Recommendations For Follow-up Care Research Articles

Evidence based clinical practice guideline for follow-up care in persons with spinal cord injury.

While it is well-established that follow-up care programs play a crucial role in preventing and early detecting secondary health conditions (SHCs) in persons with spinal cord injury [SCI, including spina bifida (SB)], the availability of evidence-based follow-up care programs remains limited. Under the leadership of the German-speaking Medical Society for Paraplegiology (DMGP), we have developed an evidence based clinical practice guideline for follow-up care of SHCs in persons with SCI and identify research gaps. This guideline was developed in accordance with the regulations of the Association of the Scientific Medical Societies in Germany (AWMF e.V.). To ensure an evidence-based guidance, we utilized the International Classification of Functioning, Disability and Health (ICF) generic core set and ICF Core Set for individuals with SCI in long-term context as our foundational framework. We conducted a comprehensive literature review to identify existing recommendations for follow-up care and graded the level of evidence according to relevant instruments. Subsequently, we formulated recommendations and achieved consensus through a structured nominal group process involving defined steps and neutral moderation, while adhering to the criteria outlined in the German guideline development instrument (DELBI). Although there is a fair number of literatures describing prevalence and severity of SHCs after SCI, the amount of literature including recommendations was low (19 for SCI and 6 for SB). Based on the current evidence on prevalence and severity of SHCs and available recommendations, a clinical practice guideline on follow-up care of most relevant SHCs was defined. The recommendations for follow-up care are described in the following chapters: (1) Nervous system; (2) (Neuropathic) pain; (3) Cardiovascular diseases; (4) Respiratory System; (5) Immunological system, vaccination and allergies; (6) Gastrointestinal tract and function; (7) Endocrinological system and nutrition; (8) Urogenital system; (9) Contraception, pregnancy, birth and postpartum care; (10) Musculoskeletal system; (11) Pressure injuries; (12) Psychological health; (13) Medication and polypharmacy. We could successfully establish an evidence based clinical practice guideline for follow-up care of SHCs in individuals with SCI. There is however a notable lack of high-quality recommendations for SCI follow-up care.

Automated survivorship care plan generation using large language models.

e13595 Background: Cancer survivorship, particularly from post-treatment to end-of-life, faces challenges such as communication gaps and coordination issues, leading to suboptimal care. A survivorship care plan (SCP) is a summarized record of patient cancer history and treatments, along with follow-up care recommendations. Despite extensive survivorship care guidelines from national cancer organizations, their adoption remains limited. Moreover, creating SCPs is time-intensive and burdensome for healthcare providers due to workforce limitations, hindering efficient personalization of care plans. Our study aims to address these issues by employing large language models (LLMs) to generate personalized SCPs. Methods: We introduce SurvGPT, a customized LLM designed to generate personalized SCPs focusing on its two main sections: the treatment summary and the follow-up care plan. Initially, our method extracts information from the structured and unstructured patient records to generate the treatment summary. Subsequently, it retrieves relevant context from a survivorship knowledge base crafted from existing medical literature and guidelines to generate a customized follow-up care plan. To mitigate LLM-related challenges such as hallucinations, our method ensures that the generated follow-up care plan is grounded on existing medical knowledge with a self-checking mechanism. Results: We created synthetic patient data based upon clinical inputs by a medical oncologist and an internist. We conducted a preliminary study using synthetic lung cancer patient EHR data to evaluate our approach. The evaluation focused on several key dimensions to validate the quality of the generated SCPs, including comprehensiveness, personalization, clarity, and actionable recommendations. The results presented in the table suggest promise for this approach yet also need for additional refinements both in degree of details extracted for ongoing care and then in formatting for effective use. The results also illustrate the complexity of generating synthetic cases for this work whose similarity to real patient care improved with iteration yet remained on occasion perceptibly different from current practice as noted by our clinical oncologist team member. Conclusions: In conclusion, our study demonstrates the potential of SurvGPT for generating personalized SCPs. The results of the preliminary results suggest that this approach is technically feasible with further validation required using real patient data. [Table: see text]

Clinical approach for solid intraocular metastases

Intraocular metastases arising from solid tumors are found in approximately 2% of patients with metastatic tumor diseases and are therefore more frequent than originally assumed. They often affect the uvea and are associated with apoor prognosis. Due to the difficult diagnosis and an inconsistent treatment regimen, ophthalmologists have aspecial responsibility here. This article gives a summary of the various types of intraocular metastases with respect to clinical features, diagnostics, treatment and prognosis as well as recommendations for follow-up care. A selective literature search was carried out on the topic of intraocular metastases using PubMed and Google Scholar. Intraocular metastases most frequently affect the uvea, specifically the choroid. In most cases the underlying disease is breast or lung cancer, but other rarer primary tumors have also been reported in the literature. Metastatic lesions can show very different morphological manifestations but can be distinguished based on the corresponding structure of manifestation in the eye and with the aid of targeted staging, thus providing valid information on the type of primary tumor. The treatment is partly experimental and usually depends on the primary tumor and leading symptoms of the patient. A differentiation between acurative or palliative treatment situation must always be made. Intraocular metastases are the most frequent intraocular tumor and are usually associated with apoor prognosis. Accurate diagnostics for finding the treatment as well as interdisciplinary collaboration and the presentation of the patient on the tumor board are essential.

Recommendation endpoints and safety of an online self-triage for depression symptoms.

Online symptom checkers are a way to address patient concerns and potentially offload a burdened healthcare system. However, safety outcomes of self-triage are unknown, so we reviewed triage recommendations and outcomes of our institution's depression symptom checker. We examined endpoint recommendations and follow-up encounters seven days afterward during 2 December 2021 to 13 December 2022. Patients with an emergency department visit or hospitalization within seven days of self-triaging had a manual review of the electronic health record to determine if the visit was related to depression, suicidal ideation, or suicide attempt. Charts were reviewed for deaths within seven days of self-triage. There were 287 unique encounters from 263 unique patients. In 86.1% (247/287), the endpoint was an instruction to call nurse triage; in 3.1% of encounters (9/287), instruction was to seek emergency care. Only 20.2% (58/287) followed the recommendations given. Of the 229 patients that did not follow the endpoint recommendations, 121 (52.8%) had some type of follow-up within seven days. Nearly 11% (31/287) were triaged to endpoints not requiring urgent contact and 9.1% (26/287) to an endpoint that would not need any healthcare team input. No patients died in the study period. Most patients did not follow the recommendations for follow-up care although ultimately most patients did receive care within seven days. Self-triage appears to appropriately sort patients with depressed mood to emergency care. On-line self-triaging tools for depression have the potential to safely offload some work from clinic personnel.

A software tool to support follow-up care in a French childhood cancer cohort: construction and feasibility

BackgroundTreatment summaries and a personalized survivorship care plans based on internationally approved, organ-specific follow-up care recommendations are essential in preserving the health and quality of life for cancer survivors. Cohorts made up of survivors of childhood cancer have made significant contributions to the understanding of early mortality, somatic late complications, and psychosocial outcomes among former patients. New treatment protocols are needed to enhance survival and reduce the potential risk and severity of late effects, and working with treatment databases is crucial in doing so.Construction and contentIn the GOCE (Grand Ouest Cancer de l’Enfant [Western Region Childhood Cancer]) network, in a participative approach, we developed the LOG-after medical tool, on which health data are registered and can be extracted for analysis. Its name emphasizes the tool’s goal, referring to ‘logiciel’ (the French word for software) that focuses on the period “after” the acute phase. This tool is hosted on a certified health data server. Several interfaces have been developed that can be used depending on the user’s profile. Here we present this innovative co-constructed tool that takes national aspects into account, including the results of the feasibility/satisfaction study and its perspective.Utility and discussionThe database contains data relating to 2558 patients, with samples from 1702 of these (66.54%) being held in a tumor bank. The average year in which treatment started was 2015 (ranging from December 1967 to November 2022: 118 patients were treated before 2012 and registered retrospectively when seen in long-term follow-up consultations or for another cancer since November 2021). A short questionnaire was distributed to healthcare professionals using the tool (physicians and research associates or technicians, n = 14), of whom 11 answered and were all satisfied. Access to the patient interface is currently open to 124 former patients. This was initially offered to 30 former patients who were over 15 years old, affected by the disease within the last 5 years, and had agreed to test it. Their opinions were collected by their doctor by e-mail, telephone, or during a consultation in an open-ended question and a non-directive interview. All patients were satisfied with the tool, with interest in testing it in the long term. Some former patients found that the tool provided them with some ease of mind; one, for instance, commented: "I feel lighter. I allow myself to forget. I know I will get a notification when the time comes."ConclusionsFreely available to all users, LOG-after: (1) provides help with determining personalized survivorship care plans for follow-up; (2) builds links with general practitioners; (3) empowers the patient; and (4) enables health data to be exported for analysis.Database URL for presentation: https://youtu.be/2Ga64iausJE

Families' experiences accessing care after genomic sequencing in the pediatric cancer context: "It's just been a big juggle".

Access to genomic sequencing (GS) and resulting recommendations have not been well described in pediatric oncology. GS results may provide a cancer predisposition syndrome (CPS) diagnosis that warrants screening and specialist visits beyond cancer treatment, including testing or surveillance for family members. The Texas KidsCanSeq (KCS) Study evaluated implementation of GS in a diverse pediatric oncology population. We conducted semi-structured interviews (n = 20) to explore experiences of KCS patients' families around learning about a CPS diagnosis and following up on recommended care. We used qualitative content analysis to develop themes and subthemes across families' descriptions of their experiences accessing care and to understand which factors presented barriers and/or facilitators. We found participants had difficulty differentiating which follow-up care recommendations were made for their child's current cancer treatment versus the CPS. In families' access to follow-up care for CPS, organizational factors were crucial: travel time and distance were common hardships, while coordination of care to streamline multiple appointments with different providers helped facilitate CPS care. Financial factors also impacted families' access to CPS-related follow-up care: having financial assistance and insurance were facilitators for families, while costs and lack of insurance posed as barriers for patients who lost coverage during transitions from pediatric to adult care, and for adult family members who had no coverage. Factors related to beliefs and perceptions, specifically perceiving the risk as less salient to them and feeling overwhelmed with the patient's cancer care, presented barriers to follow-up care primarily for family members. Regarding social factors, competing life priorities made it difficult for families to access follow-up care, though having community support alleviated these barriers. We suggest interventions to improve coordination of cancer treatment and CPS-related care and adherence to surveillance protocols for families as children age, such as care navigators and integrating longitudinal genetic counseling into hereditary cancer centers.

Participant and GP perspectives and experiences of screening for undiagnosed type 2 diabetes in community pharmacy during the Pharmacy Diabetes Screening Trial

BackgroundThe Pharmacy Diabetes Screening Trial (PDST) evaluated three approaches to screening for undiagnosed type 2 diabetes mellitus (T2DM) in community pharmacy: (1) paper-based risk assessment (AUSDRISK) alone; and AUSDRISK followed by a point of care test if AUSDRISK ≥ 12; with either (2) HbA1c; or (3) small capillary blood glucose Test (scBGT). This paper reports the perspectives and experiences of the pharmacy screening service of two key stakeholder groups: screening participants and general practitioners (GPs).MethodsAll referred participants (n = 2242) received an online survey to determine the outcome of the referral, as well as their level of satisfaction with the service. In addition, a random sample of 2,989 (20%) of non-referred participants were surveyed to determine their overall experience and level of satisfaction with the service. GPs to whom participants were referred were contacted to establish if, since the date of the screening service, their patient had (1) been to see them; (2) had further tests performed (FBG, RBG, OGTT, HbA1c); or (3) been diagnosed with diabetes or prediabetes. Descriptive statistics were reported for quantitative data. Factors associated with visiting the GP following screening were assessed using multivariable logistic regression. Qualitative data were analysed using content analysis.ResultsResponse rates 16% (n = 369) and 17% (n = 520) were achieved for the three-month referred and non-referred participant surveys, respectively. Over 90% of respondents were very positive about the screening service (n = 784/853) and would recommend it to a family member or friend (n = 784/853). Participants also reported making significant improvements in diet and exercise, because of the screening. Among referred respondents, those who received a POC test were twice as likely to visit their GP compared to those who received a risk assessment only (OR 2.11 95% CI 1.46–3.06). GPs (15.8% response rate, n = 57/361) indicated that the referral worked well and that recommendations for follow-up care by the pharmacist were appropriate.ConclusionOpportunistic screening of individuals during routine encounters with the community pharmacy in a previously undiagnosed population has been shown to foster positive engagement with consumers and GPs, which may assist in reducing the burden of T2DM on the individual and the community.

Parent-Reported Clinical Utility of Pediatric Genomic Sequencing.

Genomic sequencing (GS) is increasingly used for diagnostic evaluation, yet follow-up care is not well understood. We assessed clinicians' recommendations after GS, parent-reported follow-up, and actions parents initiated in response to learning their child's GS results. We surveyed parents of children who received GS through the Clinical Sequencing Evidence Generating Research consortium ∼5 to 7 months after return of results. We compared the proportion of parents who reported discussing their child's result with a clinician, clinicians' recommendations, and parents' follow-up actions by GS result type using χ2 tests. A total of 1188 respondents completed survey measures on recommended medical actions (n = 1187) and/or parent-initiated actions (n = 913). Most parents who completed recommended medical actions questions (n = 833, 70.3%) reported having discussed their child's GS results with clinicians. Clinicians made recommendations to change current care for patients with positive GS results (n = 79, 39.1%) more frequently than for those with inconclusive (n = 31, 12.4%) or negative results (n = 44, 11.9%; P < .001). Many parents discussed (n = 152 completed, n = 135 planned) implications of GS results for future pregnancies with a clinician. Aside from clinical recommendations, 13.0% (n = 119) of parents initiated changes to their child's health or lifestyle. In diverse pediatric clinical contexts, GS results can lead to recommendations for follow-up care, but they likely do not prompt large increases in the quantity of care received.

Recommendations for follow-up care during post-deployment screening of Canadian Armed Forces personnel: how well does self-reported mental health predict referral decisions?

ObjectiveCanadian Armed Forces (CAF) post-deployment screening aims to facilitate early care for members with mental health issues. The process consists of a questionnaire to screen for mental health problems, followed...

ChatGPT: the future of discharge summaries?

ChatGPT: the future of discharge summaries?

AI and Incidental Findings

AI and Incidental Findings

European Cancer Summit 2022 submission for Digital Health NetworkThe Survivorship Passport: a digital tool for better and homogeneous long-term care for childhood cancer survivors

BackgroundMany childhood and adolescent cancer survivors (CCS) and their healthcare professionals lack information about possible late effects, personal risk profiles and the need of long-term follow-up care. Most have poor or no access to their clinical and treatment data as well as to a survivorship care plan. The Survivorship Passport (SurPass) is an innovative, digital tool, developed by the PanCare community in previous and on-going EU-funded projects (ENCCA, ExPO-r-Net, PanCareSurFup, PanCareFollowUp, PanCareSurPass), that can be used to overcome these gaps and improve people-centered long-term follow-up care. MethodsAim of the SurPass and of the PanCare community is to improve the quality of life and health status of CCS and to address their potential needs through the development of successively improving versions and functionalities of the platform. The SurPass provides an electronical and paper-based summary of a CCS´s clinical history, with detailed information about diagnosis and treatment, coupled with personalized follow-up and screening recommendations based on evidence-based guidelines published by the International Guidelines Harmonization Group (IGHG) and the PanCare Guidelines Group. Algorithms built into the platform allow the creation of an individualized care plan. ResultsThis endeavor started in 2011 when the prototype of the SurPass platform was developed (ENCCA) and integrated the first set of IGHG follow-up recommendations. SurPass was further improved (v1.1) by multi-language translation (ExPO-r-Net), and with a complete set of organ-specific recommendations alongside further new IGHG and PanCare guidelines (PanCareFollowUp v1.2). SurPass v2.0 is currently implemented and spread over several centers in six European countries (PanCareSurPass) whilst testing the interoperability between institutional electronic medical records and the SurPass platform. Similar to Europe's vision of a ‘Cancer Survivor Smart Card’, the SurPass tool was developed as a ‘resource’ function to link the individual treatment history to best surveillance and individual follow-up care recommendations for CCS. ConclusionsSurPass can be considered a proof of concept of the clinical-history and personalized-care modules sought under the EU-announced Cancer Survivor Smart Card initiative. Within the newly funded smartCARE project coordinated by ECO, we will share the experiences of the PanCare community with SurPass and international guideline development in survivorship since 2011.

Moving toward standardization: physician reporting of sleep studies.

Lastra AC, Ingram D, Park J, etal. Moving toward standardization: physician reporting of sleep studies. J Clin Sleep Med. 2023;19(3):595-603.

Socioeconomic Disparity and Bariatric Surgery Outcomes: A Qualitative Analysis

INTRODUCTION: Disparity in socioeconomic status (SES) have been associated with less weight loss after bariatric surgery. Reasons for these disparities are unknown. Our objective was to identify socioeconomic barriers to weight loss after bariatric surgery. METHODS: We performed semi-structured interviews with bariatric surgery patients and providers from April to November 2020. Participants were asked to describe their postoperative experiences within 3 clinical areas: dietary habits, physical activity, and follow-up care. Purposeful sampling was used to recruit similar numbers of patients within low vs high SES and “optimal” vs “suboptimal” weight loss groups. Low SES patients were defined as having Medicaid within 3 years of operation. Patients with “optimal” weight loss had obtained ≥50% excess weight loss at their most recent clinic visit. Interview data were coded by team members using Directed Content Analysis based on the domains in Andersen’s Behavioral Model of Health Services Use and Torain’s Surgical Disparities Model. Codes pertaining to patient-level behaviors were included in the analysis. RESULTS: Twenty-four patients (median of 4.1 years postoperatively; mean age 50.6 ± 10.7 years; 83% female) and 21 providers (6 bariatric surgeons, 5 registered dietitians, 4 health psychologists, and 6 primary care providers) were interviewed. Barriers to weight loss at the patient level related to 5 areas (Table 1): (1) limited health literacy; (2) challenging employment environments; (3) limited income; (4) unreliable transportation; and (5) unsafe/inconvenient neighborhoods. Table 1. - Socioeconomic Barriers to Weight Loss after Bariatric Surgery Barrier Description 1. Limited health literacy Patients with less formal education needed more training/teaching regarding recommendations for diet, physical activity, and postoperative care. 2. Challenging employment environments Patients who had physically demanding jobs or multiple jobs struggled to follow dietary, physical activity, and follow-up care recommendations. 3. Limited income Lower-income patients: (a) had a difficult time affording supplements and vitamins; (b) skipped meals or relied on cheaper convenience food options/unhealthy options at food pantry; (c) did not have access to affordable fitness centers; (d) did not have reliable internet access for virtual follow-up meetings; (e) struggled with gas money and co-pays, which prevented their attendance at follow-up meetings. 4. Unreliable transportation Patients who did not have reliable transportation were restricted by bus routes to obtain healthier foods. Public transportation or insurance-provided transportation (eg, scheduled service driver) was often unreliable. 5. Unsafe/inconvenient neighborhoods Grocery stores in disadvantaged neighborhoods carried fewer healthy options. Patients in these neighborhoods struggled to have groceries delivered to their homes because of fear of theft. These neighborhoods were often unsafe for exercising or did not have sidewalks. CONCLUSION: Numerous socioeconomic barriers to weight loss exist for bariatric surgery patients. Interventions targeting these factors are needed to support patients, particularly those who are socioeconomically disadvantaged.

Recommendations for Care and Support of Female Rape Victims

Introduction According to prevalence studies, at least 5% of all women in the Federal Republic of Germany experience rape during their lifetime. While the effects vary according to the individual, rape has serious consequences for the somatic, psychological, and psychosocial health of the victim. The medical care that is provided to presumed rape victims is of special importance, as this care can have a positive influence on the patientʼs ability to process their experience and engage in healing following such a traumatic event. Furthermore, doctors are the professionals whose help is most often sought in this context. Primary care following rape consists of three aspects: the forensic medical examination, medical care, and psychological care. In this position paper, each of these aspects are discussed in detail. Recommendations for follow-up care are also provided. Methods In a multi-tiered process, a selective literature review was performed and a consensus among representative experts from different areas of specialization was formulated. Goals The goal of this paper is to contribute to the further improvement and standardization of the medical care provided to women who are presumed rape victims.

Youth Concussion Management Practices Among Athletic Trainers: A Vignette-Based Survey.

Recovery protocols for treatment of sports concussion have received widespread adoption across the country. While stages of recovery and treatment are relatively clearly defined, there remains variability in implementation of specific recommendations, particularly regarding activities that constitute rest during stages calling for limitations on activity participation. Specific recommendations being employed by practitioners have not been previously assessed. In an aim to document current concussion management practices in the field, athletic trainers were surveyed regarding how activities that may constitute rest are utilized and defined. The study was based on a cross-sectional vignette-based survey. The sample used was a geographically representative convenience sample of United States-based high school athletic trainers. E-mails were sent to 2146 potential survey respondents yielding a final sample of 226 athletic trainers. Data were gathered for questions concerning recommendations for follow-up care and rest based on provided vignettes, factors considered when developing recommendations, and differences in recommendations associated with varying symptom presentations. The percentage of practitioners that would utilize each potential recommendation was used to characterize results. Participants demonstrated consensus on the importance of physical and cognitive rest as well as school accommodations (all greater than 97% endorsement). Greater variability was present for recommendations regarding pain medication for headache, repeating baseline cognitive testing, and engaging in subsymptom threshold activities. Recommendations for attending but not participating in games and practice yielded conflicting information. Responses indicated general consensus regarding factors considered when making recommendations. There was also consensus regarding general recommendations for activity limitation following recovery with almost all participants strongly recommending cognitive and physical rest, in accordance with consensus guidelines. However, substantial differences were found for specific activities that should be limited or encouraged following youth concussion. Further research concerning the relationship between community and social interaction and clinical outcomes after concussion is warranted.

Communicating incidental and reportable findings from research MRIs: considering factors beyond the findings in an underrepresented pediatric population

BackgroundThe application of advanced imaging in pediatric research trials introduces the challenge of how to effectively handle and communicate incidental and reportable findings. This challenge is amplified in underserved populations that experience disparities in access to healthcare as recommendations for follow-up care may be difficult to coordinate. Therefore, the purpose of the present report is to describe the process for identifying and communicating findings from a research MRI to low-income Latino children and families.MethodsLatino adolescents (n = 86) aged 12–16 years old with obesity and prediabetes underwent a research MRI (3 Tesla Philips Ingenia®) as part of a randomized controlled diabetes prevention trial. The research MRIs were performed at baseline and 6 months to assess changes in whole-abdominal fat distribution and organ fat in response to the intervention. An institutional pathway was developed for identifying and reporting findings to participants and families. The pathway was developed through a collaborative process with hospital administration, research compliance, radiology, and the research team. All research images were reviewed by a board-certified pediatric radiologist who conveyed findings to the study pediatrician for determination of clinical actionability and reportability to children and families. Pediatric sub-specialists were consulted as necessary and a primary care practitioner (PCP) from a free community health clinic agreed to receive referrals for uninsured participants.ResultsA total of 139 images (86 pre- and 53 post-intervention) were reviewed with 31 findings identified and 23 deemed clinically actionable and reportable. The only reportable finding was severely elevated liver fat (> 10%, n = 14) with the most common and concerning incidental findings being horseshoe kidney (n = 1) and lung lesion (n = 1). The remainder (n = 7) were less serious. Of youth with a reportable or incidental finding, 18 had a PCP but only 7 scheduled a follow-up appointment. Seven participants without a PCP were referred to a safety-net clinic for follow-up.ConclusionsWith the increased utilization of high-resolution imaging in pediatric research, additional standardization is needed on what, when, and how to return incidental and reportable findings to participants, particularly among historically underrepresented populations that may be underserved in the community.Trial registrationPreventing Diabetes in Latino Youth, NCT02615353

Implementation of Postpartum Depression Screening for Women Participating in the WIC Program.

The national average for the occurrence of postpartum depression (PPD) is 11.5%. Women enrolled in the Women, Infants, and Children (WIC) program are at an elevated risk for PPD symptoms due to risk factors such as a low income, unemployment, low education level, and younger maternal age. To implement screening for PPD symptoms using the Edinburgh Postnatal Depression Scale (EPDS) (1987) for women participating in the local WIC program with an infant <12 months old and compare results of positive screenings to the national average. The second goal was to provide community resources to those women with a positive score. Of 72 women screened, 69 scores were used in the comparison of the positive scores to the national Centers for Disease Control and Prevention average of 11.5%. Women were offered community resources after completion of the EPDS. There were 13 positive scores out of the sample size of 69. The percentage of positive scores obtained from these data were 18.84% for the WIC population, which is higher than the national average of 11.5%. This was significant with p = .0494. One limitation of this project was a small sample size. It would be beneficial for the WIC program to screen women for PPD symptoms in this high-risk population, so that recommendations for follow-up care could be made and quality of life could be increased.

Michigan Screening and Intervention for Glaucoma and Eye Health Through Telemedicine (MI-SIGHT): Baseline Methodology for Implementing and Assessing a Community-based Program.

The Michigan Screening and Intervention for Glaucoma and eye Health through Telemedicine (MI-SIGHT) program leverages community-engaged research, telemedicine, and health coaching to overcome key logistical and psychosocial barriers to improve glaucoma screening in underserved communities. To describe the methodology of the implementation and evaluation of the MI-SIGHT Program. The MI-SIGHT Program uses community engagement, telemedicine, and health coaching to overcome key logistical and psychosocial barriers to glaucoma identification and care among underserved populations. The MI-SIGHT Program will be evaluated in 2 community clinics: Hamilton Community Health Network, a federally qualified health center in Flint, Michigan, and the Hope Clinic, a free clinic in Ypsilanti, Michigan. A Community Advisory Board including the research team and health care providers, administrators, and patients from both clinics will guide program implementation. An ophthalmic technician at the community clinics will conduct screening tests for glaucoma and eye disease. The data will be transmitted through electronic health record to be reviewed by an ophthalmologist who will make recommendations for follow-up care. The ophthalmic technician will conduct a return visit to fit low-or no-cost glasses, help arrange follow-up with an ophthalmologist, and provide education. Those diagnosed with glaucoma or suspected glaucoma will be randomized to standard education or personalized glaucoma education and coaching. Costs will be assessed. The authors hypothesize that the MI-SIGHT Program will detect a higher prevalence rate of glaucoma than that found in the general population, improve upon presenting visual acuity, enhance vision-related quality of life, and demonstrate that personalized glaucoma education and coaching improve adherence to follow-up care. The MI-SIGHT Program may serve as a model for glaucoma screening and care in high-risk communities.

Accuracy of the 4-Stage Balance Test and Sensor-Based Trunk Sway as Fall Risk Assessment Tools in the Emergency Department

Purpose: Falls are the leading cause of injury-related emergency department (ED) visits in older adults, but we lack a sensitive screening tool for fall risk. We evaluated the sensitivity and specificity of the 4-Stage Balance Test (4SBT) to identify older adults at risk of falling in an ED setting and whether accelerometry-based trunk sway measures could improve identification. Methods: Participants were 63 ambulatory adults 65 years and older in the ED, of which 47% reported a fall in the past year. Outcome measures were the 4SBT and trunk sway. Participants identified as being at risk of falling received recommendations for follow-up care. Participants were contacted 8 ± 2 weeks after their ED visits to assess compliance with ED recommendations. Results: No strong association was found between reported falls and completion of the first 3 positions of the 4SBT (P = .063). The best model was staggered stance plus average anterior-posterior sway and posterior sway of the thorax (P = .004, area under receiver operating curve = 0.8). On follow-up, 21% of those identified as being at risk, and available for follow-up, had fallen; 2 reported multiple falls. Conclusions: Administration of the first 2 positions of the 4SBT combined with measurement of posterior sway is a quick method for fall risk assessment in the ED.