Predictors and impact of survivorship care plans and survivorship care visits

PURPOSE

We performed this study to characterize the population at the Lifespan Cancer Institute (LCI) who received a survivorship care plan (SCP) with or without a survivorship care visit (SCV) to determine both the impact on specialty referrals and the demographic and clinical predictors of SCPs and SCVs.

METHODS

We retrospectively reviewed EMR records on 1960 patients at LCI between 2014 and 2017 for SCPs and SCVs and extracted demographics, distress thermometer (DT) scores collected at the time of initial presentation, and subsequent referrals. We evaluated the bivariate associations of SCP and SCV with continuous and categorical factors and assessed the adjusted effect of these factors on receipt of SCP and SCV independently. All analyses were performed in R v4.0.2.

RESULTS

SCPs were completed in 740 (37.8%) patients, and of those, 65.9% had a SCV. The mean age was 63.9, 67% were female, and 51.2% were married or partnered. Patients treated for breast, lung, and prostate cancers most received an SCP. Compared to SCP alone, the SCV was associated with more specialty referrals. Those who were younger and had breast cancer were more likely to receive a SCP, and those who were younger and female and had breast cancer were more likely to receive a SCV.

CONCLUSIONS

Gender, age, and type of cancer are significant predictors of receipt of SCP and SCV. Patients who received either SCP, SCV, or both were more likely to receive specialty referrals than those who received neither.

IMPLICATIONS FOR CANCER SURVIVORS

Identifying predictive factors of SCP and SCV can help facilitate earlier receipt of specialty services and specialty referrals as needed.

Time to first antenatal care visit among pregnant women in Ethiopia: secondary analysis of EDHS 2016; application of AFT shared frailty models

Background

The survival of pregnant women is one of great interest of the world and especially to a developing country like Ethiopia which had the highest maternal mortality ratios in the world due to low utilization of maternal health services including antenatal care (ANC). Survival analysis is a statistical method for data analysis where the outcome variable of interest is the time to occurrence of an event. This study demonstrates the applications of the Accelerated Failure Time (AFT) model with gamma and inverse Gaussian frailty distributions to estimate the effect of different factors on time to first ANC visit of pregnant women in Ethiopia.

Methods

This study was conducted by using 2016 EDHS data about factors associated with the time to first ANC visit of pregnant women in Ethiopia. A total of 4328 women from nine regions and two city administrations whose age group between 15 and 49 years were included in the study AFT models with gamma and inverse Gaussian frailty distributions have been compared using Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC) to select the best model.

Results

The factors residence, media exposure, wealth index, education level of women, education level of husband and husband occupation are found to be statistically significant (P-value < 0.05) for the survival time of time to first ANC visit of pregnant women in Ethiopia. Inverse Gaussian shared frailty model with Weibull as baseline distribution is found to be the best model for the time to first ANC visit of pregnant women in Ethiopia. The model also reflected there is strong evidence of the high degree of heterogeneity between regions of pregnant women for the time to first ANC visit.

Conclusion

The median time of the first ANC visit for pregnant women was 5 months. From different candidate models, Inverse Gaussian shared frailty model with Weibull baseline is an appropriate approach for analyzing time to first ANC visit of pregnant women data than without frailty model. It is essential that maternal and child health policies and strategies better target women’s development and design and implement interventions aimed at increasing the timely activation of prenatal care by pregnant women. The researchers also recommend using more powerful designs (such as cohorts) for the research to establish timeliness and reduce death.

Impact of COVID-19 pandemic on visits of an urban emergency department

Objective

The aim of this study was to reveal how the pandemic process affected the number of ED visits and the reasons for application.

Methods

The daily number of ED visits during the pandemic were analyzed in 3 different periods; prepandemic period (February 1st to March 11th, declaration of the first COVID-19 case in Turkey), early pandemic period (March 12th to May 31th, period of strict measures), and late pandemic period (June 1st to July 31st, period of new norms). The pandemic periods were compared with the same timeframes in 2019 (comparison periods). Demographic variables and complaints of the patients on admission were investigated.

Results

The total number of ED visits in the study period in 2020 was 78,907, which was only the half of the applications in the same period in 2019 (n: 149,387). Data showed a sharp decrease at the number of daily visits to green and yellow zones after the announcement of the first case however red zone applications were more than twice that of the previous year. During pandemic nonspecific complaints was decreased and there was an increase at the percentages of respiratory, cardiac, and neurological complaints.

Conclusion

Number of ED visits during the pandemic were decreased by half when compared to the previous year. It was an advantage of the pandemic to decrease ED visits due to “nonemergent” complaints, and thus, unnecessary patient burden. However, on the other hand, patients avoided seeking medical attention, even for life-threatening conditions which led to increased mortality and morbidity.

Cluster randomized controlled trial (RCT) to support parental contact for children in out-of-home care

BACKGROUND

There is an identified need to improve the evidence-base in relation to contact visits for children in the out-of-home-care (OOHC) system, to ensure optimal outcomes.

OBJECTIVE

The aim of this cluster randomized controlled trial (RCT) was to test the effectiveness of a contact intervention for parents having supervised contact with children in long-term OOHC.

PARTICIPANTS

183 study children in 15 clusters (OOHC services) and their parent(s) were randomized to the intervention (8 clusters, 100 children) and control groups (7 clusters, 83 children) in three Australian jurisdictions.

SETTING

The manualized intervention consisted of increasing the preparation and support provided by caseworkers to parents before and after their contact visits.

METHOD

Interviews were conducted with carers, parents and caseworkers of the study children at baseline and nine months post-randomization. Interviews included standardized assessment tools measuring child and adult wellbeing and relationships, carer and caseworker ability to support contact, and contact visit cancellations by the parent.

RESULTS

Compared with controls, the intention-to-treat (ITT) analyses showed that fewer visits were cancelled by parents in the intervention group at follow-up (-10.27; 95 % CI: -17.04 to -3.50, p = .006). In addition, per-protocol (PP) analyses showed higher caseworker receptivity to contact (6.03; 95 % CI: 0.04-12.03, p = .04), and higher parent satisfaction with contact (7.41; 95 % CI: 0.70-14.11, p = .03) in the intervention group at follow-up.

CONCLUSIONS

While the intervention did not have an effect on child wellbeing, as measured by the SDQ, the trial reports significant positive findings and demonstrates the benefits of the kC kContact intervention in providing support to parents to attend contact visits. The findings of the current study provide an important contribution to knowledge in an area where few RCTs have been completed, notwithstanding the null findings.

Providing pediatric well-care and sick visits in the COVID-19 pandemic era: the recommendations of the Italian pediatric society

Pediatricians have observed a significant decrease in in-person child health visits during the COVID-19 pandemic. In the post lockdown period, the coronavirus trend remains positive in Italy but fears of a second wave have recently grown in Italy due to active hotbeds of contagion. The pandemic may negatively affect the care of pediatric patients and overall children welfare as it may present with severe signs and symptoms or it may complicate. The Italian Pediatric Society recommend to separate well visits from sick ones, to educate families and to promote hygienic strategies to provide an adequate pediatric assistance in case of a second pandemic wave.

The impact of accessibility and service quality on the frequency of patient visits to the primary diabetes care provider: results from a cross-sectional survey performed in six European countries

Background

Visits to the primary diabetes care provider play a central role in diabetes care. Therefore, patients should attend their primary diabetes care providers whenever a visit is necessary. Parameters that might affect whether this condition is fulfilled include accessibility (in terms of travel distance and travel time to the practice), as well as aspects of service quality (for example in-practice waiting time and quality of the provider’s communication with the patient). The relationships of these variables with the frequency of visits to the primary diabetes care provider are investigated.

Methods

The investigation is performed with questionnaire data of 1086 type 2 diabetes patients from study regions in England (213), Finland (135), Germany (218), Greece (153), the Netherlands (296) and Spain (71). Data were collected between October 2011 and March 2012. Data were analysed using log-linear Poisson regression models with self-reported numbers of visits in a year to the primary diabetes care provider as the criterion variable. Predictor variables of the core model were: country; gender; age; education; stage of diabetes; heart problems; previous stroke; problems with lower extremities; problems with sight; kidney problems; travel distance and travel time; in-practice waiting time; and quality of communication. To test region-specific characteristics, the interaction between the latter four predictor variables and study region was also investigated.

Results

When study regions are merged, travel distance and in-practice waiting time have a negative effect, travel time no effect and quality of communication a positive effect on visit frequency (with the latter effect being by far largest). When region specific effects are considered, there are strong interaction effects shown for travel distance, in-practice waiting time and quality of communication. For travel distance, as well as for in-practice waiting time, there are region-specific effects in opposite directions. For quality of communication, there are only differences in the strength with which visit frequency increases with this variable.

Conclusions

The impact of quality of communication on visit frequency is the largest and is stable across all study regions. Hence, increasing quality of communication seems to be the best approach for increasing visit frequency.

Perforated Choledochal Cyst: Its Clinical Implications in Pediatric Patient

PURPOSE

Perforation of choledochal cyst (CC) is a relatively rare clinical presentation in pediatric populations and difficult to predict preoperatively. We assess the clinical implications by comparing clinical parameters based on a single-center experience between perforated and nonperforated CC to facilitate the appropriate management for future interventions.

METHODS

A total of 92 cases of CC in pediatric patients (aged <18 years) who received surgical management between January 2003 and December 2018 at a Pusan National University Children's Hospital were reviewed. After screening the clinical features of perforated cases, we compared the demographic findings, clinical characteristics, and some laboratory results between the perforated and nonperforated groups.

RESULTS

Perforated CC was identified in 8 patients (8.7%), and nonperforated CC in 84 patients (91.3%). Perforation can be classified into three categories: free perforation of cyst (3 cases), pinpoint perforation of cyst (2 cases), and necrotic change of cyst (3 cases). CC perforation occurred significantly more commonly in patients aged <24 months. Clinically, the perforated group showed significantly higher frequency of fever and higher C-reactive protein (CRP) level during the initial visit.

CONCLUSION

Perforation is more likely to be suspected in patients aged <24 months presenting together with fever and high CRP level in the initial visit. It is also necessary to keep in mind that it indicates not only a possibility of complicated disease status regardless of its association with stones but also a difficulty of applying a minimal invasive procedure and relatively increased length of hospital stay.

The Importance of Multiple, Different Rhinoplasty Consultations in Patient Selection

OBJECTIVE

We aimed to investigate the relationship between the number of visits to different physicians and postoperative satisfaction in patients undergoing primary septorhinoplasty by using the ROE survey.

METHODS

Patients for whom we performed septorhinoplasty in the last 3 years were examined. Patients who visited 3 different physicians (including us) before the surgery were allocated to group 1. Patients who visited ≥ 4 physicians comprised group 2. We randomized 50 patients in each group. Rhinoplasty outcome evaluation (ROE) was performed twice for the preoperative evaluation and to determine the satisfaction in postoperative 6th month.

RESULTS

Preoperative and postoperative ROE values were significantly lower in group 2 (p < 0.001). ROE values after surgery were 82% in group 1 and 68.92% in group 2.

CONCLUSION

We think that it is more appropriate for patients who visit many surgeons to be evaluated more carefully and to be psychologically examined.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Supporting of the Fathers to Visit Their Infants in Neonatal Intensive Care Unit Decreases Their Stress Level: A Pretest-Posttest Quasi-Experimental Study

It is known that fathers whose infants are hospitalized in NICUs (Neonatal Intensive Care Units) are severely stressed. This study was conducted for the purpose of determining the effect of supporting and visiting infants in NICUs on stress levels of Turkish fathers. This was a pretest-posttest quasi-experimental study. The population of the study consisted of 47 fathers who had their infants receiving treatment in NICU at a state hospital in the eastern Turkey and agreed to participate in the study. The data were collected by using "Father-Infant Introductory Information Form" and "Parental Stressor Scale: Neonatal Intensive Care Unit, PSS:NICU". When comparing the PSS:NICU total mean scores of the fathers before and after interventions; it was determined that their mean scores were higher before visits compared to those obtained after interventions and the difference between them was significant at advanced level. It was found that the fathers visiting and supporting their infants in NICUs had the decreased stress levels. It is a useful nursing intervention to support fathers to visit their babies in NICUs and establish environments where they could spend time with their babies.

The ED use and non-urgent visits of elderly patients

Objective

To evaluate the use of the emergency department (ED) by elderly patients, their non-urgent visits and the prevalence of main disease for ED visits.

Methods

This cross-sectional study was conducted on patients aged 65 years and over who visited the ED of a tertiary care university hospital in Turkey between January 2015 and January 2016 retrospectively.

Results

A total of 36,369 elderly patients who visited the ED were included in the study. The rate of ED visits by elderly patients was higher than their representation within the general population (p < 0.001). While the rate of elderly patients visiting polyclinics was 15.8%, the rate of elderly patients visiting the ED was 24.3% (p < 0.001). For both genders, the rates of ED visits for patients between 65 and 74 years old was higher than for other elderly age groups (p < 0.001). The prevalence of upper respiratory tract infection (URTI) was the highest within the elderly population (17.5%, CI: 17.1–17.9). The proportion of ED visits for non-urgent conditions was 23.4%. Most of the ED visits were during the non-business hours (51.1%), and they were highest in the winter season (25.9%) and in January (10.2%). The hospitalization rate was 9.4%, and 37.9% of hospitalized patients were admitted to intensive care units.

Conclusion

The proportion of ED visits by elderly patients was higher than their representation within the general population. Elderly patients often visited the ED instead of a polyclinic. The rate of inappropriate ED use by elderly patients in this hospital was higher than in other countries.

Age specificity in general and rehabilitation medical services in children with cerebral palsy

Objective

To review the medical utilization in children with cerebral palsy according to age and discern particularities

Methods

From January 2007 to December 2007, 10,659 children and adolescents between 1 and 18 years of age who had filed national insurance claims for a diagnosis of cerebral palsy were selected. Age was chosen as an independent variable, and the population was categorized into specific age groups to verify any differences in medical service utilization. Admission duration to rehabilitation, number of visits to rehabilitation outpatient clinics, numbers of admission dates and outpatient clinic visits for general medical services, number of rehabilitation utilizations, and type of rehabilitations treatment were selected as dependent variables. One-way ANOVA was used for statistical evaluation, and analysis was done with SAS software.

Results

In general medical use, adolescences diagnosed with cerebral palsy had the highest mean admission duration (p<0.001). The mean visit day to outpatient clinics for general medical services was highest for infants (p<0.001). In rehabilitation treatment, infants diagnosed with cerebral palsy had the highest mean admission duration (p<0.001). The mean visit day to outpatient clinics for rehabilitation treatment was highest for infants (p<0.001).

Conclusion

Significant differences in use of general and rehabilitation medical services among pediatric age groups with cerebral palsy were evident. This implies that particular attention is necessary when setting up a national medical care policy for patient with cerebral palsy.

Review: Quantifying animal feeding behaviour with a focus on pigs

The study of animal feeding behaviour is of interest to understand feeding, to investigate the effect of treatments and conditions or to predict illness. This paper reviews the different steps to undertake when studying animal feeding behaviour, with illustrations for group-housed pigs. First, one must be aware of the mechanisms that control feeding and the various influences that can change feeding behaviour. Satiety is shown to largely influence free feeding (ad libitum and without an operant condition) in animals, but 'free' feeding seems a very fragile process, given the many factors that can influence feeding behaviour. Second, a measurement method must be chosen that is compatible with the goal of the research. Several measurement methods exist, which lead to different experimental set-ups and measurement data. Sensors are available for lab conditions, for research on group-housed pigs and also for on-farm use. Most of these methods result in a record of feeding visits. However, these feeding visits are often found to be clustered into meals. Thus, the third step is to choose which unit of feeding behaviour to use for analysis. Depending on the situation, either meals, feeding visits, other raw data, or a combination thereof can be suitable. Meals are more appropriate for analysing short-term feeding behaviour, but this may not be true for disease detection. Further research is therefore needed. To cluster visits into meals, an appropriate analysis method has to be selected. The last part of this paper provides a review and discussion of the existing methods for meal determination. A variety of methods exist, with the most recent methods based on the influence of satiety on feeding. More thorough validation of the recent methods, including validation from a behavioural point of view and uniformity in the applied methods is therefore necessary.

The physical therapy prescription

Physical therapy was first noted in the time of Hippocrates. The physical therapy visit includes a complete history, physical examination, and development of a treatment plan. Health care providers usually initiate a referral based on physical examination, symptoms, or a specific diagnosis. Physical therapy has been shown to be particularly helpful for musculoskeletal ailments, and has a growing body of evidence for use.

Emergency department visits and admissions due to drug related problems at Riyadh military hospital (RMH), Saudi Arabia

OBJECTIVES

Aim of this study was to prospectively determine the incidence and types of emergency department (ED) visits and admissions due to drug related problems (DRPs) at Riyadh Military Hospital (RMH), to assess the severity and preventability of these drug related admissions or visits, and to identify the drugs and patient groups that are most commonly involved.

METHOD

Patients (n = 300) were selected randomly from patients presented to the ED during the study period (one month). Computerized randomization program was used to select ten beds daily on different areas and times. Patient was eligible to be included if either visited ED or admitted through it due to DRPs.

RESULTS

During the study period, 300 patients presented to ED were randomly selected with a mean age of 47.8 ± 27.7 years. One hundred and forty of them were females (46.67%) and 160 were male patients (53.33%). Of these 300 patients, 56 (18.7%) were presented to ED due to DRPs, and 244 (81.3%) patients were presented to ED due to non-drug related problems (NDRPs). About ninety-three percent (n = 52) of the DRP group were exposed to hospital admission while only 7.1% (n = 4) were ED visits (Fig. 2). Male to female ratio in ED visits was 3:1 while it was 9.7:8.9 in the ED admission group.

CONCLUSION

The prospective design of this study, sample size, and randomization increases the likelihood that our estimates are accurate and increase the generalizability of our findings. Most DRPs attributed to hospital admissions or visits were avoidable. Direct patient contact with pharmacist and family physician was beneficial in providing a safe and effective therapy. Corrective, preventive and educational strategies should concentrate on the most frequently reported populations, diseases and medications. The study addresses the proper use of medications to ensure the best outcomes of pharmacological interventions. Finally, more studies with longer duration focusing on DRPs in Saudi Arabia are needed.

The preanesthetic interview by anesthesiology residents: analysis of time and content

Background

A preanesthetic visit can increase a patient's satisfaction. However, it is uncertain whether a preanesthetic visit by an anesthesiology resident can achieve the goal. We studied the time distribution for content of preanesthetic interviews (PI) and evaluated the patient's satisfaction with the PI.

Methods

We recorded the PI duration of 200 patients by a voice recorder. The degrees of patient satisfaction with the PI and the changes of anxiety level after the PI were quantified by a questionnaire. We analyzed the time distribution for content of the PI and the correlation between patient characteristics and PI duration or a patient's satisfaction.

Results

The total PI duration was 184 (134-286) sec (median, 25-75%), and the time distributions for content of the PI were 8 (5-10) of greeting, 45 (23-70) of history taking, 15 (10-20) of physical examination, 50 (25-98) for obtainingan informed consent, 20 (10-30) of explanation for anesthetic planning, 15 (5-28) for explanation of patient controlled analgesia, and 10 (0-4) sec for questions and answers. Age, ASA physical status, and educational level were correlated with PI duration (P < 0.001). The patient's level of satisfaction was "very satisfied" in 39%, "satisfied" in 50%, and "moderate" in 11% of interviews. The anxiety level was "decreased" in 50%, "increased" in 8%, and "not changed" in 42% of patients.

Conclusions

Although the duration of a PI given by residents was a relatively short, 89% of patients of were satisfied with the interview. The PI took a longer time to complete in patients of older age, higher ASA physical status, or lower educational levels.