Follow-up Care (follow-up + care)

Distribution by Scientific Domains
Distribution within Medical Sciences


Selected Abstracts


Telephone Appointment Visits for Head and Neck Surgery Follow-up Care,,

THE LARYNGOSCOPE, Issue 6 2002
Jeffrey Eaton MD
Abstract Objectives/Hypothesis To test the hypothesis that patients with a variety of otolaryngologic diagnoses using telephone appointment visits would be equally as satisfied as patients receiving physician office visits, the study compared telephone appointment visits with physician office visits for health maintenance organization patients who needed routine follow-up care in a head and neck surgery clinic. Study Design Randomized, nonblinded cross-sectional study. Methods After their initial visit to either of two head and neck surgery clinics, new otolaryngology patients were randomly assigned into treatment and control groups. Patients in the treatment group (n = 73) received follow-up care in the form of telephone appointment visits, and patients in the control group (n = 80) received physician office visits for follow-up care. Study data were collected using telephone interviews and physician trackingforms. Results Patients receiving telephone appointment visits were significantly less satisfied with their visits than patients receiving physician office visits (,2 = 25.4, P <.005). Patients who had physician office visits were significantly more likely than were patients in the treatment group to agree "somewhat" or "strongly" that 1) the physician addressed their questions and concerns (,2 = 24.0, P <.005); 2) the physician provided personal care and attention (,2 =29.9, P <.005); and 3) the physician provided high-quality care (,2 =34.5, P <.005). Conclusions Patients who received telephone appointment visits were statistically significantly less satisfied with all aspects of their follow-up appointment than were patients who had physician office visits. The study findings indicate that telephone appointment visits may not be an ideal type of follow-up visit for all patients. Despite these findings, one third of patients in the treatment group would consider receiving a telephone appointment visit for future routine follow-up care, and 21.9% had no preference, perhaps a factor indicating willingness to receive a telephone appointment for a follow-up visit. [source]


Treatment of a severe dental lateral luxation associated with extrusion in an 8-month-old baby: a conservative approach

DENTAL TRAUMATOLOGY, Issue 1 2005
Robson Frederico Cunha
Abstract,,, This case report documents the trauma and follow-up care of lateral luxation associated with extrusion of the lower central incisors in an 8-month-old patient. The teeth were repositioned by digital pressure and stabilized using proximal sutures. Clinical and radiographic follow-up 40 months after the injury showed alterations in both incisors, but both remained functional and free of pathology. [source]


Evaluation of a holistic treatment and teaching programme for patients with Type 1 diabetes who failed to achieve their therapeutic goals under intensified insulin therapy

DIABETIC MEDICINE, Issue 9 2000
U. Bott
SUMMARY Aims To evaluate a treatment and teaching programme including psychosocial modules for patients with Type 1 diabetes mellitus on intensified insulin therapy who failed to achieve their treatment goals despite participation in standard programmes. Methods The 5-day inpatient programme comprises small groups of 4,6 patients, focusing on individual needs and problems. Beyond the teaching lessons (most topics are deliberately chosen by the patients), the programme provides intensive group discussions and offers individual counselling concerning motivational aspects, psychosocial problems and coping strategies. Of the first consecutive 83 participants, 76 were re-examined after 17.5 ± 5.5 months (range 9,31 months). Results At follow-up, HbA1c was not improved compared to baseline (8.0 ± 1.3% vs. 8.1 ± 1.5%). However, the incidence of severe hypoglycaemia per patient/year (glucose i.v., glucagon injection) was substantially decreased: 0.62 ± 1.5 episodes at baseline compared to 0.16 ± 0.9 at follow-up (P < 0.001). Twenty-six per cent of the patients at baseline, and 4% at re-examination had experienced at least one episode of severe hypoglycaemia during the preceding year (P < 0.001). Sick leave days per patient/year decreased from 17.0 ± 38.5,7.7 ± 13.6 days (P < 0.05). Patients improved their perceptions of self-efficacy, their relationship to doctors and felt less externally controlled (P < 0.001). The majority of patients perceived an improved competence regarding diet (80.6%) and adaptation of insulin dosage (82.4%), an improved knowledge (82.2%), and a renewed motivation for the treatment (84.5%). Treatment success was significantly associated with baseline HbA1c, stability of motivation, frequency of blood glucose self-monitoring, control beliefs and change in subsequent outpatient care. Conclusions The programme improved glycaemic control mainly as a result of a substantial reduction in the incidence of severe hypoglycaemia. Patients with persistent poor glycaemic control may benefit from structured follow-up care focusing on motivational aspects of self-management and psychosocial support. [source]


Alcohol consumption patterns and risk factors among childhood cancer survivors compared to siblings and general population peers

ADDICTION, Issue 7 2008
E. Anne Lown
ABSTRACT Aims This study describes alcohol consumption among adult survivors of pediatric cancer compared to sibling controls and a national sample of healthy peers. Risk factors for heavy drinking among survivors are described. Design, setting and participants Cross-sectional data were utilized from the Childhood Cancer Survivor Study including adult survivors of pediatric cancer (n = 10 398) and a sibling cohort (n = 3034). Comparison data were drawn from the National Alcohol Survey (n = 4774). Measurement Alcohol consumption, demographic, cancer diagnosis, treatment and psychosocial factors were measured. Findings Compared to peers, survivors were slightly less likely to be risky [adjusted odds ratio (ORadj) = 0.9; confidence interval (CI) 0.8,1.0] and heavy drinkers (ORadj = 0.8; CI 0.7,0.9) and more likely to be current drinkers. Compared to siblings, survivors were less likely to be current, risky and heavy drinkers. Risk factors for survivors' heavy drinking included being age 18,21 years (ORadj = 2.0; 95% CI 1.5,2.6), male (ORadj = 2.1; 95% CI 1.8,2.6), having high school education or less (ORadj = 3.4; 95% CI 2.7,4.4) and drinking initiation before age 14 (ORadj = 6.9; 95% CI 4.4,10.8). Among survivors, symptoms of depression, anxiety or somatization, fair or poor self-assessed health, activity limitations and anxiety about cancer were associated with heavy drinking. Cognitively compromising treatment, brain tumors and older age at diagnosis were protective. Conclusions Adult survivors of childhood cancer show only a modest reduction in alcohol consumption compared to peers despite their more vulnerable health status. Distress and poorer health are associated with survivor heavy drinking. Screening for alcohol consumption should be instituted in long-term follow-up care and interventions among survivors and siblings should be established to reduce risk for early drinking. [source]


Assessing the impact of late treatment effects in cervical cancer: an exploratory study of women's sexuality

EUROPEAN JOURNAL OF CANCER CARE, Issue 4 2007
M. BURNS rn, m.phil, professional development nurse
Cancer survivorship has become a major issue due to people living longer with the effects of cancer treatment. A key issue in this area are the ,iatrogenic effects' of cancer treatments and their adverse impact on the quality of long-term patient survival. This paper considers the late physical effects of treatment for cervical cancer, in particular psychosocial problems associated with sexuality. The aim of this paper was to explore women's sexuality following treatment for cervical cancer. A qualitative phenomenological design was used to explore the lived experiences of a purposive sample of 13 women 2,3 years after treatment, using in-depth interviewing. The findings demonstrate that cancer treatment can result in a number of late physical effects, including bladder and bowel dysfunction. Moreover, the physical problems led to sexual difficulties experienced several years after treatment. Concerns were expressed by patients about perceived psychosexual difficulties encountered as a result of treatment. In conclusion, the study raises issues associated with the management of late treatment effects and its impact on sexuality. The findings underline the need for effective communication of possible iatrogenic effects of treatment during follow-up care and a need for research to consider the advice and information that women require about long-term treatment effects. [source]


Clinicians' Views on Reproductive Needs and Services for Teens With Negative Pregnancy Tests

JOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 2 2004
Alison Moriarty Daley MSN
ISSUES AND PURPOSE To explore services available to adolescent girls at the time of the negative pregnancy test (NPT) in an urban community. DESIGN AND METHODS Clinicans focus groups were conducted to identify the needs of adolescents at the time of a NPT result. RESULTS Teens access care in a variety of ways, services provided at the time of a NPT were agency and clinical dependent, and strategies for follow-up care often were unstructured. Few services were available for parents or partners. Barriers included difficulty communicating with agencies, lack of staff trained to work with adolescents, and time/financial constraints. CONCLUSION Adolescents need comprehensive, teen-friendly reproductive care at the time of a NPT results. [source]


Area-Level Poverty Is Associated with Greater Risk of Ambulatory,Care,Sensitive Hospitalizations in Older Breast Cancer Survivors

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2008
Mario Schootman PhD
OBJECTIVES: To estimate the frequency of ambulatory care,sensitive hospitalizations (ACSHs) and to compare the risk of ACSH in breast cancer survivors living in high-poverty with that of those in low-poverty areas. DESIGN: Prospective, multilevel study. SETTING: National, population-based 1991 to 1999 National Cancer Institute Surveillance, Epidemiology, and End Results Program data linked with Medicare claims data throughout the United States. PARTICIPANTS: Breast cancer survivors aged 66 and older. MEASUREMENTS: ACSH was classified according to diagnosis at hospitalization. The percentage of the population living below the U.S. federal poverty line was calculated at the census-tract level. Potential confounders included demographic characteristics, comorbidity, tumor and treatment factors, and availability of medical care. RESULTS: Of 47,643 women, 13.3% had at least one ACSH. Women who lived in high-poverty census tracts (,30% poverty rate) were 1.5 times (95% confidence interval (CI)=1.34,1.72) as likely to have at least one ACSH after diagnosis as women who lived in low-poverty census tracts (<10% poverty rate). After adjusting for most confounders, results remained unchanged. After adjustment for comorbidity, the hazard ratio (HR) was reduced to 1.34 (95% CI=1.18,1.52), but adjusting for all variables did not further reduce the risk of ACSH associated with poverty rate beyond adjustment for comorbidity (HR=1.37, 95% CI=1.19,1.58). CONCLUSION: Elderly breast cancer survivors who lived in high-poverty census tracts may be at increased risk of reduced posttreatment follow-up care, preventive care, or symptom management as a result of not having adequate, timely, and high-quality ambulatory primary care as suggested by ACSH. [source]


Interactive Video Specialty Consultations in Long-Term Care

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2004
Bonnie J. Wakefield PhD
Objectives: To assess provider and resident satisfaction with and outcomes of specialist physician consultations provided via interactive video to residents of a long-term care (LTC) center. Design: Cross-sectional survey. Setting: Two Veterans Affairs Medical Centers (VAMC) and a state LTC center. Participants: Physicians (n=12) at the VAMC and nurses (n=30) and residents (n=62) at the LTC center. Intervention: Interactive video conferencing to provide physician specialty visits to residents at the LTC center. Measurements: Satisfaction ratings and record review to determine changes in treatment plan and follow-up care. Results: Data were collected on 76 individual consultations in six clinics. The most frequent outcome was a change in treatment plan with the resident remaining at the LTC setting (n=29, 38%) or no change in treatment (n=26, 34%). Physicians' ratings were 78% good to excellent for usefulness in developing a diagnosis, 87% good to excellent for usefulness in developing a treatment plan, 79% good to excellent for quality of transmission, and 86% good to excellent satisfaction with the consult format. Overall, 72% of residents were satisfied with the consult format, and 92% felt that it was easier to obtain medical care via telemedicine. Nurses felt that the telemedicine clinics were a good use of their time and skills (100%). Conclusion: There was a high rate of physician, patient, and nurse satisfaction with interactive video conferencing. Care delivered to residents of LTC settings via video conferencing offers a number of potential advantages, including avoidance of travel for patient and provider and potentially greater continuity of care. [source]


Sublingual versus vaginal misoprostol for the management of missed abortion

JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 3 2010
Fateme Davari Tanha
Abstract Aim:, To evaluate the efficacy of two routes of misoprostol administration (sublingual and vaginal) for the treatment of missed abortion. Methods:, Two hundred and twenty women with confirmed missed abortion who received 400 µg/6 h misoprostol either sublingually or vaginally, were included in this randomized control trial. All women were admitted to hospital for follow-up care for 2 days. If the pregnancy was not completely evacuated during this time, the patient underwent immediate surgical completion. Efficacy was defined as the percentage of women discharged from the study without the need for surgical intervention. Results:, The effectiveness was high in the sublingual group and statistically different (sublingual 84.5%, vaginal 46.4% P = 0.000 RR = 0.54 95%CI = 0.442,0.681). The groups differed in terms of complications like bleeding (88.2% vs 65.5%), pain (85.5% vs 56.4%), diarrhea (69.1% vs 36.4%) and fever (23.6% vs 13.3%) in the sublingual group versus the vaginal group, but the mean time to expulsion was shorter (9.68 h SD = 5.51 95%CI = 8.61,10.57) in the sublingual group than the vaginal group (16.64 h SD = 14.01 95%CI = 13.8,19.48), P = 0.000. Women in the sublingual group were highly satisfied with the method. Conclusion:, Sublingual misoprostol for the medical management of missed abortion is more effective and more acceptable than the vaginal route. However, it showed more adverse effects. [source]


Does the School Nurse-to-Student Ratio Make a Difference?

JOURNAL OF SCHOOL HEALTH, Issue 1 2004
Martha Guttu
ABSTRACT: Public schools must provide an appropriate education for students with complex health needs. Chronic illnesses such as asthma and diabetes, social morbidities, injuries, and conditions that limit learning such as poor vision commonly affect school-aged children. School nurses often assume a leadership role in providing services for these children. However, although a national standard for school nurse/student ratio has been proposed, little research has examined the relationship between different school nurse-to-student ratios, level of health services provided in schools, and student outcomes. This study examined data in a 21-county region in eastern North Carolina served by a regional school nurse consultant. The school nurse-to-student ratio in these counties ranged from 1:451 to 1:7,440 based on full-time equivalencies. Two systems offered no school nursing services.*** Data from school years ending in 2000,2002 were considered in the analysis. A significant correlation was found between the increased presence of school nurses and services provided to children with diabetes (r = ,.52, p = .000) and asthma (r = ,.43, p = .002). Schools with better ratios provided more counseling services to children for social conditions such as depression and unintended pregnancy (r = ,.38, p = .006), and more follow-up for school-related injuries (r = ,.43, p = .003), and a higher percentage of children with vision problems received follow-up care (r = ,.37, p = .007). A case analysis of one school district that experienced a significant improvement in nurse/student ratio over the study period provides further evidence that school nurses make a difference. [source]


Classification and design of teledermatology practice: What dermatoses?

JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 8 2009
Which technology to apply?
Abstract Dermatologists are mostly confined to urban regions and rural population is deprived of specialist care. Teledermatology Practice (TDP) is a solution to overcome this global problem. Tools for TDP includes video conference, store and forward, hybrid, mobile, satellite communication, integration model, nurse-led teledermatology, teledermatology focusing on difficult-to-manage cases, teledermoscopy, and teledermatopathology with combined applications. This article reviews the feasibility studies focusing teledermatology tools and analyses the possible options in designing TDP. Categorizing dermatoses for TDP depends on the purpose and types of technology. The dermatoses presenting from a remote geographic regions requires any of the following approaches (i) only TDP, (b) initial TDP followed by face-to-face, (iii) initial face-to-face followed by TDP and (iv) only face-to-face examination. The technology should suit the dermatoses, meet the purpose, be cost-effective and provide better management with follow-up care. We recommend store and forward as a basic TDP model as most dermatoses are diagnosed and follow-up care is delivered. Leprosy, pigmented skin lesions, leg ulcers, HIV and endemic dermatoses require screening and triage services using mobile teledermatology. Counselling and education require videoconference. Rural dermatology's camps require satellite communication mounted on a vehicle. Objective assessment (vitiligo and leg ulcer) after treatment requires integration model at a tertiary centre. Difficult-to-manage cases require second opinion using hybrid/store and forward TDP. Lower rural centre are provided with mobile/ store and forward teledermatology services. Selected or major community centre should be equipped with hybrid teledermatology and linked to a tertiary centre. This process helps healthcare administration to plan a TDP to cover all dermatoses, utilizing the available health care professional (HCP) and technology with minimum budget investment. Conflicts of interest None declared. [source]


The Significance of Marijuana Use Among Alcohol-using Adolescent Emergency Department Patients

ACADEMIC EMERGENCY MEDICINE, Issue 1 2010
Thomas H. Chun MD
Abstract Objectives:, The objective was to determine if adolescents presenting to a pediatric emergency department (PED) for an alcohol-related event requiring medical care differ in terms of substance use, behavioral and mental health problems, peer relationships, and parental monitoring based on their history of marijuana use. Methods:, This was a cross-sectional comparison of adolescents 13,17 years old, with evidence of recent alcohol use, presenting to a PED with a self-reported history of marijuana use. Assessment tools included the Adolescent Drinking Inventory, Adolescent Drinking Questionnaire, Young Adult Drinking and Driving Questionnaire, Center for Epidemiologic Studies Depression Scale, Behavioral Assessment System for Children, and Peer Substance Use and Tolerance of Substance Use Scale. Results:, Compared to adolescents using alcohol only (AO), adolescents who use alcohol and marijuana (A+M) have higher rates of smoking (F = 23.62) and binge drinking (F = 11.56), consume more drinks per sitting (F = 9.03), have more externalizing behavior problems (F = 12.53), and report both greater peer tolerance of substance use (F = 12.99) and lower parental monitoring (F = 7.12). Conclusions:, Adolescents who use A+M report greater substance use and more risk factors for substance abuse than AO-using adolescents. Screening for a history of marijuana use may be important when treating adolescents presenting with an alcohol-related event. A+M co-use may identify a high-risk population, which may have important implications for ED clinicians in the care of these patients, providing parental guidance, and planning follow-up care. ACADEMIC EMERGENCY MEDICINE 2010; 17:63,71 © 2010 by the Society for Academic Emergency Medicine [source]


Is the Cost of Adult Living Donor Liver Transplantation Higher Than Deceased Donor Liver Transplantation?

LIVER TRANSPLANTATION, Issue 3 2004
Mark W. Russo MD
Background An important long-term consideration for living-donor liver transplantation (LDLT) is the expense compared with cadaveric-liver transplantation. LDLT is a more complex procedure than cadaveric transplantation and the cost of donor evaluation, donor surgery, and postoperative donor care must be included in a cost analysis for LDLT. In this study, we compare the comprehensive cost of LDLT with that of cadaveric-liver transplantation. Methods All costs for medical services provided at our institution were recorded for 24 LDLT and 43 cadaveric recipients with greater than 1 year follow-up transplanted between August 1997 and April 2000. The donor costs include donors evaluated and rejected, donors evaluated and accepted, donor right hepatectomy costs, and donor follow-up costs (365 days postdonation). LDLT and cadaveric recipient costs include medical care 90 days pre-LDLT, recipient transplant costs, and recipient follow-up costs (365 days posttransplant) including retransplantation. Cost is expressed as an arbitrary cost unit (CU) that is a value between $500 to $1,500. Results Total LDLT costs (evaluations of rejected donors + evaluations of accepted donors + donor hepatectomy + donor follow-up care for 1 year + pretransplant recipient care [90 days pretransplant] + recipient transplantation + recipient 1-year posttransplant care)= 162.7 CU. Total mean cadaveric transplant costs (pretransplant recipient care [90 days pretransplant] + recipient transplantation [including organ acquisition cost] + recipient 1-year posttransplant care)=134.5 CU, (P = ns) Conclusions The total comprehensive cost of LDLT is 21% higher than cadaveric transplantation, although this difference is not significant. (Transplantation 2003;75:473,476.) [source]


Survey of long-term follow-up programs in the United States for survivors of childhood brain tumors,

PEDIATRIC BLOOD & CANCER, Issue 7 2009
Daniel C. Bowers MD
Abstract Introduction Despite recognition that childhood brain tumor survivors often suffer multiple late effects following therapy, little is known regarding the long-term follow-up (LTFU) programs for these patients. Methods A 16-question survey was mailed to member institutions of the Children's Oncology Group in the United States. Institutions were asked about the size of their brain tumor program, activities of the LTFU programs and perceived barriers to follow-up. Results One hundred forty-five (74%) of 197 institutions returned surveys. Care for patients <21 years old at diagnosis who are >2 years following completion of therapy was provided at a designated neuro-oncology LTFU clinic (31.2%), a general LTFU program for childhood cancer survivors (30.4%), or a general pediatric oncology program (29.7%). Institutions with a neuro-oncology LTFU clinic were more likely to use neuro-psychological testing following radiation therapy (P,=,0.001), have longer duration of continued surveillance imaging (P,=,0.02), use growth hormone replacement for medulloblastoma survivors (P,<,0.001) and continue the use of growth hormone into adulthood (P,=,0.05) than those with a general pediatric oncology program. Perceived barriers to care of brain tumor survivors included limited access and lack of insurance (32.1%), lack of funding or dedicated time for providers (22.9%), patients' uncertainty about need to follow-up (20.6%), and patients' desire to not be followed in a pediatric cancer program (12.2%). Conclusions Considerable variation exists across institutions in the United States in the delivery of follow-up care for survivors of childhood brain tumors. We encourage additional investigation to better define and implement optimal follow-up care for childhood brain tumor survivors. Pediatr Blood Cancer 2009; 53:1295,1301. © 2009 Wiley-Liss, Inc. [source]


Prevalence of asthma and asthma-like symptoms in inner-city elementary schoolchildren

PEDIATRIC PULMONOLOGY, Issue 2 2002
Mayris P. Webber Dr
Abstract American inner-city children are disproportionately affected by asthma. During the 1999,2000 school year, we conducted a survey of 6 Bronx, New York City elementary schools to assess the prevalence of asthma and asthma-like symptoms as reported by parents. Children with probable asthma had symptoms within the last 12 months and parents who indicated that their child had asthma. Children with possible asthma had symptoms within the last 12 months but lacked a diagnosis. Overall, 74% (4,775/6,433) of parents returned completed surveys, identifying 20% (949/4,775) of children as probable asthmatics, and 12% (589/4,775) as possible asthmatics. In multivariate analyses, probable asthma was associated with: Puerto Rican, Black, and white race/ethnicity, male gender, having health insurance, and registration at the poorest school. Possible asthma was associated with lack of health insurance and female gender, but was not associated with any specific race/ethnicity. Our findings support the effectiveness of school-based surveys to identify children at high risk for asthma. The challenge remains to engage children and families in appropriate follow-up care and to manage their illness, either through the use of school-based health centers or stronger links to community services.Pediatr Pulmonol. 2002; 34:105,111. © 2002 Wiley-Liss, Inc. [source]


Service provision for men with antisocial personality disorder who make contact with mental health services

PERSONALITY AND MENTAL HEALTH, Issue 3 2009
Mike J. Crawford
Concerns have been raised about the quality of health services for people with antisocial personality disorder (ASPD). As part of a randomized trial of cognitive behaviour therapy for men with ASPD, we collected prospective data on service utilization over a 12-month period. Among the 52 men that participated, 96% had evidence of anxiety disorder and 64% met criteria for probable alcohol misuse. Almost half the sample presented to emergency medical services and 21% were admitted to a mental health inpatient unit during the following year. Despite this, only 11 (21%) were provided with follow-up care from mental health services. Levels of alcohol and drug misuse were lower among those that were given follow-up (27.3% compared with 63.4%, p < 0.05). Although services for people with personality disorder in Britain have expanded, most men with ASPD do not receive follow-up care from mental health services. Copyright © 2009 John Wiley & Sons, Ltd. [source]


Experiences with Weight Change in African-American Breast Cancer Survivors

THE BREAST JOURNAL, Issue 2 2008
Chanita Hughes Halbert PhD
Abstract:, Although weight gain is a common side effect of breast cancer treatment, limited empirical data are available on how African-American breast cancer survivors react to changes in their weight following diagnosis and treatment. The purpose of this study was to explore psychological and behavioral reactions to weight change in African-American breast cancer survivors. We conducted a qualitative study to explore reactions to weight change following diagnosis and treatment in 34 African-American breast cancer survivors. Forty-seven percent of women reported gaining weight, 32% reported weight loss, and 21% reported no changes in their weight. Regardless of whether women gained or lost weight, these changes were viewed as stressors that caused psychological distress and health concerns. However, some women had positive reactions to weight loss, especially if they had been heavy prior to diagnosis. Women exercised and changed their dietary behaviors following treatment. Despite this, women reported being frustrated with not being able to control changes in their weight. These results suggest that changes in weight may be a critical component of breast cancer survivorship in African-American women. It may be important to provide African-American breast cancer survivors with information about the causes and implications of weight change and strategies for weight control after treatment as part of their follow-up care. [source]


Telephone Appointment Visits for Head and Neck Surgery Follow-up Care,,

THE LARYNGOSCOPE, Issue 6 2002
Jeffrey Eaton MD
Abstract Objectives/Hypothesis To test the hypothesis that patients with a variety of otolaryngologic diagnoses using telephone appointment visits would be equally as satisfied as patients receiving physician office visits, the study compared telephone appointment visits with physician office visits for health maintenance organization patients who needed routine follow-up care in a head and neck surgery clinic. Study Design Randomized, nonblinded cross-sectional study. Methods After their initial visit to either of two head and neck surgery clinics, new otolaryngology patients were randomly assigned into treatment and control groups. Patients in the treatment group (n = 73) received follow-up care in the form of telephone appointment visits, and patients in the control group (n = 80) received physician office visits for follow-up care. Study data were collected using telephone interviews and physician trackingforms. Results Patients receiving telephone appointment visits were significantly less satisfied with their visits than patients receiving physician office visits (,2 = 25.4, P <.005). Patients who had physician office visits were significantly more likely than were patients in the treatment group to agree "somewhat" or "strongly" that 1) the physician addressed their questions and concerns (,2 = 24.0, P <.005); 2) the physician provided personal care and attention (,2 =29.9, P <.005); and 3) the physician provided high-quality care (,2 =34.5, P <.005). Conclusions Patients who received telephone appointment visits were statistically significantly less satisfied with all aspects of their follow-up appointment than were patients who had physician office visits. The study findings indicate that telephone appointment visits may not be an ideal type of follow-up visit for all patients. Despite these findings, one third of patients in the treatment group would consider receiving a telephone appointment visit for future routine follow-up care, and 21.9% had no preference, perhaps a factor indicating willingness to receive a telephone appointment for a follow-up visit. [source]


Survivorship care after breast cancer: Follow-up practices of Australian health professionals and attitudes to a survivorship care plan

ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, Issue 2 2010
Meagan E BRENNAN
Abstract Objective: The increasing number of breast cancer survivors and the complexity of follow-up care make the provision of high-quality survivorship care a challenge. This study explored the follow-up practices of health professionals and their attitudes to alternative models such as shared care and the use of a survivorship care plan. Methods: Specialist oncologists (surgeons, medical and radiation oncologists) breast physicians and breast-care nurses completed an online survey. Results: A total of 217 practitioners completed the survey, which was estimated to include 42.8% of oncologists treating breast cancer in Australia. One-third of responding specialists reported spending more than 25% of their clinical time providing follow-up care. They reported many positive aspects to follow-up consultations and viewed follow-up care as an important part of their clinical role but expressed concern about the sustainability of follow-up care in their practices. The follow-up intervals and recommendations were in line with national guidelines. The specialists were supportive of sharing follow-up care with primary-care physicians, breast physicians and breast-care nurses. Most professionals felt that a survivorship care plan would improve care and said they would use a proforma. Conclusion: The oncologists felt that follow-up care was an important part of their role and they were supportive of the concepts of shared care programs and a survivorship care plan. Input from consumers is required to evaluate the acceptability of these alternative models and to assess ways of implementing these changes to work towards a more comprehensive and sustainable method of delivering survivorship care. [source]


Clinical practice guidelines for the psychosocial care of cancer survivors,,§

CANCER, Issue S18 2009
Current status, future prospects
Abstract Upon completion of their primary treatment, many cancer survivors become "lost in transition," and receive inadequate or, at best, poorly coordinated follow-up care. Unmet psychosocial and educational needs figure prominently among the concerns identified by survivors of adult-onset cancers in the post-treatment period. This article focuses on the role clinical practice guidelines could play in improving the quality of psychosocial care provided to these post-treatment survivors. After defining clinical practice guidelines and describing their development, the article provides an overview of existing clinical practice guidelines for the psychosocial care of cancer patients and identifies their strengths and weaknesses. A major weakness relevant to this article is that none of the existing guidelines focus on the post-treatment period. Two recent efforts in the field of cancer survivorship are identified that should stimulate and inform the development of guidelines for psychosocial care in the post-treatment period. One effort is the growing movement to implement survivorship care planning at the end of primary treatment. Assessing and addressing unmet and anticipated psychosocial needs have been identified as major components of survivorship care planning. The other effort is the release by the Children's Oncology Group of Long-term Follow-up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers. These guidelines provide a useful model of how guidelines for the psychosocial care of survivors of adult-onset cancers might be developed, organized, and implemented. Cancer 2009;115(18 suppl):4419,29. © 2009 American Cancer Society. [source]


Interventions to improve follow-up of abnormal findings in cancer screening,,

CANCER, Issue S5 2004
Roshan Bastani Ph.D.
Abstract The potential reduction in morbidity and mortality through cancer screening cannot be realized without receipt of appropriate follow-up care for abnormalities identified via screening. In this paper, the authors critically examine the existing literature on correlates of receipt of appropriate follow-up care for screen-detected abnormalities, as well as the literature on interventions designed to increase rates of receipt of follow-up care. Lessons learned describe what is known and not known about factors that are related to or predict receipt of follow-up care. Similarly, effective interventions to increase follow-up are described and gaps identified. A conceptual model is developed that categorizes the health care system in the United States as comprising four levels: policy, practice, provider, and patient. Some patient-level factors that influence follow-up receipt are identified, but the lack of data severely limit the understanding of provider, practice, and policy-level correlates. The majority of intervention studies to increase follow-up receipt have focused on patient-level factors and have targeted follow-up of abnormal Papanicolaou smears. Insufficient information is available regarding the effectiveness of provider, practice, or policy-level interventions. Standard definitions of what constitutes appropriate follow-up are lacking, which severely limit comparability of findings across studies. The validity of various methods of obtaining outcome data has not been clearly established. More research is needed on interventions targeting provider, system, and policy-level factors, particularly interventions focusing on follow-up of colorectal and breast abnormalities. Standardization of definitions and measures is needed to facilitate comparisons across studies. Cancer 2004. Published 2004 by the American Cancer Society. [source]


Non-adherence to immunosuppressive medication in renal transplant recipients within the scope of the integrative model of behavioral prediction: a cross-sectional study

CLINICAL TRANSPLANTATION, Issue 2 2010
Gabriela Schmid-Mohler
Schmid-Mohler G, Pechula Thut M, Wüthrich RP, Denhaerynck K, De Geest S. Non-adherence to immunosuppressive medication in renal transplant recipients within the scope of the integrative model of behavioral prediction: a cross-sectional study. Clin Transplant 2009 DOI: 10.1111/j.1399-0012.2009.01056.x © 2009 John Wiley & Sons A/S. Abstract:, Background:, Non-adherence to immunosuppressive medication is strongly associated with poor outcomes. Identifying the factors influencing it is a first step in developing adherence interventions. This study's objective was to investigate the prevalence of self-reported and collaterally-reported non-adherence to immunosuppressives, and, based on the Integrative Model of Behavioral Prediction, to explore the association between non-adherence, intention to adhere, attitudes, norms and self-efficacy. Methods:, This cross-sectional study included a convenience sample of 114 renal transplant recipients in follow-up care, one to five yr post-transplant. Non-adherence was measured by self-reports and collateral reports. Factors of the Integrative Model of Behavioral Prediction were assessed using a self-report questionnaire. Results:, Self-reports showed non-adherence of 23.7%; collateral reports showed 3.8%; and a combination of the two showed 26.4%. Logistic regression analysis showed that the attitude "Not all immunosuppressive drugs are necessary to prevent rejection" was less frequent in patients with higher intentions to adhere, with an odds ratio (OR) of 0.05 (95% CI 0.01,0.50). The barrier of "Forgetfulness/Interruption of daily routine" was associated with non-adherence, with an OR of 3.74 (95% CI 1.55,9.03). Conclusions:, Forgetfulness is the most powerful barrier against adherence. Intention to adhere plays a minor role in non-adherence in renal transplant recipients. [source]