Follow-up care

后续护理
  • 文章类型: Review
    原发性醛固酮增多症(PA)是内分泌高血压的最常见形式,以醛固酮过量产生为特征,导致心血管事件和靶器官损害的风险增加。肾上腺切除术和药物治疗均显示出改善与PA相关的临床结果和合并症的功效。包括具有自主皮质醇分泌(ACS)的特定PA亚型。了解PA的合并症并在治疗后建立适当的随访方案对于医生提高PA患者的发病率和死亡率至关重要。此外,手术前对皮质醇增多症的筛查至关重要,由于PA和ACS共存患者的预后与仅有PA的患者不同。在这次审查中,我们全面总结了PA的合并症,包括心血管,肾,和代谢并发症。我们还讨论了各种治疗后的结果,并提供了对明显或亚临床皮质醇增多症患者的糖皮质激素替代策略的见解。本临床实践指南旨在为医疗专业人员提供有关并发皮质醇增多症的最新信息。评估治疗结果,解决PA患者的合并症,从而改善后续护理。
    Primary aldosteronism (PA) is the most common form of endocrine hypertension, characterized by excess aldosterone production that leads to an increased risk of cardiovascular events and target organ damage. Both adrenalectomy and medical treatment have shown efficacy in improving clinical outcomes and comorbidities associated with PA, including a specific subtype of PA with autonomous cortisol secretion (ACS). Understanding the comorbidities of PA and establishing appropriate follow-up protocols after treatment are crucial for physicians to enhance morbidity and mortality outcomes in patients with PA. Additionally, the screening for hypercortisolism prior to surgery is essential, as the prognosis of patients with coexisting PA and ACS differs from those with PA alone. In this review, we comprehensively summarize the comorbidities of PA, encompassing cardiovascular, renal, and metabolic complications. We also discuss various post-treatment outcomes and provide insights into the strategy for glucocorticoid replacement in patients with overt or subclinical hypercortisolism. This clinical practice guideline aims to equip medical professionals with up-to-date information on managing concurrent hypercortisolism, assessing treatment outcomes, and addressing comorbidities in patients with PA, thereby improving follow-up care.
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  • 文章类型: Journal Article
    青少年和年轻的成年癌症幸存者需要终身医疗保健,以解决治疗的后期影响。我们研究了长期随访(LTFU)护理的不同提供者模式对遵守推荐监测的影响。
    我们使用安大略省的行政卫生数据库进行了一项回顾性队列研究,加拿大。从IMPACT中确定了5年的幸存者,1992年至2010年间诊断为6种癌症的15-20.9岁患者的数据库。我们分层定义了三种LTFU护理模型:专门的幸存者诊所(SCC),普通癌症诊所(GCC),家庭医生(FP)。我们评估了儿童肿瘤组心肌病和乳腺癌监测指南的依从性。多状态模型评估了LTFU出勤的依从性过渡和影响。
    根据指数(5年生存率),共对1574名幸存者进行了平均9.2年(范围4.3-13.9年)的随访。在索引后的头两年中,参加LTFU的最高水平是GCC(47%);只有16.7%参加了SCC。在研究结束时,72%的人不再参加任何模式的护理,只有2%的人仍然参加SCC。在188名需要乳腺癌监测的幸存者中,6.9%的人坚持他们的第一次监测测试。前一年参加SCC以及较高的FP或GCC累计访问次数增加了随后成为信徒的比率。在857名需要心肌病监测的幸存者中,11%的人在研究进入时坚持。随后的每次SCC访问导致粘附率增加11.3%(95%CI:1.05-1.18)。
    LTFU出勤率和监测依从性是次优的。SCC随访与更高的依从性相关,但是很少有幸存者得到这样的照顾,这个比例随着时间的推移而减少。需要采取干预措施来提高LTFU的出勤率并提高监测依从性。
    Adolescent and young adult cancer survivors require lifelong healthcare to address the late effects of therapy. We examined the impact of different provider models of long-term follow-up (LTFU) care on adherence to recommended surveillance.
    We conducted a retrospective cohort study using administrative health databases in Ontario, Canada. Five-year survivors were identified from IMPACT, a database of patients aged 15-20.9 years at diagnosis of six cancers between 1992 and 2010. We defined three models of LTFU care hierarchically: specialized survivor clinics (SCCs), general cancer clinics (GCCs), and family physician (FP). We assessed adherence to the Children\'s Oncology Group surveillance guidelines for cardiomyopathy and breast cancer. Multistate models assessed adherence transitions and impacts of LTFU attendance.
    A total of 1574 survivors were followed for a mean of 9.2 years (range 4.3-13.9 years) from index (5-year survival). The highest level of LTFU attended in the first 2-years post-index was a GCC (47%); only 16.7% attended a SCC. By the end of study, 72% no longer attended any of the models of care and only 2% still attended an SCC. Among 188 survivors requiring breast cancer surveillance, 6.9% were adherent to their first required surveillance testing. Attendance at a SCC in the previous year and higher cumulative FP or GCC visits increased the rate of subsequently becoming adherent. Among 857 survivors requiring cardiomyopathy surveillance, 11% were adherent at study entry. Each subsequent SCC visit led to an 11.3% (95% CI: 1.05-1.18) increase in the rate of becoming adherent.
    LTFU attendance and surveillance adherence are sub-optimal. SCC follow-up is associated with greater adherence, but few survivors receive such care, and this proportion diminished over time. Interventions are needed to improve LTFU attendance and promote surveillance adherence.
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  • 文章类型: Journal Article
    UNASSIGNED: To review an international guideline on the evaluation and care of living kidney donors and provide a commentary on the applicability of the recommendations to the Canadian donor population.
    UNASSIGNED: We reviewed the 2017 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors and compared this guideline to the Canadian 2014 Kidney Paired Donation (KPD) Protocol for Participating Donors.
    UNASSIGNED: A working group was formed consisting of members from the Canadian Society of Transplantation and the Canadian Society of Nephrology. Members were selected to have representation from across Canada and in various subspecialties related to living kidney donation, including nephrology, surgery, transplantation, pediatrics, and ethics.
    UNASSIGNED: Many of the KDIGO Guideline recommendations align with the KPD Protocol recommendations. Canadian researchers have contributed to much of the evidence on donor evaluation and outcomes used to support the KDIGO Guideline recommendations.
    UNASSIGNED: Certain outcomes and risk assessment tools have yet to be validated in the Canadian donor population.
    UNASSIGNED: Living kidney donors should be counseled on the risks of postdonation outcomes given recent evidence, understanding the limitations of the literature with respect to its generalizability to the Canadian donor population.
    UNASSIGNED: Examiner une directive internationale sur l’évaluation et la prise en charge des donneurs vivants d’un rein et formuler un commentaire sur l’applicabilité de ces recommandations à la population des donneurs canadiens.
    UNASSIGNED: Nous avons révisé le guide des pratiques cliniques relatives à l’évaluation et à la prise en charge des donneurs vivants d’un rein (Clinical Practice Guideline for Evaluation and Care of Living Kidney Donors) de 2017 du KDIGO (Kidney Disease: Improving Global Outcomes) et nous l’avons comparé aux recommandations canadiennes de 2014 du Protocole de don croisé d’un rein par donneurs participants (Kidney Paired Donation Protocol for Participating Donors).
    UNASSIGNED: Un groupe de travail réunissant des membres de la Société canadienne de transplantation et de la Société canadienne de néphrologie a été formé. Les membres ont été sélectionnés pour représenter tout le Canada et plusieurs sous-spécialisations relatives au don vivant d’un rein, notamment la néphrologie, la chirurgie, la transplantation, la pédiatrie et l’éthique.
    UNASSIGNED: Plusieurs des recommandations du KDIGO s’harmonisent aux recommandations du protocole de don croisé d’un rein. Les chercheurs canadiens ont contribué en grande partie aux données sur l’évaluation des donneurs et des résultats utilisées pour appuyer les recommandations formulées dans les lignes directrices du KDIGO.
    UNASSIGNED: Certains résultats et outils d’évaluation des risques doivent encore être validés dans la population des donneurs canadiens.
    UNASSIGNED: Compte tenu des plus récentes données, les donneurs vivants d’un rein devraient être mis en garde concernant les risques sur leur santé post-don, tout en comprenant les limites de la littérature en ce qui concerne leur généralisabilité à la population de donneurs canadiens.
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  • 文章类型: Journal Article
    目标:为了促进长期随访(LTFU)护理的实施,并改善儿童护理的公平性,青春期,和年轻的成年(CAYA)癌症幸存者,PanCareSurFup指南工作组为LTFU的组织制定了基于证据的建议。
    方法:我们建立了一个国际多学科指南小组。完成了对1999年至2017年发表的文献的系统回顾,以回答六个临床问题。指南小组审查了已确定的研究,制定证据摘要,评估了证据的质量,并根据证据提出建议,专家意见,以及需要在不同的医疗保健系统中保持应用的灵活性。
    结果:我们根据低级证据和专家意见提供强有力的建议,关于LTFU护理的组织,参与LTFU护理的人员,LTFU护理的组成部分和LTFU护理的开始。我们建议在癌症生存专家服务或癌症中心的指导下提供风险适应的LTFU护理,并在其整个生命周期中为所有CAYA癌症幸存者提供。
    结论:尽管证据薄弱,这些建议的成功和有效实施应该会改善LTFU,从而导致更好地获得适当的医疗保健服务,并改善CAYA癌症幸存者的健康结果。
    结论:为了改善当前和未来幸存者的健康结果和生存质量,继续对幸存者进行关于癌症的年龄适应教育,其治疗,后期影响的风险,健康行为的重要性,LTFU的必要性在癌症和生存轨迹上很重要。
    OBJECTIVE: To facilitate the implementation of long-term follow-up (LTFU) care and improve equality of care for childhood, adolescent, and young adult (CAYA) cancer survivors, the PanCareSurFup Guidelines Working Group developed evidence-based recommendations for the organization of LTFU.
    METHODS: We established an international multidisciplinary guideline panel. A systematic review of the literature published from 1999 to 2017 was completed to answer six clinical questions. The guideline panel reviewed the identified studies, developed evidence summaries, appraised the quality of the body of evidence, and formulated recommendations based on the evidence, expert opinions, and the need to maintain flexibility of application across different healthcare systems.
    RESULTS: We provide strong recommendations based on low level evidence and expert opinions, regarding organization of LTFU care, personnel involved in LTFU care, components of LTFU care and start of LTFU care. We recommend that risk-adapted LTFU care provided under the guidance of a cancer survivorship expert service or cancer centre should be available and accessible for all CAYA cancer survivors throughout their lifespan.
    CONCLUSIONS: Despite the weak levels of evidence, successful and effective implementation of these recommendations should improve LTFU, thereby leading to better access to appropriate healthcare services and an improvement in health outcomes for CAYA cancer survivors.
    CONCLUSIONS: To improve health outcomes and quality of survivorship of current and future survivors, continued age-adapted education of survivors about the cancer, its treatment, risk of late effects, importance of health behaviours, and necessity of LTFU is important along the cancer and survivorship trajectory.
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  • 文章类型: Journal Article
    BACKGROUND: With a rising number of prostate cancer survivors, transitioning patients to follow-up care has become more relevant in the current Albertan cancer care landscape and has led to a need for better patient education resources surrounding this topic. In response, the Alberta Provincial Genitourinary Tumour Team and Cancer Control Alberta have developed self-management guidelines to aid patients with prostate cancer during this transition. This study aimed to evaluate the effectiveness and impact of the new provincial self-management guidelines in facilitating transition from active curative external beam radiation treatment to primary community care.
    METHODS: This prospective study used convenience sampling to recruit 18 patients with prostate cancer from two major cancer centers in Alberta: Calgary and Edmonton. Participants were given the self-management guidelines within their final week of external beam radiation treatment and a follow-up phone questionnaire 4 weeks later. Participants answered standardized questions regarding the self-management document based on the themes of timeliness, patient-centeredness, safety, effectiveness, and comprehensiveness.
    CONCLUSIONS: A thematic analysis of the results suggested that the majority of patients were satisfied with the document in all domains, but some expressed concern with the clarity of the document. They suggested improvements such as adding a side effect timeline, adding an appendix or symptom index, further simplifying the language, and coordinating delivery of the guidelines with an in-person education session.
    CONCLUSIONS: Overall, our findings supported the effectiveness of the guidelines in providing self-management information. If implemented into practice, these guidelines could have a positive impact on the perception of patients with prostate cancer regarding transitioning to follow-up care.
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  • 文章类型: Journal Article
    In this study, we aim to determine the frequency of adherence to National Comprehensive Cancer Network follow-up guidelines in a population of head and neck cancer patients who received curative treatment. We will also assess the impact of race, ethnicity, socioeconomic status, and treatment setting on utilization of follow-up care.
    This study included patients with biopsy-proven, nonmetastatic oropharyngeal or laryngeal cancer treated with radiotherapy between January 1, 2014, and June 30, 2016, at a safety-net hospital or adjacent private academic hospital. Components of follow-up care analyzed included an appointment with a surgeon or radiation oncologist within 3 months and posttreatment imaging of the primary site within 6 months. Univariable and multivariable analyses were conducted using a logistic regression model to estimate odds ratios and corresponding 95% confidence intervals.
    Two hundred and thirty-four patients were included in this study. Of those, 88.8% received posttreatment imaging of the primary site within 6 months; 88.5% attended a follow-up appointment with a radiation oncologist within 3 months; and 71.1% of patients attended a follow-up appointment with a surgeon within 3 months. On multivariable analysis, private academic hospital treatment versus safety-net hospital treatment was associated with increased utilization of both surgical and radiation oncology follow-up. Non-Hispanic black (NHB) patients, Hispanic patients, and those with a low socioeconomic status were also less likely to receive follow-up.
    Safety-net hospital treatment, socioeconomic status, Hispanic ethnicity, and NHB race were associated with decreased follow-up service utilization. Quality improvement initiatives are needed to reduce these disparities.
    2b Laryngoscope, 129:2303-2308, 2019.
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  • 文章类型: Consensus Development Conference
    In an attempt to harmonize clinical practices among French hematopoietic stem cell transplantation centers, the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) held its seventh annual workshop series in September 2016 in Lille. This event brought together practitioners from across the country. Our workshop discusses the creation of a patient care logbook for patients undergoing autologous hematopoietic cell transplantation.
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  • 文章类型: Consensus Development Conference
    In an attempt to harmonize clinical practices among French hematopoietic stem cell transplantation centers, the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) held its sixth annual workshop series in September 2015 in Lille. This event brought together practitioners from across the country. Our article discusses the updates and modifications for the 2016 version of the national patient follow-up care logbook.
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  • 文章类型: Journal Article
    Practice guidelines are systematically developed statements and recommendations that assist the physicians and patients in making decisions about appropriate health care measures for specific clinical circumstances taking into account specific national health care structures. The 1(st) revision of the S-2k guideline of the German Sepsis Society in collaboration with 17 German medical scientific societies and one self-help group provides state-of-the-art information (results of controlled clinical trials and expert knowledge) on the effective and appropriate medical care (prevention, diagnosis, therapy and follow-up care) of critically ill patients with severe sepsis or septic shock. The guideline had been developed according to the \"German Instrument for Methodological Guideline Appraisal\" of the Association of the Scientific Medical Societies (AWMF). In view of the inevitable advancements in scientific knowledge and technical expertise, revisions, updates and amendments must be periodically initiated. The guideline recommendations may not be applied under all circumstances. It rests with the clinician to decide whether a certain recommendation should be adopted or not, taking into consideration the unique set of clinical facts presented in connection with each individual patient as well as the available resources.
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