Previous Consultation Research Articles

Direct Access to Physical Therapy: Should Italy Move Forward?

Direct access to physical therapy (DAPT) is the patient’s ability to self-refer to a physical therapist, without previous consultation from any other professional. This model of care has been implemented in many healthcare systems since it has demonstrated better outcomes than traditional models of care. The model of DAPT mainly focuses on the management of musculoskeletal disorders, with a huge epidemiological burden and worldwide healthcare systems workload. Among the healthcare professionals, physical therapists are one of the most accessed for managing pain and disability related to musculoskeletal disorders. Additionally, the most updated guidelines recommend DAPT as a first-line treatment because of its cost-effectiveness, safety, and patients’ satisfaction compared to other interventions. DAPT was also adopted to efficiently face the diffuse crisis of the declining number of general practitioners, reducing their caseload by directly managing patients’ musculoskeletal disorders traditionally seen by general practitioners. World Physiotherapy organization also advocates DAPT as a new approach, with physical therapy in a primary care pathway to better control healthcare expenses. Thus, it is unclear why the Italian institutions have decided to recognize new professions instead of focusing on the growth of physical therapy, a long-established and autonomous health profession. Furthermore, it is unclear why DAPT is still not fully recognized, considering the historical context and its evidence. The future is now: although still preliminary, the evidence supporting DAPT is promising. Hard skills, academic paths, scientific evidence, and the legislature argue that this paradigm shift should occur in Italy.

Issues of integrating central bank digital currency into the fiat money system

Since 2020, a digital equivalent of legal tender became one of the most discussed topics among the international community of central banks. Moreover, the Bahamas’ “Sand Dollar” – the world's first actually operating platform has been launched. With the onset of the pandemic, the acceleration of events is influenced by a non-economic factor – the demand for all methods of remote socio-economic interaction. In 2021, based on previous public consultations, the Bank of Russia published the Digital Ruble Concept. The article discusses the background, goals and side effects of creating central bank digital money. The idea of digital transformation of banknotes meets the public demand for a payment instrument that is practical in modern realities, but its implementation is associated with uncertain consequences for the banking sector and the future development of technologies and security standards for settlements using digital solutions. In this context, the rationale for placing on a reimbursable basis the services of private financial agents on the digital money platform is given.

Evaluation of Rural Landscape Resources Based on Cloud Model and Probabilistic Linguistic Term Set

Rural landscape resources are important ingredients of rural revitalization and modernization in developing countries and regions. Evaluation methods play a crucial role in the development planning, design, transformation, and protection of these resources. However, there has been a lack of research on the evaluation of rural landscape resources, especially from the perspective of rural revitalization. Based on previous evaluation methods and expert consultations on landscape planning and design, we proposed a new approach for evaluating rural landscape resources by establishing a new index system and using the Analytic Hierarchy Process (AHP) and probabilistic linguistic Cloud Model. To demonstrate its applicability and effectiveness, we applied our model to the case of a village (Xiapu) in Guangdong, China, determined the parameter set of its rural landscape resources, and obtained related results showing that the method is practical and can reflect the value of resources objectively and efficiently. Based on this model, further suggestions are provided to improve the design and other utilizations of rural landscape resources.

Flora of Ceará, Brazil: Loranthaceae

Abstract This study provides a taxonomic treatment for the species of Loranthaceae in the state of Ceará, Northeastern Brazil. The survey was made based on the previous consultation of virtual herbaria, in loco visits, material loans, and photographs of diagnostic traits sent by herbarium curators. Morphological traits and geographic coordinates of all specimens collected in the State were recorded to prepare the distribution maps, identification key, and taxonomic descriptions for each taxon. A total of 184 specimens (discounting duplicates) from 30 herbaria were studied. Eight species are recorded for Ceará: Passovia pedunculata, Passovia pyrifolia, Psittacanthus cordatus, Psittacanthus dichroos, Psittacanthus eucalyptifolius, Struthanthus marginatus, Struthanthus polyrrhizus, and Struthanthus syringifolius. None are included in the IUCN Red List. However, four of them were collected inside protected areas (i.e., Passovia pedunculata, Psittacanthus cordatus, S. polyrrhizus, and S. syringifolius).

Is it possible to avoid the late diagnosis of idiopathic granulomatous mastitis?

Introduction: Idiopathic granulomatous mastitis (MGI) is a rare chronic inflammatory disease of unknown etiology. Its diagnosis is one of exclusion, it requires a histological sample that confirms the presence of granulomas, and specific cultures that rule out other causes of granulomatous disease. The initial mismanagement of these patients due to the lack of sampling for histological study and cultures, leads to a delay in diagnosis. There is no established treatment for this pathology, with surgical treatment and medical treatment with corticosteroids being the most used, either individually or in combination. Objectives: To determine the incidence of MGI in those patients who consulted for inflammatory lesions of the breast and its incidence in those who finally underwent surgical treatment. Identify clinical characteristics that allow an initial diagnostic suspicion, and establish guidelines for surgical management that allow an early diagnosis. Material and Methods: A retrospective, cross-sectional and descriptive work was carried out. The medical records of all patients undergoing surgical treatment of the breast for inflammatory lesions in the period from February 2018 to February 2020 were evaluated at the Gynecology and Obstetrics Service of the Sanatorio Güemes of Buenos Aires. Its clinicopathological characteristics, type of surgery performed and whether it required subsequent corticosteroid treatment were analyzed. Results: In the period of time analyzed, 410 patients consulted for an inflammatory breast process, where only 10 of them (2.44%) had a diagnosis of MGI. If we consider those with surgical indication, the incidence of MGI amounts to 32.25% (31 patients). Ten patients had at least 2 previous consultations with a presumptive diagnosis of acute mastitis treated with different antibiotic regimens prior to the definitive diagnosis. Half of the patients required 2 surgical interventions prior to diagnosis. The average time interval elapsed between the first consultation and the definitive diagnosis was 4 months. Conclusion: Patients with inflammatory breast disease with surgical indication, the differential diagnosis between abscessed acute mastitis and MGI should be considered, especially in the subpopulation of patients between 30-40 years of age, multiparous, and with multiple previous consultations for breast inflammatory processes refractory to antibiotic treatments. The surgical approach must include biopsy and specific cultures.

Body dysmorphic disorder (BDD) in the orthodontic and orthognathic setting: A systematic review

General prevalence of Body Dysmorphic Disorder (BDD), a psychiatric disorder in which patients focus on an imagined body defect not visible to others, varies between 0.7 and 2.5%. Up to 86% present with complaints in the area of teeth or face. Patients with BDD pursue an aesthetic rather than functional recovery, making BDD a possible contraindication to treatment. The aim of this systematic review was to review prevalence of BDD within the orthodontic and/or orthognathic population, to describe diagnostic tools for early detection of patients with BDD and to assess the outcome after treatment. A systematic search was conducted up to November 2020 using PubMed, Embase, Web of Science Core Collection and Cochrane Library. Following the screening of 1423 articles, 5 prospective studies were included. Prevalence of BDD within the orthodontic and orthognathic population varied from 5.2% to 13% (average of 6.2%). Literature showed a trend of higher BDD prevalence within younger, female and single patient population, although results are not conclusive. Questionnaires can be useful for preliminary detection of BDD. General anamnesis with questioning medical or psychiatric history, medication and personal expectations remains very important. Red flags could be previous consultations for the same problem or presence of psychiatric comorbidities. Prospective studies are necessary to map satisfaction of these patients and need for re-interventions after treatment.

Risk factors for clinical deterioration in patients admitted for COVID-19: A case-control study

IntroductionThere is controversy regarding the best predictors of clinical deterioration in COVID-19. ObjectiveThis work aims to identify predictors of risk factors for deterioration in patients hospitalized due to COVID-19. Methods designNested case-control study within a cohort. Setting: 13 acute care centers of the Osakidetza-Basque Health Service. Participants: patients hospitalized for COVID-19 with clinical deterioration—defined as onset of severe ARDS, ICU admission, or death—were considered cases. Two controls were matched to each case based on age. Sociodemographic data; comorbidities; baseline treatment; symptoms; date of onset; previous consultations; and clinical, analytical, and radiological variables were collected. An explanatory model of clinical deterioration was created by means of conditional logistic regression. ResultsA total of 99 cases and 198 controls were included. According to the logistic regression analysis, the independent variables associated with clinical deterioration were: emergency department O2 saturation ≤90% (OR 16.6; 95%CI 4–68), pathological chest X-ray (OR 5.6; 95%CI 1.7–18.4), CRP > 100 mg/dL (OR 3.62; 95%CI 1.62–8), thrombocytopenia with <150,000 platelets (OR 4; 95%CI 1.84–8.6); and a medical history of acute myocardial infarction (OR 15.7; 95%CI, 3.29–75.09), COPD (OR 3.05; 95%CI 1.43–6.5), or HT (OR 2.21; 95%CI 1.11–4.4). The model’s AUC was 0.86. On the univariate analysis, female sex and presence of dry cough and sore throat were associated with better clinical progress, but were not found to be significant on the multivariate analysis. ConclusionThe variables identified could be useful in clinical practice for the detection of patients at high risk of poor outcomes.

Claims of Medical Malpractice in the Age of Information Technology

"Introduction. Medical practice is almost constantly bending to new technologies, and in recent years, the health care system has been increasingly dominated by advances in information technology. Its use offers many advantages, but it also has its own risks. Material and method. The authors conducted a literature review to see to what extent the accessibility and effective use of information technology, i.e. electronic health records (EHR) influence risk of malpractice. Results. The literature refers both to how EHR use can prevent malpractice claims, and how it can increase their number. Thus, EHR can prevent medical errors and associated complaints by: instant access to complete patient information (including laboratory and imaging results); improving communication between medical team members; reducing drug errors (e.g. drug interactions, allergic reactions); prompt request for further investigations. However, the misuse of EHR can create new problems: inadequate training with errors from implementation and accommodation; automatic or unexpected deletion of the recommended medication; the temptation to use the information obtained previously and the circumvention of the stage of obtaining a new medical history or the temptation to copy and paste the information from the previous consultations to the current consultation - which will lead to the perpetuation of errors and omissions from the previous consultations; increased risk of privacy and confidentiality breach. Likewise, certain facilities that these systems allow may be ambivalent, and may both reduce or increase the risk of complaints, depending on how they are used: communication between doctor and patient through messages, including updating prescriptions and reporting symptoms that require prompt evaluation but at the same time, delay in response may dissatisfy the patient. Conclusions. The implementation of EHR brings many advantages, both for the patient and for the medical staff in terms of accessing information, facilitating communication and carrying out treatment plans, but the medical staff must be constantly aware of the risks involved, especially related to their proper use. "

A quality improvement (QI) project on improving trainee confidence in conducting remote psychiatric consultations at Pennine Care National Health Service (NHS) Foundation Trust in the United Kingdom (UK)

AimsWhen the coronavirus disease 2019 pandemic hit the UK, clinicians within Pennine Care NHS Foundation Trust (a five-borough mental health trust) were faced with the challenge of rapidly switching to a novel way of assessing patients remotely.The idea for a QI project on trainees’ experience with remote consultations was conceived in April 2020. We present our February 2021 results here.We aimed to improve trainee confidence in conducting remote psychiatric assessments by at least 40%, to ensure effective and safe patient care during their 6 months placement.MethodOur discovery process included surveying trainees in April 2020 to explore experiences with remote psychiatric consultations, a literature search of current UK guidance and a local audit. The audit reviewed documentation of consent to remote consultations, with reference to standards as per NHS England remote consultation guidance. Key change ideas included publication of an article, ‘Remote consultations – top tips for clinical practitioners’, video-simulated remote consultations and a session on remote consultations in the trainee induction.In the first ‘plan-do-study-act’ (PDSA) cycle, we presented key findings from the article in a video presentation, which was sent trust-wide. We measured confidence in conducting remote assessments pre- and post-presentation via a feedback survey. Unfortunately, response rates were low and in the second PDSA cycle we targeted a smaller cohort of trainees at the August 2020 induction, although encountered similar difficulties. In the third PDSA cycle, we collected real-time data using an interactive app at the February 2021 trainee induction, and measured pre- and post- confidence following a presentation and a video-simulated remote consultation.Result2/34 respondents had accessed previous remote psychiatric consultation training and12/35 had some telepsychiatry experience. Pre-induction trainee confidence results revealed: extremely uncomfortable (16%), not confident (31%), neutral (47%), confident (6%) and very confident (0%) and post-induction confidence was 0%, 22%, 52%, 26% and 0%, respectively.ConclusionOur project started during the first peak of the pandemic, which may be a reason for initial limited response rates. Our results suggest that the remote psychiatric consultation trainee induction session has shown some improvement in trainee confidence; the ‘confident’ cohort improved from 6% to 26%.Our next steps include collecting similar real-time data, mid-rotation and uploading video-simulated remote consultations to the Trust Intranet. We plan to complete the local audit cycle. We also plan to incorporate patient experience (from an ongoing systematic review) to inform a potential triage process post-pandemic, choosing between face-to-face versus remote consultations.

P541 Efficacy, efficiency and aceptability of telemedicine for inflammatory bowel disease patients follow-up care during the COVID-19 pandemic lockdown

BackgroundDuring COVID-19 pandemic, numerous initiatives have been established to reduce disease transmission but ensure care for patients with inflammatory bowel disease (IBD). Ambulatory clinic visits were replaced by the implementation of telehealth modalities in most of IBD units during the pandemic lockdown. However, the efficacy, efficiency, and patient′s acceptability of using telemedicine by telephone consultation has not been evaluated.MethodsA prospective cohort study was performed in IBD patients who underwent telephone consultation during lockdown due to COVID-19 pandemic between 16th march and 13th April 2020. To assess the efficacy of this telephone consultation (COVID-visit), change in disease′s activity and treatment, non-scheduled visits, emergency consultation, hospital admission and non-elective surgery from COVID-visit to the next scheduled consultation (postCOVID-visit) were checked. To evaluate efficiency, the time period between COVID-visit and postCOVID-visit were compared with previous consultation (preCOVID-visit). Only patients with a confirmed diagnosis of IBD, regular follow-up in our IBD unit and with full available requested test results were included. A telephone survey was designed (5 questions) and conducted in all patients to rate satisfaction for using telemedicine.ResultsOut of a total of 274 patients, 220 patients (52.2% male; mean age 49±16 years; crohn′s disease n=126/ ulcerative colitis n=83/ indeterminate colitis n=11) were included. During the COVID-visit 41% patients were using biologic agents, 15% had active disease and 6.8% changed treatment (40% initiated corticosteroids; 30% started immunomodulators or biologic agents; 30% upgraded usual treatment). Only 1 patient consulted at the emergency department, 11 patients needed to rearrange the visit and none patient underwent surgery before the scheduled post-COVID visit. The interval to post- COVID visit compared to pre-COVID visit was reduced in 28.6%, remained equal in 33.6% and increased in 37.7% of patients. The satisfaction survey (n=185) revealed that 81.1% patients rated care as excellent, 94.6% perceived it was effective and solved doubts in 96.2% of patients. However, 44.4% of patients rather prefer on-site consultation for follow-up and only 52% considered that incorporating video would improve care.ConclusionTelemedicine care during the lockdown and despite been abruptly and rapidly implemented in IBD units, shows to be effective and efficient to care IBD patients. In addition, telephone consultation is well accepted by patients for short follow-up periods. Further follow-up studies should be carried out to determine the patient profile that will benefit most from this monitoring.

P204 Elevated Fecal Calprotectin Levels Predict Flare-up in Patients with Inflammatory Bowel Disease During International Air Travel

Abstract Background Inflammatory bowel disease (IBD) patients often experience disease flare-ups during international air travel. We aimed to evaluate the proportion of patients that experiences IBD flares during international air travel and identify risk factors associated with enhanced disease activity. Methods Patients with scheduled international air travel were enrolled in the study from the Seoul National University Bundang Hospital IBD clinic. Flight information and clinical data were collected via questionnaires and personal interviews, and risk factors associated with IBD flares were determined. Results Between May 2018 and February 2020, 94 patients were enrolled in the study (mean age, 33.0 years; males, 53.2%; mean disease duration, 56.7 months), including 56 (59.6%) with ulcerative colitis and 38 (40.4%) with Crohn’s disease. Of the 94 patients enrolled, 15 (16.0%) experienced an IBD flare-up and 79 (84.0%) remained in remission throughout travel. Logistic regression analysis revealed that high fecal calprotectin levels before travel (odds ratio [OR]: 1.001, 95% confidence interval [CI]: 1.000–1.001, p = 0.016), the presence of a comorbidity (OR: 6.334, 95% CI: 1.129–35.526, p = 0.036), and a prior emergency room visit (OR: 5.283, 95% CI: 1.085–25.724, p = 0.039) were positively associated with disease flare-up. The previous and current use of immunomodulators and biologics, time of flight, altitude, number countries visited, travel duration, objective of visit, and previous medical consultations were not associated with disease flare-up. Conclusion Factors including fecal calprotectin levels, prior visit(s) to the ER, and the presence of a comorbidity predicted IBD flare-up during international travel.

N18 Multidisciplinary team importance in the view of the patients with Inflammatory Bowel Disease in Brazil

Abstract Background Inflammatory Bowel Disease (IBD) is characterized by intestinal chronic inflammation that comprehend Crohn’s disease (CD) and ulcerative colitis (UC). Continuous care is essential. Constant contact with the multidisciplinary team (MDT) and its quality of care interferes with treatment adherence and patients’ quality of life (QoL). MDT must be composed by at least gastroenterologists, coloproctologists, nutritionists, nurses and psychologists. The study evaluated the importance of MDT in the patients view. Methods A cross-sectional, descriptive study was developed, including 94 patients from a Brazilian IBD reference center. Clinical data and the MDT relevance were evaluated. MDT importance was assessed through a questionnaire developed for the research with the answers: nothing important, unimportant, important and very important for each professional. The patients listed professionals in order of importance. QoL was assessed by IBDQ. Treatment adherence and disease knowledge were assessed by Morisky and CCKNOW questionnaires respectively. Results A total of 54 patients with CD and 40 with UC were included, 59.57% female and 53.19% with comorbidities. Previous hospitalization was reported by 54.26% and 36.17% were submitted by previous surgery. The majority referred previous consultation with a gastroenterologist (95.74%) and less than half with nutritionist (47.87%), IBD nurse (43.62%), psychologist (43.62%) and coloproctologist (23.40%). Gastroenterologist was considered important or very important by all patients, coloproctologist by 97.15%, IBD nurse 94.36%, endoscopist nurse 86.16%, stomatherapist 78.19%, nutritionist 88.46% and psychologist 80.55%. Regarding the order of importance, patients reported the gastroenterologist (87.50%) as the most important, followed by the coloproctologist (16.67%) and IBD nurse (14.10%). Patients with CD had more appointments with IBD nurse compared to UC patients (p = 0.007). QoL was considered excellent or good (64.51%). Drug adherence was low in 58.89% of patients. Knowledge about the disease was considered low (2.65 ± 1.65 points), being higher in patients with CD (p = 0.04). Conclusion Although the service has MDT, not all patients had the opportunity to visit all professionals. The lack of contact with the entire team, especially with the nurse, can reflect on low medication adherence and disease knowledge, impacting on disease control and QoL. Holistic patient care is recommended, emphasizing the importance of all professionals in the MDT for all patients with IBD.

Factores de riesgo de deterioro clínico en pacientes ingresados por COVID-19: estudio caso-control

IntroductionThere is controversy regarding the best predictors of clinical deterioration in COVID-19. ObjectiveThis work aims to identify predictors of risk factors for deterioration in patients hospitalized due to COVID-19. Methods DesignNested case-control study within a cohort. Setting: 13 acute care centers of the Osakidetza-Basque Health Service. Participants: Patients hospitalized for COVID-19 with clinical deterioration—defined as onset of severe ARDS, ICU admission, or death—were considered cases. Two controls were matched to each case based on age. Sociodemographic data; comorbidities; baseline treatment; symptoms; date of onset; previous consultations; and clinical, analytical, and radiological variables were collected. An explanatory model of clinical deterioration was created by means of conditional logistic regression. ResultsA total of 99 cases and 198 controls were included. According to the logistic regression analysis, the independent variables associated with clinical deterioration were: emergency department O2 saturation ≤90% (OR 16.6; 95%CI 4-68), pathological chest X-ray (OR 5.6; 95%CI 1.7-18.4), CRP>100mg/dL (OR 3.62; 95%CI 1.62-8), thrombocytopenia with <150,000 platelets (OR 4; 95%CI 1.84-8.6); and a medical history of acute myocardial infarction (OR 15.7; 95%CI, 3.29-75.09), COPD (OR 3.05; 95%CI 1.43-6.5), or HT (OR 2.21; 95%CI 1.11-4.4). The model's AUC was 0.86. On the univariate analysis, female sex and presence of dry cough and sore throat were associated with better clinical progress, but were not found to be significant on the multivariate analysis. ConclusionThe variables identified could be useful in clinical practice for the detection of patients at high risk of poor outcomes.

“We make the invisible visible”: Investigating and evaluating the one-to-one consultation service at a UK higher education institution

One-to-one consultation services comprise key forms of student academic writing support at higher education institutions across the globe. Evaluations of these services are central to sustaining provision and for supporting effective pedagogy and service development (Bell, 2000; Stevenson and Kokkinn, 2009). In line with such evaluation goals and to supplement previous consultations research (e.g. Ma, 2019; Pfrenger et al., 2017; Tiruchittampalam et al., 2017), this paper presents a mixed-methods evaluation of a consultation service operating at a UK university. This study, in contrast to the range of previous consultation evaluation research, investigates perceptions and impact of consultations delivered by professional EAP practitioners across multiple student disciplines and degree levels. Evaluation data was gathered through student focus groups, consultation feedback and impact questionnaires, and through consultant interviews and observations. These multiple sources evidenced positive perceptions of the consultation service by students and consultants and pointed to positive impact on degree performance. Characteristics of effective consultations and consultants were identified, including partnership and engagement, focus on student need, consultant expertise and flexibility, consultation preparation, listening to students, being polite and respectful, and providing something concrete for students to take away. Recommendations are made to support the development of effective consultation services.

'Reassurance and healthcare seeking in people with persistent musculoskeletal low back pain consulting orthopaedic spine practitioners: A prospective cohort study'.

Guidelines recommend self-management for most people living with persistent musculoskeletal low back pain (PMLBP) when surgery is ruled out. Conveying this message to patients can be challenging. This study examined patients' perceptions of reassuring communications from surgical spine team practitioners attempting to deliver this message in a single consultation. Pre-consultation baseline measures included levels of pain, disability and previous consultation history. Patients' perceptions of reassuring communications were measured within 1-week post-consultation. The outcome variables, measured at 3-month follow-up, included patients' report of subsequent GP visits for back pain, the number of other healthcare providers consulted for back pain and distress. Data from 296 patients (9.8% loss to follow-up) were analysed using hierarchical regression models, controlling for demographic, clinical and study-related factors. In each model, perceived reassurance accounted for a small but significant variance, above and beyond other predictors. Further GP visits were predicted by disability at baseline and perceived reassurance (adjusted R2 of 14.6%). Subsequent consultations with any healthcare professionals were predicted by a shorter duration of back pain, disability at baseline and perceived reassurance (adj. R2 =10.6%). Distress was predicted by older age, disability and reassurance (adj. R2 =59.5%). Findings suggest that better communication in consultations with orthopaedic spine clinicians might help reduce unnecessary subsequent healthcare utilization and distress. Low back pain patients' perceptions of their communication with orthopaedic spine practitioners are associated with subsequent healthcare seeking and distress at follow-up. This study examines the intersection of two important but fairly neglected areas in the pain research: provider communication and patient healthcare utilization.

A Causal Configuration Analysis of Payment Decision Drivers in Paid Q&amp;A

Abstract Purpose This paper examines factors of payment decision as well as the role each factor plays in casual configurations leading to high payment intention under systematic and heuristic information processing routes. Design/methodology/approach Based on heuristic-systematic model (HSM), we propose a configurational analytic framework to investigate complex casual relationships between influencing factors and payment decision. In line with this approach, we use fuzzy-set qualitative comparative analysis (fsQCA) to analyze data crawled from Zhihu.com. Findings The number of previous consultations is a necessary element in all five equivalent configurations which lead to high intention in payment decision. The heuristic processing route plays a core role while the systematic processing route plays a peripheral role in payment decision-making process. Research limitations Research is limited in that moderating effect of professional fields has not been considered in the framework. Practical implications Configurations in results can assist managers of knowledge communities and paid Q&amp;A service providers in the management of information elements to motivate more payment decision. Originality/value This paper is one of the few studies to apply HSM theory and fsQCA method with respect to the payment decision in paid Q&amp;A.

Epidemiology of methicillin resistant Staphylococcus species carriage in companion animals in the Greater Brisbane Area, Australia

To detect methicillin resistant Staphylococcus aureus (MRSA) and S. pseudintermedius (MRSP) swab samples were collected from dogs, cats and horses from South East Queensland (SE QLD). MRSP carriage in dogs was 8.7% and no MRSP was isolated from cats and horses; no MRSA was isolated. Risk factors for carriage included previous hospitalisation, previous bacterial infection, consultation type, average precipitation, and human population density. The probability of MRSP carriage was highest in Brisbane city, Sunshine Coast and Gympie. This suggests that MRSP carriage in dog populations from SE QLD is geographically clustered and associated with clinical and environmental factors.

Impact of treatment delays on outcome of acute testicular torsion: a 15-year retrospective study

Introduction Preservation of the testicle is directly associated with the duration of torsion. The aim in this retrospective study was to identify factors that influence pre-and in-hospital times and measure the extent to which these times affect testicle survival. Patients and methods A retrospective review of 116 patients who underwent exploration for testicular torsion between 2000 and 2015. Patients were divided into orchiectomy and salvaged testicle groups. Times in patient management and clinical features were compared with Mann–Whitney, chi-squared, and Fisher exact tests. Multivariate logistical regression was used to identify independent factors associated with orchiectomy. Results The median prehospital time of 48 h (15.4–138 h) in the orchiectomy group was longer than the 2.4 h (1.6 h–5.2h) in the salvaged group. Patients examined by a general practitioner (GP) prior to presenting at hospital had a median prehospital time of 48 h, compared to 3 h for patients not examined before presentation at hospital. In-hospital times between admission and operation room, as well as times between ultrasonography and operation room, were also longer in the orchiectomy group. Previous GP consultation (OR = 27.26, 95% CI 2.32–320.59, p = .009), prehospital time (OR = 1.04, 95% CI 1.01–1.07, p = .003) and nausea (OR = 9.25, 95% IC 1.33–64.52, p = .025) were independent predictive factors associated with orchiectomy. Conclusion Prehospital time was a determining factor in orchiectomy. For each extra hour of prehospital delay, the risk of orchiectomy increased by 4%. The rate of orchiectomy was higher among patients who first consulted a GP.

Factors affecting the non-urgent consultations in the emergency department of a tertiary hospital in the Philippines: A cross-sectional study.

The non-standard emergency medicine services and the limited utilisation of primary care providers in the Philippines may contribute towards the ED being a preferred area for patients with non-urgent conditions. Our study aims to determine the factors associated with non-urgent consultations in the ED of a tertiary hospital in the Philippines. From 7 January to 15 February 2020, we surveyed non-urgent ED patients (n = 757) presenting to a tertiary hospital in the Philippines. We evaluated the data using descriptive statistics, while chi-squared and multivariate analyses versus urgent ED patients (n = 281) were used to show the association of factors. Our recruited non-urgent patients were mostly 21-40 years old (n = 576 [76%]), single (n = 437 [58%]), with full-time employment (n = 654 [86%]), have Health Maintenance Organization coverage (n = 684 [90%]), self-referred (n = 498 [66%]), and have private means of getting to ED (n = 414 [55%]). They had moderate scores of social support-seeking behaviours (mean 3.92/5; 95% confidence interval [CI] 3.88-3.96), health literacy (mean 3.58/5; 95% CI 3.56-3.61), self-efficacy (mean 3.09/5; 95% CI 3.56-3.61), whereas their ED access score (mean 4.10/5; 95% CI 4.06-4.14) was high. They had moderate self-assessed severity (mean 3.75/6; 95% CI 3.70-3.80), urgency (mean 3.83/6; 95% CI 3.78-3.88), and anxiety (mean 3.88/6; 95% CI 3.83-3.93) scores and high ED satisfaction rating (mean 4.73/6; 95% CI 4.69-4.77). They mostly had digestive (n = 203 [26.8%]) and infection-related (n = 172 [22.7%]) chief complaints and final diagnoses (n = 198 [26.2%] and n = 145 [19.2%], respectively), without previous consultations (n = 577 [76%]), and eventually discharged (n = 755 [99%]). Our urgent patients had similar characteristics, but with higher assessed patient severity, urgency, anxiety and satisfaction with ED services (P < 0.001). Non-urgent consultations in ED are attributed to multiple factors encompassing socio-demographic, socio-economic and psychosocial dimensions. These factors must be considered in improving the current healthcare management system for the appropriate utilisation of ED in the Philippines.

ANALYSIS OF PRIMARY HEADACHES MANAGEMENT IN POLTAVA REGIONS

The aim: Assess quality of diagnosis and treatment of primary headaches (PH) in Poltava region. Materials and methods: There were examined 195 patients with PH who were previously consulted by different specialists due to headaches. We analyzed previously established diagnoses, previous consultations and prescribed investigations due to headache, drugs that were prescribed for headache treatment. Results: The misdiagnoses of PH were made due to considering the headache as secondary (as sign of dyscirculatory encephalopathy, arterial hypertension, autonomic dysfunction, cervical ostheochondrosis). Patients older 40 years were misdiagnosed more often with dyscirculatory encephalopathy, while patients under 40 years were more frequently misdiagnosed with autonomic dysfunctions. Patients sought medical help for headache problem and were repeatedly examined by different specialists (general practitioner, neurologist, cardiologist, ophthalmologist, oyorhinolaryngologist, neurosurgeon). Doctors prescribed a large number of identical uninformative neuroimaging and neurofunctional methods regardless of PH nosologies. Also it had been often prescribed therapy with the use of vascular, metabolic, nootropic drugs without specific pathogenetic effects for PH. Conclusions: It is necessary to improve the diagnosis and treatment of PH according to international standards by raising awareness among general practitioners, neurologists and other specialists about the basics of PH diagnosis and treatment.