The High-Tech High Risk Clinic

2012 ◽  
pp. 161-167
Author(s):  
Brian Drohan ◽  
Constance Roche ◽  
Kevin S. Hughes
Keyword(s):  
High Risk ◽  
High Tech ◽  
High Risk Clinic

Predicting reattendance at a high-risk breast cancer clinic

2015 ◽  
Vol 13 (5) ◽  
pp. 1441-1448 ◽  
Author(s):  
Sarah R. Ormseth ◽  
David K. Wellisch ◽  
Adam E. Aréchiga ◽  
Taylor L. Draper
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Perceived Risk ◽  
Depressive Symptomatology ◽  
High Risk Breast Cancer ◽  
High Risk Breast ◽  
Risk Breast Cancer ◽  
Cancer Clinic ◽  
High Risk Clinic

AbstractObjective:The research about follow-up patterns of women attending high-risk breast-cancer clinics is sparse. This study sought to profile daughters of breast-cancer patients who are likely to return versus those unlikely to return for follow-up care in a high-risk clinic.Method:Our investigation included 131 patients attending the UCLA Revlon Breast Center High Risk Clinic. Predictor variables included age, computed breast-cancer risk, participants' perceived personal risk, clinically significant depressive symptomatology (CES–D score ≥ 16), current level of anxiety (State–Trait Anxiety Inventory), and survival status of participants' mothers (survived or passed away from breast cancer).Results:A greater likelihood of reattendance was associated with older age (adjusted odds ratio [AOR] = 1.07, p = 0.004), computed breast-cancer risk (AOR = 1.10, p = 0.017), absence of depressive symptomatology (AOR = 0.25, p = 0.009), past psychiatric diagnosis (AOR = 3.14, p = 0.029), and maternal loss to breast cancer (AOR = 2.59, p = 0.034). Also, an interaction was found between mother's survival and perceived risk (p = 0.019), such that reattendance was associated with higher perceived risk among participants whose mothers survived (AOR = 1.04, p = 0.002), but not those whose mothers died (AOR = 0.99, p = 0.685). Furthermore, a nonlinear inverted “U” relationship was observed between state anxiety and reattendance (p = 0.037); participants with moderate anxiety were more likely to reattend than those with low or high anxiety levels.Significance of Results:Demographic, medical, and psychosocial factors were found to be independently associated with reattendance to a high-risk breast-cancer clinic. Explication of the profiles of women who may or may not reattend may serve to inform the development and implementation of interventions to increase the likelihood of follow-up care.

scholarly journals Neurodevelopmental Outcome of High Risk Babies at One Year of Age Born in a Tertiary Centre

2017 ◽  
Vol 37 (1) ◽  
pp. 45-50
Author(s):  
Merina Shrestha ◽  
Luna Bajracharya ◽  
Laxman Shrestha
Keyword(s):  
High Risk ◽  
Congenital Anomalies ◽  
Neonatal Period ◽  
Neurodevelopmental Outcome ◽  
Single Item ◽  
Tertiary Centre ◽  
Developmental Domains ◽  
One Year ◽  
High Risk Clinic

Introduction: With increasing survival of high risk babies, children with different developmental disabilities have emerged as a challenge for the baby, family as well as for physicians. With limited awareness and resources, follow-up and interventions for these babies are difficult. The study was carried out to find out the development of high risk babies in different developmental domains at one year of age.Material and Methods: NICU graduates who visited high risk clinic at one year of age were assessed. ASQ-3 was used to screen development. Children with major congenital anomalies and syndromes were excluded from the study.Results: Out of 28 high risk babies, about 29% had global delay. Those babies who had seizure during neonatal period could not score even in single item of ASQ-3. Conclusion: All high risk babies are at risk of developing delay hence should be followed up regularly. Timely early intervention needs to be started to minimize delay.  

scholarly journals Supporting surgeons in patient-centred complex decision-making: a qualitative analysis of the impact of a perioperative physician clinic

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e033277
Author(s):  
Clarabelle T Pham ◽  
Catherine L Gibb ◽  
Robert A Fitridge ◽  
Jon Karnon ◽  
Elizabeth Hoon
Keyword(s):  
Decision Making ◽  
High Risk ◽  
Elective Surgery ◽  
Structured Interviews ◽  
Complex Patients ◽  
Complex Decision Making ◽  
Complex Decision ◽  
Additional Value ◽  
The Impact ◽  
High Risk Clinic

ObjectivePatients with comorbidities can be referred to a physician-led high-risk clinic for medical optimisation prior to elective surgery at the discretion of the surgical consultant, but the factors that influence this referral are not well understood. The aims of this study were to understand the factors that influence a surgeon’s decision to refer a patient to the clinic, and how the clinic impacts on the management of complex patients.DesignQualitative study using theoretical thematic analysis to analyse transcribed semi-structured interviews.SettingInterviews were held in either the surgical consultant’s private office or a quiet office/room in the hospital ward.ParticipantsSeven surgical consultants who were eligible to refer patients to the clinic.ResultsWhen discussing the factors that influence a referral to the clinic, all participants initially described the optimisation of comorbidities and would then discuss with examples the challenges with managing complex patients and communicating the risks involved with having surgery. When discussing the role of the clinic, two related subthemes were dominant and focused on the management of risk in complex patients. The participants valued the involvement of the clinic in the decision-making and communication of risks to the patient.ConclusionsThe integration of the high-risk clinic in this study appears to offer additional value in supporting the decision-making process for the surgical team and patient beyond the clinical outcomes. The factors that influence a surgeon’s decision to refer a patient to the clinic appear to be driven by the aim to manage the uncertainty and risk to the patient regarding surgery and it was seen as a strategy for managing difficult and complex cases.

Hereditary nonpolyposis colorectal cancer in young colorectal cancer patients: High-risk clinic versus population-based registry

2002 ◽  
Vol 122 (4) ◽  
pp. 940-947 ◽  
Author(s):  
Jonathan P. Terdiman ◽  
Theodore R. Levin ◽  
Brian A. Allen ◽  
James R. Gum ◽  
Andrea Fishbach ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
High Risk ◽  
Cancer Patients ◽  
Hereditary Nonpolyposis Colorectal Cancer ◽  
Population Based ◽  
Hereditary Nonpolyposis ◽  
Colorectal Cancer Patients ◽  
Population Based Registry ◽  
High Risk Clinic

High Rate of Actionable Variants Identifed by Multigene Testing for Pancreas Cancer Patients in a High Risk Clinic

2018 ◽  
Vol 113 (Supplement) ◽  
pp. S14-S15
Author(s):  
Gina Wideroff ◽  
Daniel A. Sussman ◽  
Peter J. Hosein ◽  
Rachel Silva-Smith ◽  
Talia Donenberg
Keyword(s):  
High Risk ◽  
Cancer Patients ◽  
Pancreas Cancer ◽  
High Rate ◽  
Actionable Variants ◽  
High Risk Clinic

Cost-Effectiveness of Skin Surveillance Through a Specialized Clinic for Patients at High Risk of Melanoma

2017 ◽  
Vol 35 (1) ◽  
pp. 63-71 ◽  
Author(s):  
Caroline G. Watts ◽  
Anne E. Cust ◽  
Scott W. Menzies ◽  
Graham J. Mann ◽  
Rachael L. Morton
Keyword(s):  
Cost Effectiveness ◽  
High Risk ◽  
Standard Care ◽  
Sensitivity Analyses ◽  
Model Parameters ◽  
System Perspective ◽  
Life Years ◽  
The Mean ◽  
Quality Adjusted Life ◽  
High Risk Clinic

Purpose Clinical guidelines recommend that people at high risk of melanoma receive regular surveillance to improve survival through early detection. A specialized High Risk Clinic in Sydney, Australia was found to be effective for this purpose; however, wider implementation of this clinical service requires evidence of cost-effectiveness and data addressing potential overtreatment of suspicious skin lesions. Patients and Methods A decision-analytic model was built to compare the costs and benefits of specialized surveillance compared with standard care over a 10-year period, from a health system perspective. A high-risk standard care cohort was obtained using linked population data, comprising the Sax Institute’s 45 and Up cohort study, linked to Medicare Benefits Schedule claims data, the cancer registry, and hospital admissions data. Benefits were measured in quality-adjusted life-years gained. Sensitivity analyses were undertaken for all model parameters. Results Specialized surveillance through the High Risk Clinic was both less expensive and more effective than standard care. The mean saving was A$6,828 (95% CI, $5,564 to $8,092) per patient, and the mean quality-adjusted life-year gain was 0.31 (95% CI, 0.27 to 0.35). The main drivers of the differences were detection of melanoma at an earlier stage resulting in less extensive treatment and a lower annual mean excision rate for suspicious lesions in specialized surveillance (0.81; 95% CI, 0.72 to 0.91) compared with standard care (2.55; 95% CI, 2.34 to 2.76). The results were robust when tested in sensitivity analyses. Conclusion Specialized surveillance was a cost-effective strategy for the management of individuals at high risk of melanoma. There were also fewer invasive procedures in specialized surveillance compared with standard care in the community.

Examining screening behaviors at a high-risk ovarian cancer clinic.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e13047-e13047
Author(s):  
Courtney Lynam-Scherr ◽  
Kisha T Hope ◽  
Irene B. Helenowski ◽  
Masha Kocherginsky ◽  
Melissa Keene ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
High Risk ◽  
Insurance Coverage ◽  
Prophylactic Surgery ◽  
Ca 125 ◽  
Ovarian Cancer Risk ◽  
Race Ethnicity ◽  
The Impact ◽  
Screening Behaviors ◽  
High Risk Clinic

e13047 Background: Women with deleterious BRCA1/2mutations have a significantly increased lifetime risk to develop ovarian cancer. Prophylactic surgery can significantly reduce ovarian cancer risk. The Northwestern Ovarian Cancer Early Detection and Prevention Program (NOCEDPP) was established to monitor this high-risk population prior to risk-reducing surgery. For such patients, providers in the NOCEDPP recommend screening with CA-125 and transvaginal ultrasound (TVUS) biannually. The aim of this study was to examine screening rates of women who have not had surgery but attend the NOCEDPP. Methods: We reviewed electronic health records of 1,662 women who attended the NOCEDPP clinic between October 2005 – October 2015. Demographic and clinical characteristics and utilization of screening were analyzed retrospectively using descriptive statistics and Kruskal-Wallis H-tests to examine differences in screening rates by age, race, ethnicity and insurance type. Results: Of the 1,662 women initially identified, 385 had a known BRCA mutation, 303 had an appointment with at least 6 months between first and last procedure – the sample included in the final analysis. Compared with women ages 35-45 (median = 1.91) and 45+ (median = 1.18), women ages 20-35 attended the most screenings per year (median = 2.12) p = 0.001, a rate consistent with biannual recommendations. There were no significant differences in screening rate by race, ethnicity, or insurance coverage. Conclusions: Despite changes in national guidelines, providers in our high-risk clinic continue to recommend CA-125 and TVUS biannually. Our preliminary data indicates patients’ attendance is uninfluenced by race, ethnicity, or insurance coverage. Further exploration of the impact of age is warranted. Implication of findings indicate a high-risk clinic may positively impact screening behaviors above and beyond factors typically associated with non-adherence.

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