Urgent Consultation Research Articles

Emergency surgical consultation for cancer patients: identifying the prognostic determinants of health

BackgroundPatients with malignancy often require urgent surgical consultation for treatment or palliation of disease. The objective of this study is to explore the prognostic determinants affecting care in acute cancer-related surgical presentations and the effect on patient outcomes.Main bodyThis is a retrospective review of patients referred to the acute general surgery (ACS) service at a tertiary hospital for management of cancer-related problem from July 2017 to September 2018. Patient demographics, course in hospital, and survival were recorded. Multivariant logistic regression and Kaplan-Meier estimates were performed. One hundred eighty-nine patients were identified (53% female) with a mean age of 65.9 years. Forty-two patients (22%) were newly diagnosed with cancer on presentation, and 94 (50%) patients had metastatic disease. Cancer staging was completed in 84% of patients, and 65% had multidisciplinary team (MDT) assessment during their hospital stay. Surgery was performed on 90 (48%) patients, of which 31.2% was with palliative intent. Overall mortality was 56% with 30- and 60-day mortality of 15% and 22%, respectively. The adjusted odds ratio (OR) for a 60-day mortality was high in patients presenting with new cancer diagnosis (OR 3.18, 95% CI 1.18–9.02, p=0.03), metastatic disease (OR 5.11, 95% CI 2.03–12.85, p=0.001), or systemic therapy on presentation (OR 3.46, 95% CI 1.30–9.22, p=0.013).ConclusionEmergency surgical referral is common in patients with malignancy. Surgical decision making can be challenging due to the heterogeneity of this population and their associated comorbidities. Optimizing prognostic determinants such as goal-directed palliative care, MDT discussions, and bridging to systemic therapy can improve patient outcomes.

Changes in self-harm- and violence-related urgent psychiatric consultation in the emergency department during the different stages of the COVID-19 pandemic

BackgroundThe coronavirus disease 2019 pandemic significantly affected emergency department (ED) visits and urgent psychiatric consultation (UPC) seeking behavior in EDs. Our study explored the changes in UPCs during and after the pandemic peak.MethodsThis retrospective observational study evaluated UPCs in the ED of a referral medical center in Taiwan, where treated both physical and psychiatric complaints. We defined the COVID-19 pandemic peak period as calendar week 4–18, 2020. The corresponding baseline as calendar week 4–18, 2019, and the slack period as week 4–18, 2021. The total number of UPCs, patient demographic data such as sex and age of the patients seen, the referral system (whether police or emergency medical service [EMS] or other sources), and the chief complaint (self-harm or violence) were recorded.ResultsCompared with the baseline period, a significant decline in UPCs was observed in the pandemic peak period, and a rebound was observed in the slack period, with the median [IQR] Q1, Q3 values of 22 [18, 26], 12 [10, 17]), and 16 [15, 23], respectively. We observed significantly few men (34.9% vs 45.2%) and less violence (10.2% vs 17.6%) in the peak period compared with in the baseline period, but no significant difference was found compared with the slack period. Throughout the pandemic, younger patients (41.8 ± 17.4 in 2019, 39.2 ± 18.5 [p = 0.121] in 2020, and 35.6 ± 17.2 [p < 0.001] in 2021), higher proportions of police/EMS referral (38.7% in 2019, 41.9% [p = 0.473] in 2020, and 51.9% [p = 0.001] in 2021) and self-harm–related complaints (57% in 2019, 62.4% [p = 0.233] in 2020, and 64.9% [p = 0.049] in 2021) was noted among UPC seekers during the pandemic. However, the proportion of violence-related UPCs (17.6% in 2019, 10.2% [p = 0.023] in 2020, and 12.3% [p = 0.072] in 2021) declined.ConclusionsThis study found that UPCs changed throughout the pandemic. This result raises the concern that mental health needs are masked during the pandemic.

The Evaluation of the Comparision Between pre- and post Pandemic Era Regarding Emergency Psychiatric Consultations

IntroductionCOVID-19 had direct and indirect impacts on both mental health and healthcare systems. Evaluating urgent psychiatric consultations may be useful to determine the effects of COVID-19 pandemic since it reflects the condition of psychiatric patients and healthcare systemsObjectivesThis study aims to determine the quantitative or qualitative changes in emergency psychiatry consultations after COVID-19 pandemic.MethodsThe socio-demographic characteristics and clinical features of two hundred thirty three patients were retrospectively collected and analyzed in order to compare the emergency psychiatry consultations before (between the dates 11th of March 2019-10th of March 2020) and after (between 11th of March 2020-10th of March 2021) the COVID-19 pandemic.ResultsThe ratio of patients consulted to psychiatry to total emergency department increase after pandemic (%0.03 vs %0.07). Among these patients, the diagnosis of ‘alcohol and substance use disorder’ (%6.1 vs. %15.4) (p=0.03) increased while the diagnoses of ‘obsessive compulsive disorder (5.3% vs. 0%)(p=0.01) and bipolar disorder (%21.1 vs. %20.5) (p=0.02) decreased. Hostility among patient during consultation increased (%19.1 vs. %30.8)(p=0.04). Suicidal thoughts decreased (%25.2 vs. %14.5) (p=0.04). Furthermore, voluntary inpatient treatment (%20.9-%34.2) (p =0.02) increased, transfer to another clinic (%25.2 vs. %12) (p=0.01) and outpatient treatment (%46.1 vs. %42.7) (p=0.01) decreased. An increase in oral treatments (%10.4 vs. %26.5) (p=0.02) and decrease in parenteral treatments (%71.3 vs. 54.7) ( p=0.01) were also reported.ConclusionsOur findings confirmed that after COVID-19 spread the clinical features diagnosis, and treatment modality have changed among urgent psychiatric consultations.DisclosureNo significant relationships.

PNEUMOPERICARDIUM: UNEXPECTED FINDING IN A BLUNT THORACIC TRAUMA

TYPE: Late Breaking Abstract TOPIC: Critical Care INTRODUCTION: Pneumopericardium is a rare finding. We present a clinical case of a pneumopericardium due to blunt thoracic trauma and its management. CASE PRESENTATION: A 22-year male admitted to the Emergency Department after a high energy car crash with blunt thoracic and abdominal trauma presented with severe hypotension and tachycardia. Thoracic x-ray showed a left pneumothorax and a chest tube was inserted. FAST ultrasound was positive on the Morrison space, prompting immediate surgical intervention, during which a right chest tube was inserted due to suspicion of right pneumothorax. After surgery, the patient remained in circulatory shock, warranting high doses of vasoactive drugs. A CT scan was performed, depicting a 15 mm pneumopericardium (Figure 1). ECG had a low voltage tracing, a mild elevation of cardiac biomarkers was noted and echocardiography showed preserved biventricular systolic function, a 10 mm inferior vena cava and no signs of cardiac compression, thus making tension pneumopericardium an unlikely diagnosis. The right chest drain was hypothesized as potential cause of the pneumopericardium. An urgent consultation with cardiac surgery was requested and low pressure suction was initiated in the ICU. Pneumopericardium dimensions improved over time, with no evidence of pericardial air on day three. DISCUSSION: Although its etiology remained unclear, close monitoring for signs of cardiac suffering throughout ICU stay and a conservative approach led to clinical resolution. CONCLUSIONS: This case highlights the need for a multidisciplinary approach when managing specific thoracic pathology in the ICU setting. DISCLOSURE: No significant relationships. KEYWORD: pneumopericardium

The Impact of COVID-19 Pandemic on Psychiatric Emergencies in Two Different Settings: Emergency Room and Community Mental Health Service.

BackgroundThe SARS-CoV-2 pandemic caused a public health emergency with profound consequences on physical and mental health of individuals. Emergency Rooms (ER) and Community Mental Health Services (CMHS) played a key role in the management of psychiatric emergencies during the pandemic. The purpose of the study was to evaluate urgent psychiatric consultations (UPCs) in the ERs of the General Hospitals and in the CMHS of a Northern Italian town during the pandemic period.MethodsThis monocentric observational study collected UPCs carried out in ER from 01/03/2020 to 28/02/2021 (the so called “COVID-19 period”) and the demographic and clinical characteristics of patients who required UPCs in the 12-months period, comparing these data with those collected from 01/03/2019 to 29/02/2020 (the so called “pre-COVID-19 period”). The same variables were collected for UPCs carried out in CMHS from 01/03/2020 to 31/01/2021 and compared with those collected from 01/03/2019 to 31/01/2020. The data, were statistically analyzed through STATA 12-2011.ResultsIn ER, we reported a 24% reduction in UPCs during the COVID-19 period (n = 909) in comparison with the pre-COVID-19 period (n = 1,194). Differently, we observed an increase of 4% in UPCs carried out in CMHS during the COVID-19 period (n = 1,214) in comparison with the previous period (n = 1,162). We observed an increase of UPCs in ER required by people who lived in psychiatric facilities or with disability pension whereas more UPCs in CMHS were required by older people or those living in other institutions compared to the previous period. In the COVID-19 period, the most frequent reasons for UPCs in ER were aggressiveness, socio-environmental maladjustment and psychiatric symptoms in organic disorders whereas in CMHS we reported an increase of UPCs for control of psychopharmacology therapy and mixed state/mania.ConclusionIn light of our findings, we conclude that the most vulnerable people required more frequent attention and care in both ER and CMHS during pandemic, which disrupted individuals’ ability to adapt and induced many stressful reactive symptoms. In order to reduce the impact of the COVID-19 pandemic on mental health, psychological support interventions for the general population should be implemented, having particular regard for more psychologically fragile people.

P42 ASCENDING AORTIC DISEASE: IS CURRENT GENERAL PERCEPTION UPDATED TO CURRENT GUIDELINES ??

Abstract Backgroud Thoracic aorta diseases represent a frequent cause of hospitalization and up to 15% of workload of a modern Cardiac Surgery centre. To allow for an accurate monitoring of such activity a dedicated thoracic aorta diseases clinic was launched in January 2019 at our Division. Clinic was open for all new referrals (both by general pratictioner and different specialities clinic) as well as for follow–up of operated on patients. Here we report our analysis of new referrals during past 30 months. Materials and Metods 237 overall patients were seen at clinic. 68 patients (29%) were new referrals; 23 patients (10%) were preoperative follow up and 145 (61%) were postoperative follow up. New referrals were divided in urgent referral (42 pts 62%) and scheduled referral (26 patients 38%). Out of 168 follow up, 22 (12%) were requested as urgent follow up. Majority of urgent new referral were from general pratictioner (21 pts 50%). Results Only 5 patients (2 urgent referral) had surgical indication at time of clinic assessment, according current guidelines. 23 patients (6 urgent referral) were in the so–called grey zone and required close follow–up). 40 patients (34 urgent referral) had no significant aortic diseases to require neither urgent specialist consultation or close follow–up. Out of 181 postoperative follow up, 12 patients required surgical re–intervention none of these were referred with matter of urgency. Despite 56% of new referral did not have recent CT scan evaluation, majority of new referral clearly showed moderate aortic dilatation especially in urgent referral (Fig 1). When considering indexed–dilatation, proportion of patient with moderate dilation raised even more (Fig 2). Conclusions Current perception of clinical severity of thoracic aorta diseases is still sub–optimal. Majority of patients are indeed referred as a matter of urgency despite non–significant aortic ectasia. On other hands, potentially dangerous situation are underestimated by the general practitioner and/or medical specialist. An accurate territorial policy of sensitization and updating about these pathologies is therefore essential to try to reduce the risks of acute aortic syndromes in our country.

Knee dislocations and multi-ligament knee injuries: A review

Acute knee dislocations are a relatively rare type of injury that can lead to serious neurovascular compromise and ligament instability. These injuries can be potentially limb threatening if not properly identified and managed. The following review discusses the relevant anatomy of the knee joint and different classification systems of dislocations in order to highlight the complications that could occur. Timely evaluation and management, including reduction, is paramount to ensure stability and determine the need for additional imaging or urgent consultation. Knee dislocations are also associated with the unique presentation of a multi-ligament injury. This text provides an overview of multi-ligament knee injuries and the various surgical modalities currently being used. Finally, considerations are given on the role of the osteopathic approach in restoring function of the knee in the context of a dislocation.

Abstract #1184879: Doc! I have an urgent consultation for a patient with severe hypocalcemia and hypomagnesemia

Multiple myeloma (MM) is known to cause accelerated osteoclastogenic and increased bone resorption through Receptor Activator of Nuclear Factor Kappa-B Ligand pathway (RANKL). Denosumab, which is a RANKL inhibitor is commonly used in treating hypercalcemia in these patients. Incidence of hypocalcemia is 8-14% after the administration of denosumab in such patient population. We present a case of severe hypocalcemia and hypomagnesemia in a patient with multiple myeloma and CKD after treatment with Denosumab.

Effectiveness and Quality of Life with Paliperidone Palmitate 3-Monthly in Comparison with Other Long-Acting Drugs.

PurposeAntipsychotic long-acting injections (AP-LAIs) are indicated for patients affected by schizophrenia especially those with poor treatment adherence.Patients and MethodsTo compare paliperidone palmitate 3-monthly (PP3M), paliperidone palmitate one-monthly (PP1M) and haloperidol decanoate (HAL-D) treatment, we enrolled 90 patients with schizophrenia treated in Mental Health Center with one of the three AP-LAIs for at least six months and followed them for another 6 months. At 6 and 12 months of treatment we administered Clinical Global Impression-Severity, Global Assessment of Functioning and World Health Organization Quality of Life-26 items (WHOQOL-BREF). At 1-year treatment, we evaluated relapses (psychiatric hospitalizations and urgent consultations), side effects and drop-outs.ResultsWe did not highlight any statistically significant difference among the three treatments in relapses and scale scores. Weight increase was significantly higher in PP1M and PP3M groups. Twelve patients (13.3%) discontinued AP-LAI. At 1-year AP-LAI treatment, 69% of patients rated quality of life as “good” or “very good” and 71% declared themselves to be “satisfied” or “very satisfied”.ConclusionHAL-D, PP1M and PP3M 1-year treatments were similarly effective in preventing relapses and improving quality of life and health satisfaction. All discontinuations in the new 3-monthly antipsychotic treatment were caused by patient refusal to continue it.

Мониторинг пациентов в тяжелом состоянии, поступивших в стационары 1-го и 2-го уровня – инструмент организации оказания медицинской помощи больным и пострадавшим в чрезвычайных ситуациях

The objective of the study was to analyze the effectiveness of the “Monitoring” program for patients with new coronavirus infection and to evaluate its preparedness to work in emergency situations, as well as to substantiate the effectiveness of the program as a monitoring tool for patient care management in level 1 and level 2 medical treatment organizations when there is a shortage of intensive care beds at level 3 medical institutions. Materials and research methods. Materials of the research: normative legal documents regulating the order of application of telemedicine technologies in Russia and Kuzbass, including in the field of the Disaster Medicine Service, scientific publications, personal work experience in the organization of remote consultations. The research was based on the data on the provision of consultative medical care to the patients with the diagnoses “new coronavirus infection” and “community-acquired pneumonia”, who were hospitalized in the intensive care departments of level 1 and level 2 medical treatment organisations. Research results and their analysis. The retrospective analysis of the calls to the monitoring center from the patients in severe condition, being treated in level 1 and level 2 medical treatment organizations for the diagnoses of new coronavirus infection and pneumonia, who needed monitoring by the specialists of the consulting center (mainly by intensive care specialists), was performed. Inclusion criteria in the study: adult patients with new coronavirus infection and pneumonia; receipt of call to the monitoring center during the study period – 01.11.2020-31.01.2022; availability of patient counseling using “Monitoring” program. Conclusion was made, that the system, linking major hospitals with local hospitals, which have the maximum load in periods of peak morbidity, through conducting emergency and urgent telemedicine consultations was created in Kuzbass. The analysis of the obtained data testifies to the effective work of the monitoring center for severe patients as a type of telemedicine tool when working in high alert mode.

Psychiatric Emergencies in Minors: The Impact of Sex and Age.

ObjectiveLittle information is available on young children (age 4–12 years) with mental health problems who are seen by the psychiatric emergency services. We therefore described this population to identify (1) variables that differentiated children from those aged 13 to 18 years who had been referred for psychiatric emergency consultation; and (2) to describe sex differences.MethodWe extracted data for a 9-year period from the records of the mobile psychiatric emergency services in 2 urban areas in the Netherlands. In this period, 79 children aged 4 to 12 years (37.2% girls) and 1695 children aged 12 to 18 years (62.2% girls) had been referred for psychiatric emergency consultation. Demographic and process factors were recorded. Clinical characteristics included diagnostic and statistical manual of mental disorders, 4th edition classifications and the Severity of Psychiatric Illness scale. Logistic regression analyses were used to examine differences between the girls and boys in the 2 age groups.ResultsYoung children aged 4 to 12 years had been involved in 4.5% of all consultations of minors. In contrast with adolescents, a higher percentage of young children seen for emergency consultation were boys, and a lower percentage was admitted to a psychiatric hospital (7.7%). In boys and girls alike, a DSM classification of behavioral disorder was associated with younger age.ConclusionsThe young group of children referred for psychiatric emergency consultation comprised relatively more children with behavioral disorders. Decisions to refer them for urgent psychiatric consultation seemed to be influenced by the suspicion of psychotic symptoms or of danger to themselves or others.

Mental Health Day Hospitals and Lockdown Due to COVID-19 in Spain.

IntroductionThe COVID-19 pandemic has forced changes in patient care in Mental Health Day Hospitals (MHDHs).ObjectivesTo study the interventions performed in MHDHs during the pandemic in comparison with those performed in other facilities and to analyze the new hospital admissions in both groups.MethodA retrospective multicenter cohort study comparing the interventions received by a group of 161 patients admitted in MHDHs during the lockdown period in Spain with the interventions of another group of 109 patients who were treated at other facilities during lockdown.ResultsMHDHs reduced their face-to-face interventions during lockdown just as much as other facilities but implemented telematic intervention methods to a greater extent. Patients attached to MHDHs during lockdown were admitted significantly less and presented fewer urgent consultations in the following 6 months.ConclusionThe use of telepsychiatry made it feasible to adapt MHDHs to periods of lockdown, being useful to improve the continuity of care during the pandemic. In addition, it was possible to maintain a reduction in hospital admissions in patients treated at MHDHs.

Valsalva Retinopathy Masking as a Retinal Detachment on Point-of-care Ocular Ultrasound: A Case Report.

IntroductionApproximately two million people present to the emergency department (ED) with eye-related complaints each year in the United States. Differentiating pathologies that need urgent consultation from those that do not is imperative. For some physicians, ocular ultrasound has eclipsed the dilated fundoscopic exam as the standard posterior segment evaluation in the ED.Case reportA 60-year-old female presented with sudden onset visual disturbance in her right eye. Point-of-care ultrasound showed a hyperechoic band in the posterior segment concerning for a retinal detachment. Ophthalmology was consulted and diagnosed the patient with a condition known as Valsalva retinopathy. The patient was discharged from the ED with expectant management.ConclusionThis case highlights an important differential diagnosis that should be considered when ocular ultrasound demonstrates a hyperechoic band in the posterior segment. While previous literature has demonstrated that emergency physicians are able to accurately identify posterior segment pathology using ultrasound, there is limited information regarding their ability to differentiate between pathologies, some of which may not require urgent consultation. We highlight the important differentials that should be considered when identifying posterior segment pathology on point-of-care ultrasound and their appropriate dispositions.

Optimal management of post-discharge postpartum hypertensive disorders of pregnancy: a quality improvement initiative.

Introduction: Postpartum hypertensive disorders of pregnancy occur in 2-5% of pregnancies. It is a major cause of urgent postpartum consultation and is associated with life-threatening complications. Our objective was to evaluate if local management of postpartum hypertensive disorders of pregnancy was congruent with expert recommendations. Methods: We conducted a quality improvement initiative through a retrospective single-centre cross-sectional study. All women over 18-year-old consulting emergently for hypertensive disorders of pregnancy in the first six weeks postpartum, from 2015 to 2020, were eligible. Results: We included 224 women. Optimal management of postpartum hypertensive disorders of pregnancy was observed in 65.0%. While diagnosis and laboratory work-up were excellent, adequate blood pressure surveillance and recommendations upon discharge of an outpatient postpartum episode (69.7%) did not meet expectations. Conclusion: Efforts should be targeted to improve discharge recommendations on optimal blood pressure surveillance after delivery for women at risk for hypertensive disorders of pregnancy and for postpartum hypertensive disorders of pregnancy in women treated as outpatients.

Does a standard triage tool adequately detect the needs of children and adolescents admitted for mental health problem?

the visits to the paediatric emergency department for mental problems are increasing exponentially, but the emergency department team in not ready enough to manage them, due to the lack of adequate training. This study aimed to evaluate how the Italian Society of Paediatric Emergency Medicine and Urgency triage system was able to estimate urgency in patients accessing the paediatric emergency department for a mental health problem. We conducted a retrospective study at the emergency department of the Institute for Maternal and Child Health, IRCCS Burlo garofolo of Trieste (Italy), from December 2015 to April 2017. During the study period, we identified all the patients undergoing an urgent psychiatric consultation. We collected demographic variables, triage code, diagnosis, and outcomes of each patient. Subsequently, we have assigned a degree of psychiatric urgency, based on Gail and Rosenn's classificationwhich is a specific tool to evaluate psychiatric urgency. The primary study outcome was the comparison between the degree of urgency assigned using the triage system and the Gail and Rosenn's classification. In this series, 567 patients underwent an urgent psychiatric consultation, and 280 of them received a diagnosis of a mental health problem. The degree of urgency assigned at the triage was: emergency for 5 cases (2%), urgency for 96 (34%) and non-urgency for 179 (64%). Instead, the degree assigned with GRC was: emergency for 95 cases (34%), urgency for 112 (42%) and non-urgency for 73 (26%). The number of patients, detected as emergency and urgency by the two tools, was significantly different (p = 0.0001). In this study, we demonstrated that the Italian Society of Paediatric Emergency Medicine and Urgency triage system underestimated the urgency of patients with mental health problems compared to a specific tool to assess the degree of psychiatric urgency.

Selecting an intervention to prevent ketoacidosis at diabetes diagnosis in children using a behavior change framework.

The rate of diabetic ketoacidosis (DKA), a preventable, life-threatening complication of diabetes, at the time of diagnosis in children remains unacceptably high worldwide. We describe our initial approach to selecting a national DKA prevention strategy, to be implemented by the Canadian Pediatric Endocrine Group DKA Prevention Working Group, informed by a framework for behavior change interventions. Existing interventions were identified from a systematic review and our own gray literature search. We then characterized interventions using the Behavior Change Wheel, a framework to inform and drive behavior change, and matched interventions to behavioral targets, audiences, and identified barriers and facilitators. Feedback from the CPEG DKA prevention working group was incorporated into the intervention plan. We identified 27 interventions. Our proposed target behaviors are: (1) prompt recognition of symptoms of diabetes in children; (2) urgent attendance to medical care with a request for an office-based test for diabetes; and (3) rapid confirmation of diagnosis and urgent consultation with pediatric diabetes experts. We initially identified four possible intervention functions including education, training, environment restructuring, and enablement. Feedback from the working group favored education intervention functions including symptom recognition messages targeting parents, caregivers, teachers, and providers and messages about how to make a rapid diagnosis and need for urgent referral targeting providers. The Behavior Change Wheel has been used successfully in selecting interventions in other clinical areas. We describe how we used this framework to provide a foundation for developing an intervention to prevent DKA at diabetes diagnosis in children.

Urgent Breast-Related Consults Seen by Acute Care Surgery at a Safety Net Hospital.

Classically, urgent breast consults are seen by Breast Surgery or Surgical Oncology (BS/SO). At our safety net hospital, Acute Care Surgery (ACS) performs all urgent surgical consultations, including initial assessment of breast consults with coordinated BS/SO follow-up. The objective was to determine safety of ACS initial assessment of acute breast pathology. All urgent breast-related consultations were included (2016-2019). Demographics, consult indications, and investigations/interventions were captured. Outcomes were compared between patients assessed by ACS versus both ACS and BS/SO at presentation. 234 patients met study criteria, with median age 39years. Patients were primarily Hispanic (82%) women (96%). Most were not seen by BS/SO at presentation (69%), although BS/SO assessment was more frequent among patients ultimately diagnosed with cancer (8% vs 1%, P = .012). No patient had delay >90days to core biopsy from presentation. Outcomes including time to cancer diagnosis (14 vs 8days, P = .143) and outpatient BS/SO assessment (16 vs 13days, P = .528); loss to follow-up (25% vs 21%, P = .414); and ED recidivism (24% vs 18%, P = .274) were comparable between patients seen by ACS versus ACS/BS/SO at index presentation. Urgent breast consults at our safety net hospital typically underwent initial assessment by ACS with outpatient evaluation by BS/SO. Time to follow-up and cancer diagnosis, loss to follow-up, and ED recidivism were similar after index presentation assessment by ACS versus ACS and BS/SO. In a resource-limited environment, urgent breast consults can be safely managed in the acute setting by ACS with coordinated outpatient BS/SO follow-up.

Efficacy of a Virtual Fracture Clinic Model Created During Covid-19 Pandemic

Background: At the start of the COVID-19 pandemic we introduced a Virtual Fracture Clinic (VFC) in our orthopaedic department in which clinical records and imaging were reviewed by an orthopaedic consultant and physiotherapist / nurse without the patient being physically present. All patients received a copy of the clinic note outlining an agreed management plan. VFC’s have been successfully trailed in other orthopaedic departments, however, no study has reported on the process of setting up a VFC during a pandemic, nor the frequency and types of injuries seen in the clinic. Objectives: The aims were to document and report the frequency and types of injuries reviewed in VFC and to determine the impact in terms of efficiency (frequency of decreased face to face contacts, cost avoidances), clinical governance and effectiveness (SOS contacts, complaints and adverse effects). Method: We recorded the type of injury, discharge data, face to face urgent and non-urgent fracture clinic consultations, patients admitted for surgery, SOS queries and any complaints about all patients reviewed in VFC between March -September 2020, we also documented the perceived benefits and less positive features for this new way of working. Results: In the first 7 months the overall rate of discharge was 2021/3035 patients (66%). Of these 49/3035 (2%) re-contacted under an SOS code with on-going or new problems. There were no formal complaints about the VFC during the study period. 973 patients (31%) were reviewed in the general fracture clinic or subspecialty clinics. Only 41 patients (1.5 %) presenting to the VFC required admission for surgery. The re-design resulted in substantial annual cost avoidance of around £129,000. There were over 100 different types of injuries reviewed.

Risk Factors for Relapse in People with Severe Mental Disorders during the COVID-19 Pandemic: A Multicenter Retrospective Study.

Background: Evidence suggests that different variables associated with the COVID-19 pandemic may increase the risk of relapse in people with Severe Mental Disorders (SMDs). However, no studies have yet looked closely at the different risk factors involved to determine their influence on the worsening of these patients’ illnesses. Objective: To analyze which variables related to the COVID-19 pandemic have increased the risk of relapse in patients with SMDs. Method: A multicenter retrospective cohort study in which data were collected from 270 patients with mental disorders who had been under follow-up in day hospitals during the year 2020. Results: The proportion of full mental health inpatient admissions was significantly higher in those who lost their employment (40.7% vs. 18.1%; p = 0.01), in those who were not receiving psychotherapy interventions (33.9% vs. 16.6%; p = 0.006), and in those who were not receiving occupational therapy (25.7% vs. 13.6%: p = 0.013). Significant associations were detected between urgent mental health consultations, the number of COVID-19 symptoms (B = 0.274; p = 0.02), and the low-income group (1.2424 vs. 0.4583; p = 0.018). Conclusions: COVID-19 symptoms and certain consequences of the pandemic, such as loss of employment, economic hardship, and loss of interventions, have brought about clinical worsening in people with SMDs. Knowledge of these factors is important for health-related decision-making in future outbreaks or pandemics.

Use of telehealth services among Nepali living overseas during Covid-19 pandemic: The opportunities, limitations, lessons learned and recommendations

There are estimated over 8 million Nepali migrants spread across various countries around the globe. Though the majority of them enjoy good health in general, a large proportion of them suffer from non-communicable diseases, mental health issues and communicable diseases. Telemedicine services, which are organized by Non-Resident Nepali Association (NRNA), have been proven to be effective in addressing some of the health and medical needs of the migrant Nepali workers. The purpose of this study is to assess the use of tele-health services among Nepali migrant population and examine the limitations. During the pandemic period from March 2020 through August 2021, Nepali in different countries utilized telehealth services. Mental health issues, chronic diseases, skin diseases were the most common ailments people sought telehealth services for. Many of them sought for urgent medical consultations related to Covid-19 symptoms and ailments. Digital gap, lack of cross-border regulations and unwillingness to utilize telemedicine were the challenges the service faced in the optimal utilization of such services. Training and education, use of easy Apps and subsidies from the government would help in the long-term use and sustainability of telehealth services amongst the Nepali migrants.