Clinical Specialist Research Articles

Experimental and numerical investigation of pressure distribution in human upper airway passage before and after maxillary sinus surgery

Sinusitis, a common disease of the maxillary sinus, is initially managed with saline solution and medication, resulting in the resolution of symptoms within a few days in most cases. However, Functional Endoscopic Sinus Surgeries are recommended if pharmacological treatments prove ineffective. This research aims to investigate the effects of maxillary sinus surgery on the airflow field, pressure distribution within the nasal cavity, and overall ventilation. This study utilized a three-dimensional realistic nasal cavity model constructed from CT images of a healthy adult. Virtual surgery including uncinectomy with Middle Meatal Antrostomy, two standard procedures performed during such surgeries, was performed on the model under the supervision of a clinical specialist. Two replicas representing pre- and post-operative cases were created using 3D printing for experimental purposes. Various breathing rates ranging from 3.8 to 42.6 L/min were examined through experimental and numerical simulations. To ensure the accuracy of the numerical simulations, the results were compared to measured pressure data, showing a reasonable agreement between the two. The findings demonstrate that uncinectomy and Middle Meatal Antrostomy significantly enhance the ventilation of the maxillary sinuses. Furthermore, increasing inspiratory rates leads to further improvements in ventilation. The static pressure distribution within the maxillary sinuses remains relatively uniform, except in regions close to the sinus ostium, even after surgical intervention.

A Qualitative Study on Engaged Families' Experiences with Long-Term Follow-Up Care in the Colorado/Wyoming Newborn Screening System.

Understanding whether the long-term follow-up (LTFU) system is working for families is critical to measuring the success of newborn screening (NBS) and understanding why some families are lost to follow-up. Caregivers were recruited from six pediatric specialty care clinics. Data were gathered from caregivers via five focus groups and one individual interview (n = 24). Caregiver participants represented a wide range of children's ages and conditions identified through NBS. While this is not the first study to gather caregivers' input on LTFU, it provides a wide breadth of perspectives (e.g., metabolic, endocrine, hemoglobinopathy, etc.). When asked about goals for their children, caregivers identified health-related goals (i.e., children able to care for themselves, not hindered by diagnosis) and non-health related goals (i.e., defining themselves outside of disease, participating in sports, making friends). In describing the LTFU care they want and need for their child and the key factors that influence access and engagement, caregivers identified three themes: communication and relationships with providers; care team roles and factors; and care access and utilization factors. The themes identified are not disjointed; they are intertwined and illustrate the lived experiences of a sample of families engaged in LTFU care.

Traumatised Nurses' Desired Support Needs for Continued Recovery After the COVID-19 Pandemic: A Qualitative Descriptive Study Utilising Photovoice.

The aims of this study were to describe the experiences of nurses in the aftermath of the COVID-19 pandemic and to explore nurses' current desired support needs. This study used a qualitative descriptive design. This study was conducted in the Southeastern United States at an academic health system encompassing acute care hospitals and outpatient speciality clinics. Thirteen nurses were interviewed in August and September of 2023 in five small groups of two or three nurses. Photovoice was used for data collection and each nurse submitted two photographs. Data were analysed utilising conventional content analysis, with transcripts and photograph analysis occurring concurrently. Three themes were identified: (1) organisational turmoil, (2) personal traumatisation and transitions and (3) striving for revival and renewal. A conceptual model illustrating the three themes and their relationships was developed to depict study findings. Nurses were impacted by organisational factors, such as staffing issues and lack of support, and personally through psychological trauma that has remained challenging. Nurses found revival and renewal in their personal lives, but still desire continued improvement in organisational factors to enhance their well-being in ways not currently being addressed to allow for full recovery. Findings from this study are pertinent for healthcare organisations and leaders to develop organisational changes and mental health solutions to support nurse well-being. The prioritisation of nurse well-being is critical for the nursing profession and healthcare organisations. Organisational improvements and the implementation of support resources are urgently needed to aid in nurse recovery, nurse retention and to ensure patients receive quality care. This study identified nurses' struggles 3 years after the beginning of the COVID-19 pandemic, highlighting the ongoing need to provide resources and interventions that support nurse well-being. Our findings offer nurses' descriptions of their experiences and support needs for organisations and healthcare leaders to consider in the future. Standards for Reporting Qualitative Research (SRQR) Checklist. No patient or public contribution.

Costs of treating type 2 diabetes mellitus and its complications

The major driver of the costs of treating patients with diabetes mellitus type 2 (DM2) is its complications, which in developing countries are a consequence of poor glycemic control due to the low availability of novel, innovative antidiabetic drugs. We aimed to determine the ratio of direct medical costs arising from DM2 to the direct costs of its complications, as well as their main predictors. This was a retrospective cohort study of health care utilization and direct medical costs for adults with DM2, with (inpatients) or without (outpatients) complications. The utilization data were multiplied by the unit prices of drugs and services reimbursed by the Serbian Republic Health Insurance Fund to obtain direct costs. In total, 205 inpatients and 60 outpatients with DM2 participated in the study. Key drivers of the costs of treating diabetes complications in hospitals are consultations with specialist clinicians (B = 0.025 [0.003–0.047]), use of reserve antibiotics (B = 0.022 [0.007–0.036]), biochemical tests (B = 0.038 [0.022–0.055]) and length of stay in the hospital (B = 0.011 [0.009–0.013]). On the other hand, the number of encounters with general practitioners (B = 0.179 0.115–0.242) and the number of ultrasound examinations are strongly correlated with the total costs of treating outpatients with DM2 (B = 0.234 [0.054–0.414]). None of the outpatients included in the study were prescribed novel antidiabetic drugs. Overall, the costs of treating DM2 in Serbia are considerable and mainly driven by the 2–11-fold higher costs of complications vs. the costs of the disease itself.

Demographic and socioeconomic determinants of missing labs and imaging for otolaryngologic clinical visits.

Socioeconomics and demographics have been shown to be determinates of healthcare in specialty clinics, in which thorough research is lacking in the setting of the United States clinical sphere. We set out to determine the impact of socioeconomic and demographic factors on patient preparedness in an otolaryngologic clinic as to highlight the need for awareness in this aspect of disparate and delayed clinical care. Retrospective chart review. A chart review was conducted of 482 patients who visited our otolaryngology clinic between June 1, 2020 and June 1, 2023. Demographic data including marital status, gender, age, zip code, and race was collected. Our study found several interesting points of significance. Marital status was a significant determinant of whether patients had missing labs and/or imaging (p = .001). Age was a significant determinant of patients having their imaging (p < .0001). Patients were more likely to have all their labs and imaging at a follow-up appointment compared to an initial appointment (p < .0001). Finally, a patient's zip code was found to be a significant determinant of whether a patient no-showed an appointment or arrived with all their needed imaging and labs (p = .004). Having the needed labs and imaging for a clinical visit is vital to providing timely and well-informed care for all patients. This study highlighted several potential determinates of missing labs and imaging. Elderly patients were less likely to have imaging, which may be attributed to transportation issues and a weaker support system. Individuals who were married were more likely to have their imaging. Married individuals may have a stronger support system, where their spouses can provide transportation and reminders for appointments. Finally, the significance of zip code highlights the role transportation distance and living in an underserved area may have on patients being able to go to their appointments or obtain their needed imaging. 4.

Teamwork Training: Practicing Skills of Primary Resuscitation and Stabilization of a Newborn in the Delivery Room

The quality and safety of medical care in modern medicine are determined by the level of formation of team competence of clinical specialists. The article describes 8 years of experience in the formation of good practice and interaction of an educational institution for advanced training of medical workers with city medical institutions of the obstetric profile and obstetric departments that are part of the FAP and the Central District Hospital of the Omsk Region using the example of simulation trainings of team interaction in primary resuscitation of a newborn in the delivery room.

Comparing nursing medication rounds before and after implementation of automated dispensing cabinets: A time and motion study

Nursing medication administration is an integral, albeit time consuming component of a nursing shift. Automated dispensing cabinets (ADCs) are a medicines management solution designed to improve both efficiency and patient safety. This study aimed to evaluate the time taken to undertake a medication round including the number of locations visited to retrieve medicines, across four different clinical specialties within one hospital. Studies to date have investigated the effect of ADCs on nursing medication rounds centred around one clinical specialty, in hospitals with varying levels of digital maturity. This study adds to the existing body of evidence by investigating multiple clinical specialties where EPMA in use throughout the study period. In this study, prior to ADC implementation nurses retrieved required medicines from shelves in the medication room, mobile medication carts, and patients' own drug (POD) lockers. Post-ADC implementation, medicines were retrieved exclusively from the ADC and POD lockers only. Nurses were observed on each ward completing medication rounds, using the data collection tool designed for this study. Pre-implementation data was collected between February and June 2023, and post-implementation data collected between July and September 2023. There was a statistically significant reduction in the time required for medicines retrieval on the surgical ward only, post- ADC implementation. The time taken to retrieve each medication went from a mean of 98.1 s to 47.2 s (p = 0.0255). When comparing all four specialties as a whole, there was a reduction in the mean time required to issue each medicine preversus post-ADC implementation, from 83.3 s to 62.6 s respectively, however this difference was not shown to be statistically significant. The mean number of locations visited to obtain all required medicines for each patient reduced significantly from 1.73 to 1.04 (p < 0.01). There is potential for improved efficiency as nurses become more familiar with new workflows. It may be of benefit to repeat this study to ascertain whether time savings have been further improved.

Characteristic Features of Bimaxillary Proclination: A 5-Year Review in Najran, a Saudi Arabian Sub-population.

Background Bimaxillary proclination (BP) has been described as a clinical condition depicted by proclined upper and lower incisors with an amplified lip incompetence. The current study aimed to investigate the prevalence and characteristic features of bimaxillary proclination in Najran. Methods This was a retrospective study to appraise bimaxillary proclination in an orthodontic specialist clinic and research complex in Najran, Saudi Arabia from January 2018 to December 2022. Patients requesting orthodontic treatment for malocclusion were evaluated. Data retrieved include: age, gender, presence of bimaxillary proclination, and facial profile of affected patients. IBM SPSS Statistics for IOS Version 25 (Armonk, NY: IBM Corp) was used for analysis. Results were presented as simple frequencies and descriptive statistics. Results Three hundred and twenty-six (326) patients sought treatment for different types of malocclusion out of which 277 (84.9%) had bimaxillary proclination. There were 123 (44.4%) males and 154 (55.6%) females with an M:F ratio of 1:1.3. Age ranged from 6 to 55 years with a mean SD of 22.6 ± 8.98. More females had bimaxillary proclination. The majority of the patients with bimaxillary proclination had convex facial profiles and a Class I relationship(241 (73.9%) and (135 (48.7%)), respectively. Conclusion Bimaxillary proclination is a common orthodontic health issue with high prevalence in the Najran region. Female preponderance was observed. Most of the patients have a Class I Angle's relationship.

Clinician Perspectives of Gene Therapy as a Treatment Option for Duchenne Muscular Dystrophy.

Duchenne muscular dystrophy (DMD) is a progressive, life-limiting, neuromuscular disorder. Clinicians play an important role in informing families about therapy options, including approved gene therapies and clinical trials of unapproved therapies. This study aimed to understand the perspectives of clinicians about gene therapy for DMD, which has not previously been studied. We conducted interviews with specialist clinicians treating patients with DMD in the United States (n = 8) and United Kingdom (n = 8). Interviews were completed in 2022, before any approved gene therapies, to gain insight into barriers and facilitators to implementing gene therapy and educational needs of clinicians. Most respondents expressed cautious optimism about gene therapy. Responses varied regarding potential benefits with most expecting delayed progression and duration of benefit (1 year to lifelong). Concern about anticipated risks also varied; types of anticipated risks included immunological reactions, liver toxicity, and cardiac or renal dysfunction. Clinicians generally, but not uniformly, understood that gene therapy for DMD would not be curative. Most reported needing demonstrable clinical benefit to justify treatment-related risks. Our data demonstrate variability in knowledge and attitudes about gene therapy among clinicians who follow patients with DMD. As our knowledge base about DMD gene therapy grows, clinician education is vital to ensuring that accurate information is communicated to patients and families.

A combined tropical medicine and psychiatry approach to patients with possible delusional infestation.

Delusional infestation (DI) is a well-recognized delusional disorder presenting as the persisting belief of being infested. Combined clinics have been run by dermatology and psychiatry in a small number of centres. In this article we focus on our Liverpool University Hospitals NHS Foundation Trust clinic hosted at the Liverpool School of Tropical Medicine, UK, where we run a specialist clinic for DI. We describe the specific set-up and approach of our clinic as a guide for clinicians working in specialties likely to see patients with DI (including tropical medicine, infectious diseases and dermatology) who may either want to set up similar clinics or be better equipped to manage DI patients promptly within existing practice. We describe the details of the clinic's approach. Between 2018 and 2023, the service saw 208 patients, of which 82.7% could be assessed and 55.7% had DI. The female:male ratio was 2:1. Interdisciplinary combined clinics with medical and psychiatry consultants working together offer an approach to managing this rare, challenging and high-consequence condition.

Severe Vulvovaginal Candidiasis Associated With Sodium-Glucose Cotransporter 2 Inhibitors Use in Postmenopausal Women.

We present a case series of severe vulvovaginal candidiasis in postmenopausal women using sodium-glucose cotransporter-2 inhibitor (SGLT2i) medications for the management of their diabetes mellitus. Twenty-four cases from a private vulvovaginal specialist clinic are described. All 24 patients were referred with severe and persistent vulvar pruritus, pain, and erythema. Examination findings varied between patients and included erythema, edema, erosions, adherent white discharge, and fissuring, which were extensive and often involved the mons pubis, labia majora, and extended to the perineum and perianal region, mimicking psoriasis and/or irritant dermatitis. The clinical presentation in this postmenopausal group hindered a timely diagnosis, resulting in a delay in appropriate management. Fortunately, all patients improved on oral antifungal treatment, and in those that ceased their SGLT2i medication, there was resolution of the condition. While candidiasis is reported to occur with SGLT2i, severe genital mycotic infections are not yet a well-recognized adverse effect and may be missed. The presentation in these cases was persistent and severe. Clinicians should have a high index of suspicion in postmenopausal women presenting with vulvar pain, pruritus, and extensive erythema that mimics psoriasis or irritant dermatitis, if they are on SGLT2i therapy.

Group-based medical mistrust in genomic medicine: Associations with patient and provider perceptions of a specialty clinical encounter

PurposeInvestigating associations between group-based medical mistrust (GBMM) and perceptions of patient-provider encounters can identify one mechanism through which GBMM may influence health outcomes and serve as a barrier to equitable health care. This study investigated associations between GBMM reported by caregivers of children with a possible genetic condition and caregivers’ and providers’ perceptions of a specialty care appointment discussing diagnostic plans. MethodsCaregivers (N = 177) completed the GBMM scale and other measures before their child’s initial specialty clinic visit. After the visit, they reported their perceptions of the visit, including patient centeredness and satisfaction with care. Providers (N = 6) reported their perceptions of patient engagement. ResultsMultivariable linear regression showed that higher caregiver GBMM was associated with caregivers’ lower satisfaction with care (P < .01) and more negative perceptions of every domain of patient centeredness (P = .001-.04). Multilevel modeling showed that higher caregiver GBMM was associated with more negative provider perceptions of caregivers’ preparedness to participate in care (P = .03), likely treatment compliance (P = .03), and relevance of questions asked during visit (P = .04). ConclusionOur findings extend evidence for detrimental effects of GBMM on patient satisfaction to caregivers of pediatric patients and offer new evidence for associations with health care providers’ perceptions of caregivers’ engagement with care.

Program Signaling and Geographic Preferences in the United States Residency Match for Neurosurgery.

Postgraduateresidency training has long been the cornerstone of academic medicine in the United States. The Electronic Residency Application Service (ERAS), managed by the Association of American Medical Colleges (AAMC), is the central residency application platform in the United States for most clinical specialties, with the National Residency Matching Program (NRMP) being the algorithm for matching residency programs with applicants. However, the determination of the best fit between ERAS applicants and programs has been increasingly challenged by the rising number of applicants per residency spot. This application overburdening across competitive specialties led to several adverse downstream effects, which affected all stakeholders. While several changes and proposals were made to rectify the issue of application overburdening, the 2020-2021 ERAS Match Cycle finally saw several competitive specialties, including otolaryngology and urology, utilize a new system of supplemental residency application based on preference signals/tokens. These tokens permit applicants to electronically signal a selectnumber of programs in a specialty of choice, with the program reviewing the application now cognizant that they have been signaled, i.e., the applicant has chosen to use up a limited set of signals for their program. Initial results from otolaryngology and urology, as described in this article, indicated the value of this new system to both applicants and educators. Given the favorable outcomes and broader uptake of the system among other specialties, the field of neurosurgery adopted the utilization of the ERAS-based program signalingand geographic preferencefor the first time for the 2022-2023 Residency Application Cycle and later opted to continue them for the 2023-2024 and 2024-2025 cycles. For the 2024-2025 Match Cycle, neurosurgery applicants have 25 signals, i.e., a "high-signal" approach, where non-signaled programs have alow interview conversion rate. This literature review discusses the rationale behind the change, the outcomes of other competitive specialties from prior cycles, the evolving nature of the change, and the potential impact on applicants and programs. As we describe in this review, signaling may potentially represent a surrogate form of an application cap.Other considerations relate to cost savings for both applicants and programs from a high-signal approach in neurosurgery. These modifications represent a foundational attempt to alleviate the application overburdening and non-holistic review in the residency application process, including for neurosurgery. While these changes have been a welcomed addition for all stakeholders in residency match cycles so far, further prospectively directed surveys along with qualitative research studies are warranted to better delineate the downstream impact of these changes and guide further optimization of the application system.

Investigating innovations in outpatient services: a mixed-methods rapid evaluation.

Within outpatient services, a broad range of innovations are being pursued to better manage care and reduce unnecessary appointments. One of the least-studied innovations is Patient-Initiated Follow-Up, which allows patients to book appointments if and when they need them, rather than follow a standard schedule. To use routine national hospital data to identify innovations in outpatient services implemented, in recent years, within the National Health Service in England. To carry out a rapid mixed-methods evaluation of the implementation and impact of Patient-Initiated Follow-Up. The project was carried out in four sequential workstreams: (1) a rapid scoping review of outpatient innovations; (2) the application of indicator saturation methodology for scanning national patient-level data to identify potentially successful local interventions; (3) interviews with hospitals identified in workstream 2; and (4) a rapid mixed-methods evaluation of Patient-Initiated Follow-Up. The evaluation of Patient-Initiated Follow-Up comprised an evidence review, interviews with 36 clinical and operational staff at 5 National Health Service acute trusts, a workshop with staff from 13 National Health Service acute trusts, interviews with four patients, analysis of national and local data, and development of an evaluation guide. Using indicator saturation, we identified nine services with notable changes in follow-up to first attendance ratios. Of three sites interviewed, two queried the data findings and one attributed the change to a clinical assessment service. Models of Patient-Initiated Follow-Up varied widely between hospital and clinical specialty, with a significant degree of variation in the approach to patient selection, patient monitoring and discharge. The success of implementation was dependent on several factors, for example, clinical condition, staff capacity and information technology systems. From the analysis of national data, we found evidence of an association between greater use of Patient-Initiated Follow-Up and a lower frequency of outpatient attendance within 15 out of 29 specialties and higher frequency of outpatient attendance within 7 specialties. Four specialties had less frequent emergency department visits associated with increasing Patient-Initiated Follow-Up rates. Patient-Initiated Follow-Up was viewed by staff and the few patients we interviewed as a positive intervention, although there was varied impact on individual staff roles and workload. It is important that sites and services undertake their own evaluations of Patient-Initiated Follow-Up. To this end we have developed an evaluation guide to support trusts with data collection and methods. The Patient-Initiated Follow-Up evaluation was affected by a lack of patient-level data showing who is on a Patient-Initiated Follow-Up pathway. Engagement with local services was also challenging, given the pressures facing sites and staff. Patient recruitment was low, which affected the ability to understand experiences of patients directly. The study provides useful insights into the evolving national outpatient transformation policy and for local practice. Patient-Initiated Follow-Up is often perceived as a positive intervention for staff and patients, but the impact on individual outcomes, health inequalities, wider patient experience, workload and capacity is still uncertain. Further research should include patient-level analysis to determine clinical outcomes for individual patients on Patient-Initiated Follow-Up and health inequalities, and more extensive investigation of patient experiences. This study is registered with the Research Registry (UIN: researchregistry8864). This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 16/138/17) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 38. See the NIHR Funding and Awards website for further award information.

Posttraumatic stress symptoms in recovery from concussion

ABSTRACT Background Previous literature suggests that lingering concussion symptoms may be influenced by psychological factors. The relationship of posttraumatic stress symptoms (PTSS) during recovery with pre-existing/injury related factors and concussion symptomology is not fully understood. Identification of factors contributing to symptoms of posttraumatic stress may provide guidance to improve treatment following concussion. Method This study included 287 participants (Male 40.42%, n = 116; Female 59.58%, n = 171) aged 13–75 years diagnosed with a recent concussion at one of the North Texas Concussion Registry (ConTex) specialty concussion clinic sites. Preinjury emotional history, injury related factors, and emotional state at time of initial evaluation were analyzed as predictors of post-traumatic stress symptoms (PCL-5) during recovery. Results Sixty-one percent of participants endorsed at least one PTSS. Correlations were found between initial Sport Concussion Assessment Tool 5Ⓡ (SCAT5) total emotional symptom severity and screening measures for anxiety (GAD-7; r = .453, p < .001) and depression (PHQ-8; r = .550, p < .001) symptom scores. Of the measures from the initial visit included in the multiple regression model predicting severity of PTSS at follow-up (R2 = 0.554, β < .001), three measures predicted PTSS severity: initial SCAT5 total emotional symptom severity (β = 0.565, p < .001), PHQ-8 score (β =.166, p = .009), and GAD-7 score (β = 0.119, p = .044). Conclusions Symptoms of anxiety and depression along with specific SCAT5 emotional symptoms present at the time of initial evaluation may serve to predict overall level of PTSS and increased risk for PTSS during recovery. PTSS may be another dimension of response to injury and concussion recovery, with a large percentage of individuals endorsing at least one PTSS. Clinicians can utilize brief assessments such as the SCAT5 at the time of initial clinical evaluation to identify those at risk for PTSS following concussion.

51697 Analysis of Specialty Clinics and Subspecialty Training Among Dermatology Residency Programs

51697 Analysis of Specialty Clinics and Subspecialty Training Among Dermatology Residency Programs

Epidemiologic, clinicopathologic, and diagnostic findings in pet rabbits with myxomatosis caused by the California MSW strain of myxoma virus: 11 cases (2022-2023).

To determine epidemiologic features of naturally occurring myxomatosis in domestic rabbits in California and to characterize clinicopathologic and diagnostic findings. 11 client-owned rabbits, Oryctolagus cuniculus subsp domesticus. A prospective study of pet rabbits with myxomatosis seen at an exotic animal specialty clinic in Santa Cruz county, California, was conducted between January 1, 2022, and December 31, 2023. Rabbits were included in the study if they had bilateral blepharedema and were PCR positive for myxoma virus. All infected rabbits had spent time outdoors. Common clinical signs included bilateral blepharedema (11/11), anogenital edema (10/11), rectal temperature ≥ 39.7 °C (5/9), and sudden death (4/11). Eyelid biopsies from all rabbits (11/11) were positive for myxoma virus by qualitative PCR followed by Sanger sequencing (100% nucleotide identity to strain MSW, also known as California/San Francisco 1950 [Genbank accession KF148065]). Most rabbits had keratinocytes containing eosinophilic intracytoplasmic viral inclusions in biopsies of edematous skin (8/11) and lymphocyte necrosis in the spleen (10/11). Immunohistochemistry identified myxoma virus in samples of skin, heart, lung, ileum, spleen, and lymph node. Clinical signs of myxomatosis caused by the MSW strain of myxoma virus are distinctive but subtle. Cases occur regularly in the Santa Cruz and San Jose regions of California. As infection with this virus is almost 100% fatal and no vaccine is available in the US, owners of domestic rabbits in endemic areas should keep their pets indoors or behind mosquito screens. Myxomatosis is a reportable disease in the US, and the appropriate state or federal agencies should be contacted when outbreaks occur.

'Orthodontics is a fantastic clinical specialty'.

'Orthodontics is a fantastic clinical specialty'.

Frequency of Phenotypes and their Clinical and Hormonal Characteristics of Polycystic Ovarian Syndrome.

To determine the frequency of phenotypes of polycystic ovarian syndrome (PCOS) in patients presenting with sub-fertility, and to compare the clinical and hormonal characteristics among them. Descriptive cross-sectional study. Place and Duration of the Study: Department of Obstetrics and Gynaecology, Forest View Specialist Clinic, Peshawar, Pakistan, from August 2022 to January 2023. The study included 662 female patients presenting with menstrual irregularities, hyperandrogenism, and infertility to the clinic. PCOS was diagnosed on the basis of the Rotterdam criterion and clinical features and classified into different phenotypes on the basis of the National Institute of Health (NIH) panel criteria. Data were entered and analysed by IBM SPSS VERSION 23.0. The frequency of four phenotypes was calculated and phenotypes were compared for age, weight, hormonal profiles, and history of miscarriages. A p <0.05 was considered statistically significant. Frequency of PCOS in patients with infertility was 59.76%. Phenotype A was seen in 58.2%, phenotype D in 23.3%, phenotype C in 16.9%, and phenotype B in 1.7% of cases. The LH/FSH ratio was statistically significant in phenotype A as compared to other phenotypes, while other parameters were non-significant. The frequency of PCOS is high in patients with infertility. Phenotype A is the most common variant and is associated with significant impairment of the LH/FSH ratio. Polycystic ovarian syndrome, Subfertility, Phenotypes of PCOS, Hyperandrogenism, Anovulation, R-C1.

Patient regional index: a new way to rank clinical specialties based on outpatient clinics big data

BackgroundMany existing healthcare ranking systems are notably intricate. The standards for peer review and evaluation often differ across specialties, leading to contradictory results among various ranking systems. There is a significant need for a comprehensible and consistent mode of specialty assessment.MethodsThis quantitative study aimed to assess the influence of clinical specialties on the regional distribution of patient origins based on 10,097,795 outpatient records of a large comprehensive hospital in South China. We proposed the patient regional index (PRI), a novel metric to quantify the regional influence of hospital specialties, using the principle of representative points of a statistical distribution. Additionally, a two-dimensional measure was constructed to gauge the significance of hospital specialties by integrating the PRI and outpatient volume.ResultsWe calculated the PRI for each of the 16 specialties of interest over eight consecutive years. The longitudinal changes in the PRI accurately captured the impact of the 2017 Chinese healthcare reforms and the 2020 COVID-19 pandemic on hospital specialties. At last, the two-dimensional assessment model we devised effectively illustrates the distinct characteristics across hospital specialties.ConclusionWe propose a novel, straightforward, and interpretable index for quantifying the influence of hospital specialties. This index, built on outpatient data, requires only the patients’ origin, thereby facilitating its widespread adoption and comparison across specialties of varying backgrounds. This data-driven method offers a patient-centric view of specialty influence, diverging from the traditional reliance on expert opinions. As such, it serves as a valuable augmentation to existing ranking systems.