Multidisciplinary Follow-up Research Articles

Causes of death after oral cancer diagnosis: a population based study

BackgroundNowadays, the number of oral cancer survivors is increasing, emphasizing the importance of thoroughly understanding diverse causes of death in oral cancer survivors. Our study aimed to investigate the distribution of causes of death after oral cancer diagnosis.MethodsEligible patients were identified between 2004 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database. We calculated the number of deaths in different demographic and clinicopathological variables during each follow-up period. Standardized mortality ratios(SMRs) were generated for each cause of death after oral cancer diagnosis.ResultsA total of 30538 patients diagnosed with oral cancer were included, and 17654 deaths were reported during follow-up period. 27.08% of deaths were caused by non-caner reasons. The proportion of non-cancer related deaths increased with the extension of survival time, and non-cancer death accounted for 57.93% of all deaths when followed up more than 10 years. The most common non-cancer cause of death was cardiovascular disease (SMR 4.68#; 95%CI 4.46-4.92).ConclusionsNon-cancer causes of death should not be ignored in oral cancer patients. For oral cancer survivors, multidisciplinary follow-up strategy should be recommended to achieve longer survival time.

EOLP-01. PROPOSED FRAMEWORK FOR A PILOT MULTIDISCIPLINARY BEREAVEMENT FOLLOW-UP AND BRAIN AUTOPSY REVIEW FOR BEREAVED CAREGIVERS IN PEDIATRIC NEURO-ONCOLOGY

Abstract INTRODUCTION Brain tumors remain the leading cause of cancer-related death in children. The death of a child is distressing for caregivers and often associated with negative psychosocial outcomes. Bereaved caregivers frequently desire ongoing support after their child’s death. At our institution, brain autopsies with the option for tissue donation to research are offered to all families after the death of a child. Specific follow-up conducted to date and review of autopsy results have varied widely. We propose a pilot study to (1) evaluate feasibility of a comprehensive, multidisciplinary bereavement follow-up meeting with autopsy results review and grief supports for bereaved caregivers in pediatric neuro-oncology at Nationwide Children’s Hospital and (2) assess caregiver and provider perceptions regarding this follow-up meeting using mixed-methods design. METHODS/DESIGN Bereaved caregivers of children with a brain tumor who died and underwent brain autopsy through our institutional tissue donation protocol will be offered a follow-up meeting after their child’s death. The follow-up meeting will test an established PICU bereavement framework in the pediatric neuro-oncology setting with the addition of brain autopsy results review. Meetings will include caregivers and providers from neuro-oncology, palliative care, and psychosocial team (e.g., psychologist, social worker, chaplain). Caregivers will complete a Likert-scale questionnaire followed by a semi-structured interview via telephone. The goal is to conduct 7-10 meetings. Providers will participate in a focus group to provide feedback. Interviews and the focus group will be recorded, transcribed, and analyzed qualitatively. Concepts to be explored include perceived need for follow up; overall experience; satisfaction with structure, modality, and content; and perceived benefit and meaning of autopsy review. LONG-TERM GOAL To develop, evaluate, and formalize a comprehensive multidisciplinary bereavement follow-up meeting, guided by caregiver and provider feedback, that can be expanded to other institutions and become a “standard of care” for bereaved caregivers in pediatric neuro-oncology.

Effects of a Virtual Trauma Clinic on admissions and length of stay for minor to moderate trauma.

To investigate the feasibility of a Virtual Trauma Clinic (VTC) for patients with minor to moderate trauma, and evaluate patient satisfaction and outcomes. One hundred VTC patients were matched 1:1 with historical patients from the hospital trauma registry who received conventional care. Matching was based on age ± 5 years, sex, mechanism of injury, Injury Severity Score ± 2, trauma team activation and day of week of presentation. VTC patients were sent surveys on experience and outcome measures. VTC was associated with reduced average hospital length of stay for admitted patients by 1.81 days (95% CI = -2.82, -0.79; P = 0.001) and reduced hospital admissions (odds ratio 0.26; 95% CI = 0.14, 0.48; P < 0.001). There was an avoidance of 199 inpatient bed days in total, with no trauma-related readmissions within 30 days post-hospital discharge. 92% of respondents (n = 22) rated the care they received from VTC as excellent or good. Patient-reported outcome surveys showed overall improvement in functional domains but evidence of ongoing disability, with persistent issues of pain and psychological distress at 1 month post-injury. Patients with minor to moderate trauma have ongoing care needs with high rates of pain, psychological distress and disability remaining prevalent long after discharge. VTC provided an innovative strategy for hospital avoidance with high levels of patient satisfaction and no adverse effects on safety. The overall quality of care for these patients was enhanced through the provision of standardised, patient-centred and multidisciplinary follow-up.

Gestational diabetes, interculturality and precariousness: support and challenges

Managing gestational diabetes (GDM) is a particular challenge for women in precarious situations. Precariousness can hamper access to healthy food and medical care. The management of GDM requires careful multidisciplinary medical follow-up. Health professionals need to adopt a holistic approach, taking into account the socio-economic and cultural realities of each patient.

Inclusion of Long Covid patients in the care trajectory post-Covid-19: evidence from Belgium

Abstract Background Evidence suggests that 10-30% of COVID-19 infected people develop persistent symptoms that can be diagnosed as Long Covid. Most Long Covid cases are in patients with a mild acute COVID-19 infection and are mainly treated in primary health care. In July 2022, a care trajectory (CT) post-Covid-19 was launched in Belgium, in which Long Covid patients can benefit from reimbursement of treatment costs when consulting health professionals in primary health care for their rehabilitation. Patients are included in this CT mainly through their general practitioner (GP) and depending on patients’ care needs, treatment is organized in a monodisciplinary or multidisciplinary way. Methods A population-based study on data collected by the Belgian network of Sentinel General Practitioners (SGP) on all Long Covid patients consulting their GP during March-December 2023. Information on inclusion in the CT post-Covid-19 was also registered. Descriptive statistics were performed. Results End of 2023 in Belgium, GPs initiated the CT post-Covid-19 for more than 1000 patients, this mainly for monodisciplinary treatment, less than 10% of included patients received multidisciplinary follow-up. By the SGP, among the registered Long Covid sufferers (N = 14), a total of six cases were included in the CT post-Covid-19. Of these cases, the majority were female, of older age, higher educated and had one or two chronic conditions. Most had a mild or moderate prior COVID-19 infection and all were vaccinated multiple times against COVID-19. Symptoms lasted one year or more for 83.3% of included patients. Treatment focused mainly on self-management, energy management and physical exercise programs, mainly in collaboration with physiotherapists. Conclusions This study yields recent data on patients included in the CT post-COVID-19 in primary care in Belgium. It is important to focus on guidance, follow-up and rehabilitation of Long Covid sufferers by healthcare professionals in Belgium. Key messages • Long Covid patients included in the care trajectory post-Covid-19 in Belgium experience years of debilitating symptoms after their prior COVID-19 infection. • The establishment of the care trajectory post-Covid-19 for Long Covid patients in primary care since July 2022 stimulated collaboration between care givers in Belgian primary health care.

Progress in neurosurgical treatment of neurofibromatosis type 1

To summarize the latest developments in neurosurgical treatments for neurofibromatosis type 1 (NF1) and explore therapeutic strategies to provide comprehensive treatment guidelines for clinicians. The recent domestic and international literature and clinical cases in the field of NF1 were reviewed. The main types of neurological complications associated with NF1 and their treatments were thorough summarized and the future research directions in neurosurgery was analyzed. NF1 frequently results in complex and diverse lesions in the central and peripheral nervous systems, particularly low-grade gliomas in the brain and spinal canal and paraspinal neurofibromas. Treatment decisions should be made by a multidisciplinary team. Symptomatic plexiform neurofibromas and tumors with malignant imaging evidence require neurosurgical intervention. The goals of surgery include reducing tumor size, alleviating pain, and improving appearance. Postoperative functional rehabilitation exercises, long-term multidisciplinary follow-up, and psychosocial interventions are crucial for improving the quality of life for patients. Advanced imaging guidance systems and artificial intelligence technologies can help increase tumor resection rates and reduce recurrence. Neurosurgical intervention is the primary treatment for symptomatic plexiform neurofibromas and malignant peripheral nerve sheath tumors when medical treatment is ineffective and the lesions progress rapidly. Preoperative multidisciplinary assessment, intraoperative electrophysiological monitoring, and advanced surgical assistance devices significantly enhance surgical efficacy and safety. Future research should continue to explore new surgical techniques and improve postoperative management strategies to achieve more precise and personalized treatment for NF1 patients.

Treatment of Dento-alveolar Traumatic Injuries in a Child with Autism Spectrum Disorder (ASD)

This case report details the multidisciplinary management and follow-up of a 9-year-old boy diagnosed with autism spectrum disorder (ASD). He presented with severe intrusion injuries after a fall to his permanent maxillary central and lateral incisor teeth. The patient was initially seen in the emergency department by the maxillofacial team. Owing to the complexity of the dento-alveolar injury, it was felt that a multidisciplinary approach would improve patient outcomes. In theatre, both maxillofacial and paediatric dental teams managed the acute trauma. The paediatric dental team continued to review and follow-up with the child. A multidisciplinary team is ideal for managing paediatric patients with severe dental trauma and complex behavioural needs. This approach ensures the best care for patients and favourable outcomes. CPD/Clinical Relevance: Multidisciplinary management is important in paediatric dento-alveolar trauma.

Initiating medical abortion in an emergency department in the United States

ObjectivesThe primary objective of this study was to assess the feasibility of initiating medical abortions in a large, academic emergency department (ED) in the United States.MethodsA retrospective case series analysis...

Ophthalmologic symptoms as the first manifestation of primary complete empty sella syndrome- case report

Background: Empty sella syndrome (ESS) is a rare condition associated with loss of pituitary gland volume. ESS has a heterogeneous clinical manifestation including endocrine, neurological, and visual deficits. The most common symptoms include chronic headaches and hormonal disturbances associated with hypopituitarism.Aim of the study: To emphasize the role of ophthalmologists in the initial management of intracranial hypertension and the significance of a multidisciplinary approach in the management of ESS.Case report: Primary complete ESS was reported in a 32-year-old male presenting nonspecific ophthalmologic symptoms including ophthalmalgia and subjective worsening of the visual acuity. The ophthalmological exam revealed bilateral optic disk elevation. The subsequent MRI identified a suprasellar cistern invaginating within sella turcica with resulting pituitary gland flattening. A complete empty sella syndrome was confirmed. In addition, idiopathic intracranial hypertension was suspected. The patient was proposed hospitalization in the neurology department for additional testing however, he refused due to personal reasons.Conclusions: To date, only a few papers reported ESS with preliminary ophthalmological symptoms. All patients with nonspecific eye symptoms should have a complex ophthalmological examination. Bilateral optic disk elevation requires urgent imaging of the brain and orbits, and the golden-standard approach remains MRI. During the diagnostic process, the secondary causes of intracranial hypertension including tumor, bleeding, abscess, hydrocephalus, or venous sinus thrombosis must be excluded. Due to the heterogeneous clinical course of ESS, patients require multidisciplinary management and follow-up by endocrinologists, neurologists, neurosurgeons, and ophthalmologists.

An unusual case of Anasarca-Rapunzel syndrome

Rapunzel syndrome is a rare form of gastric trichobezoar extending into the intestine, often associated with malnutrition and protein-losing enteropathy. A 12-year-old female presented with epigastric abdominal pain, facial puffiness, bilateral lower limb swelling, and anorexia. She was a known case of sickle-thalassemia double heterozygous state but had never received a blood transfusion. Family history revealed parental separation and harsh paternal behavior. The patient was undernourished but otherwise developed normally. On examination, she was lethargic, exhibited generalized anasarca, severe anemia, signs of congestive cardiac failure, and patchy hair loss on the scalp. Abdominal examination revealed moderate ascites, hepatosplenomegaly, and a firm, mobile, non-tender epigastric mass (10×8 cm), suggestive of gastric bezoar. Laboratory findings showed microcytic hypochromic anemia with macro-ovalocytes in the context of sickle-thalassemia heterozygosity. The child required multiple blood and serum albumin transfusions for severe anemia and hypoproteinemia with anasarca. Hepatic and renal causes of anasarca were excluded. Cardiovascular and respiratory systems were normal. Contrast enhanced computed tomography (CECT) abdomen confirmed the gastric bezoar. After stabilization, exploratory laparotomy and trichobezoar evacuation were performed. Psychiatric counseling and diversion therapy were provided. The child was discharged in stable condition, with follow-up showing significant improvement in nutritional status, mood, and general well-being. This case highlights the unusual presentation of Rapunzel syndrome with generalized anasarca in a pediatric patient with underlying sickle-thalassemia, emphasizing the importance of multidisciplinary management and follow-up.

Twenty-four Month Multidisciplinary Follow-up of Multisystemic Inflammatory Syndrome Patients in a Tertiary Pediatric Hospital in Chile: A Prospective Study.

Multisystemic inflammatory syndrome (MIS-C) is a severe postinfectious condition. This study aims to detail long-term follow-up. Forty-five patients were followed up for 24 months, inflammatory markers were normalized at 3 months and echocardiographic alterations were resolved in all patients at 6 months, remaining normal. MIS-C, despite being a serious disease, presents a fast resolution of clinical, laboratory and echocardiographic alterations.

The impact of multidisciplinary geriatric follow-up on quality of life in older, non-surgical prefrail and frail patients with cancer [sbnd] A randomized controlled trial

IntroductionCancer management in older frail patients can be complex, given the high decline in functional status, comorbidity, and limited life expectancy affecting this group of patients. Therefore, this study aimed to investigate whether oncological treatment combined with comprehensive geriatric assessment (CGA) and tailored follow-up interventions improved or maintained quality of life (QoL) in older prefrail and frail patients with cancer. Materials and MethodsA single-center randomized controlled trial included participants aged 70 or older with head, neck, lung, upper gastrointestinal tract, colon, or rectum cancer referred to non-surgical treatment. All participants underwent CGA conducted by a multidisciplinary geriatric team in an outpatient oncological clinic. The team consisted of a geriatrician and a specialized nurse who provided tailored follow-up visits and phone calls within 90 days after randomization. Exclusion criteria were fit patients, referral for specialized palliative care, or participating in another geriatric research program. In patients with well-functioning cognition, QoL was assessed using the EORTC QLQ-C30 and QlQ-ELD-14 questionnaires before and after the intervention. In patients with cognitive impairment, the Overall QoL-Depression List was used. Changes in QoL were dichotomized into improved/unchanged or worsened and analyzed in a logistic regression model. ResultsIn total, 363 participants were included with a mean age of 76 years (SD 4.6) and 45 % were female. Sixty percent in the intervention group had improved or unchanged QoL compared to 66 % in the control group (odds ratio: 0.75 [95 % confidence interval(CI): 0.45–1.23]). Overall, clinically important changes were found in fatigue and reduced worries about the future. The intervention showed improvements in insomnia symptoms and reported decreased role functioning. Discrepancies were found in the burden of illness without a clinically important difference, where the intervention group experienced an increased burden while the control group had a decreased burden (coefficient: 9.02 [95 % CI, 0.49–17.5]). DiscussionMultidisciplinary geriatric follow-up did not universally improve QoL in older frail patients with cancer. However, positive changes in specific aspects of QoL revealed nuanced impacts, warranting further exploration and larger studies to validate these observations. Tailored interventions targeting fatigue, insomnia, and emotional well-being are crucial for improving QoL in this population. Trial RegistrationRegistered in January 2016 at ClinicalTrials.gov (ID: NCT02837679).

Long-term health outcome and quality of life in children with multisystem inflammatory syndrome: findings from multidisciplinary follow-up at an Italian tertiary-care paediatric hospital.

The mechanisms that might explain the long-term persistence of both metabolic alterations and neuro-behavioural outcomes and their possible relationship are far from being clarified. Our study points out to the potential long-term effects of pandemics and to the importance of a multidisciplinary follow-up to detect potential negative sequelae in different areas of health, both physical and psychosocial. • Multisystem inflammatory syndrome in children (MIS-C) is a severe complication of SARS-CoV-2 infection. • Few data exist on the medium- and long-term outcomes of MIS-C, mostly focused on cardiac involvement. Emerging evidence shows neurological and psychological sequelae at mid- and long-term follow-up. • This study reveals that MIS-C may lead to long-term glycometabolic dysfunctions joined to impairment in the realm of general well-being and decline in quality of life, in a subgroup of children. • This study highlights the importance of a long-term multidisciplinary follow-up of children hospitalised with MIS-C, in order to detect the potential long-term sequelae in different areas of health, both physical and psychosocial well-being.

Facial dysmorphism and Limb abnormalities of Fetal Valproate Syndrome.

A neonate born to nonconsanguineous parents was evaluated for dysmorphic features. The neonate was born at term by normal vaginal delivery. The mother has had epilepsy for 12 years and has been on sodium valproate (700 mg/day) since conception and throughout pregnancy. Examination revealed facial dysmorphism, including triangular forehead, sparse arched eyebrows, telecanthus, flat nasal bridge, long thin upper vermilion border, smooth philtrum, and low-set ears. The limb anomalies observed were arachnodactyly, wrist and elbow contractures, clinodactyly, hypoplastic toenails, and overlapping toes. The other dysmorphisms noted were widely spaced nipples and hypospadias. Ultrasonogram (USG) cranium showed bilateral choroid plexus cysts, and USG abdomen revealed bilateral mild hydronephrosis. 2D-Echocardiography revealed a small patent ductus arteriosus (PDA). A diagnosis of fetal valproate syndrome (FVS) was considered, and other differentials, including fetal alcohol syndrome and genetic conditions, were ruled out by a clinical geneticist review. The index neonate is currently on multidisciplinary follow-up. The index neonate had common features of FVS as described in the literature, in addition to wrist and elbow contractures. Apart from the anomalies, there is a significant risk for neurocognitive delay and neurodevelopmental disorders. Postnatally, these babies need multidisciplinary care and neurodevelopmental follow-up. Valproate use for treating epilepsy in pregnant women and women of childbearing age may be restricted, and alternative choices of ASMs with better safety profiles should be preferred. Facial dysmorphism and limb anomalies in fetal valproate syndrome may occur irrespective of the dose of sodium valproate. Fetal valproate syndrome may present with wrist and elbow contractures.

The Role of Patient Organisations-Patients' and Parents' Views and Experience of Hirschsprung's Disease.

In many countries, patient organisations offer advice and the exchange of experiences to Hirschsprung's disease patients and their families. Professional treatment by experienced health care providers and the availability of life-long multidisciplinary follow-up care are essential. However, outside the clinic, patients and their families have to manage life on a day-to-day basis at home, which often brings up uncertainties and questions: Parents go through different stages during the diagnosis and treatment of their child, the affected children themselves go through many different stages of development, and even through the course of adulthood, new questions regarding the chronic disease may arise. Patient organisations can support the patients and their families at all stages of life by listening, offering information in an understandable way, connecting people, and sharing others' experiences. This enables families and patients to develop a better understanding of the rare disease and promotes their management strategies and confidence. The holistic approach of patient organisations aims to complement the medical treatment. Therefore, the referral of all patients and their families to patient organisations should be part of the medical advice in the treatment of Hirschsprung's disease.

Long-term outcomes of congenital cytomegalovirus infection in children early identified by extended hearing-targeted screening

ObjectivesCongenital Cytomegalovirus (cCMV) has been associated with hearing, vision, and neurodevelopmental long-term sequelae. Despite the social burden associated with the disease, a universally accepted consensus on screening, diagnostic, therapeutic and follow-up approaches has not been reached. The present observational retrospective study aims at describing long-term sequelae and radiological abnormalities associated with cCMV in children early identified by extended hearing-targeted screening and evaluated by audiological follow-up in a single III Level Audiological Referral Center for at least 2 years. MethodsAudiological neonatal and follow-up data were available for all subjects. Data collection included clinical neonatal and virological assessment at birth. Ophthalmological, neurodevelopmental and neuroradiological follow-up abnormalities compatible with cCMV sequelae were collected by clinical reports. Spearman's rank correlation coefficient (rho-ρ) was used to evaluate possible correlations among the considered parameters. Results61 newborns were identified by extended hearing-targeted cCMV screening and diagnosed mostly (83.6 %) by PCR viral DNA extraction in urine collected within the 15° day of life. Seventeen babies were born preterm, with a mean gestational age of 33.5 weeks. Sixteen patients (26.2 %) were admitted to an Intensive or sub-Intensive Neonatal Care Unit. At birth, 35 newborns were symptomatic (57.3 %), and 19 of them received antiviral treatment by valganciclovir or ganciclovir. Overall, 20 children (32.7 %) were diagnosed with sensorineural hearing loss (SNHL), among them 17 (85 %) were refer at the newborn hearing screening while 3 (15 %) were Pass. 5/20 children (25 %) presented isolated SNHL, while in 15/20 (75 %) children SNHL was associated to other long-term sequelae. In 5 patients (25 %) a progression of the hearing threshold was observed, with a mean age of progression of 26 months of age. Risk factors for progression were a worse final hearing threshold (Spearman's ρ = 0.434; p = 0.0001) and a worse hearing threshold at birth (Spearman's ρ = 0.298; p = 0.020). Thirteen children were fitted with hearing aids, 8 of whom subsequently underwent cochlear implantation. Concerning long term impairments, 10/61 children (17 %) presented a variety of ophthalmological sequelae, while 16/40 cCMV patients (40 %) were diagnosed with neurodevelopmental abnormalities. Language delays were significantly associated with a worse hearing threshold (ρ = 0.582; p = 0.0001) and with other neurocognitive abnormalities (ρ = 0.677, p = 0.0001). 30 children underwent radiological brain evaluation by Magnetic Resonance Imaging, and 63.3 % of them presented abnormalities compatible with cCMV. Mean viral load at birth did not show significant associations with long-term sequelae. ConclusionsThe study highlights the diverse and significant long-term sequelae of cCMV infection detected through early screening. With a significant proportion of cCMV children developing sensorineural hearing loss, ophthalmological and neurodevelopmental issues, the results emphasize the importance of continuous, multidisciplinary follow-up. Early identification and tailored interventions are crucial for improving the long-term health and quality of life of children affected by cCMV.

Recommendations and quality criteria to improve the early diagnosis of primary biliary cholangitis

ObjectiveThe study aimed to establish recommendations and quality criteria to enhance the healthcare process of PBC. Patients and methodsIt was conducted using qualitative techniques, preceded by a literature review. A consensus conference involving five specialists in the field was held, followed by a Delphi process developed in two waves, in which 30 specialist physicians in family and community medicine, digestive system and internal medicine were invited to participate. ResultsSeven recommendations and 15 sets of quality criteria, indicators and standards were obtained. Those with the highest consensus were «Know the impact on the patient’s quality of life. Consider their point of view and agree on recommendations and care» and «Evaluate possible fibrosis at the time of diagnosis and during PBC follow-up, assessing the evolution of factors associated with poor disease prognosis: noninvasive fibrosis (elastography > 2.1 kPa/year), GGT, ALP and bilirubin annually», respectively. ConclusionsThe implementation of the consensus recommendations and criteria would provide better patient care. The need for multidisciplinary follow-up and an increased role of primary care is emphasized.

Impact of CoVID-19 pandemic on multidisciplinary follow-up and clinical outcomes among pediatric spina bifida patients

The longitudinal, multidisciplinary care of children with spina bifida was disrupted during the CoVID-19 pandemic with unclear effect. To compare outpatient care utilization and outcomes among children with spina bifida before and during the CoVID-19 pandemic. A pre-post analysis (2018-2020 vs 2020-2022) comparing outpatient care utilization and clinical outcomes was performed using the onset of the CoVID-19 pandemic as a hinge point. Clinical visits and clinically significant events - ED visits, admissions, UTIs, shunt malfunctions - were tabulated from chart review, and patients not seen in the last two years were called for follow up. Differences between visits and outcomes for individuals during pre- and intra-pandemic periods were calculated, and relationships between demographic variables and care utilization as well as clinical visits and clinical outcomes were evaluated via linear regression. A total of 216 patients were included, 39 (18%) of whom were lost to follow up intra-pandemic. Mean in-person visits decreased from 3.7 (SD 2.8) pre-pandemic to 2.5 (SD 2.3, p<0.00) intra-pandemic. Only six patients (0.03%) had virtual visits pre-pandemic vs 95 (44%) intra-pandemic; virtual visits did not equalize mean total visits with those pre-pandemic (3.3 [2.9], p=0.02). Recent surgery was significantly associated with difference in clinic visits between periods (p<0.00). Admissions (44 vs 29%, p<0.00), ED visits (55 vs 43.5%, p<0.00), and shunt malfunctions (21 vs 12.6%, p=0.01) were significantly higher pre-pandemic; UTI incidence was similar (34 vs 31%, p=0.41). Clinic visits were significantly positively associated with ED visits (p=0.02), admissions (p<0.00), and shunt malfunctions (p=0.04). Nearly half (40.5%) of patients lost to follow up were contacted; 30% of patients reported difficulty accessing appointments and 17% accessing supplies during the pandemic. Despite an increase in telehealth visits during the pandemic, there was a decrease in mean total clinic visits compared to pre-pandemic. Adverse events did not increase during the pandemic period as expected; incidence of all evaluated outcomes was higher pre-pandemic. Additionally, outpatient care utilization during the pandemic was positively associated with ED presentation and shunt malfunction and did not appear to protect against other outcomes. Though clinical follow-up for pediatric spina bifida patients decreased during the COVID-19 pandemic, clinical outcomes did not acutely worsen. Clinic visits were supplemented but not entirely replaced by telemedicine in this period and were associated with poorer clinical outcomes, possibly reflecting an increase in patients' and families' threshold to engage in outpatient care during the pandemic.

Significance of Systemic Scleroderma-Specific Autoantibodies in Idiopathic Interstitial Pneumonia.

Objective Patients with idiopathic interstitial pneumonia (IIP) often test positive for systemic scleroderma-specific autoantibodies (SSc-Ab), even if they do not meet the diagnostic criteria for systemic scleroderma (SSc). However, the significance of SSc-Ab in IIP is unknown. Methods We retrospectively studied the medical records of all patients suspected of interstitial lung disease (ILD) who visited our center between January 2016 and December 2021. We evaluated the association between SSc-Ab subtypes and clinical characteristics, prognosis, and incidence of acute exacerbation (AE) of IIP. Among 571 patients suspected of having IIP and SSc-Ab measured, we excluded cases with clear causes of ILD or those diagnosed with other diseases and analyzed 386 cases diagnosed as IIP. Results Among 386 IIP patients, 48 were SSc-Ab positive (platelet-derived growth factor receptor (PDGFR) in 0, Th/To in 10, anti-nucleolar organizer region 90 antibodies (NOR90) in 12, fibrillarin in five, RP155 in 14, RP11 in three, CENP A in seven, CENP B in 10, and Scl-70 in six). There was no significant difference in survival rate or incidence of AE between patients with or without SSc-Ab. Multivariate logistic regression analysis showed that age and malignancy were significant risk factors for death, whereas age, male sex, and anti-fibrillarin antibodies were significant risk factors for AE of IIP. Conclusion None of the SSc-Abs were associated with the risk of mortality, and anti-fibrillarin antibodies, along with age and male sex may contribute to the risk of AE of IIP, predicting severe lung involvement and warranting multidisciplinary treatment and careful follow-up.

The breastfeeding experience of women with multiple pregnancies: a meta-synthesis of qualitative studies

BackgroundThe experiences and challenges associated with breastfeeding multiple births can be considerably more complex than those of singletons. Multiple births refer to the delivery of more than one offspring in a single birth event. Emphasizing the needs and experiences of mothers with multiple births during breastfeeding can enable healthcare providers to design targeted interventions that enhance breastfeeding rates. However, existing breastfeeding and health education resources and practices do not fully meet the needs of women who breastfeed multiples. This review aimed to review and synthesize qualitative studies on the breastfeeding experiences of women with multiple births.MethodsA systematic search was conducted in 10 electronic databases for papers published from the inception of the database to March 2024. The Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research was utilized to evaluate the methodological quality of the studies included. The thematic synthesis method of Thomas and Harden was employed to integrate and analyze the included literature to derive new categories and conclusions.FindingsEight studies met the inclusion criteria and quality assessment criteria for this study. Through the integration of their results, four themes were identified: the choice and willingness to breastfeed multiple births; the challenges of breastfeeding multiple births; stage management and individualised adaptation of breastfeeding; and the experience of support.ConclusionThroughout the feeding process from pregnancy to the postpartum period, mothers with multiple births often have predominantly negative experiences with breastfeeding. Consequently, hospitals should create a multidisciplinary follow-up team comprising obstetrics, neonatology, psychology, and community services to offer specialized and personalized support to these women at various stages.Systematic review registration[https://www.crd.york.ac.uk/PROSPERO/], identifier [PROSPERO 2024 CRD42024520348].