Follow-up Care Of Patients Research Articles

STI/HIV care in times of COVID-19 according to Dutch healthcare professionals: A mixed methods study

Abstract Background Surveillance data from the Netherlands show that STI/HIV testing decreased at the start of the COVID-19 pandemic, suggesting barriers in access to STI/HIV care. However, the impact of the pandemic on STI/HIV care may be more complex, and key populations could be differentially affected. The aim of this study was to gain more insight into the impact of COVID-19 on STI/HIV care in the Netherlands from the perspective of STI/HIV care providers. Methods We investigated whether professionals in STI/HIV care experienced changes compared to pre-COVID in access to care, demand and provision of care, shifts online care, and quality of care. An online survey was completed by 192 STI/HIV care professionals. Additionally, semi-structured interviews were held with 23 STI/HIV care professionals. Results According to participants, specific subgroups of priority populations may have had difficulties accessing STI/HIV care during the pandemic especially during lockdowns and at public sexual health services. Professionals were concerned to have lost sight of subpopulations in vulnerable circumstances and that the pandemic may have magnified inequalities in access to STI/HIV care, which may be related to different levels of health and digital literacy required for telephone and video consultations. Furthermore, participants found online care provision was not up to standards and were concerned about follow-up care for patients using private online providers of remote tests. Conclusions Professionals experienced that COVID-19 measures may have compounded existing disparities. To minimize inequalities in access to STI/HIV care during a pandemic, it is recommended to prioritize services for people in vulnerable circumstances such as recent migrants and people with low health or digital literacy. More collaboration between and within sectors may help in better organizing healthcare and prevent overburdening of specific sectors. Key messages • According to STI/HIV care providers, the COVID-19 pandemic differentially impacted different STI/HIV care sectors, but also increased existing inequalities in access to care for vulnerable groups. • Professionals experienced that COVID-19 measures impacted the provision of STI/HIV care, access to care for vulnerable populations, and quality of care.

Evolution of radiology staff perspectives during artificial intelligence (AI) implementation for expedited lung cancer triage

To investigate radiology staff perceptions of an AI tool for chest radiography triage, flagging findings suspicious for lung cancer to expedite same-day CT chest examination studies. Surveys were distributed to all radiology staff at three time points: at pre-implementation, one month and also seven months post-implementation of artificial intelligence (AI). Survey questions captured feedback on AI use and patient impact. Survey response rates at the three time periods were 23.1% (45/195), 14.9% (29/195) and 27.2% (53/195), respectively. Most respondents initially anticipated AI to be time-saving for the department and patient (50.8%), but this shifted to faster follow-up care for patients after AI implementation (51.7%). From the free text comments, early apprehension about job role changes evolved into frustration regarding technical integration challenges after implementation. This later transitioned to a more balanced view of recognised patient benefits versus minor ongoing logistical issues by the late post-implementation stage. There was majority disagreement across all survey periods that AI could be considered to be used autonomously (53.3-72.5%), yet acceptance grew for personal AI usage if staff were to be patients themselves (from 31.1% pre-implementation to 47.2% post-implementation). Successful AI integration in radiology demands active staff engagement, addressing concerns to transform initial mixed excitement and resistance into constructive adaptation. Continual feedback is vital for refining AI deployment strategies, ensuring its beneficial and sustainable incorporation into clinical care pathways.

Evaluation of the practice of reprocessing ORs in German hospitals from an infection prevention and control perspective.

The aim of this study was to analyze the cleaning and disinfection of operating rooms (ORs) status quo focusing on hygiene plans in German hospitals. In 2016, a structured online survey was sent to infection prevention and control (IPC) specialists at the cost calculation hospitals of the Institute for the Hospital Remuneration System (InEK) and all university hospitals in Germany (n = 365). With a response rate of 27.4%, 78% stated that written hygiene plans were available. After cleaning and disinfecting an OR with a "septic" patient, 55% waited until surfaces were dry before reusing in accordance with national recommendations, 27% waited > 30min. Additionally, 28% of hospitals had ORs only for "septic" patients. In 56% "septic" patients were only operated on at the end of the program. Postoperative monitoring of patients with bacteria with special IPC requirements took place in the post anesthesia care unit (PACU) (29%), operating room (OR) (52%), intensive care unit (ICU) (53%), and in the intermediate care unit (IMC) (19%). Despite written hygiene plans in place the partly long duration of OR nonuse time following IPC measures, the consistent continued use of stratification for "septic" patients and the postoperative follow-up care of patients with colonizing/infecting bacteria with special IPC requirements in the OR and high care areas represent relevant potential for improvement.

The Impact of the COVID-19 Pandemic on STI and HIV Services in the Netherlands According to Health Care Professionals.

Surveillance data from the Netherlands show that STI/HIV testing decreased at the start of the COVID-19 pandemic, suggesting barriers to access to STI/HIV care. However, the impact of the pandemic on STI/HIV care may be more complex, and key populations could be differentially affected. The aim of this study was to gain more insight into the impact of COVID-19 on STI/HIV care in the Netherlands from the perspective of STI/HIV care providers. We investigated whether professionals in STI/HIV care experienced changes compared to pre-COVID in access to STI/HIV care for priority populations, demand and provision of STI/HIV care, shifts to online STI/HIV counseling and care, and the quality assurance of STI/HIV care. An online survey was completed by 192 STI/HIV care professionals. Additionally, semi-structured interviews were held with 23 STI/HIV care professionals. According to participants, people in vulnerable circumstances, such as recent migrants and people with low health or digital literacy, may have had difficulties accessing STI/HIV care during the pandemic, especially during lockdowns and at public sexual health services. Hence, these may not have received the care they needed. Participants thought that COVID-19 measures may have compounded existing disparities. Furthermore, participants found that online care provision was not up to standard and were concerned about follow-up care for patients using private online providers of remote tests. It is important to explore how STI/HIV care for people in vulnerable circumstances can be ensured in future public health crises.

Clinician- and Patient-Identified Solutions to Reduce the Fragmentation of Post-ICU Care in Australia

BackgroundCritical care survivors experience multiple care transitions, with no formal follow-up care pathway. Research QuestionWhat are the potential solutions to improve the communication between treating teams and integration of care following an Intensive Care Unit (ICU) admission – from the perspective of patients, their caregivers, intensivists, and General Practitioners (GPs) from diverse socioeconomic areas? Study Design& Methods: Qualitative design using semi-structured interviews with intensivists, GPs, and patients and caregivers. Framework Analysis was used to analyse data, and to identify solutions to improve the integration of care post-hospital discharge. Patients were previously mechanically ventilated for >24 hours in ICU and had access to a video-enabled device. Clinicians were recruited from hospital networks and a state-wide GP network. ResultsForty-six interviews with clinicians, patients and caregivers were completed (15 Intensivists, 8 GPs, 15 patients and 8 caregivers). Three higher-level feedback loops were identified, that comprised of ten themes. Feedback loop 1: ICU and primary care collaboration: 1. Developing collaborative relationships between the ICU and primary care, 2. Providing interprofessional education and resources to support primary care, 3. Improving role clarity for patient follow-up care; Feedback loop 2: Developing mechanisms for improved communication across the care continuum: 4. Timely, concise information sharing with primary care on post-ICU recovery, 5. Survivorship focused information sharing across the continuum of care, 6. Empowering patients and caregivers in self-management; 7. Creation of a care coordinator role for survivors; and Feedback loop 3: Learning from post-ICU outcomes to improve future care: 8. Developing comprehensive post-ICU care pathways, 9. Enhancing support for patients after hospital, 10. Integration of post-ICU outcomes within the ICU to improve clinician morale and understanding. InterpretationPractical solutions to enhance the quality of survivorship for critical care survivors and their caregivers were identified. These themes are mapped to a novel conceptual model that includes key feedback loops for health system improvements and foci for future interventional trials to improve ICU survivorship outcomes.

Abstract B006: Association between unmet needs and resilience among cancer survivors in Kentucky

Abstract Introduction: Despite efforts to improve patient follow-up care, cancer survivors still face challenges in addressing their mental, physical, and social well-being. Resilience, the patients’ ability to thrive and adapt following cancer diagnosis and treatment, is dynamic and variable within and between populations. Previous literature has reported a low level of resilience among those with higher levels of unmet needs. However, there is a need to assess whether the effect on resilience differs by domain to help tailor interventions. The objective of this exploratory analysis is to measure prevalent unmet needs among cancer survivors in Kentucky and to analyze the association between specific domains of unmet needs and resilience. Methods: LADDER (Life After Diagnosis and Descriptors of Experience and Responses) Study is a pilot project to evaluate the feasibility of online methods of collecting preliminary data for psychosocial factors in cancer survivors. Kentucky residents 18 years and older with a cancer diagnosis within 12 months were eligible to enroll. The CaSUN instrument was used among those who completed active cancer treatment to identify prevalent unmet needs across five domains: Information, Existential Survivorship, Comprehensive cancer care, Quality of Life (QOL), and Relationships. Multivariable logistic regression was used to calculate Odds Ratios (OR) and 95% Confidence Intervals (CI) adjusting for age, sex, education, employment, rural residence, cancer type, and time since diagnosis to estimate the likelihood of self-perceived low resilience, measured by the brief 10-item Connor Davidson Resilience Scale. Results: Of the 57 eligible participants, 46 were included in the analysis (80.7%) after accounting for missing data. A majority (67.4%) reported unmet needs for available information and access to the best medical care. Approximately 88% of those who reported unmet needs regarding cancer care were college graduates. Moreover, the majority who reported unmet needs in all five domains were younger (20-44 years), females, employed, and urban residents. Cancer survivors who reported unmet needs in information (OR: 1.14; 95% CI: 0.19, 6.97), existential survivorship (OR: 2.77; 95% CI: 0.58, 13.16), relationship (OR: 1.17; 95% CI: 0.24, 5.73) and QOL (OR: 2.08; 95% CI: 0.40, 10.82) domains had higher odds of reporting self-perceived low resilience; however, these results were not statistically significant. Negative confounding in adjusted models was observed, where survivors who reported unmet needs related to existential survivorship were 4.9 times more likely to report self-perceived low resilience. Conclusions: Based on this exploratory analysis, unmet needs in the existential survivorship domain, which includes stress reduction, coping mechanisms, and social support, is associated with low resilience. Employment and college education explained more of the likelihood of self-perceived low resilience. Understanding specific needs and factors that affect survivors’ resilience is essential to ongoing survivorship care. Citation Format: Stephie Abraham, Hoa Nguyen, Kathy B. Baumgartner, Richard Baumgartner, Stephanie Boone. Association between unmet needs and resilience among cancer survivors in Kentucky [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B006.

Abstract 15359: Impact of App-Based Monitoring and Remote Patient Management Services on Real-World Cardiac Device Clinic Workflow

Introduction: Remote monitoring (RM) is recommended as standard of care for follow-up of patients implanted with cardiac devices. International medical societies have advised that reducing the frequency of or eliminating routine in-office visits is possible, if RM compliance is ensured. With the growing patient population, staff workload to manage RM is increasing. Solutions are needed to alleviate clinic burden. Hypothesis: A technology and service-enabled workflow including app-based monitoring, patient support, and monitoring and triaging services can positively impact clinic efficiency and satisfaction. Methods: A workflow survey for LINQ II insertable cardiac monitor (ICM) was undertaken, including questions about RM. Respondents were clinicians at 66 clinics in UK/Ireland, managing an average of 563 ICM patients per clinic. Results: With app-based monitoring, workflow was rated as somewhat or much more efficient for 72% of users, with reduction in phone calls and disconnected patients highlighted as improvements (Table). The patient support service, including RM education, ordering the appropriate monitor, initial set-up, troubleshooting, and answering patient phone calls, saved 30.6 mins per implanted patient. The monitoring and triaging service had a positive efficiency impact for 69% of users. A majority of respondents were moderately or extremely satisfied with the RM solutions offered: 88% for being provided different options (app/hardware), 75% for users of the support service and 71% for users of the monitoring/triaging service. App-based monitoring was considered moderately or extremely easy by 77% of users and 79% were moderately or extremely satisfied with it. Conclusions: This survey suggests that app-based RM, patient support and monitoring and triaging services provide satisfaction and workflow efficiency improvements. Enabling time savings for RM is key to optimize management of the growing population of implanted patients.

WILLIAMS SYNDROME IN PEDIATRIC PRACTICE

This clinical case presents our observations of a 5-month-old boy diagnosed with Williams’s syndrome, highlighting the complexities of recognizing this condition, especially in the early stages of life, where paediatricians and neonatologists play a crucial role in the diagnostic process. Williams’s syndrome is a rare genetic disorder, affecting approximately 1 in 10,000 newborns across different ethnic groups and genders. The condition is primarily caused by a mutation in a group of genes located on the long arm of the 7th chromosome (7q11.23), leading to microdeletion and the loss of specific genes, including elastin, LIM-kinase-1, and replication factor C2 (RFC), while some "lost" genes remain unidentified. In rarer cases, deletions are found on the 11th and 12th chromosomes (11q13-q14 and 22q). This syndrome often presents sporadically, complicating early diagnosis due to its multisystem nature, affecting various organs and systems, such as the cardiovascular, nervous, muscular, urinary, and facial structures. The absence of timely diagnosis and treatment can adversely impact physical and neuropsychological development in affected children. In our case, the final diagnosis was confirmed through molecular genetic examination. Our conclusion highlights the challenges of diagnosing Williams’s syndrome due to its multisystem clinical manifestations. Early diagnosis is essential for parents to gain insights into the disease, its prognosis, and to make informed decisions about raising the child within the family. We recommend a comprehensive approach to the care and rehabilitation of patients with Williams’s syndrome. This necessitates the coordinated efforts of various specialists including paediatricians, geneticists, cardiologists, surgeons, orthopaedists, orthodontists, endocrinologists, ophthalmologists, neurologists, and psychologists throughout the patient's follow-up care.

A scoping review on the factors associated with the lost to follow-up (LTFU) amongst patients with chronic disease in ambulatory care of high-income countries (HIC)

BackgroundDespite the importance of long term follow-up care for patients with chronic disease, many patients fail to adhere to their follow-ups, which increase their risk of further health complications. Therefore, the purpose of this scoping review was to find out the factors associated with lost to follow-up (LTFU) amongst patients with chronic disease in the ambulatory care setting of high-income countries (HICs) to gain insights for better quality of care. Understanding the definition of LTFU is imperative in informing patients, health professionals and researchers for clinical and research purposes. This review also provided an overview of the terms and definitions used to describe LTFU.MethodsThe following databases: CINAHL, EMBASE, Medline, PsycINFO and Web of Science were searched for studies investigating the factors associated to LTFU from the date of inception until 07 January 2022.ResultsFive thousand one hundred and seven records were obtained across the databases and 3,416 articles were screened after removing the duplicates. 25 articles met the inclusion criteria, of which 17 were cohort studies, five were cross-sectional studies and three were case-control studies. A total of 32 factors were found to be associated with LTFU and they were categorised into patient factors, clinical factors and healthcare provider factors.ConclusionOverall, the factors associated with LTFU were generally inconsistent across studies. However, some factors such as financial factors (i.e., no insurance coverage) and low accessibility of care were consistently associated with LTFU for both mental and physical chronic conditions. The operational definitions of LTFU also varied greatly across studies. Given the mixed findings, future research using qualitative aproaches would be pivotal in understanding LTFU for specific chronic diseases and the development of targeted interventions. Additionally, there is a need to standardise the operational definition of LTFU for research as well as clinical practice purposes.

Outcomes and Follow-Up after Hepatitis C Eradication with Direct-Acting Antivirals.

Treatment of hepatitis C (HCV) has been revolutionized with the introduction of direct-acting antivirals (DAAs). Patients can be treated at more advanced stages of liver disease, with a growing number of cirrhotic patients achieving sustained virological response (SVR). Long-term outcomes for cured patients and the optimal follow-up care of patients after SVR are yet to be defined, because most studies on cirrhotic patients cured with DAAs have a short follow-up period. There are many open questions related to patient management after viral eradication with DAAs, such as which could be the most reliable non-invasive tool to predict liver-related complications, or to what extent viral eradication reduces the risk of liver disease progression in the long term. Growing evidence supports the personalization of follow-up care based on individual risk. The aim of this narrative review is to analyze the impact of viral eradication with DAAs on clinically significant portal hypertension, hepatocellular carcinoma, and extrahepatic manifestations, as well as to summarize indications for optimal follow-up care of HCV patients treated with DAAs.

Abstract P5-04-04: Does reducing the frequency of regularly scheduled physical examinations affect recurrence detection in patients with early breast cancer?

Abstract Purpose: Follow-up care of patients with early breast cancer (EBC) usually includes routinely scheduled physical examinations. While ASCO guidelines recommend a physical exam every three to six months for the first three years, there is little evidence to support this schedule. Health care systems continue to be challenged to meet the future growth in demand from increasing numbers of diagnosed patients and long-term survivors, scarcity of health care workers, and the need to control health care costs. Despite recognition that new follow-up models are needed, there continues to be no generally accepted well follow-up strategy. We evaluated recurrence detection patterns of patients transferred into a single centre survivorship program that follows ASCO recommendations. Methods: Consecutive patients with EBC referred to the Wellness Beyond Cancer Program (WBCP) between February 1, 2013, and January 1, 2019, who had breast cancer recurrence, were reviewed. Descriptive analyses were used to present patients and disease characteristics stratified by type of recurrence and mode of cancer detection. Results: Of 206 recurrences, 135 were distant recurrences (65.5%), 41 were ipsilateral breast recurrences (19.9%), and 30 were contralateral new breast cancers (14.6%). Patient reported symptoms lead to the detection of the majority of distant recurrences (125/135, 92.6%). The most common symptoms of recurrence were bone pain (24.8%), dyspnea/cough (13.1%), abdominal pain (10.7%). Ipsilateral breast recurrences were both quite frequently detected by patients (22/41, 53.7) and by routine mammographic surveillance (17/21, 41.5%). Contralateral breast cancers were primarily detected by imaging 83.3% (25/30). Only 2/206 (1.14%) recurrences/new primaries were detected by a healthcare provider at routinely scheduled follow-up visits. There was a statistical difference in recurrence detection between image detected vs. self-detected in the following factors: grade 3 (26.5% vs 51%, p < 0.007), triple negative breast cancer (3.9% vs. 15.1%, p=0.03), and HER2 disease (18.4% vs. 9.8%, p= 0.04). Conclusions: Despite regularly scheduled in-person follow-up visits following ASCO guidelines, healthcare providers rarely detect recurrences. Our data suggests that 30,000 – 35, 000 follow-up visits were required for the healthcare providers to detect these 2 recurrences. This leads to further need for proper survivorship programs with patient and provider education, and concentration on targeted surveillance. Provided patients attend regular screening tests, our data points to less frequent in-person follow-up being associated with non-inferior breast cancer-related outcomes. Future prospective studies are required looking at different models of follow-up. SABCS Abstract Table Citation Format: Ana-Alicia Beltran-Bless, Bader I. Alshamsan, Mashari Alzahrani, John Hilton, Kelly-Anne Baines, Vicky Samuel, Gregory R. Pond, Lisa Vandermeer, Mark Clemons, Gail Larocque. Does reducing the frequency of regularly scheduled physical examinations affect recurrence detection in patients with early breast cancer? [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-04-04.

AI and Incidental Findings

AI and Incidental Findings

Variability in surveillance practice for patients with diagnosis of bicuspid aortic valve syndrome

In patients with bicuspid aortic valves, guidelines call for regular follow-up to monitor disease progression and guide intervention. We aimed to evaluate how closely these recommendations are followed at a tertiary care center. Among 48,504 patients who received echocardiograms (2013–2018) at a tertiary care center, 245 patients were identified to have bicuspid aortic valve. Bivariate analyses compared characteristics between patients who did and did not receive follow-up by a cardiovascular specialist. During a median follow-up of 3.5 ± 2.2 years (mean age 55.2 ± 15.6 years, 30.2% female), 72.7% of patients had at least one visit with a cardiovascular specialist after diagnosis of bicuspid aortic valve. These patients had a higher proportion of surveillance by echocardiogram (78.7% vs. 34.3%, p < .0001), CT or MRI (41.0% vs. 3.0%, p < .0001), and were more likely to undergo surgery. Patients with moderate-severe valvular or aortic pathology were not more likely to be followed by a specialist or receive follow-up echocardiograms. Follow-up care for patients with bicuspid aortic valve was highly variable, and surveillance imaging was sparse despite guidelines. There is an urgent need for mechanisms to monitor this population with increased risk of progressive valvulopathy and aortopathy.

Postoperative Metabolic Phenoreversion in Clear Cell Renal Cell Carcinoma

The ultimate goal of surgical treatment in cancer is to remove the tumor mass for restoring a healthy state. A 16-lipid panel that discriminated healthy controls from clear cell renal cell carcinoma (ccRCC) patients in a prior study was evaluated in the present work in paired-serum samples collected from patients (n = 41) before and after nephrectomy. Changes in the lipid and metabolite fingerprints from ccRCC patients were investigated and compared with fingerprints from healthy individuals obtained by means of ultra-performance liquid chromatography-high-resolution mass spectrometry. The lipid panel differentiated phenotypes associated with metabolic restoration after surgery, representing a serum signature of phenoreversion to a healthy metabolic state. In particular, PC 16:0/0:0, PC 18:2/18:2, and linoleic acid allowed discriminating serum samples from ccRCC patients with poor prognosis from those with an improved outcome during the follow-up period. Ratios of PC 16:0/0:0 and PC 18:2/18:2 with linoleic acid levels may contribute as prognostic tools to support decision-making during the patient follow-up care. The preliminary character of these results should be validated with larger cohorts, including subjects with different ethnicities, life style, and diets. MetaboLights study references: MTBLS1839, MTBLS3838, and MTBLS4629.

Dobbs v. Jackson Women’s Health: An Historical Perspective on Medical Boards, Disciplinary Actions, and Abortion

<i>Dobbs v. Jackson Women’s Health:</i> An Historical Perspective on Medical Boards, Disciplinary Actions, and Abortion

Incidence and predictors of mortality among adolescents on antiretroviral therapy in Amhara Region, Ethiopia: a retrospective cohort analysis

ObjectiveThis study aimed to assess the incidence and predictors of mortality in adolescents receiving antiretroviral therapy (ART) in Ethiopia’s Amhara Region.DesignWe conducted an institution-based retrospective follow-up study.SettingsThe study was conducted...

The predictive role of mean platelet volume to lymphocyte ratio and neutrophil-to-lymphocyte ratio for cardiovascular events in adult patients with acute heart failure

Abstract Introduction The inflammatory response plays a potential role for the pathogenesis and adverse outcomes of heart failure (HF). Purpose We aimed to explore the predictive role of neutrophil-to-lymphocyte ratio (NLR) and mean platelet volume to lymphocyte ratio (MPVLR) on cardiovascular events (CVEs) in patients hospitalized with acute HF. Methods A retrospective cohort study was conducted in 321 patients with HF between January 2017 and December 2019. The association between their NLR, MPVLR and combined NLR and MPVLR, and CVEs, HF re-hospitalization, in-hospital death, and a composite outcome were explored by survival analysis using a Cox proportional hazard model. They were separately investigated and compared with the area under the receiver operating characteristics curve (AUC). Results Up to the end of the 3-year follow-up, 96 (29.9%) had CVEs, 106 (33.0%) died, 62 (19.3%) were re-hospitalized with HF, and 21 (6.5%) died during admission. The NLR and MPVLR were significantly associated with CVEs (adjusted HR for NLR ≥3.29, 3.11; 95% CI, 1.98–4.89, MPVLR ≥8.57, 2.86; 95% CI, 1.87–4.39), HF readmission (adjusted HR for NLR ≥3.58, 2.70; 95% CI, 1.58–4.61, MPVLR ≥6.43, 2.84; 95% CI,1.59–5.07), in-hospital mortality (adjusted HR for NLR ≥3.29, 9.54; 95% CI, 2.19–41.40, MPVLR ≥8.57, 7.87; 95% CI, 2.56–24.19), and composite outcome (adjusted HR for NLR ≥3.32, 4.76; 95% CI, 3.29–6.89, MPVLR ≥7.07, 3.64; 95% CI, 2.58–5.15). The AUC of NLR and MPVLR for CVEs were 0.67 (95% CI, 0.61–0.72), and 0.63 (95% CI, 0.58–0.69). Combined NLR and MPVLR increased the AUC to 0.77 (95% CI, 0.72–0.83) with statistical significance. Conclusion The elevated NLR and MPVLR on admission in patients with acute HF were independently associated with worse CVEs, HF re-hospitalization, in-hospital death, and composite outcomes. These economical biomarkers should be considered in the management and follow-up care of patients with acute HF. Funding Acknowledgement Type of funding sources: None.

Critical Test Result Recall Supporting System (CTR RSS) Improves Follow-Up among Patients in the Community.

Follow-up care of patients in the community is an important topic for improving patient outcomes, especially when medical personnel receives a notification of the critical test result (CTR) when the CTR becomes available after patients have been out of hospital; how to recall the patient back to the hospital and follow-up treatment is essential for preventing the healthcare risk of neglecting or delayed intervention with respect to the patient’s CTR. We are concerned that the follow-up of CTR and timely recall of our patients in the community improves and facilitates patient safety. We built the CTR Recall Supporting System (RSS) to follow up and recall our patients in the community. Measures were introduced to evaluate the effectiveness of CTR RSS; the rate of return of patients within 7 days increased from 58.5% to 88.8%, an increase of 30.3%, the patients in the community’s return follow-up interval days decreased from 10.9 days to 6.2 days, reduced by 4.7 days (p < 0.001), and the mortality rate of the patients in the community within 48 h decreased from 8.0% to 1.9%, a decrease of 6.1%, p < 0.001. The implementation of the CTR RSS significantly increases the discharged patient in he community’s CTR return follow-up within 7 days rate, decreases CTR return follow-up interval days, and reduces the CTR mortality rate within 48 h. This effectively improves the effects of CTR on return follow-up visits and provides a prototype system for hospitals that intend to improve this issue.

Hemato-Oncological Diseases as Risk Factor for Recurrence or Metastasis of Pleomorphic Dermal Sarcoma

BackgroundAtypical fibroxanthoma (AFX) and pleomorphic dermal sarcoma (PDS) are increasingly common sarcomas of the skin with a genetic UV signature. Immunosuppression is a known risk factor for developing other UV-induced skin cancers such as cutaneous squamous cell carcinoma (cSCC), basal cell carcinoma (BCC), and Merkel cell carcinoma with increased mortality. In case reports or small case series of AFX/PDS patients, immunosuppression has been hypothesized as a risk factor for the development of distant metastases. The aim of the present study was to analyze immunosuppression as a risk factor for AFX/PDS in a large patient cohort.MethodsA cohort of 164 patients with AFX/PDS (47 AFX and 117 PDS) was collected between 2003 and 2021 and analyzed for clinicopathological data with a special focus on immunosuppression.ResultsOf all patients, 29.9% had any kind of immunosuppression; 6.4% of the AFX and 12.0% of the PDS patients had underlying hemato-oncological diseases. Patients with immunosuppression due to an underlying hemato-oncological disease had a significantly increased risk of progressing to (p = 0.010) and developing distant organ metastases (p = 0.000).ConclusionsImmunosuppression seems to be a risk factor for developing AFX/PDS with worse clinical outcomes. Therefore, immunosuppression, especially underlying hemato-oncological diseases, should be considered in the treatment and follow-up care of patients with AFX/PDS.

Insight into the number of patients diagnosed with basal cell carcinoma in the Netherlands and an estimation of future numbers

British Journal of DermatologyVolume 186, Issue 3 p. e121-e121 Plain Language SummaryFree Access Insight into the number of patients diagnosed with basal cell carcinoma in the Netherlands and an estimation of future numbers First published: 07 March 2022 https://doi.org/10.1111/bjd.20994AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Abstract Linked Article: Schreuder et al. Br J Dermatol 2022; 186:476–484. Basal cell carcinoma (BCC) is a type of skin cancer and is largely caused by a lot of exposure to the sun or tanning beds. It mostly develops on areas of the skin that have most exposure to the sun. It appears as a small skin-coloured bump. BCC is the most common form of cancer in the Netherlands and the number of people diagnosed with it continues to rise. Although BCC grows slowly and rarely spreads beyond the original tumour site, treatment is necessary and therefore this results in pressure on healthcare services. Information from the Netherlands Cancer Registry was used to calculate the number of BCC diagnoses over the period 2001 to 2019. We investigated changes in the yearly number of patients diagnosed with a BCC and we also looked at BCC in different age groups. The percentage of patients that developed more than one BCC was calculated. Finally, the number of likely diagnoses in 2029 was estimated. We found that the number of patients diagnosed with a BCC was twice as high in 2019 (almost 50,000 diagnoses) compared with 2001. However, after a steep increase before 2009, no further increase was seen for younger patients. A quarter of the patients with a first diagnosis developed more BCC within 3 years. A further increase in the number of diagnoses is expected in 2029. The results of this study are important for policymakers – efficiency in the diagnosis, treatment and follow-up care of patients should be improved. Volume186, Issue3March 2022Pages e121-e121 RelatedInformation