion, HbA1c contributed significantly, especially to the number of patients diagnosed with preDM (32%). Regarding the patients with preDM, conversion rates to NG were much higher in the B-FG group than in the B-HbA1c group (72% vs 18%). In patients diagnosed with DM, conversion rates were found for B-FG only. Conclusion PreDM and DM are highly prevalent in psychiatric patients treated with antipsychotic drugs. HbA1c was shown to be a more stable parameter in identifying psychiatric patients with (an increased risk for) DM, and it should therefore be included in future screening instruments. PMID:25653547

  13. [Quality assurance with administrative data (QSR): follow-up in quality measurement - an analysis of patient records].

    PubMed

    Jeschke, Elke; Günster, Christian; Klauber, Jürgen

    2015-01-01

    The present study analyses the information gain obtained by evaluating adverse events during follow-up compared to the sole analysis of events during the initial hospital stay for quality measurement purposes. The analysis is based on AOK administrative data from the years 2010 to 2012. The analyses were carried out for 10 quality indicators from the 4 QSR sectors knee replacement for osteoarthritis, appendectomy, prostate surgery for benign prostatic syndrome (BPS) and therapeutic cardiac catheterization (PCI) in patients with myocardial infarction. A total of 409,774 AOK cases were included. For almost all indicators considered, a relevant share of complications can be found to have occurred only after discharge from the initial hospitalization (7.7 %-92.6 %). Furthermore, there is only a weak connection between the findings from the first hospitalization and those from the follow-up period (0.0449 < r < 0.1935). 26-66 % of the hospitals will be classified differently based on Standardized Mortality/Morbidity Ratio (SMR) quartiles if follow-up events are included in the quality assessment (with the exception of "Other Complications after PCI" of 14 %). In summary, quality assessment is improved considerably by evaluating the follow-up period for almost all indicators considered. A quality measurement based solely on events in the initial hospital stay obscures relevant adverse events that have an impact on a comparative hospital quality assessment for these indicators.

  14. Medulloblastoma: Long-term follow-up of patients treated with electron irradiation of the spinal field

    SciTech Connect

    Gaspar, L.E.; Dawson, D.J.; Tilley-Gulliford, S.A.; Banerjee, P. )

    1991-09-01

    Thirty-two patients with posterior fossa medulloblastoma underwent treatment with electron irradiation to the spinal field. The 5- and 10-year actuarial survival rates were 57% and 50%, respectively. Late complications observed in the 15 patients followed up for more than 5 years were short stature (six patients), decreased sitting-standing height ratio (four patients), scoliosis (two patients), poor school performance (seven patients), xerostomia (one patient), esophageal stricture (one patient), pituitary dysfunction (four patients), primary hypothyroidism (one patient), bilateral eighth-nerve deafness (one patient), and carcinoma of the thyroid (one patient). Complications following treatment with electrons to a spinal field are compared with reported complications following treatment with photons to the spinal field. Although short-term reactions were minimal, the authors found no difference in late complications. More sophisticated treatment planning may show such a long-term benefit in the future.

  15. Medulloblastoma: long-term follow-up of patients treated with electron irradiation of the spinal field.

    PubMed

    Gaspar, L E; Dawson, D J; Tilley-Gulliford, S A; Banerjee, P

    1991-09-01

    Thirty-two patients with posterior fossa medulloblastoma underwent treatment with electron irradiation to the spinal field. The 5- and 10-year actuarial survival rates were 57% and 50%, respectively. Late complications observed in the 15 patients followed up for more than 5 years were short stature (six patients), decreased sitting-standing height ratio (four patients), scoliosis (two patients), poor school performance (seven patients), xerostomia (one patient), esophageal stricture (one patient), pituitary dysfunction (four patients), primary hypothyroidism (one patient), bilateral eighth-nerve deafness (one patient), and carcinoma of the thyroid (one patient). Complications following treatment with electrons to a spinal field are compared with reported complications following treatment with photons to the spinal field. Although short-term reactions were minimal, the authors found no difference in late complications. More sophisticated treatment planning may show such a long-term benefit in the future.

  16. Patient Satisfaction and Surgeon Experience: A Follow-Up to the Reduction Mammaplasty Learning Curve Study

    PubMed Central

    Carty, Matthew J.; Duclos, Antoine; Gu, Xiangmei; Elele, Nkemdiche; Orgill, Dennis

    2012-01-01

    Background: While it is known that increasing surgeon experience is correlated with improved efficiency and safety in the reduction mammaplasty procedure, it is unclear whether these improvements lead to an erosion in patient satisfaction. Methods: The authors distributed the Breast-Q questionnaire to all patients who underwent bilateral reduction mammaplasty at their institution between 1995 and 2007. Univariate and multivariate analyses were performed to assess the relationship between postoperative patient satisfaction scores and surgeon experience, as well as to characterize those patients with particularly high or low satisfaction scores, in general. Results: A total of 279 (26.1%) completed surveys were analyzed. No statistically significant erosion in either Satisfaction with Breasts (SWB) or Satisfaction with Outcomes (SWO) scores were witnessed with increasing surgeon experience or efficiency. Patients older than 40 years demonstrated significantly higher SWB scores than younger patients (P = .004), while patients who suffered postoperative soft tissue necrosis demonstrated significantly lower SWB (P = .003) and SWO (P = .010) scores. Conclusions: Gains in operative efficiency with increasing surgeon experience do not appear to come at the expense of patient satisfaction in the reduction mammaplasty procedure. Younger patients and those who experience postoperative soft tissue necrosis appear to be at higher risk for reporting lower postoperative patient satisfaction scores. PMID:22582119

  17. Primary inefficacy of TNF inhibitors in patients with axial spondyloarthritis: a long-term follow-up of 25 patients.

    PubMed

    Kossi, Sandra; Dadoun, Sabrina; Geri, Guillaume; Hermet, Aurore; Fautrel, Bruno; Dougados, Maxime; Gossec, Laure

    2017-06-01

    Primary inefficacy of TNF inhibitors (TNFi) for axial spondyloarthritis (axSpA) is infrequent. The objective of this study was to assess the long-term evolution and final diagnosis of patients with primary inefficacy of TNFi for axSpA. This was a systematic retrospective study of all patients receiving a TNFi for axSpA in one tertiary referral centre. Patients had axSpA confirmed by a rheumatologist and were started on a first course of TNFi according to usual practice. If the rheumatologist interrupted treatment at 3 months for inefficacy, this was defined as primary inefficacy. Five to 10 years later, these patients were re-evaluated. Of 222 patients receiving a first TNFi for axSpA, 27 (12%) were considered as having primary inefficacy. These patients were more often females (48 vs 27%, P = 0.04), had higher functional impairment [BASDAI (0-100) 68 vs 42, P = 0.001] and less increased CRP (50 vs 78%, P = 0.008.) At the follow-up, 25 (92%) patients were re-evaluated: the diagnosis of axSpA was confirmed for 21/25 (84%) patients according to the Assessment of SpondyloArthritis criteria and 20/25 (80%) patients according to the rheumatologist; but 18/25 (72%) had at least one other cause of their symptoms from among OA, widespread pain syndrome or depression. A second TNFi was prescribed for 16 patients and was efficacious for 9 (56%). Most patients with primary inefficacy had a confirmed diagnosis of axSpA, but they often had other causes of pain. We suggest that patients with primary inefficacy to TNFi should be screened for comorbidities that may interfere with axSpA activity assessment.

  18. [Rehabilitation standards for follow-up treatment and rehabilitation of patients with ventricular assist device (VAD)].

    PubMed

    Willemsen, Detlev; Cordes, C; Bjarnason-Wehrens, B; Knoglinger, E; Langheim, E; Marx, R; Reiss, N; Schmidt, T; Workowski, A; Bartsch, P; Baumbach, C; Bongarth, C; Phillips, H; Radke, R; Riedel, M; Schmidt, S; Skobel, E; Toussaint, C; Glatz, J

    2016-03-01

    The increasing use of ventricular assist devices (VADs) in terminal heart failure patients provides new challenges to cardiac rehabilitation physicians. Structured cardiac rehabilitation strategies are still poorly implemented for this special patient group. Clear guidance and more evidence for optimal modalities are needed. Thereby, attention has to be paid to specific aspects, such as psychological and social support and education (e.g., device management, INR self-management, drive-line care, and medication).In Germany, the post-implant treatment and rehabilitation of VAD Patients working group was founded in 2012. This working group has developed clear recommendations for the rehabilitation of VAD patients according to the available literature. All facets of VAD patients' rehabilitation are covered. The present paper is unique in Europe and represents a milestone to overcome the heterogeneity of VAD patient rehabilitation.

  19. [Neurologic-psychiatric follow-up studies of reanimated tetanus patients (author's transl)].

    PubMed

    Samtleben, T

    1977-01-21

    During a study of sequela of intensive care therapy eight patients with longterm respirator treatment for severe tetanus infection were studied by neurologic-psychiatric examination two years or more after discharge from the hospital. Two out of four patients with permanent damage suffered from ankylosis of the hip joint caused by myositis ossificans. One patient showed hyperaesthetic-emotional syndrom and IQ-reduction caused by cardiac arrest. Two further patients were resuscitated from cardiac arrest without persisting psycho-physiological injury. A 70 year old man suffered from cardiopulmonary injury, lack of initiative and fatigability. None of the patients complained of depressing memories and all emphazised their pleasure of being alive. The permanent damage fation and not to the tetanus toxin per se. Improved techniques for tetanus patients on curare and artificial respiration may result in better therapeutical results in the future.

  20. Follow-up and diagnostic reappraisal of 75 patients with Leber's congenital amaurosis.

    PubMed

    Lambert, S R; Kriss, A; Taylor, D; Coffey, R; Pembrey, M

    1989-06-15

    We reexamined 75 children in whom Leber's congenital amaurosis had been previously diagnosed. On review, 30 of these patients had an ocular or systemic disorder other than Leber's congenital amaurosis. The most common of these revised diagnoses were congenital stationary night blindness, achromatopsia, infantile-onset retinitis pigmentosa, Joubert's syndrome, Zellweger syndrome, and infantile Refsum's disease. Of the 45 patients with Leber's congenital amaurosis, mental retardation occurred in six patients, and visual deterioration in six patients. Leber's congenital amaurosis should only be diagnosed if other known ocular and systemic disorders have been carefully excluded.

  1. BIOCHEMICAL CONTROL DURING LONG-TERM FOLLOW-UP OF 230 ADULT PATIENTS WITH CUSHING DISEASE: A MULTICENTER RETROSPECTIVE STUDY.

    PubMed

    Geer, Eliza B; Shafiq, Ismat; Gordon, Murray B; Bonert, Vivien; Ayala, Alejandro; Swerdloff, Ronald S; Katznelson, Laurence; Lalazar, Yelena; Manuylova, Ekaterina; Pulaski-Liebert, Karen J; Carmichael, John D; Hannoush, Zeina; Surampudi, Vijaya; Broder, Michael S; Cherepanov, Dasha; Eagan, Marianne; Lee, Jackie; Said, Qayyim; Neary, Maureen P; Biller, Beverly M K

    2017-08-01

    Cushing disease (CD) results from excessive exposure to glucocorticoids caused by an adrenocorticotropic hormone-secreting pituitary tumor. Inadequately treated CD is associated with significant morbidity and elevated mortality. Multicenter data on CD patients treated in routine clinical practice are needed to assess treatment outcomes in this rare disorder. The study purpose was to describe the burden of illness and treatment outcomes for CD patients. Eight pituitary centers in four U.S. regions participated in this multicenter retrospective chart review study. Subjects were CD patients diagnosed at ≥18 years of age within the past 20 years. Descriptive statistical analyses were conducted to examine presenting signs, symptoms, comorbidities, and treatment outcomes. Of 230 patients, 79% were female (median age at diagnosis, 39 years; range, 18 to 78 years). Length of follow-up was 0 to 27.5 years (median, 1.9 years). Pituitary adenomas were 0 to 51 mm. The most common presenting comorbidities included hypertension (67.3%), polycystic ovary syndrome (43.5%), and hyperlipidemia (41.5%). Biochemical control was achieved with initial pituitary surgery in 41.4% patients (91 of 220), not achieved in 50.0% of patients (110 of 220), and undetermined in 8.6% of patients (19 of 220). At the end of follow-up, control had been achieved with a variety of treatment methods in 49.1% of patients (110 of 224), not achieved in 29.9% of patients (67 of 224), and undetermined in 21.0% of patients (47 of 224). Despite multiple treatments, at the end of follow-up, biochemical control was still not achieved in up to 30% of patients. These multicenter data demonstrate that in routine clinical practice, initial and long-term control is not achieved in a substantial number of patients with CD. BLA = bilateral adrenalectomy CD = Cushing disease CS = Cushing syndrome eCRF = electronic case report form MRI = magnetic resonance imaging PCOS = polycystic ovary syndrome.

  2. The Effect of Interactive Text Message Follow-up on Health Promoting Lifestyle of Patients with Acute Coronary Syndrome

    PubMed Central

    Moradi, Akram; Moeini, Mahin; Sanei, Hamid

    2017-01-01

    Background: Lifestyle modification is an essential factor in the promotion of health in patients with acute coronary syndrome (ACS). One of the interventions to promote lifestyle is interactive follow-up, which, according to the traditional methods, requires spending significant amount of time and cost. Therefore, this study aimed to determine the effectiveness of interactive text message follow-up on health promoting lifestyle of patients with ACS. Materials and Methods: This was a randomized controlled trial among 100 patients suffering from ACS during October–February 2016. The participants were randomly assigned to the experimental and control groups. Collection of data on lifestyle was performed before, 3, and 4 months after the beginning of the intervention using Walker's Health Promoting lifestyle questionnaire. Six messages were sent to the intervention groups each week, and participants asked the questions by sending text message, each week 1 message were sent to the control group for 12 weeks. The statistical analysis of data was performed using independent t-test, Chi-square, Mann–Whitney U test, and repeated measures analysis of variance (ANOVA). Results: Before the intervention, there was no significant difference between the mean score of lifestyle of the two groups, however, 3 months and 4 months after the beginning of the intervention, the mean score of lifestyle in the intervention group was significantly higher than that of the control group (P < 0.001). Conclusion: The interactive text message follow-up is effective in promoting the lifestyle of patients with ACS and can be considered in the planning of follow-up of patients with ACS. PMID:28904541

  3. The Effect of Interactive Text Message Follow-up on Health Promoting Lifestyle of Patients with Acute Coronary Syndrome.

    PubMed

    Moradi, Akram; Moeini, Mahin; Sanei, Hamid

    2017-01-01

    Lifestyle modification is an essential factor in the promotion of health in patients with acute coronary syndrome (ACS). One of the interventions to promote lifestyle is interactive follow-up, which, according to the traditional methods, requires spending significant amount of time and cost. Therefore, this study aimed to determine the effectiveness of interactive text message follow-up on health promoting lifestyle of patients with ACS. This was a randomized controlled trial among 100 patients suffering from ACS during October-February 2016. The participants were randomly assigned to the experimental and control groups. Collection of data on lifestyle was performed before, 3, and 4 months after the beginning of the intervention using Walker's Health Promoting lifestyle questionnaire. Six messages were sent to the intervention groups each week, and participants asked the questions by sending text message, each week 1 message were sent to the control group for 12 weeks. The statistical analysis of data was performed using independent t-test, Chi-square, Mann-Whitney U test, and repeated measures analysis of variance (ANOVA). Before the intervention, there was no significant difference between the mean score of lifestyle of the two groups, however, 3 months and 4 months after the beginning of the intervention, the mean score of lifestyle in the intervention group was significantly higher than that of the control group (P < 0.001). The interactive text message follow-up is effective in promoting the lifestyle of patients with ACS and can be considered in the planning of follow-up of patients with ACS.

  4. Organ damage accrual and distribution in systemic lupus erythematosus patients followed-up for more than 10 years.

    PubMed

    Taraborelli, M; Cavazzana, I; Martinazzi, N; Lazzaroni, M Grazia; Fredi, M; Andreoli, L; Franceschini, F; Tincani, A

    2017-10-01

    Objective The aim of this study was to determine the prevalence, predictors and progression of organ damage in a monocentric cohort of systemic lupus erythematosus patients with a long follow-up. Organ damage was assessed by the Systemic Lupus International Collaborating Clinics Damage Index one year after diagnosis and every five years. Disease activity was measured by the systemic lupus erythematosus disease activity index (SLEDAI)-2K at the beginning of the follow-up. Univariate and multivariable analyses were used to detect items associated with damage. A total of 511 systemic lupus erythematosus patients (92% females, 95% Caucasian), prospectively followed from 1972 to 2014, were included. Results After a mean disease duration of 16 years (SD: 9.5) and a mean follow-up of 12.9 years (SD: 8.8), 354 patients (69.3%) had accrued some damage: 49.7% developed mild/moderate damage, while 19.5% showed severe damage. Damage was evident in 40% of 511 patients one year after diagnosis, and its prevalence linearly increased over time. Longer disease duration, higher SLEDAI, severe Raynaud's, chronic alopecia and cerebral ischaemia were significantly associated with organ damage. No associations between damage and autoantibodies, including anti-dsDNA, anti-Sm or antiphospholipid antibodies, were observed. Anyway, antiphospholipid syndrome and anticardiolipin antibodies predicted the development of neuropsychiatric damage. The ocular, musculoskeletal and neuropsychiatric systems were the most frequently damaged organs, with a linear increase during follow-up. Conclusion A high rate of moderate and severe damage has been detected early in a wide cohort of young lupus patients, with a linear trend of increase over time. Disease activity and long duration of disease predict damage, while antiphospholipid antibodies play a role in determining neuropsychiatric damage.

  5. Illness perception of dropout patients followed up at bipolar outpatient clinic, Turkey.

    PubMed

    Oflaz, Serap; Guveli, Hulya; Kalelioglu, Tevfik; Akyazı, Senem; Yıldızhan, Eren; Kılıc, Kasım Candas; Basyigit, Sehnaz; Ozdemiroglu, Filiz; Akyuz, Fatma; Gokce, Esra; Bag, Sevda; Kurt, Erhan; Oral, Esat Timucin

    2015-06-01

    Dropout is a common problem in the treatment of psychiatric illnesses including bipolar disorders (BD). The aim of the present study is to investigate illness perceptions of dropout patients with BD. A cross sectional study was done on the participants who attended the Mood Disorder Outpatient Clinic at least 3 times from January 2003 through June 2008, and then failed to attend clinic till to the last one year, 2009, determined as dropout. Thirty-nine dropout patients and 39 attendent patients with BD were recruited for this study. A sociodemographic form and brief illness perception questionnaire were used to capture data. The main reasons of patients with BD for dropout were difficulties of transport (31%), to visit another doctor (26%), giving up drugs (13%) and low education level (59%) is significant for dropout patients. The dropout patients reported that their illness did not critically influence their lives, their treatment had failed to control their illnesses, they had no symptoms, and that their illness did not emotionally affect them. In conclusion, the nonattendance of patients with serious mental illness can result in non-compliance of therapeutic drug regimens, and a recurrence of the appearance symptoms. The perception of illness in dropout patients with BD may be important for understanding and preventing nonattendance. Copyright © 2015 Elsevier B.V. All rights reserved.

  6. Adherence to adjuvant endocrine therapy in estrogen receptor-positive breast cancer patients with regular follow-up.

    PubMed

    Simon, Renée; Latreille, Jean; Matte, Claire; Desjardins, Pierre; Bergeron, Eric

    2014-02-01

    Adjuvant hormonal therapy is crucial in the treatment of estrogen receptor-positive breast cancer. The nonadherence rate to hormonal treatment is reported to be as high as 60%. The goal of this study was to evaluate the factors evoked by the patients as well as the demographic and disease-related factors that could be associated with nonadherence to adjuvant hormonal therapy. All consecutive patients treated for an estrogen receptor-positive breast cancer who showed up for regular follow-up with a single breast specialist between November 2008 and April 2009 were included in the study. We assessed adherence to hormonal therapy (either with tamoxifen or aromatase inhibitor). Reasons for adherence and nonadherence were collected. Records were also reviewed for demographic and cancer characteristics and for treatment components. We included 161 patients in the study; 150 (93.2%) adhered to hormonal treatment. Side effects and absence of conviction were the main reasons for nonadherence. The importance of the diagnosis of cancer, fear of recurrence and regular follow-up were reported as the main reasons for adherence. Severity of disease and side effects are associated with nonadherence to treatment. Strict follow-up appears to be a necessary adjunct in the adherence to treatment. The association between demographic and cancer characteristics and treatment components needs further investigation. However, these factors may help identify patients at risk of nonadherence and help the oncology team.

  7. Long-term follow-up of Dupuytren disease after injection of triamcinolone acetonide in Chinese patients in Taiwan.

    PubMed

    Yin, C-Y; Yu, H-H M; Wang, J-P; Huang, Y-C; Huang, T-F; Chang, M-C

    2017-09-01

    Injection of triamcinolone acetonide is a non-operative treatment for early-stage Dupuytren disease in Caucasians, but its effectiveness in non-Caucasians is unclear. We report averaged 5-year follow-up results of 37 patients (49 affected hands) with early-stage Dupuytren disease for patients in Taiwan (non-Caucasian) who received a single dose of 5 mg triamcinolone acetonide injection into nodules monthly for 3 months. Using ultrasound, we recorded no progression of sizes of the modules following injection after 6 months. After an average 5-year follow-up, two patients with three hands (6%) experienced reactivation of the treated nodules. None required surgical intervention. Ultrasound examination showed that sizes of the treated Dupuytren nodules decreased significantly by 40% 6 months after injection and 56% at the final follow-up. We conclude that in these Chinese patients in Taiwan with early Dupuytren nodules, triamcinolone acetonide injection was effective in reducing the size of the Dupuytren nodules and maintaining long-term durable control of the nodular growth. III.

  8. Surgical treatment of inflammatory abdominal aortic aneurysms: a long-term follow-up of 19 patients.

    PubMed

    Railo, Mikael; Isoluoma, Martti; Keto, Pekka; Salo, Jarmo A

    2005-05-01

    The prevalence of inflammatory abdominal aortic aneurysms (IAAA) in autopsy material ranges between 2.5 and 10% of all aneurysms. Clinical findings, the distinction between inflammatory and degenerative aneurysms, and epidemiological data are uncertain, and only a few long-term follow-up studies of patients after surgical treatment of IAAAs exist. In this study, 19 patients underwent either emergency or elective surgery for IAAA during the 10-year period between 1983 and 1993 at Helsinki University Central Hospital. Demographics, symptoms, and operative and follow-up data were collected retrospectively with emphasis on the long-term outcome of IAAA. Causes of late death were available from hospital records and the central statistical office of Finland. For survival analysis we compared ruptured versus nonruptured and emergency versus elective cases of IAAAs. Mean follow-up for the 18 surviving patients (1 hospital death) was 7.4 years. One patient (5%) died of a long-term complication of the aneurysmal disease. There was no statistically significant difference in survival rates for emergency versus elective surgery cases or ruptured versus nonruptured aneurysms. The most common cause of late death was myocardial infarction. The hospital stay mortality (5%) and morbidity (31%), and the survival rate of 26% at 5 years for ruptured and 65% and 43% for nonruptured IAAAs at 5 years and 10 years, respectively, are comparable to normal AAA survival rates. These findings show that surgery is recommended, especially as ruptures also occur in this subgroup of aneurysms.

  9. The evaluation of QT intervals during diagnosis and after follow-up in acromegaly patients.

    PubMed

    Baser, Husniye; Akar Bayram, Nihal; Polat, Burcak; Evranos, Berna; Ersoy, Reyhan; Bozkurt, Engin; Cakir, Bekir

    2014-01-01

    Introdução: O estudo teve como objectivo a determinação do intervalo QT em doentes com acromegália e a análise da correlação entre o intervalo QT e a concentração de hormona do crescimento e de IGF-1 (insulin-like growth factor-1). Material e Métodos: O estudo englobou 41 doentes com acromegália. O grupo de controlo englobou 41 indivíduos com características semelhantes no que se refere a comorbilidades, idade e género. A electrocardiografia de doentes com acromegália foi obtida no início do estudo e após o follow-up. Foi apenas obtido um electrocardiograma no grupo de controlo. Foram calculados o QT máximo, QT mínimo, dispersão do intervalo QT, QT máximo corrigido, QT mínimo corrigido e dispersão do intervalo QT corrigido. Resultados: Os valores do QT máximo basal, dispersão do intervalo QT, QT máximo corrigido e dispersão do QT corrigido foram significativamente mais prolongados no grupo de doentes com acromegália do que nos controlos. O QT máximo corrigido e a dispersão do QT corrigido foram significativamente mais curtos durante o seguimento clínico, quando comparados com os valores basais dos doentes. O QT máximo, dispersão do QT, QT máximo corrigido e dispersão do QT corrigido durante o seguimento clínico não foram estatisticamente diferentes dos valores obtidos nos controlos. Com excepção de uma correlação negativa entre os valores da hormona do crescimento e a dispersão do QT corrigido em doentes durante o seguimento clínico, nenhuma outra correlação foi assinalada entre os valores do intervalo QT e as concentrações de hormona do crescimento e de IGF-1. Concluiu-se que a dispersão do intervalo QT está correlacionada com a duração da doença nos doentes com acromegália. Discussão: Em doentes com acromegália, é importante a detecção de preditores clínicos de arritmia cardíaca. A dispersão do intervalo QT é considerada um preditor relevante de arritmias ventriculares. Os doentes com acromeg

  10. Enhanced patient reported outcome measurement suitable for head and neck cancer follow-up clinics.

    PubMed

    Ghazali, Naseem; Lowe, Derek; Rogers, Simon N

    2012-06-13

    The 'Worse-Stable-Better' (W-S-B) question was introduced to capture patient-perceived change in University of Washington Quality of Life (UW-QOL) domains. 202 head and neck cancer patients in remission prospectively completed UW-QOL and Patients Concerns Inventory (PCI). For each UW-QOL domain, patients indicated whether over the last month things had worsened (W), remained stable (S) or were better (B). 202 patients at 448 attendances selected 1752 PCI items they wanted to discuss in consultation, and 58% (1024/1752) of these were not covered by the UW-QOL. UW-QOL algorithms highlighted another 440 significant problems that the patient did not want to discuss (i.e. the corresponding items on the PCI were not selected).After making allowance for UW-QOL algorithms to identify 'significant problems' and PCI selection of corresponding issues for discussion there remained clear residual and notable variation in W-S-B responses, in particular to identify patients with significant problems that were getting worse, and patients without significant problems that wanted to discuss issues that were getting worse. Changes in mean UW-QOL scores were notably lower for those getting worse on the W-S-B question, typically by 10 or more units a magnitude that suggests clinically important changes in score. The W-S-B question adds little questionnaire burden and could help to better identify patients who might benefit from intervention. The results of this study suggest that the UW-QOL with the W-S-B modification should be used together with the PCI to allow optimal identification of issues for patient-clinician discussion during routine outpatient clinics.

  11. Enhanced patient reported outcome measurement suitable for head and neck cancer follow-up clinics

    PubMed Central

    2012-01-01

    Background The ‘Worse-Stable-Better’ (W-S-B) question was introduced to capture patient-perceived change in University of Washington Quality of Life (UW-QOL) domains. Methods 202 head and neck cancer patients in remission prospectively completed UW-QOL and Patients Concerns Inventory (PCI). For each UW-QOL domain, patients indicated whether over the last month things had worsened (W), remained stable (S) or were better (B). Results 202 patients at 448 attendances selected 1752 PCI items they wanted to discuss in consultation, and 58% (1024/1752) of these were not covered by the UW-QOL. UW-QOL algorithms highlighted another 440 significant problems that the patient did not want to discuss (i.e. the corresponding items on the PCI were not selected). After making allowance for UW-QOL algorithms to identify 'significant problems' and PCI selection of corresponding issues for discussion there remained clear residual and notable variation in W-S-B responses, in particular to identify patients with significant problems that were getting worse, and patients without significant problems that wanted to discuss issues that were getting worse. Changes in mean UW-QOL scores were notably lower for those getting worse on the W-S-B question, typically by 10 or more units a magnitude that suggests clinically important changes in score. Conclusions The W-S-B question adds little questionnaire burden and could help to better identify patients who might benefit from intervention. The results of this study suggest that the UW-QOL with the W-S-B modification should be used together with the PCI to allow optimal identification of issues for patient-clinician discussion during routine outpatient clinics. PMID:22695251

  12. [Update on the morbidity of psychiatric disorders in patients with AIDS: results of a clinical follow-up].

    PubMed

    Crespo, M D; Ochoa, E; Vicente, N; Pérez de los Cobos, J; Morales, P

    1990-01-01

    A follow-up study after one or two years of treatment was carried out on 107 AIDS patients who were seen by the Consultation-Liaison Psychiatry Unit of the Ramon y Cajal Hospital. The sample was reduced to 52 patients (49%) mainly due to the lack of check-ups in 43% and to the death of 8% of the cases. 36% of patients suffered from Delirium or Dementia and these had the greater mortality rate. Grade IV patients and those with a diagnosis of Adjustment Disorders came to the check-ups most frequently.

  13. Management of Sjogren's Syndrome Patient: A Case Report of Prosthetic Rehabilitation with 6-Year Follow-Up

    PubMed Central

    de Mendonça Invernici, Marcos; Vale Nicolau, Gastão; Naval Machado, Maria Ângela; Soares de Lima, Antônio Adilson

    2014-01-01

    Completely and partially edentulous patients with Sjogren's syndrome (SS) experience severe hyposalivation, xerostomia, and considerable difficulty in using tissue-supported prosthesis. This clinical paper describes the management, treatment, and 6-year follow-up of a patient diagnosed with SS type II, who uses corticosteroids and antihyperglycemic drugs. The patient received restorative, periodontal, and surgical treatments followed by implant-supported fixed prosthesis. Radiographic evaluation and probing depth showed gingival health and no bone loss after 6 years. Treatment with implant-retained dental prosthesis greatly increased comfort and function, offering an alternative to patients with SS. PMID:25478245

  14. Morphine versus methadone in the pain treatment of advanced-cancer patients followed up at home.

    PubMed

    Mercadante, S; Casuccio, A; Agnello, A; Serretta, R; Calderone, L; Barresi, L

    1998-11-01

    The aim of this study was to evaluate the analgesic and adverse effects and the doses of methadone in comparison to morphine. A prospective randomized study was performed in a sample of 40 patients with advanced cancer who required strong opioids for their pain management. Patients were treated with sustained-release morphine or methadone in doses titrated against the effect administered two or three times daily according to clinical need. Opioid doses, adjuvant medications, symptoms associated with opioid therapy, pain intensity, and pain mechanisms were recorded. The opioid escalation indices in percentage (OEI%) and milligrams (OEImg) were calculated. The effective analgesic score (EAS) that monitors the analgesic consumption-pain ratio was also calculated at fixed weekly intervals. differences in pain intensity were found. Patients treated with methadone reported values of OEI significantly less than those observed in patients treated with morphine. Seven patients in the methadone group maintained the same initial dosage until death, whereas only one patient in the morphine group did not require opioid dose escalation. A more stable analgesia in time in patients treated with methadone was shown by the low number of gaps in EASs reported. Symptom frequencies and intensities were similar in the two groups. Methadone is a drug of indisputable value in the treatment of cancer pain, and an unbalanced focus on the risks of inappropriate use rather than the benefits should not compromise the use of a relevant alternative to morphine in the management of cancer pain.

  15. Variability in the use of neuroimaging techniques for diagnosis and follow-up of stroke patients.

    PubMed

    Valcárcel-Nazco, C; Alonso-Modino, D; Montón-Álvarez, F; Sabatel-Hernández, R; Pastor-Santoveña, M S; Mesa-Blanco, P; López-Fernández, J C; Serrano-Aguilar, P

    2017-04-18

    Imaging diagnosis is essential for treatment planning in stroke patients. However, use of these techniques varies due to uncertainty about their effectiveness. Our purpose was to describe the use of CT and MRI in stroke and transient ischaemic attack (TIA) over 5years in hospitals belonging to the Canary Islands Health Service and analyse interhospital variability based on routinely collected administrative data. We gathered the minimum basic dataset (MBDS) from patients diagnosed with stroke or TIA between 2005 and 2010 in 4hospitals. Patients' age, sex, procedures, secondary diagnoses, and duration of hospital stay were also recorded. We conducted a descriptive analysis of patient characteristics and a bivariate analysis using the t test and the chi square test to detect differences between patients assessed and not assessed with MRI. Logistic regression was used to analyse unequal access to MRI. Our study included 10,487 patients (8,571 with stroke and 1,916 with TIA). The percentage of stroke patients undergoing a CT scan increased from 89.47% in 2005 to 91.50% in 2010. In these patients, use of MRI also increased from 25.41% in 2005 to 36.02% in 2010. Among patients with TIA, use of CT increased from 84.64% to 88.04% and MRI from 32.53% to 39.13%. According to our results, female sex, younger age, and presence of comorbidities increase the likelihood of undergoing MRI. Copyright © 2017 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  16. Percutaneous Cholecystostomy as a First-Line Therapy in Chronic Hemodialysis Patients with Acute Cholecystitis with Midterm Follow-up

    SciTech Connect

    Gumus, Burcak

    2011-04-15

    Purpose: The purpose of this article was to share midterm results of percutaneous cholecystostomy (PC) as a first-line therapy in chronic hemodialysis patients with acute cholecystitis. Methods: Fourteen chronic hemodialysis patients with acute cholecystitis underwent PC between March 2007 and May 2009 at our institute. On preoperative assessment, the patients were classified into the ASA score by the anesthesiology team. All patients were class IV because of severe underlying comorbidities. The patients were referred to interventional radiology unit for PC by consensus of the multidisciplinary team. Results: The PC was technically successful in all the patients without minor or major complications related to the procedure. Clinical symptoms in three patients who presented with sepsis and multiorgan failure did not resolve after PC, and these patients died following urgent surgery, including open cholecystectomy and common bile duct exploration. A new cholecystitis attack was detected in one patient in the acalculous group at the sixth month of the follow-up period. The mean catheterization time was 31.7 (range, 28-41) days. The mean follow-up time was 13.3 (range 4-21) months. Conclusions: The PC may come into consideration as a first-line treatment modality in the management of acute cholecystitis in poor surgical candidate chronic hemodialysis patients. This is the first report focusing on the midterm results of PC as a first-line therapy in hemodialysis patients with acute cholecystitis who could be operated on.

  17. Survival after colorectal cancer in patients with Crohn's disease: A nationwide population-based Danish follow-up study.

    PubMed

    Larsen, Mette; Mose, Hanne; Gislum, Mette; Skriver, Mette V; Jepsen, Peter; Nørgård, Bente; Sørensen, Henrik T

    2007-01-01

    Patients with Crohn's disease (CD) are at increased risk of colorectal cancer (CRC), but little is known about the impact of CD on CRC prognosis. Based on nationwide population-based registries, we compared survival among CRC patients with CD and CRC patients without CD. We used the Danish Cancer Registry and the Danish Hospital Discharge Registry to identify all patients diagnosed with CRC, with and without CD, in Denmark between 1977 and 1999. We ascertained the stage distribution at the time of CRC diagnosis and 1- and 5-yr survival both for patients with Crohn-associated CRC and patients with non-Crohn CRC. Cox regression was used to compute hazard ratios (HRs), adjusting for gender, age, calendar year, and stage. We identified 100 CRC patients with CD and 71,438 CRC patients without CD. At the time of diagnosis, patients with CD were younger, but stage distributions were similar in the two groups. The overall HR for CRC with CD compared to CRC without CD was 1.82 (95% CI 1.36-2.43) after 1 yr of follow-up, and 1.57 (95% CI 1.24-1.99) after 5 yr of follow-up. Subanalyses showed that the effect of CD on CRC survival was more pronounced in the youngest patients (0-59 yr), in men, and in patients whose tumors had regional spread. We found that CD worsens the prognosis of CRC, particularly CRC with regional spread.

  18. Two-year follow-up of cognitive functions in schizophrenia spectrum disorders of adolescent patients treated with electroconvulsive therapy.

    PubMed

    de la Serna, Elena; Flamarique, Itziar; Castro-Fornieles, Josefina; Pons, Alexandre; Puig, Olga; Andrés-Perpiña, Susana; Lázaro, Luisa; Garrido, Juan Miguel; Bernardo, Miguel; Baeza, Inmaculada

    2011-12-01

    The aim of the current study was to investigate the long-term cognitive effects of electroconvulsive therapy (ECT) in a sample of adolescent patients in whom schizophrenia spectrum disorders were diagnosed. The sample was composed of nine adolescent subjects in whom schizophrenia or schizoaffective disorder was diagnosed according to DSM-IV-TR criteria on whom ECT was conducted (ECT group) and nine adolescent subjects matched by age, socioeconomic status, and diagnostic and Positive and Negative Syndrome Scale (PANSS) total score at baseline on whom ECT was not conducted (NECT group). Clinical and neuropsychological assessments were carried out at baseline before ECT treatment and at 2-year follow-up. Significant differences were found between groups in the number of unsuccessful medication trials. No statistically significant differences were found between the ECT group and the NECT group in either severity as assessed by the PANSS, or in any cognitive variables at baseline. At follow-up, both groups showed significant improvement in clinical variables (subscales of positive, general, and total scores of PANSS and Clinical Global Impressions-Improvement). In the cognitive assessment at follow-up, significant improvement was found in both groups in the semantic category of verbal fluency task and digits forward. However, no significant differences were found between groups in any clinical or cognitive variable at follow-up. Repeated measures analysis found no significant interaction of time×group in any clinical or neuropsychological measures. The current study showed no significant differences in change over time in clinical or neuropsychological variables between the ECT group and the NECT group at 2-year follow-up. Thus, ECT did not show any negative influence on long-term neuropsychological variables in our sample.

  19. Long Term Follow up and Patient Satisfaction after Reduction Mammoplasty: Superomedial versus Inferior Pedicle

    PubMed Central

    Makboul, Mohamed; Abdelhamid, Mahmoud; Al-Attar, Ghada

    2017-01-01

    BACKGROUND Surgery for hypertrophied breast represents a challenge for plastic surgeons. The search for a good cosmetic breast has led to the development of many techniques. Objectives for reduction mammoplasty are to achieve elevated, symmetrical breasts, with round shape, good projection, small cicatrices that are not very perceptible, and a lasting result. METHODS This study was carried out on 60 cases who had done reduction mammoplasty from January 2009 to December 2014. All patients were examined and asked for late post-operative results and overall patients’ satisfaction. RESULTS Long term projection and contour of the breast were more satisfactory among patients who had superomedial pedicle with a statistical significant difference. No statistical significant difference was observed between patients undergone either types of operations concerning breast symmetry, nipple symmetry and sensation. The mean score of satisfaction was higher among patients undergone superomedial pedicle than inferior pedicle. CONCLUSION The superomedial pedicle shows better long term cosmetic result in reduction mammoplasty. PMID:28289618

  20. Neurotoxicity and LSD treatment: a follow-up study of 151 patients in Denmark.

    PubMed

    Larsen, Jens Knud

    2016-06-01

    LSD was introduced in psychiatry in the 1950s. Between 1960 and 1973, nearly 400 patients were treated with LSD in Denmark. By 1964, one homicide, two suicides and four suicide attempts had been reported. In 1986 the Danish LSD Damages Law was passed after complaints by only one patient. According to the Law, all 154 applicants received financial compensation for LSD-inflicted harm. The Danish State Archives has preserved the case material of 151 of the 154 applicants. Most of the patients suffered from severe side effects of the LSD treatment many years afterwards. In particular, two-thirds of the patients had flashbacks. With the recent interest in LSD therapy, we should consider the neurotoxic potential of LSD. © The Author(s) 2016.

  1. Adrenal Function Status in Patients with Paracoccidioidomycosis after Prolonged Post-Therapy Follow-Up

    PubMed Central

    Tobón, Angela M.; Agudelo, Carlos A.; Restrepo, Carlos A.; Villa, Carlos A.; Quiceno, William; Estrada, Santiago; Restrepo, Angela

    2010-01-01

    This study assessed adrenal function in patients with paracoccididioidomycosis who had been treated to determine a possible connection between high antibody titers and adrenal dysfunction attributable to persistence of the fungus in adrenal gland. Adrenal gland function was studied in 28 previously treated patients, 2 (7.1%) of whom were shown to have adrenal insufficiency and 7 (259%) who showed a below normal response to stimuli by adrenocorticotropic hormone. Paracoccidioides brasiliensis was detected in the adrenal gland from one of the patients with adrenal insufficiency. Although the study failed to demonstrate a significant difference between high antibody titers and low cortisol levels, the proportion of adrenal insufficiency detected and the subnormal response to adrenocorticotropic hormone confirmed that adrenal damage is an important sequela of paracoccidioidomycosis. Studies with a larger number of patients should be conducted to confirm the hypothesis of persistence of P. brasiliensis in adrenal gland after therapy. PMID:20595488

  2. Consensus guidelines for diagnosis, treatment and follow-up of patients with pancreatic cancer in Spain.

    PubMed

    Hidalgo, M; Álvarez, R; Gallego, J; Guillén-Ponce, C; Laquente, B; Macarulla, T; Muñoz, A; Salgado, M; Vera, R; Adeva, J; Alés, I; Arévalo, S; Blázquez, J; Calsina, A; Carmona, A; de Madaria, E; Díaz, R; Díez, L; Fernández, T; de Paredes, B G; Gallardo, M E; González, I; Hernando, O; Jiménez, P; López, A; López, C; López-Ríos, F; Martín, E; Martínez, J; Martínez, A; Montans, J; Pazo, R; Plaza, J C; Peiró, I; Reina, J J; Sanjuanbenito, A; Yaya, R; Carrato, Alfredo

    2016-12-19

    The management of patients with pancreatic cancer has advanced over the last few years. We convey a multidisciplinary group of experts in an attempt to stablish practical guidelines for the diagnoses, staging and management of these patients. This paper summarizes the main conclusions of the working group. Patients with suspected pancreatic ductal adenocarcinoma should be rapidly evaluated and referred to high-volume centers. Multidisciplinary supervision is critical for proper diagnoses, staging and to frame a treatment plan. Surgical resection together with chemotherapy offers the highest chance for cure in early stage disease. Patients with advanced disease should be classified in treatment groups to guide systemic treatment. New chemotherapeutic regimens have resulted in improved survival. Symptomatic management is critical in this disease. Enrollment in a clinical trial is, in general, recommended.

  3. Translumbar placement of paired hemodialysis catheters (Tesio Catheters) and follow-up in 10 patients

    SciTech Connect

    Biswal, Rajiv; Nosher, John L.; Siegel, Randall L.; Bodner, Leonard J.

    2000-01-15

    For lack of other suitable access, 10 consecutive patients received paired hemodialysis catheters for long-term hemodialysis using a translumbar approach to the inferior vena cava (IVC). All attempts were successful. Five paired catheters were placed using the single-puncture technique, and five using the dual-puncture technique. Catheters were in place for a total of 2252 catheter days. The average duration of catheter placement was 250 days (range 30-580 days). All catheters were functioning up to the time the study was completed or the patient died. The most common complication was partial dislodgment of the catheter in 3 of 23 catheters (13%), all occurring in obese patients. One episode of retroperitoneal hemorrhage was noted in a patient having the single-access technique. There were no episodes of infection or IVC thrombosis.

  4. Short-term follow-up of chagasic patients after benznidazole treatment using multiple serological markers

    PubMed Central

    2011-01-01

    Background Conventional serological tests, using total soluble proteins or a cocktail of recombinant proteins from T. cruzi as antigens, are highly sensitive for Chagas disease diagnosis. This type of tests, however, does not seem to be reliable tools for short- and medium-term monitoring of the evolution of patients after antiparasitic treatment. The aim of the present study was to search for immunological markers that could be altered in the sera from Chagas disease patients after benznidazole treatment, and therefore have a potential predictive diagnostic value. Methods We analyzed the reactivity of sera from chagasic patients during different clinical phases of the disease against a series of immunodominant antigens, known as KMP11, PFR2, HSP70 and Tgp63. The reactivity of the sera from 46 adult Chronic Chagas disease patients living in a non-endemic country without vector transmission of T. cruzi (15 patients in the indeterminate stage, 16 in the cardiomiopathy stage and 16 in the digestive stage) and 22 control sera from non-infected subjects was analyzed. We also analyzed the response dynamics of sera from those patients who had been treated with benznidazole. Results Regardless of the stage of the sickness, the sera from chagasic patients reacted against KMP11, HSP70, PFR2 and Tgp63 recombinant proteins with statistical significance relative to the reactivity against the same antigens by the sera from healthy donors, patients with autoimmune diseases or patients suffering from tuberculosis, leprosy or malaria. Shortly after benznidazole treatment, a statistically significant decrease in reactivity against KMP11, HSP70 and PFR2 was observed (six or nine month). It was also observed that, following benznidazole treatment, the differential reactivity against these antigens co-relates with the clinical status of the patients. Conclusions The recombinant antigens KMP11, PFR2, Tgp63 and HSP70 are recognized by Chagas disease patients' sera at any clinical stage

  5. Acute Achilles tendon rupture: a questionnaire follow-up of 487 patients.

    PubMed

    Bergkvist, Dan; Åström, Ingrid; Josefsson, Per-Olof; Dahlberg, Leif E

    2012-07-03

    The optimum treatment of acute total Achilles tendon rupture remains controversial. In the present study, the outcomes of surgical and nonsurgical treatment in a large number of patients were compared on the basis of patient age and sex. The records of all 487 patients with an acute total Achilles tendon rupture that had occurred between 2002 and 2006 and had been treated at one of two university hospitals in Sweden were manually reviewed. Surgical treatment was primarily used at Hospital 1, whereas nonoperative functional treatment was primarily used at Hospital 2. At one to seven years after the rupture, the majority of the patients were evaluated for complications, the Achilles Tendon Total Rupture Score was calculated, a heel-raise test was performed, and calf circumference was measured. The outcomes of surgical and nonsurgical treatment were compared on the basis of patient age and sex. The mean age at the time of the injury was forty-five years. In the surgical treatment group at Hospital 1, six (3%) of 201 patients had a re-rupture and three (1.5%) had an infection. In the nonsurgical treatment group at Hospital 2, the rate of re-rupture rate was 6.6% (fifteen of 227). When the results for the surgical treatment group at Hospital 1 were compared with those for the nonsurgical treatment group at Hospital 2, there was no significant difference in terms of the mean Achilles Tendon Total Rupture Score (81.7 compared with 78.9; p = 0.1), but both the difference in the heel-raise test (p = 0.01) and the difference in calf circumference (1.4 compared with 2.0 cm; p = 0.01) reached significance in favor of surgery. Nonsurgically managed female patients showed significant worsening of the Achilles Tendon Total Rupture Score and heel-raise test with increasing age at the time of injury. The good Achilles Tendon Total Rupture Score in the nonsurgically managed group, together with the relatively low rate of re-ruptures and other complications in these patients, makes

  6. Short-term follow-up of chagasic patients after benzonidazole treatment using multiple serological markers.

    PubMed

    Fernández-Villegas, Ana; Pinazo, María Jesús; Marañón, Concepción; Thomas, M Carmen; Posada, Elizabeth; Carrilero, Bartolomé; Segovia, Manuel; Gascon, Joaquim; López, Manuel C

    2011-07-31

    Conventional serological tests, using total soluble proteins or a cocktail of recombinant proteins from T. cruzi as antigens, are highly sensitive for Chagas disease diagnosis. This type of tests, however, does not seem to be reliable tools for short- and medium-term monitoring of the evolution of patients after antiparasitic treatment. The aim of the present study was to search for immunological markers that could be altered in the sera from Chagas disease patients after benznidazole treatment, and therefore have a potential predictive diagnostic value. We analyzed the reactivity of sera from chagasic patients during different clinical phases of the disease against a series of immunodominant antigens, known as KMP11, PFR2, HSP70 and Tgp63. The reactivity of the sera from 46 adult Chronic Chagas disease patients living in a non-endemic country without vector transmission of T. cruzi (15 patients in the indeterminate stage, 16 in the cardiomiopathy stage and 16 in the digestive stage) and 22 control sera from non-infected subjects was analyzed. We also analyzed the response dynamics of sera from those patients who had been treated with benznidazole. Regardless of the stage of the sickness, the sera from chagasic patients reacted against KMP11, HSP70, PFR2 and Tgp63 recombinant proteins with statistical significance relative to the reactivity against the same antigens by the sera from healthy donors, patients with autoimmune diseases or patients suffering from tuberculosis, leprosy or malaria. Shortly after benznidazole treatment, a statistically significant decrease in reactivity against KMP11, HSP70 and PFR2 was observed (six or nine month). It was also observed that, following benznidazole treatment, the differential reactivity against these antigens co-relates with the clinical status of the patients. The recombinant antigens KMP11, PFR2, Tgp63 and HSP70 are recognized by Chagas disease patients' sera at any clinical stage of the disease. Shortly after

  7. Outcomes of oral biotin treatment in patients with biotinidase deficiency - Twenty years follow-up.

    PubMed

    Szymańska, Edyta; Średzińska, Małgorzata; Ługowska, Agnieszka; Pajdowska, Magdalena; Rokicki, Dariusz; Tylki-Szymańska, Anna

    2015-12-01

    Biotinidase deficiency (BTD) is an inborn error of biotin metabolism inherited as an autosomal recessive trait. Due to the, biotinidase deficiency, biotin is not recycled. Individuals with BTD usually exhibit neurological and cutaneous abnormalities unless treated with biotin. Supplementation with biotin may either ameliorate or if early introduced even prevent symptoms when introduced presymptomatically. Since 1991, 22 Polish patients from 19 families have been diagnosed with BTD. In 16 children the diagnosis had been suspected on the basis of clinical signs: skin lesions, hyperventilation, seizures, spasticity, and laboratory investigation (elevated lactate and metabolites on urine organic acids profile). The defect was enzymatically (serum biotinidase activity measurement) and genetically (tested for mutations in the BTD gene) confirmed afterwards. All patients were treated with biotin. Urine organic acids analysis (GC/MS) for 3-hydroxizovaleric acid was used for patients' monitoring. Neurological, audiological and ophthalmological evaluation has been conducted once a year. In 5 symptomatic patients a progressive optic nerve atrophy had already been noted at the time of treatment initiation. In these patients sensorineural hearing loss has also been diagnosed despite biotin supplementation. Asymptomatic patients treated with biotin supplementation presented no signs or symptoms of BTD. Supplementation with biotin slows the progression of BTD in symptomatic patients, but does not reverse nerve atrophy. Nonetheless, introduction of the treatment with biotin during presymptomatic stage of the disease prevents the onset of symptoms including optic atrophy and hearing loss. Homozygosity for the p.Leu215Phe mutation in BTD gene seems to be frequent in patients from the North-Eastern region of Poland and is connected with the hearing loss. Since the prognosis for individuals diagnosed with BTD is good, provided they are treated before symptoms occur, it is justified to

  8. Long-term follow-up and patient satisfaction after reduction mammoplasty: Superomedial versus inferior pedicle

    PubMed Central

    Makboul, Mohamed; Abdelhamid, Mahmoud S.; Al-Attar, Ghada S.

    2016-01-01

    Background: Surgery for hypertrophied breasts represents a challenge for plastic surgeons. The search for a good post-surgical cosmetic breast has led to the development of many techniques. Objectives for reduction mammoplasty are to achieve elevated, symmetrical breasts, a round shape, good projection, small cicatrices that are not very perceptible, and a lasting result. Patients and Methods: This study was carried out on sixty cases who had done reduction mammoplasty from January 2009 to December 2014. All patients were examined and were asked for late post-operative results and overall patients' satisfaction. Results: Long-term projection and contour of the breast were more satisfactory among patients who had superomedial pedicle with a statistically significant difference. No statistically significant difference was observed between patients underwent either superomedial or inferior pedicle reduction mammoplasty with regard to breast shape symmetry, nipple symmetry and sensation. The mean score for satisfaction was higher among patients who underwent superomedial pedicle rather than the inferior pedicle method. Conclusion: The superomedial pedicle shows better long-term cosmetic results. PMID:27833284

  9. Vitamin D Status Does Not Affect Disability Progression of Patients with Multiple Sclerosis over Three Year Follow-Up

    PubMed Central

    Smolders, Joost; Rolf, Linda; Klinkenberg, Lieke J. J.; van der Linden, Noreen; Meex, Steven; Damoiseaux, Jan; Hupperts, Raymond

    2016-01-01

    Background and Objective The risk of developing multiple sclerosis (MS) as well as MS disease activity is associated with vitamin D (25(OH)D) status. The relationship between the main functional disability hallmark of MS, disability progression, and 25(OH)D status is less well established though, especially not in MS patients with progressive disease. Methods This retrospective follow-up study included 554 MS patients with a serum baseline 25(OH)D level and Expanded Disability Status Scale (EDSS) with a minimum follow-up of three years. Logistic regressions were performed to assess the effect of baseline 25(OH)D status on relapse rate. Repeated measures linear regression analyses were performed to assess the effect on disability and disability progression. Results Baseline deseasonalized 25(OH)D status was associated with subsequent relapse risk (yes/no), but only in the younger MS patients (≤ 37.5 years; OR = 0.872, per 10 nmol/L 25(OH)D, p = 0.041). Baseline 25(OH)D status was not significantly associated with either disability or disability progression, irrespective of MS phenotype. Conclusion Within the physiological range, 25(OH)D status is just significantly associated with the occurrence of relapses in younger MS patients, but is not associated with disability or disability progression over three years follow-up. Whether high dose supplementation to supra physiological 25(OH)D levels prevents disability progression in MS should become clear from long term follow-up of supplementation studies. PMID:27276080

  10. Three-year follow-up of protease inhibitor-based regimen simplification in HIV-infected patients.

    PubMed

    Martínez, Esteban; Arnaiz, Juan A; Podzamczer, Daniel; Dalmau, David; Ribera, Esteban; Domingo, Pere; Knobel, Hernando; Leyes, Maria; Pedrol, Enric; Force, Luís; de Lazzari, Elisa; Gatell, José M

    2007-01-30

    Patients with sustained virological suppression on protease inhibitor (PI)-based therapy were randomly assigned to switch the PI to nevirapine (n = 155), efavirenz (n = 156), or abacavir (n = 149) and were followed for at least 3 years regardless of the discontinuation of assigned therapy. There was a higher probability of maintaining virological suppression after 3 years of follow-up with nevirapine or efavirenz than with abacavir. In contrast, abacavir showed a lower incidence of adverse effects leading to drug discontinuation.

  11. Orthogeriatric Combined Management of Elderly Patients With Proximal Femoral Fracture: Results of a 1-Year Follow-Up.

    PubMed

    Förch, Stefan; Kretschmer, Reiner; Haufe, Thomas; Plath, Johannes; Mayr, Edgar

    2017-06-01

    According to the expected demographical changes, the number of elderly trauma patients will increase exponentially over the next decades. Different models of an interdisciplinary orthogeriatric care have been developed. But there is only limited evaluation of their benefit without clear and evidence-based results. In 2011, we monitored the results of our orthogeriatric combined management by conducting a 1-year follow-up. We treated 231 patients presenting a proximal femoral fracture on our orthogeriatric ward. We obtained the epidemiological data and the geriatric assessments from all these patients. One year after discharge, we sent them a written questionnaire. Primary end points were the mortality and the functional outcome, measured by Barthel score, the requirement of care, and the residential status. One hundred sixty-seven (72%) of the 231 patients completed the follow-up. The average age at admission was 81.5 years (70-99 years). The mortality rate was 2.4% during hospital stay and 31.4% after 1 year. The average Barthel score was 44 points at the time of admission, 55 points at discharge, and 72 points after 1 year. Forty-five percent of the patients were in requirement of care at the time of their admission. At the 1-year follow-up, 63% of the patients had some form of care, thus showing an increase of 18%. At the moment of the fracture, 77% of the patients were living in their own home and 23% in a nursing home. After 1 year, the surviving patients show nearly unchanged conditions (75% own home vs 25% nursing home). Eighty-six percent of the patients coming from their own home were able to continue living there independently. The orthogeriatric care is successful in reducing the short-time mortality without showing any effect on 1-year mortality. But the surviving patients seem to benefit from an improved functional outcome.

  12. Sildenafil failures may be due to inadequate patient instructions and follow-up: a study on 100 non-responders.

    PubMed

    Hatzichristou, Dimitrios; Moysidis, Kyriakos; Apostolidis, Apostolos; Bekos, Athanasios; Tzortzis, Vasilios; Hatzimouratidis, Konstantinos; Ioannidis, Evangelos

    2005-04-01

    The objective of this study was to identify factors that affect efficacy response rate to sildenafil in the clinical practice. The study comprised 100 consecutive sildenafil non-responders. Mean patient age was 59+/-14.4 years and mean duration of ED 5.5+/-6.4 years. All patients underwent detailed medical and sexual history and completed the IIEF and a questionnaire regarding the previous use of sildenafil. When inadequate instructions were reported, information on the appropriate use of sildenafil was given and patients were asked to use at least 4 tablets at home. Pharmacologic efficacy was re-evaluated in a scheduled follow-up visit. Mean Erectile Function Domain (ED) of the IIEF score was 14+/-9.9. In 56 patients inappropriate use of sildenafil was recognized; 45 had never used the highest recommended dose (100 mg), 32 had taken the pill with a full stomach right after a meal, 22 had taken the pill just before the initiation of sexual activity and 12 were not aware that sexual stimulation was mandatory to achieve an erection. Furthermore, 8 patients had tried the 100mg dose, despite the presence of factors associated with sildenafil clearance reduction (renal insufficiency, cimetidine treatment). Only 34 patients reported that their physician had scheduled a follow-up visit. Following adequate dose titration and time adjustment, 31 patients responded to sildenafil; 10 patients used the 50 mg dose and 21 the 100 mg. Second and third-line treatment options were offered to the rest of the patients. ED patients may receive inadequate instructions with their prescriptions. Response rate to sildenafil may be maximized after receiving appropriate dose titration and instructions on administration. ED should be treated in the same way as other chronic conditions; follow-up is necessary to evaluate the appropriate application and pharmacologic efficacy of the proposed treatment.

  13. Follow-up examinations: are multidrug-resistant tuberculosis patients in Uttar Pradesh, India, on track?

    PubMed

    Tripathi, U C; Nagaraja, S B; Tripathy, J P; Sahu, S K; Parmar, M; Rade, K; Bhatnagar, S; Ranjan, A; Sachdeva, K S

    2015-03-21

    Contexte : Tous les patients atteints de tuberculose multirésistante (TB-MDR) qui avaient achevé 6 mois de traitement dans le cadre du Programme National Révisé de Lutte contre la Tuberculose (RNTCP) dans l’Uttar Pradesh, le plus grand état dans le nord de l’Inde.Objectif : Déterminer la proportion de patients TB-MDR bénéficiant d’examens de suivi régulier et la vision des prestataires et des patients sur ces services de suivi.Méthodes : Une étude rétrospective de cohorte a été réalisée grâce à la revue des dossiers de 64 patients TB-MDR éligibles enregistrés entre avril et juin 2013 dans 11 districts de l’état. Les patients et le personnel du RNTCP des districts sélectionnés ont également été interviewés grâce à un questionnaire semi-structuré.Résultats : Au total, 34 (53,1%) patients ont bénéficié d’examens de culture de crachats au 3(e) mois, 43 (67,2%) au 4(e) mois, 36 (56,3%) au 5(e) mois et 37 (57,8%) au 6(e) mois. Les principaux facteurs associés à un suivi irrégulier émanant des entretiens étaient le nombre élevé de consultations, la distance à parcourir, les ruptures de stock dans les structures et le manque de connaissances des patients vis-à-vis du programme de suivi.Conclusion : La majorité des patients TB-MDR ont eu un suivi irrégulier. Les facteurs liés aux prestataires dépassent ceux liés aux patients en matière d’examens de suivi médiocres. Le RNTCP devrait se concentrer sur la décentralisation des services de suivi, assurer la logistique et le conseil centré sur le patient afin d’accroitre la régularité du suivi.

  14. Management and follow-up of Ewing sarcoma patients with isolated lung metastases.

    PubMed

    Raciborska, Anna; Bilska, Katarzyna; Rychłowska-Pruszyńska, Magdalena; Duczkowski, Marek; Duczkowska, Agnieszka; Drabko, Katarzyna; Chaber, Radosław; Sobol, Grażyna; Wyrobek, Elżbieta; Michalak, Elżbieta; Rodriguez-Galindo, Carlos; Wożniak, Wojciech

    2016-07-01

    Ewing sarcoma (ES) is the second most common pediatric malignant bone tumor with a wide spectrum of clinical presentations. Although metastatic disease to the lungs is often the cause of death, isolated lung metastases at diagnosis are not frequent. The specific role of chemotherapy, surgery, and lung radiation has not been clearly defined. We investigated prognostic factors and the impact of the different treatment modalities in a cohort of patients with ES with isolated lung metastases. Thirty-eight patients with ES and isolated lung metastases were treated using modern multimodal therapy during the period 2000-2014. According to the imaging characteristics of lung nodules patients were allocated into one of four treatment groups: "0" without nodules, "1" one solitary nodule of <0.5cm or several nodules of <0.3cm, "2" solitary nodule of 0.5-1cm or multiple nodules of 0.3-0.5cm, "3" one pulmonary/pleural nodule of >1cm, or more than one nodule of >0.5cm. Factors predictive of outcome were analyzed. Overall survival was estimated by Kaplan-Meier methods and compared using long-rank test and Cox models. Treatment of the lung metastases was performed in 23 cases (60.5%): twenty patients underwent lung surgery, 6 of them received additional postoperative whole lung radiation; three patients received lung radiation only. Malignant cells were found in all lung nodules of patients from group "3", in 5 (62.5%) patients from group "2", and none of the group "1". There was a correlation between histological response of the primary tumor and outcome. Three-year estimates of EFS and OS were 45.19% and 60.7%, respectively. Patients with good response measured by chest CT had significantly better EFS than patients with poor response (81% vs. 27.66%, respectively, p=0.006). Metastatectomy may have a role in the treatment of highly selected patients with ES and isolated lung metastases depending on the histologic response to therapy. Further studies are needed to better define

  15. The clinical profile of patients with anorexia nervosa in Singapore: a follow-up descriptive study

    PubMed Central

    Kuek, Angeline; Utpala, Ranjani; Lee, Huei Yen

    2015-01-01

    INTRODUCTION The prevalence rate of anorexia nervosa is lower in Asia than in the West, although studies have found that it is on the rise in Asia. This study aims to present the clinical profile of patients presenting with anorexia nervosa in Singapore. METHODS The present study used archival data from the Eating Disorder Programme registry of the Department of Psychiatry, Singapore General Hospital, Singapore. Patient records from 2003 to 2010 were collected and analysed. Presenting characteristics of the patients were also compared with those of another local study conducted eight years earlier. RESULTS From 2003 to 2010, a total of 271 patients were diagnosed with anorexia nervosa by a psychiatrist in our hospital. Of these, 251 (92.6%) were female and 238 (87.8%) were Chinese. Our patients had a lower mean weight (36.83 kg, p < 0.001) and a lower mean body mass index (BMI) (14.43 kg/m2, p < 0.001) than patients from the previous local study. Almost half of all our patients (n = 135, 49.8%) were diagnosed with at least one psychiatric comorbidity and 50 (18.5%) had a history of self-harm. CONCLUSION The presenting characteristics of our study cohort were similar to those of the Western population. However, the lower presenting weight and BMI in our cohort indicates that cases seen today are more severe than those seen eight years ago. Therefore, it is important to put in place prevention programmes to help adolescents cultivate a healthy body image as well as early intervention programmes to improve detection rates and treatment outcomes. PMID:26106239

  16. Intermediate-term follow-up of chronically ill patients with digital ischemia treated with peripheral digital sympathectomy.

    PubMed

    Soberón, José R; Greengrass, Roy A; Davis, William E; Murray, Peter M; Feinglass, Neil

    2016-02-01

    Digital ischemia is commonly found in patients with scleroderma and has been shown to respond to peripheral digital sympathectomy. While favorable long- and intermediate-term results have been documented in the literature, minimal objective data are available and the mechanism of surgical sympathectomy has not been entirely elucidated. Patients with digital ischemia secondary to Raynaud's phenomenon that had undergone peripheral sympathectomy surgery between 2001 and 2009 were identified and contacted for participation. Radial artery Doppler ultrasound studies were performed and compared to those done at the time of their sympathectomy. Of 11 patients treated over a 9-year period, only two patients were available for detailed follow-up analysis. Four patients were deceased, and two were lost to follow-up. Four of the five remaining patients reported excellent use of the hand and no significant episodes of digital ischemia. Of the two patients studied, functional results were favorable and pain was markedly improved despite worsening of the digital flow resistance over time. We conclude that peripheral digital sympathectomy may provide favorable long-term results in patients with digital ischemia from autoimmune causes, although this intervention should be considered in the early stages once ischemic symptoms manifest. Interestingly, Doppler data did not appear to correlate with functional status and symptom severity in these two patients. Further research, particularly prospective studies, is warranted to guide clinical decisions in this patient population.

  17. [The importance of the follow-up in patients operated on for breast cancer. A retrospective analysis of 2482 cases].

    PubMed

    Krengli, M; Pastore, G; Maffei, S

    1993-01-01

    The aim of the follow-up in breast cancer patients is the early detection of recurrences and the diagnosis of second tumours to improve the survival rate and/or the life quality of patients. In this study we analyze retrospectively 2482 cases, treated in the period 1964-1988; all patients underwent surgery: mastectomy in 1979 cases and conservative surgery in 503 cases. The follow-up was performed by clinical and radiological (chest X-ray, bone scintigraphic scanning, echotomography of the liver and mammography) examinations every 3-4 months in the first and second year, every 6 months for 5 years and then every year. The duration of the observation time ranges from 42 to 330 months (median 172). Relapses were detected in 928 cases (37.4%): 289 loco-regional recurrences (11.6%) and 639 distant metastases (25.8%). The 62.1% and the 92.5% of the failures appeared after 3 years and 10 years follow-up respectively. Local recurrences were observed in 14.1% of all relapses after mastectomy and in 9.3% after conservative surgery. 36.3% and 88.1% of the local failures appeared after 2 years and 5 years follow-up respectively. Regional lymph nodal recurrence occurred in 14.2% of all relapses: 1.6% in the axilla, 9.8% in the supraclavicular region, 2.8% in the mediastinal nodes. Distant metastases were observed in 68.9% of all relapses: 31.3% in the bone, 17.6% in the lung and 8.1% in the liver. An increase of the serum markers (CEA, TPA, CA 15-3) appeared 2-10 months before other clinical or radiological signs of disease; CA 15-3 showed the best predictive positive value. Metachronous tumours in the contralateral breast were detected in 103 cases (4.1%), all staged as T1-T2. The modalities of diagnosis of the relapses were studied in 350 patients. In these cases 76% of recurrences were detected by history (62%) and physical examination (14%), 10% by chest X-ray, 12% by bone scan and 2% by liver echotomography. 36% of relapsed patients were asymptomatic and the mean

  18. The role of near-patient coeliac serology testing in the follow-up of patients with coeliac disease.

    PubMed

    George, D A; Hui, L L; Rattehalli, D; Lovatt, T; Perry, I; Green, M; Robinson, K; Walters, J R F; Brookes, M J

    2014-01-01

    This pilot study was undertaken to assess the validity and effectiveness of near-patient coeliac immunological testing, compared to standard laboratory immunological techniques, used in the context of dietician-led coeliac disease follow-up clinics. The study was designed in two phases, each assessing the near-patient test and standard laboratory immunological techniques. Phase 1 analysed stored serum samples; Phase 2 analysed whole blood from patients attending the dietician-led coeliac disease clinics. Patients were recruited from New Cross Hospital, Wolverhampton (n=50), and Imperial College London (n=30), between March 2010 and February 2011. Those with a diagnosis of coeliac disease for greater than 12 months attending dietician-led coeliac disease clinics. In addition to whole blood taken for routine analysis, patients required a capillary finger-prick blood sample. To determine if the whole blood and serum near-patient test results were in correlation with outcomes of standard laboratory evaluation. Phase 1 demonstrated that the near-patient serum test had a sensitivity of 93.5% (95% CI 0.79% to 0.98%), specificity of 94.9% (0.83% to 0.99%), when compared to standard laboratory ELISA. Phase 2, involving patients whole blood, had a sensitivity of 77.8% (0.45% to 0.93%), and specificity of 100% (0.94% to 1%). This pilot study has demonstrated that there appears to be a role for near-patient testing in coeliac disease, but further studies are recommended.

  19. The Impact for Patient Outcomes of Failure to Follow Up on Test Results. How Can We Do Better?

    PubMed Central

    Georgiou, Andrew; Li, Julie; Westbrook, Johanna I

    2015-01-01

    Background The World Health Organization–World Alliance for Patient Safety has identified test result management as a priority area. Poor test result follow-up can have major consequences for the quality of care, including missed diagnoses and suboptimal patient outcomes. Over the last three decades there has been considerable growth in the number of requests for pathology and radiology services which has added to the complexity of how patient care is delivered and test results are managed. This can contribute to a lack of clarity about where and with whom responsibility for test follow-up should reside: a problem that is compounded by a lack of clear definitions about what are critical, unexpected or significantly abnormal results. Aim of this paper This paper will present a narrative review highlighting key issues related to the problem of failure to follow up laboratory test results, and outline potential solutions. Conclusions Information technology (IT) has the potential to enhance the performance and safety of test result management processes. Effective solutions must engage all stakeholders, including consumers, in arriving at decisions about who needs to receive results, how and when they are communicated, and how they are acknowledged and acted upon and the documentation of these actions. PMID:27683480

  20. [Comparison in the follow-up of two patients with persistent elevated PSA and negative prostate biopsy].

    PubMed

    Sciarra, Alessandro; Panebianco, Valeria

    2014-01-01

    To compare two clinical cases on the follow-up of patients with benign prostatic hyperplasia at risck of progression, negative prostate biopsy and persistent elevated PSA levels. After a first negative prostate biopsy for elevated PSA levels, Case A received dutasteride therapy for benign prostatic hyperplasia, whereas Case B continued his therapy without dutasteride. In both cases, other diagnostic procedures or other biopsies were decided on the basis of PSA level modifications. Case A showed a stabilization of PSA levels with a new nadir; the patient did not undergo new biopsies or other diagnostic procedures till the presence (24 months of follow-up) of a PSA elevation despite dutasteride therapy. A new biopsy, then, showed a prostate adenocarcinoma. Case B showed persistent and progressive PSA elevation; the patient underwent other diagnostic procedures and 2 new negative biopsies. Only after 26 months of follow-up a further biopsy showed a prostate adenocarcinoma. 5-alpha-reductase inhibitors can reduce the number of unnecessary prostate biopsies.

  1. The Impact for Patient Outcomes of Failure to Follow Up on Test Results. How Can We Do Better?

    PubMed

    Callen, Joanne; Georgiou, Andrew; Li, Julie; Westbrook, Johanna I

    2015-01-01

    The World Health Organization-World Alliance for Patient Safety has identified test result management as a priority area. Poor test result follow-up can have major consequences for the quality of care, including missed diagnoses and suboptimal patient outcomes. Over the last three decades there has been considerable growth in the number of requests for pathology and radiology services which has added to the complexity of how patient care is delivered and test results are managed. This can contribute to a lack of clarity about where and with whom responsibility for test follow-up should reside: a problem that is compounded by a lack of clear definitions about what are critical, unexpected or significantly abnormal results. This paper will present a narrative review highlighting key issues related to the problem of failure to follow up laboratory test results, and outline potential solutions. Information technology (IT) has the potential to enhance the performance and safety of test result management processes. Effective solutions must engage all stakeholders, including consumers, in arriving at decisions about who needs to receive results, how and when they are communicated, and how they are acknowledged and acted upon and the documentation of these actions.

  2. Orthodontic treatment and follow-up of a patient with cerebral palsy and spastic quadriplegia.

    PubMed

    Çifter, Muhsin; Cura, Nil

    2016-10-01

    This report describes the clinical orthodontic management of a patient with spastic quadriplegia and cerebral palsy. Guidelines to overcome difficulties encountered during the treatment period are suggested. A 13-year-old boy with cerebral palsy and spastic quadriplegia complained of an undesirable oral appearance because of his malocclusion. He had a Class II molar relationship, with severe maxillary and moderate mandibular anterior crowding. Enamel hypoplasia was apparent on all teeth. He had losses of body function and upper extremity function of 70% and 39%, respectively. His physical limitations necessitated a treatment approach that did not rely on patient-dependent appliances. The treatment plan called for maxillary first premolar extractions, mandibular incisor protrusion, and air rotor stripping. The patient's oral function and esthetic appearance were significantly improved. Aligned dental arches with good occlusion were obtained. The patient's self-confidence improved during the treatment period. Physical appearance can influence personality and social acceptability. Corrective orthodontic treatment for patients with physical handicaps can improve not only oral function, but also self-confidence and self-esteem. Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

  3. Long-term follow-up and second malignancies in 487 patients with hairy cell leukaemia.

    PubMed

    Cornet, Edouard; Tomowiak, Cécile; Tanguy-Schmidt, Aline; Lepretre, Stéphane; Dupuis, Jehan; Feugier, Pierre; Devidas, Alain; Mariette, Clara; Leblond, Véronique; Thiéblemont, Catherine; Validire-Charpy, Patricia; Sutton, Laurent; Gyan, Emmanuel; Eisenmann, Jean-Claude; Cony-Makhoul, Pascale; Ysebaert, Loïc; Troussard, Xavier

    2014-08-01

    A large, multicentre, retrospective survey of patients with hairy cell leukaemia (HCL) was conducted in France to determine the frequency of second malignancies and to analyse the long-term effects of the established purine nucleoside analogues (PNAs), cladribine and pentostatin. The survey retrospectively reviewed the medical history of patients and their immediate family, clinical and biological presentation at the time of HCL diagnosis, treatment choice, response to treatment, time to relapse and cause of death. Data were collected for 487 patients with HCL. Of the patients included in the survey, 18% (88/487) had a familial history of cancers, 8% (41/487) presented with malignancies before HCL diagnosis and 10% (48/487) developed second malignancies after HCL was diagnosed. An excess incidence of second malignancies was observed, with a standardized incidence ratio (SIR) of 1·86 (95% confidence interval (CI): 1·34-2·51), with no significant difference between PNAs. For second haematological malignancies alone, the SIR was markedly increased at 5·32 (95% CI: 2·90-8·92). This study highlights the high frequency of cancers in HCL patients and their family members. The frequency of second malignancies is notably increased, particularly for haematological malignancies. The respective role of pentostatin and cladribine in the development of second malignancies is debatable. © 2014 John Wiley & Sons Ltd.

  4. Value of mucin histochemistry in follow up surveillance of patients with long standing ulcerative colitis.

    PubMed Central

    Jass, J R; England, J; Miller, K

    1986-01-01

    It has been suggested that diffuse changes in epithelial mucins may help to identify a subgroup of patients with ulcerative colitis who are at increased risk of developing colorectal cancer. Colonoscopic biopsy specimens were taken from 11 colitic patients shortly before colectomies were performed, in which cancer was identified. These patients were matched to colitic patients without cancer for age, sex, and duration of disease. Sections were stained with high iron diamine and alcian blue (HID-AB), mild periodic acid Schiff, and for peanut lectin binding sugar sequences. The sections were assessed blindly and graded semiquantitatively. Most showed ulcerative colitis in remission or mild active disease. There were no differences between the study and control groups. Metaplastic foci were more common in the group who had cancer. These showed increased staining of mucus by mild periodic acid Schiff and increased binding by peanut lectin to the supranuclear (Golgi) zone. Epithelial dysplasia (detected in four of the patients with cancer showed focal intense binding by peanut lectin to cytoplasm, mucus, and glycocalyx. Although dysplasia differed histochemically from normal tissue, special techniques did not facilitate its diagnosis. Images PMID:3700673

  5. Risk Assessment of BRONJ in Oncologic Patients Treated with Bisphosphonates: Follow-Up to 18 Months

    PubMed Central

    Vitali, Lucia; Nori, Alessandra; Berlin, Ricarda Sara; Mazur, Marta; Orsini, Giovanna; Putignano, Angelo

    2014-01-01

    Objectives. Bisphosphonates related osteonecrosis of the jaw (BRONJ) is a pathological condition characterized by bone exposure or latent infection in patients treated with the drug. The aim of the study is to monitor the BRONJ level of risk health in patients with cancer, according to a preventive clinical protocol, which is firstly aimed at reducing risk factors such as the periodontal infections. Materials and Methods. 10 patients participated in the protocol and were evaluated at baseline and after 3 and 18 months of treatment with bisphosphonates, through full mouth plaque and bleeding scores (FMPS and FMBS), clinical attachment level (CAL) measurement, and the occurrence of osteonecrosis. Results. The mean plaque and bleeding were reduced and the CAL has not shown significant changes and in no cases was there manifestation of BRONJ. Conclusion. The protocol proved crucial for the maintenance of good oral health conditions by eliminating the risk of BRONJ during the observation period. PMID:25258628

  6. Risk Assessment of BRONJ in Oncologic Patients Treated with Bisphosphonates: Follow-Up to 18 Months.

    PubMed

    Sparabombe, Scilla; Vitali, Lucia; Nori, Alessandra; Berlin, Ricarda Sara; Mazur, Marta; Orsini, Giovanna; Putignano, Angelo

    2014-01-01

    Objectives. Bisphosphonates related osteonecrosis of the jaw (BRONJ) is a pathological condition characterized by bone exposure or latent infection in patients treated with the drug. The aim of the study is to monitor the BRONJ level of risk health in patients with cancer, according to a preventive clinical protocol, which is firstly aimed at reducing risk factors such as the periodontal infections. Materials and Methods. 10 patients participated in the protocol and were evaluated at baseline and after 3 and 18 months of treatment with bisphosphonates, through full mouth plaque and bleeding scores (FMPS and FMBS), clinical attachment level (CAL) measurement, and the occurrence of osteonecrosis. Results. The mean plaque and bleeding were reduced and the CAL has not shown significant changes and in no cases was there manifestation of BRONJ. Conclusion. The protocol proved crucial for the maintenance of good oral health conditions by eliminating the risk of BRONJ during the observation period.

  7. Family functioning in the caregivers of patients with dementia: one-year follow-up.

    PubMed

    Heru, Alison M; Ryan, Christine E

    2006-01-01

    Caregivers for relatives with dementia can maintain their quality of life without specific intervention. It is unclear which variables are protective and which variables are aggravating for the caregiver. To assess the impact of family functioning on caregiver burden over time, the authors had caregivers of out patients with dementia complete self-report questionnaires at recruitment and at 1 year. At recruitment, 63% of caregivers were female, with a mean age of 62 years. Mean patient age was 73 years. The average number of caregiving years was 3.1. Caregivers were more likely to be spouses (61%). After 1-year, caregivers who stayed in the study reported no change in burden, reward, quality of life, or overall family functioning, although the patient's activities of daily living and level of disability were perceived to have significantly deteriorated. Caregivers who reported poor family functioning at initial assessment had higher ratings of strain and burden.

  8. [Daily life of schizofrenia patients after the use of clozapine and group follow up].

    PubMed

    Durão, Ana Maria Sertori; Mello e Souza, Maria Conceição Bernardo; Miasso, Adriana Inocenti

    2007-06-01

    This study was carried out with a sample of 11 patients who are part of the atypical medication group at the Hospital das Clínicas of the University of São Paulo at Ribeirão Preto's School of Medicine. For data collection semi-structured interviews guided by a script were held in April 2003. The interviews were first taped and fully transcribed afterwards. Results indicated an improvement in patients' symptoms, demonstrated by decreased social isolation, resumption of home/work activities and studies, as well as by participation in social events. They also point out to the need for a new vision regarding patients who suffer from mental disorders and their family members in the sense of searching for adequate therapeutic attitudes that have an impact on the production of life, aimed at giving a new existential meaning in the different forms of social contact and sociability.

  9. [Circulating biomarkers association in the follow-up of patients with oral cancer].

    PubMed

    Colella, G; Cozzolino, A; Santagata, M; Vicidomini, A; Itro, A

    2001-05-01

    The goal of this study is to analyze the importance of circulating biomarkers association in the management of patients affected by oral cancer. In this study a survey is made of the international experience from 1980 to 1990 based on the presence of CEA, LASA, SCC Ag, TPA, ferritina, CA-50 and others in patients affected by oral cancer and the sensitivity and specificity of these circulating biomarkers association are assessed. In patients with active disease, the results obtained at the time of diagnosis of oral cancer are not satisfactory due to poor specificity of these circulating biomarkers association. The conclusions is drawn that the circulating biomarkers association (especially CEA, SCC Ag, LASA, ferritin, TPA and CA-50) appears to be useful in the prognosis and staging of oral cancer, while their presence is not significative for the diagnosis.

  10. A clinical follow-up of British patients with FG syndrome.

    PubMed

    Romano, C; Baraitser, M; Thompson, E

    1994-04-01

    The FG syndrome is an X-linked recessive mental retardation syndrome. Ten patients are reviewed with special emphasis on the natural history of the intellectual development, constipation, and the prognosis for growth and behaviour. Six out of 10 patients are still macrocephalic, and there is no evidence for a specific growth pattern with respect to height. The degree of mental retardation is is usually severe. The behaviour is characteristically friendly, sociable and over-talkative, with periodic aggression. Six patients have seizures. A characteristic progression seems to occur from congenital hypotonia with joint hyperlaxity at birth, to joint contractures with apparent spasticity and unsteady gait later in life. The constipation was a temporary problem in five cases. The cowlick and the fetal pads persist and are important, but not specific, for the diagnosis.

  11. [From treatment history to patient follow-up: the role of the pharmacist].

    PubMed

    Calop, Jean; Bedouch, Pierrick; Allenet, Benoit

    2013-11-01

    Pharmacists and physicians have complementary roles. Indeed, pharmacists have specific knowledge of medications and a particular relationship with patients, especially in the community. Integration of pharmacists within medical teams, based on the North-American model, helps to ensure close collaboration founded on mutual trust and face-to-face contacts. This role of the pharmacist is appreciated by physicians, notably because it helps them to verify their prescriptions. It is essential to determine patients' relationships with their medications, through a knowledge of their treatment history. The French educational model of clinical pharmacy, based on the fifth hospital year, is inspired by this experience. The challenge is now to prove the benefits both for patients, physicians and nurses, of integrating a pharmacist within the medical team. This educational model helps to develop the pharmacist's role within the community and facilitates relationships between the hospital and the community.

  12. [Follow-up of the cancer patient, maintaining self-identity].

    PubMed

    Krenz, S; Rousselle, I; Guex, P; Stiefel, F

    2009-02-11

    The individual facing the diagnosis of cancer is subjected to abrupt changes with regard to his inner world, his life, habits and social relationships. The patient's capacity to cope, to integrate changes in the way of living and to face the future is determined by his personal resources. However, psychological support may also be an important mean to search for and find sense to the singular experience of the illness. The narrative reconstruction within a supportive setting provides the patient a possibility to recognise his pain as an integral part of himself. A life narrative, which integrates the illness, allows the patient to re-appropriate his history again. Such a therapeutic project necessitates from the therapist a psychological and temporal availability and a capacity to create links all along the different stages of the disease.

  13. Motor recovery of stroke patients after rehabilitation: one-year follow-up study.

    PubMed

    Kuptniratsaikul, Vilai; Kovindha, Apichana; Suethanapornkul, Sumalee; Massakulpan, Pornpimon; Permsirivanich, Wutichai; Kuptniratsaikul, Patcharawimol Srisa-An

    2017-01-01

    Purpose To investigate motor recovery of stroke patients 1 year after rehabilitation. Materials and Methods A cross-sectional study of 192 stroke patients discharged from rehabilitation wards in nine tertiary hospitals was conducted. Motor recovery was assessed using the Brunnstrom motor recovery stages (BMRS), at 6 and 12 months after discharge. Factors related to the BMRS of the hand, arm and leg were analyzed. Results The mean age of patients was 62.2 years (57.3% male). Significantly more patients presented improvement of at least one BMRS of the hand, arm and leg compared with those with decreasing BMRS (p < 0.001). The percentage of patients with BMRS III- VI at 6 months was greater than that at discharge, but the recovery at 12 months was slightly higher than that at 6 months. It seems that motor recovery from stroke was near maximal at six months. Regarding the factors related to motor recovery, only lengths of stay (LOS) <30 d during the first admission and Barthel index at discharge ≥10 were related to the improvement of BMRS of the hand, arm and leg on multivariate analysis. Additionally, no complication at discharge was associated with the improvement of BMRS of the leg. Conclusions Approximately half of our stroke patients had motor improvement of at least one stage of BMRS at one year. Motor recovery after stroke at the end of the first year was associated with shorter LOS during the first admission, higher discharge Barthel index score and absence of complications at discharge.

  14. Red meat intolerance in patients submitted to gastric bypass: a 4-year follow-up study.

    PubMed

    Nicoletti, Carolina Ferreira; de Oliveira, Bruno Affonso Parenti; Barbin, Renato; Marchini, Julio Sergio; Salgado Junior, Wilson; Nonino, Carla Barbosa

    2015-01-01

    Bariatric surgery provides significant weight reduction; however, it may result in food intolerance followed by gastrointestinal complications that may lead to nutritional deficiencies. This study evaluated the influence of red meat intolerance on the dietary pattern, biochemical indicators, and clinical symptoms after Roux-en-Y gastric bypass (RYGB). This retrospective study evaluated patients 4 years after RYGB. The patients were divided into 2 groups: patients with and without red meat intolerance, and data for the following were collected: food intake, anthropometric data, biochemical data, and presence of nausea, vomiting, weakness, weak nails, and hair loss. The difference between groups in the times postoperative was determined by ANOVA. Of the 72 patients included in the study, 63 were evaluated during the first postoperative year, 45 during the second, 56 during the third, and 41 during the fourth. Red meat intolerance was observed in 49.2%, 42.2%, 46.4%, and 39% of the patients after 1, 2, 3, and 4 years, respectively. After 1 year, the intolerant group showed lower calorie, carbohydrate, and iron intake. After 3 years, tolerant patients showed weight regain (2.9 ± 5.3 kg), while the intolerant ones remained stable. There was no difference in the presence of clinical symptoms or biochemical indicators between groups. Red meat intolerance is frequent after bariatric surgery and may alter energy, iron intake, and weight loss; however, it is not associated with the presence of clinical symptoms and biochemical profile. Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  15. Clinical Findings, Follow-up and Treatment Results in Patients with Ocular Rosacea

    PubMed Central

    Kılıç Müftüoğlu, İlkay; Aydın Akova, Yonca

    2016-01-01

    Objectives: To report the clinical features, treatment options and complications in patients with ocular rosacea. Materials and Methods: The records of 48 eyes of 24 patients with ocular rosacea were retrospectively reviewed. Patients’ ocular signs and symptoms were scored between 1 and 4 points according to disease severity; tear film break-up time (BUT) and Schirmer’s test results were recorded before and after the treatment. Preservative-free artificial tears, topical antibiotic eye drops/ointments, short-term topical corticosteroids, topical 0.05% cyclosporine and oral doxycycline treatment were applied as a standard therapy to all patients. Additional treatments were given as needed. Complications were recorded. Results: Twenty-four patients with a mean age of 48.5±35.4 (32-54) years were followed for a mean 15±9.4 (8-36) months. Ocular findings included meibomitis in 100% of cases, anterior blepharitis in 83% (40 eyes), punctate keratopathy in 67% (32 eyes), chalazia in 50% (24 eyes), corneal neovascularization in 50% (24 eyes) and subepithelial infiltrates in 16.6% (8 eyes). Significant improvement of symptoms and clinical findings were achieved in all patients with treatment. The increases in Schirmer’s test and BUT were 3.3±1.5 and 4.5±2.8, respectively (p<0.05). Descemetocele and small corneal perforation occurred in 2 eyes; re-epithelialization was achieved in both eyes with tissue adhesive application (1 eye) and additional amniotic membrane transplantation (1 eye). Four eyes of three patients showed significant regression of corneal neovascularization with topical bevacizumab therapy. Conclusion: Ocular rosacea may present with a variety of ophthalmic signs. It is possible to control the ophthalmic disease with appropriate therapeutic modalities including topical corticosteroids, topical cyclosporine and systemic doxycycline. PMID:27800249

  16. Long term follow-up of remission patients in adult acute leukemia.

    PubMed

    Gerecke, D; Kress, M; Hirschmann, W D

    1983-10-03

    31 adults suffering from acute leukemia were followed for a period of more than 5 years after achieving complete remission. Maintenance chemotherapy consisted of antimetabolite treatment (mercaptopurine + methotrexate) as well as COAP reinduction every 3 months. Chemotherapy was stopped if the first complete remission lasted for 3 years ("long term remission"). This was the case in 8 out of 31 remission patients