临床随访模式的探讨

目前的随访工作不尽如人意,失访率、拒访率高.其影响因素是多方面的.建立有效的临床随访模式是提高随访质量,减少失访率的关键.通过对我科1993年以来1千多例喉癌随访调查的经验总结,提出临床随访模式的构架.     

临床随访在口腔正畸工作中的应用

随访是临床工作的重要组成部分之一,是患者治疗后治疗效果的反馈。正畸医生重视随访工作不仅可以观察患者的远期疗效,提高科研水平,还可以反思治疗过程中存在的潜在问题,总结经验。因此,将临床随访应用于口腔正畸工作中对医患双方都是有益的。     

临床随访在口腔正畸工作中的应用

随访是临床工作的重要组成部分之一,是患者治疗后治疗效果的反馈。正畸医生重视随访工作不仅可以观察患者的远期疗效,提高科研水平,还可以反思治疗过程中存在的潜在问题,总结经验。因此,将临床随访应用于口腔正畸工作中对医患双方都是有益的。     

肿瘤外科随访项目的策略探索

随访是目前肿瘤综合治疗的一个不可或缺的组成部分,尤其在肿瘤外科。为了提高恶性肿瘤的整体生存疗效、改善术后生活质量、提供高质量的,临床证据,应高度重视肿瘤外科术后随访工作,使参与随访成为肿瘤外科的一种积极的“诊疗文化”。我们的经验是在一个研究单位或地区组织一个针对某一患者群体进行随访的项目组实体,在校医学生作为志愿者早期参与到某些临床研究随访中。我们强调重视数据库建设、随访宣教、多平台立体式的随访方法和详尽的随访内容,以及加强质量控制。如何进一步提高随访效率和质量,以及如何完善长期运行随访项目组的机制,都需要我们在今后不断探索、交叉学习和总结经验。     

浅谈肝移植术后患者长期随诊的临床意义

回顾性分析肝移植术后随访中的临床与非临床因素对移植物和受体长期存活的影响。选择术后3年以上病例,在并发症的诊断处理、患者各种非医疗不良因素（依从性）方面调查分析和总结。结果多数术后患者均能有良好的依从性,配合移植医师的术后治疗、随访及心理健康指导,但有些患者因为个人、医院等原因不能很好地得到随访,发生并发症及不能及时处...     

浅析互联网肝脏移植随访的临床价值

随着肝移植受者数量的增加和生存时间的延长,受者健康数据资料日趋增多,根据肝移植术后终生随访的特点,研发设计了武警移植随访电子病历系统、在互联网建立了网上移植随访信息平台.本文旨在探讨建立网上信息平台在肝移植随访中的临床应用价值,方便受者获取检验数据、咨询相关问题并上传健康资料,增强患者随访依从性,降低不良事件的发生,提高患者长期生存率.在肝脏移植随访中使用网上信息平台,随访依从性增加,降低不良事件的发生率,对提高受者生活质量和远期生存率将会产生积极影响,能够更好地为临床服务.     

椎体后凸成形术治疗骨质疏松性椎体压缩骨折的随访分析

对我院应用椎体后凸成形术治疗的65例骨质疏松性椎体压缩骨折患者进行平均长达2年的随访,对随访结果进行综合分析,以初步探讨椎体后凸成形术治疗骨质疏松性椎体压缩骨折的长期疗效及安全性。结果显示随访期间疗效得到很好的维持和肯定。因此认为椎体后凸成形术的长期疗效满意,安全性好,可作为骨质疏松性椎体压缩骨折的临床干预措施继续进一步的推广和应用。     

经直肠超声在直肠癌诊疗中的应用进展

经直肠超声以其准确、价廉、无创、无辐射等优点被广泛推荐用于直肠癌术前分期和术后随访中。术前传统经直肠超声T分期准确度可达84％,术后使用经直肠超声介导活检可显著提高准确性并具有诊断早期无症状复发的独特优势。未来的研究将重．最关注直肠癌多模式术前评估,以及新型超声技术的实际应用。     

经直肠超声在直肠癌诊疗中的应用进展

经直肠超声以其准确、价廉、无创、无辐射等优点被广泛推荐用于直肠癌术前分期和术后随访中.术前传统经直肠超声T分期准确度可达84%,术后使用经直肠超声介导活检可显著提高准确性并具有诊断早期无症状复发的独特优势.未来的研究将重点关注直肠癌多模式术前评估,以及新型超声技术的实际应用.     

农村与城镇终末期肾病患者临床状况比较分析

时比分析农村与城镇终末期肾病患者的临床状况,旨在了解新农合政策带给农村终末期肾病患者的益处及今后还需完善和努力之处.对广西壮族自治区人民医院血液净化治疗中心2007年新增的238例终末期肾病患者按农村与城镇进行分组对比分析.96例农村患者,88例选择血液透析,8例放弃治疗;142例城镇患者,23例选择腹膜透析,108例血液透析,11例放弃.无论是城镇还是农村患者慢性肾炎为主要的原发病、都存在透析过晚、并发症发生率高、急诊透析率高的现象.与城镇组相比,农村组患者平均年龄、肾痛知晓率、残余肾功能、血红蛋白、二氧化碳结合力、尿素清除指数低于城镇组(P<0.05);梗阻性肾病发病率、并发症发生率、急诊透析率、死亡率、失访率高于城镇组(P<0.05).新农合的实施使农村终末期肾病患者获得了治疗的机会,针对农村患者肾病知晓率低、临床状况差的特点,需加强农村慢性肾病的防治工作.     

LONG-TERM FOLLOW-UP OF ECHOLALIA AND QUESTION ANSWERING

A long-term follow-up of echolalia and correct question answering was conducted for 6 subjects from three previously published studies. The follow-up periods ranged from 26 to 57 months. In a training site follow-up, subjects were exposed to baseline/posttraining conditions in which the original trainer and/or a novel person(s) presented trained and untrained questions. Four subjects displayed echolalia below baseline levels, and another did so in some assessments. Overall, echolalia was lower than in baseline in 80.6% of the follow-ups. Five subjects displayed correct responding above baseline levels. No clear differences were noted in correct responding or echolalia between the trainer and novel-person presentations or between trained and untrained questions. In a follow-up in a natural environment conducted by a novel person, lower than baseline levels of echolalia were displayed by 3 subjects; 2 subjects displayed lower than baseline levels in some assessments. Two subjects consistently displayed correct responding above baseline, and 3 did so occasionally. Issues related to the study of maintenance are discussed.     

Influence of Time in Treatment and Follow-Up Duration on Methadone Treatment Outcomes

Data for 422 methadone treatment clients in the National Treatment Improvement Evaluation Study (NTIES) were analyzed. Clients maintained continuously in methadone treatment for longer than 12 months and clients who leftbetween 3–12 months were compared with clients treated for less than 3 months. Additionally, clients treated for 3–12 months who had short follow-up periods (6-month average) were compared with 3–12-month clients with long follow-up periods (11-month average). Positive treatment outcomes includinglower drug use, reduced risk of viral infectionand sexually transmitted disease (through needle sharing and multiple sex partners), and less criminality wereassociated with both longer duration treatment and shorter follow-up periods. The findings suggested that continuous methadone treatment of 12 or more months is optimal, whereas stays of less than3 months may be ineffective. Furthermore, stays of 3–12 months are likelyto be beneficial over a relatively short time span, for example 6 months.     

“Tell me more about this…”: An examination of the efficacy of follow-up open questions following an initial account

In information gathering interviews, follow-up questions are asked to clarify and extend initial witness accounts. Across two experiments, we examined the efficacy of open-ended questions following an account about a multi-perpetrator event. In Experiment 1, 50 mock-witnesses used the timeline technique or a free recall format to provide an initial account. Although follow-up questions elicited new information (18–22% of the total output) across conditions, the response accuracy (60%) was significantly lower than that of the initial account (83%). In Experiment 2 (N = 60), half of the participants received pre-questioning instructions to monitor accuracy when responding to follow-up questions. New information was reported (21–22% of the total output) across conditions, but despite using pre-questioning instructions, response accuracy (75%) was again lower than the spontaneously reported information (87.5%). Follow-up open-ended questions prompt additional reporting; however, practitioners should be cautious to corroborate the accuracy of new reported details.     

Young adult outcome of children with "situational" hyperactivity: a prospective,controlled follow-up study

To examine the importance of symptom pervasiveness in ADHD, we conducted a prospective, 12-year follow-up study of boys (ages 6–12) considered hyperactive at school and home (Pervasive ADHD), boys considered hyperactive by teachers but not parents (School Only ADHD), boys considered hyperactive by parents but not teachers (Home Only ADHD), and nonhyperactive comparisons. Follow-up was completed on 82–94% participants. Clinicians interviewed participants and their parents, blind to childhood status. At follow-up, antisocial disorder was significantly more prevalent among Pervasive and School Only ADHD (29% for both) than Home Only ADHD (0%) and comparisons (8%). In a similar manner, severity of behavioral problems distinguished groups (Pervasive, School > Home, comparisons), as did educational attainment and academic performance (poorest for Pervasive and School). These findings stress the validity of teacher reports in the diagnosis of ADHD.     

Long-Term Follow-Up of a Randomized Controlled Trial Comparing Acceptance and Commitment Therapy and Standard Cognitive Behavior Therapy for Anxiety and Depression

The present study represents one of the first comparisons of the long-term effectiveness of traditional cognitive behavior therapy (i.e., Beckian cognitive therapy; CT) and acceptance and commitment therapy (ACT). One hundred thirty-two anxious or depressed outpatients were randomly assigned to receive either CT or ACT, and were assessed at posttreatment (n = 90) and at 1.5-year (n = 91) follow-up. As previously reported, the two treatments were equivalently effective at posttreatment according to measures of depression, anxiety, overall (social/occupational/symptom-related) functioning, and quality of life. However, current results suggest that treatment gains were better maintained at follow-up in the CT condition. Clinical significance analyses revealed that, at follow-up, one-third more CT patients were in the clinically normative range in terms of depressive symptoms and more than twice as many CT patients were in the normative range in terms of functioning levels. The possible long-term advantage of CT relative to ACT in this population is discussed.     

Three years follow-up of panic disorder patients: A naturalistic study

Forty Danish panic disorder patients participating in a placebo controlled study of alprazolam and imipramine (The Cross National Collaborative Panic Study, Phase II) were followed up by a telephone interview three years later, with essentially the same battery of evaluation procedures applied at baseline, end of study, and follow-up. The main finding was that panic disorder is a chronic disorder, but fluctuating in form and severity in the course of time. Twenty-five percent of the patients no longer fulfilled the DSM-III criteria for panic disorder, but had substantial disability due to a variety of symptoms, including panic attacks at infrequent rate, generalized anxiety symptoms, affective symptoms, and phobic avoidance behavior. Nearly three fourths of the patients were under treatment at follow-up. Benzodiazepines were the drugs most often prescribed, usually in combination with supportive psychotherapy. It was concluded that the different types of treatment offered were insufficient. Variables predicting panic disorder or substantial disability at 3-years follow-up were few.     

Behavioural treatment of trichotillomania: two-year follow-up results

Post-treatment evaluation studies of behaviour therapy (BT) for trichotillomania (TTM) have shown that BT is successful in reducing symptoms in this impulse-control disorder. The present study was aimed at investigating gain maintenance at long-term follow-up. TTM-related symptoms and other symptom characteristics were evaluated in 28 patients suffering from TTM before and after brief BT and at a 3-month and 2-year follow-up. The manual-based BT consisted of self-control procedures offered in six sessions. Pre-post effect sizes for TTM symptoms at post-treatment evaluation and at the two follow-ups were 2.91, 1.47, and .87. Compared to the post-treatment effects, the 3-month and 2-year follow-up effect sizes had decreased by 49% and 70%, respectively. Better 2-year follow-up results were associated with lower pre-treatment levels of depressive symptoms and with complete abstinence from hair pulling immediately after treatment.     

Young adult follow-up of hyperactive children: self-reported psychiatric disorders,comorbidity, and the role of childhood conduct problems and teen CD

We report on the psychiatric disorders present at young adult follow-up (Mean age 20–21 years; 13 + year follow-up) and the comorbidity among them for a large sample of hyperactive (H; N = 147) and community control (CC; N = 71) children. The H group had a significantly higher risk for any nondrug psychiatric disorders than the CC group (59% vs. 36%). More of the H group met criteria for ADHD (5%); major depressive disorder (26%); and histrionic (12%), antisocial (21%), passive–aggressive (18%), and borderline personality disorders (14%) at follow-up than the CC group. Severity of childhood conduct problems contributed to the risk for passive–aggressive, borderline, and antisocial personality disorders. But it only affected risk for antisocial personality after controlling for severity of teen conduct disorder (CD), which also contributed to the risk for these same 3 disorders. Examination for comorbidity among these disorders indicated that presence of either borderline or antisocial personality disorder significantly increased the risk for major depression and the other significant personality disorders. More of the hyperactive group had received various forms of mental health treatment during and since leaving high school than the control group. Results suggest that hyperactive children are at significant risk for at least 1 nondrug disorder in young adulthood, principally major depression and several personality disorders, and that this risk is largely mediated by severity of CD at adolescence.     

REDUCING NONCOMPLIANCE TO FOLLOW-UP APPOINTMENT KEEPING AT A FAMILY PRACTICE CENTER

In this study, we evaluated follow-up appointment keeping at a family practice center. To determine if noncompliance could be reduced, four treatments were implemented: no-treatment control, modified appointment card, free follow-up, and a reduced rate follow-up. Thereafter, the reduced rate follow-up was implemented again to determine the extent noncompliance could be reduced for all eligible patients. Incentives significantly increased follow-up appointment keeping, whereas the modified appointment card was ineffective. A cost analysis suggested that the no-treatment control and modified appointment card conditions were the least expensive, but also the least effective. The incentive conditions were more expensive, but the reduced rate condition generated the most net revenue. Questionnaire data suggested that the incentive conditions had an effect on noncompliance and may be considered for use in other medical settings.