Future Consultation Research Articles

Perceptions, Satisfaction, and Barriers to Telemedicine Use: A Community-Based Study From Jeddah, Saudi Arabia.

Background Telemedicine has expanded significantly, driven by technology and the necessity for accessible healthcare. However, users' knowledge, attitudes, and perceived barriers determine its application. This study aimed to assess these factors among patients in Jeddah, Saudi Arabia. Methodology We conducted a cross-sectional study on 403 participants from Ministry of Health centers in Jeddah from February to May 2023. A structured questionnaire was used for data collection, and subsequent analysis was performed using SPSS version 28.0 (IBM Corp., Armonk, NY, USA). Results Most participants (93.1%) agreed that telehealth services have improved healthcare accessibility and expressed willingness to participate in future telemedicine consultations. However, 73.7% felt potential embarrassment or discomfort due to camera and equipment presence. Remarkably, 76.2% of participants believed telemedicine suits all medical conditions, and 95% recommended its use. Barriers to telemedicine use were identified, including the need to travel to access healthcare services in the absence of telemedicine and the associated inconvenience and cost. The overall satisfaction score was 4.56 ± 0.78, with the highest satisfaction reported for the ability to talk freely over telemedicine (4.64 ± 0.76) and the ease of registration/scheduling (4.63 ± 0.82). Significant differences (p < 0.001) in satisfaction scores were found across various age groups, gender, nationality, employment status, and education level. Patients aged >55 years and those who used telemedicine services for the first time were associated with a significantly increased risk of poor satisfaction (odds ratio (OR) = 8.068, p = 0.011 and OR = 8.919, p = 0.005, respectively). Conclusions The findings suggest high satisfaction and positive attitudes toward telemedicine services in Jeddah, Saudi Arabia, despite identifiable barriers such as potential discomfort from camera presence. Patient age and familiarity with telemedicine services significantly influenced satisfaction levels, indicating areas that require attention for the successful implementation and expansion of telemedicine in Saudi Arabia.

#5951 INFLUENCE OF DIETARY INTAKE ON GASTROINTESTINAL SYMPTOMS AND INFLAMMATION MARKERS IN PERITONEAL DIALYSIS PATIENTS IN SLOVENIA

Abstract Background and Aims Gastrointestinal symptoms are prevalent in patients with end-stage renal disease. Gastrointestinal symptoms in such patients are related to gastric hypomotility, increased medication intake, uremia, and changes in diet. In addition GI symptoms and problems associated with bowel dysfunction are a common cause of technique failure and poor dialysis efficacy. The reason for presence of some gastrointestinal symptoms is also chronic inflammatory state. Inflammation can have many negative effects, including decreased appetite, accelerated protein skeletal muscle breakdown and hypercatabolism. Method 14 peritoneal dialysis patients were included in single Department of Nephrology in the University Medical Center in Ljubljana. All patients were interviewed by a dietitian and nutritional assessment was conducted. Gastrointestinal symptom Rating Scale (GSRS) with 7-grade Likert scale was used to evaluate the intensity of GI symptoms and Bristol Stool Form Scale (BSFS) to classify patient's stool. The dietary intake of peritoneal dialysis patients was assessed using 7-day food diaries and analyzed with Prodi program (PRODI® 6.4 Expert program, Stuttgart, Deutschland). Body composition has been measured with bio impedance spectroscopy. Routine blood analysis was performed. Results Among 14 patients undergoing peritoneal dialysis, most of them were male (71.4%) with average age of 53.07 ± 12.32 years. Average energy intake of 14 patients was 21.05 ± 5.72 kcal/kg body weight per day, average protein intake was 0.87 ± 0.39 g/ kg body weight per day and average fiber intake was 13.75 ± 7.25 g per day. They were inadequate according to the dietary guidelines for peritoneal dialysis patients. Average dietary protein-fiber index was 6.86 ± 3.81 per day. Average PRAL value was 15.84 ± 13.44 for women and 6.52 ± 17.99 for men. Average dietary potassium intake was 1917.80 ± 790.08 mg per day which corresponds to the guidelines for peritoneal dialysis patients and average potassium serum value 4.45 ± 0.42 mmol/L. GSRS questionnaire showed peritoneal patients had minor to mild discomfort in abdominal pain, constipation and indigestion GI symptom cluster. Patients’ self-analysis of stool showed BSFS Types 3.23 ± 1.64 if BSFS Types 3–5 are defined as normal stools. Dietary protein intake strongly correlated with dietary energy intake (r = 0.76, p = 0.003), dietary protein-fiber index strongly correlated with PRAL value (r = 0.70, p = 0.007) and dietary potassium intake moderately to strongly correlated with dietary fiber intake (r = 0.62, p = 0.025). Serum value of IL-6 strongly correlated with dietary potassium intake (r = 0.72, p = 0.006) and moderately to strongly correlated with dietary fiber intake (r = 0.6, p = 0.034). The correlation between dietary potassium intake and serum hsCRP was significant (p = 0.042). The correlation between Bristol stool consistency value and serum hsCRP was significant (p = 0.0255). The correlation between total GSRS score and serum value of albumin was significant (p = 0.0010). The correlation between total GSRS score and dietary potassium intake was significant (p = 0.0015). The correlation between total GSRS score and dietary protein-fiber index was significant (p = 0.0403). Conclusion Gastrointestinal diseases in peritoneal dialysis patients are comparatively understudied in the literature, despite having a significant impact on dialysis efficacy and the quality of life. Analysis of GSRS questionnaire showed that abdominal pain, constipation and indigestion caused minor to mild discomfort in PD patients. The analysis also showed that fiber intake, potassium intake and gastrointestinal symptoms are significantly associated with inflammation markers and are important contributing factors to chronic inflammatory state in these patients. Patients still lack the basic knowledge of nutrition, thus in the future nutritional consultations, innovative teaching techniques and help will be crucial to prevent the decline in nutritional status.

Singapore's herpetofauna: updated and annotated checklist, history, conservation, and distribution.

Given Singapore's location at the confluence of important maritime trading routes, and that it was established as a British East India Company trading post in 1819, it is unsurprising that Singapore has become one of the centres of natural history collecting and research in Southeast Asia. Despite its small size, Singapore is home to a diverse herpetofauna assemblage and boasts a rich herpetological history. The first systematic studies of Singapore's herpetofauna (within the Linnaean binomial framework) date back to Stamford Raffles and the naturalists hired by him who first came to the island in 1819. Specimens that were collected during and after this time were deposited in museums worldwide. Over time, 39 species from Singapore were described as new to science. Due to the entrepôt nature of Singapore with its associated purchasing and trading of specimens (both alive and dead), poor record-keeping, and human introductions, numerous extraneous species from outside of Singapore were reported to occur on the island. Such issues have left a complicated legacy of ambiguous records and taxonomic complications concerning the identity of Singapore's species-rich herpetofauna, many of which were only resolved in the past 30-40 years. By compiling a comprehensive collection of records and publications relating to the herpetofauna of Singapore, we construct an updated and more accurate listing of the herpetofauna of Singapore. Our investigation culminated in the evaluation of 309 species, in which we compiled a final species checklist recognising 166 species (149 native and 17 non-native established species). Among the 149 native species are two caecilians, 24 frogs, one crocodilian, 13 turtles (three visitors), 34 lizards, and 75 snakes. Of the 17 non-native species are five frogs, four turtles, six lizards, and two snakes. The remaining 143 species represent species to be excluded from Singapore's herpetofauna species checklist. For each of the 309 species examined, we provide species accounts and explanatory annotations. Furthermore, we discuss Singapore's herpetofauna from a historical and conservation perspective. Immediate deforestation and nationwide urbanisation following colonisation completely eliminated many species from throughout much of the country and restricted them to small, degraded forest patches. We hope this publication highlights the importance of publishing observations and serves as a valuable resource to future researchers, naturalists, biological consultants, and policy makers in initiating studies on species ecology, distribution, status, and promoting conservation efforts to safeguard Singapore's herpetofauna.

MANAGEMENT OF GESTATIONAL DIABETES MELLITUS: AN INSIGHT INTO EVIDENCE-BASED PRACTICE AMONG POSTGRADUATE TRAINEES OF OBSTETRICS AND MEDICINE DISCIPLINES

OBJECTIVE: To explore the discrepancies regarding screening, diagnosis &amp; management of gestational diabetes mellitus (GDM) among postgraduate trainees of Obstetrics &amp; Gynaecology (OBG) and Medicine disciplines. METHODS: This multicentre cross-sectional study was conducted from 1st to 31st August 2022. The questionnaire regarding screening, diagnosis, management of GDM, &amp; postnatal follow-up with neonatal care were distributed among postgraduate trainees of medicine/OBG through google-form/hardcopies. Data was analysed through SPSS-22 RESULTS: Out of 236 trainees, 184 (78%) were following national institute of clinical excellence (NICE) guidelines for management of GDM. Majority of medicine (n=87/120 (72.5%) &amp; OBG (n=76/116; 65.5%) trainees failed to identify the correct cut-off of oral glucose tolerance test for GDM. A big chunk of both OBG (n=93/116; 80.2%) &amp; Medicine (n=96/120; 80%) trainees were unable to differentiate pre-existing diabetes mellitus from GDM. The clinical knowledge about carbohydrate diet (n=119/236; 50.4%), calories intake (103/236; 43.6%) &amp; low glycaemic index (138/236; 58.5%) was poor among trainees of both specialities. Surprisingly, the medicine trainee’s knowledge about insulin types, dose &amp; tocolytic agent was not evidence-based. The practicing knowledge of both specialities was poor about identification of neonatal hypoglycemia (n=30/236; 12.7%) &amp; its management (n=47; 19.9%). Trainees of both specialities had poor knowledge about postnatal follow-up (n=64/236; 27.1%) of GDM patients. CONCLUSION: GDM is a common domain for OBG &amp; medicine disciplines with no consensus guidelines for its uniform management. This study has identified some basic gaps in the clinical practice of future consultants regarding GDM management, urging the need of combined local guidelines.

How do consumers prefer their care delivered: In-person, telephone or videoconference?

Aim To gain a better understanding of consumer experiences with and preferences for telephone and videoconference consultations (telehealth), and how these compare to traditional in-person consultations. Methods A national cross-sectional survey was administered to a representative sample of Australian adults who have received a telehealth service within the last year. Consumers were recruited by Qualtrics® through their online sampling service. The sample was representative of the broader Australian population according to gender, age, location (state/territory), and place of residence (urban or remote). Information on demographics (e.g., age, gender, employment status), recent telehealth experience, and preferences for consultation modality was collected. To measure preferences consumers were asked to indicate which modality they would prefer (in-person, telephone, or videoconference) for different scenarios. These included consultations of various time lengths, and for the top ten conditions for which individuals sought a general practitioner. Results A total of 1069 consumers completed the survey. When consumers were asked to describe their most recent telehealth appointment, most were for follow-up appointments (67%) and completed by telephone (77%) rather than by videoconference, and with a general practitioner (75%). In-person consultations at a clinic were the top preference in all clinical scenarios presented, except when needing a prescription or to receive test results. In these cases, a telephone consultation was the preferred modality. Inexperience with videoconference and duration of consultation influenced preference for consultation mode. Consumers preferred to have short consultations of around five minutes done by telehealth (telephone or videoconference), while they preferred in-person for longer consultations (up to 60 minutes). Conclusions Many Australians have used telehealth in the past year to access healthcare, with telephone being the most common form of communication. Given the option and the experience to date, consumers prefer telephone when consultations related to either prescriptions or test results. Experience with videoconference for consultations increased consumer preferences for using it for future consultations.

Preliminary assessment of Onchocerca-induced visual impairment using clinical fundus camera in Gashaka local government area of Taraba state, north eastern Nigeria

IntroductionOnchocerciasis is the world's second leading cause of infectious blindness and remains a major problem in parts of Africa. In light of the efforts targeted towards improving ongoing elimination program, this study assessed onchocerca-induced visual impairments in Gashaka local government areas (LGA) in Taraba State, north-eastern Nigeria. MethodsIn 2019, we recruited 158 consenting visually impaired persons across three communities in Garbabi ward of Gashaka LGA. To avoid confusion with co-endemic trachoma, the integrity of the tarsal conjunctiva, eyelashes were assessed using direct light. The anterior segment of the eye was also examined using a torchlight with oblique illumination. However, the posterior segment of the eye was assessed using a fundus camera. Two photographic images for the left and right eye of each participant were captured using the clinical fundus camera. The photographic eye images that were too dark were discarded, and only clear images were analyzed by two ophthalmologists. An ocular manifestation report was recorded for each participant following consensus between the ophthalmologists. ResultsOf the 316 photographic eye images, almost half 146 (46.2%) from 73 participants were just too destroyed for light to penetrate and was not included in the analysis. Only 170 from 85 participants were clear and examinable. A total of 33 (39%) participants had chorioretinitis suggestive of onchocerciasis, including 22(25.9%) with chorio-retinal atrophy, 7(8.2%) and 4(4.7%) had chorioretinal atrophy in combination with early cataract and signs of trachoma respectively. In addition, 3(3.5%) of the participant had eye images which showed lens opacities, 1(1.2%) showed signs of keratoconus and 1(1.2%) showed a scared and pigmented cornea, possibly due to onchocerciasis. Furthermore, 28 (32.9%) had some ill-defined changes and 19 (22.4%) showed poorly defined chorio-retinal atrophy. ConclusionIn a bid to sustain MDA gains towards elimination of onchocerciasis, this work highlights the need for continuous assessment of onchocerciasis induced visual impairment, strengthening of ivermectin delivery and optimizing compliance and patient care among affected populations. These would require resource acquisition and local capacity building. Our preliminary findings call for further operational research on ocular morbidity as well as future stakeholders' consultations in this important and understudied area.

Feasibility of Video Consultation for Preterm Neurodevelopmental Follow-up Care During the COVID-19 Pandemic: Cohort Study.

During the COVID-19 pandemic, parents of infants born very preterm or at risk were exceptionally worried about being infected. The only means of protection during the onset of the pandemic was social distancing. Video consultations for neurodevelopmental follow-up care were offered as an alternative way to stay in contact with patients and their families, to provide expert support, and to monitor and assess children's development. To assess the feasibility of and family satisfaction with video consultations, interviews were conducted after video and in-person consultations. An interview with 28 questions was created to evaluate parental satisfaction with the consultations (eg, their confidentiality and the children's behavior). A total of 93 interviews with parents were conducted between March 2020 and February 2021 and compared (58 after video consultations and 35 after in-person consultations). The interviews were conducted at the end of the consultations by a trained professional. The video consultations were conducted using a certified platform created by Zava Sprechstunde Online, maintaining data protection with end-to-end encryption. Follow-up consultations (video or in-person) were performed at corrected ages of 3, 6, and 12 months as well as 2, 3, 4, and 5 years. The rate of total follow-up appointments attended during the survey period was evaluated and compared with the previous year. There were no significant differences between the video and in-person consultation groups in satisfaction, attitudes on the confidentiality of the consultation, or discussion of private and sensitive information. Following video consultations, parents were significantly more likely to report that they were avoiding contact with medical professionals during the pandemic (P=.045; Shapiro-Wilk W=1094.5, Cohen d=-0.1782146) than the in-person consultation group. Parents in the video-consultation group stated that performing a guided examination on their child was comfortable and helped them understand their child's development. In fact, they agreed to take advantage of future video consultations. The rate of total follow-up appointments increased compared to the previous year. Between March 2019 and February 2020, 782 of 984 (79.5%) children born at Essen University Hospital attended a follow-up appointment. During the survey period, between March 2020 and February 2021, a total of 788 of 1086 children (73%) attended a follow-up appointment, of which 117 (14.9%) were video consultations. The feasibility of attending video consultations for follow-up care of very preterm or at-risk infants and parental satisfaction with these consultations were as high as for in-person consultations. Parents rated video consultations as being as confidential as in-person appointments. Telemedicine can be offered as an equivalent alternative to in-person consultations and is particularly useful under certain circumstances, such as for very sick children who require assistive devices or respiratory support and oxygen or for those living a long distance away.

The Participation of Civil Society in European Union Environmental Law-Making Processes: A Critical Assessment of the European Commission’s Consultations in Connection with the European Climate Law

AbstractThe question of how best to tackle anthropogenic climate change is a thorny one: besides scientific uncertainty regarding the consequences of climate change, another difficulty is that the recommendations of climate experts may clash with the priorities of citizens, interest groups and political institutions. With the European Green Deal, the European Union (EU) recently made significant advances in climate policy; at the same time, and as is well known, the EU and its institutions have long been criticised for their “democratic deficit” and for their failure to involve all civil society actors equally in EU law-making processes. This article sheds light on the legal framework governing civil society participation in EU law-making, and more specifically on the Commission’s consultations pursuant to Article 11(3) of the Treaty on European Union. It then critically assesses selected features of two consultations conducted by the Commission in connection with the European Climate Law, which it evaluates from the perspective of the EU primary law principles of democracy, openness and transparency. Through this analysis, and by suggesting how future climate consultations could be further improved, the article aims to contribute to the (still nascent) legal scholarship on civil society participation in environmental and climate policy.

Impact of covid-19 on subspecialty training in obstetrics and gynaecology

The Covid-19 pandemic brought substantial changes in clinical practice in Obstetrics and Gynaecology (O and G). Redeployment of staff and restrictions in elective services raised training concerns. We sought to assess the impact on subspecialty training, to identify issues to help mitigate the impact. We conducted cross-sectional anonymous electronic surveys of UK subspecialty trainees at three time points: June 2020, February 2021, September 2021. Surveys were analysed by descriptive statistics and thematic analysis of free-text responses. Response rates ranged from 30% to 40%, with higher response rates from urogynaecology trainees. Up to 72% reported an impact on training, most notable in gynaecological subspecialties, and particularly urogynaecology, which persisted over time. More than a third anticipated needing extra time to complete training. This raises serious future workforce and patient care concerns. Clinical recovery should consider training needs as essential when re-establishing services. Subspecialty trainees may need additional time to achieve competencies required of future consultants. IMPACT STATEMENT What is already known on the subject? Covid-19 led to dramatic changes in clinical practice in Obstetrics and Gynaecology. Previous studies on training in O and G during the pandemic in the UK and internationally highlighted issues from redeployment, trainee absence, and changes in service provision, that had potential to severely impact training. What do the results of this study add? Subspecialty training in Obstetrics and Gynaecology has been affected by the pandemic. Urogynaecology was worst affected and continues to be affected over the course of the pandemic. What are the implications of these findings for clinical practice and/or further research? Covid-19 recovery plans need to incorporate training requirements. Extended training due to the pandemic may affect consultant workforce numbers and thus service provision in tertiary care.

A likely pathogenic POLD1 variant associated with mandibular hypoplasia, deafness, progeroid features, and lipodystrophy syndrome in a Chinese patient

BackgroundMandibular hypoplasia, deafness, progeroid features, and lipodystrophy syndrome (MDPL; OMIM# 615381) is a rare autosomal dominant disorder, with only a few reported cases worldwide. Herein, we describe the clinical features and underlying molecular etiology of MDPL syndrome in an 8-year-old Chinese patient.MethodsWe performed otological, endocrine, ultrasound, and radiological examinations, as well as genetic testing. Additionally, the literature concerning MDPL was reviewed to do a retrospective analysis of the pathogenesis, genotype–phenotype correlation, and clinical management.ResultsThe proband was diagnosed with MDPL, presenting with mandibular hypoplasia, a characteristic facial appearance, lipodystrophy, and sensorineural hearing loss (SNHL). Whole-exome sequencing and bioinformatics analysis revealed a de novo missense variant in the POLD1 gene, NM_002691.4:c.3185A>G (NP_002682.2:p.(Gln1062Arg)). The retrospective analysis showed wide variation in the MDPL phenotype, but the most frequent features included mandibular hypoplasia, characteristic facial appearance, lipodystrophy, and SNHL.ConclusionsThis study supplements the mutational spectrum of POLD1. The genetic analysis contributes to the diagnosis of syndromic deafness, and it has a vital role in clinical management and future genetic consultation.

FinTech Past and Future:Ecosystem, Business Model and its Proximate Challenges

FinTech “financial” and “technology” is redefining financial services in the 21st century. It is an advancing intersection of financial services with a technological solution to enhance automated financial services and processes. FinTech is a groundbreaking innovation that has the capability of restructuring the traditional market. It establishes a standard in which information technology drives financial industry innovation. These approaches are advancing expeditiously, embedded by enhancing the economy, policies, and IT sector. It offers facilities including e-trading, funding payment (electronic wallets), e-insurance, e-aggregators, and cryptocurrency via Bitcoin. The main intention of this research is to discover a historical perspective of FinTech to highlight the existing gaps in the literature, and also describe the significance of the Ecosystem toward fintech. The novelty of this area of study is to explore multiple dimensions of FinTech business models, which must be helpful for future business consultants and advisors. Similarly, after evaluating previous research to understand the ground realities and comprehend future directions, technical and management problems of FinTech companies along with future challenges

A UK online survey exploring patient perspectives of remote consultations for managing psoriasis and psoriatic arthritis during the SARS-CoV-2 pandemic

ABSTRACT The use of remote consultations via telephone or video can contribute to the management of people with psoriasis and has allowed continuity of patient care throughout the SARS-CoV-2 pandemic, though little is known about the patient experience. The present study aimed to provide insights into the views and experiences of people with psoriasis and psoriatic arthritis on their remote consultations during the SARS-CoV-2 pandemic and develop guidance for patients and healthcare professionals on how to optimise future remote consultations. We conducted a cross-sectional, on-line survey of people with psoriasis and psoriatic arthritis. Data were analysed using descriptive statistics and Thematic Analysis. Overall, 126 people reported experiences of telephone (92%) or video (8%) consultations. Most participants were satisfied with (78%), and were happy for, remote consultations to continue (21%); few were not (5%). Others did not always want remote consultations (39%) and preferred alternating with face-to-face consultations (18%). Some wanted remote care during the pandemic only (17%). Five themes were identified: (1) Advantages of Remote Consultations; (2) Disadvantages of Remote Consultations plus sub-themes (2.1) Practical Issues and (2.2) the Absence of Non-Verbal Cues and Emotions; (3) Serving a Purpose; and (4) A ‘Good’ Remote Consultation; and (5) Advice to Other Patients. Remote consultations form an important part of psoriatic disease management, mainly for routine follow-up appointments in patients with stable disease, and in addition to face-to-face consultations. Additional skills training for clinicians could improve the quality of remote consultations.

TU7.8 Pay Per View: Cost and Satisfaction of Virtual Video Clinics

AimsThe Covid-19 pandemic necessitated use of video consultations to provide continued patient care. It is not clear if video clinics are well received by patients, or if they are cost efficient. We evaluate the benefits of video consultation and review the impact on waiting times and cost implications to a trust.Methods100 patients referred between January - December 2021 with gallstones were invited to complete a patient satisfaction questionnaire after initial clinic consultation. Patients were divided into three groups based on consultation type; face-to-face, telephone and video consultation (via the Attend Anywhere platform). Secondary outcome measures included time from referral to appointment, time to final outcome and cost implications.Results93 patients responded; 33 video, 30 face-to-face and 30 telephone consultations. Of these patients 62% were female and 38% male with an average age of 51 (25–84).Average time from referral was 22 days in the video cohort, 22 in the telephone cohort and 32 for face-to-face appointments. Of the video cohort, 44% were booked for cholecystectomy from initial consultation and 56% sent for further investigation. The conversion rate from video to face-to-face consultation was zero.50% of respondents stated face-to-face consultations as their preferred method of future consultation, 49% of patients opted for video and 1% preferred telephone consultation. 79% reported increased satisfaction due to convenience of consultation.ConclusionThis study demonstrates video consultations decrease costs and waiting times. Patient satisfaction is comparable to in-person visit. Specific referral criteria and patient selection is essential to maximise the benefits of video consultations.

Development of an Optimal Short Course for Pharmacy Students in Sri Lanka to Enhance the Knowledge of Antimicrobial Resistance

Antimicrobial resistance (AMR) has been identified as one of the greatest threats to human health. Healthcare professionals play a pivotal role in patient care activities, and an understanding of antimicrobial agents and AMR is a critical component of high-quality care. Pharmacists are experts in medicines, and their education and training can directly impact the quality of services they provide to patients. Antimicrobial stewardship (AMS) competencies for pharmacy students have been developed and implemented in the developed world. However, in developing countries like Sri Lanka, there is a gap in the training of pharmacy students in AMS competencies, thereby hindering their ability to be effective in stewardship activities upon graduation.This study presents a protocol that includes learning outcomes and content to explore a national consensus on AMS competencies that will improve knowledge about antibiotics and AMR in pharmacy students in Sri Lanka. The first draft of the proposed curriculum was developed through a literature review, informed by extensive investigations of pharmacy students’ current knowledge and understanding and ensuring suitability in the Sri Lankan context. A process of liaising with academics and stakeholders in Sri Lanka and discussions with academics from developed countries (such as Australia) was used to prepare the final draft. Future consultation and implementation will also seek further input from current and recently graduated pharmacy students in Sri Lanka. The competencies developed will apply to pharmacy undergraduate programs in Sri Lankan universities and for practicing Sri Lankan pharmacists in a continuous professional development program. Once implemented, this protocol will help strengthen AMS education amongst pharmacists in Sri Lanka and ultimately benefit Sri Lankan consumers and assist other health care professionals addressing AMR.

Remote Clinical Assessments and Management During COVID-19: Views of the Patients and Clinicians About the Future Preferences

AimsDuring the COVID-19 pandemic most clinical services changed to remote consultation and management to minimise virus transmission by direct contact. As the social distancing and restrictions have eased with greater control of the pandemic, the nature of consultations is going to change. At this juncture we intended to understand the perception and satisfaction of patients and clinicians on remote consultations and management during COVID-19 and to determine their preference about clinical engagement in the future.MethodsThis was a trust-wide anonymous survey conducted through surveymonkey. It involved both patients and mental healthcare staff (MHS) and explored about the quality and satisfaction in remote consultations, option to patients, and use of remote consultations in future. Clinicians were sent the online link to complete, with a reminder two weeks later. The patients were explained during their appointments about the survey, those who agreed to participate and gave informed consent, their responses to the questions were recorded.ResultsThe sample consisted of 78 patients and 107 MHS representing adult, old age, children and adolescent and intellectual disability subspecialties. Most (92.4%) participants had participated in remote consultations and understood the reason behind it. Around a third (32.7%) of MHS and 46.2% of patients felt strongly satisfied in remote consultations, and together with satisfaction these were 56.1% v 71.8% respectively (p &lt; 0.05). The quality of the remote consultations were considered somewhat (11.2% v 23.1%) or a lot better (8.4% v 15.4%) by MHS and patients respectively (p &lt; 0.05). Majority (82.7%) felt that an option should be given to patients for the type of consultation, face to face or remote. After the pandemic, the preference for psychiatric consultations were primarily face to face (30.3%), primarily remote (8.6%) and a mixture of the two (61.1%); there were no difference between patients and MHS. However while 71.4% doctors, 70.8% other clinicians (occupational therapists and psychologists) and 75.0% of clinical managers opted for mixture of face to face and remote, 26.9% of nurses opted for that. Background subspecialty, age group, ethnicity, experience of remote consultation with GP or hospital doctors, attendance or admission to general or psychiatric hospitals during pandemic, disabilities, or having COVID-19 did not influence the suggestion for the future consultation type.ConclusionFollowing the pandemic, both clinicians and patients express a preference for a mixture of face to face and remote consultations; and an option regarding that should be given to the patients.

The Effects of Remote Consultation (RC) on Outpatient Clinic Attendance Rates in City Community Mental Health Team (CMHT) and Patient Feedback on RC

AimsThe outbreak of COVID-19 in 2020 forced a sudden change in service delivery in CMHT. Remote consultations (RC) via telephone or video were introduced to facilitate safe contact between staff and patients. Traditional face to face (F2F) appointments have high rates of non-attendance (DNA). This project aimed to examine whether the DNA rate for CMHT appointments has been affected by the introduction of RC. In addition to this, patients were asked to give feedback about how they felt about the use of RC.MethodsWe retrospectively studied the outcome of outpatient medical appointments within City CMHT over two periods, namely pre COVID-19 which was between April to June 2019 and during COVID-19 which corresponded to the same period in 2020. A list of patients over these two periods were extracted from trust electrical medical record: System One (S1). Further review patients’ notes on S1 was conducted to identify DNA group, among which detailed information including gender, age groups, types of outpatient clinics (urgent or routine, first review or follow-up review), types of consultations (remote or F2F).In addition, an anonymous patient feedback form on RC was given out to 30 patients attending F2F appointments at the clinic between May and August 2021.Results94% appointments were conducted remotely in 2020 while 100% were F2F in 2019 during the periods studied. 2020 saw a 16% increase in attendance rate and a nearly half reduction in cancelled appointments from 30% to 16%. There was a slight drop in DNA rate by 2%.19 patient feedbacks indicated at least one RC experience. Among them, 47% rated it as very good and 58% felt RC offered the same level of care and treatment as F2F. On the other hand, 74% would like to be seen F2F for future appointments when given a choice.Free comments about RC were captured including ‘Not everything gets covered’, ‘it makes me anxious to talk to a medical team over the phone’ and ‘things like bruises could be missed in a RC’. However, one patient said they found RC is less stressful.ConclusionA massive shift from F2F to RC was seen due to COVID-19 restriction. Attendance rated was improved with RC, however, it was mainly achieved by a significant reduction in cancelled appointments. Its impact on overall DNA rate appeared minuscule.Despite nearly half of the patients indicated RC is as good as F2F. Most patients prefer f2f for future consultation.

P140 Patient experience of osteoporosis telephone consultations

Background/AimsThe COVID-19 pandemic resulted in a rapid change to the use of virtual consultations in both primary and secondary care. Since April 2020, our osteoporosis clinic appointments have predominantly been undertaken by telephone. We wanted to assess our patients’ experience of telephone consultations.MethodsA patient feedback questionnaire was developed by the osteoporosis team which was validated by the Patient Advice and Liaison Service team (PALS) at the Royal United Hospital Bath. A questionnaire consisting of 15 questions was sent to patients following their telephone consultation. Patient consent to receive the questionnaire was requested by the consulting clinician for each participant. The patients were provided with a stamped addressed envelope to return the completed anonymous questionnaire. Thematic analysis was used to identify themes in the qualitative data.ResultsA total of 39 questionnaires were completed. More than 86% of patients reported that their telephone consultation definitely met their needs. Over 89% answered ‘yes definitely’ to questions regarding understanding of the reason for their appointment, opportunities for questions, clear understandable answers, feeling listened to, and treatment plans. 59% of patients responded ‘yes definitely’ that they were given information prior to the appointment about what would happen in the consultation, 10% reported they hadn’t, with 31% responding they had but to some extent only. 72% of respondents reported that it was clear who they should contact if they had any further questions following the consultation. Regarding preference for future appointments, 47% of patients indicated that they would prefer a mixture of telephone, face to face and video consultations; 24% preferred telephone, 16% preferred hospital face to face, and 3% preferred video. 11% reported that they had no preference. Thematic analysis of individual comments identified positive themes such as flexibility, good communication with clinicians and convenience. Areas for development are around communication with regard to physical barriers such as hearing and telephone signal problems. There are also limitations around both physical examination and the transmission of implicit information (non-verbal communication).ConclusionVirtual consultations provide an opportunity to safely assess patients whilst meeting social distancing requirements and minimising patient flow through the hospital. Questionnaire analysis indicates an overall positive experience of telephone consultations. However, most patients would prefer a mixture of face to face, video and telephone consultations in future. There are a number of areas for improvement including: a review of the information provided to patients prior to the consultation, review of contact information for patients following the consultation, and mechanisms for identifying patients with physical/sensory limitations. The information gained through this small review will help us improve the overall telephone consultation experience for our patients.Disclosure J.L. Webb: None. S.A. Hardcastle: None. S.M. Warren: None. D.J. Hart: None. J.A. Shipley: None. T. Ahmed: None.

Overview of practice of Consultation-Liaison Psychiatry.

Overview of practice of Consultation-Liaison Psychiatry.

Stress among doctors doing residency: a cross sectional study at a tertiary care hospital in Vijayapura, Karnataka

Background: Young budding doctors doing residency is a very stressful period. There is growing concern about stress in doctors working in hospitals. So, this study was carried out to study the proportion of stress and associated factors influencing stress among resident doctors at a tertiary care hospital in Vijayapura, Karnataka.Methods: A cross-sectional study was conducted in BLDE (Deemed to be University), Shri B. M. Patil medical college, hospital and research centre, Vijayapura from July 2019 to December 2019. The perceived stress scale, 10-item self report questionnaire was used to assess the level of stress. analysis was done using SPSS 16. Results: A total of 207 post graduate residents were interviewed.90% of postgraduate students responded and all were above the age of 24 years. 52.7% were males and 47.3% were females. Of all postgraduates 91.3% were Hindu, 5.3% were Muslim by religion. Our study has revealed more stress among 2nd year resident doctors.Conclusions: Fixed duty hours, counselling and social support can help in improving the physical and mental well-being of these young doctors, who are an integral part of the health care system. Stress should be evaluated to get better future health consultants.

Telephone Clinics During the Covid-19 Pandemic-The Experiences of Interstitial Lung Disease Patients and Their Carers.

The COVID-19 pandemic has resulted in a widespread move towards virtual consultations within secondary care due to infection concerns. This service evaluation undertaken in a Welsh Interstitial Lung Disease (ILD) specialist center looks at the experiences of unselected ILD patients and their careers with telephone consultations and aims to identify the role of telephone consultations in future practice for this patient group. A mixed methods approach was used with an initial postal questionnaire followed by a virtual focus group. From the 84 patient and 26 carer questionnaire responses, there was broad support for telephone consultations from both groups. The main perceived benefit was reduced infection risk, although face-to-face consultations were seen as holding more value. Themes identified in the virtual focus group of 6 participants recognized the need to balance quality of care against practical considerations. In conclusion, there was support for future telephone consultations if patients and clinicians have flexibility in determining when this occurs, instead of a face-to-face consultation.