Specialist Practice Research Articles

The patient with obstructed defecatory symptoms: Management differs considerably between physicians and surgeons.

Patients with obstructed defecatory symptoms (ODS) are commonly referred to either gastroenterologists (GE) or colorectal surgeons (CS). Further management of these patients may be impacted by this choice of referral. An online survey of specialist practice was disseminated to GE and CS in Australia and New Zealand. A case vignette of a patient presenting with ODS was described, with multiple subsequent scenarios designed to delineate the responder's preferred approach to management of this patient. A total of 107 responders participated in the study, 62 CS and 45 GE. For a female patient with ODS not responding to pharmacological treatment, GE were more likely than CS to refer patients for anorectal manometry, while CS were more likely to refer for dynamic imaging. A quarter of CS and GE referred patients directly to pelvic floor physiotherapy, without any pre-treatment testing. Knowing the result of dynamic imaging, especially if a rectocele was demonstrated, substantially influenced management for both of the specialties: GE became more likely to refer the patients for CS consultation and less likely to refer directly for biofeedback or physiotherapy and CS were more likely to opt for an operative pathway over conservative management than they were prior to knowledge of the imaging findings. The majority (>75%) of GE and CS did not find it necessary to obtain a gynecological consultation, even in the presence of a rectocele. Practice variation across medical specialties affects diagnostic and management recommendations for patients with ODS, impacting treatment pathways. Our findings provide an incentive toward establishing interdisciplinary, uniform, management guidelines.

Zum Stand der intersektoralen Behandlung in der HNO-Heilkunde in Deutschland – Ergebnisse einer Umfrage*

The German Healthcare System is currently subject of significant structural changes. Due to politic influences it is obvious that more and more even complex diagnostic and therapeutic procedures will be performed in an office setting or as day treatments. This is due to the high rate of hospital treatments in Germany compared to other OECD countries. A revision of the healthcare system will include both, ambulatory and hospital treatments, which will only be possible with some new structures for this "intersectoral" treatment. Currently there are no data available on the status, possibilities and structure of the "intersectoral" treatment in ENT in Germany. To get an overview on the possibilities for an "intersectoral" treatment in ENT in Germany a survey was conducted. Each chariman of an ENT clinic/Department and all ENT specialists in private practice were contacted and got a questionnaire. The evaluation was performed differently for chairmen of an ENT department, ENT specialists in private practice without and with a ward for inpatients in hospitals. 4,548 questionnaires were mailed. Out of them 493 were filled and came back (10.8%). The return rate in the group of ENT Department chairmen was with 52.9% even higher. "Intersectoral" for physicians in hospitals means that they are usually working with a personal authorization by the local Association of Statutory Health Insurance Physicians, ENT specialists in private practice usually with a ward for inpatient authorization in a hospital. Appropriate structures for an intersectoral organization of patients´s treatment are currently missing. Both, ENT Department chairmen and ENT specialists in private practice declared the current remuneration system for ambulatory and day surgery as completely inaedequate and is urgently to be revised. Beside this, ENT Department chairmen declared problems with the emergency care of patients with complications operated on outside the hospital, problems with the continuing education of residents and with information transfer. They request that hospital specialists should be allowed to work in the contractual medical care of outpatients without a restriction. ENT specialists in private practice mentioned positively the good cooperation possibilities with hospital physicians, knowledge sharing, and wide ranges of indications in the ENT Departments. Negative points could be possible worse information sharing when there is no distinct contact person in the ENT Departments, a possible competitive situation between ENT Departments and specialists in private practice, and sometimes long waiting times for the patients. The German health care system is currently facing a radical reform with the overcoming of traditional rigid and inflexible sectors in outpatient care and inpatient hospital care. To achieve this, the intersectoral patient treatment should play the key role. "Intersectoral" means that the whole process of patient care from diagnosis to therapy is closely interlinked and can also be managed by the same physicians, no matter whether they are working as spcialists in an ENT-Department in a hospital or in private practice. However, currently there are no appropriate structures available to achieve this goal. Beside creating structural conditions for intersectoral treatment the current remuneration system for outpatient procedures and dayclinic treatments must be renewed in a way to cover all the costs. Further conditions are the development of good cooperation models between ENT Departments and specialists in private practice, and the possibility for hospital ENT physicians to work in the contractual medical care of outpatients without a restriction. Intersectoral patient care must take the quality management, the continuing education of residents and the patient safety under consideration.

Wayfinding artificial intelligence to detect clinically meaningful spots of retinal diseases: Artificial intelligence to help retina specialists in real world practice.

To aim of this study is to develop an artificial intelligence (AI) that aids in the thought process by providing retinal clinicians with clinically meaningful or abnormal findings rather than just a final diagnosis, i.e., a "wayfinding AI." Spectral domain optical coherence tomography B-scan images were classified into 189 normal and 111 diseased eyes. These were automatically segmented using a deep-learning based boundary-layer detection model. During segmentation, the AI model calculates the probability of the boundary surface of the layer for each A-scan. If this probability distribution is not biased toward a single point, layer detection is defined as ambiguous. This ambiguity was calculated using entropy, and a value referred to as the ambiguity index was calculated for each OCT image. The ability of the ambiguity index to classify normal and diseased images and the presence or absence of abnormalities in each layer of the retina were evaluated based on the area under the curve (AUC). A heatmap, i.e., an ambiguity-map, of each layer, that changes the color according to the ambiguity index value, was also created. The ambiguity index of the overall retina of the normal and disease-affected images (mean ± SD) were 1.76 ± 0.10 and 2.06 ± 0.22, respectively, with a significant difference (p < 0.05). The AUC used to distinguish normal and disease-affected images using the ambiguity index was 0.93, and was 0.588 for the internal limiting membrane boundary, 0.902 for the nerve fiber layer/ganglion cell layer boundary, 0.920 for the inner plexiform layer/inner nuclear layer boundary, 0.882 for the outer plexiform layer/outer nuclear layer boundary, 0.926 for the ellipsoid zone line, and 0.866 for the retinal pigment epithelium/Bruch's membrane boundary. Three representative cases reveal the usefulness of an ambiguity map. The present AI algorithm can pinpoint abnormal retinal lesions in OCT images, and its localization is known at a glance when using an ambiguity map. This will help diagnose the processes of clinicians as a wayfinding tool.

Best crossing of peripheral chronic total occlusions.

Together with colleagues from different disciplines, including cardiologists, interventional radiologists and vascular surgeons, committee members of the of the German Society of Angiology (Deutsche Gesellschaft für Angiologie [DGA]), developed a novel algorithm for the endovascular treatment of peripheral chronic total occlusive lesions (CTOs). Our aim is to improve patient and limb related outcomes, by increasing the success rate of endovascular procedures. This can be achieved by adherence to the proposed crossing algorithm, aiding the standardization of endovascular procedures. The following steps are proposed: (i) APPLY Duplex sonography and if required 3D techniques such as computed tomography or magnetic resonance angiography. This will help you to select the optimal access site. (ii) EVALUATE the CTO cap morphology and distal vessel refilling sites during diagnostic angiography, which are potential targets for a retrograde access. (iii) START with antegrade wiring strategies including guidewire (GW) and support catheter technology. Use GW escalation strategies to penetrate the proximal cap of the CTO, which may usually be fibrotic and calcified. (iv) STOP the antegrade attempt depending on patient specific parameters and the presence of retrograde options, as evaluated by pre-procedural imaging and during angiography. (v) In case of FAILURE, consider advanced bidirectional techniques and reentry devices. (vi) In case of SUCCESS, externalize the GW and treat the CTO. Manage the retrograde access at the end of the endovascular procedure. (vii) STOP the procedure if no progress can be obtained within 3 hours, in case of specific complications or when reaching maximum contrast administration based on individual patient's renal function. Consider radiation exposure both for patients and operators. In this manuscript we systematically follow and explain each of the steps (i)-(vi) based on practical examples from our daily routine. We strongly believe that the integration of this algorithm in the daily practice of endovascular specialists, can improve vessel and patient specific outcomes.

Identifying the mechanism of missingness for unspecified diabetic retinopathy disease severity in the electronic health record: an IRIS® Registry analysis.

Observational studies of diabetic retinopathy (DR) using electronic health record data often determine disease severity using International Classification of Disease (ICD) codes. We investigated the mechanism of missingness for DR severity based on ICD coding using the American Academy of Ophthalmology IRIS® Registry. We included all patient encounters in the registry with a DR ICD-9 or ICD-10 code between January 1, 2014 and June 30, 2021. Demographic, clinical, and practice-level characteristics were compared between encounters with specified and unspecified disease severity. Practices were divided into quartiles based on the proportion of clinical encounters with unspecified DR severity. Encounters with unspecified disease severity were associated with significantly older patient age, better visual acuity, and lower utilization of ophthalmic procedures. Higher volume practices and retina specialist practices had lower proportions of clinical encounters with unspecified disease severity. Results strongly suggest that DR disease severity related to ICD coding is missing not at random.

The relationship between self-regulated learning, mindful agency, and psychological resilience in Chinese master of nursing specialists: A cross-sectional study.

Self-regulated learning helps to improve academic performance and is an important strategy for the sustainable development of Master of Nursing Specialists. Consequently, it is relevant to identify the factors that affect self-regulated learning and analyze the correlation between them. This study examined the status quo of self-regulated learning, the relationship between self-regulated learning, mindful agency, and psychological resilience, and explored whether mindful agency and psychological resilience influence self-regulation learning. Chinese Master of Nursing Specialists were recruited to participate in an online survey from March to November 2022. Self-regulated learning, mindful agency, and psychological resilience were measured using three questionnaires, including the Self-Regulated Learning Scale for Clinical Nursing Practice Scale (SRLS-CNP), the Mindful Agency Scale, and the 10-item Connor-Davidson Resilience Scale (CD-RISC-10). The data were processed and analyzed using SPSS26.0. The statistical methods included descriptive statistics, Pearson's correlation analyses, and multiple linear regression. Self-regulated learning of Chinese Master of Nursing Specialists was medium level (59.24 ± 9.33 scores). Mindful agency and psychological resilience were positively correlated with self-regulated learning (p < 0.01) and important predictors of self-regulated learning of Master of Nursing Specialists, explaining 44.6% of the variation. Mindful agency and psychological resilience affected the self-regulated learning level of Master of Nursing Specialists in clinical practice. These results will enable clinical educators to pay more attention to the personal psychological factors of Master of Nursing Specialists to improve their self-regulated learning ability through mindful agency and psychological resilience.

Structure of outpatient urology care in Germany

Although urological specialist practices are central pillars of outpatient care, there is alack of current data on the care structure of these practices. Adescription of the structures in large cities versus rural areas as well as gender effects and generational differences is needed not only as abaseline measure for further studies. The survey includes data from the physician directory of the Stiftung Gesundheit as well as from the German Medical Association and the Federal Statistical Office. Colleagues were divided into subgroups. Based on the different subgroup sizes, statements about the care structure of outpatient urology in Germany can be made. While the majority of urologists in larger cities work in professional practice groups and care for fewer patients on average, in rural areas there is aparticularly high proportion of individual practices with more inhabitants to be cared for per urologist. Female urologists work more frequently in the context of inpatient care. When female urology specialists choose to establish themselves, they are more likely to do so in practice groups and in urban areas. In addition, there is ashift in gender distribution: the younger the age subgroup considered, the higher the proportion of female urologists among all colleagues. This study is the first to describe the current structure of outpatient urology care in Germany. Future trends are already emerging that will significantly influence our way of working and the care of patients in the coming years.

Choice of medical speciality: a cross-sectional study of medical students and comparison with existing practice

Abstract Objective The objectives of this study were to determine specialty choices, influencing factors, and migration intent among medical students, and to compare this with current specialist practitioners in Trinidad and Tobago (TT). Methods A Cross-sectional study using an online survey was conducted at the School of Medicine, Faculty of Medical Sciences, University of the West Indies, St Augustine Campus, TT. Descriptive statistics were presented for choice of specialty, its predictors, and comparisons with specialists in practice were done. Results Overall, 273 (response rate 21.36%) students responded with 73.6% females and an average age of 22.5(SD3.3) The ten most popular responses for specialty of first choice were unsure (9.5%), cardiothoracic surgery (8.7%), general paediatrics (8.7%), general surgery (7.5%), neurosurgery (7.5%), obstetrics and gynaecology (6.7%), cardiology (4.8%), emergency medicine (4.4%), family medicine (4.4%) and orthopaedics (4.4%). The top three factors influencing their choices were, general interest in the field (95.9%), job security (81.3%) and job availability (70.3%), Most respondents (72%) expressed intent to migrate to specialize. Compared to specialist practitioners, significantly more students aspired to do cardiothoracic surgery, neurosurgery, pediatric surgery, and cardiology, while significantly less students chose internal medicine, anaesthesia and critical care, and ophthalmology. (P&lt; 0.05 for all) Conclusion A minority of students was uncertain about speciality choice, however most intended to migrate to specialize. A mismatch between student aspirations and current practice was also found. These findings warrant student sensitization to specialties for which there is a need and workplace planning, if we are to retain locally trained doctors. Keywords: Medical student, specialization, cross-sectional study, postgraduate, Trinidad and Tobago.

My Health Record (and E-scripts): essential new resource for physicians-a personal perspective.

From a personal perspective of an endocrinologist in private practice: Integration of the My Health Record into everyday clinical practice is time- and cost-saving, allows for more accurate record keeping and most importantly improves overall patient care. The main deficiency at present is incomplete uptake by medical specialists in private and public practice, as well as pathology and imaging service providers.We will all reap the benefits as these entities become engaged and contribute towards making this electronic medical record truly universal.

Early-career general practitioners’ perceptions of the utility of vocational training for subsequent independent practice

ABSTRACT Purpose To evaluate Australian early-career general practitioners’ perceptions of the utility of their prior vocational training in preparing them for independent specialist practice. We hypothesised that in-practice teaching would be perceived as more useful than formal education delivered by Regional Training Organisations (RTOs). Methods and materials A cross-sectional questionnaire-based study of early-career general practitioners (RTO ‘alumni’). The outcomes were Likert scale ratings of alumni’s perceived impact of RTO education versus in-practice training on their preparedness for independent practice. Ratings were compared using Wilcoxon signed-rank tests. Multivariable linear regression was used to establish alumni characteristics associated with perceptions of utility of in-practice versus RTO-delivered education. Results Three hundred and fifty-four alumni responded (response rate 28%). In-practice training was rated statistically significantly higher than RTO education for minor procedural skills, teaching skills, professional responsibilities, tolerating clinical uncertainty, and preparing for managing child and adolescent health, aged care, chronic disease, multi-morbidity and mental health. RTO education rated higher than in-practice training for practising evidence-based medicine and Aboriginal and Torres Strait Islander health. For a number of further areas, there was no statistically significant difference in alumni ratings of utility. Conclusions In-practice or RTO-led teaching was perceived as more useful for some components of independent practice, whilst for others there was no significant difference. The findings support recognition of the individual educational components of a blended education/training structure.

Current Practice and Practice Competencies of Clinical Nurse Specialists Working in US Emergency Care Settings: A Survey Study.

The aim of this study was to investigate the current practice of clinical nurse specialists working in US emergency care settings to (1) explicate the application of the Emergency Nurses Association core competencies and define the specialized clinical nurse specialist role in emergency care and (2) align current clinical nurse specialist practice in emergency settings with the National Association of Clinical Nurse Specialists core competencies and the identified substantive areas of clinical nurse specialist practice. This study used a quantitative exploratory descriptive approach using survey data. A purposive convenience sample was recruited from the Emergency Nurses Association and the National Association of Clinical Nurse Specialists. Participants completed a 39-item survey based on a consensus process to develop competencies for emergency department (ED)-situated clinical nurse specialists. Respondents (n = 285) reported spending more than 50% of their work time in a primary clinical nurse specialist role. Significant differences in practice were found between geographic location, setting, educational preparation, title protection status, and type of institution. Our findings suggest that that the competencies ascribed to ED-situated clinical nurse specialists are valid in both frequency and importance. However, ED-situated clinical nurse specialists are not fully credentialed or practicing to the full extent of their education and licenses, because of professional, legislative, and environmental limitations.

DEPRESSION IN OPIATE ADICTION

IntroductionMiroslava Vasiljević psychiatrist employed in Specialist practice of psychiatry Sunce, Belgrade, Serbia.Objectives: Objectives and aimsSubstance abuse is a major public health problem with high morbidity and mortality. Treatment – seeking opioid dependent individuals frequently report mood problems in the form of depression. The aim of this study was to evaluate the depression in patients with substance abuse.MethodsWe evaluated mood problems in the form of depression and health- related quality of life (HRQoL) among patients (20) with diagnosed opiate dependance who entered detoxification program and met the criteria for abstinence in period of one month, and compared with the results of 20 healthy controls consisted of secondary medical staff.Almost all of the patients had a total PSQI score of 6 or higher, suggestive of depression, compared with control group (PSQI &lt; 5).Patients had problems with a depression, taking antidepressives and problem to keep up enough enthusiasm to get things done (P &lt; 0,05), compared with the control group.ResultsSF-36 scores for psysical functioning, role-physical, bodily pain, social functioning, role-emotional, and mental health were significantly lower mean compared to control group. Patients with disease had a reduced HRQoL, related to control group.Conclusions Majority of heroin-dependent patients reported depression and reduced quality of life. These conclusions are limited, because data was collected via questionnares of patients were small. In future we plan to include more substace abuse patients.Disclosure of InterestNone Declared

Feedback reports to the general practitioner (GP) on the patients' experiences: are GPs interested, and is this interest associated with GP factors and patient experience scores?

Patient experience feedback is key in patient centred health systems, but empirical evidence of general practitioner (GP) interest in it is sparse. We aimed to: (i) quantitatively estimate the level of GP interest for feedback reports on patient experience; (ii) explore determinants of such interest; and (iii) examine potential association between a priori interest and patient experience. The patient experience survey included maximum 300 randomly selected patients for each of 50 randomly selected GPs (response rate 41.4%, n = 5,623). GPs were sent a postal letter offering feedback reports and were grouped according to their replies: (i) interested in the report; (ii) not interested. Associations between interest and GP variables were assessed with Chi-square tests and multivariate logistic regression, while associations between interest and scores for 5 patient experiences scales were assessed with multilevel regression models. About half (n = 21; 45.7%) of the GPs showed interest in the report by asking to receive the report. The only GP variable associated with a priori interest was being a specialist in general practice (58.6% vs. 23.5% for those without) (P = 0.021). Interest was significantly associated with the practice patient experience scale (4.1 higher score compared with those not interested, P = 0.048). Interest in the report had small and nonsignificant associations with the remaining patient experience scales. Almost half of the GPs, and almost 3 in 5 of specialists in general practice, were interested in receiving a GP-specific feedback report on patient experiences. Interest in the report was generally not related to patient experience scores.

Cyclic Cushing's syndrome: difficulties of diagnostic search and choice of treatment tactics. A clinical case

Cyclic Cushing's syndrome is a pathological condition characterized by alternating periods of excessive cortisol secretion with corresponding clinical manifestations and periods of spontaneous remission of the disease.To diagnose Cyclic Cushing's syndrome it is necessary to record at least three episodes of excessive cortisol secretion alternating with periods of normalization of its production.In most cases, this pathology is diagnosed in patients with ACTH-secreting pituitary tumor, however, there are rare cases of cyclic hypercorticism with ectopic ACTH secretion by tumors of different localization and without verification of pathological hormonal secretion focus. In addition, cyclic hyperproduction of cortisol can be also observed in ACTH-independent Cushing's syndrome associated with the presence of corticosteroma or adrenal hyperplasia. The exact causes and mechanisms of the cyclic hypercorticism are currently insufficiently studied.Due to the atypical course of the disease, the unpredictability of the occurrence of a new «cycle», the variability of its duration and manifestations (not only in different patients, but also in the same patient), verification of the diagnosis and determination of treatment tactics may be difficult in the daily practice of specialists, and the prevalence of this condition can be undervalued.

More and better clinical trials in health care: focusing on people, not just systems and processes.

More and better clinical trials in health care: focusing on people, not just systems and processes.

Antibiotic prescription practices of periodontology specialists in Turkey: A cross-sectional web-based questionnaire study

1. Sanz M, Herrera D, Kebschull M, et al. Treatment of stage I–III periodontitis—The EFP S3 level clinical practice guideline. J Clin Periodontol. 2020;47(Suppl 22):4-60. doi:10.1111/jcpe.13290 CrossRef Google Scholar

Career prospects for ophthalmologists under 49years old : Asurvey in Germany from 2022

The need for care in ophthalmology is constantly increasing due to demographic changes. The study analyzed the current professional situation and future prospects of ophthalmologists under 49years old. The survey of members of the German Association of Ophthalmologists (Berufsverband der Augenärzte Deutschlands) and the German Ophthalmologic Society (Deutsche Ophthalmologische Gesellschaft) was conducted in 2022. All members under the age of 49years received an online questionnaire on the current professional situation as well as future perspectives (desired working hours, form of organization). The results of the survey were additionally compared with the 2016 survey of the German Association of Ophthalmologists. Asimilar questionnaire was used at that time. Atotal of 1014 people participated in the survey (62.7% women, mean age 39.3 ± 8years, 75.6% specialists). The response rate to the survey was 25%. Specialist practice from0 to 5years showed ahigher number of employed ophthalmologists (21% self-employed vs. 32% employed); over time the number of self-employed ophthalmologists increased (6-10years: 40%, > 10years: 59.3%). Overall, 46% of women were employed in apractice compared with 33% of men. Of the self-employed specialists, 95.9% said they planned to work in the same type of employment in 10years as currently. Regarding ophthalmologists' career future, the other employment types showed adesire to move to independent practice. Compared to the 2016 survey, gender differences related to the current type of employment were evident. The number of self-employed women decreased from 43% to 26% and self-employed men decreased from 63% to 39%. The number of ophthalmologists in ambulatory healthcare centers was doubled compared to 2016. Ophthalmologists reported similar future perspectives at both survey times. The results of the survey of ophthalmologists under 49years in Germany showed similar perceptions as in 2016. It became clear that the desire to be self-employed in 10years is very high; however, ophthalmologists expected large practices or medical care centers to prevail in the market. The number of self-employed doctors is decreasing and the desire for self-employment is difficult to realize.

Lumbar puncture for neurosyphilis investigation in asymptomatic patients with HIV-syphilis coinfection: a cross-sectional study among infectious disease specialists.

Syphilis is a major public health issue worldwide. In people living with human immunodeficiency virus (PLHIV), there are higher incidences of both syphilis and neurosyphilis. The criteria for referring PLHIV with syphilis for lumbar puncture is controversial, and the diagnosis of neurosyphilis is challenging. To describe the knowledge, attitudes, and practices of infectious disease specialists and residents in the context of care for asymptomatic HIV-syphilis coinfection using close-ended questions and case vignettes. Cross-sectional study conducted in three public health institutions in São Paulo (SP), Brazil. In this cross-sectional study, we invited infectious disease specialists and residents at three academic healthcare institutions to answer a self-completion questionnaire available online or in paper form. Of 98 participants, only 23.5% provided answers that were in line with the current Brazilian recommendation. Most participants believed that the criteria for lumbar puncture should be extended for people living with HIV with low CD4+ cell counts (52.0%); in addition, participants also believed that late latent syphilis (29.6%) and Venereal Disease Research Laboratory (VDRL) titers ≥ 1:32 (22.4%) should be conditions for lumbar puncture in PLHIV with no neurologic symptoms. This study highlights heterogeneities in the clinical management of HIV-syphilis coinfection. Most infectious disease specialists still consider syphilis stage, VDRL titers and CD4+ cell counts as important parameters when deciding which patients need lumbar puncture for investigating neurosyphilis.

Child life specialist practice and utilization across health care: a scoping review protocol.

The objective of this review is to map the available evidence regarding the scope of child life specialist practice and utilization. Child life specialists provide developmentally appropriate and emotion-focused supportive interventions that aim to build coping skills, enhance resilience, and mitigate traumatic experiences during health care encounters. Evidence of the care provided by a child life specialist is spread throughout health care literature. It is an emerging field that is aligned with a heightened focus on mental health and emotional safety. Evidence for the efficacy of child life specialists continues to grow. Mapping the current evidence will capture the breadth of services provided by child life specialists. This scoping review will consider all evidence that reports on services provided by child life specialists, including across all quantitative and qualitative study designs, systematic reviews, and scoping reviews. The review will also include child life specialist workforce studies, such as child life specialist utilization, geographic availability, multidisciplinary team integration, and clinician-focused research. Case studies or narrative experiences outside of a qualitative research methodology, descriptions of program implementation, educational surveys, and quality improvement projects will be excluded from the scoping review. JBI methodology for scoping reviews will guide the review process. Literature published from 1980 to the present will be included. Databases to be searched include PubMed, Scopus, PsycINFO, and CINAHL. The search for unpublished evidence will include Google Scholar and OpenGrey. Extracted data will be presented in tabular format with accompanying narrative summary.

Replacing conventional telecommunication with a freeform HIPAA compliant healthcare texting app: a survey of patient preference.

The ability to effectively communicate with patients continues to be a challenge for physician offices. Mobile healthcare applications have enhanced the accessibility of healthcare providers to their patients. However, the efficacy of unrestricted, personalized, bidirectional, freeform texting has not been previously evaluated. We investigated patient preference and self-reported outcomes using a smartphone HIPAA compliant mobile healthcare texting app, compared to conventional telecommunication, in self-reported quality of care, and impact on preventing unnecessary emergency department visits. A retrospective cohort survey study of a single-surgeon hernia specialist's practice was utilized. Patients with access to a smartphone who received care between July 2017 and March 2020 were instructed to utilize the healthcare texting app as a replacement to calling/receiving calls from the physician's office. Messages to and from patients were delivered directly to their surgeon and the surgical team via non-automated, personalized, freeform text messages, and templates, available to patients at all hours of the day. A depersonalized online survey was then distributed to assess patient perceived quality of care using the app, compared to their past experiences calling physician offices, and whether they preferred using text or conventional telecommunication. Additional statistics were reported using the application's built-in software, including response times, adoption rates, and message volumes. 90 patients successfully completed the entirety of the survey, median age range 50-60years old. 97% of respondents reported the texting app provided at least non-inferior quality of care compared to conventional telecommunication, with a majority (75%) experiencing a relatively improved quality of care. 9% reported an unnecessary ED visit being avoided after consulting their physician through the application. Unrestricted, freeform, non-automated communication via texting may be preferred by patients over conventional telecommunication. However, further research is warranted to assess the external validity and clinical impact of such results.