scholarly journals Beating the odds with systematic individualized care: Nationwide prospective follow‐up of all patients with COVID‐19 in Iceland

2020 ◽  
Author(s):  
D. Helgason ◽  
E. Eythorsson ◽  
L. B. Olafsdottir ◽  
T. Agustsson ◽  
S. Ingvarsdottir ◽  
...  
Keyword(s):  
Individualized Care ◽  
Beating The Odds

Individualized cancer follow-up supported by electronic Patient-Reported Outcomes: Development and evaluation (Preprint)

2020 ◽  
Author(s):  
Sissel Ravn ◽  
Henriette Vind Thaysen ◽  
Lene Seibaek ◽  
Victor Jilbert Verwaal ◽  
Lene Hjerrild Iversen
Keyword(s):  
Ct Scan ◽  
Advanced Cancer ◽  
Patient Reported Outcomes ◽  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
Structured Interviews ◽  
European Organization ◽  
Individualized Care ◽  
Patient Reported

BACKGROUND Cancer survivors experience unmet needs during follow-up. Besides recurrence, a follow-up includes detection of late side effects, rehabilitation, palliation and individualized care. OBJECTIVE We aimed to describe the development and evaluate the feasibility of an intervention providing individualized cancer follow-up supported by electronic patient-reported outcomes (e-PRO). METHODS The study was carried out as an interventional study at a Surgical and a Gynecological Department offering complex cancer surgery and follow-up for advanced cancer. The e-PRO screened for a priori defined clinical important symptoms and needs providing individualized follow-up. We included following questionnaires in the e-PRO; the general European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and the EORTC validated for colorectal and ovarian cancer patients. To support individualization, we included three prioritized issues of the patient’s preference in each e-PRO. The response-algorithm was aggregated based on the severity of the patient’s response. To ensure the sensitivity of the e-PRO, we performed semi-structured interviews with five patients. All clinicians (surgeons and gynecologists) performing the consultations reviewed the e-PRO. The evaluation was divided in two, 1)The feasibility was assessed by a)Patients’ response rate of the e-PRO, b)Number of follow-up visits documenting the use of e-PRO and c)Patients’ prioritized issues prior to the consultation(‘yes’ / ‘no’), and after the follow-up 2)Patients assessment of a)The need and purpose of the follow-up visit and b)the support provided during the follow-up visit. RESULTS In total, 187 patients were included in the study, of which 73%(n=136/187) patients responded to the e-PRO and were subjected to an individualized follow-up. The e-PRO was documented as applied in 79% of the follow-up visits. In total, 23% of the prioritized issues did not include a response. Stratified by time since surgery, significantly more patients did not fill out a prioritized issue had a follow-up >6 months since surgery. In total, 72 % follow-up visits were evaluated to be necessary in order to discuss the outcome of the CT scan, symptoms, and/or prioritized issues. Contrary, 19% of the follow-up visits were evaluated to be necessary only to discuss the result of the CT scan. A range from 19.3–56.3% of patients assessed the follow-up visit to provide support with respect to physical (42% of patients), mental (56%), sexual (19%) or dietary (27%) issues. Further, a range from 34–60% of the patients reported that they did not need support regarding physical (43% of patients), mental (34%), sexual (63%) or dietary (57%) issues. CONCLUSIONS An individualized follow-up based on e-PRO is feasible, and support most patients surgically treated for advanced cancer. However, results indicate that follow-up based on e-PRO may not be beneficial for all patients and circumstances. A thorough cost-benefit analysis may be warranted before implementation in routine clinic.

scholarly journals Gene Expression in First Trimester Preeclampsia Placenta

2010 ◽  
Vol 13 (2) ◽  
pp. 134-139 ◽  
Author(s):  
Sandra A. Founds ◽  
Lauren A. Terhorst ◽  
Kirk P. Conrad ◽  
W. Allen Hogge ◽  
Arun Jeyabalan ◽  
...  
Keyword(s):  
Candidate Genes ◽  
Chorionic Villus ◽  
First Trimester ◽  
Chorionic Villus Sampling ◽  
Qrt Pcr ◽  
Individualized Care ◽  
Additional Control ◽  
Polymerase Chain ◽  
The Difference

Background. The goal of this study was to further validate eight candidate genes identified in a microarray analysis of first trimester placentas in preeclampsia. Material and method. Surplus chorionic villus sampling (CVS) specimens of 4 women subsequently diagnosed with preeclampsia (PE) and 8 control women (C) without preeclampsia analyzed previously by microarray and 24 independent additional control samples (AS) were submitted for confirmatory studies by quantitative real-time polymerase chain reaction (qRT-PCR). Results. Downregulation was significant in FSTL3 in PE as compared to C and AS (p = .04). PAEP was downregulated, but the difference was only significant between C and AS (p = .002) rather than between PE and either of the control groups. Expression levels for CFH, EPAS1, IGFBP1, MMP12, and SEMA3C were not statistically different among groups, but trends were consistent with microarray results; there was no anti-correlation. S100A8 was not measurable in all samples, probably because different probes and primers were needed. Conclusions. This study corroborates reduced FSTL3 expression in the first trimester of preeclampsia. Nonsignificant trends in the other genes may require follow-up in studies powered for medium or medium/large effect sizes. qRT-PCR verification of the prior microarray of CVS may support the placental origins of preeclampsia hypothesis. Replication is needed for the candidate genes as potential biomarkers of susceptibility, early detection, and/or individualized care of maternal—infant preeclampsia.

Exposure, Relaxation, and Rescripting Therapy for Trauma-Related Nightmares With Psychiatric Inpatients: A Case Series

2020 ◽  
Vol 20 (1) ◽  
pp. 3-21
Author(s):  
Helen Reiter ◽  
Leanne Humphreys
Keyword(s):  
Acute Care ◽  
Psychiatric Hospital ◽  
Psychological Symptoms ◽  
Psychiatric Patients ◽  
Hospital Setting ◽  
Case Series ◽  
Psychiatric Inpatients ◽  
Empirically Supported ◽  
Individualized Care

Research has shown that posttraumatic stress disorder (PTSD) is a highly prevalent diagnosis for psychiatric patients, yet individualized care and treatment is limited in the inpatient acute care sector. Two case studies are presented which examine the use of Exposure, Relaxation, and Rescripting Therapy (ERRT) for chronic trauma-related nightmares, within a private acute care inpatient psychiatric hospital setting. ERRT is empirically supported with efficacy for veteran and civilian populations, however no research to date has been conducted with psychiatric inpatients. Two participants diagnosed with PTSD, suffering distressing trauma-related nightmares, completed ERRT over three sessions during their psychiatric hospital admission, with the aim of reducing the frequency and severity of nightmares and related psychological symptoms. PTSD, depression, sleep quality and quantity, and nightmare frequency and related distress, were measured pre-treatment, during treatment, and follow-up at one, 3 and 6 months. Only one participant reported ongoing nightmares by the third week of the intervention, with both participants reporting an absence of nightmares at the one and 3-month follow-ups, but mixed results by the 6-month follow-up. One participant also reported a reduction in PTSD symptoms and a mild improvement in depression. The results offer some preliminary support for the provision of ERRT for the treatment of trauma-related nightmares for psychiatric inpatients.

scholarly journals Mobile educational follow-up application for patients with peripheral arterial disease

2019 ◽  
Vol 27 ◽  
Author(s):  
Cristiane Baldessar Mendez ◽  
Nádia Chiodelli Salum ◽  
Cintia Junkes ◽  
Lucia Nazareth Amante ◽  
Carlos Mauricio Lopes Mendez
Keyword(s):  
Risk Factors ◽  
Peripheral Arterial Disease ◽  
Signs And Symptoms ◽  
Arterial Disease ◽  
Pedagogical Content ◽  
Analysis And Design ◽  
Individualized Care ◽  
Technological Tool ◽  
Peripheral Arterial

ABSTRACT Objective: to describe the development of a prototype mobile educational application for nursing follow-up aimed at patients diagnosed with peripheral arterial disease. Method: a prototype-based technological production study. The construction followed the contextualized instructional design model using two steps: analysis and design and development. Results: the pedagogical content of the application was based on a survey of needs of patients with Peripheral Arterial Disease and treatments recommended in the literature. The prototype developed contained concepts, risk factors, signs and symptoms, treatment, importance of medications and their side effects, frequent doubts, necessary health care, and follow-up of patients by monitoring the evolution of the cicatricial process of lesions and possible complications, clarification of doubts and stimulus for continuation of treatment. Conclusion: the use of health applications is a technological tool with the potential to improve the follow-up of patients regarding the progress of the disease and self-care, monitoring of risk factors, co-participation of the patient in the treatment, family participation, as well as planning of individualized care, and cost reduction for the health system.

Factors related with treatment adherence to interferon b and glatiramer acetate therapy in multiple sclerosis

2005 ◽  
Vol 11 (3) ◽  
pp. 306-309 ◽  
Author(s):  
Jordi Río ◽  
Joana Porcel ◽  
Nieves Téllez ◽  
Angela Sánchez-Betancourt ◽  
M ar Tintoré ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Side Effects ◽  
Expanded Disability Status Scale ◽  
Early Discontinuation ◽  
Treatment Expectations ◽  
Individualized Care ◽  
Disability Status ◽  
Relapsing Remitting ◽  
Main Factor

Background: Awareness of the factors influencing discontinuation of immunomodulatory drugs (IMD) treatment in multiple sclerosis (MS) can help to find approaches to patient management with the aim of establishing more specific indications and also attaining more optimal patient selection in future clinical trials. Objective: To identify the causes that influence adhesion to IMD therapy within the clinical practice in a large cohort of patients with MS. Patients and methods: We have studied all MS patients who have initiated IMD in our hospital. All patients took part in training sessions where treatment expectations and side effects were explained and they received training in the administration technique. Reasons for stopping therapy were recorded during follow-up. Results: We studied 632 MS patients (mean follow-up was 47.1 (28.7) months). At the time of analysis, 107/632 patients (17%) were no longer receiving IMD. Almost half of the patients who stopped IMD (52/107) did so within the first two years on therapy. Fifty-six patients stopped IMD because of lack of efficacy. Only 27 patients (4.3%) discontinued treatment for reasons other than inefficacy or side effects. The proportion of patients with secondary progressive MS that stopped IMD therapy was 30%, while only 13.5% of the patients with relapsing—remitting MS stopped therapy (P= 0.0001). Expanded Disability Status Scale (EDSS) score at entry was the main factor that predicted interruption of therapy. Conclusions: The proportion of patients interrupting IMD in our centre is low, possibly due to individualized care. Higher EDSS, mainly in the first two years of treatment, is the main factor related with interruption. Close follow-up of these patients would be useful in avoiding early discontinuation of therapy.

Comply With Us: Improving Medication Adherence

2004 ◽  
Vol 17 (3) ◽  
pp. 167-181 ◽  
Author(s):  
Patricia A. Tabor ◽  
Debra A. Lopez
Keyword(s):  
Medication Adherence ◽  
Patient Outcomes ◽  
Medication Compliance ◽  
High Risk Patient ◽  
Care Plan ◽  
Medication Noncompliance ◽  
Individualized Care ◽  
Medication Taking Behavior ◽  
Careful Assessment

Medication noncompliance is a pervasive problem resulting in significant morbidity and mortality. There are many terms used to describe medication-taking behavior including compliance, adherence, intelligent compliance, and drug forgiveness. More recently, clinicians have focused on the need for a collaborative partnership with patients to attain medication adherence. Problems identified include the patient’s failing to initiate therapy, under using or overusing a drug, stopping a drug too soon, and mistiming or skipping doses. Adherence to medications is a complex health behavior. There are many risk factors associated with decreased compliance, and many strategies have been shown to improve drug-taking behavior and patient outcomes. By careful assessment, the pharmacist can identify the high-risk patient, recommend an individualized care plan, and provide the follow-up necessary to successfully change patient behavior. Pharmacists should focus on improving their own application of behavior modification principles and patient communication skills. Improved medication compliance results in improved humanistic, clinical, and economic outcomes.

The impact of interdisciplinary shared medical appointments in newly diagnosed early-stage melanoma patients: The Cleveland Clinic experience.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 230-230
Author(s):  
Benjamin Switzer ◽  
David J Savage ◽  
Rujul Parikh ◽  
Jung Min Song ◽  
Carolyn Stanek ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Early Stage ◽  
Cleveland Clinic ◽  
Retrospective Chart Review ◽  
Shared Medical Appointments ◽  
Care Plans ◽  
Individualized Care ◽  
Melanoma Patients ◽  
The Impact

230 Background: Shared Medical Appointments (SMA) serve as a unique means of improving outcomes and patient satisfaction while reducing clinic wait times and healthcare costs. Early-stage melanoma survivors may benefit from a targeted SMA. This cohort exhibits high rates of psychosocial distress, with up to 30% warranting clinical intervention (Kasparian, 2013). Additionally,numerically more melanoma deaths are related to thin ( < 1mm) melanomas than those with thick ( > 4mm) on presentation (Whitehall et al, 2015). We hypothesized that an SMA targeting early-stage melanoma patients may reducepsychologic fear and stress, as well as improve patients’ melanoma-related knowledge and adherence to their individualized care plans. Methods: The Cleveland Clinic’s Early Stage Melanoma Survivorship SMA interdisciplinary care team focused on crucial survivorship and prevention techniques, in addition to targeting modifiable behaviors for patients to collaboratively explore (format introduced ASCO Quality 2018, abst 69). A retrospective chart review assessed for demographics, participation rates, changes in depression scores, follow-up show-rates, and post-SMA survey results. Results: Of 477 early stage melanoma patients seen during the time of SMA implementation (6/2018-4/2019), only 91 (19.1%) attended oncology follow-up appointments, and 34 (7.1%) participated in an SMA. Participants expressed high rates of satisfaction and improvement in melanoma-related knowledge, whileexhibiting a > 92% show rate in subsequent oncologic and dermatologic medical appointments compared to 74% and 73%, respectively, in the non-SMA group. No significant improvement in depression and anxiety scoring was noted in SMA vs. non-SMA groups. SMA attendance was notably higher in younger (mean age 56 vs 61) and female (56% vs 30%) patient cohorts without appreciable differences in social history, marital status, or socioeconomic region. Conclusions: Survivorship SMAs for early stage melanoma patients appear to exhibit high rates of patient satisfaction, improvement in clinical knowledge, and adherence to routine dermatology and oncology follow-up appointments.

scholarly journals Doctor, what are my options? A prospective cohort study of an individualized care plan for patients with gastrointestinal cancer

2015 ◽  
Vol 22 (3) ◽  
pp. 171 ◽  
Author(s):  
A.E. Hird ◽  
M. Lemke ◽  
M. Turovsky ◽  
V. Malecki ◽  
K. Kumar ◽  
...  
Keyword(s):  
Health Care ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Health Care Professionals ◽  
Prospective Cohort ◽  
Care Plan ◽  
Care Plans ◽  
Individualized Care ◽  
Gi Cancer

BackgroundFor cancer patients, information about their disease and its treatment is often delivered within a short time period, potentially leading to patient misunderstanding, which can impede optimal patient care. In this 3-part clinical study, we investigated the utility of an individualized care plan for patients with gastrointestinal (gi) cancer starting a new treatment.Methods In part 1, a comprehensive literature search identified items for potential inclusion in the care plan. Those items were formatted into a questionnaire. The questionnaire was then administered to patients as a structured interview. In part 2, health care professionals involved in the care of patients with gi cancer evaluated the resulting care plan for content and relevancy. In part 3, a 20-week prospective cohort study (10 weeks using standard of care, 10 weeks using individualized care plans) was conducted. Outcomes were assessed at baseline and at 2–4 weeks after administration of the care plan.Results In part 1, a 73-item questionnaire was developed and completed by 20 patients in semi-structured interviews. In part 2, long and short versions of the care plan were created. Most health care professionals preferred the long version. Based on their comments, a final version of the care plan was created. The part 3 study enrolled 104 patients. Overall satisfaction scores were significantly higher in the intervention group at baseline (p = 0.010) and follow-up (p = 0.005). Compared with control patients, the intervention cohort also reported significantly higher overall quality of life (p = 0.044) and fewer symptoms of anxiety (p = 0.048) at follow-up.Conclusions Provision of an individualized care plan resulted in improvements in outcome measures at both baseline and follow-up. Future studies are needed to confirm these findings.

scholarly journals Risk Stratification in Differentiated Thyroid Cancer: From Detection to Final Follow-Up

2019 ◽  
Vol 104 (9) ◽  
pp. 4087-4100 ◽  
Author(s):  
R Michael Tuttle ◽  
Ali S Alzahrani
Keyword(s):  
Thyroid Cancer ◽  
Risk Stratification ◽  
Differentiated Thyroid Cancer ◽  
Initial Therapy ◽  
Cancer Management ◽  
Individualized Care ◽  
Specific Mortality ◽  
Disease Specific Mortality ◽  
Disease Specific

Abstract Context Modern management of differentiated thyroid cancer requires individualized care plans that tailor the intensity of therapy and follow-up to the estimated risks of recurrence and disease-specific mortality. Design This summary is based on the authors’ knowledge and extensive clinical experience, supplemented by review of published review articles, thyroid cancer management guidelines, published staging systems, and original articles identified through a PubMed search, which included terms such as risk stratification, staging, clinical outcomes, and differentiated thyroid cancer. Main Outcome Measures In the past, risk stratification in differentiated thyroid cancer usually referred to a static estimate of disease-specific mortality that was based on a small set of clinicopathological features available within a few weeks of completing initial therapy (thyroidectomy, with or without radioactive iodine). Today, risk stratification is a dynamic, active process used to predict the appropriateness for minimalistic initial therapy, disease-specific mortality, risk of recurrence, and the most likely response to initial therapy. Rather than being a static prediction available only after initial therapy, modern risk stratification is a dynamic, iterative process that begins as soon as a suspicious nodule is detected and continues through final follow-up. Conclusions Dynamic risk assessment should be used to guide all aspects of thyroid cancer management, beginning before a definitive diagnosis is made and continuing through the final follow-up visit.

Abstract TMP107: Impact of a Stroke Transitional Care Navigator at a Comprehensive Stroke Center

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Darren T Larsen ◽  
Alexandra Lesko ◽  
Elizabeth Baraban
Keyword(s):  
Transitional Care ◽  
Positive Impact ◽  
Outpatient Setting ◽  
Unplanned Readmission ◽  
Post Discharge ◽  
Individualized Care ◽  
Ed Visits ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Background: The Stroke Transitional Care Navigator (STCN), was implemented at our Comprehensive Stroke Center (CSC) in January 2017 in order to bridge care from the inpatient to outpatient setting. The STCN nurse meets with patients prior to discharge to address secondary stroke risk factors and discuss the follow up plan in an effort to improve patient outcomes. The purpose of this study was to determine whether implementation of a STCN improved compliance with follow up stroke neurology care and reduced unplanned readmissions and Emergency Department (ED) visits. Methods: Retrospective data review, included ischemic stroke or ICH patients, 18 or over, discharged from February 2017 through February 2018. Subarachnoid hemorrhages and hospice discharges were excluded. Patients were grouped into a “Followed’ cohort if they had documented contact with the STCN prior to discharge or within 30 days; otherwise they were categorized as “Not Followed”. Outcomes of interest were percentage of patients compliant with attending an outpatient visit with a stroke provider within 45 or 120 days post-discharge and percentage of unplanned readmission and ED visits 30 days post-discharge. Analyses comparing those with and without STCN contact were performed using Fisher’s Exact test and Pearson’s chi square test. Results: There were 689 patients that met inclusion criteria with 47.2% (n=325) in the Followed and 52.8% (n=364) in the Not-Followed cohorts. The Followed cohort was more likely to comply with attending a follow-up visit within 45-days (67.2% vs. 32.8%, p<.001) as well as 120 days of discharge (61.0% vs 39.0%, p<.001). No differences were found between the Followed and Not Followed cohorts for readmissions (9.5% vs. 11.5%, p=.394) or ED visits (9.5% vs. 10.2%, p=.783). Conclusion: The STCN had a significant positive impact on patients returning to clinic for follow up stroke neurology care. Though follow up care has been shown to reduce readmission rates in some studies, in this study there was no impact on 30-day readmissions or ED visits. Given the unique, individualized care and coordination provided by the STCN, which is very well received by patients and providers, qualitative measures may be more useful in the future to determine the effectiveness of the STCN.

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