Outpatient Department Settings Research Articles

Seroprevalence of SARS-CoV-2 infection in pediatric patients in a tertiary care hospital setting.

Globally, cases of children's coronavirus disease 2019 (COVID-19) have been reported since the pandemic started. Most children have an asymptomatic or mild infection. Therefore, the incidence rate of COVID-19 in children might have been underestimated. This study aimed to determine (1) the seroprevalence (and seroconversion rates) of COVID-19, including associated risk factors, in pediatric patients visiting hospitals; and (2) the immunological responses to COVID-19. This was a prospective, cross-sectional study. Patients aged 0-18 years who visited the hospital from September 2020 to February 2022 were included. Demographic, clinical, and laboratory data were reviewed. A total of 1,443 pediatric patients were enrolled. Of these, 323 (22.6%) had a history of COVID-19. In the pre-Delta period, the seroprevalence increased from 4.1% to 70.6% in all included patients and from 0.5% to 10% in patients without a known history of COVID-19 compared with the Delta-Omicron period. The seroconversion rate was 6.8% (19 per 100 person-years) in pediatric patients with COVID-19. Risk factors for COVID-19 seropositivity were respiratory symptoms, being in an outpatient department setting, and infection during the Delta-Omicron period. Exposure to household members with confirmed COVID-19 was a risk factor for seropositivity and seroconversion. Infection during the Delta-Omicron period and testing conducted >2 weeks after the onset of symptoms was associated with spike immunoglobulin (Ig) M and spike and nucleocapsid IgG, respectively. High nucleocapsid IgG levels were associated with pneumonia in pediatric patients with COVID-19. Pediatric patients exposed to household members with COVID-19 and respiratory symptoms should be tested for COVID-19. Nucleocapsid IgG can be used as a surrogate marker to identify patients who may have experienced pneumonia from COVID-19 and as a screening tool for the COVID-19 outbreak, regardless of COVID-19 vaccination status.

Alcohol Dependence Care Pathway for Psychiatric Settings: A Cross-sectional Study from an Urban Psychiatric Center

Background: Alcohol use remains an important contributor to morbidity and mortality. There is a long-time gap between the onset of alcohol use and first contact for care. Poor referral systems and reduced awareness contribute to such delays. Yet few studies analyzed pathways to care exclusively in alcohol-dependent patients. Aims: The aim of this study was to understand the pathways traversed by alcohol-dependent patients before their access to psychiatric services and their association with sociodemographic and clinical characteristics. Methods: A cross-sectional study design was employed. All alcohol-dependent patients attending psychiatric outpatient department setting were recruited. Questionnaires including sociodemographic details, the Short Alcohol Dependence Data Questionnaire, and the World Health Organization encounter forms were used. Appropriate statistical tests were done using SPSS 20. Results: A total of 99 patients were inducted into the study. 44.44% consulted psychiatric services directly. There was a mean time lag of 15 years between the onset of alcohol use and first contact. There was a significant association between sociodemographic characteristics and the pathway chosen. Higher severity of dependence and longer duration of alcohol use were associated with patients visiting psychiatric services indirectly. The main source of referral was family members for the first contact and medical practitioner for a referral to psychiatric services. Conclusion: Understanding the pathway traversed is critical to planning effective interventions in alcohol-dependent patients. Sociodemographic variables seem to be important predictors for the pathway traversed. Although the referral system by medical practitioners is satisfactory, there is a huge gap in accessibility to psychiatric services. There is a need for community awareness programs to prevent time lag.

Assessing Residents in the Department of Surgery at a Tertiary Care Centre Using Mini-Clinical Evaluation Exercise (Mini-CEX).

This study aimed to introduce, sensitize, and train our postgraduate students and faculty of the department of general surgery with the use of mini-Clinical Evaluation Exercise (mini‑CEX) and to assess the perception of students and faculty towards it. A cross‑sectional observational study was conducted over a period of four months. Ten surgery residents in the department were asked to volunteer to participate and five professors conducted the session. Five sessions of mini‑CEX(nine points) were conducted for each resident in different settings of the out‑patient department (OPD) and in‑patient department (IPD). A total of five skills were tested. Feedback from faculty and residents regarding the perception of mini‑CEX was alsotaken. A statistically significant difference in mean scores of all domains was observed comparing the first and last assessment (p<0.05). Hundred percent of the residents scored superior category (7-9) in the final assessment in all domains, whereas the maximum was in a satisfactory scoring grade in 1st assessment. The time taken for the assessment significantly reduced from 1st assessment to the last assessment in OPD and IPD settings (p=0.001). The mini-CEX assessment tool got 100% feedback from faculty in terms of skill improvement, method, attitude of residents, and ability to identify gaps in knowledge. However, one assessor thought that "time given for assessment" was inadequate and more effort was required than the usual traditional assessment methods. The most identified problem faced by residents was that the "time given during assessment" was less (50%); however, overall residents also found it valid, effective, and helpful in identifying knowledge gaps and improving clinical and communication skills. Mini‑CEX improves the learning environment in residency and also leads to improvement in medical interviewing skills, physical examination skills, humanistic qualities/professionalism, and counseling skills. So, it can be used for residency training in clinical departments.

Evaluating the Number of Cellular and/or Tissue-Based Product Applications Required to Treat Diabetic Foot Ulcers and Venous Leg Ulcers in Non-Hospital Outpatient Department Settings

Evaluating the Number of Cellular and/or Tissue-Based Product Applications Required to Treat Diabetic Foot Ulcers and Venous Leg Ulcers in Non-Hospital Outpatient Department Settings

Mobile Device Digital Photography for Teledermatology Consultation: Real-Life Situations

Objective: The use of mobile phones for teledermatology consultations is increasing. In this study, we aimed to describe photographic problems in teledermatology performed via mobile phones and their effects on diagnostic decision-making. Materials and Methods: Three dermatologists independently reviewed the medical histories and photographs of patients taken by primary-care physicians for teledermatology between January 2018 and August 2020. The consensus of the dermatologists’ decision-making was categorized into “definite diagnoses given,” “probable diagnoses given,” and “unable to provide any diagnosis.” Relationships between photographic errors and dermatologist decision-making were investigated. Factors related to photographic problems were evaluated. Results: In all, 899 images from 220 patients were reviewed. The most common purpose of teledermatology was to make a diagnosis. The most frequent diagnoses were eczema, infection, and autoimmune diseases. Consultants gave definite diagnoses for 63.2% of patients and probable diagnoses for another 29.5%. However, diagnoses were not made in 7.3% of cases. Defocusing and non-eczematous lesions were significantly associated with the inability to give diagnoses (P = 0.002 and 0.037, respectively). Pictures from peripheral areas showed higher frequencies of distortion errors, improper framing, wasted space, and improper background, while truncal regions tended to have lighting problems. The outpatient department setting was associated with a lack of overview and defocusing. Conclusion: Focusing was the central factor for making diagnoses in teledermatology. Lighting should be more concerned in truncal regions. While using smartphone cameras, distortion should be aware. These factors should be considered to improve the effectiveness of teledermatology.

205 Exploring stakeholder experiences of Comprehensive Geriatric Assessment in community and out-patient settings: a qualitative evidence synthesis

Abstract Background Comprehensive Geriatric Assessment (CGA) is a multidimensional interdisciplinary process that addresses an older adult’s bio-psycho-social capabilities to create an integrated and co-ordinated plan of care. While there is established quantitative evidence that demonstrates the positive impacts of CGA on clinical and process outcomes, less is known about how older adults and service providers experience CGA. This study aimed to systematically review and synthesise qualitative studies reporting the experiences of CGA of community-dwelling older adults, caregivers and healthcare professionals in the community and Out-Patient Department (OPD) setting. Methods This qualitative evidence synthesis involved a systematic search across 5 databases targeting qualitative or mixed methods studies that reported qualitative findings on stakeholder experiences of CGA. The protocol was registered with the PROSPERO database (Registration: CRD42021283167). The methodological quality of the included studies was appraised using the Critical Appraisal Skills Programme checklist for qualitative research. Results were synthesised according to Noblit and Hare’s seven-step approach to meta-ethnography. Results Fourteen studies were included where CGA was completed in the home, general practice, out-patient setting in acute hospitals and in hybrid models across the community and acute OPD settings. Synthesis identified four key themes: (1) CGA is experienced as a holistic process (2) The home environment enhances CGA (3) Time, the prevailing healthcare model and interprofessional communication influenced the success of CGA in the community (4) Conflicting perspectives on the meaningful involvement of older adults, carers and family in the CGA process. Conclusion The findings demonstrate that CGA in a home-based setting allows for a more holistic approach to care while increasing patient satisfaction and accessibility to healthcare. Although potential barriers to the delivery of CGA include current fragmented health service structures and a lack of understanding of CGA, factors such as enhanced communication, carer and older adult involvement in the CGA process are potential facilitators to its implementation.

Evaluation of Bacterial Contaminants on N95 FFRS after Reuse in Hospital Personnels: A Prospective Study in the Era of COVID-19 Pandemic

Introduction: N95 Filtering Face-piece Respirators (FFRs) prevent the spread of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection and protect medical personnel. It is considered as one of the essential protective equipment. An increased demand for N95 FFRs during the Coronavirus Disease 2019 (COVID-19) pandemic has resulted in shortage crisis for the care of cases arising in hospitals. Therefore, this situation generated the need to implement alternatives like four mask policy that allows reuse of N95 FFRs in settings with limited resources. Aim: To find out the burden of bacterial isolates on N95 FFRs after reuse. Materials and Methods: The present study was a prospective study conducted at Govt. R.D.B.P. Jaipuria hospital, Jaipur, Rajasthan, India, from May 2021 to October 2021 on 526 used N95 FFRs after multiple or extended use by 96 hospital personnel who attended Outpatient Department (OPD) services. Swab samples were collected from both external as well as internal surface of the mask after each use and further subcultured to identify any microorganism present on them. Results: Growth of Gram positive bacilli, and micrococci were found on 499 samples out of total 526 samples. Other bacteria like Pseudomonas spp. and other gram negative were also observed in 19 samples. Furthermore, it was also observed that bacterial load on reused N95 FFRs was mainly commensal flora. Conclusion: Mainly commensal floras were found over internal and external surface of used N95 FFRs. This proves that four mask policy is optimum for judicious use of N95 FFRs and resulted in saving of funds for other more emergency works mainly in OPD settings.

Identification of the factors that affect clinical teaching and potential strategies to overcome them: A narrative review

ABSTRACT Clinical teaching does not limit to teaching alone, rather it actually deals with the process wherein students are supported in their learning process while interacting with real patients during clinical settings. The purpose of the current review was to explore the factors that impact clinical teaching and then propose the potential recommendations to overcome them. An extensive search of all materials related to the topic was carried out on the PubMed and Google Scholar search engines and 39 articles were selected based on their suitability with the current review objectives and analyzed. Keywords used in the search include clinical teaching, patient, student, and teacher in the title alone only. Clinical teaching is affected by a wide range of teacher-related, student-related, and patient-related factors, and as medical educators, we are aware of these factors so that we can minimize their impact to enhance the effectiveness of clinical teaching, thereby augmenting learning among medical students. Most of the identified factors that can influence clinical teaching can be taken care of in one or another way, if we strengthen the domain of the faculty development program. The shortage of patients, this concern can be managed by either adoption of standardized patients or by ensuring clinical teaching in outpatient department settings. To conclude, clinical teaching is an important aspect of the making of a competent medical graduate. However, the effectiveness of such sessions depends immensely on the stakeholders that are involved in the process. It is the need of the hour to identify the prevailing factors and then plan for corrective measures to neutralize the impact of such factors and also simultaneously enhance learning among students.

Assessment of Depression and Anxiety in Couples with Infertility

Abstract Background: Infertility is considered a major setback for the couple and the increasing magnitude of infertility issues causes life crises with a wide range of sociocultural, emotional, physical, and financial problems. The study aims to assess the prevalence and severity of depression and anxiety in couples diagnosed with infertility and to determine the relationship, if any, between the severity of depression and anxiety with sociodemographic variables, duration, and treatment of infertility. Setting and Design: This is a descriptive observational study that was carried out in the outpatient department setting of a tertiary care hospital from January “2020 to December” 2020. Aims and Objectives: The study aims at assessing the prevalence and severity of depression and anxiety in couples diagnosed with infertility and determining the relationship, if any, between the severity of depressive and anxiety symptoms and the treatment received for infertility. Materials and Methods: Fifty couples (100 subjects) diagnosed with infertility fulfilling inclusion and exclusion criteria were assessed using specially designed pro forma and relevant scales for assessment. Detailed history regarding symptoms of infertility was taken, and patients were interviewed based on the International Statistical Classification of Diseases-10 criteria for depression and anxiety. Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale questionnaires were used to measure the severity of depressive and anxiety symptoms. Statistical Analysis: The collected data were coded and entered in a Microsoft Excel sheet. The data were analyzed using Statistical Packages for the Social Science version 21.0 software. The results are presented in a tabular and graphical format. For quantitative data, mean and standard deviation (SD), etc., were calculated. Qualitative data were represented in the form of frequency and percentage. The association between qualitative variables was assessed by Fisher’s exact test. Quantitative data were represented using mean ± SD. Analysis of quantitative data between the two groups was done using an unpaired t-test if the data passed the “Normality test” and by Mann–Whitney test if the data failed the “Normality test.” P &lt; 0.05 was taken as the level of significance. Results: A statistically significant was found between depression among wives and the support received from their respective spouses and a significant correlation was observed between the duration of infertility with the presence of depression and anxiety among couples (P &lt; 0.01). A significant correlation was also observed between the duration of treatment of infertility with the presence of depression and anxiety among couples (P &lt; 0.01). Conclusion: In our study, the prevalence and severity of depression and anxiety are found to be associated with the support received from the spouse and statistically significant correlation was found between the prevalence and severity of depression and anxiety and the duration of infertility and the duration of treatment. No statistically significant relationship was found with the age of the patient, education level, occupation, and number of early issues.

Clinical Approach to Diagnosing and Treatment of Neck Pain

Background: Neck pain is one of the most common reasons patients seek treatment in the hospital. The causes of neck pain vary widely, trigger misdiagnosis, and often result in mistreatment. Misdiagnoses and mistreatment-related neck pain diagnoses are often associated with a diagnosis of cervical herniated disc. The implication of the misdiagnosis is the use of excessive investigations and inappropriate therapy. This review aims to determine the causes of neck pain often obtained in daily practice and how to diagnose and treat it. Method: Search relevant articles on clinical diagnosis of neck pain with the keywords neck pain diagnostic therapy using Medline and PubMed databases. Results: Neck pain can be in the form of axial pain, which is mostly related to disorders of the joints and muscles of the neck, or in the form of pain in the roots and spinal cord. Investigations and therapy must be related to the clinical diagnosis of neck pain experienced by patients with a history of neck pain. Conclusion: Neck pain is one of the most common complaints encountered in outpatient department settings, associated with reduced quality of life. Patients may come with differing degrees of pain, various symptoms, and aetiologies making it quite challenging to treat them into complete remission. Despite being frequently encountered, some patients with neck pain are underdiagnosed and undertreated due to failure to understand the clinical symptoms before deciding possible aetiologies.

A Comparison of the Long-Term Surgical Outcomes of Horizontal Strabismus Surgery between Resident Clinic and Private Clinic Patients

ABSTRACTPurposeTo compare the long-term surgical outcomes of patients with horizontal strabismus whose surgery was performed in an outpatient department (OPD) setting (by residents-in-training) to those whose surgery was performed in a private clinic (PC) setting (by staff-ophthalmologists) in the same operating room/institution.MethodsTwo hundred and forty-four patients’ charts who had horizontal strabismus surgeries from January 2007 to 2020 were reviewed retrospectively. A total of 92 patients were operated on by residents and followed in OPD, and 152 patients by staff-surgeons and followed in PC. Demographic data and eye exam parameters were collected. Distance and near deviation (in prism diopters, PD) were extracted and compared between groups at baseline and postoperatively (6 months and yearly for up to 6 years). Success was defined as a postoperative motor alignment of 10PD or less.ResultsThe mean age of the 244 patients was 10.5 ± 11.7 years, with no significant differences between groups. A longer follow-up duration was reported in the PC group (34.9 ± 24.3 months vs 25.3 ± 20.2 months). Patients had similar success rates in both groups in the early postoperative period (6 months and 1 year); however, a higher success rate was observed in the PC group compared to OPD at 3, 5 and 6 years with the following respective values: 72.2% vs 50% (p < .001), 75% vs. 66.7% (p = .02), and 68.6% vs. 66.7% (p = .03). The difference was more pronounced in the esotropia subgroup mostly at 3 years follow-up.ConclusionThis study showed a similar success rate of horizontal strabismus surgery performed in a PC setting by staff surgeons as compared to that performed in an OPD setting by residents at 6 months and 1 year. A significantly higher success rate was observed at long term follow-up (after 2 years) in the PC group compared to the OPD group, possibly related to the difference in compliance with post-operative follow-up management and not to surgery itself.

Prevalence of thyroid disorders in an out-patient department setting: a retrospective study

Background: Disorders of the thyroid gland has become one of the most common endocrine diseases affecting the global population next to Diabetes Mellitus. Data available on the prevalence of thyroid disorders among Indian population is scanty. This study is aimed to investigate the prevalence of thyroid dysfunction in the local population visiting the endocrinology out-patient department of National Homoeopathy Research Institute in Mental Health, Kottayam.Methods: This is a hospital based retrospective descriptive analysis carried out among the patients attended in the endocrinology out-patient department of National Homoeopathy Research Institute in Mental Health (NHRIMH), Kottayam. Patients with Thyroid disorders who seek treatment from the endocrinology OPD for a period of six months (January 2021 to June 2021) were selected for this retrospective analysis.Results: Data were collected from the medical records department of NHRIMH and were analyzed based on the age, sex, different types of thyroid disorders and the medicines prescribed including potency.Conclusions: Females are commonly affected with thyroid disorders and the common age group is between 40 and 49 years. The most common thyroid disorder encountered is hypothyoidism and the most common medicine used is ‘thyroidinum’.

Health-Related Quality of Life Among Liver Disorder Patients in Northern India.

Objective:The present study aims to determine the health-related quality of life (HRQoL) among liver disorder patients being treated in tertiary care hospital in north India and exploration of factors affecting HRQoL.Methodology:The HRQoL was assessed among 230 patients visiting either the outpatient department (OPD) or those admitted in high dependency unit (HDU) or liver intensive care unit (ICU) using direct measuring tools such as Euro QoL five-dimension questionnaire (EQ-5D) and EQ visual analog scale. Multivariate regression was used to explore the factors influencing HRQoL.Results:Mean EQ-5D scores among chronic hepatitis and compensated cirrhosis patients were 0.639 ± 0.062 and 0.562 ± 0.048, respectively. Among those who were admitted in the ICU or HDU, mean EQ-5D score was 0.295 ± 0.031. At discharge, this score improved significantly to 0.445 ± 0.055 (P < 0.001). The multivariate results implied that HRQoL was significantly better among patients with lower literacy level (P = 0.018) and those treated in OPD settings (P < 0.001).Conclusion:HRQoL is impaired among patients suffering from liver disorders specifically those admitted in ICU. Further, there is a need to generate more evidence to explore the impact of determinants and treatment-associated costs on the HRQoL.

Wide-awake local anaesthesia no tourniquet (WALANT) procedures during COVID: a single centre experience.

Background and aim:WALANT procedures are becoming more popular, and are particularly useful in the COVID-19 pandemic. Procedures can be performed without needing access to general theatres and anaesthetic support, minimising the number of patient-healthcare interactions and avoiding aerosolisation. Our unit has taken this approach and aim to present a case series that demonstrates the efficacy and safety of WALANT.Methods:A prospective analysis of WALANT cases in a single plastic surgery centre during March-August 2020 was performed. All procedures using a WALANT approach were included, that would have otherwise required general anaesthetic or regional block. Data was collected on a number of variables, including patient satisfaction.Results:37 procedures were included in analysis. The majority of the injuries consisted of hand trauma. There were no cases of post-operative complications, although one required completion in main theatres due to technicality. No patients required additional anaesthetic during the procedure and all reported pain score as 0/10. Overall patient satisfaction was 10/10 for 26 patients, 9/10 for 10 patients and 7/10 for one patient.ConclusionsResults show the use of WALANT can facilitate an effective plastic surgery trauma service during COVID-19. Most of the procedures were performed in the outpatient department setting, without the need for main operating theatres or anaesthetic support. All procedures were performed within 24 hours of initial presentation and were able to be discharged on the same day. In addition, patient satisfaction remained high and post-operative complications were minimal. We propose that the use of WALANT should continue and increase beyond the current pandemic. (www.actabiomedica.it)

Association of respiratory muscle strength with glycosylated hemoglobin (HbA1c) levels, duration of disease, and physical activity levels in patients with type 2 diabetes: A cross-sectional study

CONTEXT: Type 2 diabetes is a systemic disorder that propagates several pathological processes leading to a plethora of complications including those on skeletal muscle strength and lung function.AIMS: This study aims to evaluate the association of glycemic control, duration of disease, and physical activity level on respiratory muscle strength (RMS).SETTINGS AND DESIGN: A cross-sectional study was conducted in the outpatient department setting after approval from the institutional ethics committee.SUBJECTS AND METHODS: The Hemoglobin A1c (HbA1c) level of recruited participants was recorded from a recent laboratory test and they were interviewed with the Rapid Assessment of Physical Activity (RAPA) tool to obtain their current physical activity levels. The evaluation of maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) was performed using the MicroRespiratory Pressure Meter (MicroRPM) device.STATISTICAL ANALYSIS USED: Pearson's correlation coefficient (r) was calculated for the RMS variables (MIP and MEP) against HbA1c, duration of disease, and RAPA Score.RESULTS: Twenty-six participants were evaluated. Significant correlations were found HbA1c with MIP (r = −0.45, P = 0.02) and RAPA Score with MIP (r = 0.42, P = 0.03) at P < 0.05.CONCLUSIONS: Inspiratory muscle strength is well associated with glycemic control and physical activity of the individual.

Depression anxiety and stress in patients visiting medicine outpatient department of tertiary care hospital during COVID pandemic

Background: Coronavirus disease 2019 is a unique pandemic that has struck all the nations. Extraordinary crisis warrants extraordinary response like severe lockdown. The study aims to assess the prevalence of depression, anxiety, and stress, in general, and around corona, in particular, in people with medical comorbidity. Setting and Design: This is a cross-sectional study that was carried out in outpatient department setting of a tertiary care hospital from July 2020 to September 2020. Aims and Objectives: The study aimed to assess the prevalence of depression, anxiety, and stress, in general, and anxiety around corona, in particular, and the correlation with sociodemographic profile and comorbid medical illness. Materials and Methods: Fifty patients with various medical comorbidities were assessed using depression anxiety and stress scale and corona anxiety scale (CAS) and a specially designed pro forma. Statistical Analysis: The collected data were coded and entered in Microsoft Excel sheet. The data were analyzed using Statistical Packages for the Social Sciences version 20.0 software. The results are presented in a tabular and graphical format. For quantitative data, mean, standard deviation, median, etc., were calculated. For qualitative data, various frequency, rates, ratio, and percentage were calculated. Results: A statistically significant relationship was found between education and anxiety (P = 0.027) and between medical comorbidity and depression. Conclusion: In our study, medical comorbidities are associated with depressive cognition. Surprisingly, no significant anxiety on CAS could be found.

A Retrospective Analysis of Clinical Use and Outcomes Using Viable Placental Membrane Allografts in Chronic Wounds

Viable placental membrane (vPM) has been shown to decrease time to healing, adverse wound events, and wound-related infections. Wound research exclusion criteria commonly exclude wound types other than diabetic foot ulcers and venous leg ulcers (VLUs), comorbidities including peripheral arterial disease (PAD) and uncontrolled diabetes mellitus (DM), and wounds with exposed bone or tendon. This retrospective research study evaluated the clinical use and outcomes of the vPM with living mesenchymal stem cells used in chronic wound management in the community hospital outpatient department setting with the goal of comparing real-world use and outcomes of the product with use and outcomes described in the chronic wound literature. A retrospective analysis on vPM treatments at a Wisconsin academic health system's community hospitals. Participants included all patients who received vPM therapy between July 1, 2016, and August 21, 2019. A total of 89 patients received vPM treatment during the study period (mean age, 70 years; 69% male [n = 61], 31% female [n = 28]). Wound types were 54% diabetic or neuropathic foot ulcers (n = 48), 17% VLUs (n = 15), 7% pressure injuries (n = 6), and 22% atypical wounds (n = 20). The average wound duration prior to vPM initiation was 104 days. Average wound size at presentation was 6.9 cm2. Of study participants 54% had PAD (n = 48), 63% had DM (n = 56), 33.7% had DM and PAD (n = 30), and 17% had exposed bone or tendon (n = 15). Average adjusted time to healing after initiation of vPM was 81.2 days. The percentage of wounds healed 12 weeks after initiation of vPM treatment was 57%. Effectiveness of vPM observed in controlled trials also was observed in this real-world study on vPM for multiple wound types, patients with comorbidities including PAD and uncontrolled DM, and wounds with exposed bone or tendon. Results of this study were not statistically different from those reported in the literature. More randomized controlled trials are needed to explore the efficacy of vPM on patient presentations common to wound healing centers.

713 Wide-Awake Local Anaesthesia No Tourniquet (WALANT) Procedures During COVID-19: A Single Centre Experience

AimWALANT procedures are becoming more popular and are particularly useful in the COVID-19 pandemic. Procedures can be performed without needing access to general theatres and anaesthetic support, minimising the number of patient-healthcare interactions and avoiding aerosolisation.Our unit has taken this approach and aim to present a case series that demonstrates the efficacy and safety of WALANT.MethodA retrospective analysis of WALANT cases in a single plastic surgery centre during March-August 2020 was performed. All procedures using a WALANT approach were included, that would have otherwise required general anaesthetic or regional block. Data was collected on a number of variables, including patient satisfaction.Results37 procedures were included in analysis. The majority of the injuries consisted of hand trauma. There were no cases of post-operative complications, although one required completion in main theatres due to technicality. No patients required additional anaesthetic during the procedure and all reported pain score as 0/10. Overall patient satisfaction was 10/10 for 26 patients, 9/10 for 10 patients and 7/10 for one patient.ConclusionsResults show the use of WALANT can facilitate an effective plastic surgery trauma service during COVID-19. Most of the procedures were performed in the outpatient department setting, without the need for main operating theatres or anaesthetic support. All procedures were performed within 24 hours of initial presentation and were able to be discharged on the same day. In addition, patient satisfaction remained high and post-operative complications were minimal. We propose that the use of WALANT should continue and increase beyond the current pandemic.

Does Dose Volume Histogram of Parotid Glands Correlate with Xerostomia Radiation Therapy Oncology Group Scores in Locoregionally Advanced Head and Neck Cancer Patients Treated with Intensity-Modulated Radiation Therapy?

Introduction Xerostomia is an imminent complication of head and neck radiotherapy best assessed subjectively. This study aimed to evaluate the effects of sparing parotid glands with intensity-modulated radiation therapy (IMRT) on subjective xerostomia scores in patients with locoregionally advanced head and neck cancer. Subjects and Methods This is a prospective longitudinal study conducted in an outpatient department setting. A total of 43 patients with head and neck cancer were planned with IMRT as per the ICRU 62 (International Commission on Radiation Units and Measurement Report 62). The constraints to ipsilateral and contralateral parotid glands were 35 and 25 Gy, respectively. Treatment plan was assessed for doses to 100, 67, 50, and 33% volume of individual parotid glands. Patients were subjectively assessed using the Amosson’s Questionnaire and graded as per Eisbruch’s xerostomia Radiation Therapy Oncology Group scores. Dose volume histogram (DVH) was plotted and correlated with grades of xerostomia postradiation at 1, 3, 6, 9 and 12 months follow-ups. Statistical analysis was performed suing SPSS version 16, chi-square test, and one-way analysis of variance test. Results No statistically significant correlation between mean dose of radiation, volume of the parotid glands, and grades of xerostomia was noted postradiation. A statistically significant improvement in grades of xerostomia between 3 and 6 months (p = 0.0), 3 and 9 months (p = 0.020), 6 and 9 months (p = 0.009), 6 and 12 months (p = 0.05), and 9 and 12 months (p = 0.00) was noted. Recovery in grades was noted at 9 months. Conclusion There is no statistically significant direct correlation between DVH of the parotid glands and grades of xerostomia, although recovery in grades was statistically significant at 9 months.

Use, Prevalence and People’s Attitude towards Traditional Medicine in Outpatient Department Setting of a Tertiary Care Hospital in Northeast India

Abstract: Objectives: Present study is aimed at reporting the use and people’s attitude towards the traditional system of medicine for their medical emergencies or common ailments. Methods: Study was done in outpatient departments of Guwahati Medical College, Assam. Study design was hospital based cross-sectional study, carried out for a period of 4 months. Patients attending outpatient departments were included in the study. A survey using openand close-ended questionnaire was used to collect the data. Questionnaire survey data was entered in Excel spreadsheets and summarized and reported in Figures and Tables. Results: Out of the 259 total participants, 172 (66.41%) respondents consulted allopathic practitioners more than 3 times for diseases they suffered last year. Minority population (18.9%) had consulted traditional medicine practitioners during the last year. Moreover, 62% never consulted a traditional system practitioner during the previous year. Study proved that easy improvement of physical health (25.86%), speedier actions of allopathic medicine (11.58%), lack of improvement of their health problems by using alternative medicinal system (7.72%) and availability of free medicines in the tertiary hospital they visit (1.93%) as the reasons for increased use of allopathic system. A very small percentage (8.88%) of people opinioned that traditional system is best, because of the lack of side effects and suitability of traditional medicinal system in treatment of common ailments. Conclusion: It is clear from the study that traditional system of medicine didn’t acquire its popularity among commoners in Assam even though many of the developed countries partially or fully support such medicinal systems. Key words: Complementary and alternative medicine, Prevalence, Traditional medicine use, World Health Organization, Outpatient department, Assam.