Walk-in Patients Research Articles

Evaluating Ocular Healthcare Accessibility and the Severity of Emergencies during Times of Crisis.

Background/Objectives: The COVID-19 pandemic has profoundly impacted healthcare systems worldwide, including the delivery of ophthalmic emergency services. This study examines the impact of the COVID-19 pandemic on the clinical presentation of emergencies and the accessibility of healthcare in ophthalmology. Methods: The study employed a single-center, consecutive case series design with historical controls to examine electronic health records over a 21-day period during the COVID-19 pandemic and a matched period from the preceding year. Records were analyzed for demographic variables, diagnosis, length of stay, travel distance, and referral status. The urgency of cases was evaluated by three independent graders using the BaSe SCOrE (BAsic SEverity Score for Common OculaR Emergencies). Results: A total of 1229 patients were included in the study, with 786 patients in the 2019 cohort and 443 patients in the 2020 cohort. During the pandemic period, there was a significant decrease in the number of patients and the duration of their visits (p < 0.0001, p < 0.0001, respectively). There was an increase in walk-in patients (p = 0.03), who took significantly longer journeys to be treated as compared to referred patients (p < 0.01). At the same time, the severity of emergencies increased (p = 0.02). The 2019 logistic regression model found that age (p = 0.003), referral status (p < 0.001), distance (p = 0.009), and first presentation (p = 0.02) were significant predictors of the severity, while gender was not (p = 0.78). The 2020 model found that only age (p < 0.001) and referral status (p < 0.001) were significant predictors of severity. Conclusions: The observed decline in patient volume, increased severity of emergencies, and shifts in predictive variables within the logistic regression models are indicative of significant barriers to healthcare access. Therefore, enhancing health literacy and ensuring low-threshold access to emergency services are crucial, especially during crises.

Characteristics of walk-in clinic physicians and patients in Ontario: Cross-sectional study.

To describe family physicians who primarily practise in a walk-in clinic setting and compare them with family physicians who provide longitudinal care. A cross-sectional study that linked results from a 2019 physician survey to provincial administrative health care data in Ontario. The characteristics, practice patterns, and patients of physicians primarily working in a walk-in clinic setting were compared with those of family physicians providing longitudinal care. Ontario. Physicians who primarily worked in a walk-in clinic setting in 2019, as indicated by an annual physician survey. Physician demographic and practice characteristics, as well as their patients' demographic and health care utilization characteristics, were reported according to whether the physician was a walk-in clinic physician or a family physician who provided longitudinal care. Compared with the 9137 family physicians providing longitudinal care, the 597 physicians who self-identified as practising primarily in walk-in clinics were more frequently male (67% vs 49%) and more likely to speak a language other than English or French (43% vs 32%). Walk-in clinic physicians tended to have more encounters with patients who were younger (mean 37 vs 47 years), who had lower levels of prior health care utilization (15% vs 19% in highest band), who resided in large urban areas (87% vs 77%), and who lived in highly ethnically diverse neighbourhoods (45% vs 35%). Walk-in clinic physicians tended to have more encounters with unattached patients (33% vs 17%) and with patients attached to another physician outside their group (54% vs 18%). Physicians who primarily work in walk-in clinics saw many patients from historically underserved groups and many patients who were attached to another family physician.

Emergency department service utilisation of older patients with urgent conditions: a cross-sectional observational study

BackgroundAs with many countries worldwide, Singapore is experiencing a rapidly ageing population. Presentation of older persons for urgent but non-emergent conditions to the Emergency Department (ED) represents a growing group of patients utilising public healthcare emergency services and puts a strain on current ED resources. The medical conditions vary, and resources used has been poorly characterized.MethodsThis is a single-center cross-sectional observational study of patients aged 55 to 75 years old who visited the ED with urgent conditions, Patient Acuity Category Scale (PACS) P2 or P3, who were subsequently discharged. The patients visited a public hospital in Singapore on four randomly selected weekdays in April 2023. The utilisation of hospital resources and manpower was studied. A formulated criteria was used to determine the appropriate site of care, such as an Urgent Care Centre (UCC), Primary Care Providers (PCP) clinic or the ED.ResultsThere were 235 eligible patients during the study period, with a mean age of 65.1 years of which a majority, 183 (77.9%) were allocated to patient acuity category scale P2. Most of the patients were walk-in patients with no referrals (169 (71.9%)). Based on the criteria, the majority of 187 (79.6%) of these patient may be safely managed at an outpatient setting; 71 (30.2%) patients by PCP, 116 (49.4%) patients may be managed by an UCC, with the remaining 48 (20.4%) requiring ED care.ConclusionOur findings indicate that a significant portion of discharged older ED adults with urgent but non-emergent conditions may be adequately managed at outpatient medical services that are appropriately resourced. More research is needed on healthcare initiatives aimed at developing the capabilities of outpatient medical services to manage mild to moderate acute conditions to optimise ED resource allocation.

Improvement of survival outcomes of cholangiocarcinoma by ultrasonography surveillance: Multicenter retrospective cohorts

BackgroundMost cholangiocarcinoma (CCA) patients present with late stage of disease because of the difficulty to diagnosis at an early stage, resulting in poor survival of CCA patients. The Cholangiocarcinoma Screening and Care Program showed that ultrasound screening was an effective tool for detecting early stage CCA. This study aims to evaluate the survival outcome of patients diagnosed by ultrasound screening (US) compared to walk-in symptomatic patients. MethodsThe retrospective clinical data and medical records for this study were accessed in June 30, 2021. 5-year survival rates (5-YSR) and median survival time (MST) of CCA were calculated using the Kaplan-Meier method. Multivariate analyses were performed for significant factors from univariate analyses. ResultsA total of 711 histologically proven CCA cases were examined including ultrasound screening and walk-in groups. The screening group having 5-YSR was 53.9 %, and MST was of 67.2 months, while walk-in group, the 5-YSR was 21.9 % and MST was 15.6 months (p < 0.001). In addition, multivariate analyses revealed that screening program was an independent factor to predict a good outcome of CCA patients when compared with walk-in group (p = 0.014). ConclusionUS is an effective tool for detecting early stage CCA leading to improve clinical outcome of CCA patients. Practically, US should be considered as a first tool for screening CCA in risk populations.

Prescription writing pattern among the dental practitioners of a tertiary care hospital in Karachi

ObjectiveTo identify the frequency and types of prescription errors, assess adherence to WHO prescribing indicators, and highlight the gaps in current prescribing practices of Junior dental practitioners in a tertiary care hospital in Karachi, Pakistan.MethodsThis cross-sectional study was conducted from January 2021 to March 2021. The study included the prescriptions by house surgeons and junior postgraduate medical trainees for walk-in patients visiting the dental outpatient department. A total of 466 prescriptions were evaluated for WHO core drug prescribing indicators. The prescription error parameters were prepared by studying the WHO practical manual on guide to good prescribing and previous studies. Prescription errors, including errors of omission related to the physician and the patients, along with errors of omission related to the drug, were also noted. The statistical analysis was performed with SPSS version 25. Descriptive analysis was performed for qualitative variables in the study.ResultsThe average number of drugs per encounter was found to be 3.378 drugs per prescription. The percentage of encounters with antibiotics was 96.99%. Strikingly, only 16.95% of the drugs were prescribed by generic names and 23.55% of drugs belonged to the essential drug list. The majority lacked valuable information related to the prescriber, patient, and drugs. Such as contact details 419 (89.9%), date 261 (56%), medical license number 466 (100%), diagnosis 409 (87.8%), age and address of patient 453 (97.2%), form and route of drug 14 (3%), missing drug strength 69 (14.8%), missing frequency 126 (27%) and duration of treatment 72 (15.4%). Moreover, the wrong drug dosage was prescribed by 89 (19%) prescribers followed by the wrong drug in 52 (11.1%), wrong strength in 43 (9.2%) and wrong form in 9 (1.9%). Out of 1575 medicines prescribed in 466 prescriptions, 426 (27.04%) drug interactions were found and 299 (64%) had illegible handwriting.ConclusionThe study revealed that the prescription writing practices among junior dental practitioners are below optimum standards. The average number of drugs per encounter was high, with a significant percentage of encounters involving antibiotics. However, a low percentage of drugs were prescribed by generic name and from the essential drug list. Numerous prescription errors, both omissions and commissions, were identified, highlighting the need for improved training and adherence to WHO guidelines on good prescribing practices. Implementing targeted educational programs and stricter regulatory measures could enhance the quality of prescriptions and overall patient safety.

IJCM_210A: Assessment of Outdoor Patients Waiting Time and Consultation Time in a Tertiary Care Hospital of Kolkata

Background: Waiting and consultation times affect patient satisfaction and the managerial capacity of the health system. Whereas waiting time is mainly attributed to organizational processes, consultation time is characterized by health demands, concerns, and protocols followed by service providers, which vary between individuals. Therefore, periodic evaluation of the entire process is necessary to achieve continuing health service improvement. Objectives: 1. To measure the waiting time and consultation time for each participant 2. To find out the variation of waiting and consultation time according to the departments visited. Methodology: A descriptive, cross-sectional study was carried out at a tertiary care medical college hospital in Kolkata, between May-June 2023. A systematic sampling design was followed. Data collection was conducted for two weeks for the entire OPD duration (9 AM-3 PM). Waiting Time was defined as the time taken from registration to chamber entry. Consultation Time was defined for the study as the time taken from chamber entry to exit. Timing record was maintained by giving a time-indicated note to the patient at the time of registration. Exit interviews were conducted after completing consultations. Results: Total number of participants was 432, with 74.8% female and mean age of 28.7 years. There were 22% participants who had 10 or more years of schooling and 80.1% resided in rural areas. Mean waiting time was 98.6 minutes (SD 45.4) and the consultation time was 6.5 (SD 13.7) minutes. Waiting time was maximum for general medicine OPD (mean-122 min) and minimum for pediatric medicine OPD (mean 43 min), while consultation time was maximum for surgery OPD (mean 6.8 min). Conclusion: The study shows an imbalance between waiting time and consultation time. Walk-in patients for minor illnesses and unnecessary referrals should be reduced to prevent overcrowding of tertiary institutes and compromising quality of care.

Evaluation of Mortality Risk Factors of COVID-19 in Jakarta Tertiary Hospital During Peak of Second Wave and Predictive Utility of Community RT-PCR Low CT Values

Background: The Delta variant of SARS-CoV-2 led to a surge in COVID-19 cases in Indonesia. This study aimed to assess the demographic profile and mortality rates of hospitalized COVID-19 patients in YARSI referral hospital, Jakarta, comparing pre-Delta and Delta wave periods. The study also investigated whether low CT values in RT-PCR tests indicated heightened viral transmission before the Delta wave surge. Method: A retrospective analysis was conducted on 1,457 COVID-19 patients hospitalized at YARSI (January-August 2021) and 25,279 RT-PCR test results from walk-in patients (April-August 17, 2021). Differences were evaluated using Chi-square or Fisher’s Exact Tests while binary logistic regression was used to assess mortality risk factors. Results: There were increased proportions of pregnant women, patients aged 20-29 and those with coronary artery disease during the Delta wave. This period also showed a significant increase in mortality rates, with the highest seen in patients &gt;60 years old or those with multiple comorbidities. Notably, most of the deceased patients (131 of 139) were unvaccinated. Analysis of RT-PCR data showed rising percentages of positive results with low CT values (below 21 or 15) from April to June. Conclusion: The Delta wave saw a higher risk of hospitalization among young individuals and pregnant women, despite their low mortality risk. The unvaccinated and those with multiple comorbidities faced higher mortality risks. Increases in RT-PCR positivity with low CT values preceded the July COVID-19 case surge.

Redirection of patients from the emergency department to ambulatory care: a feasibility study

§ 120 para. 3b SGB V mandates the Federal Joint Committee to define guidelines for the initial assessment of self-referred walk-in patients as well as for the redirection of patients who can be treated by office-based physicians. A corresponding streaming and redirection process was tested in a feasibility study at the RoMed Clinic Rosenheim. For the duration of the study, triage nurses of the emergency department (ED) first assessed self-referred walk-in patients with the Manchester Triage System (MTS). Patients in categories green and blue who did not obviously need the ED's resources were additionally assessed by health professionals of the Association of Statutory Health Insurance Physicians of Bavaria using the software Structured Initial Medical Assessment in Germany (SmED). Patients with a recommendation for non-hospital medical treatment were streamed to the out-of-hours practice on campus or were redirected to a physician office after video consultation with an office-based physician. Patient pathways were documented and a qualitative survey using semistructured guided interviews of all stakeholder groups was carried out. 1,091 self-referred walk-in patients were included. Direct streaming to the ED occurred in 525 cases,13 refused to participate. Based on SmED, 24 additional patients were referred to the ED, 514 patients were streamed to the out-of-hours practice, 23 received a video consultation and five left the ED. After video consultation, eight patients were redirected to a physician's office, 10 were discharged, and five referred to the ED of which one did not want an office-based physician. No returnees from practices to the ED were identified. Generally, the redirection process was evaluated positively in the interviews (n=18). In particular, potential for technical improvement was identified. Overall, the results indicate the feasibility of the redirection process and high acceptance levels. Using SmED in addition to MTS appeared useful before redirection but not necessary for streaming on campus. Redirection to physician offices can help reduce strain on the ED when the out-of-hours practice is not operating. In addition to arranging acute care appointments, video consultations offer an additional potential to treat patients. In a follow-up study, a broader range of patients should be included and appropriateness of redirection decisions should be evaluated.

Comparison of Near Point of Accommodation and Near Point of Convergence with Positive Fusional Vergence among Young Adults, Bengaluru

Background: When encountered with mass screening and increased walk-in patients in outpatient departments (OPD), evaluating complete binocular vision assessment becomes time-consuming. Consequently, there is a need to streamline the testing process. This study also aims to explore if there are any correlations between Near Point of Accommodation (NPA) and Near Point of Convergence (NPC) with Positive Fusional Vergence (PFV). Methodology: A retrospective study was carried out at Sankara Eye Hospital in Bangalore. Data from patients aged 18 to 35, who underwent binocular vision assessment between 2016 and 2020, were included. Out of 101,896 patients who visited the hospital during this period, 3,449 attended the vision therapy clinic. Among them, 1708 patients met the criteria for inclusion, while 1,741 were excluded. Results: Out of 1708 subjects, 759 are females and 949 are males. The relationship between Near Point of Accommodation (NPA), Near Point of Convergence (NPC), and Positive Fusional Vergence (PFV) blur and break values were analysed. A positive correlation was observed between NPA and PFV blur (Spearman's rho = 0.069, p=0.004) and a negative correlation between NPC and PFV break (Spearman's rho = -0.370, p&lt;0.001). There was a significant difference between NPA and PFV blur, as well as NPC and PFV break (p=0.000), emphasizing the importance of incorporating all three tests in a binocular vision assessment. Conclusion: These results emphasize the necessity for complete binocular vision assessment to effectively diagnose and manage binocular vision anomalies. By accounting for the various parameters involved in this investigation, clinicians can enhance the precision and quality of their assessments and plan for appropriate treatment strategies for patients with binocular vision anomalies.

Calling All Coyotes: An On-Call Model for Student-Run Free Clinics

To mitigate transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the pandemic, many ambulatory healthcare practices were either deferred or temporarily discontinued. Concern surrounding exposure risk to the virus has also deterred patients from seeking elective or preventative care. Similarly, medical schools were forced to rapidly adapt and develop protocols to protect students that suspended direct patient contact, especially if this experience was deemed elective to their primary academic requirements. At the intersection of these challenges to providing safe patient care and didactic training for students were student-run free clinics. The Coyote Clinic is a medical student-run clinic affiliated with the University of South Dakota Sanford School of Medicine and Avera Medical Group Health Care Clinic that provides free, basic healthcare services and screening to uninsured community members of the greater Sioux Falls, South Dakota area. On the heels of the coronavirus disease 2019 (COVID-19) pandemic, a decreased patient volume forced multiple instances of closures at the Coyote Clinic. In an effort to catalyze the return of patients to the clinic and enhance the educational enrichment for the student volunteers, a novel on-call workflow was devised that prioritizes walk-in patients. This on-call model is more attractive to attending physician volunteers and offers an alternative learning avenue for trainees. Here, we describe the new model we have implemented at the Coyote Clinic for other student-run free clinics that may be facing similar barriers in re-establishing themselves in their communities.

Abstract WP87: To Walk-In or Not to Walk-In: Effects of ED Mode of Arrival on Acute Stroke Treatment and Hospitalization Outcomes in a Large Integrated Healthcare System

Background: Prior studies reported that only half of stroke patients arrived at emergency departments (ED) via emergency medical services (EMS). We sought to assess predictors of ED mode of arrival and its effects on acute stroke care and inpatient outcomes in a large racial-ethnically diverse cohort. Methods: In 2016, we launched a system-wide standardized telestroke program for 21 certified stroke centers. Non-cancelled stroke alerts included those patients who were potential candidates for further workup for acute ischemic stroke treatment. This study cohort included non-cancelled stroke alerts seen by Telestroke in 2021. Assessment included demographics, ED arrival mode , initial NIH Stroke Scale (NIHSS), neuroimaging results, IV thrombolytic, door-to-needle (DTN) time, large vessel occlusion (LVO), thrombectomy referral, hospital length of stay and discharge disposition. Clustered logistic regression was used to evaluate ED arrival mode’s effects on short-term outcomes. Results: Of the 7744 stroke alerts seen by Telestroke in 2021, 3264 (42.2%) were non-canceled. Among these, 2014 (61.7%) were in the early window (0-4.5 hours from last seen well). More of those arriving in the early window came via EMS compared to those seen in the extended window [1625 (80.7%) versus 729 (58.3%) respectively]. Among non-canceled ED stroke alerts, compared to patients who arrived via EMS, walk-in patients were younger, more Hispanic, had lower initial NIHSS scores, longer times for ED to contact Telestroke, slower DTN times, but less mortality [Table]. In multivariate analysis, walk-in patients were less likely to have a DTN time within 30 minutes (OR=0.37, 95% CI 0.25-0.34; p=&lt;0.001). Conclusions: In our cohort, there were several differences between walk-in patients and those who arrived via EMS. Further research is needed to understand these differences, the reasons for choosing walk-in, and whether ED mode of arrival affects clinical outcomes.

From 0-50 in Pandemic, and Then Back? A Case Study of Virtual Care in Ontario Pre–COVID-19, During, and Post–COVID-19

We review the evolution of virtual care (VC) in Ontario. Pre–COVID-19, the primary focus was on patients in remote and underserved areas who went to host sites for care. Ontario’s vision pre-pandemic was for a gradual increase in VC by physicians registered with the Ontario Telemedicine Network (OTN), using OTN-approved video technologies; some accommodated patients and doctors wherever they were. Less than 1% of care was virtual pre-pandemic. We discuss how policies that altered access to in-person care (pandemic lockdowns and guidelines to seek and provide care virtually), compensation policy changes (allowing any Ontario physician to be compensated for VC), and policies allowing common technologies not previously allowed (including, importantly, the telephone), drove and enabled a rapid shift to >50% of care being virtual at the start of the pandemic, leveling off to ∼30% over time. We review policy changes in late 2022 and predict these will result in a drop in VC compared with the policies during the pandemic, particularly for walk-in clinic patients, in a province where 2.2-4.6 million people do not have a primary care doctor and presumably use walk-in clinics. This is because, going forward, physicians will be compensated less for telephone care than for in-person or video care for rostered patients, and because compensation will be less still for telephone or video care provided to walk-in patients. Through this case study we develop a visual model of how these key policy and technology factors influence the provision of VC.

Correlation between oral health and modified OIDP index in pediatric patients undergoing treatment in Clove Dental Clinics: A cross sectional pilot study

ABSTRACT Aim: This research article aims to assess the correlation between oral health and the modified Child Oral Impact on Daily Performance (C-OIDP) index in pediatric patients undergoing treatment at Clove Dental Clinics. The study focuses on evaluating the psychometric properties of the modified C-OIDP index using a Google Forms questionnaire in a multicentric pediatric population across 10 states in India. Materials and Methods: A descriptive cross-sectional study was conducted in two phases among pediatric patients (age range: 2–18 years) undergoing treatment at Clove Dental Clinics in Pan-India. Phase 1: (1) The English version of the C-OIDP index was converted into a pretreatment and posttreatment assessment Google Forms questionnaire. (2) The psychometric and linguistic properties of the modified C-OIDP index were assessed by a panel of experts, incorporating their feedback, and resolving any discrepancies. (3) The modified Google Forms questionnaire was tested on 20 random walk-in pediatric patients visiting two Clove Dental Clinics. (4) Discussions were held with the patients, accompanying guardians, and pedodontists to evaluate their understanding and optimize the questionnaire’s face and content validity. Phase 2: (1) The main study included the reassessment of the modified C-OIDP index using the Google Forms questionnaire on a larger sample of 200 pediatric patients undergoing treatment at Clove Dental Clinics. (2) The questionnaire was administered in both pretreatment and posttreatment scenarios, with a 1-week recall period between assessments. (3) All study participants and their accompanying guardians provided written informed consent. (4) Changes to content wordings during the cultural adaptation process were summarized. Results: (1) A total of 206 voluntary responses were collected from pediatric patients across 341 Clove Dental Clinics in 10 states of India. (2) The factor analysis study revealed good internal consistency reliability and validity of the modified C-OIDP index. (3) The pretreatment and posttreatment modified OIDP scores showed a significant decrease, indicating improved oral health-related quality of life (OHRQoL) posttreatment. Conclusions: The modified C-OIDP index demonstrated good psychometric properties and validity when used in a Google Forms questionnaire among pediatric patients undergoing treatment at Clove Dental Clinics in India. The study highlights the importance of assessing OHRQoL in pediatric populations and provides valuable insights for planning and prioritizing oral health care for children.

The KLiP Mobile: A model of community engagement programme

Background: KLiP Mobile (Klinik pakar bergerak) is a mobile eye specialist clinic initiated by the state government of Negeri Sembilan and Universiti Sains Islam Malaysia (USIM). It is funded by the state of Negeri Sembilan and managed by USIM. Objectives: The four objectives of this programme are: 1) Providing essential eye services, 2) Enhancing public-private partnerships to support the programme, especially among the underprivileged community for cataract surgery, rehabilitation of vision, and glasses for children and elderly 3) Promoting awareness through knowledge transfer programme on eye disease 4) conducting research. This paper aims to describe the prevalence of common eye diseases among our target population in Negeri Sembilan. Method: This is a cross-sectional study consisting of referred or walk-in patients who visited the KLiP Mobile program between January 2016 to June 2022. Results: The result showed the prevalence of common eye diseases among the population and is comparable with our national eye survey. Conclusion: The KLiP Mobile is a model of community engagement programme and is expected to continue benefiting the community especially those who are unable to access specialist services.

Modeling strategic walk-in patients in appointment systems: Equilibrium behavior and capacity allocation

We consider an outpatient clinic with strategic patients who choose between making an appointment with an indirect wait cost (advance patients) and walking in with an inconvenience cost that includes the risk of being rejected and waiting in the clinic (walk-ins). Patients have different indirect waiting costs and show up with some probability. The clinic allocates slots to advance and walk-in patients to minimize the expected blockage of walk-in patients. We characterize the equilibrium behavior of patients and investigate the optimal capacity allocation, for unobservable (patients know the expected waiting time) and observable (patients know their exact waiting time) cases. For the unobservable case, one of the three options is optimal: allocating all slots to advance patients, allocating all slots to walk-ins, or allocating a certain number of slots to advance patients so that only urgent patients would choose the walk-in option. In contrast, for the observable case, no such structure exists. We investigate the value of information numerically. Finally, we develop a simulation platform to examine the effects of model assumptions. We find the optimal capacity allocation for the simulation model to benchmark the performance of the theoretical models and two simple policies. These analyses verify that our models work well in realistic simulations, offering a useful tool in practice. In contrast to the common practice of allocating some slots to walk-ins, our results suggest that the clinics should prefer a system that allocates all slots to advance patients in certain environments due to the strategic behavior of patients.

Identification of Patients at Risk of Obstructive Sleep Apnea in Dental Settings.

Objectives This study aims to assess the risk of obstructive sleep apnea (OSA) in the Saudi Arabian population at a dental hospital using the Berlin Questionnaire (BQ) and investigate the association of gender, age, neck circumference, systolic blood pressure (SBP), diastolic blood pressure (DBP), and smoking habits with the risk of OSA. Methodology Participants were recruited through random selection from walk-in patients aged between 18 and 80 years. BQ was used to screen for OSA. In addition, age, gender, smoking habits, neck circumference, and blood pressure were collected. Data were analyzed using descriptive statistics, Student's t-test, and chi-square test. Results In this study, 55 participants were screened for OSA using BQ. Of the participants, 44 (80%) were considered to be at low risk of OSA. Age, neck circumference, BMI, SBP, and DBP were statistically significantly associated with high risk of OSA (P < 0.05). Age and neck circumference were found to be statistically significant predictors of OSA, even after controlling for gender and smoking status (P < 0.05). Conclusions BQ is a reliable tool for assessing the risk of OSA in the Saudi Arabian population. Age, neck circumference, BMI, SBP, and DBP are all significant factors of OSA, while age and neck circumference are significant predictors of OSA. Dental practitioners can play a valuable role in the early detection and referral of patients at high risk of OSA.

Walk-In Hospital Admission of Patients with Subarachnoid Hemorrhage: Clinical Presentation and Outcome

Neurosurgeons occasionally encounter cases of subarachnoid hemorrhage (SAH) in admitted walk-in patients, termed "walk-in SAH." However, their clinical characteristics have not been fully understood. We thus, aimed to investigate several characteristics of patients with walk-in SAH and compare them with those of patients with good grade SAH who arrived at the hospital by ambulance. Between January 2011 and January 2018, consecutive patients with World Federation of Neurosurgical Society (WFNS) grade I and II aneurysmal SAH were enrolled. They were dichotomized into walk-in and ambulance groups, and their demographic and disease-related characteristics were compared. Furthermore, predictors associated with unfavorable outcomes were investigated in patients with walk-in SAH. Of 171 patients with World Federation of Neurosurgical Society grade I and II SAH, 68 (39.8%) were categorized as walk-in SAH. The mean time for diagnosis in patients with walk-in SAH was significantly longer than that in patients who arrived by ambulance (P < 0.01). Multivariate analysis demonstrated that a lower rate of hypertension, high grades on the Barrow Neurological Institute scale, and Early Brain Edema Score were significantly associated with walk-in SAH (odds ratio [OR] 0.44, 95% confidence interval [CI] 0.21-0.91, P= 0.03; OR 0.32, 95% CI 0.13-0.76, P= 0.007; OR 0.11, 95% CI 0.02-0.51, P < 0.0001, respectively). Additionally, severe angiographic vasospasm was a significant predictor of unfavorable outcomes in walk-in SAH (OR 37.7, 95% CI 1.10-1290.90, P= 0.04). Patients with walk-in SAH exhibit radiological characteristics associated with a more favorable outcome among patients with good grade SAH. Therefore, these patients may have a positive prognosis.

Barriers encountered by nurses in the care of walk-in international patients in an emergency department in Japan

BackgroundAn increasing number of international patients continue to visit emergency departments (EDs) in Japanese hospitals. However, nurses in Japan perceive challenges when caring for patients from other countries. This study explored ED nurses’ perceptions of barriers when caring for walk-in international patients. MethodsFive semi-structured online focus group interviews involving 15 registered nurses with experience in caring for patients in an ED at a university referral hospital located in the center of Tokyo were conducted. Thematic analysis was used to identify patterns from the interviews. ResultsThe themes that emerged were as follows: (1) hesitation to engage with patients due to ambiguity, (2) loss of harmony in the ED, (3) difficulty with mutual goal settings, and (4) decreased professional self-efficacy. ConclusionThe findings provide an understanding of the challenges faced when caring for walk-in international patients. Educational interventions for ED nurses and other strategies, such as the use of interpreters, can enhance nurses’ abilities to improve patient safety and maintain equality.

Clearing the smoke: are tobacco cessation interventions by the dental team successful?

This study aimed to assess the outcomes of tailored tobacco cessation interventions in a dental clinic setting over one year. This interventional study recruited 1206 tobacco users who attended a smoking cessation clinic within an Oral Medicine Department in Bangalore, India. Baseline characteristics were recorded followed by a tailored smoking cessation intervention, delivered by trained faculty members and students. This followed the 3Es and 6As model - including a combination of personalised counselling, pharmacotherapy and one year follow up. 1206 participants were recruited. 95% were already receiving treatment within the dental hospital and 5% were walk-in patients, attempting to quit tobacco use. Participants who had been smoking or using smokeless tobacco more than twice daily for greater than 6 months were included in the study. Participants were excluded from the study if they were currently using nicotine replacement therapy (NRT) or non-NRT therapy for tobacco cessation, pregnant and lactating women, a recent history of myocardial infarction or a history of gastric ulcers. Outcomes were categorised into the following four groups; Complete abstinence, Harm reduction (>50% reduction), No change and lost to follow up. Of the patients who completed the 12 month follow up, 18% quit tobacco use (n = 180), 34.2% reduced their tobacco usage by greater than 50% (n = 342), 41.5% exhibited no change (n = 415) and 6.2% relapsed (n = 62). Salivary nicotine levels were used to confirm self-reported abstinence. This study shows that dental professional led tobacco cessation programmes can be successful in supporting patients to quit or reduce tobacco usage.

Synergism of an Urgent Care Walk-in Clinic With an Emergency Department.

The overutilization of hospital emergency departments by low-urgency patients is seen as a growing problem in health-care delivery, and a variety of solutions are under discussion. We studied the change in utilization of a hospital emergency department (ED) by low-urgency patients after an urgent care walk-in clinic (WIC) was opened in the immediate vicinity. A prospective, single-center pre-post comparative study was carried out at the University Medical Center Hamburg-Eppendorf (UKE). The ED patient collective consisted of adult walk-in patients who presented to the ED between 4 pm and midnight. The "pre" period consisted of August and September 2019, and the "post" period was from November 2019 (after the opening of the WIC) to January 2020. The study patients consisted of 4765 ED walk-in patients and 1201 WIC patients. 956 (80.5%) of the WIC patients had been referred onward to the WIC after initially presenting to the ED; from this group, 790 patients (82.6%) received definitive care in the WIC. The number of outpatients treated in the ED fell by 37.3% (95% confidence interval [30.9; 43.8]), from 851.5 to 536.7 per month. The most marked decreases were in the areas of dermatology (from 62.5 to 14.3 patients per month), neurology (45.5 to 25), ophthalmology (115 to 64.7), and trauma surgery (211 to 128.7). No decrease was seen in urology, psychiatry, or gynecology. For patients presenting without any referral document, the mean length of stay fell by a mean of 17.6 [7.4; 27.8] minutes from its "pre" value of 172.3 minutes. The rate of patients who left during treatment fell from 76.5 to 28.3 patients per month (p < 0.001). A GP-led urgent care walk-in clinic next door to an interdisciplinary hospital emergency department is a resource-saving treatment option for walk-in patients who present to the emergency department. Most of the patients referred from the ED to the WIC were able to receive definitive care there.