Follow-up Status Research Articles

Intracranial Dural Arteriovenous Fistulas with Cortical Venous Drainage: Radiosurgery as an Effective Alternative Treatment

To evaluate the clinical and radiological outcome of Gamma Knife radiosurgery (GKS) in treatment of intracranial dural arteriovenous fistula (DAVF) with cortical venous drainage (CVD) and compare it with the outcome of endovascular therapy. Patients who underwent GKS or endovascular therapy for intracranial DAVF with CVD over 10 years (January 2007 to December 2016) at the All India Institute of Medical Sciences, New Delhi, were included. Demographics, clinical presentation, imaging details, and follow-up clinical status were reviewed retrospectively. Clinical follow-up was conducted once every 6 months. Radiological follow-up using digital subtraction angiography was performed at a mean 24 months after intervention. Patients with clinical follow-up of <1 year were excluded from the study. The study included 35 patients (26 in embolization group and 9 in GKS group) who had intracranial DAVF with CVD were included in the study. Clinical improvement was seen in 77.78% of the patients who received GKS and 57.7% of the patients who underwent embolization (P= 0.431). Complete obliteration of DAVF was seen in 55.56% of the patients in the GKS group and 57.7% of the patients in the embolization group (P= 1). GKS was at least as effective as embolization in terms of clinical and radiological outcome in treatment of intracranial DAVF with CVD. Contrary to popular perception, GKS should be considered as an effective first-line treatment alternative of intracranial DAVF with CVD.

Abstract 13328: Effect of Atrial Fibrillation on Patient-Reported Outcomes in Heart Failure and Preserved Ejection Fraction: Secondary Analysis of Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT) Trial

Introduction: Atrial fibrillation (AF) and heart failure (HF) both significantly impact morbidity and mortality, and also account for impaired quality of life. Patient-reported outcomes represent the most direct measurement of quality of life, without influence of interpretation by the clinician. We sought to evaluate the effect of AF on patient-reported outcomes using the Kansas City Cardiomyopathy Questionnaire (KCCQ) in patients with HF with preserved ejection fraction (HFpEF) enrolled in TOPCAT trial. Methods: This was an exploratory post-hoc analysis of the TOPCAT trial. Patients with reported KCCQ at randomization were included in this analysis. KCCQ was collected at randomization, 4, 12, 24, 36, 48, and 72 months. Mixed model repeated measure ANOVA was used to explore the effect of AF status at the time of randomization on longitudinal changes in the KCCQ- overall symptom score (OSS) over the duration of follow-up. Covariates adjusted for included age, gender, race, diabetes mellitus, history of HF hospitalization and use of ACEIs or ARBs. Results: A total of 3403 patients (mean age 68.5±9.5 years, females 51.5%) with available KCCQ-OSS at baseline were included. AF was prevalent in 1202 (35.3%) patients at baseline (mean age 71.0±9.3, 46.3% women, 91.7% white). AF patients had higher prevalence of stroke, diabetes mellitus, hypertension and lower prevalence of HF hospitalization. Over the duration of follow-up, there was a significant time by AF status interaction (p&lt;0.001), suggesting that KCC-OSS changed differently overtime based on the AF status. Conclusions: Among patients with HFpEF from TOPCAT cohort, prevalent AF at baseline was associated with lower quality of life and lower KCCQ-OSS over 5 years of follow-up, suggested by the significant interaction between AF status and time of follow-up.

NCOG-36. LONG-TERM SURVIVAL AND COGNITIVE FUNCTION FOLLOW UP OF PRIMARY CNS LYMPHOMA TREATED WITH R-MVP FOLLOWED BY HIGH DOSE CHEMOTHERAPY WITH AUTOLOGOUS STEM CELL TRANSPLANT CONSOLIDATION

Abstract BACKGROUND Primary central nervous system lymphoma (PCNSL) is a rare central nervous system malignancy, and long-term follow up studies are uncommon. First line therapy is based on high-dose methotrexate and different consolidation therapy options. This is a long-term follow up study of PCNSL patients enrolled in a prospective trial using R-MPV chemotherapy regimen followed by high dose chemotherapy and autologous stem cell rescue to determine long-term survival and cognitive effects. METHODS From June 2005 to September 2011, 32 newly diagnosed immunocompentent PCNSL were enrolled. Patients received 5-7 doses of rituximab (500mg/m2), methotrexate (3.5 gm/m2), procarbazine (100mg/m2), and vincristine (1.4mg/m2) (R-MVP). Consolidation therapy consisted of high dose chemotherapy (HDC) with thiotepa (250 mg/m2), busulfan (3.2 mg/kg), and cyclophosphamide (60 mg/kg), followed by autologous stem cell rescue (ASCT) in those with partial or complete response to R-MVP. Long-term follow-up status including disease status, cognitive status (KPS, NANO score), and leukoencephalopathy (modified Fazkas Scale) were collected. RESULTS 26 of 36 underwent HDC and ACST. Of those, 3 died due to treatment related effects; 2 died of disease progression within two years after ASCT. After a median follow-up of 10.5 years, none of the remaining 21 patients progressed. At the time of last follow up, the median KPS was 90, compared to 80 at time of ASCT. The median NANO score and leukoencephalopathy score post ASCT and at follow-up did not change. Of note, 2 of 4 patients with a partial or complete response to R-MVP that elected not to proceed with HDC-ASCT consolidation, experienced progression at a mean of 52 months. CONCLUSION Long-term follow up demonstrates that treatment was tolerated well with stable leukoencephalopathy on MRI and good performance status. Disease recurrence 2 years after HDC with ASCT consolidation was not observed.

The reasons for and mortality of patients unable to receive reimplantation after resection arthroplasty for chronic hip periprosthetic infection.

Two-stage exchange arthroplasty is a feasible treatment for chronic PJI (periprosthetic joint infection) of total hip arthroplasty (THA). However, there are large numbers of patients who are unable to ultimately receive reimplantation after resection arthroplasty owing to uncontrolled infection and multiple comorbidities. The purpose of the current study was to identify patient-related risk factors and reasons for being unable to undergo revision THA. Individuals undergoing resection arthroplasty for chronic PJI treatment from 2013 to 2020 at our institution were retrospectively reviewed. A variety of patient comorbidities, laboratory data, isolated pathogens, and follow-up status were collected for analysis. A total of 84 patients (46 men and 38 women) with a 2.7 ± 2.1-year follow-up were analyzed. Thirty-eight (45.2%) patients eventually underwent revision THA, while the other 46 (54.8%) did not receive reimplantation during follow-up. The patients without receiving reimplantation had higher Charlson comorbidity index (CCI) score (3.1 ± 2.9 versus 1.2 ± 1.5; p = 0.001). Lower cumulative incidence of receiving reimplantation was observed in patients with chronic kidney disease (log-rank test, p = 0.019), anemia (p = 0.011), presence of initial fever (p = 0.030), and oxacillin-resistant strain infection (p = 0.030). The most common reasons for not receiving reimplantation were uncontrolled infection, unstable medical conditions, and death. The patients without reimplantation had a relatively higher mortality rate (log-rank test, p = 0.002). Chronic hip PJI with poor medical conditions or oxacillin-resistant strain infection decreased the chance of undergoing revision surgery. These patients had unfavourable outcomes and a higher mortality rate after resection arthroplasty.

Safety and Preliminary Efficacy from the Expansion Cohort of a Phase 1/2 Study of Venetoclax Plus Daratumumab and Dexamethasone Vs Daratumumab Plus Bortezomib and Dexamethasone in Patients with t(11;14) Relapsed/Refractory Multiple Myeloma

Safety and Preliminary Efficacy from the Expansion Cohort of a Phase 1/2 Study of Venetoclax Plus Daratumumab and Dexamethasone Vs Daratumumab Plus Bortezomib and Dexamethasone in Patients with t(11;14) Relapsed/Refractory Multiple Myeloma

Early and Late Outcomes of Cardiovascular Surgery in Patients With Ehlers-Danlos Syndrome.

Cardiovascular surgical outcomes reports are few for vascular type IV of Ehlers- Danlos Syndrome (vEDS) compared to non-vascular types I-III (nEDS). To define cardiovascular surgical outcomes among adult patients (≥18 years) with EDS types, a review of our institution's in-house STS Adult Cardiac Surgery Database-compliant software and electronic medical records from Mayo Clinic (1993-2019) was performed. Outcomes were compared for vEDS patients and nEDS patients. Demographics, baseline characteristics, operative, in-hospital complications and follow-up vital status were analyzed. Over the study time frame, 48 EDS patients underwent surgery (mean age 52.6 ± 14.6 years; 48% females). Of these, 17 patients had vEDS and 31 patients had nEDS. Six patients (12.5%) underwent prior sternotomy. Urgent or emergent surgery was performed in 10 patients (20.8%). Aortic (vEDS 76.5% vs. nEDS 16.1%) and mitral procedures (vEDS 11.8% vs. nEDS 48.4%) were the two most common cardiovascular surgeries performed (p < .01 and p = .007, respectively). Cardiopulmonary bypass time (CPB) (165 ± 18 vs. 90 ± 13 min; p = .015) and aortic cross clamp times (140 ± 14 vs. 62 ± 10 min; p < .001) were longer for vEDS patients. There was 1 (2.1%) early and 7 (14.6%) late deaths; 6 among vEDS and 2 among nEDS patients. Survival at 5 (80% vs. 93%), 10 (45% vs. 84%) and 15 years (45% vs. 84%) was lower in patients with vEDS (p = .015 for each comparison). Cardiovascular surgeries are significantly more complex with longer bypass and cross clamp times for type IV vEDS compared to nEDS patients. Reduced overall survival underscores the complexity and fragility of vEDS patients.

Baseline and Process Factors of Anti-Retroviral Therapy That Predict Loss to Follow-up Among People Living with HIV/AIDS in China: A Retrospective Cohort Study.

We explored the predictors and predictive models of loss to follow-up (LTFU) during the first year of anti-retroviral therapy (ART). LTFU was defined as the failure to visit the clinic for antiretroviral drugs for ≥ 90days after the last missed scheduled visit. Based on the electronic medical records of 5953 patients who were HIV positive and began ART between 2016 and 2019 in China, the LTFU rate was 7.24 (95% confidence interval 6.49-7.97) per 100 person-years during the first year of ART. ART baseline factors were associated with LTFU, but were non-optimal predictors. A model including ART process-related factors such as follow-up behaviors and physical health status had an area under the receiver operating characteristic curve of 73.4% for predicting LTFU. Therefore, the medical records of follow-up visits can be used to identify patients with a high risk of LTFU and allow interventions to be implemented proactively.

Characteristics of people with dementia lost to follow-up from a dementia care center.

To identify the prevalence and characteristics of people living with dementia (PLWD) lost to follow-up (LTFU) from a specialized dementia care clinic and to understand factors influencing patient follow-up status. We conducted a retrospective chart review of PLWD seen at a dementia care clinic 2012-2017 who were deceased as of 2018 (n=746). Participants were evaluated for follow-up status at the time of death. Generalized linear regression was used to analyze demographic and diagnostic characteristics by follow-up status. Text extracted from participant medical records was analyzed using qualitative content analysis to identify reasons patients became LTFU. Among PLWD seen at a dementia care clinic, 42% became LTFU before death, 39% of whom had chart documentation describing reasons for loss to follow-up. Increased rates of LTFU were associated with female sex (risk ratio 1.27, [95% confidence interval 1.09-1.49]; p=0.003), educational attainment of high school or less (1.34, [1.13-1.61]; p=0.001), and death in a long-term care facility (1.46, [1.19-1.80]; p=0.003). Commonly documented reasons for not returning for care at the clinic included switching care to another provider (42%), logistical difficulty accessing care (26%), patient-family decision to discontinue care (24%), and functional challenges in accessing care (23%). PLWD are LTFU from specialized memory care at high rates. Attention to care coordination, patient-provider communication, and integrated use of alternative care models such as telehealth are potential strategies to improve care.

Initial visit symptoms in probable Behçet's syndrome is predictive of ISG criteria fulfillment in Behçet's syndrome: data from New York and Amsterdam cohorts.

Behçet's syndrome (BS) is a systemic vasculitis with heterogeneous clinical presentation and a relapsing disease course. The International Study Group (ISG) criteria are most often used for classification. A significant proportion of patients is classified as probable BS because they do not fulfil the criteria at initial presentation. The aim of this study is to explore clinical BS symptoms present at initial patient visit predictive of ISG criteria diagnosis during follow-up. Patients classified as probable BS at initial visit were included. Follow-up ISG status (defined as meeting criteria ISG+ vs. not meeting criteria ISG-) was abstracted from last visit. Univariable logistic regression was used to screen initial visit clinical features and symptoms with follow-up ISG status. All variables that passed screening at p<0.10 were included in the final multivariable model, which was then used to create a probability risk score. 189 patients were included (169 from New York and 20 from Amsterdam). 71 (37.6%) patients were classified as ISG+ during follow-up. In the final model, presence of morning stiffness, genital ulcers, skin lesions, and eye disease were associated with increased odds of ISG+, adjusting for age, symptom duration and family history. This was used to create a probability risk score. Over a third of patients with suspected or probable BS developed new manifestations over time that led to classification as ISG+ BS. The presence of morning stiffness, genital ulcers, skin lesions and eye disease at initial visit were independently associated with significantly higher odds for developing ISG+ Behçet's during follow-up.

Utility of telemedicine in pediatric rheumatology during the COVID-19 pandemic

BackgroundDuring the COVID-19 pandemic, telemedicine has provided an alternative to in-person visits for patients practicing social distancing and undergoing quarantine. During this time, there has been a rapid expansion of telemedicine and its implementation in various clinical specialties and settings. In this observational study we aim to examine the utility of telemedicine in a pediatric rheumatology clinic, for 3 months during the COVID-19 pandemic.MethodsA review of outpatient pediatric rheumatology telemedicine encounters were conducted from April–June 2020. Telemedicine visits (n = 75) were compared to patients seen in practice over the prior year in office-based visits (March 2019–March 2020) (n = 415). Patient characteristics, information on no-show visits, completed visits, new patient or follow-up status, and if new patients had received a visit within 2 weeks of calling to schedule an appointment were analyzed by chart review. An independent sample t-test and Chi Square statistic was used to determine statical significance between the two groups. A two-proportion z-test was used to compare visit metrics.ResultsThe percentage of new patients utilizing telemedicine (60%) was lower and statistically significant compared to the percentage of new patient office visits (84%) the previous year (p < 0.0001). There was no change in no-show rate between groups and patient characteristics were similar.ConclusionsThis study demonstrates a statistically significant decrease in new patient visits during the pandemic with telemedicine-only appointments compared to in-office visits over the previous year. This suggests a possible hesitation to seek care during this time. However, there was no significant difference among patient characteristics between telemedicine visits during the pandemic and during in-office visits in the previous year. In our experience, patient visits were able to be conducted via telemedicine with a limited physical exam using caregiver’s help during the pandemic. However, further studies will need to ascertain patient satisfaction and preference for telemedicine in the future.

Bilateral Cataract Development and Pupillary Block Glaucoma Following Implantable Collamer Lens.

Aim and objectiveWe report the first case of bilateral cataract formation and pupillary block glaucoma and high intraocular pressure (IOP) following implantable Collamer lens (ICL) implantation that resulted in advanced visual field loss.BackgroundThe patient who underwent bilateral ICL implantation can develop bilaterally elevated IOP and an anterior subcapsular cataract with altitudinal visual field defect.Case descriptionA 38-year-old man with high myopia presented for routine follow-up status post bilateral phakic ICL placement. The visual acuity was reduced due to an anterior subcapsular cataract and elevated IOP in both eyes with advanced glaucomatous visual field defects. The patient was treated with topical glaucoma medications. The left eye underwent same-day phakic ICL explanation and cataract surgery to prevent further visual field loss.ConclusionCataract and glaucoma are serious complications after phakic ICL implantation; therefore, regular postoperative monitoring may prevent advanced visual impairment.Clinical significanceThe use of a phakic intraocular lens for the correction of myopia may result in complications. As a measure is to reduce such complications, refractive surgeons preferred using phakic posterior chamber intraocular Collamer lens for the correction of myopia.How to cite this articleOwaidhah O, Al-Ghadeer H. Bilateral Cataract Development and Pupillary Block Glaucoma Following Implantable Collamer Lens. J Curr Glaucoma Pract 2021;15(2):91–95.

Barriers of Doctors and Patients in Starting Insulin for Type 2 Diabetes Mellitus.

BackgroundManagement of patients with type 2 diabetes mellitus (T2DM) may involve insulin therapy. However, this treatment may be avoided or delayed by physicians or patients due to the presence of certain barriers. This study aimed to evaluate the barriers to initiating insulin therapy for both physicians and patients with T2DM. MethodThis was a cross-sectional, questionnaire-based study. Data related to the physicians’ personal and professional experience were collected, and 15 barriers to initiating insulin therapy were scored by each physician on a four-point Likert scale. Also, the patients’ general data were collected, including previous insulin experience, discontinuation reason, and willingness to start insulin therapy if indicated. Twenty-one other barriers were examined with yes/no questions as well.ResultsFor physicians, the patient's treatment compliance, motive, dependence on others for insulin therapy, hypoglycemia, socioeconomic status, occupation, and lack of follow-up were the most highly ranked barriers to initiating insulin therapy. A history of insulin use was reported in 42 (20.7%) patients, 31 of whom had decided to discontinue insulin therapy themselves (73.8%). The three most common reasons for discontinuing insulin therapy among patients were deterioration of T2DM and causing complications, hypoglycemia, and needle injections. Based on the findings, 99 (48.8%) patients were willing to start insulin therapy, if indicated. The family history of insulin therapy was positively correlated with the patient’s willingness to start insulin. On the other hand, it was negatively correlated with a low educational level and some barriers to insulin therapy, such as fear of death, dependence on others, the difficulty of carrying insulin while traveling, follow-up challenges, the difficulty of dosing accuracy, the difficulty of keeping insulin, inconveniences in daily life, considering insulin as the last resort, the deterioration of T2DM with insulin, and social stigma.ConclusionThe physicians believed that the barriers to initiating insulin therapy were mainly related to the patient's attitudes and thoughts about this therapy. While hypoglycemia and weight gain are well-known side effects of insulin therapy, the most important patient-related barriers to insulin therapy were related to its impact on the patient’s social life and misperceptions about the side effects of insulin.

Clinical and Molecular Characterizations of Papillary Thyroid Cancer in Children and Young Adults: A Multicenter Retrospective Study.

Background: Papillary thyroid carcinoma (PTC) is a rare malignancy in children and young adults (CAYA). It often presents with aggressive disease patterns and advanced stages, which are clinically distinct from those in adult patients. In this study, we sought to characterize and better understand the clinical variants of PTC in CAYA and explore the underlying mechanisms. Methods: CAYA patients (age ≤18 years) diagnosed with PTC between June 2006 and June 2018 were retrospectively recruited from five hospitals. Demographic information, pathological data, and follow-up status were recorded. Tumor samples obtained from 20 children (mean age 15.15 years) and 10 adults (mean age 38.80 years) underwent comprehensive whole transcriptome sequencing. Differentially expressed genes (DEGs), mutational landscape, and immune infiltration were analyzed. Results: A total of 217 CAYA-PTC patients (162 females and 55 males) with an average age of 14.38 ± 3.53 years (range 2-18) were included. Lymph node metastasis (LNM) was observed in 85.71%, of which 57.60% were in the lateral cervical compartment. Disease recurred in 28 of 217 (12.90%) patients with a median follow-up of 4.76 years. Multivariate logistic regression analysis revealed that age, bilateral disease, extrathyroidal extension, and coexisting Hashimoto's thyroiditis (co-HT) were independent risk factors for LNM, while co-HT was the only risk factor for recurrence. Using whole transcriptome sequencing of PTC tissues, we identified 301 DEGs. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses showed that differences in immune mediators played important roles, based on the distributions of mutation frequencies, types, and expression levels between CAYA and adult patients. Based on the integrated data sets, we identified significantly mutated immune genes, cluster of differentiation 24 (CD24), coagulation factor 12 (F12), coagulation factor 5 (F5), integrin subunit alpha 3 (ITGA3), and retinoic acid early transcript 1L (RAET1L), which were then verified by immunohistochemistry. Furthermore, resting mast cells, resting natural killer cells, plasma cells, and regulatory T cells were different in the CAYA-PTC group and correlated with the expression of immune checkpoints. Conclusions: There are considerable variabilities that may contribute to the different clinical presentations between CAYA and adult PTC patients, among which the decrease in protective immune cells may be a factor. Collectively, our results add to the possible biological mechanisms involved in CAYA-PTC.

Kalp yetersizliği olan hastalarda klinik pratikte kılavuzların uygulanabilirliğinde cinsiyet farkı

Aim: Treatment methods decreasing mortality in heart failure (HF) are provided in detail by updated guidelines. We aimed to provide true data in our department about the applicability of guidelines into clinical practice on management of HF patients and their follow-up status.&#x0D; Materials and Methods: We retrospectively assessed the clinical data of patients hospitalized with HF between 2009 and 2010 in our hospital. All the collected data were used to assess the applicability of guidelines and follow-up status for a 5-year time period. A retrospective assessment was preferred in order to reflect the real clinical practice.&#x0D; Results: There were 496 patients hospitalized for HF between January 2009 and January 2010. New onset and chronic HF were diagnosed in 24.4% and 75.6% respectively. The most common scenario of acute HF was pulmonary oedema (77%). Ischemic heart disease was the predominant etiology (49.2%). The median age of patients was 65.62±14.48 and 67.7% of them were male. HF therapies increased from admission to discharge, but decreased during follow-up. Median length of stay was 11.26±9.26 days and in hospital mortality 9.5%. The most common complication was infection (18.2%). During follow-up, hospitalization rate was 88.2% and long-term mortality 44.5%.&#x0D; Conclusion: Patients with HF are far away from the cardiovascular prevention targets. The evidence-based therapy recommended by the guidelines was not sufficiently provided. The high rehospitalization and in hospital mortality rate was linked to high rate of pneumonia

A pre-operative MRI-based brain metastasis risk-prediction model for triple-negative breast cancer.

Triple-negative breast cancer (TNBC) patients have a high 2-year post-operative incidence of brain metastasis (BM). Currently, there is no early prediction tool to predict the risk of BM in TNBC patients. Data of breast cancer patients, who had been scanned, resected, and pathologically diagnosed at a local hospital from May 2012 to June 2018 were collected. Primary and radiological secondary exclusion criteria were used to determine patients' eligibility for inclusion in the study. Data for the TNBC cohort included qualified 2-year post-operative follow-up information, BM status, and pre-operative MRI data. Age-based propensity score matching (PSM) was used to build a comparable study cohort. The tumor regions of interest were segmented and used for lattice radiomics feature extraction. The filtered and normalized lattice radiomics features were then trained with BM status using the random forest (RF), support vector machine (SVM), k-nearest neighbor, least absolute shrinkage and selection operator regression, naïve Bayesian, and neural network algorithms. The generated prediction models were evaluated using 10-fold cross verification, and the areas under the curve (AUCs), accuracy, sensitivity, and specificity were reported. Data from 643 breast cancer patients were collected. Among these, 84 TNBC cases (comprising 42 pairs) were included in this study after primary exclusion, radiological secondary exclusion, and PSM. We extracted 3,854 lattice radiomics features from the pre-operative MRI. Of these, 2,480 were used for model training after filtration. The 10-fold verification results showed that the BM risk-prediction model, which was based on the normalized and filtered lattice radiomics features of collected cases trained by naïve Bayesian algorithm, had a high AUC (0.878), accuracy (0.786), specificity (81.0%), and sensitivity (76.2%). The pre-operative MRI data of TNBC patients can be used to predict 2-year BM risk. This application could help to achieve better early stratification, BM screening, and the overall prognosis.

Breastfeeding in Mothers with COVID-19: Insights from Laboratory Tests and Follow-Up from Early Outbreak of the Pandemic in China.

Objective: The outbreak of Coronavirus Disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) threatens a surging number of community groups within society, including women actively breastfeeding. Breastfeeding involves intimate behaviors, a major transmission route of SARS-CoV-2, and is integral to the close mother-baby relationship highly correlated with maternal psychological status. Materials and Methods: Twenty-three pregnant women and puerperae with either confirmed or suspected diagnoses of COVID-19 were enrolled in the study. The clinical characteristics and outcomes of the mothers and neonates were recorded. The presence of SARS-CoV-2, IgG, and IgM in breast milk, maternal blood, and infant blood, together with feeding patterns, was assessed within 1 month after delivery. Feeding patterns and maternal psychological status were also recorded in the second follow-up. Results: No positive detection of SARS-CoV-2 was found in neonates. All breast milk samples were negative for the detection of SARS-CoV-2. The presence of IgM for SARS-CoV-2 in breast milk was correlated with IgM presence in the maternal blood. The results of IgG detection for SARS-CoV-2 were negative in all breast milk samples. All infants were in a healthy condition in two follow-ups, and antibody tests for SARS-CoV-2 were negative. The rate of breast milk feeding increased during two follow-ups. All mothers receiving a second follow-up experienced negative psychological factors and status. Conclusions: Our findings support the feasibility of breastfeeding in women infected with SARS-CoV-2. The additional negative psychological status of mothers due to COVID-19 should also be considered during the puerperium period.

Risk Factors for Loss to Follow-Up in the Lower Extremity Limb Salvage Population.

Limb salvage for chronic lower extremity wounds requires long-term care best delivered by specialized multidisciplinary centers. This optimizes function, reduces amputation rates, and improves mortality. These centers may be limited to urban/academic settings, making access and appropriate follow-up challenging. Therefore, the authors hypothesize that both system- and patient-related factors put this population at exceedingly high risk for loss to follow-up. Records were reviewed retrospectively for 200 new patients seen at the Georgetown Center for Wound Healing in 2013. The primary outcome was loss to follow-up, defined as three consecutive missed appointments despite explicit documentation indicating the need for return visits. Demographic, clinical, and geographic data were compared. Multivariate logistic regression analysis for loss to follow-up status controlled for variables found significant in the bivariate analysis. Spatial dependency was evaluated using variograms. Over a 6.5-year-period, 49.5 percent of patients followed were lost to follow-up. Male sex and increased driving distance to the limb salvage center were risk factors for loss to follow-up. Wound-specific characteristics including ankle and knee/thigh location were also associated with higher rates of loss to follow-up. There was no spatial dependency or discrete clustering of at-risk patients. This study is the first of its kind to investigate the demographic and clinical characteristics that predispose chronic lower extremity wound patients to loss to follow-up. These findings inform stakeholders of the high rates of loss to follow-up and support decentralized specialty care, in the form of telemedicine, satellite facilities, and/or dedicated case managers. Future work will focus on targeting vulnerable populations through focused interventions to reduce patient and system burden. Risk, III.

Understanding loss to follow-up in a longitudinal study of people with traumatic brain injury

ABSTRACT Objective To examine factors related to attrition in a traumatic brain injury (TBI) study sample assessed up to 15 years after injury. Participants One thousand twenty-eight participants with TBI who completed the year 1 follow-up assessment at a TBI Model Systems Center between 1992 and 2018. Method Secondary analysis of data from a prospective longitudinal cohort study considering follow-up data collection completion status at years 1, 2, 5, 10, and 15. Results In univariable analyses, multiple factors were associated with loss to follow-up (LOFU) including being a member of a socially disadvantaged group, substance use history, residence, payor, cause of injury, and results of earlier follow-up attempts. In a multiple logistic regression analysis examining the prediction of follow-up condition at 10 or 15 years post-injury, only payor and race/ethnicity were significant predictors. Hispanic ethnicity was associated with higher odds of LOFU, and these participants often spoke Spanish and were born outside of the United States. Conclusions The findings suggest a need to understand sociodemographic variables and their influence on participant attrition in longitudinal TBI research. With a better understanding of these predictors, procedures can be developed to address retention of participants who are identified as being at increased risk for study drop out.

Nationwide survey of the follow-up practices for patients with esophageal carcinoma after radical treatment: historical changes and future perspectives in Japan.

No post-treatment follow-up methods have been established yet for patients with esophageal carcinoma who undergo radical esophagectomy (Surg) or who show complete response to definitive chemoradiotherapy (dCRT-CR). The purpose of this study was to investigate the current status of follow-up of the Surg and dCRT-CR patients in Japan, and understand the current reality and problems to establish an optimal follow-up method. A questionnaire on the follow-up method adopted was sent by e-mail to 124 institutions approved by the Japan Esophageal Society as training institutions for board-certified esophageal surgeons; responses were received from 89 institutions. The data were compared with those obtained by a similar survey conducted in 2014. Follow-up methods markedly varied among institutions. Almost all institutions scheduled computed tomography and upper gastrointestinal endoscopy at least once a year up to postoperative year 5 for both the Surg and dCRT-CR groups. At least 70% of the institutions continued follow-up up to postoperative year 10, and this proportion had increased as compared to that reported from the 2014 survey. Only 25-30% of the institutions scheduled follow-up screening for metachronous head and neck cancer for both groups, and the health-related quality of life (HR-QOL) after the treatment were seldom assessed. These trends remained unchanged as compared to those reported from the 2014 survey. The results suggest that the consensus of follow-up protocol could not be established. More attention is required for detection of metachronous cancers and assessment of the HR-QOL. Establishment of a consensus-based follow-up system and verification of its effectiveness are required.

220. Do favorable short-term patient reported outcomes after spine surgery predict loss to one- and two-year follow-up?

<h3>BACKGROUND CONTEXT</h3> Because many spine surgery patients are lost to long-term postoperative follow-up, retrospective patient outcome studies are subjected to attritional bias. Controversy ensues in the literature on whether long-term follow-up is associated with adverse clinical outcomes. Furthermore, the factors associated with loss to follow-up after spine surgery are incompletely elucidated. <h3>PURPOSE</h3> To determine if spine surgery patients with greater improvement in patient reported outcomes measures (PROM) at early postoperative follow-up are more likely to be lost to follow-up at the one- year and two- year postoperative visits. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort analysis. <h3>PATIENT SAMPLE</h3> All patients over age 18 who underwent any primary or revision decompression or fusion surgery for degenerative spinal pathologies at a single academic institution were retrospectively identified. All included patients attended a short-term (3 month) postoperative follow-up visit. Patients with a traumatic injury, infection, malignancy, or incomplete medical records or outcome measures were excluded. <h3>OUTCOME MEASURES</h3> Postoperative short- and long- term PROMs: Neck Disability Index (NDI), Oswestry Disability Index (ODI), Short Form-12 (SF-12), VAS Neck, VAS Arm, VAS Back, VAS Leg, and PROMIS pain scores. Delta outcome score. Recovery ratio. <h3>METHODS</h3> Patient surgeries were stratified by anatomic region, revision status, and number of levels fused. Distance from patient residence to postoperative clinic site was determined. Patients lost to one- and two-year postoperative follow-up visits were identified. Univariate analysis compared patient demographics, surgical factors, distances traveled, and PROMs across groups with and without one- and two- year follow-up, respectively. Logistic regression isolated predictors of loss to follow-up. Multivariate regression compared PROMs based on long-term follow-up status. <h3>RESULTS</h3> A total of 1,412 patients met the inclusion criteria. In the total cohort, 25% of patients were lost to one- year follow-up and 66% were lost to two-year follow-up. Change in patient outcome measures and recovery ratios did not meaningfully differ between patient groups with and without one- and two-year follow-up on univariate nor multivariate analyses. Multiple patient factors were found to be associated with failure to follow up at one year after spine surgery including: decreased medical comorbidities, primary and single level surgeries, private insurance status, and longer distance from residence to clinic. Additionally, younger age and female sex were associated with failure to follow up two years after index surgery. <h3>CONCLUSIONS</h3> Patient outcomes were not found to impact loss to long-term follow-up after spine surgery. While a multitude of factors may predict patient propensity to follow-up, the lack of association between postoperative follow-up status and clinical outcome may limit bias introduced in retrospective PROM studies. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.