Patient Complaints Research Articles

Diagnostic challenge of cutis Verticis Gyrata (CVG) in a patient presenting clinical features of Noonan or turner syndrome

Cutis Verticis Gyrata (CVG) is an uncommon condition, often classified as primary (idiopathic) or secondary to other diseases or syndromes. Its pathogenesis remains poorly understood, and its association with genetic syndromes is particularly rare. Noonan and Turner syndromes are distinct genetic disorders with characteristic phenotypes and multiple systemic involvements. This report aims to highlight the diagnostic complexities when CVG presents in the backdrop of these syndromes. A 38 years old patient was presented with chief complaints of receding hairline, dropping eyelids, cerebral deformations with deep furrows and thickened dermis. On the basis of patient's complaints, Noonan or turner syndrome was considered as possible diagnosis. This particular report presents a case of patient suffering from CVG having history of noonan and turner syndrome. With the detailed MRI, histology etc. CVG was finally confirmed. The novelty of this case lies in its rarity, diagnostic complexity, and the need for a multidisciplinary approach to unravel and manage the intersecting conditions. It contributes valuable insights to the existing medical literature, enhancing our understanding of the interplay between dermatological and genetic conditions. Patients with Noonan and turner syndrome exhibit clinical signs and symptoms that are strikingly similar to those of CVG, suggesting that this presents a significant diagnostic problem. An unfavorable outcome could arise from delayed or incorrect diagnosis. Because of this, it is recommended that healthcare fraternities should include uncommon illnesses like CVG as differential diagnosis. Considering CVG in differential diagnosis is crucial for early identification, accurate diagnosis, and comprehensive management. It ensures that associated systemic and genetic conditions are not overlooked and that patients receive holistic and personalized care.

Performance of Large Language Models in Patient Complaint Resolution: Web-Based Cross-Sectional Survey.

Patient complaints are a perennial challenge faced by health care institutions globally, requiring extensive time and effort from health care workers. Despite these efforts, patient dissatisfaction remains high. Recent studies on the use of large language models (LLMs) such as the GPT models developed by OpenAI in the health care sector have shown great promise, with the ability to provide more detailed and empathetic responses as compared to physicians. LLMs could potentially be used in responding to patient complaints to improve patient satisfaction and complaint response time. This study aims to evaluate the performance of LLMs in addressing patient complaints received by a tertiary health care institution, with the goal of enhancing patient satisfaction. Anonymized patient complaint emails and associated responses from the patient relations department were obtained. ChatGPT-4.0 (OpenAI, Inc) was provided with the same complaint email and tasked to generate a response. The complaints and the respective responses were uploaded onto a web-based questionnaire. Respondents were asked to rate both responses on a 10-point Likert scale for 4 items: appropriateness, completeness, empathy, and satisfaction. Participants were also asked to choose a preferred response at the end of each scenario. There was a total of 188 respondents, of which 115 (61.2%) were health care workers. A majority of the respondents, including both health care and non-health care workers, preferred replies from ChatGPT (n=164, 87.2% to n=183, 97.3%). GPT-4.0 responses were rated higher in all 4 assessed items with all median scores of 8 (IQR 7-9) compared to human responses (appropriateness 5, IQR 3-7; empathy 4, IQR 3-6; quality 5, IQR 3-6; satisfaction 5, IQR 3-6; P<.001) and had higher average word counts as compared to human responses (238 vs 76 words). Regression analyses showed that a higher word count was a statistically significant predictor of higher score in all 4 items, with every 1-word increment resulting in an increase in scores of between 0.015 and 0.019 (all P<.001). However, on subgroup analysis by authorship, this only held true for responses written by patient relations department staff and not those generated by ChatGPT which received consistently high scores irrespective of response length. This study provides significant evidence supporting the effectiveness of LLMs in resolution of patient complaints. ChatGPT demonstrated superiority in terms of response appropriateness, empathy, quality, and overall satisfaction when compared against actual human responses to patient complaints. Future research can be done to measure the degree of improvement that artificial intelligence generated responses can bring in terms of time savings, cost-effectiveness, patient satisfaction, and stress reduction for the health care system.

Transient receptor potential melastatin 8 contributes to the interleukin-33-mediated cold allodynia in a mouse model of neuropathic pain.

Cold allodynia is a common complaint of patients suffering from neuropathic pain initiated by peripheral nerve injury. However, the mechanisms that drive neuropathic cold pain remain elusive. In this study, we show that the interleukin (IL)-33/ST2 signaling in the dorsal root ganglion (DRG) is a critical contributor to neuropathic cold pain by interacting with the cold sensor transient receptor potential melastatin 8 (TRPM8). By using the St2-/- mice, we demonstrate that ST2 is required for the generation of nociceptor hyperexcitability and cold allodynia in a mouse model of spared nerve injury (SNI). Moreover, the selective elimination of ST2 function from the Nav1.8-expressing nociceptor markedly suppresses SNI-induced cold allodynia. Consistent with the loss-of-function studies, intraplantar injection of recombinant IL-33 (rIL-33) is sufficient to induce cold allodynia. Mechanistically, ST2 is co-expressed with TRPM8 in both mouse and human DRG neurons and rIL-33-induced Ca2+ influx in mouse DRG neurons through TRPM8. Co-immunoprecipitation assays further reveal that ST2 interacts with TRPM8 in DRG neurons. Importantly, rIL-33-induced cold allodynia is abolished by pharmacological inhibition of TRPM8 and genetic ablation of the TRPM8-expressing neurons. Thus, our findings suggest that the IL-33/ST2 signaling mediates neuropathic cold pain through downstream cold-sensitive TRPM8 channels, thereby identifying a potential analgesic target for the treatment of neuropathic cold pain.

What are the frequent complaints voiced by inpatients and physicians amidst the emerging infectious diseases? — An illustrative instance of the COVID-19

IntroductionEmerging infectious diseases (EIDs) can disrupt the healthcare system, causing regulatory changes that affect the healthcare-seeking process and potentially increase patient-physician dissatisfaction. This study aimed to collect and analyze patients’ and physicians’ complaints during an EID outbreak to inform potential clues regarding medical quality and patient safety enhancement in future dealing with EIDs, employing text mining methodologies.MethodsIn this descriptive study, complaint records from January 2020 to February 2023 at West China Hospital, a national medical facility in China, were analyzed. Patient and physician complaints have been retrospectively retrieved from the record from the medical department, and then categorized into distinct groups based on reporting reasons, encompassing COVID-19-related policies, healthcare access, availability of medical resources, and financial concerns.ResultsDuring the COVID-19 pandemic, 541 COVID-19-related complaints were identified: 330 (61.00%) from patients and 211 (39.00%) from physicians. The monthly volume of complaints fluctuated, starting at 10 in 2020, peaking at 21 in 2022, and dropping to 14 in 2023. Most complaints from inpatients were expressed by older males aged 40 to 65 (38.82%, 210/541). The primary source of complaints was related to mandatory COVID-19 policies (79.30%, 429/541), followed by concerns regarding timely healthcare services (31.61%, 171/541). Few complaints were expressed regarding the insufficiency of medical resources (2.77%, 15/541) and the high costs (4.25%, 23/541). The frequency of complaints expressed by doctors and patients in the emergency department was higher compared with other departments (24.58%, 133/541).ConclusionsIncreased complaints may serve as a primitive and timely resource for investigating the potential hazards and drawbacks associated with policies pertaining to EIDs. Prompt collection and systematical analysis of patient and physician feedback could help us accurately evaluate the efficacy and repercussions of these policies. Implementing complaints-based assessment might improve care standards in forthcoming healthcare environments grappling with EIDs.

Gingival Depigmentation by 810 nm Diode Laser and Cryosurgery Using 1,1,1,2-Tetrafluoroethane: A Clinical Study

Abstract Introduction: Pigmented gingival tissue is a common complaint of patients as unaesthetic. There is a dearth of literature comparing the efficacy of depigmentation by cryosurgery using a biocompatible material 1,1,1,2-tetrafluoroethylene gas and diode laser, which are relatively newer techniques. The study aims to evaluate and compare the efficacy of two different modalities of gingival depigmentation – 810 nm diode laser and cryosurgery using 1,1,1,2-tetrafluoroethane in managing gingival melanin pigmentation. Materials and Methods: A randomised controlled split-mouth trial was conducted on 15 participants. Depigmentation was done using an 810 nm diode laser and a cryosurgery technique using 1,1,1,2-tetrafluoroethane. Re-evaluation was performed at the 1st, 3rd and 6th months postoperatively. Dummett’s Oral Pigmentation Index (DOPI), Hedin’s Melanin Index (HMI), the Visual Analogue Scale for pain and Photometric analysis (RGB scale) were recorded and analysed. Results: DOPI and HMI in the subjects treated by laser and cryosurgery showed statistically significant differences (P &lt; 0.001) from baseline to 1 month, 3 months and 6 months. Intergroup comparison of RGB scores between the laser and cryosurgery depicted no significant difference at baseline (P = 0.06). Conclusions: Cryosurgery using 1,1,1,2-tetrafluoroethylene and laser ablation using an 810 nm diode laser technique was found to be equally effective for treating gingival pigmentation.

Ear Complaints in Fibromyalgia: A Narrative Review.

Patients with fibromyalgia (FM) have innumerable complaints due to the central amplification of somatic stimuli. The aim of this paper was to review the ear complaints in patients with FM. A review of articles published in PubMed/MEDLINE, Embase, Web of Science, and Scopus from 1966 to June 2023 was performed. Seventeen papers were included in the review. They showed that patients with FM have a higher hearing loss rate, mostly at high frequencies, and hyperacusis. The prevalence of vestibular symptoms (tinnitus, dizziness) and hyperacusis was higher than in the general population, reaching 87.0% of the sample. Subjective findings did not always correspond to objective results. In some studies, the degree of FM severity was associated with ear symptoms; in others, it was not. Ear complaints in patients with FM are linked to subjacent disease and may be related to stimuli central amplification.

Effectiveness of intracuff alkalinized lidocaine associated with intravenous dexamethasone in reducing laryngotracheal morbidity in children undergoing general anesthesia for tonsillectomy: a randomized controlled trial

BackgroundPostoperative sore throat is one of the main postoperative complaints in patients undergoing tonsillectomy. As the primary outcome, we aimed to determine whether endotracheal tube cuffs filled with alkalinized lidocaine are associated with a lower incidence of postoperative sore throat and anesthesia emergence phenomena in children undergoing tonsillectomy or adenotonsillectomy. We also assessed the potential additional benefits of IV dexamethasone in reducing postoperative laryngotracheal morbidity. MethodsThis is a clinical prospective, randomized, controlled trial. Patients were randomly allocated to one of four groups, as follows: air – endotracheal tube cuff filled with air; air/dex – endotracheal tube cuff filled with air and intravenous dexamethasone; lido – endotracheal tube cuff filled with alkalinized lidocaine; and lido/dex – endotracheal tube cuff filled with alkalinized lidocaine and intravenous dexamethasone. Perioperative hemodynamic parameters and the incidence of postoperative nausea and vomiting, coughing and hoarseness were recorded. Postoperative sore throat was assessed in the postanesthetic care unit and 24 hours post tracheal extubation. ResultsIn total, 154 children aged 4–12 years, ASA physical status I or II, undergoing general anesthesia for elective tonsillectomy and adenotonsillectomy, were assessed for postoperative sore throat in this study. The incidence of postoperative sore throat 24 hours after tracheal extubation was significantly lower in the lido/dex group compared to groups air and air/dex (p = 0.01). However, no additional reduction in these symptoms was observed from the intravenous administration of dexamethasone when comparing the lido and lido/dex groups. Similarly, there were no differences among groups regarding perioperative hemodynamic variables or postoperative nausea and vomiting, coughing, and hoarseness during the study period. ConclusionIntracuff alkalinized lidocaine, associated with intravenous dexamethasone, might be effective in reducing sore throat 24 hours post-tonsillectomy or adenotonsillectomy in children when compared to the use of air as the cuff insufflation media.

Lessons Learned From a Retrospective Analysis of Medicolegal Risks for Physicians Treated Adolescents and Young Adults With Medical Complexity

PurposeAdolescent and young adult patients occupy a clinically transitional space between pediatric and adult care. Youth with chronic conditions and special healthcare needs may have trouble accessing and receiving appropriate care in this transition, which may lead to patient safety issues and medicolegal risks for physicians. The objectives of this article were to explore patient safety issues and identify medicolegal risks for physicians. MethodsA national repository was retrospectively searched for medicolegal cases (MLCs) involving complaints from youth. The study included MLCs closed at the Canadian Medical Protective Association between 2013 and 2022 involving youth. The study participants were adolescents and young adults aged ≥ 15 and ≤ 21 years with medical complexity. The frequencies and proportions of patient safety events and medicolegal risks for physicians were calculated by exploring factors that contributed to each incident using established frameworks. ResultsA total of 182 eligible MLCs were identified. Of 206 involved physicians, 55 were psychiatrists. The most common reasons for patient complaints were deficient assessment, diagnostic error, and communication breakdown with the patient and/or family. More than half of the cases were related to a harmful incident. Peer experts reviewed the cases and identified factors such as a deficient assessment, a failure to perform a test or intervention, failure to refer the patient, and insufficient provider knowledge/skill as contributing to the patient safety event. DiscussionThe impact of our findings is to identify gaps in care delivery to youth that can inform practitioners of ways to mitigate the gaps and improve patient care and health outcomes.

The justification and practice of the patient rights charter from the perspective of patients admitted to surgical wards during COVID-19 pandemic: evidence from Southern Iran

BackgroundHospitals, as one of the core elements of healthcare service delivery, should pave the way for more efficient compliance with the Patient Rights Charter (PRC). The COVID-19 pandemic affected the interactions between healthcare providers and patients. The present study aimed to investigate the importance and practice of PRC from the perspective of hospitalized patients in surgical wards during the COVID-19 pandemic.MethodsThe participants in this cross-sectional study were 355 patients who underwent surgery at Imam Khomeini Hospital in southern Kerman, Iran, in 2021. Data was collected by convenience sampling. The data in this study were collected using Justification and Practice of Patient Rights (JPPR). Data analysis was performed with SPSS-16 software using the Kruskal-Wallis, Wilcoxon, and Spearman correlation tests.ResultsThe total mean score for the justification of patient rights (PR) was 69.12 ± 58.44, which was significantly higher than the total mean score of PR practice (61.02 ± 1.32) (p < 0.001). In addition, the mean scores for all PR justification dimensions were significantly higher than the mean scores for PR practice (p < 0.05). A comparison of the dimensions of the PR justification showed service facilitation had the highest score and handling patient complaints had the lowest score. Furthermore, an analysis of the dimensions of PR practice indicated that handling patient complaints had the lowest score and other dimensions had the same score.ConclusionThe results of this study showed that despite the great importance of PR from the patients’ perspective, PR is not still practiced optimally. The findings from this study can have some clinical implications and help hospital managers to take measures to better adapt to the PRC with staff training and developing a strong policy to comply with the PRC, especially by paving the way for handling patient complaints.

The Nurses' Role in Management Complaint

Background: As primary caregivers, nurses ensure patient safety and quality health services by effectively managing patient complaints. Proper handling of these complaints is crucial for providing effective treatment. Develop management and understanding of handling patient complaints efficiently by providing a systematic framework and identifying effective communication techniques to deal with patient complaints effectively. Methods: ProQuest, Ebsco, Science Direct, and Elsevier were the literature sources examined between 2013 and 2023. Results: Nursing managers should enhance nurses' communication skills to improve patient care and complaint management. Studies indicate that targeted training in communication significantly boosts nurses' effectiveness and patient satisfaction.Conclusion: Implementing training programs, regular assessments, and ongoing support will improve patient outcomes and more effective complaint handling.

Conservative versus Invasive Approaches in Temporomandibular Disc Displacement: A Systematic Review of Randomized Controlled Clinical Trials.

Temporomandibular disorders (TMDs) frequently cause orofacial pain and dysfunction, with treatment options spanning from conservative therapies to invasive surgical procedures. The aim of this systematic review was to analyze and compare the efficacy and safety profiles of conservative, minimally invasive interventions and surgical procedures in patients diagnosed with TMDs and disc displacement. Following PRISMA recommendations, PubMed, Scopus, and Web of Science databases were searched for randomized clinical trials (RCT). Data were synthesized in a table and evaluated through the Cochrane risk of bias 2 (RoB 2) tool. Thirty-eight RCTs, most with moderate RoB, were selected. Conservative approaches, including physical therapy and occlusal devices, led to an improvement in symptoms and function. Pharmacological treatments demonstrated effectiveness in reducing pain and improving function; however, they can have undesirable side effects. Minimally invasive and invasive treatments also demonstrated efficacy, although most trials did not show their superiority to conservative treatments. The primary approach to TMDs should be a conservative, multimodal treatment plan tailored to patient complaints and characteristics. Treatment goals should focus on symptom control and functional recovery. Surgical treatment should be reserved for cases with a precise diagnosis and a clear etiology.

Quality of BPJS Services at Mitra Sejati Hospital with Importance Performance Analysis (IPA) Method

The number of true partner hospitals in North Sumatra Province has increased since 2012 by 288 units to 310 units in 2023. The increasing number of true partner hospital units does not necessarily mean that true partner hospital services are adequate. This research aims to measure the factors that influence consumer satisfaction and to provide technical responses sourced from the Voice of Customer. This research uses a quantitative analysis method that combines the Importance Performance Analysis (IPA) method to determine service quality factors that influence consumer satisfaction and the Quality Function Deployment method is used to provide a technical response. This methodology uses a quantitative approach using the IPA method to show factors that are among the main priorities, namely services related to providing appropriate diagnoses by doctors at true partner hospitals, services related to responses by true partner hospitals to complaints from patients, and service attributes related to the suitability of drugs given by doctors at true partner hospitals. Increasing responses to patient complaints is a top priority that must be carried out by true partner hospitals to increase patient satisfaction. The technical response with the highest priority order is that medical personnel must provide clear answers regarding the treatment the patient is undergoing, and doctors at true partner hospitals must be more careful in administering medication that is appropriate to the patient’s illness.

Implementation of total quality management (TQM) to reduce patient complaints in hospitals: literature review

Implementation of total quality management (TQM) to reduce patient complaints in hospitals: literature review

Comparison between intravenous lidocaine and dexamethasone in reducing postoperative sore throat after endotracheal extubation at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia; a prospective cohort study

BackgroundPost-operative sore throat is the common complaint and uncomfortable side effect in patients receiving general anesthesia with endotracheal intubation. Drugs with analgesic and anti-inflammatory properties, like steroids and local anesthetics, are the best options for postoperative sore throat prophylaxis. Therefore, this study aimed to compare the effects of intravenous lidocaine and dexamethasone in reducing postoperative sore throat following endotracheal extubation at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, from January 1 to March 30, 2023 G.C.MethodsA prospective cohort study was carried out at Tikur Anbessa Specialized Hospital. Data from 50 patients in the lidocaine (1.5 mg/kg), 50 in the dexamethasone (8 mg), and 49 in the control groups were analyzed. The data were collected using observation based on structured questionnaires. A systematic random sampling technique was applied to select respondents. The data were entered into EpiData version 4.6.0.6 and transferred to STATA version 17 statistical software for analysis. A comparison of continuous data among the groups were performed using a one-way ANOVA test for parametric data. The Kruskal–Wallis rank test was used for non-parametric data. Associations between variables were tested using chi-squared test, Fisher’s exact test, and binary logistic regression. Bivariable and multivariable logistic regression was used to determine degree of association.ResultsThe incidence of POST was 40%, 32%, and 57.1% in the lidocaine, dexamethasone, and control groups, respectively (P = .0356). Dexamethasone reduced the incidence of POST during the first 24 h (AOR: 0.374, 95% CI: 0.149–0.939). However, no difference was observed in the severity of POST at 3 h (p = 0.130), 6 h (p = 0.096), 12 h (p = 0.313), and 24 h (p = 0.525) of the post-extubation period among the three groups. IV lidocaine did not effectively reduce the incidence and severity of postoperative sore throat at different time intervals.Conclusion and recommendationIntravenous dexamethasone is more effective than intravenous lidocaine in reducing the incidence of postoperative sore throat among the groups. Based on these findings, intravenous dexamethasone is recommended to decrease the incidence of postoperative sore throat.

Incidence of foreign bodies in quaternary hospital patients

Foreign bodies in the ENT area are very common, in our experience, in low-income countries, for several reasons, including a lack of appropriate and suitable toys for children. The study aims to determine the epidemiological and clinical profile of patients assisted in the ENT Service with an initial diagnosis of FB, during the period 2007-2011. A descriptive, retrospective study, which goes through a collection and analysis of the data available in several registry books of patients with foreign bodies consecutively in 5 years. Results: In this study, it was observed a total of 2615 patients with foreign bodies. Most cases occur from August to November. At the end of the week, fewer cases were observed. Most of the patients were male. The most frequent complaint of patients with foreign bodies in this study was dysphagia. Metals were the most found foreign bodies and most of them were found in the esophagus. This study presents a compilation encompassing a relatively long period, constituting an important source of information on the subject. On the other hand, if we take into account the evidence of this study and the existing evidence in the literature, we can draw some conclusions that can be useful in defining prevention and control strategies of incidents by foreign bodies in natural orifices of the head and neck.

Recent Advances In Interventional Pain Management

Introduction: Due to limited access to therapy, 60 million individuals worldwide suffer from chronic pain, with a frequency of 20–25% in some nations. Low- and middle-income countries (LMICs) are disproportionately affected by this condition. The yearly cost of diabetes, cancer, and heart disease—including medical expenses, lost productivity, and disability programs—is less than that of pain complaints. Pain management techniques, the most recent discoveries in pain research, and the most recent advancements in pain therapy technology can work together to reduce the prevalence of chronic pain and lessen the financial burden that comes with pain syndrome. Objective: To determine the extent to which the latest technological developments in interventional pain management to personalized treatment techniques according to patient complaints and conditions. The scope of technological development here is not only pain intervention techniques but also advances in understanding the pathophysiology of pain, nerve and tissue regeneration, as well as the modalities of technology used for pain interventions. Review: By conducting literature searches including journals, systematic reviews, library surveys, and case reports from the last 10 years on the latest interventional pain management techniques and serial cases. Summary: Many new minimally invasive pain intervention techniques have been developed and used in the treatment of chronic pain within the past 10 years. The necessity for standardization of processes, safety, efficacy, cost, and accessibility to new technology and techniques are among the issues and debates surrounding technical advancements and strategies for managing chronic pain. Intervention pain management techniques have grown in importance as a less intrusive method of treating chronic pain. For optimal outcomes, used in conjunction with other pain management modalities such as medication, physical therapy, cognitive behavioral change therapy, and others.

Pengaruh Kualitas Pelayanan Terhadap Kepuasaan Pasien BPJS Poli Penyakit dalam Rumah Sakit Bhayangkara Pontianak

A hospital is a public facility owned by the government or private sector which has a very strategic role in efforts to improve public health services. The new paradigm of health services requires hospitals to provide quality services according to patients' needs and desires while still referring to professional and medical codes of ethics. Quality is the core of the survival of an institution. Therefore, hospitals are required to always maintain consumer trust by improving service quality so that consumer satisfaction increases. This study aims to analyze the influence of service quality on patient satisfaction at Bhayangkara Hospital, Pontianak City. The research method used in this research is a quantitative method to determine the quality of service that has the greatest impact on community satisfaction. Samples were taken from 95 patients. Data collection techniques use observation and questionnaires. The results of the research show that the influence of service quality on BPJS patient satisfaction in internal medicine poly health services at Bhayangkara Hospital, Pontianak, most of the respondents are in the satisfactory category and a small number of respondents are in the unsatisfactory category. The results of this research show that service quality, which consists of the variables reliability (X1), responsiveness (X2), assurance (X3) and empathy (X5), has a significant effect on patient satisfaction, while the tangibles variable (X4) has no significant effect. Then the variable with the most dominant influence on patient satisfaction is the empathy variable (X5). And to improve service quality, researchers hope that Bhayangkara Hospital will test these variables, especially those that have a negative influence (tangibles X4) so that they can comply with the rules and mechanisms for improving service quality on patient satisfaction. The researcher's advice to Bhayangkara Pontianak Hospital is that nurses at Bhayangkara Pontianak Hospital should be able to maximize services according to the promised time, increase trust and responsiveness to patient complaints, and pay attention to the physical facilities of the Bhayangkara Pontianak Hospital Internal Medicine Clinic.

Electromyographic Analysis of Large Muscle Activity in Progressive Collapsing Foot Deformity.

There are various deformities described in the spectrum of Progressive Collapsing Foot Deformity (PCFD) which not only have adverse effects on the foot but also on the entire lower limb. Early lower limb muscular fatigue and pain during exertion is the most common complaint of patients with PCFD. Surface electromyography (sEMG) provides an accurate assessment of muscle activity. In this study, we aim to compare the activities of quadriceps, hamstrings, and gastrosoleus muscle groups of adult patients with PCFD with normal lower limbs and correlate the radiological parameters and functional effects of PCFD with the activities. Thirty patients with bilateral PCFD and 30 controls underwent weight-bearing anteroposterior (AP), lateral, and hindfoot alignment radiographs of the foot. Radiographic parameters of PCFD were assessed. Surface electromyography was used to assess the quadriceps, hamstrings, and gastrosoleus activities, and this was compared between the 2 groups and correlated with radiological measurements of PCFD. Tegner activity questionnaire was used to assess the functional effects of collapsed arch. Electrical activities of all muscle groups were significantly higher in cases than controls. Meary's angle and hindfoot moment arm had significant correlations with hamstring activity (P = .013) and gastrosoleus activity (P = .027), respectively. Tegner scores of cases were significantly lower than those of controls (P = .041). The PCFD causes an increase in activity of large muscles of the affected lower limb which act on joints other than those in the foot. This finding may be due to several compensatory mechanisms that counteract the deforming forces. This may be a cause for the frequent complaint, early fatigue, and hence functional impairment. However, most radiological parameters did not correlate with muscle activities and larger study size may be required for further association. Diagnostic: Level 3.

MASCC/ISOO Clinical Practice Statement: Clinical assessment of salivary gland hypofunction and xerostomia in cancer patients.

A MASCC/ISOO Clinical Practice Statement (CPS) is aimed at generating a concise tool for clinicians that concentrates practical information needed for the management of oral complications of cancer patients. This CPS is focused on the clinical assessment of salivary gland hypofunction and xerostomia in cancer patients. This CPS was developed based on a critical evaluation of the literature followed by a structured discussion of a group of leading experts, members of the Oral Care Study Group of MASCC/ISOO. The information is presented in the form of succinct bullets and tables to generate a short manual about the best standard of care. The objective assessment of saliva secretion involves an extra- and intra-oral clinical examination while the subjective assessment involves eliciting information on the patient's complaint of xerostomia and its impact on daily functioning. This CPS summarizes the common investigator- and patient-reported instruments used in clinical practice for assessing salivary gland hypofunction and xerostomia in cancer patients. There is a range of tools to assess salivary gland function in patients undergoing cancer therapy, patients recovering from cancer therapy, or cancer survivors. Clinicians should ideally conduct both objective and subjective measurements to ensure a clear understanding about the status of the patients in order to provide the most appropriate treatment.

Providing Performance Feedback and Patient Outcome Follow-Up to Emergency Medical Services (EMS) is Associated with Subsequent Improved Clinical Performance

Objective Emergency Medical Services (EMS) clinicians desire performance feedback (PF) and patient outcome follow-up (POF). Within our agency, both a peer-review and feedback/outcome (PF/POF) process exist. Our objective was to determine whether receiving feedback and outcome data improved future clinical care amongst EMS, based upon peer-review scores. Methods This retrospective cohort study took place between 1/1/2020 and 6/7/2023 within an EMS agency site with 22,000 average annual 9-1-1 calls. Requests for PF/POF were submitted on an individual basis beginning June 2020 and completed by a dedicated EMS nurse, EMS physician, or emergency medicine (EM) resident. Peer-review of select high-acuity cases were scored by two Quality Assurance (QA) specialists within the categories of assessment, treatment, disposition/outcome and process/administrative guidelines. Association between overall peer-review score and number of PF/POF requests at time of assessment was evaluated by linear regression. Results A total of 378 PF/POF requests were received, with the most common patient complaints being cardiac (n = 105; 27.8%, including 49 (13.0%) out of hospital cardiac arrests), altered mental status/neurologic (n = 103; 27.2%), trauma (n = 61; 16.1%, including 2 (0.5%) traumatic arrests); and respiratory distress (n = 47; 12.4%). A total of 378 runs meeting QA criteria were peer-reviewed post-PF/POF process implementation, including 337 (89.2%) cardiac/respiratory arrests, 27 (7.1%) with difficult airway management, and 14 (3.7%) major trauma/traumatic arrests. The number of prior PF/POF requests made by the team leader was associated with higher overall peer-review scores. Team leaders with >5 prior PF/POF requests had a peer-review score 0.39 points greater (95% CI: 0.16 − 0.62, p = 0.001) than those with <5 prior requests. The number of prior PF/POF requests amongst the entire crew was also associated with higher peer-review scores. Crews that collectively had >5 prior PF/POF requests had an increase in peer-review score 0.32 points greater (95% CI: 0.14 − 0.50, p < 0.001) than those with <5 prior requests. Conclusion Providing performance feedback and patient outcome follow-up to EMS is associated with improved peer-review scores of clinical performance. Future studies should assess if those that are submitting cases for feedback/outcome are higher performers at baseline or if the process of receiving feedback/outcome improves their performance.