Patient Complaints Research Articles

LEGAL PROTECTION FOR HEALTHCARE PROFESSIONALS AND HOSPITALS AGAINST PATIENT’ COMPLAINTS ON SOCIAL MEDIA

In the digital era, social media platforms have evolved into potent communication tools; however, they also present novel obstacles, particularly for healthcare professionals and institutions. The reputation and operations of medical institutions can be substantially influenced by the increase in patient complaints that are shared online.This research was made by using normative legal research type, namely research that focuses on examining legal norms in applicable laws and regulations relating to the subject matter. The aim of this research is to analyze existing complaint services in hospitals as well as legal protection for hospitals and health workers against patient complaints on social media. The result of this research shows that there are still complaint services in hospitals that are not yet well provided, and other factors that cause patients to complain on social media. It also shows that legal protection against defamation in corporations has not been able to serve its purpose well, as well as Indonesian penal law which is oriented towards retributive justice rather than restorative justice.

A clinical algorithm for diagnosis and treatment of insomnia in adults: an updated review.

Difficulty falling asleep and/or maintaining sleep are common complaints in patients visiting medical clinics. Insomnia can occur alone or in combination with other medical or psychiatric disorders. Diagnosis and management of insomnia at times are perplexing. This updated study review aimed at a clinical algorithm for diagnosis and treatment of insomnia in adults. We developed an easy-to-apply algorithm to diagnose and manage insomnia that can be used by general practitioners and non-sleep specialists. To this end, our team reviewed the previous studies to determine the prevalence, evaluation, and treatment of insomnia. We used the results to develop a clinical algorithm for diagnosing and managing insomnia.Insomnia occurs in a short (less than 3months duration) or chronic form (≥3months duration). Insomnia management includes both pharmacological and non-pharmacological interventions. There is ample research evidence for the impact of a variety of non-pharmacological treatments, but both types of treatments can be used for each patient. If there are any contradictions in the diagnosis process, therapists should use objective instruments, such as polysomnography, but they should not be in a hurry to use these instruments.

Subjective Cognitive Decline Patterns in Patients with Migraine, with or without Depression, versus Non-depressed Older Adults

Purpose: Cognitive decline is a common complaint in young patients with migraine, especially those with depression. Independent of psychiatric factors such as depression, subjective cognitive decline (SCD) is associated with an elevated risk of progression to dementia. This study aimed to investigate patterns of subjective cognitive complaints between migraineurs with or without depression and non-depressed older adults.Methods: This retrospective study included 331 outpatients with SCD (293 from a headache clinic and 38 from a memory clinic). SCD was diagnosed as “yes” based on two questions about SCD. The Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were used to assess cognitive function. The SCD Questionnaire (SCD-Q) with three subdomains was analyzed to compare SCD between groups.Results: Among patients with SCD, significant differences in duration of education were found among the groups—specifically, migraineurs with depression (12.39 years) had longer education than non-depressed older adults (10.50 years) and shorter education than migraineurs without depression (14.28 years). The total MMSE and MoCA scores did not differ between migraineurs with and without depression. Regarding SCD-Q scores, migraineurs with depression showed higher scores overall and in all cognitive domains than migraineurs without depression, with no significant difference compared to non-depressed older adults. Conclusion: Although the depressed migraineurs with SCD were younger and more educated than the non-depressed older adults with SCD, both groups reported similarly high levels of SCD. Higher levels of surveillance for cognitive decline are warranted for migraineurs with depression who have SCD.

Impact of Neuropsychological Assessment on Subjective Memory Complaints in Patients With Mild Cognitive Impairment.

Patients with Alzheimer's disease (AD), namely at an initial stage like amnestic cognitive impairment (aMCI), typically present with memory complaints. They also have difficulties regarding self-knowledge about their cognitive deficits. In clinical practice, a formal neuropsychological assessment is often done. The present study aimed to understand whether patients with aMCI retain the ability to monitor the success or failure in their performance during the neuropsychological assessment and adjust the report of memory complaints accordingly, as compared to healthy controls. Participants were patients with aMCI and healthy controls who were questioned about their own memory abilities using the Subjective Memory Complaints (SMC) scale, applied before and after the neuropsychological assessment protocol. A repeated measures General Linear Model was performed to analyze changes in SMC (within-subjects effects) after the neuropsychological assessment, in patients with aMCI and healthy controls (between-subjects effects). Eighty volunteers, 40 patients with aMCI and 40 healthy controls, participated in the study. Patients with aMCI showed lower MMSE scores, more depressive symptoms, and deficits in memory and learning, language and executive domains. Patients with aMCI had higher SMC scores [9.4(3.6)] than healthy controls [4.4(2.3)] before the neuropsychological assessment. A statistically significant interaction was found between the SMC and the diagnostic group, meaning that healthy controls decreased SMC [3.4(1.9)] after the neuropsychological assessment, whereas patients with aMCI kept high levels of SMC [9.6(3.9)]. In patients with aMCI, an inverse correlation between logical memory and the change in SMC was found, so that patients with lower scores in the logical memory test tended to increase their memory complaints after the assessment. Both patients with aMCI and healthy controls can monitor and update the impression about their memory abilities following a formal neuropsychological assessment. Patients with aMCI maintain a high SMC level, which is inversely associated with their memory performance. In practical terms, SMC should be measured consistently at a particular moment in time, preferably preceding the objective neuropsychological assessment.

The Influence of Hospital Service Standards on Quality of Life and Level Severity Chemotherapy Induces Nausea Vomiting (CINV) in Breast Cancer Patients

Background: Globally and in Indonesia, breast cancer is a major cause of both new cases and fatalities. One of the recommended therapies for people with breast cancer is chemotherapy. Measuring the quality of life of breast cancer patients receiving chemotherapy is necessary to evaluate the treatment provided. Side effects of chemotherapy include nausea and vomiting (CINV). Purpose: The purpose of the study is to ascertain how hospital service standards impact the quality of life and severity of chemotherapy-induced nausea and vomiting (CINV) in patients receiving chemotherapy for breast cancer. Methods: A non-equivalent control group design and a quasi-experimental research methodology were employed. The study population included patients with breast cancer receiving chemotherapy at the Baladhika Husada Hospital Jember Chemotherapy Unit and the nearby hospital Soebandi Jember. The study period was 3 weeks and the sample size was 60 patients. Results: The significance value (two-tailed) of WHOQOL from Paired Sample T-Test is less than 0.000 or 0.05, this indicates that his WHOQOL score before and after the exam differed significantly. As for his MAT results, there is no significant difference between the pre-test and post-test phases, as indicated by the significance value p of MAT being more than 1.00 or 0.05. Conclusion: The outcomes demonstrate that while the hospital's standard of has a positive impact on the quality of life but not proven effective in reducing patients' CINV complaints for patients receiving chemotherapy for breast cancer.

The Influence of Caring Training on Nurses' Ability to Manage Patient Complaints in the Intensive Room of SLG Kediri Hospital

Backgrounds: Satisfaction patient is indicator quality service nursing and success in fulfillment service patient. Standardized service​ already should runs on all units, fine room take care regular, and maintenance units intensive. Purpose: Study this aim for analyze influence caring training towards ability nurse manage complain. Method: Study this using a quantitative design with approach quasy experiment design with group control. Sample size are 21 nurses for every group. Group intervention given based caring training theory swanson. Before and after giving training group intervention will assessed ability nurse manage complain then compared to with group control. Results: Research result show there is significant improvement in implementation​ caring behavior of nurses in manage complain, after get training caring behavior with a mean of 11.38. behavior nurse in give service nursing this is form quality service nursing at home sick that can be influence satisfaction patient. Behavior nurse in give service expected and possible care​ satisfying patient is caring behavior, attention and treatment nurse to client with good. Conclusions: This result expected become reference strategy development for overcome problem related enhancement ability nurse manage complain with consider all over components that influence it in the field nursing.

Multidisciplinary strategies for cardiotoxicity management in ambulatory care: exploring practices, insights, and prospects for advancement

Abstract Background The management of cardiotoxicity, a significant concern in chemotherapy patients, necessitates a multidisciplinary approach. This study investigates the variability in cardiotoxicity management in outpatient settings across different medical specialties, which may lead to inconsistencies in patient care. Methods An extensive questionnaire-based study was conducted to assess the current practices and viewpoints of cardiologists, oncologists, and gynecologists in the management of cardiotoxicity among patients receiving outpatient chemotherapy in Germany. The survey engaged 1,329 medical professionals through an online platform, with a participation rate of 9.9%, amounting to 132 respondents. Results Respondents reported managing a combined total of 1,905 chemotherapy patients monthly, with individual patient loads ranging from 1 to 200. Notably, only a fraction of these patients – 37% under oncologist care and 48% under gynecologist care – underwent routine cardiological examinations. As shown in Figure 1, the three most common causes of cardiological presentations in patients undergoing chemotherapy were due to acute patient complaints (65.2%), before the start of chemotherapy (91.3%), and after the end of chemotherapy (78.3%). Furthermore, 37% of healthcare providers reported incorporating chemotherapy-induced cardiovascular toxicity risk assessments in their clinical routines. Medical history, ECG, and echocardiography were the most frequent examinations. Notably, 91.3% did not include cardiac biomarker measurements in their follow-up procedures (Figure 2). More than half of the participants (56%) expressed a need for simplified cardio-oncology guidelines. The majority of participants (84% and 83%, respectively) requested tools to assist in cardiovascular toxicity risk assessment and the implementation of appropriate therapeutic measures for patients undergoing chemotherapy. Conclusions The study draws attention to significant interdisciplinary care gaps in managing cardiotoxicity, which may contribute to an increased risk of undiagnosed cardiovascular complications in chemotherapy patients. The evident variability in cardiotoxicity management practices among different medical specialties underscores the critical need for heightened awareness and enhanced collaborative efforts. The implementation of comprehensive interdisciplinary clinical pathways and the establishment of a dedicated cardio-oncology network could potentially address these challenges, particularly in supporting primary care physicians.Figure 1Figure 2

Assessing Quality of Referrals to a Community-Based Chronic Pain Clinic

ABSTRACT Introduction Because patients with chronic pain are complex, with significant medical and psychiatric comorbidities, referrals to specialty pain clinics are often necessary. The present study explores the quality of information submitted and the profile of referring physicians associated with rejected patient referrals by a community pain clinic. Methods A retrospective cross-sectional study was conducted on a series of consecutive new patient referrals rejected by a noninterventional community pain clinic (November 2021–June 2022). Data were collected on the reasons for rejected referrals and physicians responsible for these referrals using the public database of the College of Physicians and Surgeons of Ontario. Results During the study period, 120 new referrals made by 99 physicians (88% primary care providers, or PCPs; male : female ratio 1:1.2; 53% Canadian university graduates) were rejected because of inadequate information (62%) or because they were inappropriate (38%). Only 46% of the rejected referrals were resubmitted within a median of 7 days (range 0–96 days) and accepted. Half of the non-resubmitted referrals could have been accepted if the referring provider had sent in the missing information. Conclusion A significant number of referrals to our pain clinic (primarily from PCPs) are rejected for mainly avoidable reasons. The process of rejected referrals and resubmissions requires 92 to 126 h of additional staff time/year. Without additional health care resources, our study highlights simple but effective improvements in the referral process that could facilitate patient care, avoid unnecessary delays, and decrease possible sources of patient complaints.

A Rare Case of Tremor Induces by Cycloserine in Drug-Resistant Tuberculosis Patient

Background: Tuberculosis is a contagious disease that generated by Mycobacterium tuberculosis. Drug-Resistant tuberculosis (DR-TB) is inculpated the use of the second-line anti-tubercular treatment which is associated with many drug side effects or so called, Adverse Drug Reactions (ADR). Cycloserine (Cs) is an important drug against drug resistant tuberculosis (DR-TB). Cycloserine has been used in tuberculosis therapy since the late 1950s. Identical with most drug, Cycloserine can cause many Adverse Drug Reactions (ADR). Case Illustration: A 23-year-old woman diagnosed with drug-resistant tuberculosis is undergoing long-term treatment. The patient received treatment for DR-TB with the Bdq-Lfx-Cfz-Cs-E regimen. After the patient underwent the 10th month of advanced phase treatment, the patient complained of shaking in both hands (tremors). The tremor is felt to be more severe in the right hand and the patient cannot grip objects tightly. Discussion: Cycloserine (Cs) play an important role in second-line drug management of DR-TB. Cs-Induced psychosis and other neurological side-effects can be detrimental towards patients yet they are rarely reports in DR-TB cases. Cs is correlated with severe psychiatric cases and Central Nervous System related ADRs. Cs-associated ADR is most likely because of production of gamma-aminobutyric acid as a result of inhibition of glutamic decarboxylase. Study Shown that among 132 patients who reported side effects in the cycloserine group, 2 (1.4%) experienced major side effects, namely tremors. Side effects possibly or probably related to Cs appeared after a median of 71 days (range 10–331 days) of Cs treatment. Conclusion: the drug side effects such as tremors are very rare in drug-resistant tuberculosis patients. In this case, the patient's complaint of tremors could be caused by cycloserine as an anti-tuberculosis drug.

Purtscher retinopathy following isolated chest compression: a case report.

This case report describes the case of a 56-year-old man who developed Purtscher retinopathy following compressive chest trauma. During the tertiary survey, the patient was found to have a unilateral partial vision decline despite sustaining only mild rib fractures. The patient was diagnosed with a rare complication of Purtscher retinopathy. At a 2-week follow-up outpatient examination, improved visual acuity was observed. This case highlights the importance of conducting a tertiary survey not only on the directly impacted site, but also comprehensively across all sites, while attentively listening to and addressing the patient's complaints.

Modern approach in microsurgical elimination of tongue defects using computerized digital planning

Introduction. The treatment of malignant neoplasms of the oral mucosa implies a combined treatment, whose first stage generally involves surgery. However, the most common non-personalized surgical methods are based on resection of the tongue, often affecting more than half of the organ, which can lead to significant functional deficiency and disability of patients.Objective. To demonstrate the possibility of tongue defect reconstruction using preoperative computer 3D planning through clinical cases.Маterials and methods. From 2021 to 2024, four patients with primary cancer of the lateral surface of the tongue were operated on using this methodology at the Maxillofacial Surgery Department of the NMICO FMBA of Russia. All patients underwent hemiglossectomy and preventive cervical lymphadenectomy on the affected side, with simultaneous reconstruction of the tongue using a radial forearm flap. The average age of the patients was 53 years; males outnumbered females by a ratio of 3:1. Patients presented with stages rT1-rT4; histological examination revealed no regional lymph node involvement (N0) in any patient. Preoperative instrumental examinations included: magnetic resonance imaging (MRI) of the soft tissues of the maxillofacial area with contrast enhancement; multislice computed tomography (MSCT) of the maxillofacial area with contrast enhancement; MSCT of the donor area (forearm) with contrast enhancement; Doppler ultrasound of the brachiocephalic trunk vessels and donor area vessels; transnasal endoscopic laryngoscopy with swallowing tests (three-swallow test) with video recording. All patients were surveyed preoperatively and postoperatively using EORT QLQ — H&N35, EORT QLQ — C30, FACT– H&N, MD Anderson, and VHI-10 questionnaires. Patients with abundant hair in the donor area underwent laser hair removal prior to hospitalization. After performing computer simulation of the surgical intervention using Slicer and Blender software, templates were printed on a Elegoo Saturn 2 printer. Assessment of speech and swallowing functions was carried out by a speech therapist specializing in these areas using the Pokrovsky protocol and Vospector-DSI software at both preoperative and postoperative stages. The attending physician performed anthropophotometry and video recording of patient complaints and speech at all stages of care. The postoperative period was without complications; nasogastric tubes were removed on the 12th day; the average hospital stay was 14 days.Results. The flap survival rate was 100% across the entire series of observations. Oncological radicality was achieved at R0 for all patients. The average duration of the surgical intervention was 288 minutes. In three patients, the acoustic parameters of speech were within normal limits (in one patient, this parameter could not be assessed due to systemic speech underdevelopment caused by hearing impairment). The average syllable intelligibility coefficient according to Pokrovsky was 88%. All patients adapted to their usual diet and continued their professional activities. According to the results of the EORT QLQ — H&N35, EORT QLQ — C30, and FACT — H&N questionnaires, patients rated their quality of life as good in one case and excellent in three cases.Conclusions. The developed algorithm for preoperative computer planning is promising. The use of surgical templates allowed for adequate oncological radicality, synchronized the simultaneous work of two surgical teams, reduced the duration of anesthetic assistance (with an average surgical intervention time of 288 minutes), and achieved good functional and aesthetic results. However, this methodology requires further refinement in a larger group of patients.

Togetherness Reminded by the Earthquake: Relationship Between Stress and Peptic Ulcer Perforation

Background: Severe stress is one of the leading causes of peptic ulcer perforations. Peptic ulcer perfora-tion is a clinical condition that can be fatal if not treated urgently. This study aimed to investigate the effects of social stress caused by the earthquakes in Kahramanmaraş on peptic ulcer perforation. Materials and Methods: A retrospective evaluation was conducted on 66 peptic ulcer perforation cases operated on in three major centers in Şanlıurfa, considering two large earthquakes that occurred on February 6, 2023, and by comparing the 6-month periods before and after the earthquakes. Patients were assessed in terms of age, gender, diagnostic method, perforation site, surgical technique, operation time, length of hospital stay, and mortality. Our study also evaluated laboratory parameters such as white blood cell (WBC) count, hemoglobin, urea, creatinine, and albumin levels. Results: In the 6 months prior to the earthquakes, 21 patients underwent surgery for peptic ulcer perfo-ration, whereas 45 patients were operated on for the same reason in the 6 months following the earthquakes; there were two deaths in each group. The number of patients operated on after the earthquakes was significantly higher than the number of patients operated on before the earthquakes. Furthermore, the two groups were also compared in terms of demographic data and laboratory findings; no significant differences between the two groups were observed regarding these parameters. Conclusions: Stress plays a remarkable role in the development of peptic ulcer perforation. In stressful situations that affect the general population, such as earthquakes, it is essential to assess stress tenden-cies and dyspeptic complaints in patients presenting to the hospital. Patients with positive findings should undergo endoscopy if necessary, followed by appropriate gastric treatment.

Nurses' attitudes towards patient safety and their relationship to adverse patient events in Oman.

Adverse events (AEs) are major causes of mortality. Identification of nurses' attitudes towards patient safety and their impact on AEs is critical in enhancing safe practices. To assess the relationship between attitudes towards patient safety and AEs as perceived by nurses working in Sultanate of Oman. A descriptive, cross-sectional study was conducted. Data to evaluate nurses' attitudes towards patient safety was collected using the Safety Attitude Questionnaire. The relationship between attitudes towards patient safety and the perceived incidence of adverse patient events was examined using logistic regression analysis. A total of 184 questionnaires were administered from February to April 2022, with a response rate of 96.8%. The results revealed that nurses had a negative attitude towards patient safety. The highest reported adverse event was patient and family complaints. Findings showed a significant relationship between working conditions and patient and family verbal abuse (OR = 0.505, CI (0.283-0.901), p = 0.021). Job satisfaction was a significant predictor of patient fall (OR = 0.57, CI (0.353-0.932), p = 0.025) and medication error (OR = 0.58, CI (0.354-0.949), p = 0.030). Nurses' attitudes towards patient safety are a significant predictor contributing to the occurrence of AEs. This finding provides key insights about patient safety status that key stakeholders could use to improve safety culture, including raising patient safety awareness.

12233 Weight Gain Following Thyroidectomy For Benign Conditions

Abstract Disclosure: A. Krueger: None. A. Chiu: None. S. Pabich: None. S. Syed: None. A. Poloju: None. S. Holoubek: None. Background: Weight gain is a common complaint of patients with hypothyroidism irrespective of etiology that causes dissatisfaction and decreased quality. Patients often report thyroidectomy as the precipitating event leading to subsequent weight gain and resistance to weight loss. Reported data on body weight changes following surgery are conflicting and there is limited literature on patients with benign pathologies. The average weight gain in the general population has been reported as 0.5/year. The primary outcome of this study was to determine if patients undergoing thyroidectomy for benign conditions experienced greater than expected weight gain compared to the general population when TSH values were controlled. Secondary outcomes assessed were whether pre-operative disease pathology or antibody status affected weight changes. Methods: A retrospective review was performed on 325 patients undergoing total thyroidectomy for benign conditions from January 2015 to December 2020 using the University of Wisconsin Thyroid Surgery Database. The weight change was determined from the time of surgery to the following intervals: 1-2 years, 2-5 years, and >5 years. Study groups were then compared by pathology and presence of antibodies. Exclusion criteria included age <18 years, thyroid cancer, pregnancy within one-year post-surgery, incomplete weight or TSH data, post-operative gastric-bypass surgery, and patients who were not euthyroid pre- and post-op. Results: Our patient population (n=219) gained a mean of 1.58 kg at the 1-2 year interval. There was no significant difference in weight gain based on pathology or antibody status. At the 2-5 year interval, the average weight gain was 2.05 kg and those with antibodies had significantly higher weight gain. Patients with TPO antibodies (n=34) gained a mean weight of 4.58 kg, and those with TRAB and or TSI antibodies (n=17) gained a mean weight of 4.67 kg. Those with both types of antibodies (n=10) did not have any significant weight gain. Conclusion: Conservatively, the expected weight gain of the general population over 2-5 years is 2.5 kg. Using a logistic regression model, patients with autoimmune thyroid disease had twice the odds of gaining more weight than expected by 2-5 years. The presence of auto-immune thyroid antibodies may serve as a target population for intensive weight management programs following surgery. Presentation: 6/1/2024

12233 Weight Gain Following Thyroidectomy For Benign Conditions

Abstract Disclosure: A. Krueger: None. A. Chiu: None. S. Pabich: None. S. Syed: None. A. Poloju: None. S. Holoubek: None. Background: Weight gain is a common complaint of patients with hypothyroidism irrespective of etiology that causes dissatisfaction and decreased quality. Patients often report thyroidectomy as the precipitating event leading to subsequent weight gain and resistance to weight loss. Reported data on body weight changes following surgery are conflicting and there is limited literature on patients with benign pathologies. The average weight gain in the general population has been reported as 0.5/year. The primary outcome of this study was to determine if patients undergoing thyroidectomy for benign conditions experienced greater than expected weight gain compared to the general population when TSH values were controlled. Secondary outcomes assessed were whether pre-operative disease pathology or antibody status affected weight changes. Methods: A retrospective review was performed on 325 patients undergoing total thyroidectomy for benign conditions from January 2015 to December 2020 using the University of Wisconsin Thyroid Surgery Database. The weight change was determined from the time of surgery to the following intervals: 1-2 years, 2-5 years, and >5 years. Study groups were then compared by pathology and presence of antibodies. Exclusion criteria included age <18 years, thyroid cancer, pregnancy within one-year post-surgery, incomplete weight or TSH data, post-operative gastric-bypass surgery, and patients who were not euthyroid pre- and post-op. Results: Our patient population (n=219) gained a mean of 1.58 kg at the 1-2 year interval. There was no significant difference in weight gain based on pathology or antibody status. At the 2-5 year interval, the average weight gain was 2.05 kg and those with antibodies had significantly higher weight gain. Patients with TPO antibodies (n=34) gained a mean weight of 4.58 kg, and those with TRAB and or TSI antibodies (n=17) gained a mean weight of 4.67 kg. Those with both types of antibodies (n=10) did not have any significant weight gain. Conclusion: Conservatively, the expected weight gain of the general population over 2-5 years is 2.5 kg. Using a logistic regression model, patients with autoimmune thyroid disease had twice the odds of gaining more weight than expected by 2-5 years. The presence of auto-immune thyroid antibodies may serve as a target population for intensive weight management programs following surgery. Presentation: 6/1/2024

The Prevalence Pediatric Patients Attending in A Tertiary care Hospital in Dhaka, Bangladesh

Introduction The incidence of skin conditions in young people typically varies between nations and within a single nation’s regions based on social, economic, racial, and environmental factors. A significant public health issue is the morbidity that skin diseases cause in children. There is a dearth of research on this pediatric issue in our nation, which is either centered on a condition, a community, or a particular population group. Objective To evaluate the dermatological complaints of the pediatric patients attending a dermatology outpatient department in a tertiary care hospital. Materials And Methods We retrospectively analyzed a total of 2472 pediatric patients who were in age range 0-18 years and came to the OPD of dermatology & venereology department of Ibn Sina Medical College Hospital, Dhaka, Bangladesh, over a period of 1½ year from January, 2020 to June, 2021. Data were collected on special proforma and analyzed with appropriate method. Results Among 2472 patients 1157 (46.8%) were male and 1315 (53.2%) were female and most of the patients belonged to the age group 12-18 year (52.6%). Male female ratio was 0.88:1. All diseases were broadly classified into noninfectious (71.2%) and infectious dermatoses (28.8%). Dermatitis (38.9%), infections (28.8%) and acne (14.44%) came out to be the top most common cause for OPD attendances. For the specific skin diseases, 20.1% were atopic dermatitis, 14.44% were acne, and 11.8 % were fungal infections. Atopic dermatitis was the most common condition below 12 years of age. In 12-18 years of age group, the most common condition was acne; females were more affected than males. Among the viral infections, wart was the most common (22.1%). Conclusion Atopic dermatitis was found to be the most common noninfectious disease and fungal infection was the most common infectious disease in all age groups and genders. Bangladesh Journal of Medical Science Vol. 23 No. 04 October’24 Page : 1054-1059

What does current diabetes and endocrine speciality outpatient training look like and what will change? Observations from a single training region in England

Introduction: Diabetes and endocrine speciality training in the UK has traditionally been lasted five years but moved to a four- year model in 2021 with the introduction of the Internal Medical Training (IMT)3 year programme. Here we aim to review the case mix of outpatients seen by a single diabetes and endocrinology Specialty Registrar (SpR) during clinical training and offer insights into the range of patients seen. We will also review the NHS ePortfolio entries for Diabetes and Endocrinology and for General Internal Medicine to establish how many self-entered forms, assessments (completed and expired) and summary assessments are typically undertaken before certification of completion of training (CCT). Methods: A diabetes and endocrinology registrar (JD) kept an anonymised log of all outpatient consultations from starting speciality training as an ST3 in August 2017 up until his CCT was awarded in May 2023. Duration of training was extended because JD was a less than full time trainee (LFTT), with a period of shared parental leave. Non-patient-identifiable data included diagnosis or presenting complaint of patient seen, type of clinic and date of clinic between August 2017 and May 2023. Following CCT, NHS ePortfolio data were reviewed to establish NHS ePortfolio entries, including the number of requested assessments and number of completions. Results: For the last 18 months of training, approximately 40% of JD’s working time was spent on general medicine and 60% on diabetes and endocrinology. Over the total time of training from 2017 to 2023 JD had a total of 4,150 consultations in outpatient clinics. There were 1,347 consultations in the endocrine clinic and 2,803 consultations in the diabetes clinic. There were 472 ePortfolio entries: 158 of these were self-entered, 284 requested assessments completed and 30 summary or progression assessments. 130 requested assessments expired before completion, giving a response rate of 68.5%. Conclusion: Observations from a single training region in England show that five years of diabetes and endocrinology registrar training provided a broad mix and depth of outpatient experience. The greater number of patients seen in diabetes clinic represents the requirement for service delivery in the area and subspecialist interest being developed. The change to four years’ speciality training is likely to represent around 800 fewer consultations as a speciality trainee in diabetes and endocrinology. The reduction in training opportunities could be addressed through having more protected time for specialist teaching clinics, particularly pump and technology clinics. A large amount of evidence from both the trainee and assessors is required in NHS ePortfolio to achieve CCT in diabetes and endocrinology and general internal medicine. Although the data come only from one trainee and one region, they can provide a point of reference for future analysis of the effect of four years’ speciality specific training on the breadth of training and a stimulus for other trainees and other region to reflect and analyse their rota and data.

Diverse phenotype of Ménière's disease associated with family history, thyroid disorder, migraine and associated disorders

ObjectiveTo better understand the clinical phenotype of Ménière's disease (MD), we examined family history, thyroid disorder, migraine, and associated disorders in complaints of people living with MD. MethodWe designed the study as a retrospective and examined data gathered from 912 participants with MD. Their data were originally collected by the Finnish Ménière Federation (FMF). The survey data included individual case histories for environmental factors, comorbidities, disease-specific complaints, impact-related questions, cognitive complaints, health-related quality of life (HRQoL), and sense of coherence (SOC). ResultsWe observed significant differences between those with and without sporadic occurrence, family history, thyroid disorder, and migraine-associated complaints. Family history explained 20% of variability in patient complaints. Patients with a family history of MD whose disease started at younger age experienced balance problems, more severe vertigo spells, more severe vestibular drop attacks (VDA), and less nausea, although they had good SOC. Thyroid disorder explained 14% of variability in patient complaints. MD patients with a thyroid disorder comorbidity suffered more often from constant dizziness, balance problems, greater impact of hearing problems, cognitive complaints, and poor HRQoL. Migraine explained 12% of variability in patients’ complaints and was associated with poor SOC and cognitive balance problems. MD patients with both thyroid disorder and migraine used antidepressants more often than other groups. Logistic regression analysis showed comorbidities of ischemic brain disorder (among 7.1%), kidney insufficiency (among 1.2%), and diabetes (among 7.3%) had statistically significant but restricted association with balance and gait problems, VDA, and reduced HRQoL. ConclusionsFamily history of MD and thyroid disorder or migraine comorbidities in MD influence the complaint pattern and partially explain complex symptom profiles, including symptoms of cognitive problems. Confounders play a minimal role in complaint profile and impact of MD whereas comorbidities influence the complaint structure and partly explain the complex symptom profile in MD.

339 - Can socio-demographic and clinical characteristics predict presenting complaints in patients with defecatory disorders?

339 - Can socio-demographic and clinical characteristics predict presenting complaints in patients with defecatory disorders?

Battling pain from osteoarthritis: causing novel cell death.

Osteoarthritis (OA) is a significant contributor to pain and disability worldwide. Pain is the main complaint of OA patients attending the clinic and has a large impact on their quality of life and economic standards. However, existing treatments for OA-related pain have not been shown to achieve good relief. The main focus is on preventing and slowing the progression of OA so that the problem of OA pain can be resolved. Pain caused by OA is complex, with the nature, location, duration, and intensity of pain changing as the disease progresses. Previous research has highlighted the role of various forms of cell death, such as apoptosis and necrosis, in the progression of pain in OA. Emerging studies have identified additional forms of novel cell death, such as pyroptosis, ferroptosis, and necroptosis that are linked to pain in OA. Different types of cell death contribute to tissue damage in OA by impacting inflammatory responses, reactive oxygen species (ROS) production, and calcium ion levels, ultimately leading to the development of pain. Evidence suggests that targeting novel types of cell death could help alleviate pain in OA patients. This review delves into the complex mechanisms of OA pain, explores the relationship between different modes of novel cell death and pain, and proposes novel cell death as a viable strategy for the treatment of these conditions, with the goal of providing scientific references for the development of future OA pain treatments and drugs.