Adequate Follow-up Care Research Articles

General practitioner and practice nurses perspectives on implementation of the 75+ health assessment: Implications for dementia care and well-being.

The uptake of the health assessment for persons aged 75 years and older (75 + HA) remains low. Repeat assessments provide an opportunity to identify areas of change in cognitive function which may mark the onset of dementia. We aimed to explore general practitioner (GP) and practice nurse experiences of implementing the 75 + HA with a focus on clinical considerations for dementia care. An interpretative qualitative study involving interviews with 15 GPs (female = 11, male = 4) and 5 practice nurses (all female). Data were analysed using an inductive thematic approach. The majority of GPs (n = 11) worked in metropolitan settings and four GPs worked in regional settings across NSW. All participants worked in separate clinics, except for two GPs and one practice nurse who worked within the same metropolitan clinic. Distinct themes emerged regarding participants experiences of implementing the 75 + HA for patients with dementia: (1) negotiating aged care is complex and facilitated by a comprehensive assessment; (2) implementing work practices that support the 75 + HA in patients with cognitive decline; and (3) variations in follow up of findings and implications for care. The 75 + HA provides an opportunity for monitoring and acting on emergent physical and cognitive health changes. Increased engagement and support towards implementing the 75 + HA, particularly in the context of dementia, may facilitate the instigation of interventions. While some participants in this study were confident with identifying and managing cognitive decline, the majority relied on geriatricians to confirm dementia diagnosis and refer to community support services. We suggest the need for greater initiatives and clinical guidelines to assist GPs in the identification and management of cognitive decline. From a nursing perspective, this study highlights the valuable role of nurses towards assessment and management of issues raised in the health assessment for persons aged 75 years and older. However, more resources are needed to enable nurse time for adequate follow-up care.

Depression screening in patients with coronary heart disease : Anarrative review of the current evidence.

In view of the large and sometimes conflicting body of research, this narrative review summarizes the current evidence on depression screening in patients with coronary heart disease. Depression is arisk factor for development and progression of coronary heart disease. Consequently, many international cardiac guidelines recommend screening for depression in patients with coronary heart disease. However, the efficacy and implementation of these guidelines are debated due to the lack of empirical evidence supporting the benefits of routine depression screening. Studies conducted in cardiac routine care support this assumption: Patients with positive depression screens do not receive adequate follow-up care, which highlights gaps in the detection-to-treatment pathway. Barriers to effective screening and treatment include system-level factors, such as insufficient integration of mental health resources in cardiology, and patient-related factors like stigma and low acceptance of mental health treatment. Innovative interventions that address these barriers and involve patients as active partners in depression care should be developed through atheory-driven, transparent, multistage process involving key stakeholders such as patients, nurses, and cardiologists. Asound methodological evaluation of such multilevel interventions could answer the question of whether early detection of depression in patients with coronary heart disease would lead to health benefits.

Exploring factors influencing quality of life variability among individuals with coeliac disease: an online survey

ObjectivePatients with coeliac disease (CD) need to follow a strict gluten-free diet to manage symptoms and prevent complications. Restrictions imposed by the diet can be challenging and affect quality of...

Optimised endoscopic access for intrajejunal levodopa application in idiopathic Parkinson's syndrome

Pump-guided intrajejunal levodopa administration is one of the indispensable forms of therapy in advanced Parkinson's syndrome, along with deep brain stimulation and subcutaneous apomorphine injection. The standard application of levodopa gel via a JET-PEG, i.e. a percutaneous endoscopic gastrostomy (PEG) with an inserted internal catheter into the jejunum, has not been unproblematic due to the restricted absorption area of the drug in the region of the flexura duodenojejunalis and especially due to the sometimes considerable accumulated complication rates of a JET-PEG. Causes of complications are mainly a non-optimal application technique of PEG and internal catheter as well as the often missing adequate follow-up care. This article presents the details of a—compared to the conventional technique—modified and optimised application technique, which has been clinically proven successfully for years. However, many details derived from anatomical, physiological, surgical and endoscopic aspects must be strictly observed during the application to reduce or avoid minor and major complications. Local infections and buried bumper syndrome cause particular problems. The relatively frequent dislocations of the internal catheter (which can ultimately be avoided by clip-fixing the catheter tip) also prove to be particularly troublesome. Finally, using the Hybrid technique, a new combination of an endoscopically controlled gastropexy with 3 sutures and subsequent central thread pull-through (TPT) of the PEG tube, the complication rate can be dramatically reduced and thus a decisive improvement achieved for patients. The aspects discussed here are highly relevant for all those involved in the therapy of advanced Parkinson's syndrome.

Prompt initiation of triple therapy following hospitalization for a chronic obstructive pulmonary disease exacerbation in the United States: An analysis of the PRIMUS study.

BACKGROUND: Severe exacerbations requiring hospitalization contribute a substantial portion of the morbidity and costs of chronic obstructive pulmonary disease (COPD). Triple therapy (inhaled corticosteroid + long-acting β-agonist + long-acting muscarinic antagonist) is a recommended option for patients who experience recurrent COPD exacerbations or persistent symptoms. Few real-world studies have specifically examined the effect of prompt initiation of triple therapy, specifically among patients hospitalized for a COPD exacerbation. OBJECTIVE: To assess whether prompt initiation of triple therapy following a severe COPD exacerbation was associated with lower risk of subsequent exacerbations and lower health care use and costs and the effects of each 30-day delay of initiation. METHODS: Adults aged 40 years or older with COPD were identified in the Merative MarketScan Databases between January 1, 2010, and December 31, 2019, and were required to meet the following criteria: open or closed triple therapy (date of first closed prescription or last component of open=index treatment date), more than 1 inpatient admission with a primary COPD diagnosis (ie, severe exacerbation) in the prior 12 months (index exacerbation), 12 months of continuous enrollment before (baseline) and after (follow-up) index exacerbation, and absence of select respiratory diseases and cancer. Patients were stratified based on timing of open or closed triple therapy after the index exacerbation: prompt (≤30 days), delayed (31-180 days), or very delayed (181-365 days). Multivariable regression controlled for baseline characteristics (age, sex, insurance type, index year, comorbidities, prior treatment, and prior exacerbations) and estimated the odds of subsequent exacerbations, change in the number of exacerbations, and change in health care costs during 12-month follow-up associated with each 30-day delay of triple therapy initiation. RESULTS: A total of 6,772 patients met inclusion criteria (2,968 [43.8%] prompt, 1,998 [29.5%] delayed, and 1,806 [26.7%] very delayed). The adjusted odds of any exacerbation and a severe exacerbation during 12-month follow-up increased by 13% (odds ratio [95% CI]: 1.13 [1.11-1.15]) and 10% (1.10 [1.08-1.12]), respectively, for each 30-day delay in triple therapy initiation, and the mean number of exacerbations increased by 5.4% (95% CI = 4.7%-6.1%). There was a 3.0% increase (95% CI = 2.2%-3.8%) in mean all-cause costs and a 3.7% increase (95% CI = 2.9%-4.6%) in total COPD-related costs for each 30-day delay of triple therapy initiation. CONCLUSIONS: Longer delays in triple therapy initiation after a COPD hospitalization result in greater risk of subsequent exacerbations and higher health care resource use and costs. Adequate post-discharge follow-up care and earlier consideration of triple therapy may improve clinical and economic outcomes among patients with COPD. DISCLOSURES: This study was funded by AstraZeneca. Dr Evans is employed by Merative, formerly IBM Watson Health, and Mr Tkacz was employed by IBM Watson Health at the time of this study; Merative/IBM Watson Health received funding from AstraZeneca to conduct this study. Mr Pollack, Dr Staresinic, Dr Feigler, and Dr Patel are employed by AstraZeneca. Dr Touchette, Dr Portillo, and Dr Strange are paid consultants to AstraZeneca. Dr Strange also participates in research grants paid to the Medical University of South Carolina by AstraZeneca, CSA Medical, and Nuvaira, and is a consultant to GlaxoSmithKline, Morair, and PulManage regarding COPD.

Measuring clinical lead testing coverage to support a population health initiative

Abstract Despite national efforts to reduce lead exposure, some children are still exposed to lead, leading to damage to the nervous system, delayed development, and learning and behavioral problems. CDC has recommended targeting high-risk groups for screening. In addition, Texas Department of State Health Services reported a concerning 17% lead testing coverage of 0-to-5-year-olds in in Harris County (where Houston is located). With the eventual goal of improving lead-related clinical care in a large pediatric hospital network, we asked the following questions: 1) What are the high-risk groups specific to our patient population? 2) For patients who are screened positive, are we adequately confirming the results? 3) For those with confirmed lead exposure, are we providing adequate follow-up care? To answer these questions, we analyzed lead testing and hemoglobin testing data on all children less than 6 years of age from the Texas Children’s Hospital’s electronic health record between 2017 and 2021. Lead screening could be performed on capillary or venous blood, but for elevations on capillary blood we analyzed if the results were confirmed with a venous blood test, as recommended by CDC. We used hemoglobin testing as an indicator of follow-up care of lead-exposed children, because an anemia work-up is recommended for such children. We repeated analysis using two different lead level thresholds, because of recent change to the CDC blood lead reference value from 5 mcg/dL to 3.5 mcg/dL in May 2021. We found 273 children (0.33% of children with capillary blood test) to have cBLL = 3.5mcg/dL. There was a significant racial disparity in the rate of lead screening. For example, the screening rate of Black children was 14%, whereas that of White children were 23%. There was a geographic discrepancy between the areas with most elevated cBLL and testing volume. For example, the area where cBLL was most frequently elevated (3.7%) received less than a fifth of tests compared to the most well-tested area. Only 75% of children with a cBLL = 5mcg/dL received a timely venous blood lead test for confirmation, and this dropped to 43% for children with a cBLL = 3.5mcg/dL. Similarly, only 75% of children with a confirmed venous lead level = 5 mcg/dL received a follow-up repeat vBLL test, and 55% received a follow-up hemoglobin measurement. There is room for improvement in population lead health, in terms of both equity and resource distribution. Improvement of lead-related clinical practice could benefit hundreds of children in the Houston metropolitan area.

Factors associated with a high level of unmet needs and their prevalence in the breast cancer survivors 1-5 years after post local treatment and (neo)adjuvant chemotherapy during the COVID-19: A cross-sectional study.

ObjectiveTo assess the prevalence of unmet needs in post-treatment breast cancer survivors and identify sociodemographic, clinical, and psychosocial variables associated with reported unmet needs during the COVID-19 pandemic.Materials and methodsIn this cross-sectional study, 430 post-treatment breast cancer survivors, ranging between 1 and 5 years after the procedure, completed the Cancer Survivors’ Unmet Needs (CaSUN) questionnaire from September 2021 and January 2022. The multivariate logistic analysis identified factors associated with at least one reported unmet need in the total CaSUN scale and specific domains.ResultsA total of 67% of survivors reported at least one unmet need. The most frequently reported unmet needs were the lack of accessible hospital parking (43%) and recurrence concerns (39.5%). The majority of reported unmet needs relate to comprehensive care (44%), followed by the psychological and emotional support domain (35.3%). Younger age (OR = 0.95, 95% CI = 0.92–0.99; p < 0.001), three or more comorbidities (OR = 0.27, 95% CI = 0.11–0.71, p < 0.01), a lower quality of life (OR = 0.06, 95% CI = 0.01–0.47, p < 0.01) and low resilience (OR = 0.95, 95% CI = 0.93–0.99) were associated with a high level of unmet needs in the multivariate regression model. Results are presented for factors associated with a high level of unmet needs for comprehensive cancer care and psychological and emotional support domain.ConclusionA high prevalence found in our study could be attributed to the COVID-19 pandemic, where patients may have missed adequate follow-up care, although comparing to studies done in non-pandemic time is difficult. Family physicians should be more attentive toward younger cancer survivors and those with more comorbidities as both characteristics can be easily recognized in the family practice.

Utilization of mechanical prostheses and outcomes of surgical aortic valve replacement at safety net hospitals

BackgroundSafety-net hospitals care for a high proportion of uninsured/underinsured patients who may lack access to longitudinal care. The present study characterized the use of mechanical valves and clinical outcomes of surgical aortic valve replacement at safety net hospitals. MethodsAll adults undergoing surgical aortic valve replacement were abstracted from the 2016–2018 Nationwide Readmissions Database. Hospitals were divided into quartiles based on volume of all Medicaid and uninsured admissions, with the highest quartile defined as safety net hospitals. Multivariable regression was used to determine the association between safety net hospitals and several outcomes including mechanical valve use, perioperative complications, index hospitalization costs, 90-day readmission, and complications at readmission. ResultsOf the 94,580 patients undergoing surgical aortic valve replacement, 14.5% of operations were at safety net hospitals. Patients at safety net hospitals more commonly received mechanical valves (20.3% vs 16.9%, P < .01) compared to those at non–safety net hospitals. After adjustment, safety net hospitals remained associated with a greater odds of mechanical aortic valve use (adjusted odds ratio, 1.13, 95% confidence interval 1.05–1.21). However, operation at safety net hospitals was also associated with increased odds of perioperative complications (adjusted odds ratio 1.10, 95% confidence interval 1.03–1.17) and higher hospitalization costs (β coefficient +$6.15K, 95% confidence interval +$5.26− +$7.03) despite similar 90-day readmissions. Upon readmission, safety net hospitals patients were more likely to experience mortality (adjusted odds ratio 1.87, 95% confidence interval 1.18–2.98) and stroke (adjusted odds ratio 2.41, 95% confidence interval 1.23–4.70) compared to those at non–safety net hospitals. ConclusionHospital safety net status is associated with increased use of mechanical valves for surgical aortic valve replacement despite also being associated with increased perioperative complications, costs, and significant complications upon readmission. Ability to access adequate follow-up care may be an important consideration for surgical aortic valve replacement at safety net hospitals.

A pilot study of game-based learning programs for childhood cancer survivors

BackgroundChildhood cancer survivors lacking awareness on their potential risks of late effects often fail to seek adequate follow-up care. Patient education matching their preference is of great importance to improve their adherence to survivorship care. In this study, we developed two age-dependent game-based learning programs, which enable continuous approaches for childhood cancer survivors along their intellectual maturation. Then, we assessed the effectiveness of the programs.MethodsChildhood cancer survivors over 10 years of age who regularly visited a long-term follow-up clinic were enrolled in this study. They were requested to play either of two different types of game tools, one for school children and another for adolescents and young adults, for one month at home. To evaluate the educational effects of the programs, they were examined for health management awareness, self-esteem, and knowledge on cancer-related late effects before and after the intervention with age-based questionnaires and knowledge tests.ResultsAmong 83 participants, 49 (59.0%) completed the assessments over the period of 12 months. The health management awareness and knowledge levels increased significantly at 1-month after the intervention as compared to the baseline in both school children and adolescents/young adults (for health management awareness, p = 0.011 in elementary school children; p = 0.007 in junior high school children; p < 0.001 in adolescents/young adults; for knowledge levels, p < 0.001 in school children; p < 0.001 in adolescents/young adults). The effect was maintained for 12 months in school children while it decreased in adolescents and young adults with time. Self-esteem significantly increased at 1-month (p = 0.002 in school children; p = 0.020 in adolescents/young adults) and was maintained for 12 months in both age groups.ConclusionThe game-based learning programs enhanced health locus of control and self-esteem in childhood cancer survivors. The game-based learning programs could be applied effectively to survivorship care as a new modality of patient education.Trial registrationThis study was retrospectively registered in UMIN-CTR (UMIN000043603) on March 12, 2021.

Emergency care to 'persons with confused behavior': Lived experiences of, and collaboration between, police and members of a mobile crisis team - A hermeneutic-phenomenological study.

Police officers and members of a mobile crisis team (MCT) are the two actors who respond to nuisance in Dutch society related to 'persons with confused behavior' and serious violent incidents. Their collaboration creates tension and dissatisfaction about roles and responsibilities. To explore the lived experiences of, and collaboration between, police officers and members of a MCT. A hermeneutic-phenomenological study with unstructured in-depth interviews of eight police officers and eight members of a MCT. The main findings in this study are that in the emergency care of 'persons with confused behavior' two very different professions are forced to work together, and that this collaboration is quite challenging. It becomes clear that different visions and expectations cause frustration in the collaboration. Police want the participation of the MCT as soon as possible after they are called in. The MCT wants to be easily accessible for police and can identify the great diversity of problems adequately but cannot solve all problems. There are shortcomings in adequate follow-up care provided by other health-care facilities. It turns out that it is extremely important for police officers that members of the MCT explain to them why a crisis assessment has a certain outcome. The exposed frictions and stagnation in the collaboration should be discussed openly as part of the process in order to acknowledge this and resolve it together. A recently started project called 'street triage', in which the police and MCT work together as one team and give a joint response, seems to remove a lot of the friction and stagnation. Further studies are needed to explore the effects of street triage by testing the validity of the hypothesis that street triage can close the gap between the two professions.

Socio-demographic factors and suicidal behavior among the patients with psychiatric disorder attending outpatient department of a tertiary level hospital

The majority of suicides worldwide are related to psychiatric disorders. Overall, suicide rates vary concerning the age, gender, and socioeconomic status of the individual and the method of suicide. The objectives of the study were to find the socio-demographic factors and suicidal behavior associated with suicidal attempts in patients with psychiatric disorders. A cross-sectional, hospital-based, descriptive study was conducted among the patients attending the psychiatry outpatient departments (OPD) of the National Institute of Mental Health, Dhaka, Bangladesh. A total of 98 consecutive cases were included those who were at and above18year, have a definite psychiatric disorder and history of suicidal attempt. The data were collected by face-to face interview using semi structured questionnaire. The study identified that most of the patients were in the age group 21-30 years (53.1%), mean age± SD was 27.02±8.42, more in female (66.2%), housewives (35.7%), 57.1% were from an urban background and 35.7% of them studied up to SSC. The vast majority (73.5%) came from a nuclear family. Suicidal behavior revealed that mean suicidal attempt was 2.63±2.84, Communication intent was 20.4%, Suicidal note was put by10.2%, at home (90.8%),59.2%, sample choose day time and common method were hanging (25.5%) and medicine (22.4%). Help nearby in 72.4%, precaution against rescue was 18.4%, intent to die was 65.3% and hospitalization needed for 34.7% cases. Suicides can be prevented by early identification, diagnosis and proper intervention of psychiatric disorder among risk groups. Restricting access to means of suicide, by training caregivers, provide adequate follow-up care may reduce impulsive suicidal attempts.&#x0D; Bang J Psychiatry June 2018; 32(1): 14-18

Suicide: A Précis!

Background:Suicide remains a psychiatric emergency, tragedy, a public health burden, and for those aged 15-29, is the second leading cause of death globally. Stigma attached to psychiatric disorders and suicide means many people feel unable to seek help.Aim of Work:We highlighted confusing nosology, psychopathology, neurobiological underpinnings, typology, and, risk factor pertinent to suicide. A road-map to the clinical assessment and management of suicide has also been provided. Last, but not least, we tried to dispel the long-held myths about suicide.Methods:EMBASE, Ovid MEDLINE, PubMed, Scopus, Web of Science, and Cochrane Database of Systemic Reviews were searched for all relevant studies up to date of Jan, 2020.Results:Suicide is self-inflicted death with evidence (explicit/implicit) of intention to die. Suicide reflects many disparate determinants release/relief, response-to the disordered thinking, religious, revenge, rebirth, reunification or rational. 5-HT deficiency appears central to the neurobiology of suicide. Durkheim proposed 4 types of suicide (egoistic, altruistic, anomic, fatalistic). Risk factors for suicide entail both static and dynamic factors. Dynamic factors encompass both clinical and situational variables. Shneidman's concepts of perturbation and psychache are very crucial to consider when assessing the risk. Suicide rating scales are only ancillary with the Modified high-risk construct scale balances vectors of suicidality versus survivality. Myths germane to suicide abound that need to be demystified. Psychiatric management capitalizes on determining a setting for treatment and supervision, attending to patient's safety, as well as working to establish a cooperative and collaborative physician-patient relationship. This entails both psychosocial 'package' and somatic treatments and the best outcomes mandate well-keeled combined approaches. Pharmacologic interventions aim chiefly at acute symptomatic relief. Recently, heaps of data accrue speaking to the idea of ground-breaking 'anti-suicidal' agents that might alleviate suicidal ideation (SI)Conclusion:Suicide continues to be a complex public health problem of global calibre. It is variably tied to a myriad of risk factors underscoring likely etiological heterogeneity. That said, suicides can, at least partially, be prevented by restricting access to means of suicide, by training primary care physicians and health workers to identify people at risk as well as to assess and manage respective crises, provide adequate follow-up care and address the way this is portrayed in the media. A host of psychotherapeutic, pharmacological, or neuromodulatory treatments of mental disorders are readily available that can alter this acrimonious trajectory.

&lt;p&gt;Prevention of cervical and breast cancer mortality in low- and middle-income countries: a window of opportunity&lt;/p&gt;

Breast and cervical cancer are the two most common women’s cancers worldwide. Countries have invested for decades in early detection programs for breast and cervical cancer through screening, community education, and opportunistic case detection by health professionals. However, effectiveness in low- and middle-income countries (LMICs) has been limited due to low coverage, insufficient laboratory capacities for diagnosis, health information systems (HIS) that are not designed to track patients or monitor program performance, barriers that inhibit women’s uptake of services, and inadequate treatment options. Even where some screening activities exist, there has not been sufficient attention to ensuring completion of appropriate diagnosis and treatment after women receive a positive screening test result or report symptoms suggesting cervical or breast cancer. Because of this failure to provide adequate follow-up care, these women miss the potential benefit from early detection and have a higher than average risk to develop cancer or progress to more advanced cancer stages that could have been avoided. There are several critical steps in a woman’s journey from good health to elevated cancer risk, then to cancer prevention or diagnosis, and finally to treatment. There is a window of opportunity that extends from the time a positive finding is identified—by a cervical or breast screening test or recognition of a breast abnormality—to the point when cervical precancer treatment is delivered or a treatment plan for diagnosed breast cancer is initiated. Building on existing health systems and adapting measurable, affordable, and culturally acceptable interventions can achieve a lasting impact. If women can successfully navigate this window of opportunity, they can avoid progression to cervical cancer or greatly reduce the need for invasive treatments for breast cancer and improve their chances for survival and improved quality of life. We propose several actions that can lead us on the path towards reduction of this cancer burden.

Racial and socioeconomic disparities in adherence to preventive health services for ovarian cancer survivors.

To examine ovarian cancer survivors' adherence to evidence-based guidelines for preventive health care. A case-control, retrospective study of Medicare fee-for-service beneficiaries diagnosed with stage I, II, or III epithelial ovarian cancer from 2001 to 2010 using the Surveillance, Epidemiology, and End Results-Medicare database. Survivors were matched 1:1 to non-cancer controls from the 5% Medicare Beneficiary file on age, race, state of residence, and follow-up time. Receipt of flu vaccination, mammography, and bone density tests were examined in accordance with national guidelines. Adherence was assessed starting 1year after cancer diagnosis, across 2years of claims. Interaction with the health care system, including outpatient and cancer surveillance visits, was tested as a potential mechanism for receipt of services. 2437 survivors met the eligibility criteria (mean age, 75; 90% white). Ovarian cancer survivors were more likely to be adherent to flu vaccination (5 percentage points (pp); < 0.001) and mammography guidelines (10pp.; < 0.001) compared to non-cancer controls, but no differences were found for bone density test guidelines (- 1pp.; NS). Black women were less likely to be adherent to flu vaccination and bone density tests compared with white women. Women dually eligible for Medicare and Medicaid were less likely to be adherent compared to those without such support. Adherence was not influenced by measures of outpatient visits. Ovarian cancer survivors are receiving preventive services with the same or better adherence than their matched counterparts. Minority and dual-eligible survivors received preventive services at a lower rate than white survivors and those with higher income. The number of outpatient visits was not associated with increased preventive health visits. Ovarian cancer survivors are receiving adequate follow-up care to be adherent to preventive health measures. Efforts to improve care coordination post-treatment may help reduce minority and low SES disparities.

Reduction in Specialist Outpatient Clinic Visits with an Integrated Care Programme for Frequent Admitters in Singapore

Introduction : Frequent admitters FA, defined as patients with three or more inpatient acute hospital admissions within one year, account for about 27% of episodes and incur high healthcare costs. National University Health System Regional Health System NUHS-RHS Integrated Interventions and Care Extension NICE, launched in 2014, targeted FA with the aim of reducing avoidable hospital utilisation. NICE patients were assigned a case manager who customised their care plan based on holistic needs assessment. NICE provided post-discharge home visits and/or phone calls to monitor patients’ progress, appropriate referrals to community health and social services, and consolidated care under one team. We retrospectively evaluated NICE’s effect on reducing utilisation over 1-year post-enrolment: all-cause admissions ADM, emergency admissions EM, emergency department visits ED, specialist outpatient clinic visits SOC, and total inpatient length of stay LOS. Methods : NICE patients enrolled between June 2014 to December 2015 were grouped as cases n=668. Unenrolled patients who were FA during the same period were designated as potential controls n=5,714, taking their third admission date during this period as proxy date of enrolment. Propensity score matching was conducted with the following: gender, race, age, residential housing type, number of comorbidities at enrolment, date of enrolment and pre-enrolment utilisation 1-year prior. This resulted in 604 matched case-control pairs. As the variance of each measure of utilisation is greater than its mean, negative binomial regression was used to model post-enrolment utilisation, adjusting for log-transformed pre-enrolment levels and matching propensity score, with an offset term to account for potential mortality during follow-up. We report incidence rate ratios IRR of cases to controls, with 95% confidence intervals 95%CI. Results : Cases unadjusted mean=6.7 had significantly fewer post-enrolment SOC than controls unadjusted mean=8.6, IRR=0.86 95%CI: 0.77-0.97. No statistically significant differences were observed for post-enrolment ADM, EM, ED, and LOS. Discussion : The results suggest that NICE provided adequate post-discharge follow-up care that patients would otherwise seek from SOC, thus potentially decreasing patients’ time and cost burden. For a significant proportion of patients in both groups, post-enrolment ADM, EM, ED, and LOS may have regressed to a low mean following an acute period of high admissions, resulting in floor effects which limit any further reductions in a 1-year period. Conclusion : NICE had an impact in reducing patients’ SOC post-discharge. Lessons Learned : The higher than expected variability in the utilisation patterns suggest FA are a heterogeneous group, and stratification could allow for more targeted interventions that better cater to care needs. Limitations : Patients were not randomised into cases and controls, but inherent bias from confounding factors was mitigated with matching. Different patient profiles and needs possibly also led to implementation inconsistencies. Suggestions for Future Research : Future research could stratify FA into subgroups and explore programme effects in reducing readmissions within patient subsets over a longer follow-up period. Targeted interventions for various subsets could be tested and inform future iterations of such programmes. Cost-benefit analysis should be conducted to determine if the savings from reduced SOC that are attributable to NICE outweighs the cost to run the programme.

The Course of Geriatric Syndromes in Acutely Hospitalized Older Adults: The Hospital-ADL Study

ObjectivesTo establish the prevalence and course of geriatric syndromes from hospital admission up to 3 months postdischarge and to determine the probability to retain geriatric syndromes over the period from discharge until 3 months postdischarge, once they are present at admission. DesignProspective multicenter cohort study conducted between October 2015 and June 2017. Setting and participantsAcutely hospitalized patients aged 70 years and older recruited from internal, cardiology, and geriatric wards of 6 Dutch hospitals. MeasuresCognitive impairment, depressive symptoms, apathy, pain, malnutrition, incontinence, dizziness, fatigue, mobility impairment, functional impairment, fall risk, and fear of falling were assessed at admission, discharge, and 1, 2, and 3 months postdischarge. Generalized estimating equations analysis were performed to analyze the course of syndromes and to determine the probability to retain syndromes. ResultsA total of 401 participants [mean age (standard deviation) 79.7 (6.7)] were included. At admission, a median of 5 geriatric syndromes were present. Most prevalent were fatigue (77.2%), functional impairment (62.3%), apathy (57.5%), mobility impairment (54.6%), and fear of falling (40.6%). At 3 months postdischarge, an average of 3 syndromes were present, of which mobility impairment (52.7%), fatigue (48.1%), and functional impairment (42.5%) were most prevalent. Tracking analysis showed that geriatric syndromes that were present at admission were likely to be retained. The following 6 geriatric syndromes were most likely to stay present postdischarge: mobility impairment, incontinence, cognitive impairment, depressive symptoms, functional impairment, and fear of falling. ImplicationsAcutely hospitalized older adults exhibit a broad spectrum of highly prevalent geriatric syndromes. Moreover, patients are likely to retain symptoms that are present at admission postdischarge. Our study underscores the need to address a wide range of syndromes at admission, the importance of communication on syndromes to the next care provider, and the need for adequate follow-up care and syndrome management postdischarge.

Epidemiology of Suicide and the Psychiatric Perspective.

Suicide is a worldwide phenomenon. This review is based on a literature search of the World Health Organization (WHO) databases and PubMed. According to the WHO, in 2015, about 800,000 suicides were documented worldwide, and globally 78% of all completed suicides occur in low- and middle-income countries. Overall, suicides account for 1.4% of premature deaths worldwide. Differences arise between regions and countries with respect to the age, gender, and socioeconomic status of the individual and the respective country, method of suicide, and access to health care. During the second and third decades of life, suicide is the second leading cause of death. Completed suicides are three times more common in males than females; for suicide attempts, an inverse ratio can be found. Suicide attempts are up to 30 times more common compared to suicides; they are however important predictors of repeated attempts as well as completed suicides. Overall, suicide rates vary among the sexes and across lifetimes, whereas methods differ according to countries. The most commonly used methods are hanging, self-poisoning with pesticides, and use of firearms. The majority of suicides worldwide are related to psychiatric diseases. Among those, depression, substance use, and psychosis constitute the most relevant risk factors, but also anxiety, personality-, eating- and trauma-related disorders as well as organic mental disorders significantly add to unnatural causes of death compared to the general population. Overall, the matter at hand is relatively complex and a significant amount of underreporting is likely to be present. Nevertheless, suicides can, at least partially, be prevented by restricting access to means of suicide, by training primary care physicians and health workers to identify people at risk as well as to assess and manage respective crises, provide adequate follow-up care and address the way this is reported by the media. Suicidality represents a major societal and health care problem; it thus should be given a high priority in many realms.

Is Mental Illness a Risk Factor for Hospital Readmission?

People with mental illnesses (MI) receive suboptimal care for medical comorbidities and their high risk for readmission may be addressed by adequate medication management and follow-up care. We examined the association between MI, medication changes, and post-discharge outpatient visits with 30-day readmission in 40,048 Medicare beneficiaries hospitalized for acute myocardial infarction, heart failure or pneumonia. Beneficiaries with MI were more likely to be readmitted than those without MI (14 vs. 11%). Probability of readmission was 13 and 12% when medications were dropped or added, respectively, versus 11% when no change was made. Probability of readmission also increased with outpatient visits.

Predictors of Follow-Up Visits Post Radical Prostatectomy.

Long-term follow-up care among prostate cancer patients is important as biochemical recurrence can occur many years after diagnosis, with 20%–30% of men experiencing biochemical recurrence within 10 years of treatment. This study examined predictors of follow-up care among 1,158 radical prostatectomy patients, treated at the Washington University in St. Louis, within 6 months, 1 year, and 2 years post surgery. Predictors examined included age at surgery, race (Black vs. White), rural/urban status, education, marital status, and prostate cancer aggressiveness. Multivariable logistic regression was used to assess the association between the predictors and follow-up visits with a urologist in 6 months, the 1st year, and the 2nd year post surgery. In a secondary analysis, any follow-up visit with a prostate-specific antigen (PSA) test was included, regardless of provider type. Men that were Black (6 months OR: 0.60; 95% CI [0.36, 0.99], 1 year OR: 0.34; 95% CI [0.20, 0.59], 2 year OR: 0.41; 95% CI [0.25, 0.68]), resided in a rural residence (1 year OR: 0.61; 95% CI [0.44, 0.85], 2 year OR: 0.41; 95% CI [0.25, 0.68]), or were unmarried (2 year OR: 0.69; 95% CI [0.49, 0.97]) had a reduced odds of follow-up visits with a urologist. In models where any follow-up visit with a PSA test was examined, race remained a significant predictor of follow-up. The results indicate that Black men, men residing in a rural residence, and unmarried men may not receive adequate long-term follow-up care following radical prostatectomy. These men represent a high-risk group that could benefit from increased support post treatment.

THE CLINICAL AND GENETIC ASPECTS OF DIFFUSE INFILTRATING RETINOBLASTOMA: A LITERATURE REVIEW AND CLINICAL CASE PRESENTATION

Purpose. The objective of the present study was to provide a short review and summarize the available information concerning the main symptoms of diffuse infiltrating retinoblastoma encountered in the ophthalmological practice and compare them with the manifestations of typical retinoblastoma. The secondary objective was to discuss the genetic paradigm of diffuse infiltrating retinoblastoma that is frequently interpreted as a sporadic condition despite the evidence suggesting its genetic predisposition and inheritable etiology that have become increasingly widely recognized during the last years. A literature search for the information about diffuse infiltrating retinoblastoma in the Russian, English, German, and Spanish scientific journals made it possible to reveal a total of 77 patients described in the available literature. In addition, the main specific clinical and gender-related features of diffuse infiltrating retinoblastoma were identified. The results of initial working diagnostics and referral diagnoses are presented with special reference to the importance of the molecular-genetic analysis and the multidisciplinary approach to the treatment and examination of the patients and their relatives. It is concluded that the adequate medical follow-up care needs to be provided in order to diagnose the possible associated cancers. A clinical case of diffuse infiltrative retinoblastoma in a 6-year old male patient is presented.