Unscheduled Appointments Research Articles

The safety and efficacy of ambulatory urologic surgery: A paradigm shift towards optimizing resource utilization in outpatient settings.

Amidst substantial surgical waitlists, novel methods are needed to improve the delivery of surgical care in Canada. One strategy involves shifting select surgeries from hospitals into community ambulatory centers, which expedite procedures and allow hospitals to prioritize critical and complex patients. We sought to evaluate surgical outcomes at a novel Canadian urologic clinic and surgical center. A retrospective study was conducted at a novel accredited surgical facility and outpatient ambulatory clinic from August 2022 to August 2023. Procedures ranged from scrotal and transurethral surgeries to inflatable penile prosthesis insertion. Traditional outpatient procedures, including vasectomy and cystoscopy, were excluded. All patients were discharged the same day and seen 4-6 weeks post-procedure. Variables of interest included surgery type, anesthesia administered, additional clinic appointments, unplanned family physician appointments, visits to the emergency department (ED), and hospital admissions. In a 12-month period, 519 surgeries were performed. The mean patient age was 49.6±17.3 years, with most classified as American Society of Anesthesiologists (ASA) 1-2 (88.8%). Most (95.8%, n=497) patients did not require medical care outside the clinic before scheduled followup; 2.5% (n=13) visited the ED presenting for wound concerns, postoperative pain, query infection, or catheter-related concerns. Only 1.7% (n=9) required an unscheduled appointment with their family physician, with concerns being inadequate postoperative pain management (n=4) or suspected infection (n=4). No patient required hospital admission. Many urologic surgeries classically performed in hospital operating rooms can be safely performed in a non-hospital, outpatient surgical facility with preservation of good outcomes. This strategy can potentially improve the efficiency of urologic healthcare delivery in select patients.

Customized GRASP for rehabilitation therapy scheduling with appointment priorities and accounting for therapist satisfaction

Physical therapy in acute care hospitals plays an important role in the rehabilitation of patients. Nevertheless, the profession must deal with staff shortages caused by a lack of potential employees and absenteeism which are results of high physical and mental workloads. The therapist shortage negatively affects the total number of daily appointments the department can fulfill. For appointments that can be successfully scheduled, continuity of care with the same therapist cannot be guaranteed for individual patients. Lack of continuity of care negatively influences the therapist's satisfaction. Therapist preferences for individual appointments in general cannot always be guaranteed when designing schedules, which also hurts satisfaction. This paper develops a multi-criteria model for the daily therapy appointment-scheduling problem. The primary objective is to minimize the total sum of priority violations for unscheduled appointments. To improve therapist satisfaction, we consider therapist preferences including continuity of care as a secondary objective. Here, our integer programming formulation aims to minimize the total sum of preference violations for scheduled appointments. We are dealing with an operational planning problem with a daily planning horizon. The operational objective is to achieve therapist schedules in at most two hours. The therapists’ schedules together need to include several hundred appointments for a planning day. Due to intractability, the developed integer program cannot provide schedules for such problem sizes. Therefore, we develop a customized Greedy Randomized Adaptive Search Procedure (GRASP) with six innovative local search operations to improve an initially constructed solution. We test the heuristic algorithm on realistic data instances. The metaheuristic provides high-quality schedules for various problem sizes in short runtimes, i.e., within minutes. Comparisons with the optimal solutions for small problem instances show very good results of the GRASP with a similar number of scheduled appointments and good adherence to continuity of care and therapist preference requirements.

Viral suppression rate at operation triple zero (Otz) and regular art follow-Up programs and associated factors among adolescent clients of Addis Ababa Ethiopia: a comparative cross-sectional study

Background- Viral suppression is the main goal of currently available treatment and it is used as a primary indicator of successful treatment for human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). This ensures a reduction in AIDS-associated morbidity and mortality and decreases the risk of both vertical and horizontal viral transmission. This study aimed to investigate the magnitude of viral suppression and its associated factors among adolescents, comparing the operation triple zero (OTZ) program to regular antiretroviral therapy (ART) follow-up programs.Methods- The research consisted of a comparative cross-sectional study, which included a total sample size of 446 adolescents on Active Antiretroviral Therapy (ART) — 223 enrolled in OTZ, and 223 in regular ART from public hospitals. Sociodemographic data were obtained using a self-administered semi-structured questionnaire, and clinical data were extracted from medical records. To examine the prevalence of viral suppression (VS) the latest status was used and multivariate logistic regression analysis was performed to identify factors associated with VS.Results- Overall, the adolescent viral suppression was 88.3%, with 92.4% in the OTZ group and 84.3% in the regular ART group. Among OTZ participants, the factors that significantly reduced the odds of viral suppression were having a history of admission in the last year, alcohol use, biological mother not alive, cigarette smoking, social discrimination, and current medication regimen TDF/3TC/EFZ. Among those in regular ART, factors associated with a lesser chance of viral suppression were alcohol use, social discrimination, unscheduled appointments, and current medication regimen TDF/3TC/EFZ when compared to their counterparts. When we compared the two programs, OTZ had a 26.1 times greater chance of suppressing HIV viral load (AOR = 26.1, 95% CI: 3.499–133.9; P = 0.041).Conclusion- The overall VS was 88.3%, while viral suppression is better achieved through the OTZ program than through regular ART services. Alcohol use, biological mother not alive, cigarette smoking, social discrimination, and current medication regimen TDF/3TC/EFZ were identified to be factors associated with viral nonsuppression. Therefore, it is advisable to implement the OTZ program in all HIV care centers and focus on factors reducing viral suppression.

Flare-ups After Nonsurgical Retreatments: Incidence, Associated Factors, and Prediction

IntroductionThe aims of this study were to determine the incidence, associated factors, and predictability of flare-ups after nonsurgical retreatments (NSRetx). MethodsAll patients (n = 3,666) who received NSRetx by 3 endodontists in 2 endodontic offices during a period of 6 years (2016–2022) were included. Demographic, diagnostic, and procedural data were collected. A flare-up was defined as moderate-severe pain with/without swelling that took place within 14 days of initiation of NSRetx and resulted in an unscheduled appointment. Bivariate analyses on the entire cohort and multivariable analyses on cases with complete dataset (n = 2,846) were performed to identify significant associations. A Random Forest algorithm was used to make a prediction model. ResultsIncidence of flare-ups was 3.95% (n = 145). Increased risk of flare-ups was associated with diabetes (adjusted odds ratio [AOR] = 2.01; 95% confidence interval [CI], 1.01–3.97), mandibular teeth (AOR = 1.67; 95% CI, 1.11–2.52), moderate-severe preoperative pain on percussion (AOR = 2.13; 95% CI, 1.31–3.50), and pain on palpation (AOR = 1.63; 95% CI, 1.01–2.64). Lower risk of flare-up was associated with high blood pressure (AOR = 0.44; 95% CI, 0.21–0.82) (P < .05). The prediction model was not able to predict flare-ups with sufficient confidence (precision = 0.13). ConclusionsIncidence of flare-ups following NSRetx was low (∼4%) and had a weak but significant association with the history of diabetes. Moderate-severe pain on percussion, pain on palpation (any intensity), and mandibular teeth had a significant association with flare-ups. The history of high blood pressure was associated with lower risk of flare-ups. Flare-ups were difficult to predict in this clinical setting.

Acceptability of a Hypothetical Reduction in Routinely Scheduled Clinic Visits Among Patients With History of a Localized Melanoma (MEL-SELF): Pilot Randomized Clinical Trial.

After treatment for a localized melanoma, patients attend routinely scheduled clinics to monitor for new primary or recurrent melanoma. Patient-led surveillance (skin self-examination with patient-performed teledermoscopy) is an alternative model of follow-up that could replace some routinely scheduled visits. This study aims to assess the acceptability of a hypothetical reduction in routinely scheduled visits among participants of the Melanoma Self Surveillance (MEL-SELF) pilot randomized clinical trial of patient-led surveillance (intervention) versus usual care (control). Patients previously treated for localized melanoma in New South Wales who were participating in the MEL-SELF pilot randomized clinical trial were asked to respond to a web-based questionnaire at baseline and after 6 months on trial. We used mixed methods to analyze the data. The main outcome of interest was the acceptability of a hypothetical reduction in routinely scheduled visits for melanoma surveillance. Of 100 randomized participants, 87 answered the questionnaire at baseline, 66 answered the questionnaire at 6 months, and 79 provided a free-text explanation at either time point. At 6 months, 33% (17/51) of the control group and 35% (17/49) of the intervention group indicated that a hypothetical reduction in routinely scheduled visits with all melanoma doctors was at least slightly acceptable (difference in proportions -1%, 95% CI -20% to 17%; P=.89). Participants suggested that prerequisites for a reduction in routinely scheduled visits would include that sufficient time had elapsed since the previous diagnosis without a new primary melanoma or recurrence, an unscheduled appointment could be made at short notice if the patient noticed something concerning, their melanoma doctor had suggested reducing their clinic visit frequency, and patients had confidence that patient-led surveillance was a safe and effective alternative. Participants suggested that a reduction in routinely scheduled visits would not be acceptable where they perceived a very high risk of new or recurrent melanoma, low self-efficacy in skin self-examination and in the use of technologies for the patient-led surveillance intervention, and where they had a preference for clinician-led surveillance. Some patients said that a partial reduction to once a year may be acceptable. Some patients may be receptive to a reduction in routinely scheduled visits if they are assured that patient-led surveillance is safe and effective. Australian New Zealand Clinical Trials Registry ACTRN12616001716459; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371865&isReview=true; ClinicalTrials.gov NCT03581188; https://clinicaltrials.gov/ct2/show/NCT03581188. RR2-10.1001/jamadermatol.2021.4704.

Improving access to highly effective emergency contraception: an assessment of barriers and facilitators to integrating the levonorgestrel IUD as emergency contraception using two applications of the Consolidated Framework for Implementation Research.

Emergency contraception prevents unwanted pregnancy after sexual intercourse. New evidence has demonstrated that the levonorgestrel 52 mg IUD is a highly effective method of emergency contraception. However, translating this research finding into clinical practice faces existing barriers to IUD access, including costs and provider training, novel barriers of providing IUDs for emergency contraception at unscheduled appointments. The purpose of this study was to identify barriers and facilitators to the utilization of the levonorgestrel IUD as emergency contraception from client, provider, and health systems perspectives. We conducted English and Spanish-speaking focus groups (n=5) of both contraceptive users (n=22) and providers (n=13) to examine how the levonorgestrel IUD as EC was perceived and understood by these populations and to determine barriers and facilitators of utilization. We used findings from our focus groups to design a high-fidelity in-situ simulation scenario around EC that we pilot tested with clinical teams in three settings (a county health department, a community clinic, and a midwifery clinic), to further explore structural and health systems barriers to care. Simulation scenarios examined health system barriers to the provision of the levonorgestrel IUD as EC. We coded both focus groups and in-clinic simulations using the modified Consolidated Framework for Implementation Research (CFIR). We then applied our findings to the CFIR-Expert Recommendations for Implementing Change (ERIC) Barrier Busting Tool and mapped results to implement recommendations provided by participants. Ultimately, 9 constructs from the CFIR were consistently identified across focus groups and simulations. Main barriers included suboptimal knowledge and acceptability of the intervention itself, appropriately addressing knowledge and education needs among both providers and contraceptive clients, and adequately accounting for structural barriers inherent in the health system. The CFIR-ERIC Barrier Busting Tool identified eight strategies to improve levonorgestrel IUD as EC access: identifying implementation champions, conducting educational meetings, preparing educational toolkits, involving patients and their partners in implementation, conducting a local needs assessment, distributing educational materials, and obtaining patient feedback. To sustainably incorporate the levonorgestrel IUD as EC into clinical practice, education, health systems strengthening, and policy changes will be necessary.

Implementation of a heart failure clinic in a non-cardiovascular center in Mexico

Abstract Introduction The incidence and prevalence of Heart Failure (HF) has been increasing throughout these years, with it, the need to implement HF clinics. In Latin America, it is rare to find non-cardiovascular centers with the capacity, human resources, and infrastructure to make this project sustainable, viable and useful for patients. Our center is a highly concentrated hospital in the country, with patients referred from different areas of Mexico. This makes it a unique site of multiple rare pathologies in the general population. Objectives To determine if there is a relationship between the implementation of a HF clinic and the decrease in mortality, the rate of rehospitalization of patients with HF over 6 months, as well as to implement and optimize the therapy of mainstay drugs for HF and the timely referral of the hospitalized or ambulatory patient, for follow-up, control, and education of HF. Methods A prospective descriptive study was designed with analytical intent. 80 patients with a diagnosis of HF were included. A comprehensive system was used to collect objective and subjective patient data through a database. The information was obtained from the review of medical records and by telephone follow-up of the patients. Each patient was evaluated at the first consultation with Brain Natriuretic Peptide (BNP) values, iron profile, troponin I, blood cytometry and complete blood chemistry. Follow-up appointments included BNP, nitrogen products and VExUS protocol for drug titration, study of reversible causes of HF, assessment of ejection fraction evolution, decision making regarding the indication of devices such as implantable defibrillator and resynchronizer, and scheduled appointments according to functional class and unscheduled appointments in case of alarm signs. Results Of the 80 total patients included in our registry during the first 6 months, we found the presence of Heart failure with reduced ejection fraction (HFrEF) in 66% of our patients, of whom 46% were reclassified as recovered Heart failure with recovered ejection fraction at the end of these first 6 months. In patients with HFrEF at least 94% receive a complete scheme of 4 drugs considered pillars in the treatment of this disease, (MRA, iSGLT2, ARNI/iECA or ARA-ll and β-blocker) 6% did not tolerate this quadruple therapy mainly due to episodes of hypotension. During our first 6 months, there were no deaths due to cardiovascular causes; however, mortality due to non-cardiovascular causes was 0.8%. Rehospitalizations due to HF decompensation was 3%. Intermittent administration of levosimendan was necessary in 2% of patients to improve conditions prior to major surgical events. Conclusion The implementation of a HF clinic decreases mortality due to cardiovascular causes, rehospitalizations due to HF decompensation, and increases adherence to optimal treatment, follow-up, and patient self-care. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): The National Institute of Medical Sciences and Nutrition Dr. Salvador Zubiran Secretary of Health of Mexico

A 3-year prospective cohort on the incidence of prosthodontic complications associated with three implant treatment options for the edentulous mandible.

This prospective study assessed the number and reasons for post-treatment visits due to prosthodontic complications in patients treated with three types of implant treatment for the edentulous mandible. Study groups comprised patients treated with single-implant overdenture (G-I; n= 11), 2-implant overdenture (G-II; n= 13), and 4-implant fixed prosthesis (G-III; n= 13). Programmed recall visits occurred at the 6-, 12- and 36-month follow-ups. The management of prosthodontic complications occurred continuously in unscheduled appointments. Data analysis included calculation of incidence rates, chi-square and Kruskal-Wallis tests, and Poisson regression with robust error variance to model the occurrence of visits due to prosthodontic complications. There were 89 unscheduled appointments during the entire follow-up period, ranging from 0 to 7 (mean=2.41; SD=2.2) per patient. No between-group differences were found regarding the frequency of unscheduled visits. However, the duration of the appointments (scheduled and unscheduled) was significantly higher for G-III (p< .001). The length of follow-up was the only predictor of the number of post-insertion visits (p= .004). The frequency of prosthodontic events was higher for G-I and G-II compared to G-III (p< .001). Nearly half of the events in G-I and G-II were matrix replacements, and artificial teeth fracture was more frequent in G-III. All patients were at risk of post-delivery prosthodontic complications and required regular recall visits to achieve satisfactory function and to prevent further problems. Overdentures required higher rates of maintenance visits, particularly for replacement of the retentive inserts, while fixed implant prostheses required longer clinical times for management of complications when compared to overdentures.

Inequitable access: factors associated with incomplete referrals to paediatric cardiology.

To assess the variables associated with incomplete and unscheduled cardiology clinic visits among referred children with a focus on equity gaps. We conducted a retrospective chart review for patients less than 18 years of age who were referred to cardiology clinics at a single quaternary referral centre from 2017 to 2019. We collected patient demographic data including race, an index of neighbourhood socio-economic deprivation linked to a patient's geocoded address, referral information, and cardiology clinic information. The primary outcome was an incomplete clinic visit. The secondary outcome was an unscheduled appointment. Independent associations were identified using multivariable logistic regression. There were 10,610 new referrals; 6954 (66%) completed new cardiology clinic visits. Black race (OR 1.41; 95% CI 1.22-1.63), public insurance (OR 1.29; 95% CI 1.14-1.46), and a higher deprivation index (OR 1.32; 95% CI 1.08-1.61) were associated with higher odds of incomplete visit compared to the respective reference groups of White race, private insurance, and a lower deprivation index. The findings for unscheduled visit were similar. A shorter time elapsed from the initial referral to when the appointment was made was associated with lower odds of incomplete visit (OR 0.62; 95% CI 0.52-0.74). Race, insurance type, neighbourhood deprivation, and time from referral date to appointment made were each associated with incomplete referrals to paediatric cardiology. Interventions directed to understand such associations and respond accordingly could help to equitably improve referral completion.

Comparative study on conventional ligation and self ligation bracket systems

Aim: The purpose of the present study was to evaluate the comparison between conventional ligation and self-ligation bracket system. Methodology: Seven hundred and sixty two patients, consecutively treated with fixed appliances, were evaluated retrospectively. All patients were treated by one orthodontist in a private orthodontic practice. Three hundred and eighty three patients were treated using a conventional pre-adjusted bracket system and 379 patients were treated with active self-ligating brackets. The total treatment time, number of appointments, appointment intervals, number of bracket breakages and number of unscheduled emergency appointments were recorded. Pretreatment characteristics identified by the ICON were related to these variables. Results: The average treatment duration was 15.7 months (Range: 4.1–40.5 months; SD: 5.6 months). Comparable amounts of time were spent in rectangular and round archwires by both appliances. Overall, there was no statistically significant difference between the durations of treatment with active self-ligating brackets and conventional pre-adjusted brackets. The number of debonded brackets and other emergency visits was significantly higher in patients treated with active self-ligating brackets. The treatment characteristics associated with prolonged treatment were: extraction of teeth, a Class II molar relationship and the degree of maxillary crowding or spacing.

Comparative study on conventional ligation and self ligation bracket systems

Aim: The purpose of the present study was to evaluate the comparison between conventional ligation and self-ligation bracket system. Methodology: Seven hundred and sixty two patients, consecutively treated with fixed appliances, were evaluated retrospectively. All patients were treated by one orthodontist in a private orthodontic practice. Three hundred and eighty three patients were treated using a conventional pre-adjusted bracket system and 379 patients were treated with active self-ligating brackets. The total treatment time, number of appointments, appointment intervals, number of bracket breakages and number of unscheduled emergency appointments were recorded. Pretreatment characteristics identified by the ICON were related to these variables. Results: The average treatment duration was 15.7 months (Range: 4.1–40.5 months; SD: 5.6 months). Comparable amounts of time were spent in rectangular and round archwires by both appliances. Overall, there was no statistically significant difference between the durations of treatment with active self-ligating brackets and conventional pre-adjusted brackets. The number of debonded brackets and other emergency visits was significantly higher in patients treated with active self-ligating brackets. The treatment characteristics associated with prolonged treatment were: extraction of teeth, a Class II molar relationship and the degree of maxillary crowding or spacing.

Patient-reported outcome measurement (PROM) program in patients with lymphoma receiving intravenous therapy: Preliminary results of a prospective study using PRO-CTCAE to individualize healthcate and to reduce unscheduled appointments.

e18670 Background: PROMs have been included in cancer clinical trials but it is yet to come in daily clinical practice. Their implications in healthcare management have not been well stablished yet. We hypothesize that patients subscribed to these programs may benefit from a better self-perception of health status and might require fewer hospital admissions and emergency room visits, which could allow a reduction in the costs of treatment. Methods: “E-Res Salud” is a value-based healthcare program implemented in patients with hematological malignancies in our institution. Patients (pts) with diagnosis of any type of lymphoma in the need of treatment between 1st Jan 2019 and 31st Dec 2020 were included in our research. Inclusion in PROMs program was offered to every patient starting intravenous treatment in 2020. Pts who started treatment in 2019 and those who rejected inclusion in 2020 were considered the control arm of our study. The principal endpoint was to compare physician and patient-reported adverse events through a standardized questionnaire such as PRO-CTCAE. Secondary endpoints included association between inclusion in PROMs program and reduction of hospital admissions and emergency room visits. Results: A total of 142 pts were included in our study; 76 of them (53.5%) were included in a PROMs program. There were no differences in pts characteristics with regards of age or sex. Most frequent diagnoses were diffuse large B-cell, follicular and Hodgkin lymphoma. Adverse events (AEs) most frequently reported by physicians were hematological complications (76.1%), general (73.9%), gastrointestinal symptoms (59.9%) and infections (43.7%). When patients were asked to report AEs of higher intensity, the most frequently reported were general (31.6%), genitourinary (26.3%), gastrointestinal (23.7%), neurological (15.8%) and cutaneous (13.2%) symptoms. Patients included in PROMs program experienced reported fewer general (64.5% vs. 84.8%; p &lt; 0.05) and infectious (30.3% vs. 59.1%; p &lt; 0.05) AEs than those in the control arm. Moreover, inclusion in the PROMs program was associated with fewer number of visits to Emergencies, with 34.2% of pts vs 60% of pts not enrolled in the PROM program (p = 0.003). None of the different types of AEs were associated to an increase in the number of admissions or outpatient consultations. With such a short follow-up we have not found association between any type of AE and survival. Conclusions: This program can help to increase awareness among hematologists about patients’ perception of symptoms and what really matters to them. Our study establishes the association of PROMs with health care utilization among patients with different types of lymphoma. A longer follow-up and changes in PROMs during the treatment will be further analyzed.

Improving childhood asthma outcomes in East Harlem: the East Harlem Asthma Center of Excellence’s Asthma Counselor Program

Objectives To evaluate the effectiveness of the Asthma Counselor Program, a program of the New York City Department of Health and Mental Hygiene, designed to improve asthma outcomes among children. Methods We used a pre-post study design among children who enrolled in the program. We included self-reported outcome measures by comparing the previous 12 months (captured at intake) to the 12 months following program enrollment. To calculate the 12 months after enrollment, we added the number of outcome events reported at each follow-up session, which are conducted approximately three months apart, to compute 12-month (or “year-end”) post-enrollment outcomes. Results We enrolled 136 children during the study period (2018); 85 children remained in the program for 12 months and 51 became lost-to-follow-up. Among those who remained in the program, at the “year-end” session, there were statistically significant reductions in the mean number of asthma-related unscheduled healthcare appointments or urgent-care visits (73%), uses of prednisone (65%), asthma-related school absences (60%), asthma-related ED visits (57%), and asthma-related hospitalizations (50%). Conclusions Twelve months after children enrolled in the program, they had significantly improved asthma outcomes. Our findings, along with results from similar studies, support multicomponent interventions, especially those led by masters-level social workers.

Incidence and Cost of Surgical Site Infections After Osteochondral Allograft Transplantation and Meniscal Allograft Transplantation in the Knee.

Background:Surgical site infections (SSIs) significantly influence outcomes and health care costs after orthopaedic surgery, but they have not been well characterized for osteochondral allograft (OCA) transplantation with or without meniscal allograft transplantation (MAT).Purpose:To characterize the incidence, cost, and risk factors associated with potential or confirmed SSIs after large single-surface, multisurface, or bipolar allograft transplantation in the knee.Study Design:Case-control study; Level of evidence, 3.Methods:Prospectively collected registry data were analyzed for patients who underwent primary or revision OCA transplantation with or without MAT in the knee. The Centers for Disease Control and Prevention (CDC) guidelines were used to define SSIs and calculate the SSI incidence. Both potential and confirmed SSIs were analyzed to determine related treatment methods, calculate associated health care costs, and characterize risk factors based on the OCA surgery type (single-surface, multisurface, bipolar, ±MAT), American Society of Anesthesiologists physical status classification system, surgery duration, length of stay, age, sex, body mass index (BMI), and current tobacco use.Results:A total of 224 patients were included in the analysis. There were 2 SSIs in 1 patient that met CDC criteria, such that the incidence for this patient population was 0.9%. An additional 7 patients (3.1%) were examined for potential infections not classified as SSIs. Patients with potential or confirmed SSIs had a significantly higher mean BMI compared to patients with no evidence of an SSI (P <.001). BMI >35 (odds ratio, 9.1) and tobacco use (odds ratio, 6.6) were associated with greater odds for a potential or confirmed SSI. The mean health care costs were $6101 for patients who required additional emergency room visits and/or irrigation and debridement within 90 days postoperatively for potential or confirmed SSIs, $19 for patients with potential superficial incisional SSIs, and $12,100 for patients who experienced a potential or confirmed deep incisional or organ/space SSI >90 days from surgery.Conclusion:Large OCA transplantation with and without MAT were associated with a low incidence of confirmed SSIs (0.9%), and patients with BMI >35 and current tobacco use had greater odds of an SSI. Potential and confirmed SSIs were associated with unscheduled appointments, additional surgical procedures, and higher costs.

Endodontic postoperative flare up: A review

Have you ever experienced a situation where the patient came back to you in an unscheduled appointment complaining of pain or swelling in the region where you have done root canal treatment, sometimes a few hours or in some cases after some days of Root Canal Treatment and this situation resulted in an emergency treatment.As a Dental Surgeon we all must have gone through this phase at least once in our daily clinic hours. And this situation has made a true nightmare or agony for every dentist in day-to-day life.This article will be discussing about the etiology, the other factors affecting this condition, the remedy for the same, how to deal with these kinds of patients and do perfect time management during the busy schedule.Root Canal treatment is a chemo-mechanical method of disinfection of root canal followed by three dimensional hermetic obturation.The root canal treatment is done to eradicate the pulpal and peri radicular diseases causative agents and to enhance peri radicular tissue recovery.As an Endodontist our main intension is to preserve a tooth. Once the tooth is infected with the dental caries initially will go with normal restorative procedure and if we are not able to find a solution with normal restoration the next step is Root Canal Procedures.Now a days all the Dental Surgeons and especially the Endodontist are using modern root canal procedures and new rotary system, still the post operative endodontic flare up is a major problem faced by dental surgeons.

Awareness and utilization of urgent care services among patients attending Al-Wazarat PHCC in Riyadh, Saudi Arabia 2020.

Background:Urgent Care Clinics (UCCs) offer unscheduled appointments with a “treat and release” length of visits not exceeding 60 min. The growth of clinics is dictated by patients’ demand for quality care that is unscheduled, expedited, and ubiquitous, making them accessible and available.Objectives:This study aimed to assess the patient's level of awareness and utilization pattern of UCCs in Wazarat Health Care Center (WHCC) and assess factors associated with them.Aim:This study aims to provide information contributing to the support of decision-makers about the level of awareness among patients on urgent care services and their pattern of use within primary health care.Methods:This cross-sectional study included 288 patients visiting PHC clinics to measure their level of awareness and pattern of utilization using a self-administered questionnaire.Results:A total of 288 patients participated, 55.99% were females, and the highest percentage was in the age group of 18-38 years at 60.07%. Only one quarter, 73 (25.35%) of the patients were aware of the term urgent clinics, from them, more than a half (53.42%) visited such clinics 1–3 times in the three months before the time of study conduction, and the main cause of the visits was the common cold (25.76%). Less than half of the participants reported visiting the primary clinics without booking an appointment in advance at 44.79%. The reason for this was mainly because of having difficulty booking appointments at 54.55%. Awareness level was the highest (28.32%) among the lowest age group (18-38 years) and decreased gradually by increasing the age. A significantly higher percentage of low educational level participants reported visiting primary clinics without booking an appointment in advance at 51.33% vs. 37.68% of the university and above participants. According to patients ‘ income, there was a significant (0.023) difference in the awareness level; the highest was among participants with an income of 6000-12000 SAR at 32.86%.Conclusion:Only one-quarter of the studied patients know about the UCCs. More than half of the patients reported visiting these clinics because of difficulties in booking an appointment at the primary healthcare centers and convenience with the services provided at the UCCs. The common cold was the main reason for visiting the UCCs.

COVID-19 pandemic impact on Primary Health Care Accessibility in Portugal

The COVID-19 pandemic disrupted health systems worldwide, mobilizing most of its resources to COVID-19 care. In Portugal, since mid-March 2020, the scheduled assistance activity of the primary health care services has been altered or interrupted, to respond to the needs of users with suspected or diagnosed SARS-CoV-2 infection. This study intends aims to assess the impact of the COVID-19 pandemic in terms of access to primary health care during 2020 in Portugal. Primary Health Care accessibility data were extracted from the national data transparency portal. Data were aggregated by the 5 health regions and compared to homologous periods for years 2019 and 2020. In Portugal, in 2020 the number of primary health care consultations decreased in the regions of Alentejo (-5%), Algarve (-1%) and Centre (-1%) but increased in both North (+6%) and Lisbon and the Tagus Valley regions (+7%). The number of scheduled appointments decreased in the 5 regions (-16%), increasing the unscheduled appointments (+24%). Those differences were higher during the first lockdown (-42% schedule appointments vs + 13% unscheduled appointments). Presential consultations decreased by 38%, non-presential increased by 101%, and domiciliary consultations were reduced by 37%. Changes to regular activity of primary health care units compromised the access to presential health care by the non-COVID-19 population. After the first pandemic wave, the resumption of scheduled activity changed from face-to-face to non-presential consultation. The adoption of new technologies and telemedicine increased the total of registered consultations, compared to previous year. However, not all non-presential consultation is in fact patient-facing teleconsultation, with some of them being just for prescription renewal or to prescribe complementary exams. Predominantly urban regions were less affected by the suspension of presential activity, maintaining their assistance by non-presential provision of care and telework.Key messages Amidst the COVID-19 pandemic, the Portuguese primary health care services ensured the assistance to their population by non-presential provision of care.Predominantly rural regions were most affected by the suspension of presential consultation.

Teleneurology in a center for neuromuscular diseases during the COVID-19 pandemic.

ObjectiveThe coronavirus disease 2019 (COVID-19) pandemic has urged the adoption of telemedicine services as a measure of greater patients’ safety. This study aims to investigate efficacy and feasibility of teleneurology care for patients with neuromuscular diseases (NMD).MethodsAll patient visits from 4th March 2020 to 27th March 2021, the period of COVID-19 lockdown requiring partial transition to tele-consultation, were reviewed. Demographic data and medical records during the implementation of the “hybrid model” of both remote and in-person visits during COVID-19 era were analyzed and compared to those of the pre-pandemic era.ResultsA total of 2179 tele-consultation contacts for 182 patients (mean age 46.4 years, 42.3% female) were conducted. Tele-consultation was primarily performed by telephone calls. During that period, 1745 telephone calls were conducted, resulting in a 4.5 mean increase/patient compared to 2019. There was a 15.1% decrease in first time in-person consultations compared to 2019. However, the mean number of monitoring visits per person during pandemic was no different from previous years. With the exception of 3 patients with advanced stage of amyotrophic lateral sclerosis, no other patients required an unscheduled appointment or hospitalization for unforeseen reasons related to tele-consultation restrictions.ConclusionMonitoring of NMD patients could benefit from tele-provided multidisciplinary services. The experience gained during COVID-19 pandemic could be useful for further development of tele-medicine.

The Peanut Allergy Burden Study: Real-world impact of peanut allergy on resource utilization and productivity

BackgroundThere is limited research demonstrating the real-world economic burden of peanut allergy (PA) in the United States. The Peanut Allergy Burden Study (PABS) is a cross-sectional quantitative survey designed to determine the real-world experience of patients and caregivers with PA. The objective of the study was to understand the real-world utilization of PA-related healthcare resources and the impact of PA on productivity. MethodsParticipants completed an online survey to examine the real-world 12-month and lifetime healthcare utilization and past week productivity impact of PA in children (as reported by caregiver proxy), adolescents with PA, adults with PA, and caregivers of children with PA. ResultsHealthcare resource use over the past 12 months was frequent for adults (n = 153), adolescents (n = 102), and children (as reported by caregivers) (n = 382) with PA. Patients and caregivers reported the following rates of PA-related utilization in the past 12 months: at least 3 regular allergist appointments (28.8%–39.3%), unscheduled allergist appointments (15.6%–18.3%), general practitioner appointments (16.7%–24.2%), over-the-counter (OTC) medication usage (28.5%–35.7%), and epinephrine autoinjector usage (17.7%–26.2%). Additionally, over half of patients and caregivers reported ≥1 PA-related emergency department (ED)/urgent care visit (57.5%–59.9%), overnight hospital admission (36.3%–47.4%), IV epinephrine use (37.2%–52.3%), or intubation (26.2%–39.8%) over the past 12 months for PA. Healthcare resource use was high among all groups. Regarding productivity, PA significantly impacted household work, schoolwork, and employed work for patients and caregivers. PA-related reactions also impacted school attendance of children with PA. ConclusionMany healthcare resources were utilized by patients with PA and there was a loss of productivity associated with PA for patients and caregivers. New treatments to prevent or lower the risk of PA reactions could potentially help reduce healthcare resource utilization and PA-related productivity loss among patients and their families, particularly for patients for whom avoidance as a treatment strategy has not been reliable.

P214 Virtual cystic fibrosis doctor: design, development, and user experience pilot study

Background: Patients often contact the cystic fibrosis (CF) multidisciplinary team (MDT) via phone to express health-related concerns in between the standard quarterly review. This often requires a phone evaluation before organising an unscheduled appointment. These sporadic interactions heavily affect available resources. This strain on resources will be further impacted when considering that data from the European CF registry predicts that there will be a 75% increase in the adult CF population by 2025. Furthering this, CF services are increasingly more strained now during the global Covid-19 pandemic. Objective: This research first sets about to design and develop a Virtual Doctor system based on the expertise of a MDT through multiple consultations. Next, pilot data pertaining to user acceptance and experience with using this novel technology is gathered. We therefore aim to investigate if the use of such technology can be beneficial in a specific clinical setting. Method: The final collaborative-design of the Virtual Doctor comprises several technical features and is primarily a voice synthesis system allowing the patient to interact with natural language. The virtual doctor asks the patient questions regarding their health concerns and can collect real-time clinical metrics such as FEV1, oxygen saturation, temperature. The patients’ responses and metrics are then compared to baseline values calculating a score which stratifies a response time from the CF team. This information is then collated in a report and sent to the CF team for action. Future works: Initial stress testing of the technical performance is now complete. Supportive visual media to improve coaching of using clinical devices have now been implemented in preparation for patient pilot testing which is currently ongoing. It is anticipated that a virtual system such as the Virtual Doctor will become more accessible and acceptable to patients, especially during the Covid-19 pandemic.