Physician Survey Regarding Patient Nonattendance at Follow-up Appointments at a University-Affiliated Medical Dermatology Clinic

2012 ◽  
Vol 16 (2) ◽  
pp. 92-96
Author(s):  
Eiman Nasseri ◽  
Janie Bertrand ◽  
Danielle Brassard ◽  
Geneviève Fortier-Riberdy ◽  
Isabelle Marcil
Keyword(s):  
Medical Association ◽  
High Morbidity ◽  
Beliefs And Practices ◽  
Centre Hospitalier ◽  
National Medical ◽  
Dermatology Clinic ◽  
Medical Associations ◽  
Structured Approach ◽  
Case Basis

Background: Patient nonattendance is a frequent occurrence in dermatology clinics, and our responsibility regarding the follow-up of these patients remains nebulous. Objective: This study sought to evaluate the beliefs and practices of physicians at a university-affiliated medical dermatology clinic regarding patient nonattendance at follow-up appointments and to provide an algorithm to deal appropriately with absentee patients based on various Canadian medical association guidelines. Methods: A questionnaire was distributed to the 17 dermatologists practicing at the Centre Hospitalier de l'Université de Montréal medical dermatology clinic. We contacted provincial and national medical associations regarding directives for patient follow-up. Results: There is a lack of consensus among dermatologists at the Centre Hospitalier de l'Université de Montréal regarding responsibility toward patients who miss their follow-up appointments. However, the majority of survey respondents consider that patient follow-up must be adjusted on a case-by-case basis and that diagnoses at risk for high morbidity and mortality require particular attention, which is in line with various Canadian medical association guidelines. Conclusion: Dermatologists should have a structured approach to dealing with patients who miss their follow-up appointments to ensure the appropriate care of all patients.

Perspective From the National Medical Association

PEDIATRICS ◽  
1989 ◽  
Vol 83 (5) ◽  
pp. 911-911
Author(s):  
Roselyn Payne Epps
Keyword(s):  
Sickle Cell Disease ◽  
Medical Association ◽  
Sickle Cell ◽  
Education Program ◽  
Well Being ◽  
The United States ◽  
Professional Organization ◽  
Cell Disease ◽  
National Medical

I am pleased to comment as a member of the National Medical Association, the professional organization founded in 1895, which currently represents the 14,000 black physicians practicing in the United States. Members of the National Medical Association (many of whom have been inspired by the leadership of Dr Roland B. Scott) have been and continue to be in the forefront of sickle cell disease research. Their sustained interest and that of many other colleagues has contributed to the research accomplishments we observe today. On the other hand, some physicians have been reluctant to assume a prominent role in sickle cell screening, counseling, and follow-up because of their own uncertainties and legitimate differences of opinion. During this conference, experienced and knowledgeable speakers have eloquently presented varying and sometimes divergent points of view, reflecting existing practices and highlighting the need for consensus development. As the consensus panel approaches its deliberations, I would like to emphasize that the health of the child and family must be paramount. I define health in its broad sense as the physical, mental, and social well-being of children and families. Results of the collaborative oral penicillin study, presented by Dr Gaston, leave no doubt that identification of sickle cell disease during infancy and prevention of its complications are imperative. Also, many speakers from successful programs spoke of the extensive time, effort, and resources required to screen, follow up, counsel, and treat patients and to coordinate services. I request that the panel carefully consider the advisability and feasibility of a public health education program, patterned after the highly successful high blood pressure education program launched by the National Heart, Lung, and Blood Institute, which included every resource of the country.

scholarly journals When less is more: a daring conservative approach to postpneumonectomy oesophago-pleural fistula

2019 ◽  
Vol 30 (1) ◽  
pp. 146-148
Author(s):  
Lara Girelli ◽  
Elena Prisciandaro ◽  
Niccolò Filippi ◽  
Lorenzo Spaggiari
Keyword(s):  
Clinical Presentation ◽  
Clinical Status ◽  
High Morbidity ◽  
Conservative Approach ◽  
Chronic Fistula ◽  
Less Is More ◽  
Primary Surgery ◽  
History Of ◽  
Uncommon Complication

Abstract Oesophago-pleural fistula is an uncommon complication after pneumonectomy, usually related to high morbidity and mortality. Due to its rarity and heterogeneous clinical presentation, its diagnosis and management are challenging issues. Here, we report the case of a patient with a history of pneumonectomy for a tracheal tumour, who developed an asymptomatic oesophago-pleural fistula 7 years after primary surgery. In consideration of the patient’s good clinical status and after verifying the preservation of respiratory and digestive functions, a bold conservative approach was adopted. Five-year follow-up computed tomography did not disclose any sign of recurrence of disease and showed a stable, chronic fistula.

scholarly journals Brain Abscess Caused by Nocardia: Case Report and Literature Review

2020 ◽  
Author(s):  
Guilherme Finger ◽  
Maria Eduarda Conte Gripa ◽  
Tiago Paczko Bozko Cecchini ◽  
Tobias Ludwig do Nascimento
Keyword(s):  
Case Report ◽  
Antibiotic Therapy ◽  
Brain Abscess ◽  
Clinical Signs ◽  
Occipital Lobe ◽  
High Morbidity ◽  
Rare Clinical Entity ◽  
Brain Abscesses

AbstractNocardia brain abscess is a rare clinical entity, accounting for 2% of all brain abscesses, associated with high morbidity and a mortality rate 3 times higher than brain abscesses caused by other bacteria. Proper investigation and treatment, characterized by a long-term antibiotic therapy, play an important role on the outcome of the patient. The authors describe a case of a patient without neurological comorbidities who developed clinical signs of right occipital lobe impairment and seizures, whose investigation demonstrated brain abscess caused by Nocardia spp. The patient was treated surgically followed by antibiotic therapy with a great outcome after 1 year of follow-up.

scholarly journals 346. Eastern Equine Encephalitis and Use of Intravenous Immunoglobulin Therapy and High-Dose Steroids

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S242-S243
Author(s):  
Sarah I Collens ◽  
Douglas R Wilcox ◽  
Shibani Mukerji ◽  
Farrah J Mateen ◽  
Isaac H Solomon
Keyword(s):  
Cerebrospinal Fluid ◽  
Temporal Lobe ◽  
Standard Of Care ◽  
High Dose ◽  
High Morbidity ◽  
Intravenous Immunoglobulin Therapy ◽  
Eastern Equine Encephalitis ◽  
Neuroanatomical Region ◽  
Ivig Administration

Abstract Background Eastern equine encephalitis (EEE) is a mosquito-borne viral infection with significant neurological morbidity and mortality. The clinical presentation and patient outcomes after treatment with IVIG, high-dose steroids, or standard of care alone in EEE remains unclear. Methods A retrospective observational study of patients admitted to two tertiary academic medical centers in Boston, Massachusetts with EEE from 2005 to 2019. Results Of 17 patients (mean [SD] age, 50 [26] years; 10 (59%) male, and 16 (94%) White race), 17 patients had fever (100%), 15 had encephalopathy (88%), and 12 had headache (71%). Eleven of 14 patients with cerebrospinal fluid (CSF) cell count differential had a neutrophil predominance (mean [SD], 60.6% of white blood cells [22.8]) with an elevated protein level (mean [SD], 112 mg/dL [48.8]). Affected neuroanatomical regions included the basal ganglia (n=9/17), thalamus (n=7/17), and mesial temporal lobe (n=7/17). A total of 11 patients (65%) received IVIG; 8 (47%) received steroids. Of the patients who received IVIG, increased time from hospital admission to IVIG administration correlated with worse long-term disability as assessed by modified Rankin Score (mRS) (r=0.72, p=0.02); steroid use was not associated with mRS score. The mortality was 12%. Figure 1. Imaging Characteristics: Typical Pattern of MRI Involvement and Affected Neuroanatomical Regions in Patients with Eastern Equine Encephalitis. All images displayed are the T2-FLAIR sequence. (A) Representative images of pattern of typical neuroanatomical region involved in one patient with demonstrated involvement of the temporal lobe and pons, temporal lobe and midbrain, and basal gangial by T2-FLAIR hyperintensity (panels left to right). (B) Representative images of patients with mild (mRS 0–2), moderate (mRS 3–4), and severe (mRS 5–6) disability score at discharge. (C) Representative images of one patient over course of hospitalization at days 1, 4, and 10 after admission. (D) Quantification of neuroanatomical region involvement in initial MRI of patients with EEE as determined by T2-FLAIR hyperintensity. An area was scored as abnormal only once per patient. Figure 2. Outcomes in Patients with Eastern Equine Encephalitis. Patient disability by modified Rankin Score (mRS) of EEE patients at admission to the hospital, discharge from the hospital, and last recorded follow-up (A). Time to IVIG administration compared to mRS at discharge (B), and most recent clinical follow-up (C). Table 1. Demographics, Clinical Characteristics, and Laboratory Data in Patients with Eastern Equine Encephalitis. Abbreviations: CSF = cerebrospinal fluid, WBC = white clood count, EEG = electroencephalogram, ALT = alanine aminotransferase, AST = aspartate transaminase. Demographic data was collected for all patients with confirmed EEE. Altered mental status included any description of encephalopathy, confusion, or difficulty with attention. Seizures were defined as clinical events with a high-degree of suspicion to be true seizures, and were entirely comprised of generalized tonic-clonic seizures. Conclusion Clinicians should suspect EEE in immunocompetent patients with early subcortical neuroimaging abnormalities and CSF neutrophilic predominance. This study suggests a lower mortality than previously reported, but a high morbidity rate in EEE. IVIG as an adjunctive to standard of care may be considered early during hospitalization. Disclosures All Authors: No reported disclosures

scholarly journals Protein Intake and Physical Activity in Newly Diagnosed Patients with Acute Coronary Syndrome: A 5-Year Longitudinal Study

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 634 ◽  
Author(s):  
Andrea Greco ◽  
Agostino Brugnera ◽  
Roberta Adorni ◽  
Marco D’Addario ◽  
Francesco Fattirolli ◽  
...  
Keyword(s):  
Physical Activity ◽  
Acute Coronary Syndrome ◽  
Protein Intake ◽  
Processed Meat ◽  
High Morbidity ◽  
Newly Diagnosed ◽  
Healthy Behaviors ◽  
Coronary Syndrome ◽  
Over Time

Cardiovascular disease is one of the most common causes of hospitalization and is associated with high morbidity and mortality rates. Among the most important modifiable and well-known risk factors are an unhealthy diet and sedentary lifestyle. Nevertheless, adherence to healthy lifestyle regimes is poor. The present study examined longitudinal trajectories (pre-event, 6-, 12-, 24-, 36-, and 60-month follow-ups) of protein intake (fish, legumes, red/processed meat) and physical activity in 275 newly-diagnosed patients with acute coronary syndrome. Hierarchical Generalized Linear Models were performed, controlling for demographic and clinical variables, the season in which each assessment was made, and the presence of anxiety and depressive symptoms. Significant changes in protein intake and physical activity were found from pre-event to the six-month follow-up, suggesting the adoption of healthier behaviors. However, soon after the six-month follow-up, patients experienced significant declines in their healthy behaviors. Both physical activity and red/processed meat intake were modulated by the season in which the assessments took place and by anxiety symptoms over time. The negative long-term trajectory of healthy behaviors suggests that tailored interventions are needed that sustain patients’ capabilities to self-regulate their behaviors over time and consider patient preference in function of season.

scholarly journals THU0502 EFFICACY AND SAFETY OF SECUKINUMAB TREATMENT IN JUVENILE IDIOPATHIC ARTHRITIS PATIENTS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 489.3-489
Author(s):  
I. Kriulin ◽  
E. Alexeeva ◽  
T. Dvoryakovskaya ◽  
K. Isaeva ◽  
A. Chomakhidze ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Psoriatic Arthritis ◽  
Response To Therapy ◽  
Inactive Disease ◽  
Hla B27 ◽  
Serious Adverse Events ◽  
National Medical ◽  
Alternative Drug ◽  
Baseline Information

Background:Anti-IL-17A biologic drug secukinumab (SEC) proved to be effective for treatment of psoriatic arthritis. However data about its efficacy in juvenile idiopathic arthritis (JIA) are restricted to off-label experience.Objectives:To evaluate the effectiveness and safety of SEC in JIA patients in the National Medical Research Center of Children`s health, Moscow, Russia.Methods:25 patients started SEC therapy from 12/2017 to 11/2019 in single-center prospective study. 3 patients withdrew treatment: two patients (8%) due to AE (1 - allergy followed by MAS after first injection and 1 – leukopenia) and one patient (4%) – after 10 months of treatment due to secondary inefficacy. Among others, 14 patients which were successfully treated for 6 months or longer were included into analysis. At the baseline, information was collected on the characteristics of the onset of the disease, previous therapy and its success. Patients were monitored at least 1 time per year. At each visit, clinical and laboratory characteristics of JIA severity were assessed. Response to therapy was assessed using the ACRPedi 30/50/70/90 criteria, the C.Wallace criteria for inactive disease (WID) and clinical remission. AEs were assessed at each visit.Results:Among 14 patients received SEC for at least 6 months, 7 (50%) have enthesitis-related arthritis, one (7.1%) – persistent oligoarthritis, 4 (28.6%) – RF-negative polyarthritis, 2 (14.3%) – psoriatic arthritis. 6 patients (42.9%) were HLA-B27 positive. Median age of JIA onset was 8.8 (IQR 5:11), age at SEC initiation – 14 (9.9:16.1), disease duration before SEC start – 3.3 (2.7:5.8). 7 (50%) were biologics-naïve, 2 (14.3%) were previously treated with anti-TNF drug, 5 (35.7%) have 2 or more different biologics in anamnesis.SEC demonstrated high efficacy after the first injection resulting in JADAS-71 decreasing in all patients by median 4.3 (1.6:7.1) points and 7/7/5/2 patients (50%/50%/35.7%/14.3%) achieved ACR Pedi 30/50/70/90 response.After 6 months of treatment, WID was achieved by 7 (50%) patients, JADAS-71 decreased from baseline level 15.2 (12.7:20.5) to 0.8 (0:4.2) points, and 14/13/11/9 patients (100%/92.9%/78.6%/64.3%) achieved ACR Pedi 30/50/70/90 response. One patients who had active uveitis at SEC initiation remained with subactive uveitis; one patient with uveitis remission had not flare episodes during follow-up period. One patient (7.1%) had successfully treated evaluation of transaminases after 4-th injection.Conclusion:Secukinumab showed high effectiveness and safety in children with JIA and can be further used both as a first-line drug in JIA associated with HLA-B27, and as an alternative drug for the ineffectiveness of the standard treatment regimen with biologics. No serious adverse events were registered during follow-up period.Disclosure of Interests:Ivan Kriulin: None declared, Ekaterina Alexeeva Grant/research support from: Roche, Pfizer, Centocor, Novartis, Speakers bureau: Roche, Novartis, Pfizer., Tatyana Dvoryakovskaya: None declared, Ksenia Isaeva: None declared, Aleksandra Chomakhidze: None declared, Evgeniya Chistyakova: None declared, Olga Lomakina: None declared, Rina Denisova: None declared, Anna Mamutova: None declared, Anna Fetisova: None declared, Marina Gautier: None declared, Dariya Vankova: None declared, Elizaveta Krekhova: None declared, Meyri Shingarova: None declared, Alina Alshevskaya: None declared, Andrey Moskalev: None declared

Outcomes of nonagenarians with acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Echarte Morales ◽  
P.L Cepas Guillen ◽  
G Caldentey ◽  
E Martinez Gomez ◽  
J Borrego-Rodriguez ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
High Risk Population ◽  
High Morbidity ◽  
Baseline Characteristic ◽  
Invasive Approach ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
All Cause Mortality

Abstract Background Myocardial infarction (MI) in nonagenarians is associated with high morbidity and mortality. Nonetheless, this population has typically been underrepresented in cardiovascular clinical trials. Objective The aim of this study was to evaluate outcomes of nonagenarian patients presenting with MI who underwent either conservative or invasive management. Methods We retrospectively included all consecutive patients equal to or older than 90yo admitted with non-ST segment elevation (NSTEMI) or ST segment elevation MI (STEMI) in four tertiary care centers between 2005 and 2018. Patients with type 2 myocardial infarction were excluded. We collected patients' baseline characteristic and procedural data. In-hospital and at 1-year follow-up all-cause mortality and major adverse cardiovascular events were assessed. Results 523 patients (mean age 92.6±2 years; 60% females) were analyzed. Overall, 184 patients (35.2%) underwent percutaneous coronary intervention (PCI), increasing over the years, mostly in STEMI group (from 16% of patients in 2005 to 75% in 2018). PCI was preferred in those subjects with less prevalence of disability for activities of daily living (p<0.01). The use of a radial access (76.6%) and bare metal stents (52.7%) was predominant. No significant differences were found in the incidence of major bleeding events or MI-related mechanical complications between both strategies. During index hospitalization, 99 (18.9%) patients died. Whereas no differences were found in the NSTEMI group (p=0.61), a significant lower in-hospital mortality was observed in STEMI group treated with PCI (p<0.01). At one-year follow up, 203 (38.8%) patients died, most of them due to a cardiovascular cause (60.6%). PCI was related to a lower all-cause mortality in either NSTEMI (p<0.01) or STEMI groups (p<0.01) however, lower cardiovascular mortality was only found in STEMI group (p=0.03). Conclusion An invasive approach was performed in over a third of nonagenarian patients, carrying prognostic implications and with a few numbers of complications. PCI seems to be the preferred strategy for STEMI in this high-risk population in spite of age. Figure 1 Funding Acknowledgement Type of funding source: None

National Medical Association Centennial

JAMA ◽  
1995 ◽  
Vol 274 (12) ◽  
pp. 929 ◽  
Author(s):  
Charles Marwick
Keyword(s):  
Medical Association ◽  
National Medical
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