Leveraging technology for health services continuity in times of COVID-19 pandemic: Patient follow-up, and mitigation of worse patient outcomes

AbstractCounts data with excessive zeros are frequently encountered in practice. For example, the number of health services visits often includes many zeros representing the patients with no utilization during a follow-up time. A common feature of this type of data is that the count measure tends to have excessive zero beyond a common count distribution can accommodate, such as Poisson or negative binomial. Zero-inflated or hurdle models are often used to fit such data. Despite the increasing popularity of ZI and hurdle models, there is still a lack of investigation of the fundamental differences between these two types of models. In this article, we reviewed the zero-inflated and hurdle models and highlighted their differences in terms of their data generating processes. We also conducted simulation studies to evaluate the performances of both types of models. The final choice of regression model should be made after a careful assessment of goodness of fit and should be tailored to a particular data in question.

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Multimodal Rehabilitation Programs (MMRP) for patients with longstanding complex pain conditions – The need for quality control with follow-up studies of patient outcomes

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2015.11.001 ◽

2016 ◽

Vol 10 (1) ◽

pp. 104-105 ◽

Cited By ~ 1

Author(s):

Dag Lemming

Keyword(s):

Quality Control ◽

Patient Outcomes ◽

Rehabilitation Programs ◽

Follow Up Studies

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Transdiagnostic versus Diagnosis-Specific Group Cognitive Behavioral Therapy for Anxiety Disorders and Depression: A Randomized Controlled Trial

Psychotherapy and Psychosomatics ◽

10.1159/000516380 ◽

2021 ◽

pp. 1-14

Author(s):

Nina Reinholt ◽

Morten Hvenegaard ◽

Anne Bryde Christensen ◽

Anita Eskildsen ◽

Carsten Hjorthøj ◽

...

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Behavioral Therapy ◽

Controlled Trial ◽

Well Being ◽

Major Depressive ◽

Outpatient Mental Health ◽

End Of Treatment

Introduction: The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) delivered in a group format could facilitate the implementation of evidence-based psychological treatments. Objective: This study compared the efficacy of group UP and diagnosis-specific cognitive behavioral therapy (dCBT) for anxiety and depression in outpatient mental health services. Methods: In this pragmatic, multi-center, single-blinded, non-inferiority, randomized controlled trial (RCT), we assigned 291 patients with major depressive disorder, social anxiety disorder, panic disorder, or agoraphobia to 14 weekly sessions in mixed-diagnosis UP or single-diagnosis dCBT groups. The primary test was non-inferiority, using a priori criteria, on the World Health Organisation 5 Well-Being Index (WHO-5) at the end of the treatment. Secondary outcomes were functioning and symptoms. We assessed outcomes at baseline, end-of-treatment, and at a 6-month follow-up. A modified per-protocol analysis was performed. Results: At end-of-treatment, WHO-5 mean scores for patients in UP (n = 148) were non-inferior to those of patients in dCBT (n = 143; mean difference –2.94; 95% CI –8.10 to 2.21). Results were inconclusive for the WHO-5 at the 6-month follow-up. Results for secondary outcomes were non-inferior at end-of-treatment and the 6-month follow-up. Client satisfaction and rates of attrition, response, remission, and deterioration were similar across conditions. Conclusions: This RCT demonstrated non-inferior acute-phase outcomes of group-delivered UP compared with dCBT for major depressive disorder, social anxiety disorder, panic disorder, and agoraphobia in outpatient mental health services. The long-term effects of UP on well-being need further investigation. If study findings are replicated, UP should be considered a viable alternative to dCBT for common anxiety disorders and depression in outpatient mental health services.

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Endoscopic treatment of suprasellar cysts without hydrocephalus

Journal of Neurosurgery Pediatrics ◽

10.3171/2016.4.peds15695 ◽

2016 ◽

Vol 18 (4) ◽

pp. 434-441 ◽

Cited By ~ 8

Author(s):

Song-Bai Gui ◽

Sheng-Yuan Yu ◽

Lei Cao ◽

Ji-wei Bai ◽

Xin-Sheng Wang ◽

...

Keyword(s):

Surgical Technique ◽

Success Rate ◽

Patient Outcomes ◽

Endoscopic Treatment ◽

Foramen Of Monro ◽

Image Guided ◽

Operative Complications ◽

Appropriate Therapy ◽

Endoscopic Fenestration

OBJECTIVE At present, endoscopic treatment is advised as the first procedure in cases of suprasellar arachnoid cysts (SSCs) with hydrocephalus. However, the appropriate therapy for SSCs without hydrocephalus has not been fully determined yet because such cases are very rare and because it is usually difficult to perform the neuroendoscopic procedure in patients without ventriculomegaly given difficulties with ventricular cannulation and the narrow foramen of Monro. The purpose of this study was to find out the value of navigation-guided neuroendoscopic ventriculocystocisternostomy (VCC) for SSCs without lateral ventriculomegaly. METHODS Five consecutive patients with SSC without hydrocephalus were surgically treated using endoscopic fenestration (VCC) guided by navigation between March 2014 and November 2015. The surgical technique, success rate, and patient outcomes were assessed and compared with those from hydrocephalic patients managed in a similar fashion. RESULTS The small ventricles were successfully cannulated using navigational tracking, and the VCC was accomplished in all patients. There were no operative complications related to the endoscopic procedure. In all patients the SSC decreased in size and symptoms improved postoperatively (mean follow-up 10.4 months). CONCLUSIONS Endoscopic VCC can be performed as an effective, safe, and simple treatment option by using intraoperative image-based neuronavigation in SSC patients without hydrocephalus. The image-guided neuroendoscopic procedure improved the accuracy of the endoscopic approach and minimized brain trauma. The absence of hydrocephalus in patients with SSC may not be a contraindication to endoscopic treatment.

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Laryngeal cancer

InnovAiT Education and inspiration for general practice ◽

10.1177/17557380211010564 ◽

2021 ◽

pp. 175573802110105

Author(s):

Kelvin Miu

Keyword(s):

Head And Neck Cancer ◽

Early Diagnosis ◽

Head And Neck ◽

Patient Outcomes ◽

Laryngeal Cancer ◽

Neck Cancer ◽

Early Recognition ◽

Signs And Symptoms ◽

Diagnosis And Treatment

Laryngeal cancer is a common head and neck cancer and typically presents with voice hoarseness in patients older than 60 years. Early recognition of signs and symptoms of laryngeal cancer can lead to early diagnosis and treatment, therefore improving patient outcomes. This article aims to provide an overview of the anatomy of the larynx, presentation and management of laryngeal cancer, and common follow-up problems.

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A Minimally-Invasive, Simple, Rapid, and Effective Surgical Technique for the Treatment of Ingrown Toenails: A Reminder of the Original Winograd Procedure

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18010278 ◽

2021 ◽

Vol 18 (1) ◽

pp. 278

Author(s):

Jahyung Kim ◽

Sanghyeon Lee ◽

Jeong Seok Lee ◽

Sung Hun Won ◽

Dong Il Chun ◽

...

Keyword(s):

Patient Outcomes ◽

Simple Procedure ◽

Wedge Resection ◽

Operation Time ◽

University Hospital ◽

Wound Infections ◽

Germinal Matrix ◽

One Year ◽

Ingrown Toenails

(1) Background: Ingrown toenail is a common disorder of the toe that induces severe toe pain and limits daily activities. The Winograd method, the most widely used operative modality for ingrown toenails, has been modified over years to include wedge resection of the nail fold and complete ablation of the germinal matrix. We evaluated the outcomes of original Winograd procedure without wedge resection with electrocautery-aided matrixectomy. (2) Methods: We retrospectively analyzed the outcomes of patients who underwent surgery for ingrown toenails at a university hospital for two years from November 2015 to October 2017. Surgery was performed in 76 feet with a mean operation time of 9.34 min. (3) Results: The minimal interval from surgery to return to regular activities was 13.26 (range 7 to 22) days. Recurrence and postoperative wound infections were found in 3 (3.95%) and 2 (2.63%) patients, respectively. Evaluation of patient satisfaction at one-year follow-up showed that 40 (52.63%) patients were very satisfied, 33 (43.42%) were satisfied, 3 (3.95%) were dissatisfied, and none of them were very dissatisfied. The average follow-up duration was 14.66 (range 12 to 25) months. (4) Conclusions: Therefore, it is believed that this less-invasive and simple procedure could be easily performed by clinicians, with satisfactory patient outcomes.

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Remote Follow-up of Self-isolating COVID-19 Patients with a Patient Portal: Protocol for a Mixed-method Pilot Study (The Opal-COVID Study) (Preprint)

10.2196/preprints.35760 ◽

2021 ◽

Author(s):

David Lessard ◽

Kim Engler ◽

Yuanchao Ma ◽

Adriana Rodriguez Cruz ◽

Serge Vicente ◽

...

Keyword(s):

Patient Outcomes ◽

Mixed Method ◽

Healthcare Professionals ◽

Qualitative Interviews ◽

Sociodemographic Characteristics ◽

Patient Portal ◽

Implementation Outcomes ◽

Service Outcomes ◽

Qualitative Analyses

BACKGROUND Individuals diagnosed with COVID-19 are instructed to self-isolate at home. However, during self-isolation, they may experience anxiety and insufficient care. Some patient portals can allow patients to self-monitor and share their health status with healthcare professionals for remote follow-up, but little data is available on the feasibility of their use. OBJECTIVE This manuscript presents the protocol of the Opal-COVID Study which has four objectives: 1) assess the implementation of using the Opal patient portal for distance monitoring of COVID-19 patients self-isolating at home; 2) identify influences on the intervention’s implementation; and describe 3) service and 4) patient outcomes of this intervention. METHODS This mixed-method pilot study aims to recruit 50 COVID-19 patient participants tested at the McGill University Health Centre (MUHC, Montreal, Canada) for 14 days of remote follow-up. With access to questionnaires through the Opal patient portal smartphone app, configured for this study, patients will complete a daily self-assessment of symptoms, vital signs, and mental health, monitored by a nurse, and receive subsequent teleconsultations, as needed. Study questionnaires will be administered to collect data on sociodemographic characteristics, medical background, implementation outcomes (acceptability, usability, and respondent burden) and patient satisfaction. Coordinator logbook entries will inform on feasibility outcomes, namely, recruitment/retention rates and fidelity, as well as on the frequency and nature of contacts with healthcare professionals via Opal. The statistical analyses for Objectives 1 (implementation outcomes), 3 (service outcomes), and 4 (patient outcomes) will evaluate the effects of time and sociodemographic characteristics on the outcomes. For Objectives 1 (implementation outcomes) and 4 (patient outcomes), the statistical analyses will also examine the attainment of predefined success thresholds. As to the qualitative analyses, for Objective 2 (influences on implementation), semi-structured qualitative interviews will be conducted with four groups of stakeholders (i.e., patient participants, healthcare professionals, technology developers and study administrators) and submitted to content analysis, guided by the Consolidated Framework for Implementation Research to help identify barriers and facilitators of implementation. For Objective 3 (service outcomes), reasons for contacting healthcare professionals through Opal will also be submitted to content analysis. RESULTS Between December 2020 and March 2021, 51 patient-participants were recruited. Qualitative interviews were conducted with 39 involved stakeholders, from April to September 2021. Delays in the study process were experienced due to implemented measures at the MUHC to address COVID-19 but the quantitative and qualitative analyses are currently underway. CONCLUSIONS This protocol is designed to generate multidisciplinary knowledge on the implementation of a patient portal-based COVID-19 care intervention and will lead to a comprehensive understanding of feasibility, stakeholder experience, and influences on implementation that may prove useful for scaling up similar interventions. CLINICALTRIAL ClinicalTrials.gov identifier NCT04978233.

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Perceptions of Resilience and Physical Health Symptom Improvement Following Post Disaster Integrated Health Services

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2018.35 ◽

2018 ◽

Vol 13 (02) ◽

pp. 223-229 ◽

Cited By ~ 2

Author(s):

Howard J. Osofsky ◽

Carl F. Weems ◽

Rebecca A. Graham ◽

Joy D. Osofsky ◽

Tonya C. Hansel ◽

...

Keyword(s):

Health Services ◽

Physical Health ◽

Stepped Care ◽

Symptom Improvement ◽

Health Symptoms ◽

Physical Health Outcomes ◽

Behavioral Health Treatment ◽

Integrated Health Services ◽

Post Disaster

AbstractObjectiveTheorists and researchers have linked resilience with a host of positive psychological and physical health outcomes. This paper examines perceptions of resilience and physical health symptoms in a sample of individuals exposed to multiple community disasters following involvement in integrated mental health services.MethodsA multiwave naturalistic design was used to follow 762 adult clinic patients (72% female; 28% minority status), ages 18-92 years (mean age=40 years), who were evaluated for resilience and physical health symptoms prior to receiving services and at 1, 3, and 6 months’ follow-up.ResultsData indicated increases in perceptions of resilience and decreased physical health symptoms reported over time. Results also indicated that resilience predicted physical health symptoms, such that resilience and physical health symptoms were negatively associated (ie, improved resilience was associated with decreases in physical health symptoms). These effects were primarily observed for those individuals with previous exposure to natural disasters.ConclusionsFindings provide correlational evidence for behavioral health treatment provided as part of a stepped-care, collaborative model in reducing physical health symptoms and increasing resilience post-disaster. Controlled trials are warranted. (Disaster Med Public Health Preparedness. 2019;13:223–229)

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