follow up care
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2022 ◽  
Vol 9 ◽  
Li Yun Teng ◽  
Sen Wei Tsai ◽  
Chun Yuan Hsiao ◽  
Wei Hung Sung ◽  
Ko Long Lin

ObjectivePulmonary valve (PV) stenosis affects cardiac pulmonary function and exercise performance. A cardiopulmonary exercise test (CPET) combined with a transthoracic echocardiogram (TTE) can measure exercise performance, disease progression, and treatment effects. We assessed the exercise capacity in children with PV stenosis by conducting CPET and TTE.MethodsFrom 2005 to 2021, 84 patients with PV stenosis aged 6–18 years were enrolled; 43 were treated with balloon pulmonary valvuloplasty (BPV) (Group A), and 41 received follow-up care (Group B), and their CPET and pulmonary function test results were compared with 84 healthy, matched individuals (Control). We also conducted TTE to compare the peak pulmonary artery pulse wave velocity and pulmonary valve (PV) area before and after catheterization and follow-up care.ResultsThere were no significant differences among the CPET parameters of the patient groups and controls in anaerobic metabolic equivalent (MET) (group A: 6.44 ± 0.58; group B: 6.28 ± 0.47, control: 6.92 ± 0.39, p = 0.110), peak MET (group A: 9.32 ± 0.74; group B: 9.13 ± 0.63; control: 9.80 ± 0.52, p = 0.263), and heart rate recovery (group A: 28.04 ± 4.70; group B: 26.44 ± 3.43, control:26.10 ± 2.42, p = 0.718). No significant differences were found in the pulmonary functions between the three groups. The pulmonary artery pulse wave velocity significantly decreased after catheterization (3.97 ± 1.50 vs. 1.95 ± 0.94, p < 0.0001), but not after follow-up care (1.67 ± 0.77 vs. 1.75 ± 0.66, p = 0.129). The pulmonary vale area significantly improved in group A (0.89 ± 0.71 vs. 1.16 ± 0.58, p < 0.0001), whereas only insignificant progression of PV stenosis was observed in group B (1.60 ± 0.64 vs. 1.57 ± 0.65, p = 0.110).ConclusionsPatients treated with BPV had a similar exercise capacity with that of patients under follow-up care and the healthy controls. Larger or multi-center studies should be conducted to confirm the physical fitness of pediatric patients with PV stenosis after management.

2022 ◽  
Vol 22 (1) ◽  
Heidi Sjoberg ◽  
Wenhui Liu ◽  
Carly Rohs ◽  
Roman A Ayele ◽  
Marina McCreight ◽  

Abstract Background Veterans increasingly utilize both the Veteran’s Health Administration (VA) and non-VA hospitals (dual-users). Dual-users are at increased risk of fragmented care and adverse outcomes and often do not receive necessary follow-up care addressing social determinants of health (SDOH). We developed a Veteran-informed social worker-led Advanced Care Coordination (ACC) program to decrease fragmented care and provide longitudinal care coordination addressing SDOH for dual-users accessing non-VA emergency departments (EDs) in two communities. Methods ACC had four core components: 1. Notification from non-VA ED providers of Veterans’ ED visit; 2. ACC social worker completed a comprehensive assessment with the Veteran to identify SDOH needs; 3. Clinical intervention addressing SDOH up to 90 days post-ED discharge; and 4. Warm hand-off to Veteran’s VA primary care team. Data was documented in our program database. We performed propensity matching between a control group and ACC participants between 4/10/2018 – 4/1/2020 (N- = 161). A joint survival model using Markov Chain Monte Carlo technique was employed for 30-day outcomes. We performed Difference-In-Difference analyses on number of ED visits, admissions, and primary care physician (PCP) visits 120-day pre/post discharge. Results When compared to a matched control group ACC had significantly lower risk of 30-day ED visits (Hazard Ratio (HR) = 0.61, 95% Confidence Interval (CI) = (0.42, 0.92)) and a higher probability of PCP visits at 13–30 days post-ED visit (HR = 1.5, 95% CI = (1.01, 2.22)). Veterans enrolled in ACC were connected to VA PCP visits (50%), VA benefits (19%), home health care (10%), mental health and substance use treatment (7%), transportation (7%), financial assistance (5%), and homeless resources (2%). Conclusion We developed and implemented a program addressing dual-users’ SDOH needs post non-VA ED discharge. Social workers connected dual-users to needed follow-up care and resources which reduced fragmentation and adverse outcomes.

2022 ◽  
Vol 20 (4) ◽  
pp. 205-210
M. A. Manukyan ◽  
A. Yu. Falkovskaya ◽  
V. F. Mordovin ◽  
V. V. Saushkin ◽  
T. R. Ryabova

The article presents a case of diagnosis and treatment of coarctation of the aorta in a 20-year-old woman, who previously received follow-up care with the diagnosis of hypertension. This case demonstrates the importance of qualitative examination of young patients with hypertension, including tonometry in the lower extremities and transthoracic echocardiography. The peculiarities of this clinical case encompass a rarer, isolated type of coarctation of the aorta and high physical fitness of the patient, which reduced doctors’ alertness regarding this anomaly. After surgical correction, a significant decrease in the blood pressure was achieved; however, such patients need longterm follow-up in order to detect complications, such as aneurysms, restenosis, or residual stenosis. 

Bonnie Ruder ◽  
Alice Emasu

AbstractConsidered the most severe of maternal morbidities, obstetric fistula is a debilitating childbirth injury that results in complete incontinence with severe physical and psychosocial consequences.The primary intervention for women with obstetric fistula is surgical repair, and success rates for repair are reported between 80% and 97%. However, successful treatment is commonly defined solely by the closure of the fistula defect and often fails to capture women who continue to experience urinary incontinence after repair. Residual incontinence post-fistula repair is both underreported and under-examined in the literature. Through a novel mixed-method study that examined clinical, quantitative, and qualitative aspects of residual incontinence post-repair, this chapter draws on in-depth interviews with women suffering with residual incontinence and fistula surgeons, participant observation, and a desk review of fistula policies and guidelines to argue that an inadequate model of fistula treatment that neglects follow-up care exists. We found that obstetric fistula policy has been determined in large part over the years by international development agencies and funding organizations, such as international nongovernmental organizations (INGOs). We argue that the neglect in follow-up care is evident in fistula policy and can be traced to a donor-funded treatment model that fails to prioritize and fund follow-up care as an essential component of fistula treatment, instead focusing on a “narrative of success” in fistula treatment. As a result, poor outcomes are underreported and women who experience poor outcomes are largely erased from the fistula narrative. This erasure has limited the attention, resources, research, and dedicated to residual incontinence, leaving out women suffering from residual incontinence largely without alternative treatment options.

2022 ◽  

The COVID-19 pandemic has affected trauma practices all over the world. Despite the increasing number of studies focused on the epidemiology of vertebral fractures (VFs) in COVID-19 patients, the impact of the pandemic on the incidence of trauma pathologies at the emergency department (ED) remains unclear. In Spain, very few studies have explored how the pandemic has affected the care of patients with osteoporotic vertebral fracture (OVF) in the ED and on their follow-up. The aim of this work is to evaluate the impact on the demand for care and diagnosis of VF during the COVID-19 pandemic, as well as the repercussions on patient follow-up. A longitudinal retrospective observational study was designed comparing two cohorts (pre-COVID and COVID) of patients for whom an emergency computed tomography scan was requested due to suspected vertebral fracture. Information was gathered on patient demographics, number and type of OVFs, time of day at which the diagnosis was made, follow-up, and treatment received. Comparative analyses were performed between both patient groups, with stratification by time intervals according to the pandemic waves in the COVID cohort. A total of 581 eligible patients were included in the study. The analyzed cohorts included 288 patients (145 and 143 in the pre-COVID and COVID cohorts, respectively), with a mean age of 73.4 ± 13.8 years and 205 (71.4%) women. No significant differences were observed on most measured variables. In the COVID cohort, the group of patients who received follow up care had a significantly lower mean age than the group that did not receive follow up care (70.2 ± 12.7 vs 76.2 ± 14.1 years, respectively, p = 0.008). In conclusion, the COVID-19 pandemic has had little impact on the diagnosis and management of patients with OVF in our hospital. This could be explained by the specific characteristics of OVFs and the type of patients it affects. Our study has some limitations, mainly derived from its retrospective and single-center nature with a short follow-up interval.

Neurology ◽  
2021 ◽  
Vol 98 (1 Supplement 1) ◽  
pp. S13.1-S13
James Pate ◽  
Ian Cummins ◽  
Kasey Cooper ◽  
Marshall Chandler McLeod ◽  
Laura Ferrill ◽  

ObjectiveThe objective of this study was to examine the association between insurance status and prevalence of follow up care at a tertiary referral center compared to the emergency department.BackgroundConcussions are extremely common in today's society, affecting patients of all demographic backgrounds. There is concern that public insurance status may affect follow up care at tertiary treatments centers compared to children with private insurance, as evidenced by Copley et al. who documented insurance disparities between children presenting to a sports medicine clinic with orthopedic injuries verses concussion.Design/MethodsWe compared insurance status of patients presenting to our pediatric concussion clinic to the insurance status of patients diagnosed with concussion at the emergency department of our tertiary hospital. From 2018 to 2019, 725 patients received an ICD-10 diagnosis code for concussion in our clinic. Patients were excluded if insurance status was not available for the clinic visit (4), or if they were lost to follow up (380). ICD-10 codes for concussion during the same period were recorded from the COA emergency department (ED). The insurance status was then recorded for each patient.ResultsOf the 345 patients included from the COA concussion clinic, 253 (73%) patients had private insurance while only 92 (27%) had public insurance. In comparison, of the 1,160 patients diagnosed with concussion in the COA ED, 642 (55%) patients had private insurance, 478 (41%) had public insurance, 37 (3.1%) were self-pay, and 3 (0.3%) were listed as “other.”ConclusionsThere is a significant difference in the insurance status of patients with concussion that present to the COA ED when compared to those presenting to concussion clinic. As a result, children with public insurance may have prolonged recovery and more significant symptoms burden compared to children with private insurance.

2021 ◽  
pp. 154041532110676
Seiichi Villalona ◽  
Heide Castañeda ◽  
Jason W. Wilson ◽  
Nancy Romero-Daza ◽  
Mery Yanez Yuncosa ◽  

Introduction: The emergency department (ED) is one clinical setting where issues pertaining to health communication uniquely manifest themselves on a daily basis. This pilot study sought to understand satisfaction with care, perceptions of medical staff concern, awareness, and comprehension of medical care among Spanish-speaking patients with limited English-language proficiency (LEP). Methods: A two-phase, mixed-methods approach was employed among Spanish-speaking patients with LEP that presented to an ED in West Central Florida. The prospective phase consisted of semistructured interviews ( n = 25). The retrospective phase analyzed existing patient satisfaction data collected at the study site ( n = 4,940). Results: Content analysis revealed several linguistic barriers among this patient population including limited individual autonomy, self-blame for being unable to effectively articulate concerns, and lack of clarity in understanding follow-up care plans. Retrospective analysis suggested differences between responses from Spanish-speaking patients when compared with their English-speaking counterparts. Conclusions: Our findings suggest discordance between satisfaction and health literacy in this unique patient population. Although high satisfaction was reported, this appeared to be secondary to comprehension of follow-up care instructions.

2021 ◽  
Vol 17 (6) ◽  
pp. 226-229
Scott Ramsay

Background: Follow-up visits after a concussion are important in the children and young people for ensuring good health outcomes. Aims: This commentary will briefly detail the factors associated with children and young people obtaining follow-up care, review the evidence supporting the benefits of follow-up care after concussion and discuss opportunities for improving follow-up care in the paediatric population. Findings: Data suggest that whether or not children and young people receive follow-up care varies. Children and young people are under-represented in investigations into follow-up care after concussion. Conclusions: More research is needed on how follow-up care after concussion affects health outcomes in children and young people. The form that follow-up care should take, particularly in light of the pandemic, also requires further research.

2021 ◽  
Vol 21 (1) ◽  
Sandra Skogby ◽  
Ewa-Lena Bratt ◽  
Bengt Johansson ◽  
Philip Moons ◽  
Eva Goossens

Abstract Background A substantial proportion of young people with Complex Chronic Conditions (CCCs) experience some degree of discontinuation of follow-up care, which is an umbrella term to describe a broken chain of follow-up. Discontinuation of follow-up care is not clearly defined, and the great plethora of terms used within this field cannot go unnoticed. Terms such as “lost to follow-up”, “lapses in care” and “care gaps”, are frequently used in published literature, but differences between terms are unclear. Lack of uniformity greatly affects comparability of study findings. The aims of the present study were to (i) provide a systematic overview of terms and definitions used in literature describing discontinuation of follow-up care in young people with CCC’s; (ii) to clarify operational components of discontinuation of follow-up care (iii); to develop conceptual definitions and suggested terms to be used; and (iv) to perform an expert-based evaluation of terms and conceptual definitions. Methods A systematic literature search performed in PubMed was used to provide an overview of current terms used in literature. Using a modified summative content analysis, operational components were analysed, and conceptual definitions were developed. These conceptual definitions were assessed by an expert panel using a survey. Results In total, 47 terms and definitions were retrieved, and a core set of operational components was identified. Three main types of discontinuation of follow-up care emerged from the analysis and expert evaluation, conceptually defined as follows: Lost to follow-up care: “No visit within a defined time period and within a defined context, and the patient is currently no longer engaged in follow-up care”;Gap in follow-up care: “Exceeded time interval between clinic visits within a defined context, and the patient is currently engaged in follow-up care”; andUntraceability: “Failure to make contact due to lack of contact information”. Conclusion By creating a common vocabulary for discontinuation of follow-up care, the quality of future studies could improve. The conceptual definitions and operational components provide guidance to both researchers and healthcare professionals focusing on discontinuation of follow-up care for young people with CCCs.

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 864-865
Helen-Maria Vasiliadis ◽  
Catherine Lamoureux-Lamarche ◽  
Sébastien Grenier ◽  
Pasquale Roberge

Abstract Receipt of quality mental health (MH) care can influence mortality. Given the scarce literature on the topic, the aim was to assess the 3-year risk of mortality in older adults (OA) associated with receiving adequate MH treatment for depression/anxiety in an epidemiologic context. The study sample included 358 OA with depression/anxiety recruited in primary care practices and followed prospectively for 3 years. Mortality was assessed from vital statistics data. Adequate care was based on receipt of pharmacotherapy, follow-up care and psychotherapy. Propensity score analysis was carried out where the inverse probability (IPW) of receiving adequate treatment was calculated. Time to event analyses with IPW was used to assess the effect of receipt of adequate MH treatment on the risk of mortality controlling for individual and health system factors. The results showed that receipt of adequate MH treatment reduced the risk of mortality (HR0.44; 95% CI: 0.22 – 0.99). Individual factors that increased mortality were male sex, being single, reduced functional status and cognitive functioning, # physical disorders, current smoking; while exercise reduced risk. Health system factors such as past # of hospitalizations increased the risk; while # of emergency department visits and continuity of care reduced mortality. Finally, treating depression/anxiety with minimal follow-up care and pharmacotherapy or psychotherapy has a significant impact on reducing mortality in OA. Primary care physicians should recognize the important potential impact of years of lives saved when providing quality MH care to OA.

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