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Flippin JA, DeMario BS, Adomshick VJ, Stanley SP, Truong EI, Hendrickson S, Kalina MA, Lasinski AM, Ho VP. Post-Trauma Discharge Instructions: Are We Dropping the Ball? Am Surg 2023; 89:4625-4631. [PMID: 36083613 PMCID: PMC10829078 DOI: 10.1177/00031348221111515] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
INTRODUCTION Complex follow-up plans for polytrauma patients are compiled at the end of hospitalization into discharge instructions. We sought to identify how often patient discharge instructions incorrectly communicated specialist recommendations. We hypothesized that patients with more complex hospitalizations would have more discharge instruction errors (DI-errors). METHODS We reviewed adult trauma inpatients (March 2017-March 2018), excluding those who left against medical advice or were expected to follow up outside our system. Complex hospitalizations were represented using injury severity (ISS), hospital length of stay (LOS), intensive care unit length of stay (iLOS), and number of consultants (NC). We recorded the type of consultant (surgical or nonsurgical), and consultant recommendations for follow-up. DI-errors were defined as either follow-up necessary but omitted or follow-up not necessary yet present on the instructions. Patients with DI-errors were compared to patients without DI-errors. Groups were compared using Wilcoxon rank sum or chi-square (alpha <.05). RESULTS We included 392 patients (median age 45 [IQR 26-58], ISS 14 [10-21], LOS 6 [3-11]). 55 patients (14%) had DI-errors. Factors associated with DI-errors included the total number of consultants and use of nonsurgical consultants. ISS, LOS, iLOS, were not associated with DI-errors. CONCLUSION Common measures of admission complexity were not associated with DI-errors, although the number and type of consultants were associated with DI-errors. Non-surgical specialty consultant recommendations were more likely to be omitted. It is crucial for patients to receive accurate discharge instructions, and systematic processes are needed to improve communication with the patients at discharge.
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Affiliation(s)
| | | | | | | | - Evelyn I. Truong
- Department of Surgery, MetroHealth Medical Center, Cleveland, OH
| | - Sarah Hendrickson
- Community Trauma Institute, MetroHealth Medical Center, Cleveland, OH
| | - Mark A. Kalina
- Community Trauma Institute, MetroHealth Medical Center, Cleveland, OH
| | | | - Vanessa P. Ho
- Department of Surgery, MetroHealth Medical Center, Cleveland, OH
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH
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Parretti HM, Subramanian A, Adderley NJ, Abbott S, Tahrani AA, Nirantharakumar K. Post-bariatric surgery nutritional follow-up in primary care: a population-based cohort study. Br J Gen Pract 2021; 71:e441-e449. [PMID: 33824163 PMCID: PMC8041293 DOI: 10.3399/bjgp20x714161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/15/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Bariatric surgery is the most effective treatment for severe obesity. However, without recommended follow-up it has long-term risks. AIM To investigate whether nutritional and weight monitoring in primary care meets current clinical guidance, after patients are discharged from specialist bariatric care. DESIGN AND SETTING Retrospective cohort study in primary care practices contributing to IQVIA Medical Research Data in the UK (1 January 2000 to 17 January 2018). METHOD Participants were adults who had had bariatric surgery with a minimum of 3 years' follow-up post-surgery, as this study focused on patients discharged from specialist care (at 2 years post-surgery). Outcomes were the annual proportion of patients from 2 years post-surgery with a record of recommended nutritional screening blood tests, weight measurement, and prescription of nutritional supplements, and the proportions with nutritional deficiencies based on blood tests. RESULTS A total of 3137 participants were included in the study, and median follow-up post-surgery was 5.7 (4.2-7.6) years. Between 45% and 59% of these patients had an annual weight measurement. The greatest proportions of patients with a record of annual nutritional blood tests were for tests routinely conducted in primary care, for example, recorded haemoglobin measurement varied between 44.9% (n = 629/1400) and 61.2% (n = 653/1067). Annual proportions of blood tests specific to bariatric surgery were low, for example, recorded copper measurement varied between 1.2% (n = 10/818) and 1.5% (n = 16/1067) where recommended. Results indicated that the most common deficiency was anaemia. Annual proportions of patients with prescriptions for recommended nutritional supplements were low. CONCLUSION This study suggests that patients who have bariatric surgery are not receiving the recommended nutritional monitoring after discharge from specialist care. GPs and patients should be supported to engage with follow-up care. Future research should aim to understand the reasons underpinning these findings.
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Affiliation(s)
- Helen M Parretti
- Norwich Medical School, Faculty of Medicine and Health, University of East Anglia, Norwich
| | | | - Nicola J Adderley
- Institute of Applied Health Research, University of Birmingham, Birmingham
| | - Sally Abbott
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham; Department of Diabetes, Endocrinology and Weight Management, University Hospitals Birmingham NHS Foundation Trust, Birmingham
| | - Abd A Tahrani
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham; Centre for Endocrinology Diabetes and Metabolism (CEDAM), Birmingham Health Partners, Birmingham; Department of Diabetes, Endocrinology and Weight Management, University Hospitals Birmingham NHS Foundation Trust, Birmingham
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham; CEDAM, Birmingham Health Partners, Birmingham; Department of Diabetes, Endocrinology and Weight Management, University Hospitals Birmingham NHS Foundation Trust, Birmingham; Midlands Health Data Research UK
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Ferrer-Garcia M, Pla-Sanjuanelo J, Dakanalis A, Vilalta-Abella F, Riva G, Fernandez-Aranda F, Forcano L, Riesco N, Sánchez I, Clerici M, Ribas-Sabaté J, Andreu-Gracia A, Escandón-Nagel N, Gomez-Tricio O, Tena V, Gutiérrez-Maldonado J. A Randomized Trial of Virtual Reality-Based Cue Exposure Second-Level Therapy and Cognitive Behavior Second-Level Therapy for Bulimia Nervosa and Binge-Eating Disorder: Outcome at Six-Month Followup. Cyberpsychol Behav Soc Netw 2018; 22:60-68. [PMID: 30059240 DOI: 10.1089/cyber.2017.0675] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
This article reviews the 6-month followup data of a randomized, multicenter, parallel-group study conducted at five clinical sites in three European cities, which compared two second-level treatments for bulimia nervosa (BN) and binge eating disorder (BED): virtual reality-based cue exposure therapy (VR-CET) versus additional cognitive behavioral therapy (A-CBT). Post-treatment outcomes of this study were previously published and details of its design can be found at clinicaltrials.gov (identifier: NCT02237300). This article focuses on the evolution of symptoms assessed after 6 months of followup in a subgroup of 58 patients from the original study. In this study 64 patients with eating disorders (EDs) (35 with BN and 29 with BED), who still showed active episodes of binge eating by the end of a structured CBT program (first-level treatment), were randomly assigned to one of two second-level treatments (A-CBT or VR-CET). Frequency of binge and purge episodes, and attitudinal features of binge-related EDs (bulimia, drive for thinness, and body dissatisfaction) were assessed before starting the second-level treatment (n = 64), at the end (n = 64), and at 6-month followup (n = 58). Mixed between-within subject analyses of variance were used to compare outcomes of both second-level treatments over time. Although both treatment conditions showed statistically significant improvements at the end and after 6-month followup, obtained reductions were greater after VR-CET, regarding binge and purge episodes, as well as the decrease of self-reported tendency to engage in overeating episodes. Accordingly, abstinence from binge episodes were higher in VR-CET than A-CBT at followup (70 percent vs. 26 percent, respectively; χ2 = 11.711, p = 0.001). These results provide further support for the use of VR-CET as an effective second-level intervention for BN and BED treatment-resistant patients.
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Affiliation(s)
- Marta Ferrer-Garcia
- 1 Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
| | - Joana Pla-Sanjuanelo
- 1 Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
| | - Antonios Dakanalis
- 2 Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy.,3 Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Ferran Vilalta-Abella
- 1 Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
| | - Giuseppe Riva
- 3 Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,4 Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Milan, Italy.,5 Department of Psychiatry and Mental Health, Igualada General Hospital, Barcelona, Spain.,6 Department of Psychiatry, University Hospital of Bellvitge-IDIBELL and CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), ISCIII, Barcelona, Spain.,7 Department of Psychiatry, University Hospital Joan XXIII, Tarragona, Spain.,8 Unit of Eating Disorders, Centro ABB Tarragona, Tarragona, Spain.,9 Department of Psychology, Universidad Católica de Temuco, Temuco, Chile.,10 Department of Psychology, University Cattolica del Sacro Cuore, Milan, Italy
| | - Fernando Fernandez-Aranda
- 6 Department of Psychiatry, University Hospital of Bellvitge-IDIBELL and CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), ISCIII, Barcelona, Spain
| | - Laura Forcano
- 6 Department of Psychiatry, University Hospital of Bellvitge-IDIBELL and CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), ISCIII, Barcelona, Spain
| | - Nadine Riesco
- 6 Department of Psychiatry, University Hospital of Bellvitge-IDIBELL and CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), ISCIII, Barcelona, Spain
| | - Isabel Sánchez
- 6 Department of Psychiatry, University Hospital of Bellvitge-IDIBELL and CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), ISCIII, Barcelona, Spain
| | - Massimo Clerici
- 4 Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Milan, Italy
| | - Joan Ribas-Sabaté
- 5 Department of Psychiatry and Mental Health, Igualada General Hospital, Barcelona, Spain
| | - Alexis Andreu-Gracia
- 5 Department of Psychiatry and Mental Health, Igualada General Hospital, Barcelona, Spain
| | | | - Osane Gomez-Tricio
- 7 Department of Psychiatry, University Hospital Joan XXIII, Tarragona, Spain
| | - Virginia Tena
- 8 Unit of Eating Disorders, Centro ABB Tarragona, Tarragona, Spain
| | - José Gutiérrez-Maldonado
- 1 Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
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Carter RL, Wrabetz L, Jalal K, Orsini JJ, Barczykowski AL, Matern D, Langan TJ. Can psychosine and galactocerebrosidase activity predict early-infantile Krabbe's disease presymptomatically? J Neurosci Res 2017; 94:1084-93. [PMID: 27638594 DOI: 10.1002/jnr.23793] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 04/28/2016] [Accepted: 05/24/2016] [Indexed: 11/11/2022]
Abstract
Krabbe's disease (KD) is a fatal neurodegenerative disorder, with the early-infantile form (EIKD) defined by onset of symptoms before age 6 months. Early and highly accurate identification of EIKD is required to maximize benefits of hematopoietic stem cell transplantation treatment. This study investigates the potential for accurate prediction of EIKD based on a novel newborn screening (NBS) tool developed from two biomarkers, galactocerebrosidase (GALC) enzyme activity and galactosylsphingosine concentration (psychosine [PSY]). Normative information about PSY and GALC, derived from distinct samples of normal newborns, was used to develop the novel diagnostic tool. Bivariate normal limits (BVNL) were constructed, assuming a multivariate normal distribution of natural logarithms of GALC and PSY of normal newborns. The (lnGALC, lnPSY) points for newborns in various "abnormal groups," including one group of infants who subsequently suffered EIKD, were plotted on a graph of BVNL. The points for all EIKD patients fell outside of BVNL (100% sensitivity). In a simulation study to compare the false-positive rate of existing univariate methods of diagnosis with our new BVNL-based method, we generated 100 million normal newborn data points. All fell within BVNL (i.e., zero false positives), whereas 5,682 false positives were observed when applying a two-tiered univariate method of the type suggested in the literature. These results suggest that (lnGALC, lnPSY) BVNLs will allow highly accurate prediction of EIKD, whereas two-tiered univariate approaches will not. Redevelopment of the BVNL based on GALCs and PSYs measured on a common large sample of normal newborns is required for NBS use. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Randy L Carter
- Department of Biostatistics, Population Health Observatory, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York.,Hunter James Kelly Research Institute, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Lawrence Wrabetz
- Hunter James Kelly Research Institute, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.,Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Kabir Jalal
- Department of Biostatistics, Population Health Observatory, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York.,Hunter James Kelly Research Institute, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Joseph J Orsini
- Newborn Screening Program, Wadsworth Center, New York State Department of Health, Albany, New York
| | - Amy L Barczykowski
- Department of Biostatistics, Population Health Observatory, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York.,Hunter James Kelly Research Institute, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Dietrich Matern
- Biochemical Genetics Laboratory, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Thomas J Langan
- Hunter James Kelly Research Institute, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York. .,Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.
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Abstract
To determine how frequent chronic multiyear delusional activity is in modern-day schizophrenia, we studied 200 patients over a 20-year period. We also studied the relation of delusions to hallucinations and thought disorder-disorganization, to work disability, and to later periods of global recovery and assessed several protective factors against delusional activity. The sample was assessed 6 times over 20 years and includes 43 patients with schizophrenia. Participants were evaluated at each follow-up for delusions, hallucinations, thought disorder-disorganization, work disability, and global recovery. Possible protective factors were assessed prospectively at index hospitalization. Twenty-six percent of the patients with schizophrenia were delusional at all follow-ups over the 20 years. Overall, 57% had frequently recurring or persistent delusions. A subgroup of over 25% of the schizophrenia patients had no delusional activity at any of the 6 follow-ups over 20 years. Schizophrenia patients with posthospital delusional activity had increased work disability (P < .05). Delusions that persisted after the acute phase in schizophrenia patients predicted a lower likelihood of future global recovery (P < .01). In conclusion, slightly over half of modern-day schizophrenia patients are vulnerable to frequent or "chronic" delusional activity after the acute phase. Schizophreniform patients and other types of psychotic disorders are vulnerable to posthospital delusional activity, but less frequently, less severely, and more episodically. Delusional activity is associated with work disability. Internal factors such as good premorbid developmental achievements and favorable prognostic factors are protective factors that reduce the probability of chronic multiyear, delusional activity in schizophrenia (P < .01).
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Affiliation(s)
- Martin Harrow
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA.
| | - Thomas H. Jobe
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL
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