Outpatient Department Follow-up Research Articles

Lower Limb Comprehensive Reconstructive Surgery: Experiences from an Orthopedic Teaching Unit

Abstract Introduction: The burden of open extremity fractures is well recognized in placing a burgeoning demand on an already exhausted medical facility in low- and middle-income countries. This study aims to evaluate the functional outcome following “orthoplastic management” by orthopedic surgeons trained in limb reconstruction surgery. Methodology: Adult patients with open lower limb injuries treated from January 1, 2022, to December 30, 2022, who underwent single or staged fixation and reconstruction procedures were identified. Patients with Gustilo–Anderson type IIIB fractures requiring skeletal stabilization with soft-tissue cover were included. Polytrauma patients requiring multidisciplinary surgical attention were excluded. A team of orthopedic surgeons trained in limb reconstruction was involved in the management. Inpatient and outpatient department follow-up by the treating team was done to document complications (infections, reoperations, and graft failures) and functional outcomes using the Lower Extremity Function Score. The duration of mean follow-up was 1 year since index surgery. Results: A total of 24 adult patients with open lower limb injuries with preoperative Ganga Hospital Score (GHS) were included. Decision toward fixation with primary closure or further reconstruction was made collectively. The gray zone (GHS score of 15–16) of patients was more aggressively managed with emphasis on salvage. Additional reconstructive procedures were carried out based on the assessment at consequent follow-up. Three patients had a suboptimal joint function (less than functional range of motion for the involved joint) due to the resultant loss of compartment(s) and joint contracture. Five patients were retaken to the theater for further supplementary or corrective procedures following the index, definitive surgical procedure (bone grafting, partial flap loss, and fixator readjustment). Conclusion: Good-to-excellent functional outcome was demonstrated with the “orthoplastic approach” where skeletal stabilization as well as soft-tissue reconstruction was performed by trained orthopedic surgeons. This study demonstrated that orthoplastic surgery is a safe and effective method of limb salvage.

Preliminary experience with 18 months result of endoscopic sleeve gastroplasty from an Asian population: Learning curve of one bariatric surgeon

Abstract Background Endoscopic sleeve gastroplasty (ESG) is emerging as an innovative approach to treating obesity. It provides a bridge between surgical and medical treatments for obesity. Nevertheless, the majority of reports on ESG originate from Western countries, and there is a lack of data from Asian nations. This study aims to share our pioneering experience with this novel technique in Asia. Materials and Methods We enrolled obese patients with a body mass index greater than 27 kg/m2 who were at least 20 years old. ESG was conducted following a comprehensive preoperative assessment. Following the procedure, patients were scheduled for regular outpatient department follow-up appointments at 7 days, 1 month, 2 months, 3 months, and then every 3 months up to 18 months postoperation. Body weight and any adverse events were documented during each follow-up visit. Results A total of 49 obese patients were enrolled in this study. Our findings demonstrate that ESG can be safely integrated into a conventional bariatric surgery center, with a learning curve observed after 10 cases in this study. In our series, the results showed that total body weight loss (TBWL) reached 7% at 1 month, 9% at 3 months, 14% at 6 months, 16% at 12 months, and 18.6% at 18 months. No adverse events or complications were reported in the study; however, five patients experienced procedure failures. Four of these patients underwent a repeat ESG, whereas one patient opted for surgical intervention. Conclusions ESG can be used in Asian countries, and the effectiveness of weight loss has proven to be satisfactory.

Prevalence of Helicobacter pylori infection in adult immune thrombocytopenia patients

Background: Helicobacter pylori is a Gram-negative, microaerophilic bacteria colonizing more than half of the world’s human stomachs. It is the causal agent of active chronic gastritis and the most common cause of peptic ulceration, including gastric and duodenal ulcers. Aims and Objectives: This study aims to the prevalence of H. pylori infection in adult immune thrombocytopenia (ITP) patients. Materials and Methods: An interventional and prospective study was conducted over 6 months with over 50 ITP patients, including those admitted to the general medicine ward and those in regular follow-up in medicine outpatient department. In addition, in all primary ITP patients, a stool antigen test for H. pylori Ag and baseline complete blood count, including platelet count, were done. In addition, all patients’ platelet count was monitored twice weekly for 6 months. Results: Of the 50 patients, 40 are female and 10 are male. The bleeding manifestation was present in 34 patients (68%) and absent in 16 (32%). Among 34 patients, purpura was more frequent (35.3%), followed by gum bleeding 17.6%. Fourteen people tested positive for the H. pylori antigen. Thirty-six patients were found to be H. pylori antigen negative. H. pylori positive frequency was 28%. Patients who receive both steroids and an H. pylori regimen are 9 (18%). Patients who received the H. pylori regimen were only 5 (10%). Patients only receiving steroid doses are 27 (54%). Conclusion: We conclude that 28% of our study patients are infected with H. pylori, and eradicating this organism significantly improves the platelet count. However, a more extended follow-up period is needed to detect the true prevalence of H. pylori infection and the duration of remission.

Modelling and forecasting of primary healthcare utilisation, perceived quality of care and non‐emergency referrals to hospitals in a national health insurance pilot district of South Africa


 
 
 Background. The first phase of the National Health Insurance (NHI) pilot programme focusing on primary healthcare has been implemented in Tshwane and 10 other districts of South Africa since 2012. This was envisaged to improve the quality of healthcare at primary healthcare level, and offset the burden of non-emergency healthcare at hospital outpatient level. However, there are no population-level studies that have been done to determine the relationship and interdependence of primary healthcare and hospital outpatient-level indicators that are needed to forecast utilisation of health services. This information is key to plan for roll-out of NHI, in setting benchmarks to guide health policy and allocation of resources.
 Objectives. To determine the interdependence and relationships between primary healthcare and hospital outpatient-level indicators in a NHI pilot district, and forecast the utilisation of services to 2030.Methods. This was a quasi-experimental ecological study design, making use of selected primary healthcare and outpatient department indicators in the District Health Information System monthly reports between January 2010 and December 2019 for Tshwane district. We used the vector error correction model to determine the interdependence and relationships between these indicators, and used these to forecast utilisation of services to 2030.
 Results. The study found that most non-emergency care is provided at primary healthcare level by professional nurses. It confirmed the influence of selected primary healthcare and outpatient department headcounts on each other by finding the existence of four co-integration relationships between the variables. Both long-run and short-run causality exists between them. Based on these relationships, we forecasted that by the end of 2030, the outpatient department follow-up headcounts would have doubled, but both primary healthcare total and clients seen by a professional nurse will marginally decline.
 Conclusion. Our findings confirm that there is a relationship between primary healthcare and outpatient department indicators, which can be used to plan for provision of services in the future. Based on this relationship and current trends, we found that implementation of the NHI pilot programme will not attain the envisaged goal by 2030.
 
 

Bilateral fractures of the femoral neck

Bilateral fractures of the femoral neck are rare and are usually associated with underlying bone diseases, previous metabolic diseases, high-energy trauma, electroshock, or seizure attack. Low-energy trauma, such as a fall, related bilateral fractures of the femoral neck are rare. We report a case of a 74-year-old woman with displaced bilateral femoral neck fractures following a fall. After admission, we performed bilateral cemented bipolar hemiarthroplasty and restored functional outcome postoperatively. Osteoporosis was confirmed by X-ray bone densitometry at the postoperative outpatient department follow-up.

Immature Granulocyte Percentage in Early Chronic Myeloid Leukemia

A 38-year-old man presented with mild fatigue of recent onset to the medical outpatient department (OPD). Clinical examination showed an absence of fever, pallor, and no organomegaly. Routine complete blood count (CBC) showed mild leukocytosis (total leukocyte count 22.93 × 109/L), absence of features of sepsis but with immature granulocyte (IG) fraction of 26.6% on peripheral blood film without basophilia or eosinophilia. A diagnosis of chronic myeloid leukemia (CML) was suspected which was confirmed by conventional karyotyping and quantitative reverse transcription − polymerase chain reaction (QPCR). Following administration of imatinib for 2 weeks, a follow-up CBC showed a reduction in IG fraction to 1.5%. The patient is under follow-up in OPD for 4 months and is responding well as substantiated by follow-up QPCR. To the best of our knowledge, this is the first ever report where CML was first suspected on the basis of IG fraction and the same parameter proved useful for follow-up.

Evaluation of uric acid disorders and associated factors in essential hypertensive patients at Wolkite University specialized hospital, Southern Ethiopia.

BackgroundEssential hypertension is a condition characterized by a rise in blood pressure of undetermined cause, includes 90% of all hypertensive cases and is a highly important public health challenge with major modifiable cause of morbidity and mortality. Uric acids disorders in particular hyperuricemia are significant problems in essential hypertensive patients and can cause substantial morbidity and mortality. Determination of uric acid disorders may play a major role in the management and early aversion of complications in hypertensive patient. Therefore, this study aimed to determine uric acid disorders and associated factors among essential hypertensive adults in the outpatient department at Wolkite University specialized Hospital, Southern Ethiopia from November 1 to February 30, 2021.Methods and materialsAn institional based cross sectional study was conducted on 270 essential hypertensive adults on follow-up in outpatient department from November 1 to February 30, 2021. Structured questionnaires through face to face interviews and participants’ medical records were used to collect information on determinants related with uric acid disorders. The blood specimen was collected and level of serum uric acid, blood sugar and lipid profile was measured using standard principles and procedures with an ABX Pentra 400 automated chemistry analyzer. Bivariate and multivariate logistic regression analyses were done to identify factors associated with hyperuricemia. The p-value was set at <0.05 with a 95% confidence interval of the adjusted odds ratio.ResultsA total of 270 adult essential hypertensive patients were participated in the study, among those 196(27.4%) of study participants were hyperuricemic with 95%CI (21.9, 33.3). Being alcoholic [(AOR: 15.68, 95% CI: (5.93, 21.41)], taking antihypertensive medication [(AOR: 11.56, 95% CI: (3.94, 23.80)], BMI > = 30 [(AOR: 4.89, 95% CI: (1.46, 25.5)] and being centrally obese [(AOR: 6.87, 95% CI: (2.53, 18.63)] were factors significantly associated with hyperuricemia.ConclusionIn this study, the high burden of hyperuricemia (27.4%) was observed in essential hypertensive patients with follow-up in outpatient department. Taking alcohol and antihypertensive medication, being overweight and centrally obese were identified factors of uric acid disorders. The finding of this study should be taken into consideration to implement preventive interventions on identified predictors in hypertensive patients. Taking fruit and vegetable, and promoting physical exercise and determinations of serum uric acid level in adult essential hypertensive patients was recommended to minimize the emergence of hyperuricemia.

The relation between regular outpatient follow-up and frequency of emergency department visits in sickle cell pediatric patients.

Objectives:To evaluate the relationship between the frequency of ED visits and outpatient department (OPD) follow-up in sickle cell disease (SCD) pediatric patients.Methods:A retrospective cohort study included 247 SCD pediatric patients between January 2016 and December 2018 at the Maternity and Children Hospital, Department of Pediatrics, Al Medinah Al Munawarah, Saudi Arabia. Data were extracted from electronic medical record system; patient demographics, medications, frequency of emergency department (ED) and OPD visits. Pearson correlation coefficient, linear regression and independent sample t-test were applied.Results:There was no significant correlation (95% CI [-0.013- 0.233]; p=0.07) between the frequency of ED and OPD visits. However, a significant correlation was found between ED visits and missed OPD appointments. Thus, linear regression was applied and indicated that one missed OPD appointment is associated with 1.92 ED visits, (95% CI: 0.19-0.42; p<0.001). Also, a higher rate of ED visits was observed when compared with other studies, with a high ED reliance of 43%.Conclusion:This study found that regular OPD visits could improve SCD management, as a directly proportional relationship between the frequency of ED visits and missed OPD appointments were found, along with high ED reliance.

Phantom simulation of liver metastasis on a positron emission tomography with computed tomography scan after neoadjuvant chemoradiotherapy for distal esophageal cancer: a case report

BackgroundNeoadjuvant chemoradiotherapy is currently the gold standard treatment for esophageal cancer prior to surgery. This radiation therapy will sometimes lead to liver damage parallel to esophageal lesions, which mimics liver metastasis visualized by 18F-fluorodeoxyglucose positron emission tomography with computed tomography. In this report, we publish virtual radiation-induced liver damage images obtained during surgery, along with the coherent pathology, in order to confirm the false-positive result through an optimally decisive radiological examination.Case presentationWe report a case of a Asian male patient with distal esophageal cancer who had undergone neoadjuvant chemoradiotherapy (5000 cGy). Subsequently, a new lesion was discovered during a positron emission tomography with computed tomography scan 6 weeks later, near the left caudate lobe of the liver during tumor restaging. To exclude the possibility of liver metastasis, serial imaging was conducted, which included liver sonography, computed tomography, and magnetic resonance imaging for a more intimate probe. The patient’s condition was verified as being liver inflammation change, as seen by the liver magnetic resonance imaging presentation. Thoracoscopic esophagectomy was performed with cervical esophagogastrostomy via the retrosternal route, along with a feeding jejunostomy. The procedure was performed smoothly, with an intraoperative liver biopsy also being conducted 2 weeks later, after positron emission tomography with computed tomography restaging. The pathology report revealed esophageal cancer in the form of poorly differentiated squamous cell carcinoma, pT3N1M0. The liver biopsy revealed obvious inflammation change after radiation therapy, which elucidated sinusoidal congestion with the attenuated hepatic cords and filled with erythrocytes. There was no evidence of liver metastasis. The patient recovered uneventfully and was discharged with his oral intake performing smoothly, and a stable condition was observed during 12 months of outpatient department follow-up.ConclusionsNew foci of increased 18F-fluorodeoxyglucose avidity are commonly seen in the caudate and left hepatic lobes of the liver during neoadjuvant chemoradiation for distal esophageal cancer, and these findings generally reflect radiation-induced liver disease rather than metastatic disease. Awareness of the pitfalls of a high 18F-fluorodeoxyglucose uptake in radiation-induced liver injury is crucial in order to avoid misinterpretation and overstaging. Except for the location of 18F-fluorodeoxyglucose uptake, the shape of the lesion, and an maximum standardized uptake value (> 10/h), a convincing liver magnetic resonance imaging scan or even a liver biopsy can provide accurate information for distinguishing radiotherapy-induced liver injury from liver metastasis.

Smartphone-Based Application for Tele-follow-up of Patients with Endocrine Disorders in Context of a LMIC: A Compliance, Satisfaction, Clinical Safety and Outcome Assessment.

Remote video consultations are increasingly used in clinical practice, and a lot of data are emerging on its feasibility and acceptability. This study aims to bring out qualitative and quantitative data which will enhance our understanding of strengths and limitations of this media in the setting of a low- and middle-income country (LMIC). This was a prospective study conducted from January 2017 to May 2018, at the Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India. A total of 107 patients were selected who chose remote follow-up care through social media (WhatsApp). Data were analyzed on feasibility, clinical safety, satisfaction and economic burden. A total of 107 postoperative patients were followed up using a social media tool. A total of 396 tele-sessions were held. The average number of tele-consultations per patient was 3.7 (range 2-6). Reasons for tele-follow-up included: confirmation of histology report (n = 92), medication dosage adjustments (n = 148), wound evaluation (n = 102), reporting of serum TSH and serum calcium levels (n = 296) and medical fitness certificate (n = 13). Wound evaluation through tele-follow-up was on par with the outpatient department (OPD) follow-up as no patient had to report to OPD for wound infection. Satisfaction level was excellent in 55% of patients and very good in 25%. 20% of the patients reported an average satisfaction level. If all of these 107 patients would have come to our OPD follow-up, they would have traveled 613.2 miles (908km) per patient on an average, apart from losing work hours. Average cost and workdays saved per visit were $78 and 5.4days, respectively. Video consultation using social media tools is clinically safe and cost effective. Economic benefits far outweigh the risk of missing an adverse event, especially in the setting of low- and middle-income countries.

Knowledge and Practice on Prevention of Complications of Diabetes Mellitus among Patients with Diabetes in a Tertiary Hospital

Introduction: Diabetes is a major contributing factor for overall health status, morbidity, mortality and quality of life. Adequate knowledge and sufficient practice can prevent many possible diabetic complications. Hence, the objective of this study was to find out the knowledge and practice regarding prevention of complications of diabetes among diabetic patients. Methods: A descriptive, cross-sectional design was carried out in Tribhuvan University Teaching Hospital Kathmandu (TUTH). A total 124 diabetic patients who came for follow-up in endocrine Outpatient Department were selected through purposive sampling technique by using pre-tested structured interview schedule during four weeks. Data was analyzed by using the descriptive and inferential statistics with the help of Statistical Package of Social Science (SPSS) version 16. Results: The study findings showed that 24.2% respondents had adequate knowledge about complications . More than half of the respondents had sufficient practice (52.4%) regarding prevention of diabetic complications. Association between knowledge and selected variables showed that sex and education level tends to be significantly associated and regarding practice, area of residence and duration of illness were significantly associated (p&lt;0.05). There was a statistically significant (p&lt;0.001) and average positive relationship (r=0.605) was found between knowledge and practice. Conclusion: The study concluded that though only few respondents had adequate knowledge, more than half of the respondents had sufficient practice regarding preventing complications. This finding suggests awareness program regarding prevention of compilcations of diabetes mellitus should be launched periodically to increase knowledge and sufficient practice on prevention of diabetic complications.

Frequency and Risk Factors of Hypothyroidism in Children with Down Syndrome

Objective: To determine the frequency of hypothyroidism in children with Down Syndrome attending out-patients&nbsp;department of National Institute of Child Health, Karachi. Methods: This cross-sectional study was conducted on Down Syndrome patients visiting for various clinical&nbsp;the&nbsp; problems and regular follow-up in outpatient department of National Institute of Child Health, Karachi from 12&nbsp;th September 2016 to 13 March 2017. All children of Down syndrome aged between 1 month to 5 years and of either&nbsp;gender was consecutively enrolled. Venous blood sample was drawn (4 ml) to investigate the T4 and TSH levels.&nbsp;Outcome variable (hypothyroidism) was noted.&nbsp; Results: Of 104 children, the median age was 2 (1-4) years. There were 58 (56%) females and 46 (44%) males. Mean&nbsp;2 weight, height and BMI was 10 (6-13) kg, 74 (64-83) cm and 16.6 (14.35-18.30) kg/m respectively. Frequency of&nbsp;hypothyroidism was found in 16 (15.4%) of the children. Hypothyroidism was significantly associated with age&nbsp;(p-value 0.030), BMI (p-value 0.009), and presence of gastrointestinal anomalies (p-value &lt;0.001) of the children. Conclusion: Hypothyroidism was found considerably higher in our cohort of Down syndrome's children. Moreover,&nbsp;age, BMI and presence of gastrointestinal anomalies were observed as significantly associated determinants

Multiple wandering jejunal intussusceptions in an adult patient with celiac disease: Atypical presentation

Intussusception is a rare presentation of celiac disease. In this report, we describe the condition of a 28-year-old Saudi male known case of brucellosis diagnosed and treated 10 months ago. The patient presented to the hospital complaining of diffuse intermittent dull abdominal pain with mild abdominal distention for 1-month duration, which starts gradually with progressive course. Patient also was given history of generalized fatigability for the same duration. These symptoms were associated with a weight loss about 10 kg in the last 6 months. Abdominal examination revealed soft and lax abdomen with mild tenderness at epigastria area. Computed tomography (CT) abdomen showed jejunal loop intussusceptions with diffuse jejunal wall thickening. Gastroscopy was done and showed fissuring of duodenal folds. Biopsy report came later as duodenal villa atrophy with increased intraepithelial lymphocytosis. The patient diagnosed as celiac disease. After establishing the diagnosis, dietary advice was given and he was discharged for outpatient department follow-up. Currently, the patient remains well and repeat CT scan showed persistence of multiple intussusceptions, though at different sites of the jejunum.

SURGICAL SITE INFECTION;

Objective: To assess the post operative wound complication after opencholecystectomy for uncomplicated Cholelithiasis. Design: Cross sectional descriptive. Setting:Surgical unit of Khyber Teaching Hospital Peshawar Pakistan. Patients: 223 patients underwentelective open cholecystectomy January 2011 to July 2012. Results: 90% patients had normalhealing (grade 0 or I) ,7.5% had minor complications (grade II or III), 2.5% patients had majorcomplication (grade IV or V) recorded during hospital stay. On follow-up in out-patientdepartment 81%patients found to have normal healing (grade 0 or I), 15% patients had minorcomplications (grade II or III) and 4% patients had major complications (grade IV or V). There wasan increase noted in wound grades during follow up for surgical site infections as compared totheir record during hospital stay. Conclusions: Southampton wound scoring system is a usefultool for detection of surgical site infection and standardization. Auditing of surgical site infectionby Southampton wound scoring will help the patient, surgical team and sterilization protocol tobe improved.

Analysis on on-site rescue and traumatic features of victims involved in gas explosion accident in Hangzhou

Objective: To investigate the situations of on-site rescue and traumatic features of victims involved in gas explosion accident in Hangzhou, so as to provide more data support for emergency medical rescues of the similar incidents of massive casualty. Methods: Two medical workers with a certain clinical experience were sent to Hangzhou 120 emergency medical centers to collect data of the on-site rescue on 21st July, 2017, including ambulance call-outs, on-site command and traffic conditions, and on-site triage and evacuation of the victims. They were then sent to the hospitals receiving the victims to investigate the situations of these victims including the general information (such as gender, age, admitted hospitals, and number of admission, discharge, and transferring in the first two weeks after the accident) and injury assessment [such as injury position and type, injury severity evaluation by New Injury Severity Scoring (NISS), and burn severity evaluation for victims with burns]. Results: (1) A total of 15 ambulances reached the accident site for rescue. The traffic and transportation were jammed and interrupted after this accident. On-site triage and distribution were disorderly conducted. (2) Clinical data of 53 victims were collected, including 24 males and 29 females, with the age of 8 to 70 (34±14) years old. They were sent into 6 hospitals in Hangzhou. Two victims died on the day of accident. Up to two weeks after this accident, 28 (52.8%) victims were discharged from the hospitals and received follow-up in outpatient department. Five victims with severe injuries were transferred to the other hospitals. (3) Based on the results of NISS, the injury severities were mild in 29 (54.7%) cases, moderate in 9 (17.0%) cases, serious in 3 (5.7%) cases, and severe in 12 (22.6%) cases. Those 2 dead victims were classified into the severe category due to the highest NISS score of 75. For all of the victims, skin and soft tissue defects were most common. Six (11.3%) victims were combined with burns. According to the classification of burn severity, there were one case of mild, one case of serious, and 4 cases of severe. Conclusions: The gas explosion accident in Hangzhou caused massive casualties with complex injuries. The local emergency medical rescue responded quickly, but during the rescue process, lots of aspects should be further improved.

Comparision of functional outcome in elderly patients with inter trochanteric fracture: Dynamic hip screw vs proximal femoral nail

Introduction: The conservative approach has high complication rate. The common problems of prolonged immobilization, decubitus ulcers, U.T.I, joint contractures, pneumonia, and thrombo-embolism contribute to the high mortality rate. The increased incidence of varus deformity and shortening results in poor function. Methodology: This was a retrospective study carried out in department of orthopaedics, MIMS, mandya. The material for the present study was obtained from the patients visiting for follow-up in out-patient department with the diagnosis of intertrochanteric fracture femur who had undergone operative treatment between 2014 and 2015 ( 6 months elucidated after surgery at this visit)were de-identified and analysed. Results: Comparision of clinical, radiological and functional outcomes between group DHS and group PFN were presented in the Table-2 and Table-3. No patients had wound problems, union problems and screw out in both the groups. In the group DHS, 6 patient had shortening, 5 patients had restricted range of motion and collapse radiologically in 6 patients. In the group PFN, 2 patient had shortening, 2 patients had restricted range of motion and collapse radiologically in 2 patients. Conclusion: PFN group had statistically significant improvement with respect to harris hip scoring and PCS, MCS of SF-12 health survey.

Prospective evaluation of a virtual urology outpatient clinic.

Outpatient department (OPD) clinics account for a significant proportion of healthcare expenditure. We report on a pilot study of a virtual outpatient clinic (VC) for urology patients as an alternative to a general urology clinic review. The study aims to assess the safety and cost-effectiveness of a virtual clinic as an alternative to general OPD review. A prospective study performed between March 2015 and December 2015 investigated the effectiveness of a VC in our institution. Eligible patients were recruited from general urology outpatient visits, from medical team members and from general practitioners (GP). Data recorded on each VC review included patient demographics, indication for referral to VC, outcome of VC and method of communication with the patient and their GP after the VC. Three hundred eighty-five patients were registered for the VC. Indications for referral included review of imaging results (n=136), doctor or patient query (n=112) and review of laboratory results (n=67). Outcomes after VC review included general OPD follow-up (n=134), discharge from urology care (n=39), referral for urological intervention (n=29) and referral for radiological investigation (n=23). VC review prevented 217 OPD clinic visits, saved €17,360 and provided a failsafe mechanism for reviewing investigation results. Two patients booked for OPD review following VC review did not receive appointments. Virtual clinic is a safe and cost-effective alternative to general OPD review in appropriately selected patients.

Use of hospital services by age and comorbidity after an index heart failure admission in England: an observational study

ObjectivesTo describe hospital inpatient, emergency department (ED) and outpatient department (OPD) activity for patients in the year following their first emergency admission for heart failure (HF). To assess the proportion...

Efficacy of knee joint aspiration in patients with acute ACL injury in the emergency department

PurposeTo evaluate the influence of joint aspiration on the sensitivity of physical examination for diagnosing acute anterior cruciate ligament (ACL) lesion in the second outpatient-department (OPD) follow-up referred from emergency department (ED). MethodsThis retrospective study included sixty patients underwent ACL reconstruction with initial visit at ED. They were divided into two groups based on the presence or absence of joint aspiration at ED. All participants were referred to second OPD follow-up within 7–14days after the injury. Clinical manifestation (including visual analogue scale (VAS) for pain, range of motion (ROM), and severity of knee effusion) and physical examination (Lachman test and pivot shift test) were checked in ED and the second OPD follow-up. ResultsThe group of patients with joint aspiration (G1) showed substantial decreases in mean values of VAS for pain (p=0.005), ROM (p=0.001), and effusion level (p<0.001), even higher VAS and effusion level and lower ROM at the initial visit of ED than the other group (G2). The sensitivity of positive Lachman and pivot shift test was significantly (p<0.05) increased following knee joint aspiration. Positive Lachman test was recorded at 76.5% in the second follow-up in G1, which was significantly (p=0.047) higher than that (47.6%) in G2. The percentage of positive pivot shift test was recorded at 76.5% in the second follow-up in G1, which as significantly (p<0.001) higher than that (31.0%) in G2. ConclusionsKnee joint aspiration in acute ACL injury with suspected hemarthrosis could be considered as a diagnostic procedure. Joint aspiration in early medical attendance might be able to lower pain scores or raise the sensitivity of physical examination for diagnosing acute ACL injury at follow up visit in orthopedic outpatient department. Level of evidenceRetrospective cohort study III.

A retrospective observational study on the treatment outcomes of 26 patients with spinal cord astrocytoma including two cases of malignant transformation.

To determine the biologic behavior and prognostic factors of spinal cord astrocytoma, we reviewed surgical and clinical outcomes. Due to the rarity of spinal cord astrocytoma, there is a lack of research regarding this type of tumor and malignant transformation. We retrospectively reviewed the data from all patients on whom we performed spinal cord tumor removal between 1983 and 2014. Twenty-six patients were pathologically confirmed to have spinal cord astrocytoma or glioblastoma. Surgical extent and disease progression were confirmed by the surgeon based on operative findings, postoperative MRI, and outpatient department (OPD) follow-up. Pain or neurological deficit was the chief complaint for all patients. With MRI studies, there is a tendency for high-grade astrocytomas to show as enhanced and heterogeneous images. Two of the low-grade astrocytomas showed malignant transformation over the course of 4 and 11months, respectively. The overall survival (OS) for low-grade astrocytoma was 28-480months (mean 156.38months); the OS for high-grade astrocytoma was 1-36months (mean 12.00months). Two of 12 low-grade cases showed malignant transformations at 4 and 11months, respectively, based on pathological confirmation. With spinal cord astrocytomas, enhanced MRI results appeared similar to those of a malignant lesion. We suggest close observation and image correlation of low-grade astrocytomas, even when pathologically confirmed as low-grade. In this review, we found that histologic grade is the most important prognostic factor, although it is not always concordant with biologic behaviors.