Can the LACE Index help Identify Uninsured Patients at Risk of Loss to Follow-Up during a Pharmacist-led Transitions of Care Program?

Aims The management of acetabular defects at the time of revision hip arthroplasty surgery is a challenge. This study presents the results of a long-term follow-up study of the use of irradiated allograft bone in acetabular reconstruction. Patients and Methods Between 1990 and 2000, 123 hips in 110 patients underwent acetabular reconstruction for aseptic loosening, using impaction bone grafting with frozen, irradiated, and morsellized femoral heads and a cemented acetabular component. A total of 55 men and 55 women with a mean age of 64.3 years (26 to 97) at the time of revision surgery are included in this study. Results At a mean follow-up of 16.9 years, there had been 23 revisions (18.7%), including ten for infection, eight for aseptic loosening, and three for dislocation. Of the 66 surviving hips (58 patients) that could be reassessed, 50 hips (42 patients; 75.6%) were still functioning satisfactorily. Union of the graft had occurred in all hips with a surviving implant. Survival analysis for all indications was 80.6% at 15 years (55 patients at risk, 95% confidence interval (CI) 71.1 to 87.2) and 73.7% at 20 years (eight patients at risk, 95% CI 61.6 to 82.5). Conclusion Acetabular reconstruction using frozen, irradiated, and morsellized allograft bone and a cemented acetabular component is an effective method of treatment. It gives satisfactory long-term results and is comparable to other types of reconstruction. Cite this article: Bone Joint J 2018;100-B:1449–54.

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Risk factors for loss to follow‐up among at‐risk HIV negative men who have sex with men participating in a research cohort with access to pre‐exposure prophylaxis in coastal Kenya

Journal of the International AIDS Society ◽

10.1002/jia2.25593 ◽

2020 ◽

Vol 23 (S6) ◽

Cited By ~ 1

Author(s):

Elizabeth W Wahome ◽

Susan M Graham ◽

Alexander N Thiong’o ◽

Khamisi Mohamed ◽

Tony Oduor ◽

...

Keyword(s):

Risk Factors ◽

At Risk ◽

Loss To Follow Up ◽

Coastal Kenya ◽

Sex With Men ◽

Exposure Prophylaxis ◽

Hiv Negative

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Effect of Health Insurance on Hepatitis C Sustained Virologic Response Rates to Sofosbuvir-Based Treatment Regimens in a South Florida Community Hospital

Journal of the International Association of Providers of AIDS Care (JIAPAC) ◽

10.1177/2325958219835590 ◽

2019 ◽

Vol 18 ◽

pp. 232595821983559 ◽

Cited By ~ 1

Author(s):

Paula Eckardt ◽

Jianli Niu ◽

Angela Savage ◽

Tara Griffin ◽

Elizabeth Sherman

Keyword(s):

Health Insurance ◽

Hepatitis C ◽

Sustained Virologic Response ◽

Community Hospital ◽

Virologic Response ◽

South Florida ◽

Uninsured Patients ◽

Loss To Follow Up ◽

Insured Patients

The high cost of direct-acting antiviral–based regimens raises concerns about the outcome of treatment in uninsured patients with chronic hepatitis C virus (HCV) infection. This study assessed the relationship between health insurance status and sustained virologic response (SVR) rates in a community hospital in South Florida. Sofosbuvir-based therapy was initiated in 82 patients, of which 73% were uninsured and 28 (34%) were HIV coinfection. The overall SVR rate for those tested was 98%. The SVR rates were similar between HCV mono- and HCV/HIV coinfected patients (96% versus 100%, P = .204). Uninsured patients, with access to patient assistance programs, had comparable SVR rates to insured patients (100% versus 95%, P = .131). However, there was a trend toward a higher rate of loss to follow-up in uninsured compared to insured patients (25% versus 9%, P = .116). Strategies specific to adherence to treatment for uninsured patients are needed to reduce rates of loss to follow-up.

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An empirical analysis of dealing with patients who are lost to follow-up when developing prognostic models using a cohort design

10.21203/rs.3.rs-54715/v3 ◽

2020 ◽

Author(s):

Jenna M Reps ◽

Peter Rijnbeek ◽

Alana Cuthbert ◽

Patrick B Ryan ◽

Nicole Pratt ◽

...

Keyword(s):

At Risk ◽

Real World ◽

Synthetic Data ◽

Real World Data ◽

Test Set ◽

Loss To Follow Up ◽

World Data ◽

Cohort Design ◽

Lost To Follow Up

Abstract Background: Researchers developing prediction models are faced with numerous design choices that may impact model performance. One key decision is how to include patients who are lost to follow-up. In this paper we perform a large-scale empirical evaluation investigating the impact of this decision. In addition, we aim to provide guidelines for how to deal with loss to follow-up.Methods: We generate a partially synthetic dataset with complete follow-up and simulate loss to follow-up based either on random selection or on selection based on comorbidity. In addition to our synthetic data study we investigate 21 real-world data prediction problems. We compare four simple strategies for developing models when using a cohort design that encounters loss to follow-up. Three strategies employ a binary classifier with data that: i) include all patients (including those lost to follow-up), ii) exclude all patients lost to follow-up or iii) only exclude patients lost to follow-up who do not have the outcome before being lost to follow-up. The fourth strategy uses a survival model with data that include all patients. We empirically evaluate the discrimination and calibration performance.Results: The partially synthetic data study results show that excluding patients who are lost to follow-up can introduce bias when loss to follow-up is common and does not occur at random. However, when loss to follow-up was completely at random, the choice of addressing it had negligible impact on model discrimination performance. Our empirical real-world data results showed that the four design choices investigated to deal with loss to follow-up resulted in comparable performance when the time-at-risk was 1-year but demonstrated differential bias when we looked into 3-year time-at-risk. Removing patients who are lost to follow-up before experiencing the outcome but keeping patients who are lost to follow-up after the outcome can bias a model and should be avoided.Conclusion: Based on this study we therefore recommend i) developing models using data that includes patients that are lost to follow-up and ii) evaluate the discrimination and calibration of models twice: on a test set including patients lost to follow-up and a test set excluding patients lost to follow-up.

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Multicentric survey of patient doses in fluoroscopy guided diagnostic and interventional cardiac procedures: comparison with Diagnostic Reference Levels and follow-up levels for patients at risk for radiation induced skin effects

Bulgarian Cardiology ◽

10.3897/bgcardio.26.e52193 ◽

2020 ◽

Vol 26 (1) ◽

pp. 44-52

Author(s):

Anna Zagorska ◽

Desislava Ivanova ◽

Dessislava Kostova-Lefterova ◽

Filip Simeonov ◽

Valeri Gelev ◽

...

Keyword(s):

At Risk ◽

Coronary Intervention ◽

Fluoroscopy Time ◽

Diagnostic Reference Levels ◽

Reference Levels ◽

Cardiac Procedures ◽

Patients At Risk ◽

Radiation Induced ◽

Patient Doses

Introduction. Interventional cardiac procedures are often associated with high patient exposure and therefore require special care in protecting patients from radiation-induced effects. Materials and methods. A retrospective study of typical patients’doses was performed in nine hospitals, with a total number of fourteen angiography systems. The typical values for kerma-area product (KAP), cumulative dose (CD) and fluoroscopy time (FT) for two of the most commonly performed procedures - percutaneous coronary intervention (PCI) and coronary arteriography (CA), were calculated and compared with the Bulgarian National Diagnostic Reference Levels (NDRL). Data analysis, regarding the risk of radiation-induced skin effects due to interventional cardiac procedures, was performed. Aim. 1) to present and analyze the typical KAP values for PCI and CA procedures in cardiology departments with high workload and to compare them with the NDRL; 2) to compare the patient doses with the follow-up levels published in Ordinance 2, to identify patients at risk for radiation-induced effects. Results. The results show that typical values for PCI and CA procedures for some of the angiography systems are higher than the NDRL. In all investigated departments there are patients with at least one exceeded follow-up level for PCI. Conclusions. The results show a potential for optimization in the departments with both high or very low typical dose or FT values. No radiation-induced effect was observed in the followed-up group of patients. The introduction of procedure with "Instruction to the patient after an interventional cardiac procedure(s) with greater complexity and a long fluoroscopy time" for patient follow-up and its regular implementation into the routine clinical practice will help for timely diagnosis and treatment of radiation-induced skin effects after cardiac procedures under fluoroscopy control.

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859. Same-Day HIV Pre-exposure Prophylaxis (PrEP) Initiation During Drop-in STD Clinic Appointments Is a Safe, Feasible, and Effective Method to Engage Patients at Risk for HIV in PrEP Care

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy209.044 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S20-S20 ◽

Cited By ~ 1

Author(s):

Kevin Kamis ◽

Kenneth Scott ◽

Edward Gardner ◽

Karen Wendel ◽

Grace Marx ◽

...

Keyword(s):

At Risk ◽

Logistic Regression ◽

Health Insurance ◽

Low Income ◽

Median Income ◽

Navigation Support ◽

Patients At Risk ◽

Exposure Prophylaxis ◽

Research Grant

Abstract Background Patients at risk for HIV generally do not have immediate access to PrEP. We hypothesized that by offering free, 30-day PrEP starter packs and navigation support during drop-in STD clinic appointments, individuals would be likely to initiate and continue PrEP. Methods Individuals aged ≥18 years presenting for drop-in appointments in the Metro Denver STD Clinic and indicated for PrEP were eligible for the study. Exclusion criteria were history of renal dysfunction, chronic hepatitis B (HBV), HIV, pregnancy, and indications for postexposure prophylaxis. Eligible individuals were provided PrEP education and offered a free, 30-day PrEP starter pack and navigation support for cost assistance. Participants were tested for creatinine, HBV, HIV, and pregnancy at enrollment, and navigated to an appointment for ongoing PrEP care. Participants’ medical records were reviewed for a minimum of 4 months after enrollment. Descriptive statistics and logistic regression were used to characterize the study population and follow-up. Results From April to October 2017, 100 individuals filled a tenofovir–emtricitabine prescription (figure). Median participant age was 28 years, 98% were male, 53% were non-Hispanic White, 8% non-Hispanic Black, and 34% Hispanic. Median annual income was $24,000, 62% had health insurance, 26% had a primary care provider (PCP), and 50% had a recent bacterial STI. No participants had abnormal baseline creatinine or HBV. 77% completed ≥1 PrEP follow-up visit during the study period; 57% completed their first visit within 31 days. 56% completed a second follow-up visit. No HIV seroconversions were detected during follow-up. Factors significantly associated with attending ≥1 follow-up appointment were age ≥ 30 years, higher income, and having health insurance or a PCP at enrollment. In multivariate logistic regression, only higher income was associated with attending ≥1 follow-up appointment (median income for those with ≥1 follow-up visit vs. no follow-up: $24,960 vs. $14,000, P <0.01). Conclusion Providing immediate access to PrEP during drop-in STD clinic visits is a safe and feasible approach to initiation of PrEP care. Additional resources are needed to support PrEP continuity care, particularly for low-income individuals. Disclosures K. Kamis, Gilead Scienes: Research Coordinator, Research grant. S. Rowan, Gilead Sciences: Investigator, Research grant.

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Abstract 19477: Transthoracic Bioimpedance Monitoring Predicts Readmission After Hospitalization for Heart Failure: Preliminary Results From the SENTINEL-HF Study

Circulation ◽

10.1161/circ.132.suppl_3.19477 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Chad E Darling ◽

Silviu Dovancescu ◽

Jarno Riistama ◽

Jane Saczynski ◽

Nisha Kini ◽

...

Keyword(s):

Heart Failure ◽

At Risk ◽

Acute Decompensated Heart Failure ◽

Decompensated Heart Failure ◽

Detection Algorithm ◽

Fluid Accumulation ◽

Predictive Values ◽

Preliminary Results ◽

Patients At Risk

Introduction: Patients and health systems are focused on reducing readmissions for patients with acute decompensated heart failure (ADHF). Readmission after hospitalization is often secondary to HF decompensation, but it remains challenging to identify patients at-risk. Bioimpedance is a validated marker of thoracic fluid accumulation. We examined whether changes in bioimpedance, measured using a Fluid Accumulation Vest (FAV), predicted subsequent HF decompensation in patients discharged after ADHF. Methods: Participants included 83 patients hospitalized for ADHF. Subjects were trained on the use of a FAV-smartphone dyad to obtain and transmit a 5-minute bioimpedance measurement once daily for 45-days after discharge.(see Figure) The outcome of interest, HF-related readmission was assessed using participant report and medical records. Sensitivity, specificity, negative and positive predictive values were calculated to describe the efficacy of the bioimpedance alert algorithm as a predictor of HF readmission. Results: Subject characteristics: mean age 68 ± 11 years, 36% female, 92% white, mean ejection fraction of 44 ± 19%. 49 participants completed the 45-day follow-up and had sufficient, daily FAV data for analysis. Our main outcome of HF-related rehospitalization occurred in 8% of patients during follow-up. The decompensation detection algorithm demonstrated a sensitivity of 75%, specificity of 47%, positive/negative predictive values of 11% and 96%, respectively. Conclusions: The preliminary results of this ongoing study suggest that HF readmissions may be predicted with modest sensitivity by our current decompensation detection algorithm. Further refinement of our transthoracic bioimpedance system may offer possibilities for reducing HF readmissions by enabling identification and treatment of outpatients at risk for readmission.

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Abstract P193: A Cardiopulmonary Resuscitation Training Program for Family Members of In-Hospital Patients at Risk for Cardiac Arrest

Circulation ◽

10.1161/circ.118.suppl_18.s_1487-a ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Marion Leary ◽

Lori Albright ◽

Emily B Meshberg ◽

Noah T Sugerman ◽

Lance B Becker ◽

...

Keyword(s):

At Risk ◽

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Family Members ◽

Care Hospital ◽

Hospital Patients ◽

Patients At Risk ◽

Bystander Cpr ◽

Self Instruction

Background: Resuscitation from cardiac arrest often depends on prompt cardiopulmonary resuscitation (CPR) from the lay public, yet bystander CPR rates in the US are low. One barrier to bystander CPR delivery is that most arrests occur in the home, where only family members may be available to provide care. Little data exist regarding the ability to target and train family members of “at-risk” patients in CPR. Objective: We sought to implement a CPR video self-instruction (VSI) program for family members of in-hospital patients at risk for cardiac arrest. After training in situ before hospital discharge, we tested the hypothesis that at-risk patient family members would be motivated to secondarily train others in the home after leaving the hospital setting. Methods: Family members of patients hospitalized for cardiac conditions at one tertiary-care hospital between 12/07 and 6/08 who met pre-defined inclusion criteria were offered CPR VSI training requiring 25–30 min. All trainees were assessed for skill competence and video recorded for analysis. Trainees were encouraged to take the VSI kit home, and follow-up surveys were conducted to gauge secondary training of other family members. Results: Among 36 enrollees, mean age (SD) was 50 (13) and 78% of trainees were female; only 17% had been CPR trained within the past 10 years, and 44% had never been trained. Most (67%) of the trainees were either children or spouses of the at-risk hospitalized patients. Most (78%) trainees rated their experience with learning CPR via VSI as “comfortable” or “very comfortable”. During 2 min of CPR skills assessment, mean (SD) chest compression rate was 100 (19), mean percentage (SD) adequate depth was 89% (15%), and mean (SD) time for two breaths was 10.8 (4.6) sec. Follow-up surveys revealed that 33% of recipients performed secondary training at home, with a mean (SD) of 1.8 (1.3) secondary trainees. Conclusions: CPR VSI training for family members of hospitalized cardiac patients may serve as a cost-effective model to disseminate resuscitation skills and allows for secondary training in the home of patients at risk for sudden cardiac arrest.

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