Outpatient Clinic Appointments Research Articles

Carbon Emission Reduction Associated With Utilisation Of Telehealth In Outpatient Clinics In An Australian Quaternary Health Service

Objective: To assess the impact of implementing telehealth in outpatient clinics on the carbon emissions associated with the delivery of health care. Design & Setting: Retrospective cohort study in large metropolitan quaternary referral health service from January 2021- December 2022. Participants: All patients who attended an outpatient clinic appointment during the study period, either in-person, via telehealth or via telephone. Main outcome measures: The estimation of carbon emissions in tonnes (t) of CO2-equivalent (CO2-e) associated with in-person and telehealth appointments based on emissions associated with travel, telehealth platform usage and N95 mask usage. Results: There were 571,121 outpatient clinic appointments during the study period. Of the appointments, 251,458 (44%) were conducted remotely, resulting in an estimated reduction in 3,629t of CO2-e emissions in the two-year period. Telehealth consultations in this time contributed 4.5t of CO2-equivalent emissions. The total emission usage of telehealth clinic was only 0.12% of emissions generated from face-to-face clinic appointments. Conclusion: Telehealth offers the opportunity of substantial carbon emissions reduction within the healthcare sector, while also providing cost and time-saving benefits for healthcare services and patients. Limitations include generalisation of transportation modes and the retrospective nature of the data collection.

Spine to pelvis “T-Construct” using magnetic controlled growing rods in non-walkers neuromuscular early-onset scoliosis: a preliminary study

BackgroundsMagnetic controlled growing rods (MCGRs) have been proven to be effective in controlling early onset neuromuscular scoliosis but no study has evaluated the combination with a sacro-bi-iliac construct. The aim of our study is to report surgical management of early onset non-walkers neuromuscular scoliosis correction using MCGRs associated with a sacro-bi-iliac “T-construct” and its mid-term outcomes. Our hypothesis was that this set-up provided well correction of the pelvic obliquity and that this correction was maintained over time. MethodsA retrospective single-center study was conducted including all consecutive neuromuscular early onset scoliosis who underwent spinopelvic fixation using “T-construct” with two MCGRS. Four millimeters lengthening was performed every 4 months during outpatient clinics sessions. All children had a low-dose biplanar stereoradiography in EOS-Chair at pre/postoperative phase, each outpatient clinic appointment and last follow-up. ResultsEighteen patients were included and 17 analyzed at the last follow-up. The mean age at surgery was 9.5 (range from 5 to 12 years), the mean follow-up was 4,7 years (range from 2.5 to 6.6 years) and 8 patients had a Risser stage above four. The global complication rate was 35% (N = 6/17 patients) including three medical and three mechanical complications related to “T-construct”, while the reoperation rate was 18% (N = 2 patients for wound debridement and one for iterative pelvic fixation). Cobb angle and pelvic obliquity were significantly improved by surgery (mean correction was 33.2 ° (55%) and 11 ° (77%) respectively; p < 0.001). At the last follow-up, we noted a loss of frontal Cobb angle correction (p < 0.01) whereas we did not observe any significant loss of pelvic obliquity (p > 0.9). ConclusionsAlthough the global complication rate was 35% (half of which are mechanical complications), the treatment combining pelvic T-construct and MCGRs provides satisfactory correction of pelvic obliquity correction, good maintenance in the medium term and may be a procedure to consider for the surgical treatment of early onset neuromuscular scoliosis. Level of evidenceIV; Retrospective cohort prognostic study

Determining the role of remote consultations in general surgical practice in Scotland: a qualitative questionnaire-based study

INTRODUCTION Telemedicine consultations became widespread during the COVID-19 pandemic to deliver healthcare while minimising viral transmission. Research around establishing the role of remote appointments in general surgery outpatient clinics after the pandemic has not been undertaken. The aim of this study was to investigate views on remote consultations to determine this. METHODS Patients attending the adult general surgical outpatient clinic at Aberdeen Royal Infirmary between August 2021 and January 2022 as well as general surgeons from three neighbouring hospitals were invited to complete an anonymous questionnaire on the acceptability of remote and face-to-face (F2F) appointments in pre and postoperative scenarios. Differences in patients’ preferences between demographic groups, and between patients’ and surgeons’ views were analysed. RESULTS A total of 51 patients and 26 surgeons responded. Patients’ views differed depending on demographic parameters and the scenario. Patients and surgeons had similar views on preoperative consultations. Given the choice of telephone, video or F2F appointments, the F2F option was overall most popular. Patients and surgeons differed in their views on remote consultations following surgery and acute admissions. In some scenarios, young patients, those who lived in remote regions and those in employment/education preferred remote appointments. CONCLUSIONS While telemedicine is feasible and acceptable in general surgery clinics, there are differences in preferences between surgeons and patients. Patients’ preferences varied depending on their background, home circumstances and clinical context. Service provision should ensure that when remote consultations are available, patient preference is prioritised rather than surgeon ease.

Living With Spasticity During the COVID‐19 Pandemic: A Qualitative Study of Patient, Carer and Physician Experiences

ABSTRACTBackgroundApproximately 4.4 million people in England (8% of the total population) are living with a long‐term neurological condition. Within this group of vulnerable individuals, there will be individuals living with severe spasticity that requires regular outpatient treatment with botulinum toxin injection. The closure of outpatient spasticity services during the pandemic impacted individuals who required spasticity treatment and their carers, as well as the specialist clinicians responsible for service delivery.ObjectivesWe aimed to gain insight into the experiences of individuals living with spasticity, their carers and a clinical spasticity service lead during the pandemic, and to reflect on potential learning for the future.MethodsA qualitative study was designed using semi‐structured interviews conducted by telephone. Participants comprised patients living with a long‐term neurological condition who attended outpatient spasticity clinics before the start of the pandemic in England, primary carers who accompanied patients attending these clinics and a clinical spasticity service lead. Data were audio recorded, transcribed, anonymised and coded. Data analysis utilised the One Sheet of Paper thematic approach to identify themes, which were discussed and analysed by the interdisciplinary research team and two patient and carer participants.ResultsOut of the 11 participants recruited, aged 36–77 years, seven comprised people living with spasticity related to a long‐term neurological condition, three were carers and one was a clinical spasticity service lead. Six participants were male and five were female. Among the participants, four were stroke survivors, two were living with spinal cord injury and one was living with multiple sclerosis. Analysis revealed six major themes: experience of living with spasticity during the pandemic; impact of the pandemic on patient, carer and clinician health; access to and experience of outpatient clinic appointments; coping strategies during the pandemic; system improvements; and learning from the pandemic period.ConclusionThese findings contribute research knowledge to a very limited research knowledge base and suggest that there is scope for improving system and service delivery through the allocation of research funding to senior clinicians working in this specialist area.

Tracking aspects of healthcare activity during the first nine months of COVID-19 in Ireland: a secondary analysis of publicly available data.

Sláintecare aims to introduce universal healthcare in Ireland. The COVID-19 pandemic poses both challenges and opportunities to this process. This study explored the impact of COVID-19 on aspects of Irish healthcare during the first nine months of the pandemic and considers the implications for Sláintecare implementation. Secondary analysis was undertaken on publicly available data on three key domains of the Irish healthcare system: primary care, community-based allied healthcare, and hospitals. Descriptive statistics were computed using Microsoft Excel 2016. Up to March 2021, 3.76 million COVID-19 tests were performed by Ireland's public healthcare system, 2.48 million (66.0%) of which were referred from the community. General practitioners delivered 2.31 million telephone triages of COVID-19 symptoms, peaking in December 2020 when 416,607 consultations occurred. Patient numbers across eight allied healthcare specialties fell by 35.1% versus previous years, with the greatest reductions seen in speech and language therapy (49.0%) and audiology (46.1%). Hospital waiting lists increased from 729,937 to 869,676 (or by 19.1%) from January 2019 to January 2021. In January 2021, 629,919 patients awaited a first outpatient clinic appointment, with 170,983 (27.1%) waiting longer than 18 months. The largest outpatient lists were observed in orthopaedic surgery (n=77,257); ear, nose and throat surgery (n=68,073); and ophthalmology (n=47,075). The proportion of patients waiting more than 12 months for a day-case gastrointestinal endoscopy rose from 6.0% in January 2020 to 19.0% in January 2021. Healthcare activity has been significantly disrupted by COVID-19, leading to increased wait times and greater barriers to healthcare access during the pandemic. Yet, Ireland's health system responses also revealed strong willingness and ability to adapt and to implement novel solutions for healthcare delivery, rapidly and at scale. This has demonstrated what is achievable under Sláintecare and provides a unique opportunity to 'build back better' towards sustainable recovery.

FP3.7 - Do we need to follow up perianal abscesses in clinic?

Abstract Aim The Association of Coloproctology of Great Britain and Ireland (ACPGBI) states those who present with their first perianal abscess do not require routine follow up in clinic after surgical intervention. This audit aimed to assess the percentage of perianal abscess patients being referred to clinic and their subsequent clinic outcome. An additional outcome was a cost analysis of clinic waste. Methods We reviewed the patient records of all patients who underwent an incision and drainage of perianal abscess between 1st January 2022 to 31st December 2022 within a district general hospital setting. We recorded the number of these patients being referred to clinic and their clinic outcome. The 2022/23 National Tariff Workbook resource was used to analyse the cost of clinic wastage. Results A total of 72 incision and drainages of perianal abscesses were performed in 2022 and 92% (N=66) were first presentation perianal abscesses. 46% (N=33) had a post-operative outpatient clinic appointment requested; and of these 67% (N=22) were first presentation perianal abscesses. This culminated in a total cost burden of £1568; in addition to prolonging patient anxiety, increasing their need for time off work and adding to NHS clinic wait time. Conclusion As per guidance, first presentation perianal abscesses do not need to be seen in clinic. The results suggest that we are referring too many patients to colorectal or general surgery outpatient clinics, which is increasing workload, adding to financial costs and affecting patient care.

2222 Individual telephone calls to frail older adults improve outpatient clinic attendance rates

Abstract Introduction The multidisciplinary assessment clinic (MDAC) is an outpatient service for older people at a district general hospital. Patients are triaged to the MDAC clinic if they have geriatric syndrome (for example falls) plus comorbidity and/or mobility, social or cognitive concerns. The service had a high ‘did not attend’ (DNA) rate compared with other geriatric outpatient clinics. This project aimed to reduce MDAC DNA rates and improve cost effectiveness through implementation of a new pre-appointment telephone service. Method We analysed six months of attendance data prior to establishing the pre-appointment telephone service. The existing system consisted of a standardised trust appointment letter and a text message reminder. For the new system a healthcare assistant (HCA) telephoned patients the day before their appointment to confirm attendance and discuss any concerns. We analysed six months of attendance data following the implementation of the new system and compared DNA rates. Results Prior to implementation of the new pre-appointment telephone service, 29 of 268 patients DNA (11%). From the second data set, following implementation of the new telephone system, 11 of 253 patients DNA (4%). Successful contact was made with 72% of those phoned, allowing confirmation or cancelled appointments to be rebooked. Chi square analysis found a significant difference between the two systems, with a p value of &amp;lt;0.01 indicating an improvement in attendance rates with the new system. Conclusion Telephoning frail older patients prior to an outpatient clinic appointment significantly reduces DNA rates—a similar system could be implemented in other geriatric medicine outpatient settings.

The Development and Feasibility of a Novel Electronic Patient-Reported Outcome Measures (Eproms) Questionnaire in patients with penile cancer

BackgroundPenile cancer (PeCa) is a rare cancer with surgical options that affect patients’ quality-of-life. Patient-reported outcome measures (PROMs) are uncommonly utilized in this cohort despite their several patient-centered benefits and there are recommendations to further digitalize PROMs. This prospective, population-based study aimed to report the development and feasibility of a novel electronic patient-reported outcome measures (ePROMs) questionnaire for patients with PeCa. Materials and methodsA novel ePROMs questionnaire was developed and sent to patients 3 days before outpatient clinic appointments. The questionnaire included up to 30 items on patient symptomology and quality-of-life, including a self-reported quality-of-life score (rated 0 being worst and 100 being best). Data were collected for patients followed up between August 2021 and May 2022. The primary feasibility outcomes, adherence and engagement, were measured by response and drop-out rates. Differences in responders and nonresponders were also ascertained. Secondary outcomes explored the clinical utility of the questionnaire. Responders were subcategorized into 3 groups: circumcision (Ci), partial penectomy (PP) or total penectomy (TP) and differences were analyzed. This study was approved by the local Trust Governance Panel, including for ethical considerations. Results220 adult males were sent ePROMs questionnaires, and 141 (64%) responded initially. The mean dropout rate of subsequent questionnaires was 56%. The maximum number of questionnaires sent to and completed by a patient was 8 (n = 1). Nonresponders were older (P < .0001), with poorer performance status (P < .0001) and lower body mass index (P = .0288). TP patients reported the lowest median quality-of-life score 68.50 (8-99), followed by the Ci group (72.0, 37-94) and the PP group (76.0, 10-99). ConclusionsPatients initially engaged and adhered to the ePROMs questionnaire but struggled to maintain this over time. Clinical data gathered by the questionnaire may be utilized to inform patient care. The questionnaire requires additional validation, research, and education.

Comparison of 30-day retention in treatment among patients referred to opioid use disorder treatment from emergency department and telemedicine settings

IntroductionTelemedicine is a feasible alternative to in-person evaluations for people with opioid use disorder (OUD). The literature on medications for opioid use disorder (MOUD) telemedicine has focused on ongoing OUD treatment. Emergency department (ED) visits are an opportunity to initiate MOUD; however, little is known regarding the outcomes of patients following telemedicine referrals for MOUD from emergency settings. The current study describes rates of initial outpatient clinic appointment attendance and 30-day retention in care among patients referred by telemedicine compared to ED referrals. MethodsThis paper reports a retrospective review of data for patients referred from EDs or telemedicine through the Medication for Addiction Treatment and Electronic Referrals (MATTERS) Network. The MATTERS online platform collects data on patient demographic information (e.g., age, gender, race/ethnicity, and insurance type), reason for visit, prior medical and mental health history, prior OUD treatment history, and past 30-day substance use behaviors. Analyses compared initial visit attendance and 30-day retention among the patients for whom follow-up data were received from clinics by demographic and initial treatment factors. ResultsBetween October 2020 and September 2022, the MATTERS Network made 1349 referrals; 39.7 % originated from an ED and 47.8 % originated from telemedicine. For patients with available data, those referred from telemedicine were 1.64 times more likely to attend their initial clinic appointment and 2.59 times more likely be engaged in treatment at 30 days compared to those referred from an ED. More than two-thirds of patients referred from the emergency telemedicine environment followed up at their first clinic visit and more than half of these patients were still retained in treatment 30 days after referral. ConclusionsThe rates of initial clinic visit and 30-day retention when referred following a telemedicine evaluation are encouraging. Further development of telemedicine programs that offer evaluations, access to medications, and referrals to treatment should be considered.

Characteristics of the Basel Postpartum Hypertension Cohort (Basel-PPHT Cohort): An Interim Analysis.

Postpartum hypertension (PPHT) is hypertension that persists or develops after delivery and is a frequent cause of readmission, affecting 10% of pregnancies. This interim analysis aims to describe the cohort and to determine the feasibility and acceptance of a home-based telemonitoring management strategy (HBTMS) in PPHT patients. Enrollment at the University Hospital Basel began during the 2020 SARS-CoV-2 pandemic. Maternity-ward patients were screened for preexisting hypertension, hypertensive disorders of pregnancy, and de novo PPHT. In this pragmatic non-randomized prospective trial, the participants chose the HBTMS or standard of care (SOC), which consisted of outpatient hypertension clinic appointments. The HBTMS was a smartphone application or a programmed spreadsheet to report blood pressure (BP), followed by telephone consultations. Three months postpartum, the participants underwent a 24 h BP measurement and a blood, biomarker, and urine analysis. A total of 311 participants were enrolled between 06/20 and 08/23. The mean age was 34 (±5.3) years. The current pregnancy history demonstrated the following (≥1 diagnosis possible): 10% had preexisting hypertension, 27.3% gestational hypertension, 53% preeclampsia (PE), 0.3% eclampsia, 6% HELLP (hemolysis, elevated liver enzymes, and low platelets), and 18.3% de novo PPHT. A family history of cardiovascular disease and PE was reported in 49.5% and 7.5%, respectively. In total, 23.3% were high-risk for PE. A total of 68.5% delivered via c-section, the mean hospitalization was 6.3 days (±3.9), and newborn intrauterine growth restriction occurred in 21%. A total of 99% of the participants chose the HBTMS. This analysis demonstrated that the HBTMS was accepted. This is vital in the immediate postpartum period and pertinent when the exposure of hospital visits should be avoided.

Deferring diagnostic evaluation of suspected deep vein thrombosis using direct oral anticoagulant or low-molecular-weight heparin as a single dose anticoagulant: A prospective real-world study in a regionwide care pathway

BackgroundPatients with suspected deep vein thrombosis (DVT) are typically referred to the emergency department for immediate evaluation. To enhance efficiency, our hospital implemented a regional, general practitioner (GP)-driven DVT care pathway, deferring diagnostic evaluation to a scheduled outpatient DVT clinic appointment the following day. Patients receive a single dose anticoagulant from their GP to prevent thrombosis progression while awaiting diagnostic workup. This prospective study aimed to evaluate the safety and patient preferences regarding the DVT care pathway and the type of single dose anticoagulant (low-molecular-weight heparin (LMWH) vs. direct oral anticoagulant (DOAC)). MethodsPatients enrolled in the DVT care pathway between June 2021 and July 2023 were eligible. Until July 2022, LMWH was administered, and thereafter, the protocol recommended DOAC as the single dose anticoagulant. Patients completed questionnaires, incorporating patient-reported outcome and experience measures (PROMs/PREMs), during their DVT clinic visit and after five days. The primary endpoint was bleeding events within 72 h of receiving the single dose anticoagulant. ResultsOf 460 included patients, 229 received LMWH and 231 received DOAC as the single dose anticoagulant. DVT was confirmed in 24.8 % of patients. No major or clinically relevant non-major bleeding were reported. LMWH was associated with more minor bleedings (22.3 % vs. DOAC 13.4 %), primarily attributed to injection site hematomas. Patients reported high satisfaction with the DVT care pathway (96.5 %) and generally preferred DOAC over LMWH. ConclusionDeferring diagnostic evaluation for DVT using a single dose of either LMWH or DOAC in a real-world population is deemed safe. Considering practical advantages, patient preferences, and fewer skin hematomas, we favor DOACs as the single dose anticoagulant in this care pathway.

#841 Healthcare workload amongst people with chronic kidney disease: what impact do mental disorders have?

Abstract Background and Aims People with chronic kidney disease (CKD) often experience a high healthcare workload in the form of medication management, contacts with healthcare services, and other tasks. Co-existing health conditions can increase healthcare workload, with mental disorders generating additional workload alongside physical conditions. We hypothesised that mental disorders in people with CKD would be common and that healthcare workload would be elevated for people with mental disorders. Method Data were used from the Secure Anonymised Information Linkage Databank: primary care data for people living in Wales, UK, with linkage to hospital records. We studied adults over the age of 18 with CKD G3-5 not on kidney replacement therapy. We defined “mental disorder” as any primary care-recorded diagnosis of anxiety, depression, eating disorders, schizophrenia, and/or bipolar disorder. We estimated healthcare workload by quantifying visits to accident and emergency (A&amp;E), days spent in hospital during emergency admissions (general hospitals and psychiatric hospitals), number of outpatient clinic appointments, locations of clinic appointments, and number of long-term medications prescribed. We estimated associations between mental disorders and healthcare workload using negative binomial models, making adjustments for age, sex, diabetes, ischaemic heart disease, smoking status, and socioeconomic deprivation. Results Of 173 388 people with CKD, mean age was 77 years, 54 537 (31.5%) had one or more mental disorder and 20 374 (11.8%) had two or more. Over a median follow-up period of 5.5 years, people with CKD and mental disorders spent a median 1.9 days in hospital (interquartile interval [IQI] 0.0 to 14.7) compared to people with CKD without mental disorders: 1.0 (IQI 0.0 to 9.9) days. People with CKD and mental disorders attended a median of 2.6 clinics (IQI 1.0 to 5.5) compared to people with CKD without mental disorders: 2.3 (IQI 0.8 to 4.9). The presence of any mental disorder was associated with more days spent in hospital: adjusted rate ratio (aRR) 1.58 (95% confidence interval 1.54-1.62), more A&amp;E attendances: aRR 1.37 (1.35-1.39) and more clinic appointments: aRR 1.13 (1.11-1.14). The association with hospital days was strongest for people with eating disorders: aRR 3.70 (2.50-5.49). People with any mental disorder attended a similar number of locations for clinics than those without mental disorders: median 2 for both groups (IQI 1 to 3). However, people with schizophrenia, bipolar disorder or eating disorders attended more locations: median 3 (IQI 2 to 4). People with mental disorders took more medications (median 9: IQI 6 to 13) than those without mental disorders (median 7: IQI 4 to 10). Conclusion Mental disorders are common amongst people with CKD and healthcare workload is greater for people with than without mental disorders. Although a proportion of the increased healthcare workload might be expected (such as people taking medications for their mental health), the additional days spent in hospital is a notable finding. This may reflect problems with how these people experience healthcare and it is likely to have an impact on their quality of life. Targeted work is required to understand the specific healthcare needs of people with CKD and mental health disorders.

Evaluating the Impact of the COVID-19 Pandemic on Late-Canceled and No-Show Appointments at the Department of Neurological Surgery.

The coronavirus disease 2019 (COVID-19) pandemic resulted in unprecedented restrictions on the general public and disturbances to the routines of hospitals worldwide. These restrictions are now being relaxed as the number of vaccinated individuals increases and as the rates of incidence and prevalence decrease; however, they left a lasting impact on healthcare systems that is still being felt today. This retrospective study evaluated the total number of canceled or missed outpatient clinic appointments in a Neurological Surgery department before and after peak COVID-19 restrictions and attempted to assess the impact of these disruptions on neurosurgical clinical attendance. We also attempted to compare our data with the data from another surgical subspecialty department. We evaluated 32,558 scheduled appointments at the Loyola University Medical Center Department of Neurological Surgery, as well as 139,435 scheduled appointments with the Department of Otolaryngology. Appointments before April 2020 were defined as pre-COVID, while appointments during or after April 2020 were defined as post-COVID. Here, we compare no-show and non-attendance rates (no-shows plus late-canceled appointments) within the respective time range. Overall, we observed that before COVID-19 restrictions were put into place, there was an 8.9% no-show rate and a 17.4% non-attendance rate for the Department of Neurological Surgery. After COVID restrictions were implemented, these increased to 10.9% and 18.3%, respectively.Greater no-show and cancellation rates (9.8% in the post-COVID era vs 8.0% in the pre-COVID era) were associated with varying socioeconomic and racial demographics. African-American patients (2.56 times higher), new-visit patients (1.67 times higher), and those with Medicaid/Medicare insurance policies (1.48 times higher) were at the highest risk of no-show in the post-COVID era compared to the pre-COVID era.

Effect of Financial Penalties on Appointment Nonadherence in Academic Obstetrics and Gynecology Clinics [ID 2683433

INTRODUCTION: The objective of this study was to examine the effect of patient financial penalties on appointment nonadherence within a single academic institution's obstetrics and gynecology outpatient clinics. METHODS: This retrospective policy effectiveness-implementation hybrid study included administrative data from all appointments at a single academic institution’s obstetrics and gynecology outpatient clinics from May 1, 2018, to April 30, 2022. Institutional review board approval was waived for this study. The department-wide patient financial penalty policy for appointment nonadherence was implemented on May 1, 2020. We conducted an interrupted time series analysis after stratifying by insurance (Medicaid versus all insurance). Poisson regression was used to calculate incidence risk ratios (IRRs) with 95% CIs. RESULTS: There were 414,006 obstetrics and gynecology outpatient clinic appointments (pre-implementation [pre]: 208,696; post-implementation [post]: 205,410). Of these, 58,473 (14.1%; pre: 29,533 [14.2%]; post: 28,940 [14.1%]) appointments were not attended. Compared to the all insurance group, Medicaid patients had a higher rate of appointment nonadherence (36,872/188,343 [19.6%]; pre: 18,070 [19.6%]; post: 18,802 [19.6%]). In the all insurance group, the implementation of financial penalties resulted in a 4% increase in nonadherence (IRR 1.04 [95% CI, 0.99–1.09]). In the Medicaid group, the implementation of financial penalties did not change nonadherence (IRR 1.00 [95% CI, 0.98–1.02]). There was no significant difference in the coefficient between Medicaid and all insurance groups (P&gt;.05). CONCLUSION: Institutional implementation of patient financial penalties for appointment nonadherence did not change appointment nonadherence rates in obstetrics and gynecology outpatient clinics. The lack of change persisted after stratifying by insurance despite the inability to charge Medicaid patients a financial penalty for appointment nonadherence.

BEEC psychosocial screening at Royal Manchester Children's Hospital

Bladder Exstrophy and Epispadias Complex (BEEC) is associated with psychosocial difficulties. Screening questionnaires, alongside consultation with a clinical psychologist, can help identify children/young people for further assessment and track trends over time to improve service delivery. To screen paediatric BEEC patients for a range of general psychosocial difficulties in a multi-disciplinary out-patient clinic setting and compare these results with our previous study and against published norms. The current service evaluation collected data at outpatient BEEC clinic appointments between 2016 and 2022 (2016-2022 sample). Children aged 4-5, 10-11 and 14-15 years and their parents/proxy were asked to complete two standardised psychosocial questionnaires: Paediatric Quality of Life Inventory (PedsQL 4.0 Generic Core and Family Impact Module) and the Strengths and Difficulties Questionnaires (SDQ). 79 children (CYP) and 93 parent/proxy (P/P) responses were recorded. The sample included paired CYP and P/P responses for the PedsQL (n=67) and SDQ (n=35). The mean age for CYP was 9.9 years (SD 3.99, range 2-17), 69.8% (n=120) of responses for male children. The percentage of total CYP scores falling within the 'At Risk' category on the PedsQL increased in the 2016-2022 sample compared to our 2015 sample, indicating the prevalence of greater difficulties. Differences between P/P and CYP responses on both the PedsQL and SDQ favoured CYP. Age, gender, and diagnosis appeared to influence certain questionnaire responses, depending on respondent (CYP or P/P). A significant difference between P/P and CYP in the emotional domain of the PedsQL for those aged 13-18 was observed (p=0.020), with P/P reporting greater difficulties, but this was not seen in the younger age ranges. Physical Health on the PedsQL were significantly lower for children with a cloacal exstrophy diagnosis, in comparison to bladder exstrophy and epispadias. P/P SDQ scores for boys were significantly higher in several domains. The results demonstrate the need for psychosocial screening, providing benchmarking for psychosocial difficulties within this patient group. Results indicate that patients accessing our clinic are reporting a higher level of challenge across psychosocial domains in recent years reflected by the percentage within the 'At Risk' category for psychosocial difficulty. Linked questionnaire data with condition specific information and surgical history would improve service evaluations. CYP reaching clinical thresholds are offered further psychological assessment within the service.

P065 Patient-initiated follow up in rheumatoid arthritis: a systematic review and meta-analysis

Abstract Background/Aims Inflammatory arthritides including rheumatoid arthritis (RA) typically require lifelong outpatient care. Patient-initiated follow up (PIFU) has been employed to alleviate burdens on over-stretched rheumatology clinics, aiming to eliminate unnecessary clinic visits and reduce waiting times. There is a paucity of robust data to establish whether clinical outcomes differ under PIFU compared to clinician-mandated follow up. We examined the effect of PIFU on key outcomes in patients with inflammatory arthritis. Methods We searched MEDLINE, Embase, PsycInfo and CENTRAL for randomised controlled trials comparing PIFU (and similar patient-directed strategies) with clinician-mandated follow up in patients with inflammatory arthritis. Publications were screened in accordance with PRISMA guidelines and included based on pre-specified criteria. Risk of bias was assessed using the Cochrane ROB2 tool. Outcome measures analysed were disease activity, serum C-reactive protein, disability, service use and satisfaction with care. Standardised mean differences (SMD) were used to account for variable use of outcome measures between papers. Results Six studies were included with a total of 1,059 patients, all of whom had RA, followed up for between one and six years. Two trials were conducted in Denmark, two in the UK and one each in Sweden and the Netherlands. Two involved two sites; four were single centre. Three studies were deemed to be at high risk of bias, two at moderate risk and one at low risk. The data demonstrated a reduced burden of clinic visits for patients under PIFU (all studies; SMD -0.56, [95% CI -0.85 to -0.28]) equivalent to a reduction in approximately one clinic visit for every two patients over the course of the study period. This was balanced by an increased number of telephone consultations (4 studies, 817 patients; SMD 0.40 [0.13 to 0.66]) equating to an extra consultation per 2.5 patients under PIFU. Non-significant trends were seen towards higher patient satisfaction (all studies; SMD 0.28 [-0.12 to 0.68]) for patients under PIFU. However, there were also trends towards higher CRP (three studies, 490 patients; SMD 0.22 [-0.08, 0.52]) and DAS28 score (4 studies, 658 patients; SMD 0.08[-0.20, 0.36]. No significant difference was seen in patient-reported disability. There was substantial statistical heterogeneity between studies. Conclusion PIFU is associated with a reduction in outpatient clinic appointments but increased numbers of telephone consultations, while maintaining patient satisfaction. Current data do not exclude the possibility of inferior long-term clinical outcomes for patients receiving PIFU. Transition to PIFU risks reducing services’ capacity to assess and modify clinically important parameters (e.g. cardiovascular risk) through regular scheduled review. These studies highlight the challenges in conducting meaningful trials on this question due to the heterogeneity of interventions and outcomes and the already-widespread use of some aspects of PIFU in routine care. Disclosure E. Alveyn: Other; Educational support from UCB. R. Crowder: None. M. Perry: None. S. Norton: None. J. Galloway: Honoraria; from AbbVie, Celgene, Chugai, Gilead, Janssen, Eli Lilly, Pfizer, Roche and UCB.

Different anatomical variations in the anterior segment of the right upper lung

During a routine physical examination three years ago, a 47-year-old woman received a diagnosis of a nodule in her right upper lung. Since then, she has been regularly attending outpatient clinic appointments for follow-up. Over time, the nodule has shown gradual growth, leading to a suspicion of lung cancer. Through the use of enhanced CT imaging, a three-dimensional reconstruction was performed to examine the bronchi and blood vessels in the patient’s chest. This reconstruction revealed several variations in the anatomy of the anterior segment of the right upper lobe. Specifically, the anterior segmental bronchus (B3) was found to have originated from the right middle lung bronchus. Additionally, the medial subsegmental artery of the anterior segmental artery (A3b) and the medial segmental artery (A5) were observed to share a common trunk. As for the lateral subsegmental artery of the anterior segmental artery (A3a), it was found to have originated from the right inferior pulmonary trunk. Furthermore, the apical subsegmental artery of the apical segmental artery (A1a) and the posterior segmental artery (A2) were found to have a shared trunk.

How practitioner-led colonoscopy surveillance management improves productivity while saving money

Background: The British Society for Gastroenterology (BSG) guidelines for post-polypectomy and post-cancer-resection surveillance were changed in October 2020, essentially excluding a large proportion of patients awaiting a surveillance colonoscopy as they now no longer fit the criteria for surveillance. Aims: To audit the colonoscopy surveillance waiting list at the Wye Valley Trust to ascertain patient appropriateness for colonoscopy under the new BSG guidelines. Methods: A practitioner-led colonoscopy surveillance clinic led by a clinical endoscopist was set up to audit the colonoscopy surveillance waiting list of over 1200 patients. The aim was to clinically assess each patient against the guidelines and determine discharge from, or continuation of, the surveillance pathway for each patient. The patients were then offered outpatient clinic appointments where fitness was assessed and appropriate investigations were finalised. Results: Patient numbers on the colonoscopy surveillance waiting list were reduced by nearly 50%, with waiting times down to 0 weeks, by facilitating practitioner-led pre-assessment and outpatient clinics, all while saving Weston General Hospital almost £300000 in the initial 9 months. Conclusions: The new colonoscopy surveillance guidelines presented an opportunity to audit and evaluate the colonoscopy guidelines in the Wye Valley Trust. The facilitation of a clinical endoscopist committed time to implement new pre-assessment processes and outpatient clinics, this process allowed the discharge of almost 50% of patients upon the colonoscopy surveillance waiting list, it created extra colonoscopy capacity for 2 week wait and urgent colonoscopies, while generating a positive financial implication for the trust.

Case Report: Urethral Diverticulum after Distal Hypospadias Repair: An Uncommon Complication.

Abstract* Introduction A urethral diverticulum can be defined as a pocket that forms from the lining of the urethra and protrudes into the surrounding tissue, a condition which causes voiding dysfunction and may result as a rare complication of hypospadias repair surgery. Case report We report the case of a 2-year-old child who presented to us in 2019 complaining of a thin forceful stream, ballooning of the ventral aspect of the penis while voiding, and post-void dribbling. He has a history of undergoing a tabularised incised plate urethroplasty for distal penile hypospadias at 18-months-old. Ultrasound showed increased post-void residual volume and cystourethroscopy confirmed a urethral diverticulum extending from the subcorona to the base of the penis. The patient underwent partial excision of diverticulum, urethroplasty, and meatoplasty. He was followed-up 3 months later with complete resolution of his symptoms and a normal urinary stream with no urethral ballooning or dribbling. Conclusion Urethral diverticulum may present as a complication post hypospadias repair. Although it is rare, we believe that it is important for the patient’s parents to understand the possibility and know of the signs and symptoms in addition to attending regular outpatient clinic appointments in order to facilitate early management if needed. Furthermore, it is highly important for physicians to assess newborns for hypospadias before carrying out circumcision as it is a contraindication for the procedure.

Perspectives of Women of Reproductive Age Regarding Sexuality During Their Menstruation Period

IntroductionThis study aimed to determine the views and experiences of women of reproductive age regarding their sexuality and sexual life during their menstrual period.MethodsA qualitative, interpretive, phenomenological design was used. The study sample consisted of 16 women of reproductive age (18–49), who volunteered to participate and came to gynecology outpatient clinic appointments at a research hospital in Istanbul, Turkey. Data were collected online through in-depth individual interviews.ResultsThe research was composed of six themes: “symptoms of the menstruation period,” “duration and severity of symptoms during menstruation,” “effect of the menstrual period on sexual life,” “sexual desire during the menstrual period,” “opinions about sexual life during menstruation,” and “spouses’ opinions about sexual life during menstruation.”ConclusionsThe women in the study noted that they experienced physiological and psychological symptoms during their menstrual period. Although some of the women stated that they do not have changes in sexual desire during this period, most of them think that they should not engage in sexual intercourse due to the symptoms they experience during their menstrual period, religious beliefs, and sociocultural values.Policy ImplicationsNurses should counsel couples about the possible advantages and disadvantages of sexual intercourse during menstruation without displaying a judgmental attitude.