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Core Concepts
Published in Prabhanjan Narayanachar Tattar, H. J. Vaman, Survival Analysis, 2022
Prabhanjan Narayanachar Tattar, H. J. Vaman
It is worthwhile mentioning that a patient in a clinical trial may experience severe adverse effects rendering the patient as “lost to follow up”. When the observations are censored at the right-side, we call them out as right-censored and the mechanism is called as right-censoring. Aalen, et al. (2008)[2], Kalbfleish and Prentice (2002)[60], and Klein and Moeshberger (2003)[64] are a few of the benchmark books that can be referred for more details. How does censoring impact the analysis?
Telehealth
Published in Salvatore Volpe, Health Informatics, 2022
The availability of a “home clinic” kits has opened many opportunities. These kits, which are available for as little as $199, can provide the clinician with remote access to a stethoscope, otoscope, tongue blade for evaluating the mouth, thermometer, and camera with a ring light. Add a $25 pulse oximeter and a $10 scale, and many routine evaluations could be performed remotely. The kits include apps that help guide the end user on device placement with or without the guidance of the clinician. Depending on the health coverage, many of these are covered items. Imagine the value of deploying such devices during the COVID-19 pandemic. Patients who were not ill enough to be admitted but would benefit from ongoing monitoring could stay at home and not be lost to follow-up. Considering the financial and staffing strains faced by hospitals, this should be considered during future emergencies. What would be the return on investment related to decreased ED room visits, hospital admissions, hospital readmissions and staffing burnout?
Long-term follow-up after vertical rectus muscl transposition and botulinum toxin for sith nerve paralysis
Published in Jan-Tjeerd de Faber, 28th European Strabismological Association Meeting, 2020
RESULTS: Seven patients had tumor compression and 12 patients had trauma causing their sixth nerve paralysis. Two patients died and two were lost to follow up. The mean postoperative follow up was 30 months (range 3 to 107). Generally, the tumor patients had a longer lasting paralysis (mean 72 months)than those with injury (mean 20 months)prior to surgery. Three patients had fully recovered contralateral sixth nerve palsy and in one patient bilateral paralysis persisted. The average preoperative distance deviation was +36 ^ ((range 10 ^ to 60 ^). The induced exoshift at the last visit was 29 ^((range 6 to 55). Eight patients were exotropic at the one month follow up, 4 at the 3 month follow up and only one at the last visit. No anterior segment ischemia occurred. Generally, the result of the procedure was well received by the patients.
Clinical trials for neuroregenerative therapies for spinal cord injury: what have we learnt so far?
Published in Expert Review of Neurotherapeutics, 2023
Raymond Wong, Nader Hejrati, Michael G. Fehlings
On the flipside of patient recruitment, patient retention is equally critical to maintain robust sample sizes throughout the duration of SCI clinical trials. Successful trials require longitudinal monitoring of patient status, which necessitates routine follow-ups. However, patients may become lost to follow-up for a number of reasons. Unfortunately, study attrition can also threaten the validity of clinical trials due to the introduction of attrition bias caused by an incomplete dataset [14]. This bias that comes from the potentially unequal loss of patients between study groups detracts from the generalizability of trial findings, and consequently raises challenges in adapting these findings to clinical guidelines for the management of SCI. Thus, to better inform the public, it is important to reduce this potential source of bias by recognizing and understanding the multifactorial causes that might be contributing to patients not coming for follow-ups, and then implementing potential solutions accordingly.
Suspected suicides and suicide attempts involving antipsychotic or sedative-hypnotic medications reported to America’s Poison Centers, 2000–2021
Published in Clinical Toxicology, 2023
Larissa Ybanez, Henry A. Spiller, Jaahnavi Badeti, Marcel J. Casavant, Natalie Rine, Nichole L. Michaels, Motao Zhu, Gary A. Smith
The National Poison Data System defines medical outcomes as: 1) no effect, 2) minor effect (minimal symptoms that generally resolve rapidly), 3) moderate effect (more pronounced, prolonged, or systemic symptoms than minor effect), 4) major effect (symptoms are life-threatening or result in significant disability or disfigurement), 5) death, 6) not followed (minimal clinical effects possible), or 7) unable to follow (judged as potentially toxic exposure) [12]. During analyses in this study, moderate effect, major effect, and death were combined into a serious medical outcome category. The level of health care received is categorized by the NPDS as: 1) no health care facility treatment received, 2) treated/evaluated and released, 3) admitted to a critical care unit, 4) admitted to a non-critcal care unit, 5) admitted directly to a psychiatric facility, 6) patient refused referral/did not arrive at a health care facility, or 7) patient lost to follow-up/left against medical advice.[12] During study analyses, admitted to a critcal care unit, admitted to a non-critcal care unit, and admitted directly to a psychiatric facility were grouped as “admitted.” We also grouped admissions as 1) admitted to a critcal care unit or non-critcal care unit (to capture medical-related admissions) and 2) admitted directly to a psychiatric facility (to capture psychiatric-related admissions).
Clinical profile and management outcomes of lacrimal drainage system malignancies
Published in Orbit, 2022
Md. Shahid Alam, Bipasha Mukherjee, Subramanian Krishnakumar
We retrospectively reviewed all cases diagnosed with lacrimal sac malignancy over the past 24 years (1995–2019). Institutional review board approval was obtained and the study adhered to the tenets of the Declaration of Helsinki. Patients gave consent for publication of their photographs and clinical details for research purposes. Data analyzed included demographic details, common clinical features, radiological investigations, histopathology, management details, and details at each follow-up visit. Patients lost to follow-up were also contacted over the phone wherever possible. No American Joint Committee for Cancer Classification (AJCC) staging system exists for lacrimal sac malignancies, hence the tumors have not been staged. Removal of the lacrimal sac along with the nasolacrimal duct and surrounding bone/sinuses using a lateral rhinotomy approach was termed as wide local excision. The surgeries were carried out along with an ENT surgeon wherever required.