Influence of Health Care Providers on the Development of Diabetes Complications: Long-term follow-up from the Pittsburgh Epidemiology of Diabetes Complications Study

Background: Nevus lipomatosus superficialis (NLS) is a unique developmental anomaly or nevoid form of lipoma characterized by the ectopic presence of mature adipocytes in reticular dermis. The condition is rare; apart frrom isolated case reports, there are no large case series dealing with the clinicoepidemiologic characteristics and posttreatment long-term follow-up in patients with NLS and little published information on treatment outcome. Objective: To study the clinicoepidemiologic characteristics and long-term posttreatment follow-up in patients with NLS. Methods: This was an 11-year retrospective study analyzing disease characteristics and treatment outcome in eight patients with NLS. Results: There were eight (six males, two females) patients with NLS, of whom three were children. The classic variant of NLS was the predominant presentation. One patient demonstrated a combination of both classic and solitary variants. Most patients, especially those with solitary variants, were commonly misdiagnosed before presenting to us. Four patients, including two with the solitary variant, one each with the classic and the combined type, underwent surgical resection without any recurrence over 8 years of follow-up. Conclusions: The rare nature of the disorder, which is commonly misdiagnosed, and the absence of long-term follow-up data prompted us to share our experience about NLS to increase its awareness among health care providers.

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Programs for adult survivors of childhood cancer.

Journal of Clinical Oncology ◽

10.1200/jco.1998.16.8.2864 ◽

1998 ◽

Vol 16 (8) ◽

pp. 2864-2867 ◽

Cited By ~ 101

Author(s):

K C Oeffinger ◽

D A Eshelman ◽

G E Tomlinson ◽

G R Buchanan

Keyword(s):

Health Care ◽

Childhood Cancer ◽

Health Care Providers ◽

Primary Care Physicians ◽

Adult Survivors ◽

Care Providers ◽

Care Needs ◽

Survivors Of Childhood Cancer

PURPOSE The potential for late effects of treatment necessitates long-term monitoring of adult survivors of childhood cancer. The purpose of this study was to determine how institutions follow up young adult survivors of pediatric malignancy. Specifically, we were interested in the types of health care providers who follow up these patients, how the follow-up is administered, and what barriers to follow-up have been encountered. METHODS A 16-item questionnaire was mailed to the 219 members of the Children's Cancer Group (CCG) and the Pediatric Oncology Group (POG). The survey consisted of four categories of questions that asked for information regarding the existence of a program to follow up young adults, the setting of the program, routine activities of the program, and commonly encountered barriers to care. RESULTS One hundred eighty-two members returned the survey (83% response rate). Fifty-three percent of the respondents have a long-term follow-up clinic at their institution. Whereas 44% have a mechanism for following up adult survivors, only 15% of the programs have established a formal database for adults. Nearly all the programs (93%) use a pediatric oncologist. Although an adult oncologist assists in 13% of the programs, primary care physicians are uncommonly (8%) involved. CONCLUSION Few programs focus on the long-term health care needs of adult survivors of childhood cancer. The majority of existing programs are in pediatric institutions, without significant input from adult-oriented, generalist health care providers.

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Development of Risk-Based Guidelines for Pediatric Cancer Survivors: The Children's Oncology Group Long-Term Follow-Up Guidelines From the Children's Oncology Group Late Effects Committee and Nursing Discipline

Journal of Clinical Oncology ◽

10.1200/jco.2004.11.032 ◽

2004 ◽

Vol 22 (24) ◽

pp. 4979-4990 ◽

Cited By ~ 473

Author(s):

Wendy Landier ◽

Smita Bhatia ◽

Debra A. Eshelman ◽

Katherine J. Forte ◽

Teresa Sweeney ◽

...

Keyword(s):

Health Care Providers ◽

Pediatric Cancer ◽

Late Effects ◽

Adolescent And Young Adult ◽

Care Providers ◽

Oncology Group ◽

Follow Up Care ◽

Long Term Follow Up

The Children’s Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers are risk-based, exposure-related clinical practice guidelines intended to promote earlier detection of and intervention for complications that may potentially arise as a result of treatment for pediatric malignancies. Developed through the collaborative efforts of the Children’s Oncology Group Late Effects Committee, Nursing Discipline, and Patient Advocacy Committee, these guidelines represent a statement of consensus from a multidisciplinary panel of experts in the late effects of pediatric cancer treatment. The guidelines are both evidence-based (utilizing established associations between therapeutic exposures and late effects to identify high-risk categories) and grounded in the collective clinical experience of experts (matching the magnitude of risk with the intensity of screening recommendations). They are intended for use beginning 2 or more years following the completion of cancer therapy; however, they are not intended to provide guidance for follow-up of the survivor’s primary disease. A complementary set of patient education materials (“Health Links”) was developed to enhance follow-up care and broaden the application of the guidelines. The information provided in these guidelines is important for health care providers in the fields of pediatrics, oncology, internal medicine, family practice, and gynecology, as well as subspecialists in many fields. Implementation of these guidelines is intended to increase awareness of potential late effects and to standardize and enhance follow-up care provided to survivors of pediatric cancer throughout the lifespan. The Guidelines, and related Health Links, can be downloaded in their entirety at www.survivorshipguidelines.org .

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Determining transition readiness in Swiss childhood cancer survivors – a feasibility study

BMC Cancer ◽

10.1186/s12885-021-07787-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Maria Otth ◽

Patrick Wechsler ◽

Sibylle Denzler ◽

Henrik Koehler ◽

Katrin Scheinemann

Keyword(s):

Health Care ◽

Cancer Survivors ◽

Childhood Cancer ◽

Childhood Cancer Survivors ◽

Self Management ◽

Transition Readiness ◽

Long Term Follow Up ◽

Time Point

Abstract Background The successful transition of childhood cancer survivors (CCSs) from pediatric to adult long-term follow-up care is a critical phase, and determining the right time point can be challenging. We assessed the feasibility of the use of existing transition readiness tools in the context of the Swiss health care system, assessed partly transition readiness in Swiss CCSs, and compared our findings with Canadian CCSs for which these tools were originally developed. Methods We officially translated the Cancer Worry Scale (CWS) and Self-Management Skill Scale (SMSS) into German and integrated them into this cross-sectional study. We included CCSs attending the long-term follow-up (LTFU) clinic in the Division of Oncology-Hematology, Department of Pediatrics, Kantonsspital Aarau. We used descriptive statistics to describe transition readiness. Results We randomly recruited 50 CCSs aged ≥18 years at participation. The CCSs had a median CWS score of 62 (interquartile range 55–71), indicating a moderate level of cancer-related worry. Despite high self-management skills, some answers showed a dependency of CCSs on their parents. Our experience shows that the CWS and SMSS are easy for Swiss CCSs to use, understand, and complete. The interpretation of the results must take differences in health care systems between countries into account. Conclusions The translated CWS and SMSS are appropriate additional measures to assess transition readiness in CCSs. These scales can be used longitudinally to find the individual time point for transition and the completion by CCSs enables the health care team to individualize the transition process and to support the CCSs according to their individual needs.

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TELE-MONITORING SYSTEM OF RISK IN RESPIRATORY PATIENTS

Biomedical Engineering Applications Basis and Communications ◽

10.4015/s1016237221500411 ◽

2021 ◽

pp. 2150041

Author(s):

Awad Al-Zaben ◽

Lina M.K. Al-Ebbini ◽

Badr Qatashah

Keyword(s):

Health Care ◽

Signal Processing ◽

Health Care Providers ◽

Mobile Phones ◽

Model Parameters ◽

Care Providers ◽

Server Side ◽

Respiration Signal ◽

At Home

In many situations, health care professionals need to evaluate the respiration rate (RR) for home patients. Moreover, when cases are more than health care providers’ capacity, it is important to follow up cases at home. In this paper, we present a complete system that enables healthcare providers to follow up with patients with respiratory-related diseases at home. The aim is to evaluate the use of a mobile phone’s accelerometer to capture respiration waveform from different patients using mobile phones. Whereas measurements are performed by patients themselves from home, and not by professional health care personnel, the signals captured by mobile phones are subjected to many unknowns. Therefore, the validity of the signals has to be evaluated first and before any processing. Proper signal processing algorithms can be used to prepare the captured waveform for RR computations. A validity check is considered at different stages using statistical measures and pathophysiological limitations. In this paper, a mobile application is developed to capture the accelerometer signals and send the data to a server at the health care facility. The server has a database of each patient’s signals considering patient privacy and security of information. All the validations and signal processing are performed on the server side. The patient’s condition can be followed up over a few days and an alarm system may be implemented at the server-side in case of respiration deterioration or when there is a risk of a patient’s need for hospitalization. The risk is determined based on respiration signal features extracted from the received respiration signal including RR, and Autoregressive (AR) moving average (ARMA) model parameters of the signal. Results showed that the presented method can be used at a larger scale enabling health care providers to monitor a large number of patients.

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Using ePROMs for follow-up after palliative radiotherapy: an exploratory study with patients and health care providers.

Patient Education and Counseling ◽

10.1016/j.pec.2021.11.022 ◽

2021 ◽

Author(s):

Eva Oldenburger ◽

Inge Neyens ◽

Annemarie Coolbrandt ◽

Sofie Isebaert ◽

Aline Sevenants ◽

...

Keyword(s):

Health Care ◽

Health Care Providers ◽

Exploratory Study ◽

Palliative Radiotherapy ◽

Care Providers

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Depression: A Long-Term Illness

The British Journal of Psychiatry ◽

10.1192/s0007125000293239 ◽

1994 ◽

Vol 165 (S26) ◽

pp. 9-15 ◽

Cited By ~ 52

Author(s):

Martin B. Keller

Keyword(s):

Health Care ◽

Health Care Providers ◽

Maintenance Treatment ◽

Depressive Disorders ◽

Care Providers ◽

Serious Illness ◽

Antidepressant Treatments ◽

Continued Education ◽

Low Levels

The realisation that major depression is often both chronic and recurrent has slowly begun to change the way that depression is diagnosed and treated. In particular, the need for continuation and maintenance treatment is an issue that now deserves increased attention, especially with the availability of new classes of antidepressant treatments, which have excellent efficacy and more favourable side-effect profiles. Although the serious consequences of depressive disorders clearly indicate the need for effective and prompt intervention on the part of clinicians, the results of several studies indicate that patients with depression consistently receive no or low levels of antidepressant therapy. It is hoped that, through continued education of health care providers and patients about the consequences of depression, the issue of undertreatment of this serious illness will be resolved.

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The crucial role of primary care providers in the long-term follow-up of adult survivors of childhood cancer

Cancer Management and Research ◽

10.2147/cmar.s197644 ◽

2019 ◽

Vol Volume 11 ◽

pp. 3411-3418

Author(s):

Justin Jain ◽

Bessi Qorri ◽

Myron R Szewczuk

Keyword(s):

Primary Care ◽

Crucial Role ◽

Adult Survivors ◽

Primary Care Providers ◽

Care Providers ◽

Long Term Follow Up ◽

Survivors Of Childhood Cancer

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“Take the treatment and be brave”: Care experiences of pregnant women with rifampicin-resistant tuberculosis

PLoS ONE ◽

10.1371/journal.pone.0242604 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0242604

Author(s):

Marian Loveday ◽

Sindisiwe Hlangu ◽

Jennifer Furin

Keyword(s):

Health Care ◽

Pregnant Women ◽

Health Care System ◽

Health Care Providers ◽

Physical Symptoms ◽

Coding System ◽

Care Providers ◽

Convenience Sample ◽

Care System

Background There are few data on the on the care experiences of pregnant women with rifampicin-resistant TB. Objective To describe the treatment journeys of pregnant women with RR-TB—including how their care experiences shape their identities—and identify areas in which tailored interventions are needed. Methods In this qualitative study in-depth interviews were conducted among a convenience sample from a population of pregnant women receiving treatment for RR-TB. This paper follows COREQ guidelines. A thematic network analysis using an inductive approach was performed to analyze the interview transcripts and notes. The analysis was iterative and a coding system developed which focused on the care experiences of the women and how these experiences affected their perceptions of themselves, their children, and the health care system in which treatment was received. Results Seventeen women were interviewed. The women described multiple challenges in their treatment journeys which required them to demonstrate sustained resilience (i.e. to “be brave”). Care experiences required them to negotiate seemingly contradictory identities as both new mothers—“givers of life”—and RR-TB patients facing a complicated and potentially deadly disease. In terms of their “pregnancy identity” and “RR-TB patient identity” that emerged as part of their care experiences, four key themes were identified that appeared to have elements that were contradictory to one another (contradictory areas). These included: 1) the experience of physical symptoms or changes; 2) the experience of the “mothering” and “patient” roles; 3) the experience of the care they received for their pregnancy and their RR-TB; and 4) the experience of community engagement. There were also three areas that overlapped with both roles and during which identity was negotiated/reinforced and they included: 1) faith; 2) socioeconomic issues; and 3) long-term concerns over the child’s health. At times, the health care system exacerbated these challenges as the women were not given the support they needed by health care providers who were ill-informed or angry and treated the women in a discriminatory fashion. Left to negotiate this confusing time period, the women turned to faith, their own mothers, and the fathers of their unborn children. Conclusion The care experiences of the women who participated in this study highlight several gaps in the current health care system that must be better addressed in both TB and perinatal services in order to improve the therapeutic journeys for pregnant women with RR-TB and their children. Suggestions for optimizing care include the provision of integrated services, including specialized counseling as well as training for health care providers; engagement of peer support networks; provision of socioeconomic support; long-term medical care/follow-up for children born to women who were treated for RR-TB; and inclusion of faith-based services in the provision of care.

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Abstract WP408: Tacls: Taking Action for Optimal Community and Long Term Stroke Care

Stroke ◽

10.1161/str.48.suppl_1.wp408 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Theresa L Green ◽

Patrice Lindsay

Keyword(s):

Health Care ◽

Acute Stroke ◽

Health Care Providers ◽

Stroke Care ◽

Residential Aged Care ◽

Stroke Survivors ◽

Care Providers ◽

Community Based ◽

Taking Action

Introduction: In Canada, approximately 12% of acute stroke patients are admitted to long-term care (LTC; or residential aged care) facilities following an acute stroke event. An additional 20-30% of patients are discharged home from hospital with referral for community-based homecare. Training programs for health care providers in these settings is variable and at times inconsistent with best practices. Internationally, focus is now shifting from a predominant inpatient acute care focus, to one encompassing ongoing care and support in the community for people living with stroke. In 2015, an educational resource called Taking Action for Optimal Community & Long Term Stroke Care (TACLS) was launched across Canada to ensure the appropriate knowledge and skills of front line care providers for stroke survivors in community and LTC facilities; the focus of this resource is on rehabilitation and recovery. Methods: The purpose of this interactive session is to introduce the TACLS resource and to engage health professionals in an examination of current international community based rehabilitation and recovery programs. The discussion/workshop will allow participants to examine, compare and contrast components of the TACLS program with programs being developed or offered elsewhere. Results: As health care providers helping stroke survivors live well and longer means investing in the use of best practice tools and resources that fit the local context and organizational practices. Bringing together international opinions and observations around post-stroke community care will allow cross-collaboration and inter-professional networking opportunities that ultimately will benefit patients living with stroke in community based settings. Discussion: As care shifts from hospital to community based settings, the importance of tools available to support stroke survivors in this area of the care continuum is essential. In Canada, utilizing the HSF education resource (TACLS) provides information to support community based health care providers working with people who have had a stroke in helping them achieve optimal outcomes, regain their best level of functioning, and live meaningful lives.

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