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Adequate Follow-up (adequate + follow-up)
Selected AbstractsAccessibility, continuity and appropriateness: key elements in assessing integration of perinatal servicesHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 5 2003Danielle D'Amour RN PhD Abstract A trend toward the reduction in the length of hospital stays has been widely observed. This increasing shift is particularly evident in perinatal care. A stay of less than 48 hours after delivery has been shown to have no negative effects on the health of either the mother or the baby as long as they receive an adequate follow-up. This implies a close integration between hospital and community health services. The present article addresses the following questions: To what extent are postnatal services accessible to mothers and neonates? Are postnatal services in the community in continuity with those of the hospital? Are the services provided by the appropriate source of care? The authors conducted a telephone survey among 1158 mothers in a large urban area in the province of Quebec, Canada. The results were compared to clinical guidelines widely recognised by professionals. The results show serious discrepancies with these guidelines. The authors found a low accessibility to services: less than half of the mothers received a home visit by a nurse. In terms of continuity of care, less than 10% of the mothers received a follow-up telephone call within the recommended time frame and only 18% benefited from a home visit within the recommended period. Finally, despite guidelines to the contrary, hospitals continue to intervene after discharge. This results in a duplication of services for 44.7% of the new-borns. On the other hand, 40.7% are not seen in the recommended period after hospital discharge at all. These results raise concerns about the integration of services between agencies. Following earlier work, the present authors have grouped explanatory factors under four dimensions: the strategic dimension, particularly leadership; the structural dimension, including the size of the network; the technological dimension, with respect to information transmission system; and the cultural dimension, which concerns the collaboration process and the development of relationships based on trust. [source] Further observations on the empty "amnion sign"JOURNAL OF CLINICAL ULTRASOUND, Issue 3 2010N. Tugce Yegul MD Abstract Objective. To assess the positive predictive value of the empty "amnion sign" (visualization of an amnion without concomitant visualization of an embryo) for the diagnosis of early pregnancy failure. Methods. Retrospective study of 882 1st trimester sonographic examinations with abnormal findings among women who were threatening to abort. Eight hundred six met the inclusion criteria. Results. In the study cohort 286 (35.5%) had no identifiable embryo and 71 of those without an identifiable embryo had a visible amnion (24.8%). The breakdown of the mean sac diameter of the study cohort was as follows: those measuring less than 16 mm (n = 16); those measuring 16,20 mm (n = 20); those measuring 21 mm or more (n = 35). Sixty-eight of the 71 patients had adequate follow-up. Pregnancy failure was confirmed in all 68 patients (positive predictive value = 100%). Conclusions. The data from this study indicate that visualization of an amnion without concomitant visualization of an embryo (the empty "amnion sign") confirms pregnancy failure regardless of the mean sac diameter and with a sufficiently high positive predictive value to make a definitive diagnosis. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound, 2010 [source] Periodontitis as an infectious disease: specific features and their implicationsORAL DISEASES, Issue 2003A Mombelli Periodontitis may be viewed as an infectious disease with a number of specific characteristics. Pathogens of the subgingival microbiota can interact with host tissues even without direct tissue penetration. Hence, antimicrobial agents must be available at a sufficiently high concentration not only within the periodontal tissues, but also outside, in the environment of the periodontal pocket. The subgingival microbiota accumulate on the root surface to form an adherent layer of plaque with the characteristics of a biofilm. Several mechanisms, such as diffusion barriers, and selective inactivation of agents lead to an increased resistance of bacteria in biofilms. Mechanical supragingival plaque control is indispensable to prevent the re-emergence of periodontal pathogens and the re-establishment of a biofilm in treated sites. Since specific features have important implications for the use of antimicrobial agents in periodontal therapy, extrapolations from experiences made in the therapy of other infections are only partially valid. The ultimate evidence for the efficacy of systemic or local chemotherapy must be obtained from treatment studies in humans with adequate follow-up. [source] One agent, many diseases: Exposure-response data and comparative risks of different outcomes following silica exposure,AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 1 2005Kyle Steenland Abstract Background Evidence in recent years indicates that silica causes lung cancer, and probably renal disease, in addition to its well-known relationship to silicosis. There is also suggestive evidence that silica can cause arthritis and other auto-immune diseases. Silica has, therefore, joined a handful of other toxic exposures such as tobacco smoke, dioxin, and asbestos which cause multiple serious diseases. Methods The available exposure-response data for silica and silicosis, lung cancer, and renal disease are reviewed. We compare the corresponding excess risks (or absolute risks in the case of silicosis) of death or disease incidence by age 75 for these three diseases, subsequent to a lifetime (45 years) of exposure to silica at current US standard (0.1 mg/m3 respirable crystalline silica). Results The absolute risk of silicosis, as defined by small opacities greater than or equal to ILO classification 1/1 on an X-ray, ranges from 47% to 77% in three cohort studies with adequate follow-up after employment. The absolute risk of death from silicosis is estimated at 1.9% (0.8%,2.9%), based on a pooled analysis of six cohort studies. The excess risk of lung cancer death, assuming US male background rates, is 1.7% (0.2%,3.6%), based on a pooled analysis of ten cohort studies. The excess risk of end-stage renal disease (assuming male background rates) is 5.1% (2.2%,7.3%), based on a single cohort. The excess risk of death from renal disease is estimated to be 1.8% (0.8%,9.7%), based on a pooled analysis of three cohorts. Conclusions Keeping in mind that the usual OSHA acceptable excess risk of serious disease or death for workers is 0.1%, it is clear that the current standard is far from sufficiently protective of workers' health. Perhaps surprisingly, kidney disease emerges as perhaps a higher risk than either mortality from silicosis or lung cancer, although the data are based on fewer studies. Am. J. Ind. Med. 48:16,23, 2005. © 2005 Wiley-Liss, Inc. [source] Penile Rehabilitation after Radical Prostatectomy: Where Do We Stand and Where Are We Going?THE JOURNAL OF SEXUAL MEDICINE, Issue 4ii 2007FACS, Run Wang MD ABSTRACT Introduction., Postprostatectomy erectile dysfunction (ED) remains a serious quality-of-life issue. Recent advances in the understanding of the mechanism of postprostatectomy ED have stimulated great attention toward penile rehabilitation. Aim., This review presents and analyzes a contemporary series of the recent medical literature pertaining to penile rehabilitation therapy after radical prostatectomy (RP). Main Outcome Measures., The laboratory and clinical studies related to penile rehabilitation are analyzed. The validity of the methodology and the conclusion of the findings from each study are determined. Methods., The published and presented reports dealing with penile rehabilitation following RP in human and cavernous nerve injury in animal models are reviewed. Results., Exciting scientific discoveries have improved our understanding of postprostatectomy ED at the molecular level. The rationale for postprostatectomy penile rehabilitation appears to be logical according to animal studies. However, clinical studies have not consistently replicated the beneficial effects found in the laboratory studies. Currently available clinical studies are flawed due to short-term follow-up, small number of patients in the studies, studies with retrospective nature, or prospective studies without control. Rehabilitation programs are also facing a challenge with the compliance, which is critical for success for any rehabilitation program. At the present time, we do not have concrete evidence to recommend what, when, how long, and how often a particular penile rehabilitative therapy can be used effectively. Conclusions., Large prospective, multicentered, placebo-controlled trials with adequate follow-up are necessary to determine the cost-effective and therapeutic benefits of particular penile rehabilitative therapy or therapies in patients following the treatment of clinically localized prostate cancer. Until such evidence is available, it is difficult to recommend any particular penile rehabilitation program as a standard of practice. Wang R. Penile rehabilitation after radical prostatectomy: Where do we stand and where are we going? J Sex Med 2007;4:1085,1097. [source] Randomized clinical trial and follow-up study of cost-effectiveness of laparoscopic versus conventional Nissen fundoplication,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 6 2006W. A. Draaisma Background: Laparoscopic Nissen fundoplication (LNF) has essentially replaced its conventional open counterpart (CNF). An economic evaluation of LNF compared with CNF based on prospective data with adequate follow-up is lacking. Methods: Data from two consecutive studies (a randomized clinical trial (RCT) of 57 patients undergoing LNF and 46 undergoing CNF that was terminated prematurely, and a follow-up study of 121 consecutive patients with LNF) were combined to determine incremental cost-effectiveness 1 year after surgery. Results: Mean operating time, reoperation rate and hospital costs of LNF were lower in the second series. The mean overall hospital cost per patient was ,9126 for LNF and ,6989 for CNF at 1 year in the initial RCT, and ,7782 in the second LNF series. The success rate of both LNF and CNF at 1 year was 91 per cent in the RCT, and LNF was successful in 90·1 per cent in the second series. A cost reduction of ,998 for LNF would cancel out the cost advantage of CNF. Similarly, if the reoperation rate after LNF decreased from 0·05 to below 0·008 and/or if the mean duration of sick leave after LNF was reduced from 67·2 to less than 61·1 days, the procedure would become less expensive than CNF. Complications, reoperation rate and quality of life after both operations were similar. Conclusion: Including reinterventions, the outcome at 1 year after LNF and CNF was similar. In a well organized setting with appropriate expertise, the cost advantage of CNF may be neutralized. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Combined intravitreal anti-vascular endothelial growth factor (Avastin®) and photodynamic therapy to treat retinal juxtapapillary capillary haemangiomaACTA OPHTHALMOLOGICA, Issue 5 2010Stefan Mennel Abstract. Objective:, Retinal capillary haemangioma complications are characterized by progressive exudation with consecutive intraretinal and subretinal leakage. A successful therapy without side-effects has not been found. We report a case of retinal juxtapapillary capillary haemangioma causing consecutive leakage with macular involvement. The tumour was treated with a combination of anti-vascular endothelial growth factor (VEGF) and photodynamic therapy (PDT) and was followed for 1 year. Methods:, A 44-year-old woman with retinal juxtapapillary capillary haemangioma in the right eye experienced a decrease of visual acuity from 20/20 to 20/60 because of a severe leakage from the tumour involving the macula with lipid depositions. Two sessions of PDT (sparing the part of the haemangioma located within the optic disc) and five injections of bevacizumab were applied in a period of 5 months. Visual acuity, visual field testing, retinal thickness measurements, fundus photography and fluorescein angiography were performed to evaluate the treatment effect. Results:, One year after the last injection, visual acuity increased to 20/40. All lipid exudates at the posterior pole resolved. Retinal thickness decreased from 490 to 150 ,m with the restoration of normal central macular architecture. Leakage in fluorescence angiography reduced significantly, but hyperfluorescence of the tumour was still evident. Visual field testing and angiography did not show any treatment-related vaso-occlusive side-effects. Conclusion:, In this single case, the combination of anti-VEGF and PDT appeared to be an effective strategy for the treatment of retinal juxtapapillary capillary haemangioma without side-effects. Further studies with a greater number of eyes and adequate follow-up are necessary to support these first clinical results. [source] Gain in accuracy for diagnosis and follow-up of uveitis through indocyanine green angiographyACTA OPHTHALMOLOGICA, Issue 2009CP HERBORT Purpose The proportion of diseases involving principally the choroid is as frequent if not more frequent than those involving the superficial structures of the fundus and are therefore not accessible or poorly accessible to fluorescein angiography (FA) nor OCT. Methods Illustrative cases where the preponderant lesions are in the choroid are presented showing that the detection and follow-up of choroiditis is only meaningful using indocyanine green angiography (ICGA). Results Diseases that do not involve the choroid are the minority. Except for intermediate uveitis, mainly of the pars planitis type, and Behçet's uveitis, choroidal involvement cannot be excluded. Therefore in most other uveitis cases with suspected posterior involvement, if angiographic investigation is felt necessary, the initial angiography should always be a dual FA/ICGA angiography even if the predominant fundus sign is retinal vasculitis. Only if the initial angiography does not show choroidal involvement can the follow-up be preformed by FA alone. Conclusion In order to perform adequate diagnosis, adequate assessement of lesions and adequate follow-up in uveitis cases with choroidal involvement ICGA is mandatory. [source] State of the art and recommendationsKangaroo mother care: application in a high-tech environmentACTA PAEDIATRICA, Issue 6 2010KH Nyqvist Abstract Since Kangaroo Mother Care (KMC) was developed in Colombia in the 1970s, two trends in clinical application emerged. In low income settings, the original KMC model is implemented. This consists of continuous (24 h/day, 7 days/week) and prolonged mother/parent,infant skin-to-skin contact; early discharge with the infant in the kangaroo position; (ideally) exclusive breastfeeding; and, adequate follow-up. In affluent settings, intermittent KMC with sessions of one or a few hours skin-to-skin contact for a limited period is common. As a result of the increasing evidence of the benefits of KMC for both infants and families in all intensive care settings, KMC in a high-tech environment was chosen as the topic for the first European Conference on KMC, and the clinical implementation of the KMC model in all types of settings was discussed at the 7th International Workshop on KMC. Kangaroo Mother Care protocols in high-tech Neonatal Intensive Care Units (NICU) should specify criteria for initiation, kangaroo position, transfer to/from KMC, transport in kangaroo position, kangaroo nutrition, parents' role, modification of the NICU environment, performance of care in KMC, and KMC in case of infant instability. Conclusion:, Implementation of the original KMC method, with continuous skin-to-skin contact whenever possible, is recommended for application in high-tech environments, although scientific evaluation should continue. [source] | ||||||||||