Outcomes and post-discharge follow-up of neonatal tracheotomy in NICU / 中国小儿急救医学

Objective:To study the outcomes and post-discharge follow-up of neonatal tracheotomy in neonatal intensive care unit(NICU).Methods:This study included patients who were admitted to NICU in Beijing Children′s Hospital from January, 2016 to August, 2021, and less than 28 days or 44 weeks(corrected age)on admission, and required tracheotomy.The patients were divided into tracheotomy group and the non-tracheotomy group (the parents signed to refuse the tracheotomy) according to whether perform tracheotomy.Demographic data, general hospitalization information, diagnosis, indications for tracheotomy, follow-up outcomes at 3/6/12 months of age after discharge of patients were collected and analyzed.Results:Totally 26 patients were included in this study, 14 cases in tracheotomy group and 12 cases in non-tracheotomy group.The average gestational age was(37.7±3.80)weeks and(38.99±1.83)weeks, and birth weight was(2 823.57±948.89)g and (3 320.83±378.76)g, respectively.There were no significant differences in sex, gestational age, birth weight, age on admission, weight on admission, age at diagnosis, ratio of endotracheal intubation for respiratory support on admission between two groups( P>0.05). The commonest indications of tracheotomy group were bilateral vocal cord paralysis(50.0%) and congenital anomaly/defect of throat/larynx(21.4%), and the commonest indications of non-tracheotomy group were bilateral vocal cord paralysis(50.0%) and vocal cord/subglottic mass(25.0%), and there was no significant difference between two groups( P>0.05). The rate of discharge-against-medical order of tracheotomy and non-tracheotomy group was 7.14% and 66.67%( P=0.003), respectively.The total follow-up rate of tracheotomy and non-tracheotomy group was 88.9% and 38.9%, while the follow-up rates at 3 months, 6 months, and 12 months were 100.0% vs. 50.0%, 83.3% vs. 41.7%, and 81.8% vs. 25.0%, respectively, whose differences were statistically significant(all P<0.05). In the 14 cases of tracheotomy group, 3 cases died, 4 cases successfully removed the tracheal cannula, 5 cases did not remove the tracheal cannula, and 2 cases were lost. Conclusion:Bilateral vocal cord paralysis is the commonest indication of neonatal tracheotomy.Parents′ compliance in the tracheotomy group is significantly higher than that in non-tracheotomy group.To give caring skill training for parents of neonates with tracheotomy before discharge is beneficial for improving the overall prognosis of children.

Effectiveness of SMS reminders on improving follow-up rate of hypertensive patients during COVID-19 pandemic: An interim analysis of randomized controlled trial

Background@#Non-communicable diseases are a challenge to manage, more so during the COVID-19 pandemic. SMS-text messaging can be part of the solution, although more studies are needed.@*Objective@#Researchers evaluated the effectiveness of sending SMS reminders on different time intervals from the scheduled follow-up among hypertensive patients during the COVID-19 pandemic.@*Methods@#This is an interim analysis using a multi-clinic, three-armed, blinded, randomized controlled trial. 65 participants from two primary care facilities were recruited. Group A and B were sent SMS reminders three days and one day prior to their follow up appointment, respectively. Participants randomized to group C were not sent SMS reminders. Primary outcome measured was the difference between the follow-up rates of the three study arms. Intention to treat analysis was done.@*Results@#Follow-up rates for groups A, B, and C were 23.81%, 6.25%, and 19.05% respectively. Compared to the control group, participants in group A were likely to follow-up, while group B were less likely to follow-up (RR= 0.94 and 1.16 respectively). Comparing the two treatment arms, group A showed 19% risk reduction in non-attendance compared to group B (RR=0.81). The researchers failed to demonstrate statistical significance (p = 0.361024) between the three study arms.@*Conclusion@#This interim analysis shows a possible benefit of sending SMS reminders three days before scheduled follow-up. More robust conclusion can be made once more participants are added to the study. Longer time interval for sending SMS reminders, longer follow-up schedule, and broader inclusion criteria are recommended for future studies.

Outcomes of retinopathy of prematurity screening at a tertiary government hospital

Objective@#To determine the outcomes of retinopathy of prematurity (ROP) screening at a tertiary government hospital.@*Method@#Medical records of premature infants who underwent ROP screening at a tertiary government hospital from January 2008 to July 2012 were obtained. Eventual outcomes of the ROP screening were collated and analyzed.@*Results@#A total of 194 premature infants (388 eyes) were included in the study. Forty six (23.71%) infants developed some form of ROP of which 41 (90.21%) had bilateral disease. Of the 388 eyes, 92 (23.71%) were diagnosed with ROP. Thirty-five eyes (38.08%) with ROP were classified as stage 2, 23 (25.00%) stage 1, and 13 (14.13%) stage 3. Twelve eyes (13.04%) diagnosed with ROP received treatment that included laser therapy in 4 eyes (33.33%), intravitreal bevacizumab injection in 4 eyes (33.33%), cryotherapy in one eye (8.33%), and laser therapy plus intravitreal bevacizumab injection in 3 eyes (25%). Seven eyes (7.60%) required treatment but parents did not comply. Sixteen patients (10.81%) without ROP and 27 patients (57.61%) with ROP had follow-up examinations. Of the 54 eyes with ROP that were followed up, only 26 eyes had refraction. Twelve eyes (46.15%) were hyperopic, 12 (46.15%) myopic, and two (7.69%) emmetropic. Among 16 eyes without ROP with follow-up examination, 14 eyes (87.50%) had hyperopia and two (12.50%) myopia. The follow-up rate for this study was 22.16%.@*Conclusion@#There was a low follow-up rate for premature babies screened for ROP at a tertiary government center. No association was found between presence of ROP and refractive outcomes, and between refractive outcomes and treatment received.

The Fourth Korea National Health and Nutrition / 신경정신의학

OBJECTIVES: The patient with alcohol dependence needs continuing care in an outpatient treatment setting. This naturalistic retrospective study is the first report investigating the long-term follow-up rate and predictors of outcome in outpatient-based alcoholism treatment in Korea. METHODS: We conducted a chart review of patients, who visited a university-affiliated hospital alcohol clinic from 2005 to 2007. All patients diagnosed with alcohol dependence were enrolled. Patients were evaluated using a customized alcoholism evaluation package. Demographic factors, clinical data and self rating scales were included in the evaluation form. RESULTS: Of 109 patients, 27 (24.8%) adhered to our outpatient-based treatment for 30 months. The mean follow-up duration of participants was 11.1 months. A Kaplan-Meier survival analysis showed that comorbidity, initial treatment on admission, previous treatment history and family history made a significant difference to follow-up duration. Age, sex, alcohol history, motivation, AUDIT-K, BDI, BAI and RTCQ-TV were not significantly associated with follow-up duration. CONCLUSION: Comparing to outcomes of previous inpatient alcohol treatment in Korea, long term follow-up rate in outpatient treatment was superior, and abstinence/controlled drinking rate is not inferior. This finding suggests that outpatient based alcoholism treatment has sufficient efficacy.

Postoperative Mortality and the Associated Factors for Senile Hip Fracture Patients / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to report on the mortality, follow-up rate and some factors related to mortality for elderly patients with hip fractures. MATERIALS AND METHODS: The subjects of the study were one hundred and eighteen (40 males and 78 females) patients older than 65 years and who underwent surgery for hip fracture between June 2003 and October 2005. The mortality and follow-up rates were determined retrospectively. We analyzed the relationship between postoperative mortality and such variables as age, gender, the type of fracture, the operative methods, operative delay, comorbidity, the ASA score, BMD (Bone mineral density) and the ambulatory capability. RESULTS: At three months, the follow-up rate and mortality rate were 58.4% and 11.8%, respectively. At six months, they were 40.7% and 18.6%, respectively; at 1 year, they were 28.8% and 28.8%, respectively. There was no relationship between postoperative mortality and age, gender, the type of fracture, the operative methods, operative delay and the BMD. However, there were significant relationships between postoperative mortality and comorbidity, the ASA score and the ambulatory capability. CONCLUSION: The one year mortality rate and follow-up rate were 28.8% and 28.8% for senile hip fracture patients. Comorbidity, the ASA score and the ambulatory capability were factors associated with postoperative mortality following hip fracture in elderly patients.

Results of Total Knee Arthroplasty using NexGen(R) System / 대한정형외과학회잡지

Purpose: To prospectively evaluate the survival rate, follow-up rate, clinical and radiographic results of NexGen(R) total knee replacement arthroplasty (TKRA). Materials and Methods: Between June 1998 and March 2002, 434 knees in 278 patients after TKRA performed by a single-surgeon using the same implant were evaluated prospectively. The preoperative diagnosis was primary osteoarthritis in 399 knees, osteonecrosis in 17 knees, rheumatoid arthritis in 12 knees and post-traumatic arthritis in 6 knees. Data collection, physical examination and radiographic evaluation were carried out at postoperative 1, 2, 3 and 5 years. A telephone survey was carried out for the patients who could not visit the outpatient clinic, and the mean follow-up duration was 4.3 years (3-7 years). The follow-up rate and survival rate was analyzed using the Kaplan-Meier method with the reimplantation cases being counted as a failure. The clinical results were evaluated by the Knee Society Score, and the range of motion and status of the implants were assessed by a radiographic evaluation. Results: The total follow up rate was 91.0% (395/434). The survival rate was 98.3% at 5 years after surgery and the survival rate excluding the infection cases was 99.0% 5 years after surgery. The Knee Society Total Score improved to 96.8 in the cruciate retaining (CR) type and to 95.2 in the Legacy posterior stabilized (LPS) type. The Knee Society Function Score improved to 82.6 in the CR type and to 73.8 in the LPS type on the final follow up. The average preoperative further flexion was 122.6, which improved to 125.4. The radiographic evaluation revealed 6 cases (1.5%) of osteolysis with reimplantation being performed in 2 cases. Conclusion: In this prospective study, with a high follow-up rate (91.0%), the survival rate of TKRA using the NexGen(R) implant was relatively high and satisfactory in terms of the functional improvement. However, a long-term follow-up evaluation will be needed.

Factors related to the follow-up of class II patients on the pap smear

BACKGROUND: Cervical cancer is the second most commonly diagnosed cancers in women and is responsible for about 14 percent of all female cancer found in Korean women. Early detection is very important because the likelihood of a complete cure is greater, and among the early screen only tools to detect cervical cancers, a Pap smear is most widely used. It has the clinical significance to follow - up patients whose results are classified as class II in their Pap smear. Thereto we tried to find the factors associated with follow-up in class II patients. METHODS: On Pap smear practiced from Jan. 1, 2000 to Dec. 31 in a University Hospital, 159 patients Pap smear results were categorized as class II, and among the 159 patients, we were able to collect data from 107 patients who voluntarily answered a phone survey. The categories in the survey were the followings : follow- up for the Pap smear, age, age of marriage, presence of menopause, age of menopause, occupation, family history of chronic diseases or cancers, educational level, presence of concomittant diseases, income, average hospital visit frequency in a year, belief of general health, and reason for doing follow- up and reason for not doing it. RESULTS: Among 107 patients, only 62 patients (57.9 Percent) did follow-up for their Pap smear results. The reasons were doctors follow-up recommendation for Pap smear results and regular health check-up, and the two main reasons not doing follow-up were nonexistence of further symptom and financial distress. In a single variable analysis, the higher educational level, individual income, and hospital visit frequency, the more People had follow-up. But in multiple logistic anarsis, only individual income was statistically significant. CONCLUSION: The follow-up rate was as low as 57.9 percent, and the reasons why they did not follow-up were mainly the lack of understanding about the clinical significance of class II result on the Pap smear. Therefore, an advertisement and public education Programs to general public about cervical cancer will make more patients follow up their result on the Pap smear, especially to the low income and low education class people.