Custody of the Myelodysplastic Child: Implications for Selection for Early Treatment

PEDIATRICS ◽  
1974 ◽  
Vol 53 (2) ◽  
pp. 253-256
Author(s):  
Patricia W. Hayden ◽  
David B. Shurtleff ◽  
Arline B. Broy
Keyword(s):  
University Hospital ◽  
Contributory Factor ◽  
Foster Home ◽  
Term Care ◽  
Long Term Follow Up ◽  
Selection For ◽  
Foster Home Care ◽  
Highly Correlated ◽  
High Level

Of 173 patients with myelodysplasia followed in the Birth Defects Center at University Hospital between 1968 and 1972, 30 (17%) have been placed outside their natural families for temporary or long-term care. Only one has been adopted and five have been institutionalized; the remainder have been in foster home care. High level paralysis, mental retardation, and lower socioeconomic status correlate positively with placement. In this series, gender was not a contributory factor. An initial "hopeless" prognosis and/or selection for "no treatment" were decisions often made prior to referral to this center but were highly correlated to placement. Considering the multiple medical, emotional, and economic problems facing these families, relinquishment of custody should be anticipated in a significant percentage of cases. To date, placement outside the natural family has been viewed primarily as abandonment or as an emergency solution to a crisis. Long-term follow-up study of this group of children may indicate that transfer of custody can be a positive therapeutic alternative for the child and his family.

scholarly journals Home or foster home care versus institutional long-term care for functionally dependent older people

2017 ◽  
Author(s):  
Camilla Young ◽  
Amanda M Hall ◽  
Daniela C Gonçalves-Bradley ◽  
Terry J Quinn ◽  
Lotty Hooft ◽  
...  
Keyword(s):  
Home Care ◽  
Older People ◽  
Long Term Care ◽  
Foster Home ◽  
Term Care ◽  
Foster Home Care

scholarly journals Long-Term Follow-Up After Maxillary Sinus Balloon Sinuplasty and ESS

2021 ◽  
pp. 014556132098603
Author(s):  
Anni Koskinen ◽  
Marie Lundberg ◽  
Markus Lilja ◽  
Jyri Myller ◽  
Matti Penttilä ◽  
...  
Keyword(s):  
Maxillary Sinus ◽  
Revision Surgery ◽  
University Hospital ◽  
Sinus Surgery ◽  
Control Group ◽  
University Hospitals ◽  
Balloon Sinuplasty ◽  
Long Term Follow Up

Objectives: The aim of this controlled follow-up study was to compare the need for revision surgery, long-term efficacy, and satisfaction in chronic rhinosinusitis patients who had undergone maxillary sinus operation with either balloon sinuplasty or traditional endoscopic sinus surgery (ESS) technique. Methods: Thirty-nine ESS patients and 36 balloon patients of our previously described cohort, who had been primarily operated in 2008 to 2010, were contacted by phone. Symptoms, satisfaction, and need for revision surgery were asked. In addition, we collected data of patients who had undergone primary maxillary sinus balloon sinuplasty in the Helsinki University Hospital during the years 2005 to 2019. As a control group, we collected data of patients who had undergone primary maxillary sinus ESS at 3 Finnish University Hospitals, and 1 Central Hospital in years 2005, 2008, and 2011. Results: Altogether, 77 balloon patients and 82 ESS patients were included. The mean follow-up time was 5.3 years in balloon group and 9.8 years in ESS group. Revision surgery was performed on 17 balloon patients and 6 ESS patients. In the survival analysis, the balloon sinuplasty associated significantly with a higher risk of revision surgery compared to ESS. According to the phone interviews, 82% of ESS patients and 75% of balloon patients were very satisfied with the primary operation. Conclusion: Although the patient groups expressed equal satisfaction and change in symptoms after the operations, the need for revision surgery was higher after balloon sinuplasty than after ESS. This should be emphasized when counselling patients regarding surgical options.

Utilisation of dental services in a university hospital palliative and long-term care unit in Geneva

Gerodontology ◽  
2008 ◽  
Vol 25 (2) ◽  
pp. 107-112 ◽  
Author(s):  
Martin Schimmel ◽  
Patricia Schoeni ◽  
Gilbert B. Zulian ◽  
Frauke Müller
Keyword(s):  
Long Term Care ◽  
University Hospital ◽  
Dental Services ◽  
Term Care

Plasma von Willebrand factor, thrombosis, and the endothelium: The first 30 years

2006 ◽  
Vol 95 (01) ◽  
pp. 49-55 ◽  
Author(s):  
Andrew Blann
Keyword(s):  
Arterial Disease ◽  
Endothelial Damage ◽  
Contributory Factor ◽  
Long Term Follow Up ◽  
Von Willebrand ◽  
Plasma Marker ◽  
Willebrand Factor ◽  
Late Stages

Summary “It is quite useless to argue the questions concerning the development of intimal scleroses if we study and discuss the late stages of the disease alone. If we wish to gain insight into the complex question of arterio-sclerosis we must attempt to follow the lesion from its earliest beginning” (Klotz and Manning, J Path Bact 1911: 16; 211–20).Over thirty years ago Boneu and colleagues publisheda report of raised levels of plasma vonWillebrand factor (vWf) in patients with arteritis, diabetes and sepsis. They concluded that raised levels of this molecule indicate endothelial damage, and may possibly be a contributory factor in thrombosis in arterial disease. The former aspect of this conclusion is now accepted, and numerous studies on the risk factors for atherosclerosis provide mechanisms for this damage. Other studies have demonstrated raised levels in cancer and in connective tissue disease. Numerous long-term follow-up studies have also demonstrated that increased vWf predicts major cardiovascular end points. However, the link between these studies, and the latter aspect of Boneu’s conclusion, that raised vWf contributes to thrombosis is,although attractive, nevertheless unproven. Despite this, vWf remains the most important plasma marker of endothelial damage/dysfunction and as such attracts clinical attention.

scholarly journals Establishing an ad hoc COVID-19 mortality surveillance during the first epidemic wave in Belgium, 1 March to 21 June 2020

2021 ◽  
Vol 26 (48) ◽  
Author(s):  
Françoise Renard ◽  
Aline Scohy ◽  
Johan Van der Heyden ◽  
Ilse Peeters ◽  
Sara Dequeker ◽  
...  
Keyword(s):  
Ad Hoc ◽  
Participation Rate ◽  
Term Care ◽  
Data Flows ◽  
Care Facilities ◽  
Definition Of ◽  
High Level ◽  
Mortality Surveillance ◽  
Related Mortality

Background COVID-19-related mortality in Belgium has drawn attention for two reasons: its high level, and a good completeness in reporting of deaths. An ad hoc surveillance was established to register COVID-19 death numbers in hospitals, long-term care facilities (LTCF) and the community. Belgium adopted broad inclusion criteria for the COVID-19 death notifications, also including possible cases, resulting in a robust correlation between COVID-19 and all-cause mortality. Aim To document and assess the COVID-19 mortality surveillance in Belgium. Methods We described the content and data flows of the registration and we assessed the situation as of 21 June 2020, 103 days after the first death attributable to COVID-19 in Belgium. We calculated the participation rate, the notification delay, the percentage of error detected, and the results of additional investigations. Results The participation rate was 100% for hospitals and 83% for nursing homes. Of all deaths, 85% were recorded within 2 calendar days: 11% within the same day, 41% after 1 day and 33% after 2 days, with a quicker notification in hospitals than in LTCF. Corrections of detected errors reduced the death toll by 5%. Conclusion Belgium implemented a rather complete surveillance of COVID-19 mortality, on account of a rapid investment of the hospitals and LTCF. LTCF could build on past experience of previous surveys and surveillance activities. The adoption of an extended definition of ‘COVID-19-related deaths’ in a context of limited testing capacity has provided timely information about the severity of the epidemic.

scholarly journals Development and Evaluation of Clinical Practice Guideline for Delirium in Long-Term Care

2020 ◽  
Vol 17 (21) ◽  
pp. 8255
Author(s):  
Eunhye Jeong ◽  
Jinkyung Park ◽  
Sung Ok Chang
Keyword(s):  
Clinical Practice ◽  
Development Process ◽  
Healthcare Professionals ◽  
Long Term Care ◽  
Structured Interviews ◽  
Term Care ◽  
Barriers To Implementation ◽  
Selection For ◽  
Search Quality

Delirium is highly prevalent and leads to several bad outcomes for older long-term care (LTC) residents. For a more successful translation of delirium knowledge, Clinical Practice Guidelines (CPGs) tailored to LTC should be developed and applied based on the understanding of the barriers to implementation. This study was conducted to develop a CPG for delirium in LTC and to determine the barriers perceived by healthcare professionals related to the implementation of the CPG. We followed a structured, evidence- and theory-based procedure during the development process. After a systematic search, quality appraisal, and selection for eligible up-to-date CPGs for delirium, the recommendations applicable to the LTC were drafted, evaluated, and confirmed by an external group of experts. To evaluate the barriers to guideline uptake from the users’ perspectives, semi-structured interviews were conducted which resulted in four major themes: (1) a lack of resources, (2) a tendency to follow mindlines rather than guidelines, (3) passive attitudes, and (4) misunderstanding delirium care in LTC. To minimize adverse prognoses through prompt delirium care, the implementation of a CPG with an approach that comprehensively considers various barriers at the system, practice, healthcare professional, and patients/family levels is necessary.

Oxford University Hospital Long Term Follow Up Data of Vaginal Vault Brachytherapy Following a Serious Radiation Incident

Brachytherapy ◽  
2019 ◽  
Vol 18 (3) ◽  
pp. S90
Author(s):  
Loryn Caulfield ◽  
Mary Costelloe ◽  
Sally Trent ◽  
Amanda Horne ◽  
Amanda Horne
Keyword(s):  
University Hospital ◽  
Vaginal Vault ◽  
Oxford University ◽  
Radiation Incident ◽  
Long Term Follow Up

scholarly journals RARE-36. BORTEZOMIB WOKE UP A PATIENT WITH ANTI-NMDA RECEPTOR ENCEPHALITIS REFRACTORY TO STANDARD THERAPY AND LONG TERM FOLLOW-UP

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi229-vi229
Author(s):  
Kong Xiao-Tang ◽  
Leonid Groysman ◽  
Cyrus Dastur ◽  
Beverly Fu ◽  
Daniela Bota
Keyword(s):  
Nmda Receptor ◽  
Standard Therapy ◽  
Autoimmune Encephalitis ◽  
Ivig Therapy ◽  
Term Care ◽  
Good Communication ◽  
Nmda Receptor Encephalitis ◽  
Long Term Follow Up ◽  
One Year

Abstract OBJECTIVE To report a case with refractory NMDA encephalitis in comatose for 18 months, who was treated successfully with bortezomib. BACKGROUND Anti-NMDA encephalitis is a rare autoimmune encephalitis. Standard therapy include corticosteroid, IVIG or plasma exchange, cyclophosphamide, rituximab, and tumor removal. Refractory cases are very severe and often stay in ICU on ventilation for several months to years. Bortezomib for the treatment of refractory anti-NMDA receptor encephalitis was reported. We have applied the treatment to our refractory case and successfully woke up the patient. And we have followed up the patient for 3 years. METHODS Case report. RESULTS A 40 yo male was diagnosed as anti-NMDA encephalitis. Standard therapy was applied. After stabilization, the patient was eventually discharged to ICU at a long term care subacute hospital. The patient was brought back for more Rituxan or steroid or IVIG therapy. The condition had not improved at all. Eighteen months in comatose, the patient had worsening NMDA titer in CSF to 1:640. Decision was made to start bortezumib as reported with modification: 1.3 mg/m2 bortezomib were administered on days 1, 8, 11 and 14 and allowed two weeks off therapy. After first cycle, the patent started to talk first word “hurt.” After 6 cycles, the patient sat up and started riding bicycles for physical therapy. The NMDA titer in CSF was reduced to 1:40 at the end of 6 cycles. One year later, the patent stood up and ambulated with a walker. One and half year later, the patient walks without assistance and his speech and cognition have significantly improved with good communication with family members and staff. CONCLUSIONS Proteasome inhibitor bortezomib might be considered to be the third line therapy as early as possible if the first line and second line are ineffective to treat anti-NMDA receptor encephalitis.

scholarly journals Long-Term Management of Patients with Celiac Disease: Current Practices of Gastroenterologists in Canada

2010 ◽  
Vol 24 (8) ◽  
pp. 499-509 ◽  
Author(s):  
Jocelyn Anne Silvester ◽  
Mohsin Rashid
Keyword(s):  
Celiac Disease ◽  
Practice Guideline ◽  
Long Term Care ◽  
Intestinal Biopsy ◽  
Term Care ◽  
Follow Up Care ◽  
Long Term Follow Up ◽  
Current Practices

BACKGROUND: Long-term follow-up of patients with celiac disease is important for monitoring their clinical status, dietary compliance and complications.AIM: To examine the current practices of Canadian gastroenterologists providing long-term care to patients with celiac disease.METHODS: All gastroenterologists in Canada (n=585) were surveyed regarding their practice demographics, familiarity with celiac disease practice guidelines, and follow-up clinical examination and investigations.RESULTS: Of the 585 surveys mailed to gastroenterologists, 567 were expected to be returned. A total of 242 completed surveys (43%) were received. Of these, 237 (184 adult, 51 pediatric and two mixed) had an active practice that included patients with celiac disease. Long-term follow-up care was provided routinely by 76% of respondents. Follow-up consisted of annual clinic visits (67%), dietary review (77%), reinforcement of the need for adherence to a gluten-free diet (90%) and recommending membership in an advocacy group (65%). Physical examination was performed by 78%; most ordered laboratory tests including serology (65%).Adult gastroenterologists performed routine follow-up intestinal biopsy more often than their pediatric counterparts (46% versus 10%), but performed serology less frequently (48% versus 86%). Pediatric patients were more likely to be followed by a multidisciplinary team. All pediatric gastroenterologists were familiar with at least one celiac disease practice guideline, whereas 15% of adult gastroenterologists were not familiar with any practice guideline. The majority of gastroenterologists who did not routinely provide follow-up expected care to be provided by the patient’s primary physician (86%).CONCLUSIONS: Most gastroenterologists in Canada who responded to the survey provided long-term follow-up care to patients with celiac disease. The diverse practices reported underscore the need to develop consensus-based guidelines for long-term care of these patients.

Clinical Relevance of Neovascularisation on Duplex Ultrasound in the Long-Term Follow-up after Varicose Vein Operation

1999 ◽  
Vol 14 (3) ◽  
pp. 118-122 ◽  
Author(s):  
M. G. De Maeseneer ◽  
I. F. Tielliu ◽  
P. E. Van Schil ◽  
S. G. De Hert ◽  
E. J. Eyskens
Keyword(s):  
Varicose Vein ◽  
Clinical Relevance ◽  
Varicose Veins ◽  
University Hospital ◽  
Duplex Scanning ◽  
Recurrent Varicose Veins ◽  
Varicose Vein Operation ◽  
Long Term Follow Up

Objective: To evaluate the clinical relevance of neovascularisation at the saphenous ligation site. Design: Long-term follow-up after previous varicose vein surgery in a single patient group. Setting: Vascular clinic of a university hospital. Patients: Eighty-two patients (106 limbs) with a mean follow-up period of 56 months after correct saphenous ligation were submitted to duplex scanning. Intervention: Clinical assessment and colour duplex scanning of all the operated limbs. Reintervention in 15 limbs with perioperative evaluation of recurrent veins. Main outcome measures: Limbs with and without recurrent varicose veins were classified according to the degree of neovascularisation: grade 0 = no new communicating veins, grade 1 = tiny new vein with diameter <4 mm, grade 2 = new communicating vein with diameter >4 mm and pathological reflux. On reintervention the presence of neovascular veins at the site of the previous ligation was checked. Results: In 68 limbs without recurrent varicose veins, grade 0 was observed in 50 limbs (74%), grade 1 in 12 limbs (18%) and grade 2 in six limbs (9%). In 38 limbs with recurrent varicose veins, grade 0 was diagnosed in eight limbs (21%), grade 1 in four limbs (11%) and grade 2 in 26 limbs (68%). In 15 limbs with recurrent varicose veins and grade 2 neovascularisation, reintervention confirmed the duplex findings. Conclusions: The presence of grade 2 neovascularisation was associated with the recurrence of varicose veins, suggesting a causal relationship.

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