Prospective Cross-sectional Survey Research Articles

MP53-16 TELEMEDICINE HERE TO STAY? KEY INDICATORS TO PATIENT SATISFACTION

You have accessJournal of UrologyCME1 Apr 2023MP53-16 TELEMEDICINE HERE TO STAY? KEY INDICATORS TO PATIENT SATISFACTION Gideon Harianja, Michael Reimer, Cayde Ritchie, Matthew Buell, Akin S. Amasyali, Kai Wen Cheng, Catherine Chen, David Chamberlin, and Joshua Chamberlin Gideon HarianjaGideon Harianja More articles by this author , Michael ReimerMichael Reimer More articles by this author , Cayde RitchieCayde Ritchie More articles by this author , Matthew BuellMatthew Buell More articles by this author , Akin S. AmasyaliAkin S. Amasyali More articles by this author , Kai Wen ChengKai Wen Cheng More articles by this author , Catherine ChenCatherine Chen More articles by this author , David ChamberlinDavid Chamberlin More articles by this author , and Joshua ChamberlinJoshua Chamberlin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003301.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic initiated rapid widespread utilization of telemedicine affecting all health care providers, including those in pediatric urology. Understanding the factors of patient and parent satisfaction can aid in health care delivery. The aim of this study was to identify key indicators of patient and parent satisfaction with pediatric urology telemedicine visits. METHODS: We conducted a prospective cross-sectional survey of all patients evaluated with a telehealth visit from October 2021 - April 2022. We included all consecutive patients aged 0-18 years who received an outpatient pediatric urology telehealth visit. All patients received an 8-question patient/parent reported outcome (PRO) survey via email within 30 days of the visit, including 5 satisfaction questions regarding various aspects of telemedicine rated on a scale of 1-5. Statistical analysis was performed using Pearson correlation, Mann-Whitney U, and Chi Squared tests, with p<0.05 considered significant. RESULTS: A total of 1213 patients completed a telehealth visit, of which 83 (7%) completed the PRO survey. Visit type included 40 (48%) post-operative, 29 (35%) follow-up, and 14 (17%) new consults. From the survey responses, 84% reported time savings, 31% reported money savings, 30% avoided time away from work, and 27% of children avoided missing school. No technical issues were experienced in 86% of the visits. Satisfaction with telehealth was highest for the post-operative patient, 4.8/5 after orchiopexy and 4.4/5 after circumcision. Patients saved a median travel distance of 22 miles [IQR: 15-41]. Patients living farther than 22 miles had higher satisfaction scores in terms of simplicity and preference to in-person visits compared to those who lived closer (p=0.019). Patients living in zip codes below the median household income had significantly higher satisfaction scores (p=0.032). Patients with public health insurance had significantly higher overall satisfaction scores compared to those with private health insurance (p=0.022). There was no difference in satisfaction based on parent age or whether the patient was evaluated for a new, follow-up, or post-operative video visit. CONCLUSIONS: Children and their caregivers were satisfied with pediatric urology telehealth visits when seen as a new, follow-up, or post-operative patient. Indicators for satisfaction may include long travel distance to the clinic, lower than median household income zip codes, and public health insurance. Appropriate use of telehealth may provide better access to care and optimize healthcare delivery. Source of Funding: AOA Research Fellowship Grant © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e718 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gideon Harianja More articles by this author Michael Reimer More articles by this author Cayde Ritchie More articles by this author Matthew Buell More articles by this author Akin S. Amasyali More articles by this author Kai Wen Cheng More articles by this author Catherine Chen More articles by this author David Chamberlin More articles by this author Joshua Chamberlin More articles by this author Expand All Advertisement PDF downloadLoading ...

A syphilis screening survey on HIV-positive and HIV-negative pregnant women, with placental histopathological evaluation of reactive cases, in a hospital in Uyo, Southern Nigeria

Objectives: Veneral Disease Research Laboratory (VDRL) test is an important screening tool for syphilis in pregnancy (because of adverse pregnancy outcomes, particularly congenital syphilis {CS}) and can be combined with the placental histopathological examination in the diagnosis of CS. Thus, we aimed to compare VDRL test results from HIV-positive/HIV-negative pregnant women with relevant historical data and perinatal/placental histopathological findings.&#x0D; Methods: A prospective hospital-based cross-sectional survey of VDRL tests for two study groups (HIV-positive {tests} and HIV-negative {controls} pregnant women) at ante-natal care (ANC)/delivery. A convenient sampling method was used. Relevant (maternal/fetal) historical data were extracted from their case notes, and placentas of reactive VDRL cases were histopathologically examined.&#x0D; Results: We surveyed 145 pregnant women (49 tests and 96 controls). The VDRL tests, for both groups, were not strongly associated with maternal age (p-value = 0.097), booking for ANC (p-value = 0.770), gravidity (p-value = 0.331), and HIV/AIDS stage (for tests only). Notably, one subject from the tests had a reactive VDRL test, and she was in HIV/AIDS clinical stage 2, her baby had microcephaly (fetal head circumference of 31 cm), low birth weight (of 2.4 kilograms), and intermediate APGAR score. Histopathological examination of her placenta showed avascular villi, large hypercellular villi, and obliterative vasculopathy with an onion-skinning pattern in the placental disk.&#x0D; Conclusions: The obstetrical, fetal, and placental histopathological features of the reactive VDRL case were consistent with CS and syphilitic placentitis. Hence placental histopathological evaluation can play a critical role in the diagnosis of maternal/congenital syphilis.

The Effect of Displaying Educational Messages in the Emergency Department on Reducing Violence

Objectives: The Emergency Department (ED) is one of the most important places in a hospital in which patients are full of pain and stress because of its hectic nature. Consequently, there are a lot of quarrels and fights in the emergency department. This study intends to assess the effect of exhibition of educational messages as a way to decrease the violence in the Emergency Room (ER). Methods: We conducted a cross-sectional prospective survey at the Emergency Room (ER) of Shariati hospital of Tehran in September 2016. Data collection was carried out via distributing a qualitative questionnaire among the Emergency Department (ED) staff at baseline and 3 months after the educational intervention. We measured the total and mean number of various types of violence per survey. We utilized SPSS software version 16 in analysis of data using Mann-Whitney Test. Results: The analysis showed 47.5% verbal violence before the intervention vs 60% after that (p-value=0.598), 20.8% financial violence pre- ervention versus 43.8% post intervention (p-value=0.253), both of which were notsignificant statistically; however, physical violence considerably decreased from 83.9% to 47.6% during the study (p-value=0.01). During the semi-structured interviews with personnel, it was found that this presentation had some positive effects on controlling the stress of the environment practically, although it did not appear in the analysis. Conclusion: This type of public education in the hospital does not seem to be independently effective in reducing the violence in the Emergency Room (ER). According to the results, most violence indexes, except Physical violence, have not been mitigated after the intervention significantly. Perhaps, it could be more efficient by using audiovisual media, animation, and other captivating methods.

Anesthesiology Fellowships in the Military Health System: An Education Analysis of the Supply and Demand.

Evidence indicates that desire for fellowship training is most influenced by personal interest, enhancement of career options, and a specific interest in an academic medicine career. The overall objective of this study is to evaluate anesthesiology fellowship interest and its potential impact on military retention and other outcomes. We hypothesized that current fellowship training accessibility is outpaced by the interest for fellowship training and that additional factors will be associated with the desire for fellowship training. This prospective cross-sectional survey study was approved as Exempt Research by the Brooke Army Medical Center Institutional Review Board in November 2020. Participants were eligible to complete the online voluntary survey if they were active duty anesthesiologists. Anonymous surveys were administered via the Research Electronic Data Capture System from December 2020 to January 2021. Aggregated data were evaluated using univariate statistics, bivariate analyses, and a generalized linear model. Seventy-four percent of general anesthesiologists (those without fellowship training) were interested in pursuing future fellowship training versus 23% of subspecialist anesthesiologists (those currently in fellowship training or have completed fellowship training), odd ratio 9.71 (95% CI, 4.3-21.7). Of subspecialist anesthesiologists, 75% indicated serving in a nongraduate medical education (GME) leadership position (e.g., service/department chief), with 38% serving in a GME leadership position (e.g., program or associate program director). Almost half (46%) of subspecialist anesthesiologists reported being "extremely likely" to serve ≥20 years, versus 28% of general anesthesiologists. There is a high demand among active duty anesthesiologists for fellowship training, which in turn, may improve military retention. The demand for fellowship training is outpaced by what the Services currently offer, including training in Trauma Anesthesiology. Leveraging this interest in subspecialty fellowship training, particularly when the skills align with combat casualty care-related requirements, would greatly benefit the Services.

Knowledge and Awareness of Human Papillomavirus Vaccination and Cervical Cancer among Men and Women in Japan: A Questionnaire Survey.

In many advanced countries other than Japan, the incidence and mortality rates of cervical cancer, which is mainly caused by the human papillomavirus (HPV) infection, are decreasing probably due to the high rate of HPV vaccination and cervical cancer screening. In Japan, these rates are on the rise owing to the stagnation of vaccination and low screening rate. To improve these situations, active promotion of HPV vaccination and screening is required. As a preliminary stage, we investigated perceptions regarding cervical cancer and HPV vaccines among Japanese men and women and examined the difference in perceptions by sex. This was a prospective cross-sectional questionnaire survey targeting Sojo University students and working adults. University students were targeted before learning about cervical cancer. Working adults were recruited on the basis of information from the Health Promotion of Health and Welfare Department of Kumamoto Prefectural Government in Japan and from companies via student organizations promoting cancer prevention. We surveyed respondents' knowledge and awareness about HPV vaccination and cervical cancer and performed logistic regression analysis to compare the results between men and women. A total of 557 completed questionnaires (205 men and 352 women) were analyzed. Women had high levels of knowledge and awareness about HPV vaccination and cervical cancer compared with men. However, 70% of women surveyed had never been screened for cervical cancer. A total of 557 completed questionnaires (205 men and 352 women) were analyzed. Women had high levels of knowledge and awareness about HPV vaccination and cervical cancer compared with men. However, among surveyed women, the degree of knowledge and awareness was lower than that among women in other countries with established HPV vaccination programs. Furthermore, 70% of women surveyed had never been screened for cervical cancer.

Patterns in Urogenital Health in Active Duty Servicewomen: A Prospective Cross-Sectional Survey Evaluating Impacts of Water, Sanitation, and Hygiene Resources Across Three Military Environments.

Female warfighters are at risk for sex-specific and frequently unrecognized urogenital health challenges that may impede their ability to serve. The constraints on water, sanitation, and hygiene (WASH) resources by austere environments, whether at home or abroad, require women to practice unhealthy hygiene behaviors that jeopardize their urogenital health. In this manuscript, we examine the use of WASH resources by U.S. Army active duty servicewomen (ADSW) across three settings-home duty, field training, and deployment-to determine how the changing availability of WASH resources alters hygiene and sanitation practices in austere environments. Additionally, we report findings from a previously developed theoretical framework for determining the impacts of austere environments on ADSW's hygiene knowledge, behaviors, and outcomes. This study used a prospective, cross-sectional survey design with population sampling and generalized ordered logit regression models. We recruited ADSW assigned to a large military installation in the southeastern United States after conducting a structured field hygiene training for female readiness. We surveyed a highly diverse sample of 751 ADSW and found that the use of WASH resources significantly differs between field training and deployment. Clean running water significantly differed among all settings, with nearly 70% reporting clean running water to be rarely or never available during field training. Bathing facility types significantly differed in each setting, with Cadillac bathrooms more often used during deployment than during field training and wipe baths more often used during field training than during deployment. We found that women were significantly less likely to wash their private areas more than 2 days a week during field training, compared to deployment. Women reported changing their underwear ≤2 times per week in field training environments as compared to during deployment. Soap and water were reported as the most common ways of washing in both home duty stations and during deployment, followed by wipes at home duty stations and in deployed settings. Participants reported wipes as their primary bathing method during field training, followed by soap and water. Participants used intentional dehydration or delayed urination more frequently in field training than during deployment. Women reported significant differences in holding their urine between field training and deployment, with principal reasons reported as "dirty facilities" and "distance to the nearest restroom." Significantly, they reported safety concerns when bathing, using the bathroom, or toileting facilities across the three settings. This is the first study to characterize sex-specific challenges by a large sample of operational ADSW and to explore the use of WASH resources in home duty, field training, and deployment settings. The results show that field training is more austere than deployed settings, indicating that austerity, not deployment, increases the urogenital infection risk for ADSW. With women more integrated into the military strategy than at any time in U.S. history, military leaders can use our results to develop interventions that ameliorate the unique challenges that influence the military readiness and overall health of female warfighters.

Sleep disturbances in Norwegian children with fetal alcohol spectrum disorders (FASD) with and without a diagnosis of attention-deficit hyperactivity disorder or epilepsy.

Fetal alcohol spectrum disorder (FASD) describes a combination of developmental, cognitive, and behavioral disabilities in children with prenatal exposure to alcohol. The literature suggests that there are higher rates of sleep disturbances in these children. Few studies have investigated sleep disturbances in relation to common comorbidities of FASD. We examined the prevalence of disturbed sleep and the relationship between parent-reported sleep problems in different FASD subgroups and comorbidities like epilepsy or attention-deficit hyperactivity disorder (ADHD) and impact on clinical functioning. In this prospective cross-sectional survey, caregivers of 53 children with FASD completed the Sleep Disturbance Scale for Children (SDSC). Information about comorbidities was collected, and EEG and assessment of IQ, daily-life executive and adaptive functioning were performed. Group comparisons and ANCOVA interaction models were used to test the associations between different sleep disturbances and clinical factors that could interfere with sleep. An abnormal sleep score on the SDSC was very common, affecting 79% of children (n= 42) with equal prevalence in all FASD subgroups. Difficulty falling asleep was the most common sleep problem, followed by difficulty staying asleep and waking early. The incidence of epilepsy was 9.4%, with an abnormal EEG seen in 24.5%, and a diagnosis of ADHD in 47.2% of children. The distribution of these conditions was equal in all FASD subgroups. Children with signs of sleep disturbance had poorer working memory, executive function, and adaptive functioning. Children with ADHD had a greater prevalence of sleep disturbance than those without ADHD (OR 1.36; 95% CI 1.03 to 1.79). Problems with sleep are very common in FASD children and seem independent of FASD subgroup and the presence of epilepsy or a pathological EEG finding, while those with ADHD had more sleep problems. The study underscores the importance of screening for sleep disturbances in all children with FASD as these problems may be treatable.

Reply to the comment on "Fluid restriction in management of patent ductus arteriosus in Italy: a nationwide survey".

The Authors Chang Liu B.S and Yuan Shi commented our paper on Fluid restriction in management of patent ductus arteriosus (PDA) in Italy. With our study, we conducted a prospective cross-sectional survey among all Italian Neonatal Intensive Care Units (NICUs) to address conservative management of patent ductus arteriosus (PDA) in preterm infants below 29 weeks' gestational age (GA), with specific regard to fluid restriction (FR). The Authors wondered if the heterogeneity of use of fluid restriction both as a prophylactic tool and as a conservative tool when a hemodynamically significant PDA is diagnosed, was due to economic disparities among areas of the included centers. Conducting a secondary analysis of our data, we observed that if we separately consider the responses of two areas, northern and central-southern Italy, FR is slightly more frequently applied in Central and Southern regions (82%) as compared to Northern regions (78%), although this finding does not reach statistical significance. No correlation between the likelihood to adopt conservative measures and the amount of allowed fluid intake was found. The hypothesis that "less fluid intake resulted in milder clinical and echocardiographic presentations of PDA, and thus a lower rate of pharmacological treatment" cannot be supported by our current study design and might deserve future investigations.

Patient perspective on the use of carbon fibre plates for extremity fracture fixation

IntroductionCarbon fibre-reinforced polyetheretherketone (CFR-PEEK) plates represent an exciting development within trauma and orthopaedic surgery, offering advantages including radiolucency, material properties similar to bone, and lack of localised tissue reaction. As more call for trials examining their use, there is no data available as to the acceptability of these implants to patients. This study aimed to therefore examine the acceptability of CFR-PEEK plates to patients undergoing fracture surgery.MethodsThis was a prospective cross-sectional survey of patients undergoing surgery for a fracture of the ankle, distal femur, distal radius, or proximal humerus. Once a decision had been made to pursue operative fixation with a plate, patients were provided with descriptions of both CFR-PEEK and stainless steel and titanium metal implants alongside the current clinical evidence. All patients undertook a questionnaire examining their views as to the advantages and disadvantages of CFR-PEEK plates, and whether they would be happy to participate in a trial comparing both.ResultsNinety-nine patients were happy to participate (64 females, mean age 50). Eighty-seven patients reported that they would want a CFR-PEEK implant for their fracture, and 76 reported that they would be willing to participate in an RCT comparing their use. Commonly reported advantages included radiolucency, low weight and biocompatibility. Disadvantages reported included cost and concerns regarding durability.ConclusionsThis study demonstrates that CFR-PEEK implants would be acceptable to patients undergoing fracture surgery, with high numbers of patients stating that they would be willing to participate in a randomised study examining their use.

Evaluation of changes to work patterns in multidisciplinary cancer team meetings due to the COVID-19 pandemic: A national mixed-method survey study.

It is not well understood the overall changes that multidisciplinary teams (MDTs) have had to make in response to the COVID-19 pandemic, nor the impact that such changes, in addition to the other challenges faced by MDTs, have had on decision-making, communication, or participation in the context of MDT meetings specifically. This was a mixed method, prospective cross-sectional survey study taking place in the United Kingdom between September 2020 and August 2021. The participants were 423 MDT members. Qualitative findings revealed hybrid working and possibility of virtual attendance as the change introduced because of COVID-19 that MDTs would like to maintain. However, IT-related issues, slower meetings, longer lists and delays were identified as common with improving of the IT infrastructure necessary going forward. In contrast, virtual meetings and increased attendance/availability of clinicians were highlighted as the positive outcomes resulting from the change. Quantitative findings showed significant improvement from before COVID-19 for MDT meeting organisation and logistics (M= 45, SD=20) compared to the access (M= 50, SD=12, t(390)=5.028, p= 0.001), case discussions (M= 50, SD=14, t(373)=-5.104, p= 0.001), and patient representation (M= 50, SD=12, t(382)=-4.537, p= 0.001) at MDT meetings. Our study explored the perception of change since COVID-19 among cancer MDTs using mixed methods. While hybrid working was preferred, challenges exist. Significant improvements in the meeting organisation and logistics were reported. Although we found no significant perceived worsening across the four domains investigated, there was an indication in this direction for the case discussions warranting further 'live' assessments of MDT meetings.

Discerning Clinician Perceptions of an Established Opioid Stewardship (DISCLOSE) Program.

The Opioid Stewardship Program (OSP) was created to promote safe and rational prescribing of opioids, where the risks associated with providing opioids for patients must be balanced against the risk of patients experiencing uncontrolled pain. The pharmacist-led OSP was established at 2 Fraser Health Authority (FHA) sites, British Columbia, to provide clinical services through patient referrals and screening. The rate of acceptance of OSP pharmacists' recommendations has been high, but there was a need to assess clinicians' perceptions of the program. To assess the perceptions of health care professionals at FHA hospitals offering the OSP regarding various aspects of the program and to identify areas of the program that could be modified to further optimize service delivery. A prospective cross-sectional survey was distributed to about 250 targeted health care professionals, who answered questions regarding their perceptions of the OSP. Data were analyzed using simple descriptive statistics. A total of 71 respondents initiated the survey, of whom 59 were included in the final analyses. Most participants indicated that the OSP pharmacists' suggestions were valuable for optimizing pain management (52/57, 91%) and preventing adverse events (49/56, 88%). Most participants were satisfied with the quality of communication (51/56, 91%), timeliness to consults (51/52, 98%), and recommendations provided (52/55, 95%). Increasing knowledge transfer, improving communication about intentions for patient follow-up, and expanding services at current sites and to other sites were recommended to improve the OSP. Clinicians responding to the survey reported a high level of satisfaction with and positive views of the pharmacist-led OSP. Providing more education and clarifying intentions for patient follow-up are modifications that could be made to improve the program.

Impact of Uterine Fibroids on Perceived Health-Related Quality of Life among Women in Selected Tertiary Institutions across Nigeria: A Prospective Cross-Sectional Survey

Abstract Introduction: Uterine fibroids can be associated with poor health-related quality of life (HRQoL) when symptomatic. Our objective was to assess the severity of uterine fibroid symptoms (UFSs) and its impact on perceived HRQoL among women with uterine fibroids attending selected secondary and tertiary health institutions across Nigeria. Materials and Methods: This was a prospective and questionnaire-based cross-sectional survey. Data collected included demographics, symptoms severity, medical/gynecological history, mental health status, perceived HRQoL, and myomectomy benefits. The study was conducted between May 1, 2019 and August 31, 2019, across the six geopolitical zones in Nigeria, namely: Northeast, Northwest, North Central, South–South, Southeast, and Southwest zones, including Lagos. A total of 464 women were interviewed. Results: The average age of the respondents was 37 years (range 18–59 years). About 81%–87% experienced UFS-related menstrual disorders, with 50% experiencing moderate to severe symptoms. Overall, up to 70% of the women indicated that UFS impacted their HRQoL, with the majority reporting moderate to severe impact across all domains, including concern (55.6 ± 26.6), control (54.3 ± 26.4), self-conscious (53.5 ± 27.3), energy/mood (52.1 ± 24.5), and sexual function (49.1 ± 26.4). About 75% reported improvements after myomectomy. Conclusion: This study revealed that a significant number of women with uterine fibroids had symptoms affecting their perceived HRQoL. Many of the respondents reported a decreased overall HRQoL with significant improvement after myomectomy. Early recourse to definitive care is therefore imperative in the quest to improve overall HRQoL, including reproductive health.

Gynecology Resident Experience with Office Hysteroscopy Training.

Hysteroscopy is the gold standard for evaluating intrauterine pathology. The majority of physicians currently perform hysteroscopy in the operating room. Lack of training has been cited as a barrier to performing office hysteroscopy; however, resident training in office hysteroscopy has not yet been evaluated. A prospective cross-sectional survey was performed. A validated 17 question survey tool was sent to 297 program directors of Accreditation Council for Graduate Medical Education accredited obstetrics and gynecology residency programs for distribution to their residents. The survey utilized a Likert scale to assess resident interest in learning office hysteroscopy, satisfaction in training, and perceived self-efficacy to perform office hysteroscopy independently upon graduation. Two hundred and ninety-three obstetrics and gynecology residents responded. Of the respondents, 26.3% reported receiving training in office hysteroscopy. There was no statistically significant difference in training among postgraduate years or program regions. A greater proportion of male residents received training when compared to female residents (42.9% vs. 24.2%, p = 0.019). Ninety-four percent of residents reported interest in learning office hysteroscopy. Satisfaction with hysteroscopy training in the operating room versus the office was 91.1% vs. 11.3% respectively. Of the fourth-year residents, 17.4% felt they could perform office hysteroscopy independently upon graduation and 14.5% reported feeling comfortable performing the procedure. Residency training in office hysteroscopy is lacking and residents are unprepared to perform the procedure after graduation. Enhanced residency training in office hysteroscopy would likely improve resident comfort and ability to perform office hysteroscopy in practice.

Public Perceptions Regarding the Preparedness of Government to Combat the Third Wave of COVID-19 (SARS-CoV-2) Infection Across Various States of India.

India has already passed through 2 waves of the coronavirus disease (COVID-19) pandemic losing many lives. The reason for losing lives may be due to the unpreparedness of the health care system of India for this unprecedented pandemic. To assess the government's preparedness, an institutional-based cross-sectional prospective survey was conducted among the adult population of selected states in India. A self-administered 30-item questionnaire divided into 5 sections (demography of the participants, steps to create awareness, prevent spread of infection, handle the emergency, and prognosis) was distributed online through Google Forms. The responses were collected in an Excel file. SPSS software was used to perform the descriptive statistics and analysis of variance (ANOVA). Nearly a quarter of the participants "strongly disagree"/"disagree" about the government's preparedness for the third wave. Considering their perception, it cannot be assured that the government is well prepared to handle the emergency. So, the government must maintain emergency funding and develop a health infrastructure. The government should take steps to reduce social stigma, prevent spreading of unscientific propagation, and make people aware of the World Health Organization (WHO) as the reliable source of information for health emergencies to avoid a human crisis in the future.

Impact of family structure and sociodemographic characteristics on parents headed families in Ramadi City, Iraq

Background: Several factors in the family profile contribute significantly to determining the effective policy when heading the family. This study aims to evaluate the sociodemographic and economic burdens on parents-headed families in Ramadi City, west of Iraq. Methods: A prospective cross-sectional household-based survey was conducted from 1st to 28th February 2019 among Iraqi people residents in Ramadi city, Anbar province. A multistage sampling technique was recruited to identify the eligible sample. A semi-structured questionnaire was used to interview (face-to-face) the respondents. Data from 267 households have undergone univariate and bivariate analyses. Multiple logistic regression, odds ratio (OR), and confidence intervals (CIs) were estimated to explore the predicting variables. The statistically significant is considered at less than 0.05. Results: The mean age of respondents was 43.88 (± 12.1) years (range: 25 to 69 years). Out of the total surveyed people, 52.8% were young (less than 44 years), male-headed families (59.6%), low educated level (65.5%), unemployed (52.4%), married (67.4%) and headed big families of seven members and above (43.1%). History of chronic diseases and smoking habits was positive among 46.4% and 45.7% of respondents, respectively. Findings of the binary logistic regressions showed that history of smoking (OR = 7.201, 95% CI: 3.254 to15.936), families of 7 members and above (OR = 6.239, 95% CI: 2.938 to 13.250), unhappy (OR = 5.237, 95% CI: 2.140 to 12.818), aged 44 years and above (OR = 3.518, 95% CI: 1.581 to 7.829), being single (unmarried, divorced, widow) (OR = 2.697, 95% CI: 1.230 to 5.914), and had a monthly income of less than USD400 (OR = 2.333, 95% CI: 1.112 to 4.859) are significantly associated with female-headed family. Conclusion: Priority must be given to some elements such as genetic, physical differences, biopsychosocial factors, and the economic situation when discussing parents' behavior in heading the family.

Reasons for Altering Bladder Management and Satisfaction with Current Bladder Management in Chronic Spinal Cord Injury Patients

Patients with spinal cord injury (SCI) often require bladder management. However, patients routinely change their bladder management for better satisfaction. The reasons for altering a bladder management method in SCI patients remain insufficiently understood. The purposes of this study are to assess current satisfaction with bladder management and the reasons for changing bladder management in SCI patients. A prospective cross-sectional survey with a convenience sampling method was used. The study was conducted from January 2018 to December 2019. The inclusion criteria included an age ≥18 years and a diagnosis of SCI more than one year previously. The questionnaires were self-administered and collected from eligible patients during a free clinic service. A total of 515 SCI participants were enrolled. Two hundred and eighty-three (55.0%) participants had experienced changing their bladder management. The most used method of current bladder management was self-voiding. About 84.7% of participants reported being satisfied with their current bladder management. Bladder management changes were most often made due to frequent urinary tract infections. Furthermore, the participants dissatisfied with their management had more urological complications. This study indicates that appropriate bladder management can improve the subjective satisfaction of patients. For long-term care, preventing urinary tract infections is a helpful strategy for patients' satisfaction with bladder management.

Telehealth in cancer care during the COVID-19 pandemic

Introduction The Victorian COVID-19 Cancer Network (VCCN) Telehealth Expert Working Group aimed to evaluate the telehealth (TH) experience for cancer patients, carers and clinicians with the rapid uptake of TH in early 2020 during the COVID-19 pandemic. Methods We conducted a prospective multi-centre cross-sectional survey involving eight Victorian regional and metropolitan cancer services and three consumer advocacy groups. Patients or their carers and clinicians who had TH consultations between 1 July 2020 and 31 December 2020 were invited to participate in patient and clinician surveys, respectively. These surveys were opened from September to December 2020. Results The acceptability of TH via both video (82.9%) and phone (70.4%) were high though acceptability appeared to decrease in older phone TH users. Video was associated with higher satisfaction compared to phone (87.1% vs 79.7%) even though phone was more commonly used. Various themes from the qualitative surveys highlighted barriers and enablers to rapid TH implementation. Discussion The high TH acceptability supports this as a safe and effective strategy for continued care and should persist beyond the pandemic environment, where patient preferences are considered and clinically appropriate. Ongoing support to health services for infrastructure and resources, as well as expansion of reimbursement eligibility criteria for patients and health professionals, including allied health and nursing, are crucial for sustainability.

Health Related Quality of Life of Children with Cerebral Palsy among 3-12 Years Old

Introduction: Health-related Quality of Life (HRQOL)refers to a set of characteristics that may have an effect on health because they are related with an increased risk of chronic diseases related to low levels of physical activity. HRQOL is especially appropriate to conditions that are continuing and disabling such as cerebral palsy (CP). This study aims to determine the quality of life of children with cerebral palsy. Methods: Cross sectional prospective survey under a quantitative study design was conducted for six months. Data was collected from the outdoor and indoor Paediatric physiotherapy unit of the Centre for the Rehabilitation of the Paralysed (CRP), Bangladesh. 100 cerebral palsy children were taken as the sample based on eligibility criteria, LAQ-CP questionnaire was used to assesses the effect of disability in children with CP and their families. Results: From the analysis, found that cerebral palsy most commonly limits the schooling of the cerebral palsy child. Also, it limits the ability of mobility, physical independence, and social integration. Besides it causes economic and clinical burden for the family members of the child with CP. Overall, the QOL severely affected 40% (n=40) cerebral palsy children, moderately 29% (n=29), mildly 20%(n=20) children. Only 11% (n=11) was found with good QOL in this study. Conclusion: HRQOL is pointedly affected in most of the children suffering from cerebral palsy. Measurement of HRQOL should be include with other type of assessment, to specify the areas in which a patient is most suffering and help the expert in making suitable decisions for patient management. The present finding indicates that cerebral palsy has a negative impact on health status and quality of life of children with cerebral palsy, as reported by the respondent parent.

Discussion of costs and financial burden in clinical practice: A survey of medical oncologists in Australia.

BackgroundA diagnosis of cancer is associated with significant physical, psychological and financial burden. Including costs of cancer is an important component of shared decision making. Doctors bear a responsibility towards educating patients about the financial aspects of care. Multiple organisations have advocated for price transparency and implementing Informed Financial Consent in the clinic. However, few studies have evaluated the perspectives of oncologists on the current state of this discussion.AimsThe aim of this study is to determine the views and perspectives of medical oncologists regarding communication of costs and financial burden in patients with cancer.MethodsWe conducted a prospective cross-sectional online survey via REDCap. The survey was distributed to medical oncologists and advanced trainees currently registered with Medical Oncology Group of Australia (MOGA). Data was collected using the online survey comprising socio-demographic characteristics, discussion of costs and financial burden, and facilitators and barriers to these discussions.Results547 members of MOGA were invited to participate in the study, and 106 of 547 MOGA members (19%) completed the survey. Most oncologists (66%) felt that it was their responsibility to discuss costs of care, however a majority of oncologists (59.3%) reported discussing costs with less than half of their patients. Only 25% of oncologists discussed financial concerns with more than half of their patients, and most oncologists were unfamiliar with cancer-related financial burden. Most Oncologists with greater clinical experience and those working in private practice were more likely to discuss costs with a majority of their patients.ConclusionsCertain characteristics of medical oncologists and their practices were associated with reported prevalence of discussing costs of care and financial burden with their patients. In the context of rising costs of cancer care, interventions targeting modifiable factors such as raising oncologist awareness of costs of care and financial burden, screening for financial toxicity and availability of costs information in an easily accessible manner, may help increase the frequency of patient-doctor discussions about costs of care, contributing to informed decision-making and higher-quality cancer care.

S529 Do Social Determinants of Health Impact Which Patients Are Referred for the Low FODMAP Diet?

Introduction: The aim of this study was to explore if differences in social determinants of health in irritable bowel syndrome (IBS) patients impact access to the low FODMAP diet (LFD). Methods: A prospective cross-sectional survey of 486 adults was performed from May – June 2022. All respondents completed a 31-question survey via Survey Monkey. The survey link was distributed via social media platforms, low FODMAP dietician blog posts, and the IFFGD newsletter. Questions consisted of social determinants, such as the number of family members in their home, education attainment, employment status, healthcare insurance, access to healthcare, housing, utilities, transportation, childcare, and food access and insecurities. Statistical analyses included the Mann-Whitney U test and chi-square test. A p-value of ≤ 0.05 was considered statistically significant. Results: 462/486 (95.1%) respondents reported a diagnosis of IBS. Patients without a diagnosis of IBS were removed from the analysis. IBS cohort demographics consisted of 93% female, 92.5% Caucasian, and 92.7% residing in the United States. The primary IBS complaint was equally distributed: IBS-Diarrhea (35.1%), IBS-Constipation (29.1%), and IBS-Mixed (35.1%). 83.6% (n = 400) of IBS respondents were recommended the low FODMAP diet for treatment of their GI symptoms by a medical provider. IBS respondents were divided into two groups: IBS-LFD+ (n = 400, those referred for low FODMAP diet education) and IBS-LFD- (n = 62, those not referred for low FODMAP diet education). Compared with their IBS-LFD+, IBS-LFD- respondents had a lower education level (14.8% with high school diploma or less vs. 5.8%, p =0.01), lower household income (46.7% with income ≤ $74,999 vs. 30.7%, p =0.03), and decreased access food when needed (8.1 vs. 2.8 %, p = 0.03). IBS-LFD- respondents were also less likely start a low FODMAP diet on their own compared to IBS-LFD+ counterparts (12.4% vs. 87.6%, p < 0.001). Conclusion: IBS patients with a lower socioeconomic position were less likely to be recommended the low FODMAP diet as treatment compared to patients with higher socioeconomic positioning. This raises concern socioeconomic status negatively impacts referral for low FODMAP diet for IBS management and suggests implicit referral bias. Given the increasing evidence for dietary therapy for managing GI symptoms, further investigation is needed to identify how provider perceptions of patients influence dietary treatment recommendations. Table 1. - Comparison of social determinants between IBS patients recommended vs. NOT recommended the low FODMAP diet by their health provider Social Determinant Variable IBS patients recommended low FODMAP Diet [IBS-LFD+](n = 400) IBS patients NOT recommended low FODMAP Diet[IBS-LFD-](n = 62) P-Value Cramer V Coefficient Odds Ratio (OR) 95% Confidence Interval (CI) Highest Level of Education Attainment High school diploma/ GED or less 5.8% 14.8% 0.01 0.12 2.31 1.26, 4.25 ≥ High School Diploma/GED 94.2% 85.2% Household Income $0.00 - $74,999 30.7% 46.7% 0.03 0.11 1.81 1.05, 3.11 ≥ $75,000 69.3% 53.3% Access to Food When Needed Unable to access food when needed 2.8% 8.1% 0.03 0.10 2.45 1.14, 5.26 Likely to start low FODMAP diet on their own Yes 87.6% 12.4% < 0.001 0.19 0.28 0.16, 0.50 No 56.6% 44.4% Visit a registered dietitian about the low FODMAP diet Yes 88.2% 11.8% 0.06 0.09 0.64 0.40, 1.03 No 81.6% 18.4%