UNASSIGNED: Early diagnosis and continuity of care is vital for atrial fibrillation (AF), to reduce stroke ; There is a lack of understanding of when and how AF is being diagnosed and managed the care pathway) in in low- and middle-income countries (LMICs). We aimed to identify the AF care pathway in Northern Province, Sri Lanka and determine how the COVID-19 pandemic impacted the care pathway.
UNASSIGNED: This descriptive longitudinal study utilised two quantitative questionnaires to evaluate the AF pathway: The first questionnaire (baseline) was used to identify where AF was being diagnosed and the second questionnaire (3 months following baseline) was used to identify where and how often AF follow-up care was being received. How the COVID-19 pandemic impacted the care pathway was asked in the second questionnaire. We aimed to recruit 236 adults (≥18 years) with AF from Jaffna Teaching Hospital. Data were collected between October 2020 and June 2021 and analysed using descriptive statistics.
UNASSIGNED: 151 participants were recruited (median age 57 years; 70% female). Most participants were diagnosed in the accident & emergency (38%) or inpatient department (26%), followed by an outpatient department (19%) or private facility (16%). Nearly all (97%) participants received follow-up care during the study period, with an average of 1.3 AF-related healthcare visits per person for a month; most visited an outpatient department (88%). The COVID-19 pandemic negatively impacted 39% of participants\' care: healthcare visits were reduced or, delayed or medications were unattainable, and longer intervals between blood tests were experienced; however, 24% of participants were able to receive their medication by ambulance, public health staff or post during lockdowns.
UNASSIGNED: Primary care was not involved in the diagnosis of AF, indicating that most diagnoses occurr after a medical emergency. The frequency of blood tests was lower than the guideline recommendations of one per month which could in-part be due to the adverse impacts of the pandemic. Strengthening primary and community-based care may enable early diagnosis and improve continuity of care during and beyond future healthcare crises.

BACKGROUND: More than half of patients with pulmonary embolism (PE) experience persistent functional limitations. Despite guideline recommendations for a structured integrated care model for patients with pulmonary embolism (PE), consensus on an optimal follow-up strategy is lacking, and evidence is insufficient.
OBJECTIVE: To describe the development of a structured model for pulmonary embolism (PE) follow-up using co-production methods.
METHODS: Co-production of the Attend-PE-model was conducted from October 2021 to June 2022, featuring participatory design techniques. This was combined with a stepwise approach based on Intervention Mapping, to ensure that the developed model was evidence-based and theoretically grounded.
RESULTS: Development of the Attend-PE included 1) A needs assessment mapping follow-up at 18 sites treating PE in Denmark; 2) Definition of the overall goal and performance objectives of the Attend-PE model, based on the needs assessment in combination with a literature review; 3) Co-production of the Attend-PE model in workshops with patient representatives, healthcare professionals, and experts in the field 4) Refinement of the structure and organization of the Attend-PE model and production of patient education material. The Attend-PE model outlines a structured approach for in-hospital follow-up, involving group-based patient education, individual consultations, and patient-reported outcomes to assess physical and psychological well-being. The model supports a personalized post-hospitalization care plan.
CONCLUSIONS: The co-production process was successful in developing a structured follow-up model aligned with patients\' needs, health provider perspectives and existing guidelines. The Attend-PE model is currently undergoing clinical evaluation to determine its effectiveness and usability.

In Japan, the Pharmaceutical and Medical Device Act was amended in December 2019, and now requires pharmacists to follow-up on patients during treatment. Although there have been some studies on the effectiveness of follow-ups by pharmacists, there are no reports on the status of implementation in clinical practice. We conducted a nationwide survey on follow-up care to investigate the actual situation. We randomly selected 10% of community pharmacies in each prefecture and conducted a survey. We built a web-based system for the collection of basic information on the pharmacies and follow-up cases. A total of 561 pharmacies were pre-entered. Of these, 110 pharmacies (19.6%) reported 326 follow-up cases. Information was provided to doctors in 129 cases (39.6%), of which prescription proposals were made in 10 (7.8%) instances. The follow-up implementation rate based on the number of prescriptions dispensed was estimated to be 0.84% (95% confidence interval: 0.76-0.94%). This study revealed the status of follow-ups in clinical practice. Pharmacists can contribute to the optimization of drug treatment by providing follow-up information to doctors and making prescription proposals.

OBJECTIVE: This study aimed to demonstrate the compliance, feasibility, and acceptability of telehealth monitoring among surgical patients discharged with wounds or drains.
METHODS: This is a cross-sectional feasibility study. Post-surgical breast, plastic, and hepatobiliary patients with wounds and/or surgical drains were recruited using convenience sampling. The control group received conventional care which consisted of daily telephone follow-up. The intervention group used a mobile wound application to take wound and drain images, report drainage amount and symptoms. Compliance was assessed by measuring the percentage of actual to expected patient entries, feasibility was assessed by comparing detection of abnormalities and unexpected hospital visits, and acceptability was assessed by subjective feedback from nurses and patients from the intervention group.
RESULTS: 59 patients were recruited, with 30 patients in the control group and 29 patients in the intervention group. 9 specialty nurses were involved in the patients\' post-discharge care. The mean compliance rate for the hepatobiliary, breast and plastic patients were 89.9 %, 89.5 % and 75.9 % respectively. 4 patients from the intervention group (13.8 %) and 6 patients from the control group (20.1 %) were flagged as having potential abnormalities. As for unexpected hospital visits, there were 2 (6.9 %) in the intervention group and 1 (3.4 %) in the control group. 25 patients and 9 specialty nurses responded to the feedback survey. 22 patients (88 %) did not face any application issues. 18 patients (72 %) preferred to self-report symptoms via the application rather than to call the nurses and reported feeling safe knowing that they are remotely monitored. Most nurses found the app convenient and timesaving (n = 7, 78 %), with monitoring through pictures as more accurate than phone conversation (n = 8, 89 %).
CONCLUSIONS: The results suggest that use of a mobile application by surgical patients discharged with wounds or drains is feasible and serves as a viable monitoring tool.

UNASSIGNED: Access to audiology services for older adults residing in sparsely populated regions is often limited compared to those in central urban areas. The geographic accessibility to follow-up care, particularly the influence of distance, may contribute to an increased risk of hearing aid abandonment.
UNASSIGNED: To assess the association between the home-to-healthcare-calibration-center distance and hearing aid abandonment among older adults fitted in the Chilean public health system.
UNASSIGNED: 455 patients who received hearing aids from two public hospitals in two regions were considered. Univariate and multivariate Poisson regression models with robust variance estimation were used to analyze the association between the geographical distance and hearing aid abandonment, accounting for confounding effects.
UNASSIGNED: Approximately 18% of the sample abandoned the hearing aid, and around 50% reported using the hearing aid every day. A twofold increase in distance between home and the hearing center yielded a 35% (RR = 1.35; 95% CI: 1.04-1.74; p = 0.022) increased risk of hearing aid abandonment. Also, those in the second quintile had a 2.17 times the risk of abandoning the hearing aid compared to the first quintile (up to 2.3 km). Under the assumption that patients reside within the first quintile of distance, a potential reduction of 45% in the incidence of hearing aid abandonment would be observed. The observed risk remained consistent across different statistical models to assess sensitivity.
UNASSIGNED: A higher distance between the residence and the healthcare center increases hearing aid abandonment risk. The association may be explained by barriers in purchasing supplies required to maintain the device (batteries, cleaning elements, potential repairs, or maintenance).

UNASSIGNED: Intensive care units deliver care to a heterogeneous group of patients with pre-existing co-morbid disease. Focus has shifted to improving health related quality of life with more patients surviving beyond hospital discharge. Randomised controlled trials evaluating follow-up interventions, to improve physical recovery, have not demonstrated a health-related quality of life benefit. Qualitative research may provide the context to understand the experiences of intensive care survivors during follow-up care addressing physical limitations.
UNASSIGNED: To synthesise qualitative studies and explore Intensive Care survivors\' experiences and perspectives of physical symptoms in the context of follow-up care.
UNASSIGNED: A systematic search of electronic databases (MEDLINE, Cumulative Index of Nursing and Allied Health Literature, Web of Science, Applied Social Sciences Index and Abstracts, Ovid Nursing and Ovid Emcare) was conducted to identify peer-reviewed primary qualitative studies. No date parameters were applied. Inclusion/exclusion criteria guided the screening process.
UNASSIGNED: The data from eligible primary research studies was extracted into NVivo (v12).
UNASSIGNED: Critical appraisal was completed using the Joanna Briggs Critical Appraisal Tool. Thematic analysis, guided by Braun and Clarke (2022), informed the data synthesis.
UNASSIGNED: From 2457 studies, ten relevant studies were included. Two main themes were identified: 1. Recovery as uncertain; which outlines the uncertainty experienced by intensive care unit survivors during recovery. This theme pertained to system-level factors (role of healthcare professional and information provision) which provides the context for delivering follow-up care. 2. Self-determination of recovery; outlines individual characteristics in determining recovery which is conceptualised by patient-level factors (motivation, support network and perception of health).
UNASSIGNED: For intensive care survivors, the recovery trajectory is uncertain with a gap in information provision during the acute phase following hospital discharge. Patients\' self-determination of recovery is an important consideration to ensure follow-up care addresses the needs of individual patients. The impact of pre-existing co-morbid disease and subgroups of patients deriving benefit from follow-up care remains uncertain.
UNASSIGNED: PROSPERO Registration no. CRD42022355711.
UNASSIGNED: Patients\' experiences of post-hospital follow-up care to improve physical recovery for intensive care survivors: A Systematic Review of Qualitative Research.

BACKGROUND: Muscle injuries are common in football. Imaging diagnostics have a major role in establishing a diagnosis. The main diagnostic procedures are MRI and ultrasound. Both diagnostics have advantages and disadvantages, which should be balanced against each other.
UNASSIGNED: The role of MRI as the gold standard is increasingly being replaced by high-resolution ultrasound techniques, and MRI imaging is not always useful. To detect complications in the early stages it is advised to perform regular ultrasound-imaging check-ups. The healing process can be monitored, and it offers additional options for ultrasound-guided interventions such as hematoma punctures and targeted infiltrations.
UNASSIGNED: However, ultrasound imaging is highly user dependent. Experienced operators can eliminate this disadvantage, which makes ultrasound a superior imaging system in many areas, especially for dynamic examinations. Nevertheless, MRI imaging remains a necessary imaging method in certain areas.
UNASSIGNED: HINTERGRUND: Im Fußballsport sind Muskelverletzungen ein häufiges Verletzungsmuster. Die Bildgebung ist ein zentrales Element zur Diagnosestellung. Hierfür werden hauptsächlich die MRT und der Ultraschall eingesetzt. Beide Verfahren haben Vor- und Nachteile, welche abgewogen werden sollten.
UNASSIGNED: Die Rolle der MRT als Goldstandard wird zunehmend durch neue Techniken des hochauflösenden Ultraschalls abgelöst und nicht immer ist eine MRT-Bildgebung sinnvoll. Auch während der Reha-Phase empfehlen sich regelmäßige Ultraschallbildgebungen, um Komplikationen frühzeitig zu erkennen. Hierbei kann der Heilungsverlauf monitorisiert werden, und es besteht die Möglichkeiten für ultraschallnavigierte Interventionen, wie Hämatompunktionen und gezielte Infiltrationsbehandlungen.
UNASSIGNED: Ein Nachteil der Ultraschalldiagnostik ist jedoch die Nutzerabhängigkeit. Bei erfahrenen Anwendern wird diese durch die zahlreichen Vorteile des modernen Ultraschalls ausgeglichen, womit er der MRT in vielen Bereichen – speziell auch mit der Möglichkeit eines dynamischen Ultraschalls – überlegen ist. Dennoch bleibt die MRT bei bestimmten Fragestellungen eine sinnvolle und notwendige Untersuchungsmethode.

BACKGROUND: Side effects can occur within hours to days of starting antidepressant medications, whereas full therapeutic benefit for mood typically takes up to four weeks. This mismatch between time to harm and lag to benefit often leads to premature discontinuation of antidepressants, a phenomenon that can be partially reversed through early doctor-patient communication and follow-up. We investigated the relationship between relational continuity of care - the number of years family physicians have cared for older adult patients - and early follow-up care for patients prescribed antidepressants.
METHODS: A retrospective cohort study was conducted on residents of Ontario, Canada aged 66 years or older who were dispensed their first antidepressant prescription through the provincial drug insurance program between April 1, 2016, and March 31, 2019. The study utilized multivariable regression to estimate the relationship between relational continuity and 30-day follow-up with the prescribing family physician. Separate estimates were generated for older adults living in urban, non-major urban, and rural communities.
RESULTS: The study found a small positive relationship between relational continuity of care and follow-up care by the prescribing family physician for patients dispensed a first antidepressant prescription (RRR = 1.005; 95% CI = 1.004, 1.006). The relationship was moderated by the patients\' location of dwelling, where the effect was stronger for older adults residing in non-major urban (RRR = 1.009; 95% CI = 1.007, 1.012) and rural communities (RRR = 1.006; 95% CI = 1.002, 1.011).
CONCLUSIONS: Our findings do not provide strong evidence of a relationship between relational continuity of care and higher quality management of antidepressant prescriptions. However, the relationship is slightly more pronounced in rural communities where access to continuous primary care and specialized mental health services is more limited. This may support the ongoing need for the recruitment and retention of primary care providers in rural communities.

UNASSIGNED: Lifestyle promotion during follow-up consultations may improve long-term health and quality of life in endometrial cancer patients. This study aimed to identify barriers and facilitators to improve and sustain a healthy lifestyle that can be translated to behavioral methods and strategies for lifestyle counseling.
UNASSIGNED: Endometrial cancer patients from three hospitals were recruited to participate in a semi-structured interview. The data were transcribed and coded. Thematic analysis was applied to identify themes and the behavior change wheel was used as a theoretical framework. Data saturation was confirmed after 18 interviews.
UNASSIGNED: Barriers included knowledge gaps as well as lack of motivation and environmental opportunities to engage in health-promoting behavior. Facilitators included applying incremental lifestyle changes, social support, positive reinforcements, and the ability to overcome setbacks.
UNASSIGNED: We propose the following intervention functions: education, persuasion, training, environmental restructuring, and enablement. Suitable behavior change techniques to deliver the intervention functions include information about the consequences of certain behavior, feedback on behavior, credible source, graded tasks, habit formation, restructuring of the environment, prompts/cues, goal setting, action planning, and social support. Including these recommendations in lifestyle counseling could aid lasting lifestyle change since it suits the needs and preferences of patients.

Interdisciplinary multimodal pain therapy (IMPT) is an established procedure in the treatment of chronic pain. In daily practice, many institutions regard so-called booster units as an integral part of IMPT. However, no consensual recommendations and evidence for booster concepts are available to date. This article uses the results of a discussion between clinical experts in the field of IMPT at the German Pain Congress in 2022 in order to show the status quo in care. It has been shown that currently applied booster offers vary greatly in terms of time intervals, intensities, therapy content and patient selection and that there is a need for structural and process parameters for the implementation of cross-sectoral booster treatments. In conclusion, the authors outline how the development of these parameters will be planned as an expert consensus with the participation of interested institutions and the inclusion of the patient perspective and offer opportunities for participation in this process.
UNASSIGNED: Die interdisziplinäre multimodale Schmerztherapie (IMST) gehört zu den etablierten Verfahren in der Behandlung chronischer Schmerzen. Im praktischen Alltag werden sogenannte Boostereinheiten von vielen behandelnden Einrichtungen als integraler Bestandteil der stationären bzw. teilstationären IMST angesehen. Allerdings liegen bisher keine konsentierten Empfehlungen und Evidenznachweise für Boosterkonzepte vor. Der vorliegende Beitrag zeigt anhand der Ergebnisse einer Diskussionsveranstaltung („Thementisch“) im Rahmen des Deutschen Schmerzkongresses 2022 den Status quo in der Versorgung auf. Es ließ sich nachweisen, dass aktuell angewendete Boosterangebote in Bezug auf Zeitintervalle, Intensitäten, Therapieinhalte und Patientenauswahl stark variieren und ein Bedarf an Struktur- und Prozessparametern zur Umsetzung von sektorenübergreifenden Boosterbehandlungen besteht. Als Fazit stellen wir dar, wie die Ausarbeitung dieser Parameter als Expertenkonsens unter Beteiligung interessierter Einrichtungen und Einbeziehung der Patientenperspektive geplant ist, und bieten Möglichkeiten zur Beteiligung an diesem Prozess an.