Guidelines For Follow-up Of Patients Research Articles

Inadequate neuraxial anaesthesia during caesarean delivery: a survey of practitioners

BackgroundWe aimed to determine the knowledge, training, practices and attitudes of obstetric anaesthetic practitioners with regard to failed neuraxial anaesthesia for caesarean delivery. MethodWe performed a contemporaneous and representative survey in an innovative fashion. We conducted an international cross-sectional study of obstetric anaesthetic practitioners at the Annual Scientific Meeting of the Obstetric Anaesthetists’ Association (OAA 2021). Validated survey questions were collected in real time using an audience response system. ResultsOf the 426 participants who logged into the survey system, 356 provided responses (4173 responses to 13 questions, across all grades/seniority of practitioner). The number of responses to questions ranged from 81% to 61%. Survey responses suggest that it is routine for respondents to inform patients about the difference between pain and expected intra-operative sensations, (320/327, 97.9%) but less routine to inform patients of the risk of intra-operative pain (204/260, 78.5%), or the possibility of conversion to general anaesthesia. (290/309 93.8%). Only 30% of respondents reported the use of written guidelines for follow-up of patients who experience intra-operative pain under neuraxial anaesthesia, and only 23% reported formal training in management of intra-operative pain under neuraxial anaesthesia. Respondents felt that inadequate block duration, prolonged surgery, and patient anxiety were contributory factors to failed anaesthesia, and the contributory factors differed between grade/seniority of practitioner. Modalities used to test a block were cold, motor block and light touch, with approximately 65% of respondents routinely using three modalities. ConclusionsOur study survey found that the consent process may not always be adequately comprehensive, and that standardised documentation and testing of the block and focused training may be beneficial to prevent patient dissatisfaction and the chance of litigation.

Test Utilization for Thyroglobulin and Anti-Thyroglobulin Antibody Assays in Korea.

When measuring thyroglobulin (Tg), simultaneous measurement of Tg autoantibodies (Ab) is recommended by clinical guidelines for follow-up of patients with differentiated thyroid cancers after thyroidectomy and radioactive iodine ablation. We aimed to investigate test utilization of Tg and Tg Ab assays in local clinics and hospitals in Korea. We retrospectively reviewed data from the laboratory information system between November 6, 2017 and December 31, 2019. During the study period, 10,551 Tg tests were performed on 2,592 Korean adults from 97 local clinics and hospitals. Among them, 3,924 (37.2%) test results lacked concurrent Tg Ab assays, while 6,627 test results had concurrently measured Tg Ab, and 528 (8.0%) showed positive Tg Ab results, which could interfere with measurement of Tg concentration. The results of this study provide basic information regarding test utilization of Tg Ab assays to improve test utilization for accurate Tg measurement in Korean patients.

Commentary: No-test medication abortion: A sample protocol for increasing access during a pandemic and beyond

Author(s): Raymond, Elizabeth; Grossman, Daniel; Mark, Alice; Upadhyay, Ushma; Dean, Gillian; Creinin, Mitchell; Coplon, Leah; Perritt, Jamila; Atrio, Jessica; Taylor, DeShawn; Gold, Marji | Abstract: No abstract

A risk prediction model for the development of subsequent primary melanoma in a population-based cohort.

Guidelines for follow-up of patients with melanoma are based on limited evidence. To guide skin surveillance, we developed a risk prediction model for subsequent primary melanomas, using demographic, phenotypical, histopathological, sun exposure and genomic risk factors. Using Cox regression frailty models, we analysed data for 2613 primary melanomas from 1266 patients recruited to the population-based Genes, Environment and Melanoma study in New South Wales, Australia, with a median of 14 years' follow-up via the cancer registry. Discrimination and calibration were assessed. The median time to diagnosis of a subsequent primary melanoma decreased with each new primary melanoma. The final model included 12 risk factors. Harrell's C-statistic was 0·73 [95% confidence interval (CI) 0·68-0·77], 0·65 (95% CI 0·62-0·68) and 0·65 (95% CI 0·61-0·69) for predicting second, third and fourth primary melanomas, respectively. The risk of a subsequent primary melanoma was 4·75 times higher (95% CI 3·87-5·82) for the highest vs. the lowest quintile of the risk score. The mean absolute risk of a subsequent primary melanoma within 5 years was 8·0 ± SD 4.1% after the first primary melanoma, and 46·8 ± 15·0% after the second, but varied substantially by risk score. The risk of developing a subsequent primary melanoma varies considerably between individuals and is particularly high for those with two or more primary melanomas. The risk prediction model and its associated nomograms enable estimation of the absolute risk of subsequent primary melanoma, on the basis of on an individual's risk factors, and can be used to tailor surveillance intensity, communicate risk and provide patient education. What's already known about this topic? Current guidelines for the frequency and length of follow-up to detect new primary melanomas in patients with one or more previous primary melanomas are based on limited evidence. People with one or more primary melanomas have, on average, a higher risk of developing another primary invasive melanoma, compared with the general population, but an accurate way of estimating individual risk is needed. What does this study add? We provide a comprehensive risk prediction model for subsequent primary melanomas, using data from 1266 participants with melanoma (2613 primary melanomas), over a median 14 years' follow-up. The model includes 12 risk factors comprising demographic, phenotypical, histopathological and genomic factors, and sun exposure. It enables estimation of the absolute risk of subsequent primary melanomas, and can be used to tailor surveillance intensity, communicate individual risk and provide patient education.

Setting the international standard for longitudinal follow-up of patients with systemic sclerosis: a Delphi-based expert consensus on core clinical features

BackgroundSystemic sclerosis (SSc) is a severe, progressive multiorgan disease but to date, there are no established standardised international guidelines for follow-up of patients with SSc. The goal of this project...

Cost-effectiveness analysis of imaging strategy for an intensive follow-up of patients with American Joint Committee on Cancer stage IIB, IIC and III malignant melanoma.

Many follow-up guidelines for patients with high-risk melanoma include expensive imaging studies, serum biomarkers and regular visits to the dermatologist, with little attention to cost-effectiveness. To establish the cost-effectiveness of chest-abdomen-pelvis computed tomography (CT) and brain magnetic resonance imaging (MRI) in a follow-up protocol for patients at high risk of relapse. This was a prospective single-centre cohort study of 290 patients with clinicopathological American Joint Committee on Cancer (AJCC) stage IIB, IIC and III melanoma. Patients had a body CT scan and brain MRI every 6 months and were withdrawn from the study after completing a 5-year follow-up or when metastases were detected. A cost-effectiveness analysis for each follow-up radiological procedure was performed. Patients underwent 1805 body CT scans and 1683 brain MRIs. Seventy-six metastases (26·2%) were identified by CT or MRI. CT scan was cost-effective in the first 4 years (cost-effectiveness ratio €4710·70-€14 437·10/patient with metastasis); brain MRI was cost-effective during the first year (cost-effectiveness ratio €14 090·60/patient with metastasis). Limitations included lack of survival analysis and comparisons with willingness-to-pay thresholds. Six-monthly CT scan of the chest, abdomen and pelvis is a cost-effective technique for the early detection of metastases in the first 4 years of follow-up in patients with AJCC stage IIC and III melanoma, and in the first 3 years in patients with AJCC stage IIB melanoma. In addition, brain MRI has been shown to be cost-effective only in the first year of follow-up in patients with AJCC stage IIC and III melanoma.

Describing perspectives of health care professionals on active surveillance for the management of prostate cancer

BackgroundOver the last decade, active surveillance has proven to be a safe approach for patients with low-risk prostate cancer. Although active surveillance presents several advantages for both patients and the health care system, all eligible patients do not adopt this approach. Our goal was to evaluate the factors that influence physicians to recommend active surveillance and the barriers that impact adherence to this approach.MethodsFocus groups (n = 5) were held with physicians who provided care for men with low-risk prostate cancer and had engaged in conversations with men and their families about active surveillance. The experience of health care professionals (HCPs) was captured to understand their decisions in proposing active surveillance and to reveal the barriers and facilitators that affect the adherence to this approach. A content analysis was performed on the verbatim transcripts from the sessions.ResultsAlthough physicians agreed that active surveillance is a suitable approach for low-risk prostate cancer patients, they were concerned about the rapidly evolving and non-standardized guidelines for patient follow-up. They pointed out the need for additional tools to appropriately identify proper patients for whom active surveillance is the best option. Urologists and radiation-oncologists were keen to collaborate with each other, but the role of general practitioner remained controversial once patients were referred to a specialist.ConclusionsIntegration of more reliable tools and/or markers in addition to more specific guidelines for patient follow-up would increase the confidence of both patients and physicians in the choice of active surveillance.

Colorectal cancer liver metastases \u2013 a population-based study on incidence, management and survival

BackgroundColorectal cancer (CRC) is a leading cause of cancer-associated deaths with liver metastases developing in 25–30% of those affected. Previous data suggest a survival difference between right- and left-sided liver metastatic CRC, even though left-sided cancer has a higher incidence of liver metastases. The aim of the study was to describe the liver metastatic patterns and survival as a function of the characteristics of the primary tumour and different combinations of metastatic disease.MethodsA retrospective population-based study was performed on a cohort of patients diagnosed with CRC in the region of Stockholm, Sweden during 2008. Patients were identified through the Swedish National Quality Registry for Colorectal Cancer Treatment (SCRCR) and additional information on intra- and extra-hepatic metastatic pattern and treatment were retrieved from electronic patient records. Patients were followed for 5 years or until death. Factors influencing overall survival (OS) were investigated by means of Cox regression. OS was compared using Kaplan-Meier estimations and the log-rank test.ResultsLiver metastases were diagnosed in 272/1026 (26.5%) patients within five years of diagnosis of the primary. Liver and lung metastases were more often diagnosed in left-sided colon cancer compared to right-sided cancer (28.4% versus 22.1%, p = 0.029 and 19.7% versus 13.2%, p = 0.010, respectively) but the extent of liver metastases were more extensive for right-sided cancer as compared to left-sided (p = 0.001). Liver metastatic left-sided cancer, including rectal cancer, was associated with a 44% decreased mortality risk compared to right-sided cancer (HR = 0.56, 95% CI: 0.39–0.79) with a 5-year OS of 16.6% versus 4.3% (p < 0.001). In liver metastatic CRC, the presence of lung metastases did not significantly influence OS as assessed by multivariate analysis (HR = 1.11, 95% CI: 0.80–1.53).ConclusionThe worse survival in liver metastatic right-sided colon cancer could possibly be explained by the higher number of metastases, as well as more extensive segmental involvement compared with left-sided colon and rectal cancer, even though the latter had a higher incidence of liver metastases. Detailed population-based data on the metastatic pattern of CRC and survival could assist in more structured and individualized guidelines for follow-up of patients with CRC.

Uncharted territory: Life after cancer for young adults.

30 Background: Similar to survivors of childhood cancer, young adult (YA) survivors have distinct and complex medical and psychosocial needs. However, there are no specific follow-up guidelines for patients who were diagnosed as a young adult. Most YA survivors receive inadequate survivorship care with minimal surveillance for late effects. This study aims to examine the concept of survivorship care planning and determine what aspects of post-therapy care is most needed. Methods: Two focus groups were held to investigate the post treatment experience of YA survivors. Participants completed cancer treatment and were diagnosed between 2005 and 2011. They either continued to receive follow-up care or did not. These were further subdivided based on age at diagnosis: 18-24; 25-30; 31-39 years. Participants answered predetermined questions during their session. A demographic questionnaire was given and a SCP (a treatment summary [TS] and its associated long- and late-term risks) developed based on their electronic medical records. Results: 27 YAs participated in the focus groups. SCPs were developed for each participant and required 45 - 180 minutes to complete. 78% felt TS were accurate and 44% learned of long/late-term side effects they were previously not aware of nor receiving surveillance on. Barriers to continued follow-up were related to health insurance status, poor communication with their oncologist, and on-going adjustment challenges. Initial feedback from the SCPs indicates that YAs seek additional information on long/late-term side effects, roadmap for follow-up visit, and information on psychosocial support and YA specific resources. Conclusions: For young adults diagnosed with cancer, there are no guidelines on follow-up care. Young adult survivors are not aware of long- and late-term side effects they may have, and many do not know how often they need to have continued follow-up. Despite great strides made in survivors of childhood cancer, the same cannot be said for young adult survivors.

Processus du traitement par irradiation

The purpose of this article is to describe the regulatory framework of the radiotherapy practice in France, the external irradiation and brachytherapy process and the guidelines for patient follow-up.

Cardiovascular imaging in children and adults following Kawasaki disease.

Kawasaki disease (KD) is a paediatric vasculitis with coronary artery aneurysms (CAA) as its main complication. Two guidelines exist regarding the follow-up of patients after KD, by the American Heart Association and the Japanese Circulation Society. After the acute phase, CAA-negative patients are checked for cardiovascular risk assessment or with ECG and echocardiography until 5 years after the disease. In CAA-positive patients, monitoring includes myocardial perfusion imaging, conventional angiography and CT-angiography. However, the invasive nature and high radiation exposure do not reflect technical advances in cardiovascular imaging. Newer techniques, such as cardiac MRI, are mentioned but not directly implemented in the follow-up. Cardiac MRI can be performed to identify CAA, but also evaluate functional abnormalities, ischemia and previous myocardial infarction including adenosine stress-testing. Low-dose CT angiography can be implemented at a young age when MRI without anaesthesia is not feasible. CT calcium scoring with a very low radiation dose can be useful in risk stratification years after the disease. By incorporating newer imaging techniques, detection of CAA will be improved while reducing radiation burden and potential complications of invasive imaging modalities. Based on the current knowledge, a possible pathway to follow-up patients after KD is introduced.Key Points• Kawasaki disease is a paediatric vasculitis with coronary aneurysms as major complication.• Current guidelines include invasive, high-radiation modalities not reflecting new technical advances.• Cardiac MRI can provide information on coronary anatomy as well as cardiac function.• (Low-dose) CT-angiography and CT calcium score can also provide important information.• Current guidelines for follow-up of patients with KD need to be revised.

Kidney cancer, version 3.2015.

The NCCN Guidelines for Kidney Cancer provide multidisciplinary recommendations for the clinical management of patients with clear cell and non-clear cell renal carcinoma. These NCCN Guidelines Insights highlight the recent updates/changes in these guidelines, and updates include axitinib as first-line treatment option for patients with clear cell renal carcinoma, new data to support pazopanib as subsequent therapy for patients with clear cell carcinoma after first-line treatment with another tyrosine kinase inhibitor, and guidelines for follow-up of patients with renal cell carcinoma.

Cervical Cancer Screening: Exploring Appalachian Patients’ Barriers to Follow-Up Care

This article describes a community-based Patient Navigation (PN) project conducted to identify potential barriers to seeking follow-up cervical cancer care in southeastern Kentucky. Patient navigators (PNs) were placed in cervical cancer programs within county public health departments where they interviewed patients about their perceived barriers to seeking follow-up care after receiving a positive Pap test result. Participants identified various potential barriers at three levels: the individual/personal level, the health care system level and the community/environmental level. One identified barrier that was unique to this study was a lack of consistency between follow-up recommendations and follow-up guidelines for patients under age 21. Implications are discussed.

De Novo Aneurysm: Case Reports and Literature Review

Formation of cerebral de novo aneurysms (CDNAs) is rare, and the pathogenesis remains obscure. We analyzed factors involved in formation of CDNAs and suggest guidelines for follow-up of patients. We retrospectively reviewed intracranial aneurysms at our institute and published reports from 1964 to 2008. Eleven patients were found with CDNAs, and 138 patients were collected from the published literature. We assessed the clinical characteristics, such as sex, size, and site of CDNA, past history, and time to occurrence of CDNAs. Of 11 patients, 10 were female and 1 was male; the mean age of the first onset was 53 years (range, 25-69 years). The mean time between first aneurysms and CDNAs was 10.6 years (range, 3-29 years). The most common site of occurrence was anterior circulation. One patient experienced contralateral occurrence, and 2 patients changed from anterior to posterior circulation CDNAs. Six (54.5%) patients had a history of arterial hypertension. Results from analysis of the whole series from the literature revealed that the risk of rupture increased with a previous history of hemorrhage. Contralateral occurrence of CDNAs was related to previous location, and multiplicity, whereas the occurrence of anterior to posterior changes of CDNAs and shorter interval only correlated with an older age group. Although the formation of CDNAs is rare, several factors may contribute to its occurrence. Female patients with a history of arterial hypertension were at a higher risk for CDNA occurrence. We recommend follow-up imaging studies within 10 years after the initial aneurysms; therefore, at least 50% of CDNAs can be found before rupture.

An evidence base for reconsidering current follow-up guidelines for patients with cutaneous melanoma less than 0.5mm thick at diagnosis

An evidence base for reconsidering current follow-up guidelines for patients with cutaneous melanoma less than 0.5mm thick at diagnosis

Current Therapy of Cutaneous Melanoma

Melanoma is a growing public health problem. Optimal care of the melanoma patient is multidisciplinary, but plastic surgeons and other surgical specialties play a central role in the management of these patients. Although surgery remains the mainstay of therapy for melanoma, several recent clinical studies have helped to clarify the biology of the disease and have changed the patterns of care for patients with melanoma. The advent of lymphatic mapping for interrogation of regional lymph nodes and interferon as the first effective postsurgical adjuvant therapy have had a major impact on the care of melanoma in the United States and elsewhere. This article will review the current clinical approach and therapy for cutaneous melanoma. The diagnosis, prognostic variables, staging evaluation, current surgical and medical treatment, and follow-up guidelines for patients with all stages of melanoma are reviewed. Recent studies, controversies, and directions of future investigational therapies will be discussed.

Treatment of superficial bladder carcinoma in private practice

Until the mid-1950s, patients with superficial bladder carcinoma were routinely treated with repeat electrocoagulation. Several new developments revolutionized the management of this malignancy, including the introduction of ileal conduits, the growing use of radiotherapy and total cystectomy for the treatment of carcinoma with muscle invasion, the availability of thiotepa, and the development of flexible cystoscopes. Today, the spectrum of chemotherapeutic and immunotherapeutic agents for the treatment of superficial bladder cancer has expanded and a variety of agents are available, each characterized by a distinct therapeutic and side effect profile. The indications for the use of intravesical therapy and guidelines for patient follow-up are outlined. A favorable therapeutic outcome (including good patient compliance) also depends in large part on the degree to which the practitioner provides adequate patient reassurance and education, and encourages dialogue. Personal experience in the private practice setting suggests that the combination of good interpersonal communication and the use of an effective and well-tolerated agent, such as mitomycin, ensures a positive prognosis for most patients with superficial bladder carcinoma.

New primary nonmelanoma skin cancer in patients with a history of squamous cell carcinoma of the skin: Implications and recommendations for follow-up

Rational follow-up guidelines for skin cancer patients should be based on the risk of three separate events: cancer recurrence, cancer metastasis, and the development of subsequent skin cancers. However, currently no guidelines exist for follow-up of patients with squamous cell carcinoma of the skin (SCC), which take into account all three of these risks. The purpose of this study is to establish rational minimum guidelines for follow-up of patients with SCC. To do this, we first must determine the risk of SCC patients for the development of subsequent skin cancers. Combining these data with previously published data on SCC recurrence and SCC metastasis, we then propose guidelines for follow-up of patients with SCC. We followed up 101 SCC patients on a yearly basis for 5 years after treatment and recorded the date and site of subsequent nonmelanoma skin cancers (NMSCs). Thirty percent of SCC patients developed additional SCCs and 52% developed subsequent NMSCs within 5 years of therapy for their first SCC. Patients showing the highest risk of subsequent NMSC were those presenting with multiple SCC, SCC greater than 1 cm in diameter, SCC requiring more than 1 Mohs surgery layer to remove, or SCC occurring on the scalp, ear, nose, or extremities. One hundred percent of subsequent NMSCs were detected by the fourth year of follow-up; 54% of these occurred within the first year of follow-up. After combining our data with previously published studies of SCC recurrence and metastasis, we recommend that all patients with SCC be followed up for at least 4 years after treatment. Moreover, because most subsequent NMSCs, SCC recurrences, and SCC metastases developed early in the follow-up period, we recommend that patients be reexamined at least every 3 months during the first year of follow-up and every 6 months thereafter. It must be stressed that these are meant as minimum follow-up guidelines.