PHYSICIAN PERCEPTION ON COMMON HAND CONDITION, AND THEIR REFERRAL PATTERN

Background:Several hand conditions have an overlap in term of management by surgeons from different departments. They usually rely on referrals from general health providers. Suitable referral depends on the knowledge and understanding of the referring physicians to the problem and the best available treatment. Recently the number of referrals and operations of elective hand surgeries increased by more than 30%. Physician from different specialties can sometimes disagree on their perception on what is the best treatment option for the patient. Aim: to study physicians perception on common hand condition, and their referral pattern. Material and Method: The research was conducted using a survey with a sample size of 102 focusing on health care providers from King Abdul-Aziz University Hospital and they were collected by convenience sampling. The raw data was collected in an excel sheet. We used SPSS statistics 21st for quantitative data analysis. Results: The results gave us a general idea that there is a lot of difference of understanding to the hand conditions and which should be referred to where, with orthopedic being the most referred to Speciality. Conclusion: Referral for different hand and wrist conditions remains unclear to many practicing physicians at our institute. Establishment of a separate hand and wrist unit/clinic that includes all individual specializations may help improve patient care and wait timing.

Are We Facing a New Colposcopic Practice in the HPV Vaccination Era? Opportunities, Challenges, and New Perspectives

The combination of primary and secondary prevention has already influenced the colposcopic practice by reduction in HPV (human papillomavirus) vaccine-type HSIL (HIGH-GRADE SIL), colposcopy referral numbers, colposcopic positive predictive value (PPV) for CIN2+, and by modification of referral pattern, colposcopic performance, and procedures. Different strategies, both isolated and combined, have been proposed in order to maintain the diagnostic accuracy of colposcopy: patient risk stratification based on immediate or future risk of CIN3+ or on HPV genotyping after a positive screening test. Data are needed to support alternative colposcopic strategies based on vaccination status and on the application of artificial intelligence where the patient’s risk stratification is implicit in precision medicine which involves the transition from an operator-dependent morphology-based to a less-operator dependent, more biomolecular management. The patient’s risk stratification based on any combination of “history” and “test results” to decrease colposcopy workload further reduce colposcopic and histologic morphological approaches, while adding genotyping to the risk stratification paradigm means less cytologic morphologic diagnosis. In Italy, there is a strong colposcopic tradition and there is currently no immediate need to reduce the number of colposcopies. Instead, there is a need for more accredited colposcopists to maintain the diagnostic accuracy of colposcopy in the vaccination era.

Testicular torsion: An assessment of knowledge and referral pattern among health care workers in primary health-care facilities in Auchi, Nigeria

Objectives: Testicular torsion is the twisting of the spermatic cord with attendant loss of the blood supply to the affected testis. It is a common urological emergency and one of the frequent causes of acute scrotum in adolescents and young adults. Prompt diagnosis and immediate surgical intervention are necessary for testicular salvage. Testicular loss is directly linked to delay in presentation, surgery, and the referral patterns at the point of the first contact with health-care providers. The purpose of our study is to assess the knowledge, management methods, and referral pattern among health care workers in the primary health-care facilities in Auchi primary health-care zone, Nigeria. Material and Methods: This was a cross-sectional carried out among primary health care workers in Auchi primary health-care zone between May and October 2020. A structured self-administered questionnaire was given to all the first contact health care workers in this zone. The knowledge, management, and referral pattern of testicular torsion were determined based on responses to the questionnaires. Data were analyzed using SPSS version 21. Results were displayed with frequency distribution tables and charts. Results: Eighty-seven health care workers met the inclusion criteria and were given questionnaires to fill. The mean age of the respondents was 37.74 ± 7.53 years. The majority of the health workers (n = 66, 75.9%) have more than 5 years’ experience with only 12 (13.8%) having a secondary level of education. Most respondents have heard of testicular torsion (n = 77, 88.5%) and know the symptoms (n = 68, 78.2%) but they have a poor knowledge of the age group predominantly affected (n = 36, 41.1%) and testicular survival time following torsion (n= 41, 47.7%). Only about a third (n = 28, 32.2%) had attended to patients with testicular torsion. Of the 28 health workers who had managed patients with testicular torsion, less than half (n = 11, 39.3%) referred almost immediately, while about half treated conservatively (n = 14, 49.9%) keeping the patients under their care for a period of 3–7 days. Conclusion: This study showed that a comprehensive education of all categories of health workers in the primary health-care centers is needed. This is necessary for the early identification and appropriate surgical intervention or prompt referral of patients with testicular torsion to prevent avoidable testicular losses.

Referral pattern of oral and maxillofacial surgery cases in Sudan: A retrospective age-and sex-specific analysis of 3,478 patients over four years

Oral and maxillofacial surgery (OMFS) is a specialty widening in its scope. An objective analysis of the referral pattern can provide essential information to improve healthcare. This four-year retrospective study was implemented in Khartoum Teaching Dental Hospital. Data (age, sex, diagnosis, and type of treatment) were collected from patient records. Disease frequency, as well as the effect of sex and age, were analyzed for each group. The frequency of treatment types was also assessed. Data were collected from a total of 3,478 patients over the four-year study period. There was a male predominance with the third decade of life being the most common age group. Pathological diseases were the most common (37%) reason for referral, followed by trauma (31%). Temporomandibular joint (TMJ) disorders and dentoalveolar extraction were the least frequently observed. Open reduction and internal fixation (ORIF) was the most commonly performed procedure (28%). These data represent the epidemiology of oral and maxillofacial diseases in Sudan. Given that the third decade of life is the most represented age group, it is beneficial to learn the long-term consequences of these diseases in these young patients and to use modern surgical techniques to improve their lives.

Elderly Patients in a Large Nephrology Unit: Who Are Our Old, Old-Old and Oldest-Old Patients?

The world population is aging, and the prevalence of chronic kidney disease (CKD) is increasing. Whether this increase is also due to the methods currently being used to assess kidney function in the elderly is still a matter of discussion. We aimed to describe the actual referral pattern of CKD patients in a large nephrology unit and test whether the use of different formulae to estimate kidney function could affect the staging and the need for specialist care in the older subset of our population. In 2019, 1992 patients were referred to our center. Almost 28% of the patients were aged ≥80 and about 6% were ≥90 years old. Among the causes of kidney disease, glomerulonephritis displayed a higher prevalence in younger patients whereas hypertensive or diabetic kidney disease were more prevalent in older patients. The prevalence of referred patients in advanced CKD stages increased with age; estimated glomerular filtration rate (eGFR) decreased with age regardless of which equation was used (chronic kidney disease epidemiology collaboration (CKD-EPI), Lund–Malmö Revised (LMR), modification of diet in renal disease (MDRD), Full Age Spectrum (FAS), or Berlin Initiative Study 1 (BIS)). With CKD-EPI as a reference, MDRD and FAS underestimated the CKD stage while LMR overestimated it. The BIS showed the highest heterogeneity. Considering an eGFR threshold limit of 45 mL/min for defining “significant” CKD in patients over 65 years of age, the variability in CKD staging was 10% no matter which equation was used. Our study quantified the weight of “old” and “old-old” patients on follow-up in a large nephrology outpatient unit and suggested that with the current referral pattern, the type of formula used does not affect the need for CKD care within the context of a relatively late referral, particularly in elderly patients.