Standard Follow-up Research Articles

A comparative study of compliance: standard model CPAP Follow-up with telemonitoring and a cost-effective subscription monthly model with periodic accessories supply

A comparative study of compliance: standard model CPAP Follow-up with telemonitoring and a cost-effective subscription monthly model with periodic accessories supply

Determination of Body Composition in Community-Dwelling Older Adults With and Without Sarcopenia Using Data From Practical Measures.

Adequate body composition is essential for health, function, and independence in older adults. However, standard body composition assessments require complex and costly modalities, limiting their use for early detection of body composition changes and periodic follow-up. This study explored the ability of three practical measures-handgrip strength, five times sit-to-stand test, and upper limb loading during seated push-up test (ULL-SPUT)-to determine body composition in 109 older adults with and without sarcopenia. Participants (average age 76years) were cross-sectionally measured for outcomes of the study. The ULL-SPUT and handgrip strength, but not the five times sit-to-stand test, significantly correlated with body composition (rs, r = .297-.827, p < .01). The ULL-SPUT, in combination with demographic data, could determine body composition up to 82%. Therefore, the ULL-SPUT may be a practical preliminary measure to identify older adults for whom standard body composition assessments and follow-up would prove timely and beneficial.

Positive Effect of a Financial Incentive on Radiologist Compliance With Quality Metric Placement in Knee Radiography Reports

PurposeOngoing quality improvement (QI) processes in the authors’ department include the insertion of a Kellgren-Lawrence (KL) osteoarthritis grading template in knee radiography reports to decrease unnecessary MRI. However, uniform adoption of this grading system is lacking. Department-wide financial incentives were instituted to improve compliance with QI metrics. The purpose of this study was to evaluate the effect of a financial incentive on KL grading system use and to compare compliance rates of musculoskeletal (MSK) radiologists with those of general radiologists who were not financially incentivized to use KL grading. MethodsPercentages of all knee radiography reports containing KL grading with standardized follow-up recommendations were determined by querying the departmental radiology database before and after the introduction of the new quality-based financial incentive. Preincentive compliance rates for MSK and general radiologists were compared with an adoption period and two separate 6-month postincentive periods. ResultsIn total, 52,673 reports were retrospectively analyzed for KL grading use (41,670 reports interpreted by MSK radiologists and 11,003 interpreted by general radiologists). Increase in compliance was greatest among MSK radiologists’ reports during the incentivized adoption period (from 36.1% to 53.2%). This improvement was sustained among MSK radiologists and averaged 62.7% during the most recently studied postimplementation period. A lesser degree of improvement in compliance was observed in nonincentivized general radiologists’ reports (from 19.3% to 27.5%); during the postimplementation follow-up period, their compliance decreased to 26.5%. ConclusionsThe introduction of a financial incentive resulted in significantly increased adoption of QI practices with sustained improvement among incentivized MSK radiologists compared with nonincentivized general radiologists.

Right ventricular injury in critically ill patients with COVID-19: a descriptive study with standardized echocardiographic follow-up

PurposePatients with COVID-19 admitted to intensive care unit (ICU) may have right ventricular (RV) injury. The main goal of this study was to investigate the incidence of RV injury and to describe the patient trajectories in terms of RV injury during ICU stay.MethodsProspective and bicentric study with standardized transthoracic echocardiographic (TTE) follow-up during ICU stay with a maximum follow-up of 28 days. The different patterns of RV injury were isolated RV dilation, RV dysfunction (tricuspid annular plane systolic excursion < 17 mm and/or systolic tricuspid annular velocity < 9.5 cm/s and/or RV fractional area change < 35%) without RV dilation, RV dysfunction with RV dilation and acute cor pulmonale (ACP, RV dilatation with paradoxical septal motion). The different RV injury patterns were described and their association with Day-28 mortality was investigated.ResultsOf 118 patients with complete echocardiographic follow-up who underwent 393 TTE examinations during ICU stay, 73(62%) had at least one RV injury pattern during one or several TTE examinations: 29(40%) had isolated RV dilation, 39(53%) had RV dysfunction without RV dilation, 10(14%) had RV dysfunction with RV dilation and 2(3%) had ACP. Patients with RV injury were more likely to have cardiovascular risk factors, to be intubated and to receive norepinephrine and had a higher Day-28 mortality rate (27 vs. 7%, p < 0.01). RV injury was isolated in 82% of cases, combined with left ventricular systolic dysfunction in 18% of cases and 10% of patients with RV injury experienced several patterns of RV injury during ICU stay. The number of patients with de novo RV injury decreased over time, no patient developed de novo RV injury after Day-14 regardless of the RV injury pattern and 20(31%) patients without RV injury on ICU admission developed RV injury during ICU stay. Only the combination of RV dysfunction with RV dilation or ACP (aHR = 3.18 95% CI(1.16–8.74), p = 0.03) was associated with Day-28 mortality.ConclusionRV injury was frequent in COVID-19 patients, occurred within the first two weeks after ICU admission and was most often isolated. Only the combination of RV dysfunction with RV dilation or ACP could potentially be associated with Day-28 mortality.Clinical trial registration NCT04335162.

Protocol for open-label, randomised, controlled trial of intensive surveillance vs. standard postoperative follow-up in patients undergoing surgical resection for oesophageal and gastric cancer (SARONG trial).

TPS416 Background: Despite recent improvements in oncological and surgical treatment for patients with oesophageal and gastric cancer, 60% of patients with locally advanced disease who are treated with a curative intent will develop tumour recurrence and die within three years of completing treatment. In the absence of robust scientific evidence national or international guidelines have failed to reach consensus on the optimal surveillance strategy after primary treatment of oesophageal or gastric cancer. Methods: The primary research question of the proposed randomised controlled trial (RCT) is does the routine use of a structured follow-up program with regular radiological and endoscopic investigations improve survival in patients who have had surgical treatment for oesophageal or gastric cancer with curative intent? We aim to assess whether structured follow-up, including radiological and endoscopic investigations after completing curatively intended treatment, improves survival in patients with oesophageal or gastric cancer. The secondary aims of this RCT are to determine the impact of a structured post-treatment surveillance upon the detection and treatment of cancer recurrence and health-related quality of life, including anxiety and to assess the cost-effectiveness. We will undertake a national prospective, multi-centre, randomised controlled trial of structured follow-up including radiological and endoscopic investigations versus standard clinical follow-up. The setting will be at least 24 large oesophago-gastric cancer UK cancer centres. We will aim to recruit 952 oesophageal and gastric cancer patients receiving surgical resection for curatively intended treatment of oesophageal or gastric cancer +/- neoadjuvant/adjuvant chemo(radio or immuno)therapy. At 4-12 weeks after surgery for oesophageal or gastric cancer, patients will be assessed for eligibility for inclusion in the trial. Patients will be randomised 1:1 to receive either intensive follow-up for up to 3-years, with clinical and computerised tomography (CT) investigation every 6 months, and an endoscopy at 12 months or to current standard NHS follow-up, i.e. clinical review at 6 and 12 months followed by targeted investigation as required based upon the onset of new symptoms. The primary outcome is 3-year all-cause mortality and secondary outcomes include health-related quality of life (including anxiety), 3-year disease-specific mortality, pattern and treatment of tumour recurrence, and cost-effectiveness of follow-up in both study arms. The findings of this RCT will inform national and international guidelines for patients with oesophageal and gastric cancer, as this will be the first RCT to provide robust evidence concerning the value of surveillance in this population. Clinical trial information: 14417629.

Abstract A112: Liquid biopsy shows distinctive proteome of long-term recurrence free survivors after PDAC resection

Abstract Pancreatic ductal adenocarcinoma (PDAC)patients have a 5-year survival rate of less than 10%, partly due to 80% developing recurrence within 2 years after curative intent surgery. As surgical resectability criteria expand and techniques progress, better understanding of tumor biology regarding post-resection prognosis is needed to improve patient outcomes. Our study therefore investigated usefulness of liquid biopsy and proteomics analysis for stratification of post-resection risk groups. Patients undergoing standardized follow-up after resection of PDAC at the European Pancreas Center (Heidelberg, Germany) donated blood samples and clinical data after giving informed consent. Outcomes were extracted from the institutional database or Electronic Health Records and documented retrospectively. From all included patients (n=101) 7mL serum was drawn at different follow-up time points. Overall, 139 samples were collected. Protein expression values of 2953 proteins were determined via antibody microarrays. For analysis and statistics, GenePix 6.0, R and GraphPad Prism were used. First, a principal component analysis was performed on the complete data set. Then the data set was split in a training and test set and A subgroup of 43 patients experienced recurrence of PDAC within 24 months post resection (median: 11.39 months), classified as “early recurrence” (ER). Furthermore, 23 patients experienced recurrence between 26 and 144 months and were termed “late recurrence” (LR). 32 patients had a follow up &amp;gt; 26 months after resection and 6 months after sampling and remained recurrence-free; those were termed “long-term recurrence free survivors” (LT-RFS). Principal component analysis of protein microarray data revealed distinct clustering of LT-RFS together along the primary axis. Contrarily, all of the samples taken at time of recurrence were exclusively found in other quadrants, as were all samples but one of the ER subgroup preceeding diagnosis of recurrence. Samples of the LR subgroup appeared to shift from clustering with LT-RFS samples towards samples from ER and post-recurrence. Lasso regression yielded a panel of 10 proteins, with a specificity of 98.0%/90.9% and a sensitivity of 89.4%/65.0% (training/test set), for identification of samples from LT-RFS. The findings of our protein microarray analysis on PDAC recurrence monitoring suggest a distinct proteome of patients with RFS of &amp;gt;2a post resection. Furthermore, we found hints that the post-resection proteome undergoes a dynamic shift from recurrence-free phenotype towards a phenotype of recurrence. These data need validation in prospective cohorts to determine clinical relevance, however, they point towards opportunities offered by liquid biopsy for sophisticated disease monitoring post resection and for novel insights into mechanisms of disease in PDAC. A protein panel predictive of long-term RFS might enable personalized follow-up pathways and have a positive impact on frequency and invasiveness of post-resection diagnostic testing for PDAC patients. Citation Format: Teresa Colbatzky, Fawaz N. Al-Shaheri, Andrea S. Bauer, Nathalia Giese, Jörg D. Hoheisel, Ulrike Heger. Liquid biopsy shows distinctive proteome of long-term recurrence free survivors after PDAC resection [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Pancreatic Cancer; 2023 Sep 27-30; Boston, Massachusetts. Philadelphia (PA): AACR; Cancer Res 2024;84(2 Suppl):Abstract nr A112.

12 Month vs 6 Month Follow-up Colonoscopy After Piecemeal Endoscopic Resection of Large Nonpedunculated Colorectal Lesions

Background and aims:Current colonoscopy guidelines recommend nonpedunculated lesions ≥20mm in size and removed piecemeal should have follow-up colonoscopy in 6 months to ensure complete resection. Some data suggest that a 12-month follow-up may be safe and effective for selected lesions. Standard follow-up is 6, 18, 54 and 114 months after piecemeal resection. If the first follow-up visit is 12 months, the sequence is 12, 48, and 108 months. We investigated whether planned 12-month follow-up colonoscopy is as safe and effective for selected lesions when compared to 6-month follow-up.&#x0D; Methods:We utilized a prospectively collected database of 1599 consecutive, large, and nonpedunculated colorectal lesions referred to an expert colonoscopist at a tertiary center. Lesions were removed by endoscopic mucosal resection and assigned a follow-up interval based on their size, histology, and the need to resect additional synchronous lesions identified during the index colonoscopy at our center. Pedunculated polyps (n=158), no follow-up at our center (n=553), follow-up outside of 2 to 36 month reference range (n=10), no polyp or benign growth (n=81), patients referred to surgery for cancer (n=64), and inability to endoscopically resect the lesion (n=24), were excluded from this analysis. Polyp size, location, removal method, endoscopic mucosal resection (EMR) utilization, and lesion pathology were compared to reduce confounding factors.&#x0D; Results:Lesions assigned to a 12-month surveillance interval (n=151) had a smaller mean size (19.48mm +- 7.59 vs. 34.32mm +- 17.84), were more likely to have serrated histology (n=69 (45.70%) vs. n=62 (11.85%), and more likely to be resected en bloc (n=31 (20.53%) vs. n=31 (5.93%) compared to lesions assigned to a 6-month surveillance interval. Of the 151 lesions assigned to a 12-month surveillance interval, 11 (7.3%) had recurrence and none had cancer at follow-up. Among 523 lesions assigned to a 6-month surveillance interval, 53 (10.1%) had recurrence and 1 had cancer at follow-up. Among 65 lesions ≥ 20 mm resected piecemeal and assigned to a 12-month surveillance interval, 8 (12.31%) had recurrence and none had cancer at follow-up.&#x0D; Conclusion and Potential Impact:These results support a 12-month surveillance interval after piecemeal resection of selected large, nonpedunculated, colorectal lesions. Initial 12-month surveillance results in fewer colonoscopies, lower cost, and less inconvenience to patients.

MicroRNA-125b Is a Potential Predictor of Surgical Outcomes in Chronic Rhinosinusitis with Nasal Polyps.

Despite advances in surgical techniques, recurrence rates after endoscopic sinus surgery (ESS) for chronic rhinosinusitis with nasal polyps (CRSwNP) remain high and difficult to predict. This study aimed to evaluate the potential role of microRNA 125b (miR-125b) in predicting disease evolution following ESS. We conducted a prospective study including patients undergoing first ESS for CRSwNP in our department between January 2020 and November 2021. We determined miR-125b levels from nasal polyps and pursued a standardized follow-up for at least 18 months for each patient. A total of 86 patients were included in the study. Higher postoperative endoscopy scores were associated with more severe disease at presentation on computed tomography scan, presence of concomitant asthma, and higher values of miR-125b. Even after multivariate repeated measures analysis and adjustments for confounders, miR-125b remained statistically significant. Moreover, miR-125 was the most important factor in predicting disease evolution at 18 months. A clear, robust relation between nasal polyp control evaluated through objective measures and miR-125b values was observed. This finding indicates the potential role of miR-125b in predicting the course of the disease following ESS.

Meticulous initial clinical and pathological staging with standardized long-term follow-up after radical cystectomy is required to validate and improve overall prognostic performance in patients undergoing neoadjuvant chemotherapy for bladder cancer.

Meticulous initial clinical and pathological staging with standardized long-term follow-up after radical cystectomy is required to validate and improve overall prognostic performance in patients undergoing neoadjuvant chemotherapy for bladder cancer.

Impact on weight loss and body composition of a food education intervention associated with Liraglutide treatment to address obesity

Introduction: clinical practice guidelines recommend considering pharmacological treatment of obesity only as a complement to lifestyle modification. Drugs alone are usually ineffective in the long term after discontinuation, so pharmacological weight loss strategies should always be accompanied by lifestyle modifications. Objective: to analyze the changes in weight, body mass index and body composition by means of electrical bioimpedance after a 32-week treatment with liraglutide in patients with obesity, associated or not with a food education program. Materials and methods: the study involved 68 patients who were randomly divided into 2 groups. One group received treatment with liraglutide 3.0 mg/day along with individual dietary education, and the other group was treated with liraglutide 3.0 mg/day and standard medical follow-up for 32 weeks. The data collected were weight (kg), height (m) (Seca® brand), body mass index (kg/m2) and body composition using multifrequency bioimpedance (SECA 112® brand). The variables were analyzed at the beginning and at the end of the treatment. Results: after 32 weeks of treatment, both study groups lost weight significantly. The group treated with liraglutide and individual dietary education had a reduction of 8.77 kg (9.08 %) (p < 0.001) and the group treated with liraglutide without education had a reduction of 3.55 kg (3.45 %) (p < 0.001). The BMI of the participants treated with liraglutide and education decreased by -4,04 kg/m2 (10.35 %) (p < 0.001) and in the group without education it decreased by -3.22 kg/m2 (8.30 %) (p = 0.003). In the educated group, fat mass decreased by -7.65 kg (15.89 %) (p < 0.001), although skeletal muscle mass also decreased by -1.62 kg (6.8 %) (p < 0.001). In those treated with liraglutide without education, a reduction in fat mass and skeletal muscle mass was also observed - fat mass by -4.72 kg (9.43 %) (p < 0.001) and skeletal muscle mass by -0.17 kg (0.70 %) (p < 0.001). Differences were also observed between groups, observing a greater reduction in weight, BMI, fat mass and skeletal muscle mass in the group with liraglutide and education compared to the group without education, although these differences were not statistically significant. Conclusions: dietary education associated with liraglutide treatment may contribute to increasing weight and fat mass losses. However, it was also associated with an unwanted loss of skeletal muscle mass, probably related to the greater intensity of weight loss, which will have to be reversed in future therapeutic approaches. Habit modification through multidisciplinary treatment, including nutritional education, combined strength and resistance exercise, and cognitive-behavioral therapy, could be an effective way to treat obesity and maintain weight, body composition, and adherence to a lifestyle.

Coordinated patient outreach for reduction of unplanned postoperative 30-day readmission

ObjectiveThirty-day readmission rates after surgery are being increasingly used as a quality performance metric. Readmission rates in vascular surgery are frequently reported to be higher than other surgical specialties, and many coordinated efforts have been developed at local and national levels to reduce avoidable readmissions. MethodsWe constructed a multi-pronged readmission reduction quality improvement (QI) initiative aimed at addressing the clinical drivers of readmission after vascular surgery. Proposed interventions were implemented in Plan-Do-Study-Act (PDSA) cycles. Interventions aimed to improve patient communication and included post-discharge phone calls; mandatory follow-up before 2 weeks, with in-person visits required for all groin incisions and ischemic lower extremity wounds; and protocolized distribution of “calling cards,” which contained emergency and routine contact information. The primary outcome measure was 30-day readmission rate. ResultsAfter implementation of a multi-modal QI initiative, there was a statistically significant decrease in the 30-day readmission rate, from 14.1% to 8.2% (P = .02). A slightly higher percentage of readmissions, 57%, occurred within the first 2 weeks of discharge. ConclusionsThe consensus-driven development and implementation of a QI protocol to reduce 30-day readmission, based on increased patient communication and more standardized patient follow-up, showed promising results at our institution. Further efforts to improve readmission should focus on decreasing barriers to patient-provider communication after discharge.

European survey on follow-up strategies for unruptured intracranial aneurysms

IntroductionThe increasing detection rates of unruptured intracranial aneurysms (UIA) pose a challenge for both neurovascular centers, tasked with managing a growing pool of patients requiring regular monitoring with imaging, and the healthcare system that must bear the costs of such surveillance. While there is consensus on the need for follow-up of UIA, uncertainties persist regarding the optimal cessation of surveillance, especially when considering diverse patient risk factors and, notably, in cases of treated aneurysms with stable rest perfusion. Detailed guidelines on UIA follow-up are currently lacking, exacerbating these challenges. Research questionWe sought to investigate European strategies for follow-up of untreated, microsurgically and endovascularly treated UIA. Material and methodsAn online survey consisting of 15 questions about follow-up management of UIA was sent out to the cerebrovascular section of the European Association of Neurosurgical Societies (EANS). ResultsThe survey response rate was 27.3% (68/249). There was consenus upon the necessity for long-term follow-up of UIA (100% [n = 68]). The recommendation to perform follow-up was inversely correlated with patient age and more prevalent among endovascularly compared to microsurgically treated patients (92.6% [n = 63] vs. 70.6% [n = 48]). A majority recommended continued follow-up of treated aneurysms with stable rest perfusion, with lifelong surveillance in patients under 60 years and continuation for 5–10 years in patients aged 61–80, irrespective of whether they underwent microsurgical (38.3% [n = 23]; 33.3% [n = 20]) or endovascular (41.9% [n = 26]; 30.6% [n = 19]) treatment. Discussion and conclusionThis survey confirmed a European consensus on the necessity of long-term follow-up for untreated UIA. However, significant variations in follow-up strategies, especially for treated UIA and post-treatment rest perfusion, were noted. Despite limited evidence suggesting low risk from aneurysm remnants, respondents favored long-term follow-up, highlighting uncertainty in management. This underscores the need for collaborative research on aneurysm remnants and standardized follow-up protocols for UIA in Europe.

Associations between maternal syphilis infection during pregnancy and low birth weight and preterm birth: a prospective cohort study.

In recent years, syphilis is still the most common sexually transmitted disease worldwide. Pregnant women infected with syphilis can transmit it to the fetus in utero through mother-to-child transmission, which can directly lead to adverse pregnancy outcomes. The aim of this study was to investigate the associations between maternal syphilis infection and low birth weight and preterm birth in offspring. Multinomial logistic regression model was used to analyze the associations between maternal syphilis infection and low birth weight and preterm birth, and to explore its stability through subgroup analysis. A total of 34,074 subjects were included in the study. After adjusting for potential confounders, maternal syphilis infection during pregnancy was associated with a 2.60-fold (95% CI 1.83-3.69) increased risk of low birth weight and a 1.91-fold (95% CI 1.35-2.69) increased risk of preterm birth. Subgroup analysis showed that the association was stable. We found that maternal syphilis infection during pregnancy was significantly associated with an increased risk of low birth weight and preterm birth. The implementation of reasonable syphilis screening and standardized treatment and follow-up of pregnant syphilis may have important practical significance in reducing the low birth weight and preterm birth rate in offspring.

Construction of natural population cohort on telephone follow-up management quality control system and discussion regarding critical issues by REDCap system

With completing a baseline survey of a large natural population cohort, conducting regular follow-up has become a key factor in further improving the quality of cohort construction and ensuring its sustainable development. Typical cohort follow-up methods include repeat surveys, routine monitoring, and community-oriented surveillance. However, in practical applications, there are often issues such as high costs, difficulty, and high error rates. Telephone follow-up is an important supplementary method to the methods mentioned above, as it has the characteristics of low cost, fast response, and high quality. However, the with difficult organization, quality control is challenging, response rates are low, and management levels vary widely, which limits its widespread use in large-scale population cohort studies. Given the above problems, this study draws on customer relationship management based on the actual needs of the China Northwest Cohort follow-up. It relies on the REDCap electronic data collection platform to build a telephone follow-up management and quality control system. Targeted solutions are provided for key issues in telephone follow-up implementation, including organizational structure, project management, data collection, and process quality control, to improve the quality control level of telephone follow-up comprehensively and thereby enhance the quality and efficiency of follow-up. We hope to provide standardized follow-up programs and efficient quality control tools for newly established and existing cohort studies.

Bone quality in LAMA2-related muscular dystrophy and SELENON-related congenital myopathy, a one-year prospective natural history study

Fragility fractures are frequently reported in neuromuscular diseases and negatively influence functional prognosis, quality of life and survival. In LAMA2-related muscular dystrophy (LAMA2-MD) and SELENON(SEPN1)-related congenital myopathy (SELENON-RM) cross-sectional and prospective natural history studies on bone quality and fragility long bone fractures (LBFs) are lacking. We therefore aim to systematically assess bone quality and provide recommendations for clinical care. We performed a one-year prospective natural history study in 21 LAMA2-MD and 10 SELENON-RM patients including a standardized fracture history and bone quality assessment through dual energy Xray absorptiometry scan (DEXA-scan) and/or bone health index (BHI). Ninety percent of the LAMA2-MD and SELENON-RM patients showed low bone quality. Eight (38%) LAMA2-MD and five (50%) SELENON-RM patients had a history of fragility LBFs. During the one-year follow-up period, one LAMA2-MD patient (female, 3 years) experienced a fragility LBF of the right humerus. We found no difference in bone mineral density between baseline and one-year follow-up. Based on general international guidelines for osteoporosis, we advise adequate vitamin D and calcium intake, and standardized clinical follow-up through a DEXA-scan or BHI in all LAMA2-MD and SELENON-RM patients. On indication, patients should be referred to the pediatrics or internal medicine for consideration of additional treatments.

Standardized community management on the diagnosis, treatment, and risk factors control for non-valvular atrial fibrillation in elderly patients

BackgroundBy investigating the knowledge, medication, occurrence of complications, and risks among elderly non-valvular atrial fibrillation (NVAF) patients in Shanghai communities, and providing standardized comprehensive management and follow-up, we aim to explore the impact of standardized community management on improving disease awareness, standardizing atrial fibrillation (AF) treatment, reducing the risk of complications occurrence, and addressing risk factors for AF patients.MethodsThis research selected elderly atrial fibrillation patients from Zhuanqiao Community Health Service Center, Minhang District, Shanghai from July 2020 to October 2022. Their personal health records and examination results were reviewed, and the incidence of AF, awareness, medication, and complications were investigated. Age-adjusted Charlson Comorbidity Index (aCCI), CHA2DS2-VASc score, and HAS-BLED score were used to evaluate disease burden, thromboembolic risk, and bleeding risk, respectively. The patients were subjected to standardized community management, and the compliance rate of disease awareness, treatment, resting heart rate, blood pressure, fasting blood glucose, and body mass index (BMI) were assessed at the baseline, 6 months and 1 year after management.ResultsA total of 243 NVAF patients were included, with an average aCCI score of (4.5 ± 1.1). Among them, 28% of the patients were aware of their AF, and 18.1% of the patients were aware of the hazards of AF. Of the patients, 11.9% used anticoagulant drugs, including 6.6% and 5.3% for warfarin and non-vitamin K antagonist oral anticoagulants (NOACs), respectively. 7% of patients used antiplatelet drugs. 26.7% of the patients used heart rate control drugs. 10.3% of the patients experienced thromboembolic events, and 0.8% of the patients experienced bleeding events. 93.0% of the patients were at high risk of thromboembolism, and 24.7% of the patients were at high risk of bleeding. Compared with the baseline, there were significant statistical differences (P < 0.001) in disease awareness, awareness of the hazards of AF, use of anticoagulant drugs and heart rate control drugs, and control of risk factors among NVAF patients after standardized community management. Moreover, with the extension of management time, there was a linear increase in the awareness of NVAF, awareness of the hazards of AF, utilization rate of anticoagulant drugs, utilization rate of heart rate control drugs, blood pressure, blood glucose, and BMI compliance rate (P < 0.001).ConclusionCurrently, the awareness, treatment, and control of risk factors for AF in elderly NVAF patients in Shanghai community are not satisfactory. Standardized community management helps to improve the diagnosis, treatment, and control of risk factors in AF.

Functional Imaging As a Key Diagnostic Tool in the Follow-up of RRMM Patients after CAR-T-Cell Therapy

Introduction: Anti BCMA CAR T-cell therapy (CART) is establishing itself as a new standard of care for relapsed and refractory multiple myeloma (RRMM). However, the optimal follow-up strategy post CART has yet to be determined. Prior studies of our own and others have emphasized the role of functional imaging in monitoring RRMM patients post traditional chemotherapy, revealing residual disease in up to 50 % of otherwise minimal residual disease (MRD) negative patients (Rasche et al. Leukemia 2019). Whether a similar patchy disease pattern is relevant post CART remains unknown. To address this, we implemented a standardized follow-up program post CART, which includes 18F-FDG PET-CT, diffusion-weighted MRI, and bone marrow aspiration with MRD measurements at our center. Methods: We conducted monthly ambulatory visits and serological testing to monitor patients post CART infusion. Additionally, an extended follow-up visit at three months post CART infusion was performed, encompassing whole body PET-CT, whole body diffusion-weighted MRI, and bone marrow aspiration with MRD testing. Response assessments were based on IMWG criteria. MRI classified focal lesions as vital if they exhibited 1) significant diffusion-restriction, 2) a fat fraction less than 20 %, and 3) homogenous hypointensity on T2-weighted images. MRD measurements were performed with flow cytometry with a sensitivity of at least 10 -5 following the Euroflow recommendations. Results: From December 2021 to July 2023 we treated 37 heavily pretreated patients with idecabtagene vicleucel at our center. These patients had a median of 5 prior lines of therapy. High-risk cytogenetics, extra-medullary disease (EMD), and non-secretory disease were seen in 17, 14 and 6 patients, respectively. At data cut off, the ORR, VGPR and CR rates were 78 %, 27 % and 27 %, respectively. We observed primary refractory disease in 14 % of the patients. Among the 22 patients who underwent extended follow-up examinations at three months, the majority achieved MRD negativity, with only 7/22 (32 %) remaining MRD positive after CART. However, functional imaging revealed a higher number of patients with residual disease, with positive results on PET-CT and DW-MRI in 9/22 (41 %) and 10/22 (45 %) of patients, respectively. Notably, 6 of 22 (27 %) patients displayed active lesions on imaging despite MRD negativity at the iliac crest at this time point. Next, we focused on patients who experienced relapse from CART and sought to determine the necessary technology to detect relapse in this setting. Thirteen patients experienced relapse during the study period, and in 8 (61%) of them, functional imaging was the sole method to detect progressive disease. Only 1 patient transitioned from MRD negative to positive during the follow-up period, while the remaining 4 patients showed a significant M protein increase as defined by the IMWG criteria. Conclusion: In our heavily pretreated RRMM population, functional imaging emerged as a crucial diagnostic tool, detecting relapse alone in more than half of the patients. Our data supports inclusion of cross-sectional imaging in a comprehensive follow-plan after CART.

Incidence of chronic thromboembolic pulmonary Hypertension after acute pulmonary embolism in real-world practice

Abstract Background Recently a large prospective multicentre observational cohort study demonstrated a 2-year cumulative CTEPH incidence of 2.3% after acute PE with a standardized and pre-defined follow-up plan. Thus, we sought to investigate the prevalence and incidence of CTEPH diagnosis after acute PE in real-world practice in a twelve-year observational period. Methods This study is based on nationwide ambulatory billing claims (VDA) and drug prescription (AVD) data of all residents with statutory health insured (SHI) in Germany from 2010 to 2019 (approx. 73 million in 2019). Results We identified 573,972 patients with acute PE in the German ambulatory care system between 2010 and 2019. The majority of patients were women (57.4%) and had a median age of 71 years. Prevalence of CTEPH increased during this twelve-year observational period from 0.4% in 2010 to 0.7% in 2019. Overall, a CTEPH diagnosis was made in 2556 (0.4%) patients after acute PE during a follow-up of 30 quarters (90 months). The majority of CTEPH cases (17.7%) were diagnosed in the first quarter after the index PE event. The incidence rate after the first quarter was calculated as 0.08%. The cumulative incidence after two years (8th quarter) was calculated as 0.37% and after the complete follow-up time (90 months) as 0.76% (Figure 1). Patients with CTEPH diagnosis during follow-up had considerably more often a diagnosis of acute right ventricular dysfunction at the index PE event compared to patients without CTEPH during follow-up (14.9% vs. 8.3%; ARR +6.67%). Regarding predisposing risk factors for CTEPH, especially hypothyreodism and consecutive levothyroxine application were more often present in patients with acute PE and CTEPH diagnosis during follow-up opposed to those without (18.9% vs. 16.8%; ARR +2.11%). Conclusions In conclusion, our study provides a comprehensive view of incidence of CTEPH after acute PE in real-word practice. The low rate of CTEPH incidence after acute PE indicate a limited awareness regarding CTEPH and lack of standardized follow-up for patients with acute PE in real-world practice, which may lead to a considerable under-diagnosis of CTEPH in Germany. On the basis of these data, a better implantation of existing clinical evaluation strategies for follow-up after acute PE seems indicated.Cumulative Incidence CTEPH

Impact of extracorporeal circulation support systems on blood product resources during the course of intensive care unit treatment

Abstract Background Extracorporeal circulatory support systems necessitate careful blood product management due to the large cannulas and exposure of blood components to artificial surfaces in the circuits. Blood component derangements can occur during implantation and the operational period of these systems, posing a significant complication. To enhance patient safety and bolster the body's own blood reserves, accurate characterization of the extent of necessary blood product substitution is imperative. Methods We analyzed data from consecutive patients who received extracorporeal circulatory support systems (Impella, veno-arterial extracorporeal membrane oxygenation (VA-ECMO), or ECMella) over a 5-year period (2016-2021). We obtained information on blood product usage, costs, and various clinical parameters. We assessed the vascular access site according to the Bleeding Academic Research Consortium (BARC) and Global Utilization of Streptokinase and tPA for Occluded Coronary Arteries (GUSTO) criteria, and hemolysis was evaluated using serum free hemoglobin (fHb). Results We studied 370 patients (Table 1) who received extracorporeal circulatory support systems (Impella, VA-ECMO, and ECMella) from 2016 to 2021. The median number of RBC transfusions was 7 (3 - 12) for the entire cohort, with ECMella patients requiring the highest amount (12.5 (6.7 - 27.5)) and VA-ECMO patients requiring the most within the first 24 hours (57%, p &amp;lt; 0.05). Hemolysis was present in all groups, with Impella patients having the highest levels (49.8 µmol / L (21.3 – 113.1), p &amp;lt; 0.01). ECMella patients required the highest overall blood product substitution (Figure 1) and incurred the highest associated costs (1642.4 EUR (1079.1 – 3660.3), p &amp;lt; 0.01). Bleeding complications in the groin area were moderate in 45% of patients, with VA-ECMO patients having the highest incidence (58%, p &amp;lt; 0.05). Type 3a bleeding according to the BARC criteria was most common (31.7%). Conclusion Although extracorporeal circulatory support systems have made technical advances, significant resources are still required during the operational period to maintain coagulation homeostasis, particularly in ECMella patients. Complications at the insertion site are also common, with bleeding being expected, especially in emergency situations when a VA-ECMO is used. To ensure patient safety, interdisciplinary teams should establish standardized follow-up protocols to detect peripheral complications early.

Evaluation of the Effectiveness of Telemedicine in Postoperative Follow-Up Care After Dental Implant Surgery. A Pilot Study.

Telemedicine has emerged as a potential solution to enhance postoperative follow-up care after dental implant surgery, offering the convenience of remote monitoring and reduced need for in-person visits. Participants were randomly assigned to either the telemedicine group (n = 15) or the in-person group (n = 15). In the telemedicine group, patients received remote follow-up care through virtual consultations, during which they could communicate their concerns and share images of the surgical site. The in-person group received standard in-person follow-up visits. Patient satisfaction was measured using a standardized survey, with responses collected on a Likert scale. Telemedicine group exhibited comparable levels of patient satisfaction (mean satisfaction score ± standard deviation: 4.6 ± 0.3) to the in-person group (4.7 ± 0.2). Moreover, clinical outcomes, including wound healing assessment, were similar between the two groups. No significant differences were observed in the incidence of postoperative complications or the need for additional interventions. In conclusion, this pilot study demonstrates that telemedicine is an effective alternative to traditional in-person follow-up care for postoperative dental implant surgery patients. It offers comparable patient satisfaction and clinical outcomes while proving to be more cost-effective.