Loss to Specialized Cardiology Follow-Up in Adults Living with Congenital Heart Disease

Background:Much has been written about the loss to follow-up in the transition between pediatric and adult Congenital Heart Disease(CHD)care centers.Much less is understood about the loss to follow-up(LTF)after a successful transition.This is critical too,as patients lost to specialised care are more likely to experience mor-bidity and premature mortality.Aims:To understand the prevalence and reasons for loss to follow-up(LTF)at a large Australian Adult Congenital Heart Disease(ACHD)centre.Methods:Patients with moderate or highly complex CHD and gaps in care of>3 years(defined as LTF)were identified from a comprehensive ACHD data-base.Structured telephone interviews examined current care and barriers to clinic attendance.Results:Overall,407(22%)of ACHD patients(n=1842)were LTF.The mean age at LTF was 31(SD 11.5)years and 54%were male;311(76%)were uncontactable.Compared to adults seen regularly,lost patients were younger,with a greater socio-economic disadvantage,and had less complex CHD(p<0.05 for all).We interviewed 59 patients(14%).The top 3 responses for care absences were“feeling well”(61%),losing track of time(36%),and not needing fol-low-up care(25%).Conclusions:A large proportion of the ACHD population becomes lost to specialised cardiac care,even after a successful transition.This Australian study reports younger age,moderate complexity defects,and socio-economic disadvantage as predictive of loss to follow-up.This study highlights the need for novel approaches to patient-centered service delivery even beyond the age of transition and resources to maintain patient engagement within the ACHD service.

Effects of hospital–community integrated transitional care on quality of life in patients with chronic obstructive pulmonary disease

Objective: To explore the effects of “hospital–community integrated transitional care” model on quality of life in patients with chronic obstructive pulmonary disease (COPD). Methods: A total of 117 inpatients with COPD from the Department of Respiratory Medicine in a tertiary general hospital in Nanjing were enrolled by convenience sampling from January to December in 2016 and then were divided into intervention group (n = 60) and control group (n = 57) by random number table. Patients in the intervention group accepted both routine care and hospital– community integrated transitional care for 3 months after discharge. Assessment of quality of life by telephone follow-up or interview within a week before discharge and 1, 3, and 6 months after discharge was evaluated using the Short Form-36 (SF-36) health survey questionnaire. Results: For a total score of quality of life, there was a significant difference between the two groups (P < 0.05): 1, 3, and 6 months after discharge. In addition, for each dimension score of quality of life, there were no significant differences (P > 0.05) except vitality dimension, 1 month after discharge, and there were significant differences in all dimensions, 3 and 6 months after discharge (P < 0.05) Conclusions: Hospital–community integrated transitional care model can improve the quality of life of patients with COPD.

Study on the Application Effect of Family Follow-Up Rehabilitation Nursing in Elderly Autistic Patients in Community Institutions

Objective:To study the effect of family follow-up nursing in rehabilitation of elderly autistic patients in community institutions.Methods:120 elderly autistic patients from February 2021 to July 2022 were randomly divided into a control group and a test group with 60 cases each.The patients in the control group were cared for at home by their family members,while the patients in the test group were given family follow-up rehabilitation care on the basis of the control group.The compliance of patients in the rehabilitation process,the UCLA loneliness score,the autism treatment assessment scale(ATEC)score of patients after this nursing care,and the quality-of-life scores of patients of the two groups before and after nursing care were compared.Results:The compliance of patients in the process of rehabilitation treatment was better in the experimental group than in the experimental group.The physical function score of patients after nursing was better in the experimental group than in the experimental group.The UCLA loneliness score and ATEC score of patients in the experimental group after nursing were lower than those of the control group(P<0.05);the quality-of-life score was higher in the experimental group(P<0.05).Conclusion:The application of family follow-up nursing in the rehabilitation of elderly autistic patients in community institutions can significantly improve patients’compliance and improve their prognosis,thus having high clinical value.

Disconnect between primary care and cancer follow-up care: An exploratory study from Odisha, India

Objective:There has been a steady increase in the demand for cancer follow-up care in India.Compared with Western countries,there is little evidence on the capacity of the Indian primary care workforce to accommodate such tasks.We explored the perceptions of oncologists,general practitioners,and patients with regard to the involvement of primary care in cancer follow-up care.Methods:We undertook semistructured focus-group discussions with eight oncologists,nine general practitioners,and 17 cancer patients to gain an understanding of their perceived roles and responsibilities with regard to primary care in delivering follow-up care and the potential concerns.Data from the focus groups were transcribed verbatim,translated,and analyzed with use of a the-matic approach.Results:Most general practitioners felt that their job is to see‘normal’patients,and cancer patients were exceptions to routine care.Oncologists were apprehensive with regard to the com-petence of general practitioners and patient trust.Patients consult oncologists for cancer follow-up care as they perceive it to be very specialized.Patients expressed difficulty in accessing follow-up care and want specialized oncological care by trained personnel in their vicinity.Conclusion:Despite the growing number of cancer survivors,we found a disconnect between primary care and cancer follow-up care.

Factors associated with non-adherence to scheduled medical follow-up appointments among Cameroonian children requiring HIV care: a case-control analysis of the usual-care group in the MORE CARE trial

Background:A better understanding of why HIV-exposed/infected children fail to attend their scheduled follow-up medical appointments for HIV-related care would allow for interventions to enhance the delivery of care.The aim of this study was to determine characteristics of the caregiver-child dyad(CCD)associated with children’s non-adherence to scheduled follow-up medical appointments in HIV programs in Cameroon.Methods:We conducted a case-control analysis of the usual-care group of CCDs from the MORE CARE trial,in which the effect of mobile phone reminders for HIV-exposed/infected children in attending follow-up appointments was assessed from January to March 2013.For this study,the absence of a child at their appointment was considered a case and the presence of a child at their appointment was defined as a control.We used three multivariate binary logistic regression analyses.The best-fit model was the one which had the smallest chi-square value with the Hosmer-Lemeshow test(HLχ^(2)).Magnitudes of associations were expressed by odds ratio(OR),with a p-value<0.05 considered as statistically significant.Results:We included 30 cases and 31 controls.Our best-fit model which considered the sex of the adults and children separately(HLχ^(2)=3.5)showed that missing scheduled medical appointments was associated with:lack of formal education of the caregiver(OR 29.1,95%CI 1.1-777.0;p=0.044),prolonged time to the next appointment/follow-up(OR[1 week increase]1.4,95%CI 1.03-2.0;p=0.032),and being a female child(OR 5.2,95%CI 1.2-23.1;p=0.032).One model(HLχ^(2)=10.5)revealed that woman-boy pairs adhered less to medical appointments compared to woman-girl pairs(OR 4.9,95%CI 1.05-22.9;p=0.044).Another model(HLχ^(2)=11.1)revealed that man-boy pairs were more likely to attend appointments compared to woman-girl pairs(OR 0.23,95%CI 0.06-0.93;p=0.039).There were no statistical associations for the ages of the children or the caregivers,the study sites,or the HIV status(confirmed vs.suspected)of the children.Conclusion:The profile of children who would not attend follow-up medical appointments in an HIV program was:a female,with a caregiver who has had no formal education,and with a longer follow-up appointment interval.There is a possibility that female children are favored by female caregivers and that male children are favored by male caregivers when they come to medical care.

Chinese Medicine Approach in Clinical Practice for Breast Cancer Survivors

A Chinese medicine （CM） approach, designed based on the clinical experiences of the West Los Angeles Center for Traditional Chinese Medicine, is a practical path for assessing and treating breast cancer survivors. The approach consists of balancing the body with deciphering the cause of the patient＇s chief complaints by assessing and recognizing the six physiological dysfunctions that include gastrointestinal problems, sleeps problems, emotional imbalance, low body energy, menstrual change and pain. Multifaceted interventions are used for eliminating various CM pathologies based on identifying the basic CM patterns （syndromes） differentiation. Watching to assess the above two situations dynamically is used for outcome evaluation and predicting prognosis. Therefore this approach is called BMW. It can serve as a reference for CM clinical practice and integrative clinical care. It also can be used to simplify the clinical interpretation of CM and provide an easier way for CM doctors to communicate with Western medical doctors and patients. Additionally, it can be used as a guide for patients to assess their own symptoms for self-monitoring and self-care.