scholarly journals 649 COVID BOAST In Practice: Our Experience Implementing BOA Recommendations During the UK Coronavirus Pandemic Peak

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A Hoyle ◽  
K Iqbal ◽  
J Henry ◽  
L Hughes ◽  
D Johnson
Keyword(s):  
Long Term Outcomes ◽  
Residual Deformity ◽  
Fracture Clinic ◽  
Face To Face ◽  
Retrospective Audit ◽  
Neck Fracture ◽  
The Uk ◽  
The Impact

Abstract Background In anticipation of the UK coronavirus pandemic peak, BOA published new pandemic-specific guidance (“COVID BOAST”) in April 2020. We describe our experience implementing this restructured T&O service in a busy DGH setting during the pandemic peak. Method A rapid retrospective audit was conducted of all patients presenting to our T&O service in April 2020, with particular emphasis compliance with COVID BOAST. Results Our service conducted 511 outpatient reviews, and 95 operative procedures. 94% of outpatients were treated non-operatively. We provided telephone appointments to 12.8% of follow-up patients, and 39% of new patients. 82% of patients were treated with removable casts/splints/boots. 23% of patients were discharged direct from VFC or after one face-to-face fracture clinic review. Residual deformity was consciously accepted in 13% of patients. Theatre throughput fell significantly due to pandemic precautions however, femoral neck fracture volumes remained constant. Conclusions We demonstrate broad compliance with COVID BOAST guidance. The majority of patients were treated non-operatively, including conscious acceptance of residual deformity. Our pre-existing VFC allowed us to provide a significant number of telephone consultations, although despite the practice shift towards removable splintage, face-to-face consultations were required for clinical and/or radiological assessment. The impact of increased conservative management on patients’ long-term outcomes needs further evaluation.

scholarly journals 885 Telephone Consultations During the Covid-19 Pandemic; from the Perspective of One Oral and Maxillofacial Unit

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
H Chaudhry ◽  
J Abiola
Keyword(s):  
Emergency Treatment ◽  
Electronic Patient Record ◽  
Ad Hoc ◽  
Healthcare Provision ◽  
Face To Face ◽  
Global Impact ◽  
The Uk ◽  
Benign Biopsy

Abstract Introduction The Covid-19 pandemic has had a global impact on healthcare. As a result, changes have been made to healthcare provision. In the UK, the focus was changed to urgent and emergency treatment only, and therefore a shift from face-to-face consultations to video and telephone consultations was implemented. Our aim was to look at the telephone consultations in our oral and maxillofacial (OMF) department to identify their effectiveness. Method A search was carried out using the electronic patient record for patients booked for consultations in the OMF clinics from the 23rd of March to the 1st of May 2020. Trauma clinics and ad-hoc clinics were excluded. Results 21 clinic codes were found as suitable for inclusion. 185 consultations were booked during the 6-week period. Of these, 165 were via telephone and 20 face-to-face. A total of 75 consultations resulted in discharge and 110 required further follow up or further investigation. Of the 75 patients discharged, 73 of these were via telephone. The main reason for discharge was delivery of benign biopsy results. Conclusions Covid-19 will have long term impacts on healthcare provision. If implemented correctly, virtual consultations carry the potential in making healthcare more accessible.

Abstract 19771: Persistent Thrombocytopenia after Myocardial Infarction is Associated with Increased Short- and Long-Term Mortality

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Anirudh Kumar ◽  
Salim Virani ◽  
Scott Bassett ◽  
Mahboob Alam ◽  
Ravi Hira ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Bleeding Complications ◽  
Group Differences ◽  
Long Term Outcomes ◽  
Post Discharge ◽  
Short And Long Term ◽  
The Impact ◽  
Long Term Mortality

Background: Thrombocytopenia (TCP) occurs commonly in patients hospitalized with acute myocardial infarction (AMI). It is unclear whether persistent TCP after discharge among AMI survivors is associated with worse outcomes. Methods: We examined the impact of persistent post-discharge TCP on outcomes in a registry of consecutive AMI patients hospitalized between January 2004 and December 2007. In-hospital (IH) TCP was defined by a nadir platelet count < 150 x 109/L. Resolved TCP was defined as IH TCP which resolved within 3 months after discharge while persistent TCP was defined as IH TCP which did not resolve within 3 months. Results: Of 842 patients hospitalized for a first AMI, we examined data on 617 hospital survivors who had follow-up within 3 months of discharge and documented long-term outcomes. Of those, 474 (76.8%) patients did not experience IH TCP while 42 (6.8%) and 101 (16.4%) had persistent and resolved TCP, respectively (Table). Patients with persistent TCP were older, had worse comorbidities, and were more likely to have TCP at baseline and discharge. There were no inter-group differences in infarct size, major bleeding complications, revascularization, or ejection fraction at discharge. Mortality following discharge was higher at all time-points among AMI patients with persistent TCP compared to patients with resolved or without IH TCP (Figure). Patients with resolved TCP had comparable mortality to those without IH TCP. Conclusion: Persistent TCP within 3 months after hospital discharge for AMI is associated with significantly increased short- and long-term mortality compared to patients with recovered TCP or without IH TCP.

Food Insecurity and Mortality in American Adults: Results From the NHANES-Linked Mortality Study

2020 ◽  
pp. 152483992094592 ◽  
Author(s):  
Srikanta Banerjee ◽  
Tim Radak ◽  
Jagdish Khubchandani ◽  
Patrick Dunn
Keyword(s):  
Health Risk ◽  
Food Insecurity ◽  
Public Health Problem ◽  
The United States ◽  
Mortality Data ◽  
Long Term Outcomes ◽  
Interdisciplinary Approaches ◽  
The Impact

Food insecurity is a significant public health problem in the United States leading to substantial social, economic, and health care–related burdens. While studies continue to estimate the prevalence of food insecurity, the long-term outcomes are not extensively explored. The purpose of this study was to assess the impact of food insecurity on mortality. We analyzed data on adults (≥ 20 years) from the 1999–2010 National Health and Nutrition Examination Survey, with mortality data obtained through 2015. Among the total study participants (n = 25,247), 17.6% reported food insecurity. Food-insecure individuals were more likely to be younger in age, minorities, poorer, with lesser education, obese, smokers, and with diabetes compared to food-secure counterparts. During a 10.2-year follow-up, among the food insecure, 821 individuals died (11%). The hazard ratio (HR) for mortality among the food insecure compared with the food secure, with adjustment for age and gender only, was 1.58; 95% confidence interval [CI: 1.25, 2.01]. The adjusted HRs for all-cause mortality, HR = 1.46, CI [1.23, 1.72], p < .001, and cardiovascular mortality, HR = 1.75, CI [1.19, 2.57], p < .01, were statistically significantly higher among food-insecure individuals, after adjustment for multiple demographic and health risk factors. Individuals who are food-insecure have a significantly higher probability of death from any cause or cardiovascular disease in long-term follow-up. Comprehensive and interdisciplinary approaches to reducing food insecurity–related disparities and health risks should be implemented. Including food insecurity in health risk assessments and addressing food insecurity as a determinant of long-term outcomes may contribute to lower premature death rates.

Belastung von Patienten und Gesundheitssystem durch Pleuraverweildrainage zur Versorgung chronischer Pleuraergüsse

2019 ◽  
Vol 7 (2) ◽  
pp. 84-85
Author(s):  
Axel Tobias Kempa
Keyword(s):  
Length Of Hospital Stay ◽  
Chest Drain ◽  
Long Term Outcomes ◽  
Talc Pleurodesis ◽  
In Situ Methods ◽  
Hospital Visits ◽  
The Impact

Background: Indwelling pleural catheters (IPC) offer an alternative to talc pleurodesis in recurrent effusion, especially in patients wishing to avoid hospitalization. Two randomized trials have demonstrated reduced time in hospital using IPCs versus talc pleurodesis in malignant pleural effusion (MPE). However, the impact of IPCs on hospital services and patients has not been well studied. Objectives: To analyze long-term outcomes of IPCs and understand the hospital burden in terms of requirement for hospital visits and contacts with healthcare, while the IPC was in situ. Methods: IPC insertions in a tertiary pleural center were analyzed retrospectively. Reviews of patients with IPCs in situ considered «additional» to routine clinical follow-up were defined pre-hoc. Results: A total of 202 cases were analyzed: 89.6% MPE group (n = 181) and 10.4% non-MPE group (n = 21). There were a median 3.0 (interquartile range [IQR] 3) and 2.0 (IQR 2) ipsilateral pleural procedures prior to each IPC insertion in non-MPE and MPE groups, respectively (p = 0.26), and a mean 1.3 (SD 1.7) planned IPC-related outpatient follow-up visits per patient. There were 2 (9.5%) and 14 (7.7%) IPC-related infections in non-MPE and MPE groups, respectively. Four (19.0%) and 44 (24.3%) patients required additional IPC-related reviews in non-MPE and MPE groups, respectively (p = 0.6), and these occurred within 250 days post IPC insertion. Conclusions: Although IPCs decrease initial length of hospital stay compared to talc pleurodesis via chest drain, IPCs are associated with significant hospital-visit burden, in addition to planned visits and regular home IPC drainages. IPC-using services need to be prepared for this additional work to run an IPC service effectively.

scholarly journals Long-term outcomes of psychological interventions on children and young people’s mental health: A systematic review and meta-analysis

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0236525
Author(s):  
Stephen Pilling ◽  
Peter Fonagy ◽  
Elizabeth Allison ◽  
Phoebe Barnett ◽  
Chloe Campbell ◽  
...  
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Publication Bias ◽  
Meta Analysis ◽  
Psychosocial Interventions ◽  
Long Term Outcomes ◽  
Self Harm ◽  
The Impact

Background Over 600 RCTs have demonstrated the effectiveness of psychosocial interventions for children and young people’s mental health, but little is known about the long-term outcomes. This systematic review sought to establish whether the effects of selective and indicated interventions were sustained at 12 months. Method We conducted a systematic review and meta-analysis focusing on studies reporting medium term outcomes (12 months after end of intervention). Findings We identified 138 trials with 12-month follow-up data, yielding 165 comparisons, 99 of which also reported outcomes at end of intervention, yielding 117 comparisons. We found evidence of effect relative to control at end of intervention (K = 115, g = 0.39; 95% CI: 0.30–0.47 I2 = 84.19%, N = 13,982) which was maintained at 12 months (K = 165, g = 0.31, CI: 0.25–0.37, I2 = 77.35%, N = 25,652) across a range of diagnostic groups. We explored the impact of potential moderators on outcome, including modality, format and intensity of intervention, selective or indicated intervention, site of delivery, professional/para-professional and fidelity of delivery. We assessed both risk of study bias and publication bias. Conclusions Psychosocial interventions provided in a range of settings by professionals and paraprofessionals can deliver lasting benefits. High levels of heterogeneity, moderate to high risk of bias for most studies and evidence of publication bias require caution in interpreting the results. Lack of studies in diagnostic groups such as ADHD and self-harm limit the conclusions that can be drawn. Programmes that increase such interventions’ availability are justified by the benefits to children and young people and the decreased likelihood of disorder in adulthood.

scholarly journals Long-Term Outcomes of Lymph Node Transfer in Secondary Lymphedema and Its Correlation with Flap Characteristics

Cancers ◽  
2021 ◽  
Vol 13 (24) ◽  
pp. 6198
Author(s):  
Dimitrios Dionyssiou ◽  
Alexandros Sarafis ◽  
Antonios Tsimponis ◽  
Asterios Kalaitzoglou ◽  
Georgios Arsos ◽  
...  
Keyword(s):  
Lymph Node ◽  
Major Complication ◽  
Vascular Pedicle ◽  
Long Term Outcomes ◽  
Secondary Lymphedema ◽  
Lymph Node Transfer ◽  
The Impact ◽  
Vascularized Lymph Node Transfer

Background: This retrospective study aimed to assess the impact of certain flap characteristics on long-term outcomes following microsurgical treatment in Breast Cancer-Related Lymphedema (BCRL) patients. Methods: Sixty-four out of 65 BCRL patients, guided by the “Selected Lymph Node” (“SeLyN”) technique, underwent Vascularized Lymph Node Transfer (VLNT) between 2012 and 2018. According to their surface size, flaps were divided into small (<25 cm2, n = 32) and large (>25 cm2, n = 32). Twelve large and six small flaps were combined with free abdominally based breast reconstruction procedures. Lymphedema stage, flap size, vascular pedicle and number of lymph nodes (LNs) were analyzed in correlation with long-term Volume Differential Reduction (VDR). Results: At 36-month follow-up, no major complication was recorded in 64 cases; one flap failure was excluded from the study. Mean flap size was 27.4 cm2, mean LNs/flap 3.3 and mean VDR 55.7%. Small and large flaps had 2.8 vs. 3.8 LNs/flap (p = 0.001), resulting in 49.6% vs. 61.8% VDR (p = 0.032), respectively. Lymphedema stage and vascular pedicle (SIEA or SCIA/SCIP) had no significant impact on VDR. Conclusion: In our series, larger flaps included a higher number of functional LNs, directly associated with better outcomes as quantified by improved VDR.

Three year follow-up study of families referred to a family intervention team – what are the outcomes that make a difference?

2014 ◽  
Vol 13 (2) ◽  
pp. 93-102
Author(s):  
Leah Salter ◽  
Jessica Williams
Keyword(s):  
Early Intervention ◽  
Family Intervention ◽  
Small Sample ◽  
Small Scale ◽  
Long Term Outcomes ◽  
Content Type ◽  
Intervention Team ◽  
The Impact

Purpose – The purpose of this paper is to examine the long-term outcomes for 15 young people on a range of indicators including school success, involvement with other agencies and the perceived effectiveness by the family. Design/methodology/approach – Semi-structured telephone interviews were used to gather a range of both quantitative and qualitative data. Interviews were with a parent of the referred child (n=15). Findings – In all, 87 per cent of care-givers interviewed rated the service they had received as helpful 85 per cent reported these changes to be maintained at the three year follow-up. Rate of school exclusion was only 7 per cent and 0 per cent of families went on to have involvement with statutory social services or the youth justice system. Research limitations/implications – This is a small-scale study offering a small sample (n=15) of families previously referred to this Family Intervention Team, at a three-year post-intervention period. More routine longitudinal information needs to be gathered for a more robust indication on long-term outcomes. Practical implications – The impact this study will have on the team involved will be in its recommendations for further long-term outcome studies; but also in feeding back to the service the significant key messages from those interviewed. Social implications – Contributing to a wider understanding of the long-term benefits of early intervention. Originality/value – This paper offers some new though small statistical data in the growing pool of statistics that are indicating positive outcomes for early intervention and family intervention projects.

scholarly journals The impact of subclinical hypothyroidism on long-term outcomes in older patients undergoing percutaneous coronary intervention

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yong-Sheng Liu ◽  
Mei Wei ◽  
Le Wang ◽  
Gang Liu ◽  
Guo-Ping Ma ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Subclinical Hypothyroidism ◽  
Older Patients ◽  
Coronary Intervention ◽  
Long Term Outcomes ◽  
Percutaneous Coronary ◽  
Significant Difference ◽  
The Impact

Abstract Background Subclinical hypothyroidism (SCH) is reportedly associated with an increased risk of adverse events in patients undergoing percutaneous coronary intervention (PCI). The prognostic significance of SCH in the elderly was poorly defined. The purpose of this study was to evaluate the association between SCH and long-term outcomes in older patients undergoing PCI. Methods Three thousand one hundred sixty-eight patients aged 65 years or older who underwent PCI from January 2012 to October 2014 were included. Patients were divided into SCH group (n = 320) and euthyroidism (ET) group (n = 2848) based on thyroid function test. Cox proportional hazard regression analyses were used to estimate the relative risks (RRs) of all-cause death and cardiac death for patients with SCH during a 4-year follow-up period. Results There were 227 deaths during the follow-up period including 124 deaths caused by cardiac events. There was no significant difference in mortality rate between the SCH group and the ET group (p > 0.05). After adjustment for covariates, compared with patients with ET, the RRs of death from all-cause and cardiac in patients with SCH were 1.261 (95%CI: 0.802–1.982, p = 0.315) and 1.231 (95%CI: 0.650–2.334, p = 0.524), respectively. When SCH was stratified by age, gender, and degree of thyroid-stimulating hormone elevation, no significant associations were also found in any stratum. Conclusion Our investigation revealed that SCH was negatively associated with the outcome of PCI in older patients.

scholarly journals Patients with rheumatoid arthritis have impaired long-term outcomes after myocardial infarction: a nationwide case-control registry study

Rheumatology ◽  
2021 ◽  
Author(s):  
Antti Palomäki ◽  
Anne M Kerola ◽  
Markus Malmberg ◽  
Päivi Rautava ◽  
Ville Kytö
Keyword(s):  
Myocardial Infarction ◽  
Real Life ◽  
Stroke Rate ◽  
Long Term Outcomes ◽  
Antirheumatic Drugs ◽  
Serological Status ◽  
The Impact ◽  
Long Term Mortality

Abstract Objective To investigate the long-term outcomes of patients with RA after myocardial infarction (MI). Methods All-comer, real-life MI patients with RA (n = 1614, mean age 74 years) were retrospectively compared with propensity score (1:5) matched MI patients without RA (n = 8070) in a multicentre, nationwide, cohort register study in Finland. The impact of RA duration and the usage of corticosteroids and antirheumatic drugs on RA patients’ outcomes were also studied. The median follow-up was 7.3 years. Results RA was associated with an increased 14-year mortality risk after MI compared with patients without RA [80.4% vs 72.3%; hazard ratio (HR) 1.25; CI: 1.16, 1.35; P &lt;0.0001]. Patients with RA were at higher risk of new MI (HR 1.22; CI: 1.09, 1.36; P =0.0001) and revascularization (HR 1.28; CI: 1.10, 1.49; P =0.002) after discharge from index MI. Cumulative stroke rate after MI did not differ between RA and non-RA patients (P =0.322). RA duration and corticosteroid usage before MI, but not use of methotrexate or biologic antirheumatic drugs, were independently associated with higher mortality (P &lt;0.001) and new MI (P =0.009). A higher dosage of corticosteroids prior to MI was independently associated with higher long-term mortality (P =0.002) and methotrexate usage with lower stroke rate (P =0.034). Serological status of RA was not associated with outcomes. Conclusion RA is independently associated with poorer prognosis after MI. RA duration and corticosteroid usage and dosage were independent predictors of mortality after MI in RA. Special attention is needed for improvement of outcomes after MI in this vulnerable population.

scholarly journals Long Term Outcomes of Blended CBT Compared to Face-to-Face CBT and Treatment as Usual for Adolescents with Depressive Disorders: Analyses at 12 Months Post-Treatment

2021 ◽  
Vol 10 (10) ◽  
pp. 373
Author(s):  
Sanne P. A. Rasing ◽  
Yvonne A. J. Stikkelbroek ◽  
Wouter den den Hollander ◽  
Ana Okorn ◽  
Denise H. M. Bodden
Keyword(s):  
Internalizing Symptoms ◽  
Depressive Disorders ◽  
Post Treatment ◽  
Long Term Outcomes ◽  
Treatment As Usual ◽  
Face To Face ◽  
Treatment Conditions ◽  
Blended Treatment

Depression is a major problem in youth mental health and identified as the leading cause of disability worldwide. There is ample research on the acute effects of treatment, with estimated small-to-moderate effect sizes. However, there is a lack of research on long-term outcomes. A total of 129 adolescents with clinical depression (82.2% female), aged 13–22 (M = 16.60, SD = 2.03), received blended CBT, face-to-face CBT or treatment as usual. Data were collected at 12 months after the intervention and compared between treatment conditions. Clinical diagnosis, depressive symptoms, suicide risk, internalizing symptoms and externalizing symptoms decreased significantly over time, from baseline to the 12-month follow-up, and also from post-treatment to the 12-month follow-up in all three conditions. Changes were not significantly different between conditions. At the long-term, improvements following the treatment continued. Due to the large amount of missing data and use of history control condition, our findings need to be interpreted with caution. However, we consider these findings as a clinical imperative. More evidence might contribute to convincing adolescents to start with therapy, knowing it has lasting effects. Further, especially for adolescents for whom it is not possible to receive face-to-face treatment, blended treatment might be a valuable alternative. Our findings might contribute to the implementation of blended CBT.

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