Consultant Appointments Research Articles

[Translated article] Diagnosis of Onychomycosis: Utility of an Immunochromatography Strip Test Compared with Conventional Culture

BackgroundRingworm is highly prevalent in our setting and is frequently observed in our routine clinical practice. Diagnostic confirmation depends on techniques that are not always accessible (PCR), with highly variable sensitivity depending on the observer (direct microscopy) or delayed results (culture, histopathology). Recently, an immunochromatography-based rapid test (Diafactory®) for the antigenic detection of dermatophytes has been developed. This diagnostic tool can help diagnose ringworm, allowing early initiation of treatment and fewer consultation visits. ObjectiveTo determine the sensitivity and specificity of the rapid antigen detection test compared to conventional culture. Material and methodsFor a full year, 333 nail samples were collected from patients with suspected onychomycosis. The rapid test and the conventional culture were simultaneously performed on each sample. Those with a positive antigenic test result began treatment early. The remaining patients had appointments for serial cultures and subsequent medical consultation to evaluate the results. ResultsCompared to conventional culture, the sensitivity and specificity rates of the rapid antigen detection test are 97.2% and 80.7%, respectively. ConclusionThe effectiveness of the rapid antigen detection test is similar to that of conventional culture for the detection of dermatophytes in nail samples. It is a quick and simple diagnostic technique that reduces the number of patient visits to the hospital, and allows early treatment start.

Upper gastrointestinal training in the UK and Ireland: a Roux Group Study.

Surgical training programmes in the United Kingdom and Ireland (UK&I) are in a state of flux. This study aims to report the contemporary opinions of trainee and consultant surgeons on the current upper gastrointestinal (UGI) training model in the UK&I. A questionnaire was developed and distributed via national UGI societies. Questions pertained to demographics, current training evaluation, perceived requirements and availability. A total of 241 responses were received with representation from all UK&I postgraduate training regions. The biggest discrepancies between rotation demand and national availability related to advanced/therapeutic endoscopy and robotic surgery, with 91.7% of respondents stating they would welcome greater geographical flexibility in training. The median suggested academic targets were 3-5 publications (trainee vs consultant <3 vs 3-5, p<0.001); <3 presentations (<3 vs 3-5, p=0.002); and 3-5 audits/quality improvement projects (<3 vs 3-5, p<0.001). Current operative requirements were considered achievable (87.6%) but inadequate for day one consultant practice (74.7%). Reassuringly, 76.3% deemed there was role for on-the-job operative training following consultant appointment. Proficiency in diagnostic endoscopy was considered a minimum requirement for Certificate of Completion of Training (CCT) yet the majority regarded therapeutic endoscopy competency as non-essential. The median numbers of index UGI operations suggested were comparable with the current curriculum requirements. Post-CCT fellowships were not considered necessary; however, the majority (73.6%) recognised their advantage. Current CCT requirements are largely consistent with the opinions of the UGI community. Areas for improvement include flexibility in geographical working and increasing national provisions for high-quality endoscopy training.

Registered nurse lactation consultants' experiences supporting maternal mental health: A qualitative descriptive study

BackgroundThe province of Nova Scotia has the highest rates of perinatal mental health disorders in Canada, and rates of exclusive breastfeeding fall below the Canadian national average. Exclusive breastfeeding is identified as a protective factor against the development of perinatal mental health disorders. Lactation consultant support is associated with increased rates of exclusive breastfeeding and decreased rates of perinatal mental health disorders. Despite this, little is known regarding the experiences of Registered Nurse Lactation Consultants related to supporting maternal mental health. ObjectiveTo understand the experiences of Registered Nurse Lactation Consultants related to supporting maternal mental health. DesignA qualitative descriptive design using online semi-structured interviews. Setting & ParticipantsTen Registered Nurse Lactation Consultants employed in the publicly funded healthcare system in Nova Scotia, Canada, were recruited via purposive sampling. FindingsThree themes emerged regarding the relational experiences of Registered Nurse Lactation Consultants while supporting maternal mental health; these included (1) Experiences supporting maternal mental health, (2) Providing maternal mental health care, and (3) Mothers need support. Key conclusions and implications for practiceRegistered Nurse Lactation Consultants described positive experiences supporting maternal mental health and indicated that lactation consultant appointments were an opportune time to provide screening and support for maternal mental health. Enhancing support for maternal mental health requires collaborative and integrated approaches throughout the perinatal period. Healthcare providers, including Registered Nurse Lactation Consultants, must be provided with the support and resources to provide timely and appropriate support for maternal mental health throughout the perinatal period.

Patient Retention in a Substance Use Disorder Telemedicine Clinic.

Although research has continued to show that substance use disorders (SUDs) can be treated effectively with evidence-based treatment, there continues to be gaps in access, and utilization remains low. Alternative SUD treatment methods, including telemedicine, are increasingly being explored to reach patients where traditional in-person treatment approaches are inaccessible. This cross-sectional study aimed to explore SUD treatment retention, specifically comparing telemedicine-delivered opioid use disorder (OUD) treatment with a traditional in-person treatment delivery approach. Patients at Cahaba Medical Care, an FQHC in Birmingham, AL with a diagnosis of OUD and undergoing buprenorphine/naloxone or buprenorphine treatment were categorized into two groups: treatment and control. The dependent variable, retention to SUD treatment, was assessed at four different time periods over 12 months to determine patient SUD consultation appointment attendance. Multiple linear regression was used to examine the relationship between SUD treatment retention and delivery mode. Correlations were obtained to assess associations between frequency of urine drug screens performed and SUD treatment retention. As the number of the urine drug screens patients received increased by 1, the number of SUD treatment program consultations patients attended increased by 0.69 (P < 0.001). There was no significant difference in SUD treatment retention between traditional in-person and telemedicine delivered approaches, however. The findings of this study suggest that a telemedicine-delivered treatment program equals retention effectiveness when compared with in-person delivery. This suggests that leveraging telemedicine to treat patients with SUD could be an effective alternative for those unable to access treatment or who are less likely to attend or complete traditional in-person treatment sessions.

M-Thyroid Care Mobile App: Virtual Video Consultation Application for Thyroid Clinic

The present study aims to enhance thyroid clinics by proposing solutions through collaboration between medical experts and researchers, thereby enhancing the quality of healthcare services. To minimize unnecessary in-person consultations, a doctor requested the development of an app to address non-critical physical consultation appointments. Design-based research is a robust methodology that combines theory-driven inquiry with real-world problem-solving to develop interventions or serve as the basis for the research being discussed. M-Thyroid Care is designed to provide a practical and cost-effective platform for online consultations, facilitating video calls between patients and doctors. By leveraging this technology, the app aims to enhance patient monitoring and optimize the efficiency of thyroid clinic consultations. Moreover, the integrated chat feature allows for real-time communication, fostering effective doctor-patient interaction even outside of scheduled appointments. Additionally, the app enables the sharing of files, videos, and images, empowering doctors to review diagnostic reports and relevant visual data remotely. This further streamlines the consultation process. By reducing the reliance on physical visits for non-critical cases, the app has the potential to enhance access to specialized care, decrease wait times, and optimize resource utilization in the clinic setting. The prototype has the potential to enhance patient care, as demonstrated by this proactive engagement with stakeholders.

Simultaneous bilateral total hip arthroplasty—a survey of Irish orthopaedic surgeons’ practice

BackgroundBilateral total hip arthroplasty may be performed simultaneously (SIMTHA) or in two staged operations.AimTo assess attitudes towards and utilization of SIMTHA in Irish orthopaedic practice, and to assess patient and surgeon factors which are associated with the management of bilateral hip arthritis.MethodsA 16-question electronic survey (Google Forms) was distributed via email to consultant Irish orthopaedic surgeons who perform total hip arthroplasty, followed by a reminder 1 month later. A p value < 0.05 was considered significant.ResultsThere were 53 responses from arthroplasty surgeons, with 28% reporting they never perform SIMTHA, 26% have performed ≤ 5 SIMTHA, and 46% do ≥ 1 SIMTHA per year. Amongst the 15 surgeons who do not do SIMTHA, 60% reported a preference for staged arthroplasty, 20% felt it was not feasible in their institution, and a third reported a lack of experience with SIMTHA. There was a significant association between not performing SIMTHA and years of consultant experience (p = 0.002). There were no institutional guidelines on eligibility criteria for SIMTHA. The most common time interval for staged bilateral arthroplasty was 6–12 weeks (60%). Overall, 56% of surgeons felt SIMTHA is underutilised in the Irish healthcare system; this was associated with greater SIMTHA volume (p = 0.023).ConclusionHalf of the Irish arthroplasty surgeons report SIMTHA is a regular aspect of their practice. Performing SIMTHA is associated with greater arthroplasty volume, more recent consultant appointments, and a perception that the operation is underutilised.

Decades old communication training influences seen in patient-centric communication skills of transplant hematologists.

12099 Background: Competency in communication skills was added as a requirement for residencies in 1999. Numerous strategies have since been incorporated into all phases of medical education and beyond. “Ask-tell-ask” and “NURSE” are commonly taught strategies used to guide conversations between physicians and patients. “Ask-tell-ask” provides a structure for assessing and delivering medical knowledge to a patient. “NURSE” outlines methods for incorporating empathy into the medical provider’s statements. We evaluated for the presence of these communication strategies in a high-stakes discussion between a transplant hematologist and a simulated patient facing a new diagnosis of high-risk myelodysplastic syndrome (MDS). Methods: This is a sub-analysis from a mixed-methods, observational study. Our team recruited hematologists who routinely perform hematopoietic cell transplants and designed a patient scenario of a 67-year-old man with recently diagnosed high-risk MDS referred to hematology. Video-recorded virtual encounters simulated an initial hematology consultation appointment between the hematologist and an actor trained to portray the patient. We analyzed transcripts and coded for themes in the discussion content and structure. We evaluated for the use of known communication strategies “ask-tell-ask”, and “NURSE” empathic responses. Results: Of 37 hematologists from 25 academic centers who participated, 73% reported receiving at least some formal communication training. Hematologists ” when teaching patients about their disease and treatment options. For example, nearly all hematologists opened the encounter by asking the patient a perception question regarding their understanding of their disease; nearly all incorporated at least one "NURSE" empathic statement after telling the patient about their disease and its prognostic implications. Most explored the patient’s goals for treatment and described treatment options utilizing an “ask-tell-ask” approach. Nearly all concluded the encounter with a summary and strategy for next steps. Conclusions: While it is commonly held that teaching communication is difficult, these conversations between hematologists and patient actors show the impact of communication training delivered over the past twenty years through the routine incorporation of well-described strategies of “ask-tell-ask” and "NURSE". This observational study provides a window into how these teachings have permeated into medical practice and hematology/oncology specifically. The incorporation of commonly taught communication strategies into these physician-patient encounters provides evidence that teaching high-quality communication may change physician behavior in a sustained and diffuse way.

Diagnóstico de onicomicosis. La utilidad del test rápido de detección antigénica en comparación con el cultivo

BackgroundRingworm is highly prevalent in our setting and is frequently observed in our routine clinical practice. Diagnostic confirmation depends on techniques that are not always accessible (PCR), with highly variable sensitivity depending on the observer (direct microscopy) or delayed results (culture, histopathology). Recently, an immunochromatography-based rapid test (Diafactory®) for the antigenic detection of dermatophytes has been developed. This diagnostic tool can help diagnose ringworm, allowing early initiation of treatment and fewer consultation visits. ObjectiveTo determine the sensitivity and specificity of the rapid antigen detection test compared to conventional culture. Material and methodsFor a full year, 333 nail samples were collected from patients with suspected onychomycosis. The rapid test and the conventional culture were simultaneously performed on each sample. Those with a positive antigenic test result began treatment early. The remaining patients had appointments for serial cultures and subsequent medical consultation to evaluate the results. ResultsCompared to conventional culture, the sensitivity and specificity rates of the rapid antigen detection test are 97.2% and 80.7%, respectively. ConclusionThe effectiveness of the rapid antigen detection test is similar to that of conventional culture for the detection of dermatophytes in nail samples. It is a quick and simple diagnostic technique that reduces the number of patient visits to the hospital, and allows early treatment start.

Implementing a clinical scientist-led screening clinic for hypertrophic and dilated cardiomyopathies

BackgroundThe burden of screening for inherited cardiac conditions on health services grows ever larger, with each new diagnosis necessitating screening of additional family members. Screening these usually asymptomatic, low-risk individuals is currently performed by consultant cardiologists, consuming vital clinic resources that could otherwise be diverted to sicker patients requiring specialist consultant input. Clinical scientists now constitute a highly skilled and often underutilised group of individuals with training in areas such as clinical evaluation, 12-lead electrocardiography (ECG) interpretation, and echocardiography. These skills place them in a unique position to offer a full screening evaluation in a single consultation. The aim of this study was to implement and evaluate a novel clinical scientist-led screening clinic for first-degree relatives of patients with hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM). The clinical scientist-led screening clinic was established at a London tertiary centre to allow review of asymptomatic, first-degree relatives of patients with a confirmed diagnosis of HCM or DCM, independent of a cardiology consultant. Patients were evaluated with history, examination, ECG, and echocardiography, with further investigations if deemed necessary. A retrospective review was performed of the first 200 patients seen in the clinic.ResultsOf the 200 individuals reviewed between September 2019 and July 2022, 99 had a proband with HCM and 101 a proband with DCM. Overall, 169 individuals (85%) revealed normal screenings and were discharged. Thirty-one individuals (15.5%), all asymptomatic, revealed ECG changes and/or significant echocardiographic findings. Of these, 21 individuals (10.5% of the total cohort) were subsequently diagnosed with a cardiomyopathy or early phenotypic changes consistent with a cardiomyopathy (11 with HCM and 10 with DCM). These individuals were referred on to an inherited cardiac conditions consultant clinic for regular follow-up. Overall, 179 consultant clinic appointments were saved which could instead be allocated to patients requiring specialist consultant input.ConclusionsThis is the first description of a clinical scientist-led screening clinic for first-degree relatives of patients with HCM and DCM. The findings demonstrate that implementation of such a service into routine clinical practice is feasible, effective, safe, and can free up capacity in consultant clinics for patients requiring specialist input.

Actes auto-agressifs avec substance chez les moins de 18 ans : étude prospective des cas régulés par le centre antipoison et de toxicovigilance de Marseille

ObjectivesTo describe poison exposures in case of self-poisoning subjects younger than 18 years old reported to the Marseille Poison Control Center. Patients and methodThis is a descriptive, monocentric and prospective review of self-poisoning patients aged<18years who reported to the Marseille Poison Control Center from 1st October 2021 to 31st January 2022. ResultsThe 308 subjects included were aged 11 to 17years with an average age of 14.9years (±1.5) for girls and 14.6 (±1.7) for boys (P=0.234). The sex ratio was 0.14. Two hundred and forty patients (77.9%) already had prior psychological or psychiatric follow-up. It was a recurrence of suicide attempts in 43.8% of cases (n=135). The use of an emergency department was almost systematic (n=277, 89.9%). Most of these were mono-intoxications (n=193, 62.7%). The poisonings were in most cases drug-induced (n=281, 91.2%). Analgesics-antipyretics were the most used drug class (n=147 patients, 47.7%), followed by anxiolytics (n=62, 20.1%). Paracetamol proved to be the most ingested substance (n=108, 35.1%). One hundred and six patients remained asymptomatic (34.4%). Of the 308 cases included, 78.6% were hospitalized for an average of four days. Two hundred forty-nine cases (80.8%) had one psychiatric evaluation in an emergency department and 200 (64.9%) will have an appointment for a psychiatric consultation on discharge. DiscussionThe demographic characteristics of young suicides and those of intoxication were globally like those found in the literature although our recurrence rate was higher than those in the literature. More than two years after the start of the SARS-CoV-2 pandemic, the malaise of young people remains while the care offer is already saturated. To reverse the trend by 2027 the French Ministry of Health and Prevention has updated its national prevention strategy by various means. A subsequent study could be interesting to see the impact of these measures. ConclusionThis study is limited but seems to complement some indicators, which shows that the pediatric mental health crisis is worsening, especially among the youngest adolescents who have an increased recurrence rate. We must remain vigilant and continue to implement screening actions and means of prevention, particularly of recurrences.

A Meta-Analysis of the Global Stillbirth Rates during the COVID-19 Pandemic

COVID-19 has been shown to have variable adverse effects on pregnancy. Reported data on stillbirth rates during the pandemic have, however, been inconsistent—some reporting a rise and others no change. Knowing the precise impact of COVID-19 on stillbirths should help with the planning and delivery of antenatal care. Our aim was, therefore, to undertake a meta-analysis to determine the impact of COVID-19 on the stillbirth rate. Databases searched included PubMed, Embase, Cochrane Library, ClinicalTrials.gov, and Web of Science, with no language restriction. Publications with stillbirth data on women with COVID-19, comparing stillbirth rates in COVID-19 and non-COVID-19 women, as well as comparisons before and during the pandemic, were included. Two independent reviewers extracted data separately and then compared them to ensure the accuracy of extraction and synthesis. Where data were incomplete, authors were contacted for additional information, which was included if provided. The main outcome measures were (1) stillbirth (SB) rate in pregnant women with COVID-19, (2) stillbirth rates in pregnant women with and without COVID-19 during the same period, and (3) population stillbirth rates in pre-pandemic and pandemic periods. A total of 29 studies were included in the meta-analysis; from 17 of these, the SB rate was 7 per 1000 in women with COVID-19. This rate was much higher (34/1000) in low- and middle-income countries. The odds ratio of stillbirth in COVID-19 compared to non-COVID-19 pregnant women was 1.89. However, there was no significant difference in population SB between the pre-pandemic and pandemic periods. Stillbirths are an ongoing global concern, and there is evidence that the rate has increased during the COVID-19 pandemic, but mostly in low- and middle-income countries. A major factor for this is possibly access to healthcare during the pandemic. Attention should be focused on education and the provision of high-quality maternity care, such as face-to-face consultation (taking all the preventative precautions) or remote appointments where appropriate.

Reducing 30% of waiting time in the administration of antineoplastic oral drugs in patients with urological cancer.

325 Background: In order to reduce waiting time in the administration of oral antineoplastics we participated in ASCO/ECO QTP. We propose the creation of an oncology nursing office, trained to evaluate and administer oral antineoplastic medication. Methods: The waiting times of patients diagnosed with urological cancer and receiving treatment with oral antineoplastic drugs are collected, between their arrival at the hospital and the drug’s dispensation. Waiting times are calculated using a prospective qualitative analysis and we represent the data using SPC graphs such as R-Charts, process maps, Pareto and cause-effect diagram, objectifying, the longest waiting time between the oncology consultation appointment and the entrance to consultation. An oncology nursing consultation, with protocols based on checklists (where the most frequent adverse effects are collected, blood pressure is measured and the corresponding analytical parameters are assessed) is created to facilitate the job and train nursing for the administration of drugs. Subsequently, the waiting times are analyzed again, after the implementation of the nursing consultation and a month after it. Results: Along a period of 6 months (time from when we started the ASCO/ECO QTP course, until we implemented the medical oncology consultation), we have reduced the median time between the patient's appointment to the drug dispensation, from 35 minutes to 5 minutes, approximately a reduction higher than the 80%. One month after the implementation of the nursing consultation, waiting times are analyzed again, and the improvement is maintained. Conclusions: The creation of a specific nursing consultation has made possible to reduce waiting times in the administration of oral antineoplastic drugs, reducing the waiting list and managing to quote 3 more patients each day in medical oncology consultation.

An In Silico study of a One-Day One-Machine Workflow for Definitive Radiotherapy Cases on a Novel Simulation and Treatment Platform

The workflow in Radiotherapy (RT) has largely unchanged for the past three decades, despite increasing evidence suggesting that delayed access to RT, including the wait time between consultation, simulation, and treatment appointments, can negatively impact clinical outcomes. In this pilot study, we present preliminary results of an in silico study that demonstrate the feasibility of a novel RT platform, which integrates simulation into the treatment process and enables patients to receive immediate RT after their initial RT consultation. A prospective clinical study has been approved to assess the capabilities of a novel RT platform with a high quality CBCT system for imaging guidance as well as planning. This new platform enables a novel clinical workflow that allows clinicians to review contours and plans created on diagnostic CT images prior to the initial RT consultation and allow them to approve new plans adapted on the actual simulation dataset acquired on the first treatment fraction. Four patients receiving standard of care RT (three abdomen and one thorax) consented for this study and underwent additional experimental CBCT simulation on the new platform in addition to their standard CT simulation. The CBCT simulation was taken in two setups: with a specific mold on a flat couch and without a mold on a curved couch. To demonstrate the equivalence of the new workflow to the current standard of care, the plan created on the most recent diagnostic CT images was compared to the plans adapted on the experimental simulation images and the standard CT simulation images, using a knowledge-based model. Contours were propagated from approved datasets to the new datasets through deformable image registration. All experimental simulations were completed between 14 and 21 minutes with the assistance of two therapists. The contouring, editing, and replanning process took less than one hour in all cases, in line with our experience and peer-reviewed literature. Despite notable anatomical changes observed, the dose-volume histograms (DVH) were consistent, as shown in Table 1. The novel workflow presented herein was feasible and demonstrates that the integration of simulation with image-guided RT on one single platform may unlock the potential of accelerating the RT workflow and reducing the wait time for treatment from weeks to hours.

Care Pathways and Initial Engagement in Early Psychosis Intervention Services Among Youths and Young Adults

Broad efforts to improve access to early psychosis intervention (EPI) services may not address health disparities in pathways to care and initial engagement in treatment. To understand factors associated with referral from acute hospital-based settings and initial engagement in EPI services. This retrospective cohort study used electronic medical record data from all patients aged 16 to 29 years who were referred to a large EPI program between January 2018 and December 2019. Statistical analysis was performed from March 2022 to February 2023. Patients self-reported demographic information in a structured questionnaire. The main outcome for the first research question (referral source) was an exposure for the second research question (initial attendance). Rate of EPI referral from acute pathways compared with other referral sources, and rate of attendance at the consultation appointment. The final study population included 999 unique patient referrals. At referral, patients were a mean (SD) age of 22.5 (3.5) years; 654 (65.5%) identified as male, 323 (32.3%) female, and 22 (2.2%) transgender, 2-spirit, nonbinary, do not know, or prefer not to answer; 199 (19.9%) identified as Asian, 176 (17.6%) Black, 384 (38.4%) White, and 167 (16.7%) other racial or ethnic groups, do not know, or prefer not to answer. Participants more likely to be referred to EPI services from inpatient units included those who were older (relative risk ratio [RRR], 1.10; 95% CI, 1.05-1.15) and those who identified as Black (RRR, 2.11; 95% CI, 1.38-3.22) or belonging to other minoritized racial or ethnic groups (RRR, 1.79; 95% CI, 1.14-2.79) compared with White participants. Older patients (RRR, 1.16; 95% CI, 1.11-1.22) and those who identified as Black (RRR, 1.67; 95% CI, 1.04-2.70) or belonging to other minoritized racial or ethnic groups (RRR, 2.11; 95% CI, 1.33-3.36) were more likely to be referred from the emergency department (ED) compared with White participants, whereas participants who identified as female (RRR, 0.51 95% CI, 0.34-.74) had a lower risk of ED referral compared with male participants. Being older (odds ratio [OR], 0.95; 95% CI, 0.90-1.00) and referred from the ED (OR, 0.40; 95% CI, 0.27-0.58) were associated with decreased odds of attendance at the consultation appointment. In this cohort study of patients referred to EPI services, disparities existed in referral pathways and initial engagement in services. Improving entry into EPI services may help facilitate a key step on the path to recovery among youths and young adults with psychosis.

Current status and challenges in prenatal and neonatal screening, diagnosis, and management of congenital heart disease in China.

Congenital heart disease (CHD), a wide spectrum of diseases with varied outcomes, is the most common congenital malformation worldwide. In this Series of three papers, we describe the burden of CHD in China; the development of screening, diagnosis, treatment, and follow-up strategies; and challenges associated with the disease. We also propose solutions and recommendations for policies and actions to improve the outcomes of CHD. In the first paper in this Series, we focus on prenatal and neonatal screening, diagnosis, and management of CHD. Based on advanced international knowledge, the Chinese Government has developed a network system comprising prenatal screening, diagnosis of CHD subtypes, specialist consultation appointments, and treatment centres for CHD. A new professional discipline, fetal cardiology, has been formed and rapidly developed. Consequently, the overall coverage of prenatal and neonatal screening and the accuracy of CHD diagnoses have gradually improved, and the neonatal CHD mortality rate has decreased substantially. However, China still faces several challenges in the prevention and treatment of CHD, such as insufficient diagnostic capabilities and unqualified consultation services in some regions and rural areas. TRANSLATION: For the Chinese translation of the abstract see Supplementary Materials section.

Database System for Medical Record Keeping and Retrieval

The field of healthcare is producing a lot of information in the form of data and knowledge. Medical knowledge is increasing day by day. The data needs to be accessed for providing health services and for administrative, economic, and legal purposes. Most of the health sectors use a paper-based system, which due to its certain limitations can affect the quality of care. Modern medical systems observed the need for the use of medical databases. Medical Database System (MDS) is an advancing concept and is defined as a systematic collection of online-based health records in any health facility that helps to overcome the limitations of conventional paper-based systems. The problem remains in the existing methods of medical record keeping and retrieval, which are less efficient as well as accurate. Recent systems have problems in their systems, such as inaccuracies in data, inefficiencies in their workflows, and other potential security weaknesses. Thus, there is a need for a database system specifically designed for medical record keeping that can overcome these problems and can offer a reliable, secure, and efficient solution for storing and retrieving medical records. In this research, an online-based health record system is designed that can keep, manage, and retrieve medical health records. The system’s frontend, as well as backend, are designed on Microsoft Access 365. Microsoft Access 365 offers suitability in keeping medical records, cost-effectiveness, integration capabilities, user-friendly interface, and scalability which also support the objectives and requirements of our project. The system includes patient registration for reception, a questioner and data retrieval for cancer diagnosis, and a complete pharmacy system including multiple forms and ledgers as well as the reports to get the summary of data where desired. Furthermore, the system contains a login system to make it secure. Our proposed database system shows a very significant improvement over existing systems in terms of efficiency, scalability, security, retrieval capabilities, and societal impact in medical record keeping and retrieval with significant societal impacts. This system can further be improved in the future, expanding its design by including other hospital services, like laboratories, finance departments, and consultation appointments. Nowadays artificial intelligence is performing an excellent role in each domain. Implementing artificial intelligence in this database system can lead this database system to the next level.

Management of urinary tract infections in the community: a clinical audit and patient survey.

Urinary tract infection (UTI) is a common ailment but can develop into sepsis. The outcomes related to UTI may potentially be affected by both patient and clinician management of UTI. To explore the circumstances around a single UTI episode to determine whether there are patient and clinician-related variables that may contribute to differences in management. Survey and clinical audit in 12 general practices in England. Patients (n = 504) completed a bespoke survey and their corresponding index UTI consultation was audited. The TARGET (Treat Antibiotics Responsibly, Guidance, Education and Tools) UTI audit toolkit was utilised. A significantly higher proportion of females compared with males used self-management measures. Increase in fluid intake was 78% for females aged <65 years and 71% for females aged >65 years compared with 53% for males (P<0.001, Χ2 test). Analgesic use was 50% for females aged <65 years and 41% for females aged >65 years compared with 36% for males (P = 0.036, Χ2 test). Males also indicated they lacked UTI knowledge when compared with females (P = 0.002, Kruskal-Wallis test). Males also claimed to have waited significantly longer for a consultation appointment (P = 0.027, Χ2 test). Antibiotics were prescribed in 98% of all cases, with adherence to clinical diagnostic guidelines lowest in females aged <65 years. Only 40% (89/221 of cases in this guideline sub-cohort [females aged >65 years]) would have been a UTI, according to TARGET criteria, following a medical record audit. UTI symptom management by clinicians is suboptimal; the presence or absence of symptoms is often insufficiently recorded in medical records. Additionally, suboptimal adherence to guidelines concerning urinalysis and microbiological investigation is common. Known increased clinical risks for males may be compounded by their more limited knowledge of (self)-managing UTI and their comparatively late presentation.

Teledermatological Follow-Up Consultations in Individual Prevention of Occupational Dermatoses: A Monocentric Feasibility Study on Quality and Satisfaction by Patients and Physicians.

Teledermatology has become very popular, and not only due to the SARS-CoV-2 pandemic. Patients with occupational skin diseases (OSDs) could also benefit from teledermatology services as part of their follow-up care, but the opportunities and challenges for patients and dermatologists, especially regarding quality and satisfaction, need exploration. In this single-center feasibility study, 215 patients taking part in a tertiary prevention program for OSD were invited to participate. After obtaining consent, a follow-up video consultation appointment with the center's dermatologists was made. Quality and satisfaction with the consultations were evaluated by fully standardized online questionnaires filled in by the patients and dermatologists. A total of 68 teledermatological follow-up consultations were conducted by 10 dermatologists on 42 patients. Half of the dermatologists (50.0%) and 87.6% of the patients were satisfied with the video consultations. However, the lack of physical examination seems to be a problem, especially from the physicians' point of view (75.8%). A total of 66.1% of the dermatologists and 87.5% of the patients saw video consultations as useful supplements to face-to-face consultations. The results of our feasibility study indicate general satisfaction of patients and physicians with teledermatological sessions in occupational dermatology, especially as a useful supplement to face-to-face consultation.

(003) The Impact of Gender Affirming Mastectomy on the Sexual Health and Satisfaction of Trans Patients

Abstract Introduction Gender-affirming mastectomy (GAM) is the most commonly performed gender-affirming surgery. Unfortunately, many areas of sexual health for transmasculine people are understudied. In particular, there are few studies that assess how chest and nipple stimulation, or lack of sensation, affect the sexual health and satisfaction of trans patients after GAM. Objective This study aims to 1) assess the importance of chest and nipple stimulation for trans patients before any chest surgery, 2) evaluate how GAM affects patients’ sexual health postoperatively, and 3) investigate how chest and nipple sensation change after GAM. Methods This is a prospective study performed at one institution. All participants are patients recruited at their GAM consultation or follow-up appointment. Pre-operative and post-operative surveys were developed based on previous validated Patient Reported Quality of Life Survey with multiple rounds of editing by two gender affirming surgeons. Surveys were distributed through Qualtrics (Qualtrics XM, Seattle, Washington). Results Since July 2021, 144 unique surveys (45 unique pre-operative and 99 unique post-operative) have been completed. The three most common gender identities are man (43%), non-binary (25%), and transgender man (9%). Eighty-four to 89% of pre-operative patients reported being able to sense normal pressure, light touch, and temperature on their chests. Sixty-two percent of preoperative patients were not concerned about potential loss of nipple sensation after surgery. Compared to their sensation before top surgery, 43 – 65% of post-operative patients reported they had decreased sensation of normal pressure, light touch, and temperature on their chests and nipples. Regarding sexual satisfaction levels, 76% of pre-operative patients reported that nipple stimulation is sometimes, rarely, or never involved in their sexual activities. Seventy-six percent of preoperative patients also stated that nipple and chest stimulation is slightly important or not at all important to their sexual activity. Compared to their sexual health pre-operatively, 59% of post-operative patients reported that the importance of their nipple and chest stimulation stayed the same, is little less, or much less important to their sexual life after the operation. After surgery, 40% of patients thought their sexual satisfaction was much or a little better. Less than 1% of patients reported that their sexual satisfaction was much worse. One hundred percent of post-operative patients were satisfied having undergone GAM and agreed that top surgery had changed their life for the better. Conclusions Sexual health of patients undergoing GAM has rarely been studied before. This study shows that nipple stimulation for the majority of top surgery patients is not heavily involved in their sexual activities and may actually decrease after surgery. Although most patients report decreased sensation postoperatively, patients’ overall sexual satisfaction does not change and for some may even improve after surgery. GAM can immensely improve quality of life while preserving or even improving patients’ sexual health. Disclosure No

Current landscape of academic neurosurgical training in the United Kingdom: analysis by the Society of British Neurological Surgeons

Objective Little is known about the impact of academic training on Neurosurgery in the United Kingdom (UK). The aim was to understand the early career clinical and research training journeys of potential future clinical academics, with a view to informing future policy and strategy to improve career development for academic neurosurgical trainees and consultants in the UK. Methods An online survey from the Society of British Neurological Surgeons (SBNS) academic committee was distributed to both the SBNS and British Neurosurgical Trainee Association (BNTA) mailing lists in early 2022. Neurosurgical trainees for any period between 2007 and 2022 or who had done any dedicated academic or clinical academic placement were encouraged to complete the survey. Results Sixty responses were received. Six (10%) were females and fifty-four (90%) were males. At the time of response, nine (15.0%) were clinical trainees, four (6.7%) were Academic Clinical Fellows (ACF), six (10.0%) were Academic Clinical Lecturers (ACL), four (6.7%) were post-CCT fellows, eight (13.3%) were NHS consultants, eight (13.3%) were academic consultants, eighteen (30.0%) were out of the programme (OOP) pursuing a PhD potentially returning to training, whilst three (5.0%) had left neurosurgery training entirely and no longer performing clinical neurosurgery. The mentorship was sought in most programmes, which tended to be informal. Self-reported success on a scale of 0 to 10 with 10 being the most successful, was greatest in the MD and the “Other research degree/fellowship group” which does not include a PhD. There was a significant positive association between completing a PhD and having an academic consultant appointment (Pearson Chi-Square = 5.33, p = 0.021). Conclusions This study provides a snapshot to better understand the opinions of academic training in neurosurgery within the UK. Establishing clear, modifiable, and achievable goals, as well as providing tools for research success, may contribute to the success of this nationwide academic training.