Seeking Medical Advice Research Articles

Frequency and risk factors for headache disability: A population-based cross-sectional study in Egypt.

A headache is a very common condition that can have a significant impact on one's quality of life. It is one of the leading causes of years lived with disability worldwide. The objective of the study was to determine the prevalence of primary headache disability, its characteristics, risk factors and its impact on daily life. A cross-sectional study was conducted in Fayoum governorate. The sample size was 1909 participants. A multistage random sample technique was used to select adults aged above 18 years. A self-structured questionnaire solicited information on sociodemographic characteristics, headache characteristics, and the headache disability index. SPSS v 22.0 was used for data analysis. Headaches caused complete disability in 19.5% of the study group, and 76.8% developed severe disability. Participants who reported that they had a headache more than once a week were; 44.5% had moderate pain and 40.2% had more intense pain. About 55% complained of attacks rather than continuous headache and were more likely to have a degree of complete disability, (P = 0.001). A statistically significant association was found between living in urban areas, working in professional occupations, complaining of severe headache in the form of an attack and seeking medical advice, with high scores of headache disability. Headache is a condition that affects the entire population in a way that causes high levels of disability. Good management is necessary for the reduction of the adverse effects of headaches on the health of the population. This should focus on raising public awareness by means of education and on the provision of basic healthcare.

Prescription of Silexan Is Associated with Less Frequent General Practitioner Repeat Consultations Due to Disturbed Sleep Compared to Benzodiazepine Receptor Agonists: A Retrospective Database Analysis

The aim of the present study was to analyze the association between the prescription of Silexan and the recurrence of general practitioner (GP) repeat consultations because of disturbed sleep versus benzodiazepine receptor agonists including zolpidem, zopiclone, and zaleplon (Z-drugs). This retrospective cohort study was based on data from the IQVIA Disease Analyzer (DA) database. The study included adult patients treated by 1284 GPs in Germany with a documented sleep disorder and their first prescription of Silexan or Z-drug (prescription between January 2010 and October 2020). The recurrence of seeking medical advice because of sleep disorders in the 15-365 days after the first prescription was evaluated. Multivariate regression models were used, adjusted for age, sex, insurance status, and defined co-diagnoses. Data were available for 95,320 (Silexan: 5204; Z-Drug: 90,526) patients. In total, 15.6% of the Silexan patients and 28.6% of the Z-drug patients had a further documented GP consultation because of a sleep disorder. Silexan prescription was associated with significantly lower odds of recurrent sleep disorder diagnosis in the 15-365 days after the index date (Odds Ratio (OR): 0.56; 95% confidence intervals (CI): 0.51-0.60), although mental burden levels appeared higher in this group. Our study shows that the prescription of Silexan to adult patients consulting GPs for disturbed sleep results in less frequent repeat consultations than Z-drugs. This may support Silexan's role as an efficacious, self-enabling, well-tolerated, and sustained treatment option. Because Silexan is a proven anxiolytic, its impact in improving undiagnosed anxiety disorders may have had a lasting effect for certain patients.

Preclinical and clinical safety and efficacy assessment of an organic cotton medical device for the management of moderate to heavy urinary incontinence

Urinary incontinence (UI) is a widespread condition affecting about 200 million people worldwide, with women affected more often than men and prevalence increasing with age. UI is a significant health problem that negatively impacts affected women’s well-being, sociality, and productivity. Therefore, seeking medical advice is highly recommended since valid treatment options exist. However, a definitive solution to the problem is not always possible. In these cases, absorbent containment products can help women deal with the persistent symptoms of incontinence, minimising the effects on the quality of life. High-quality products are paramount to avoid or reduce the onset of irritating skin phenomena, which can sometimes lead to more serious consequences, such as skin infections. Cotton is a natural fibre characterised by softness and hypoallergenic properties that has already shown its ability to improve skin health when used as a component of pads and other absorbent containment products. The aim of this work was to assess the safety and efficacy of a new organic cotton pull-on absorbent product in reducing skin erythema and oedema in women suffering from moderate to heavy urinary incontinence. In-vitro and clinical studies were performed. Results showed that the tested product effectively reduces skin erythema and oedema caused by the conventional use of synthetic pull-on absorbent products. Moreover, good compliance with the use was demonstrated compared to a non-cotton competitor device available on the market. In conclusion, the organic cotton absorbent device tested has improved the quality of life of women suffering from moderate to heavy urinary incontinence.

Surveying the Landscape of Social Media Usage for Health Care by Otolaryngology Patients.

To determine factors associated with social media usage for finding a doctor or seeking medical advice among otolaryngology patients. Cross-sectional study of 361 patients visiting our clinics. All participants were asked if they were aware social media may be used to find doctors and if they had ever done so, and also if they were aware social media could be used to get advice about a medical condition or its treatment and if they had ever done so. Demographic characteristics were examined for association with affirmative answers to these questions. Facebook was the most used social media platform with 50.7% using Facebook daily. Over 50% of participants were aware social media could be used to find a doctor or seek medical advice. Daily use of Facebook was associated with using social media for finding a doctor (OR=2.57, 95%CI: 1.41-4.67, p=0.002) and seeking medical advice (OR=1.72, 95%CI: 1.09-2.71, p=0.020). Having Medicare was associated with using social media to find a doctor (OR=2.20, 95%CI: 1.15-4.21, p=0.017), whereas Medicaid was associated with using social media for medical advice (OR=1.99, 95%CI: 1.08-3.67, p=0.027). A majority of otolaryngology patients may be aware of health care applications of social media, with Facebook being the dominant platform, and Medicare insurance identifying patients who may most use social media in this manner. There is also an indication that social determinants of health, as reflected by Medicaid insurance, may be associated with using social media to seek medical advice. NA Laryngoscope, 133:2116-2121, 2023.

Knowledge of Breast Cancer Among Urban Women in the South of Peninsular Malaysia

Introduction: : Breast cancer (BC) is the most commonly diagnosed cancer globally and it is the leading cause of cancer mortality in Malaysian women. Increasing women knowledge of BC and breast self-examination (BSE) leads to increased compliance in early diagnosis and treatment. This study aims to determine the level of knowledge on BC and its association with socio-demographic characteristics among urban women. Methods: A cross-sectional study was conducted among 270 urban women in the South of Peninsular Malaysia using the adapted Breast Cancer Awareness Measure. Data were analyzed through SPSS software version 26.0. Results: Of the participants, 53.7% (n=145) had poor knowledge of BC warning signs, 50.7% (n=137) of BSE and 55.6% (n=150) of risk factors. High education was associated with better BC knowledge on warning signs (p=0.006) and risk factors (p=0.048). Chinese women have poor BC knowledge on warning signs (p=0.005) and BSE (p<0.001) than other ethnicities. Age (p=0.024) and marital status (p=0.028) were statistically significant with BC knowledge on breast self-examination (BSE) while family history of BC (p=0.019) and duration of seeking medical advice (p=0.041) were associated with BC knowledge on the risk factor. Conclusion: The findings of this study may give insight into effective health education strategies for urban women concerning breast cancer awareness.

The landscape of medical care consumption in Israel: a nationwide population cross-sectional study

BackgroundThe Ecology of medical care was first published in 1961. The graphical square model showed that 75% of the population in the US and England experience a feeling of illness during a given month, 25% seek medical help and only one percent are hospitalized. In 2001, Green and colleagues found the same findings despite the many changes that occurred over the past decades. The frequency of illness, the desire for assistance and the frequency of seeking and getting medical assistance may differ in different populations due to cultural, economic, social, demographic background and local Health policy. This work describes the ecology of medical care consumption in Israel for the first time and examines the socio-demographic effects on consumption.MethodsThis is a Nationwide cross-sectional study. A telephone survey was conducted among a representative sample of the adult population (> 15 years) in Israel. Subjective morbidity rate in the preceding month, the rate of those considering medical assistance and those who got assistance were calculated. Correlation between socio-demographic variables and patterns of morbidity and medical care consumption was examined using a t-test and chi square for continuous quantitative and categorical variables. Logistic regression was used for multivariate analysis.ResultsA total of 1862 people participated; 49.5% reported having symptoms in the previous month, 45% considered seeking medical advice, 35.2% sought out medical assistance and only 1.5% were hospitalized. The vast majority chose to contact their family physician (58%) and the primary care setting provided their needs in 80% of the cases; Subjective morbidity and medical care consumption differed significantly between Israeli Jews and Arabs. Gaps in the availability of medical services were observed as residents of the periphery forewent medical services significantly more than others (OR = 1.42, p = 0.026).ConclusionsSubjective morbidity is less common in Israel than in other countries, but paradoxically consumption of medical services is higher. An Israeli who feels ill will usually consider receiving assistance and will indeed receive assistance in most cases. However, a greater tendency to forego medical services in the periphery indicates barriers and inequality in the provision of health services. Different cultural perceptions, lack of knowledge and low accessibility to medical services in the periphery probably contribute to the contrast shown between low consumption of medical services and high prevalence of chronic illness in Arab society. The prevailing preference for family medicine and its ability to deal with most requests for assistance suggest that strengthening family medicine in the periphery may reduce those barriers and inequalities.

Impact of COVID-19 on mental health of pregnant women in Punjab, Pakistan

Background: Maternal depression and anxiety can predispose the women to higher risk of complications. The COVID-19 pandemic is a unique stressor which may affect the mental and psychological well-being of pregnant women. Aim: To determine prevalence of depression and anxiety and related factors in pregnant women during COVID-19. Methods: This multicenter analytical cross-sectional study was carried out from August 2021 to December 2021 in six cities of Pakistan. Two stage sampling technique was used to include sample of 400 pregnant women. Patient Health Questionnaire-9 (PHQ-9) and Corona virus Anxiety Scale (CAS) were used to measure depression and anxiety level along with self-constructed questionnaire to record socio-demographic profile. Data entry and analysis was done in SPSS version 23. Association between variables was assessed by applying Chi square test and strength of association was measured by binary logistic regression. p-value ≤ 0.05 was taken as statistically significant. Results: Mean age of participants was 27.25±5.22 years. The mean gestational age was 23.5±9.6 weeks. About 37.1% had mild depression. Moderate depression was found in 7.8% and moderately severe depression in 0.5% participants. Significant association was found between depression and no physical activity (p value=0.02), not having spouse support (p value=0.03), perceived vulnerability to get COVID (p value=0.004) and fear of infection to baby (p value=0.05). Only 3.25% participants had dysfunctional anxiety. Conclusion: Findings of the study would be helpful for policy makers to launch health awareness campaigns about regular physical activity, role of social support and seeking medical advice for mental well-being during pregnancy. Keywords: COVID-19, Anxiety, Depression, Mental health, Pregnancy

Upper airway multilevel radiofrequency under local anesthesia can improve CPAP adherence for severe OSA patients

ObjectiveTo evaluate the effect of upper airway radiofrequency (RF) tissue reduction under local anesthesia (LA) in severe obstructive sleep apnea (OSA) patients using continuous positive airway pressure (CPAP) in order to improve their compliance and adherence. DesignThirty (30) patients were included in this randomized clinical trial, suffering from severe OSA seeking medical advice for better upper airway management while using CPAP. Multilevel RF tissue reduction at tongue base, soft palate and inferior nasal turbinates was done under LA in multiple sessions. The Apnea hypopnea index (AHI), arousal index, lowest SpO2, CPAP pressure, and CPAP using time were recorded pre-operatively and six months after the last RF session. ResultsPost-operatively, there were significant reduction in AHI (86.03 ± 20.5 vs. 54.65 ± 16.6 p < 0.001), arousal index (71.14 ± 17.7 vs. 35.90 ± 11.8 p < 0.001), and CPAP Pressure (17.13 ± 1.7 vs. 10.97 ± 1.5 p < 0.001). Also there was a significant increase in the lowest SpO2 (60.2 ± 0.2 vs. 75 ± 0.1 p < 0.001), and CPAP using time in hours (1.57 ± 0.56 vs. 3.75 ± 0.41 p < 0.001). Visual analogue scale (VAS) for pain was recorded showing that all patients reported throat pain mainly in the first five post-operative days which was well controlled on analgesia. Conclusion and relevanceUpper airway multilevel RF tissue reduction of tongue base, soft palate and inferior nasal turbinates under local anesthesia significantly improves the tolerance and adherence of severe OSA patients using CPAP.

Trajectories to a cancer diagnosis: Why and when women seek help for breast symptoms in Vietnam.

Women in low- and middle-income countries where the prevalence and mortality of breast cancer are growing rapidly are more likely to be diagnosed at advanced stages, which negatively affects their treatment outcomes and chance of survival. The current literature in those settings tends to focus largely on explaining patient delay in seeking medical attention for breast symptoms. Meanwhile, little is known as to what prompts women to attend screening and diagnostic services after discovering symptomatic breasts. Drawn upon the data from in-depth interviews with 33 breast cancer patients in Central Vietnam conducted in 2019, this paper examines the context of women's decisions about breast screening and how the practice of seeking cancer diagnosis occurred. Our findings reveal an absence of a national screening program and that seeking medical advice was conducted on an ad hoc basis after self-detection of breast symptoms. Women's interpretations of symptomatic breasts as suspicious signs of cancer, the co-occurrence of important life events, or encouragement by people in their social network motivated women to seek medical attention at different public and private health facilities. Their encounters with the health sector often involved multiple visits across time and space in which they experienced various forms of diagnosis delay produced by the health system. Our study carries implications for interventions to encourage women's awareness of early cancer symptoms and prompt medical presentation after self-discovery of symptomatic breasts.

Quality of Life and the Presence of Depression Among Adults with Hair Loss in the South of Saudi Arabia.

PurposeThis study aims to measure quality of life and the presence of depression among adults suffering from perceived hair loss.MethodsThis study used a cross-sectional design that targeted adult subjects with perceived hair loss in the Jazan region of Saudi Arabia. Data were collected during interviews in selected primary healthcare centers. Data pertaining to the demography, quality of life, and presence of depression in participants were collected. Quality of life was assessed via a modified Arabic version of the Dermatology Life Quality Index (DLQI). The presence of depression was assessed via Patient Health Questionnaire-9 (PHQ-9). A chi-squared test was used to detect statistically significant differences between the levels of quality of life and depression and the measured demographic characteristics.ResultsA total of 483 subjects reported having hair loss. The median age of the sample was 30 years. The majority of the respondents were female (74.5%) and had university-level education (71.4%). Only 169 (35%) reported seeking medical advice concerning their hair loss. The effect of hair loss on quality of life score varied between 2 and 29, with a median score of 6. The median depression level was 6, and the level varied between 0 and 27. Gender, education level, seeking medical care due to hair loss, and worsening of hair loss seem to have an impact on quality of life and depression levels (p values < 0.05).ConclusionNearly half of the sample experienced a more than moderate impact on their quality of life induced by their perceived hair loss. Additionally, more than half of the sample exhibited moderate or stronger levels of depression. Encouraging subjects with perceived hair loss to seek medical advice concerning their hair loss may result in early identification, appropriate diagnosis, and the use of curative measures, may consequently improving patients’ quality of life and preventing depression.

Effect of simultaneous application of positional release technique and Maitland mobilization technique on sciatica: a randomized controlled trial

BackgroundLow back pain (LBP) associated with sciatica is considered the primary cause of seeking medical and physical therapy advice. Treating sciatica symptoms is the main goal in the physical therapy practice, and the literature supports the use of manual therapy techniques in management of patients with sciatica.ObjectivesThis study aimed to assess the effect of simultaneous application of positional release technique and grade-4 Maitland mobilization technique on sciatic nerve sensory nerve conduction velocity (NCV) in patients with LBP associated with sciatica.MethodsA randomized controlled trial was performed among 50 patients (mean age 41.86 ± 7.90) diagnosed with LBP with sciatica. Patients were randomly assigned to two groups: experimental “group A, n = 25” and control “group B, n = 25.” Patients were tested twice, before and after a 6-week period, during which group A received a traditional physical therapy program along with piriformis muscle positional release technique and grade-4 Maitland mobilization technique, while group B received a traditional physical therapy program along with a sham mobilization technique.ResultsStatistical analysis revealed a significant increase (p < 0.05) in the sciatic nerve sensory NCV in the post-test condition compared with the pre-test in group A with no significant difference (p > 0.05) in group B.ConclusionSimultaneous application of the piriformis muscle positional release technique and grade-4 Maitland mobilization technique on lower lumbar spine may improve sciatic nerve function in patients with LBP associated with sciatica.

Endometriotic cyst and fibrocystic disease of the breast treated with individualised homoeopathy – A case report

Introduction: Endometriosis is one of the benign gynaecological disorders in childbearing women, characterised by the presence of functioning endometrial tissue outside the uterine mucosa. Fibrocystic disease of the breast is the most common and benign lesion among women of reproductive age group seeking medical advice for breast problems during a lifetime. It is characterised by hyperproliferation of connective tissue or fibrosis, which is followed by facultative epithelial proliferation in the breast tissues. Case Summary: A case of a left endometriotic ovarian cyst with multiple cystic lesions in the right breast in a 36-year-old patient successfully treated with individualised homoeopathic medicine is reported. She had severe cyclic lower abdominal pain for more than 7 years, and conventional analgesics and even surgical procedures could not afford relief. Homoeopathic treatment was started with Silicea based on the totality of symptoms and repertorisation and later switched to Conium maculatum as an anti-miasmatic remedy, which showed disappearance of the left endometriotic cyst and reduction in the size of cystic lesion in the right breast with general improvement. The Modified Naranjo Criteria were used to assess causal attribution to the prescribed medicine in this case. Assessment of pain was done using a visual analogue scale. This evidence-based case reported according to the HOM-CASE guidelines suggested that individualised homoeopathic medicines can be used as a useful, safe and non-invasive mode of treatment for ovarian endometriotic cyst, associated with fibrocystic disease of the breast.

Knowledge and experience of using performance and image enhancing drugs among attendees of a Needle and Syringe Program in Australia: A qualitative study

BackgroundThe availability and utilisation of performance and image enhancing drugs (PIEDs) have been increasing in the last decade. This study aimed to understand the knowledge and experience of PIED use amongst attendees of a Needle and Syringe Program (NSP) in Australia. It also investigated their experience of seeking medical advice and accessing the NSP service. MethodsSemi-structured interviews were conducted with 19 participants between September 2016 and April 2017. Audio recordings of the interviews were transcribed verbatim and content analysis was conducted. ResultsAll 19 participants were male, with 10 participants aged 18–25 and 15 working. Participants showed sound knowledge of injecting practices and side effects; however, their understanding about blood-borne virus transmission risks was limited. Most of them reported experiencing injection-related injuries and considered this as common. They would seek general medical advice; however, they would not disclose their PIED use if not required as their past experience indicated that general practitioners lacked knowledge and support. Participants expressed concerns before their first visit to the NSP service, but thought staff were open minded, non-judgemental and helpful after the visit. They also highlighted the difficulty in accessing the service for injection equipment during business hours and provided suggestions on service improvement including extending the opening hours, using vending machines and providing a peer support program. ConclusionsThe findings suggest there is a need to educate PIED users about blood-borne virus transmission risks, improve general practitioners’ understanding about PIED use, and investigate the feasibility of extending the NSP service hours and for the service to provide a peer support program to clients who use PIEDs.

Community awareness of myocardial infarction in Bisha region, Saudi Arabia

Background: Early seeking medical advice can save the lives of many people in our community. This study aimed at assessing the community awareness of causes, risk factors, symptoms, and preventive measures of myocardial infarction (MI) in Bisha, Saudi Arabia. Also, to spread health culture regarding preventive measures and early seek of medical advice in our community. Methods: A descriptive community-based cross-sectional study was conducted in Bisha town in the southern region of Saudi Arabia. A total of 556 people have been selected randomly to participate in the study. Data were collected through the &amp;quot;Online Survey,&amp;quot; which contained eight questions that assessed the knowledge about MI among the community in Bisha, and feedback on their response was offered to correct the wrong answer and promote the right answers. Data analysis by Statistical Package for the Social Sciences version 23. Results: A total of 566 participants were included in this study. Regarding age, 360 (63.3.%) participants were 18-40 years old, while 206 (36.4%) were 41 years and older. Regarding gender, 291 (51.4%) of the participants were male, while 275 (48.6%) were female. 8 (1.4%) participants had a primary school education, 10 (1.8%) had intermediate school education, 91 (16.1%) had a high school education, 426 (75.3%) had a university education, and 31 (5.5%) had other levels of education. A significant association was observed between age and knowledge of MI (p = 0.025). Conclusion: This study&amp;apos;s outcome showed relatively limited knowledge of MI symptoms among the Bisha community.

Breast lumps awareness level and attitude of seeking medical advice among female population in Madinah city

Breast lumps awareness level and attitude of seeking medical advice among female population in Madinah city

Awareness about total knee replacement among Saudi population.

Introduction:The purpose of this study is to identify the knowledge of the general population about knee osteoarthritis and its surgical interventions in the management of knee osteoarthritis. Knee osteoarthritis is a prevalent disease. A lack of knowledge about the nature of the disease may delay seeking medical advice until the advanced stage of the disease.Methods:This cross-sectional study was conducted among 486 participants (≥18 years) who were sampled randomly from an osteoarthritis awareness campaign located within a shopping facility located in Riyadh in 2020. Data were collected via a structured questionnaire, which included six domains; demographic information, causes, symptoms, treatment, complications, and general questions. Data for this study were analyzed by using the Statistical Package for Social Studies (SPSS 22; IBM Corp., New York, NY, USA). Continuous variables were expressed as mean ± standard deviation and categorical variables were expressed as percentages. The t-test and one-way Analysis of Variance (ANOVA) were used for continuous variables. Univariate and multivariate logistic regression were used to assess the associated factors with a low level of knowledge. A P value of <0.05 was considered statistically significant.Results:Most of the participants in our study were males (56.8%) and Saudi nationals (89.7%). (83.74%). Consider that surgical intervention is the best treatment when non-surgical options do not work. The mean questionnaire score for the 486 participants was found to be 20.85 ± 5.29 out of 35 points. In comparing the male to female total scores, we found the mean female total score to be statistically significant and higher than that of the males with a P value of 0.036. Furthermore, we found that the non-Saudis had a total score higher than the Saudis with a P value of 0.016. On the other hand, the difference in the total scores between the city and rural area residents and different educational levels were statistically insignificant.Conclusions:Our results demonstrate that the majority of the community has satisfactory awareness about the treatment options of knee osteoarthritis. It also demonstrates the domains that require more effort for increased public awareness of knee osteoarthritis.

Detection of Typical Compensatory Movements during Autonomously Performed Exercises Preventing Low Back Pain (LBP).

With the growing number of people seeking medical advice due to low back pain (LBP), individualised physiotherapeutic rehabilitation is becoming increasingly relevant. Thirty volunteers were asked to perform three typical LBP rehabilitation exercises (Prone-Rocking, Bird-Dog and Rowing) in two categories: clinically prescribed exercise (CPE) and typical compensatory movement (TCM). Three inertial sensors were used to detect the movement of the back during exercise performance and thus generate a dataset that is used to develop an algorithm that detects typical compensatory movements in autonomously performed LBP exercises. The best feature combinations out of 50 derived features displaying the highest capacity to differentiate between CPE and TCM in each exercise were determined. For classifying exercise movements as CPE or TCM, a binary decision tree was trained with the best performing features. The results showed that the trained classifier is able to distinguish CPE from TCM in Bird-Dog, Prone-Rocking and Rowing with up to 97.7% (Head Sensor, one feature), 98.9% (Upper back Sensor, one feature) and 80.5% (Upper back Sensor, two features) using only one sensor. Thus, as a proof-of-concept, the introduced classification models can be used to detect typical compensatory movements in autonomously performed LBP exercises.

Telemedicine (virtual clinic) effectively delivers the required healthcare service for pediatric ambulatory surgical patients during the current era of COVID-19 pandemic: A mixed descriptive study

BackgroundChildren often suffer from congenital or acquired diseases. Ambulatory cases represent the vast majority of pediatric surgical cases. COVID-19 pandemic-associated regulatory precautions had made the process of seeking medical advice at a suitable appointment such a big problem. We utilized telemedicine (online encounter) to deliver the required healthcare service for sorting and guiding pediatric ambulatory surgical patients. In this article, we aimed to: (1) present our experience, (2) evaluate the effectiveness, and (3) document the results of this technology to solve the problem of difficult healthcare accessibility. Materials and methodsIn this study, we compared the utilization of telemedicine (virtual clinic via video consultation) prospectively in the current era of the COVID-19 pandemic in the period from June 2020 to July 2021 to the in-person clinic encounter at the outpatient department (OPD) retrospectively in the previous year (from June 2019 until the end of May 2020) for perioperative management of pediatric ambulatory surgical patients. The study was conducted at 3 tertiary care pediatric surgery centers. The information recorded for analysis included: demographic data, surgical condition distribution, time interval from the appointment request till the actual encounter with the surgeon, conversation duration, distance traveled, and ultimate fate of the consultations. For both groups, service was evaluated after the first follow-up visit by a patient survey questionnaire (Patient Experience Assessment form) including questions relevant to each encounter. ResultsA total of 1124 pediatric patients with various ambulatory surgical conditions had been scheduled for virtual clinic video encounters. Of them, 1056 cases were evaluated by video consultation, supervised by their parents or caregivers, thus, achieving an attendance rate of 94%. Of the remaining cases, 2% (n = 23) were canceled and 4% (n = 45) did not attend the virtual clinic. Two-thirds of the cases live in rural /remote areas. Patients’ overall satisfaction was 92%. This was in comparison to 872 pediatric ambulatory surgical patients scheduled for in-person clinic visits before the implementation of the virtual clinic. Of them, only 340 cases had attended the clinic, thus, achieving an attendance rate of 39%. Of the remaining cases, 450 cases (51.6%) were canceled and 82 cases (9.4%) did not attend the clinic (no show). About 48% of the cases live in rural areas. For this group, patients’ overall satisfaction was 63%.The mean encounter duration was similar for both groups (∼ 5 min). Surgical condition distribution was also similar (p-value: 0.694). For new cases, the time interval from appointment request till the actual encounter was very short for the virtual clinic group (range: 6–15 days) as compared to the in-person clinic group (range: 30–180 days). Patients were followed up for a median period of 14 ± 3.25 months (range: 6–22 months) with no patient loss to follow-up. ConclusionTelemedicine can effectively bridge the patient-physician communication gap caused by the regulatory precautions mandated by the current COVID-19 pandemic. It achieved an attendance rate of 94% and parents’ / patients’ overall satisfaction of 92%.

A PROSPECTIVE STUDY ON CLINICAL PRESENTATION AND MANAGEMENT PROTOCOLS OF CARCINOMA PENIS IN TERTIARY CARE CENTRE

INTRODUCTION:Carcinoma of the penis is a malignancy with a wide range of clinical and pathological presentations. It constitutes a major substantial health concern in many developing countries including India. Proper evaluation of both the primary lesion and lymph nodes is critical because nodal involvement is the most important factor for survival. This study was undertaken to [1,2,3] determine incidence with age, religion, and socioeconomic status and to study risk factors and its management . METHODS:A descriptive study was conducted among 30 patients with proven carcinoma penis for a period of 2 years. RESULTS: In my study the maximum incidence was found to be in the age group of 50 to 70. All cases were Hindus and Muslims were free of disease may be due to early circumcision. In my study 86.6% of the patients associated with carcinoma penis were smokers. The commonest symptom at presentation was proliferative growth (76%). The most common site of origin was the Glans penis. The average time interval between onset of symptoms and seeking medical advice is 7 Months. The most common surgery performed was partial penectomy (73.3%) and a majority of the biopsy report showed SCC. Moderately and poorly differentiated tumors had a very strong association with nodal involvement. CONCLUSION: Carcinoma penis can be avoided by better penile hygiene and circumcision. It is a curable disease, if detected early and treated properly. The surgery is the mainstay of treatment. Creating awareness in public is the only way to reduce mortality and morbidity due to the carcinoma of the penis.

1118 The Role of Emergency Surgery in Diverticular Strictures of Those Who Were Initially Managed Conservatively

Abstract Aim The presence of diverticulosis can lead to several different complications including formation of strictures. However, the literature concerning management of diverticular strictures is poor. The purpose of this study is to evaluate the patients who were initially treated non surgically and had to undergo emergency surgery. Method A retrospective study was performed using a cohort of patients between 2016 and 2020 where 84 patients with diverticular strictures were identified and followed up. Data on the management of diverticular stricture was captured using the hospital’s electronic medical records. Results Out of 84 patients with diverticular strictures, 9 had elective surgery without any medical treatment while 75 had medical treatment first. Out of the 75 patients who were medically treated, 12 underwent emergency surgery while 2/75 underwent elective surgery after receiving medical treatment due to ongoing symptoms. Out of the 12 patients that underwent emergency surgery, 9 patients presented with obstruction while 3 had a bowel perforation. 6 patients had Hartmann’s procedure, 5 had defunctioning colostomy and 1 patient had adhesiolysis. No patient deaths were recorded at 12 months. Conclusions Although medical management remains the preferred method of managing diverticular strictures in the UK, it is not without its complications. 1 in 5 patients had an acute surgical admission requiring emergency surgery. This raises the importance of a good ‘safety net’ in those managed non-surgically, to reduce delays associated with seeking medical advice. We also appreciate the importance of carrying out more extensive studies to establish the best way to manage diverticular strictures.