Evaluation of Patient-Initiated Direct Care Mobile Phone–Based Teledermatology During The COVID-19 Pandemic

Background With advances in telecommunication, especially smartphones, teledermatology services offered by specialists are now being directly requested by the patients themselves. This model is known as patient-initiated, direct care teledermatology. It has been pushed to the forefront due to the COVID-19 pandemic. Objective The objectives of this study were to determine patients’ satisfaction and dermatologists’ confidence when a diagnosis was made via direct care mobile phone–based teledermatology. Methods Patients availing direct care teledermatology services during the COVID-19 pandemic at a tertiary care center were subjected to a questionnaire within 5 days of the teleconsultation to assess patient satisfaction and opinions regarding using this model during and beyond the current COVID-19 pandemic. The dermatologists rated their confidence in making the clinical diagnosis on a scale from 1-10 for every case. Results Of 437 participants, 419 (95.9%) were satisfied with this mode of teledermatology. An overwhelming majority (n=428, 97.9%) felt safe consulting the dermatologist via teleconsultation and not having to visit the hospital during the COVID-19 pandemic. In addition, 269 (61.6%) patients agreed that they would be happy to use a teledermatology service beyond the COVID-19 pandemic. The dermatologists’ confidence score in making an accurate diagnosis ranged from 3 to 10, with a mean of 9.20 (SD 1.12). Conclusions The high levels of patient satisfaction and dermatologists’ confidence scores indicate that direct care mobile phone–based teledermatology may be a useful tool in providing dermatological services in appropriate settings and its use should continue to be explored beyond the COVID-19 pandemic. Conflicts of Interest None declared.

Evaluation of Patient-Initiated Direct Care Mobile Phone–Based Teledermatology During The COVID-19 Pandemic (Preprint)

BACKGROUND With advances in telecommunication, especially smartphones, teledermatology services offered by specialists are now being directly requested by the patients themselves. This model is known as patient-initiated, direct care teledermatology. It has been pushed to the forefront due to the COVID-19 pandemic. OBJECTIVE The objectives of this study were to determine patients’ satisfaction and dermatologists’ confidence when a diagnosis was made via direct care mobile phone–based teledermatology. METHODS Patients availing direct care teledermatology services during the COVID-19 pandemic at a tertiary care center were subjected to a questionnaire within 5 days of the teleconsultation to assess patient satisfaction and opinions regarding using this model during and beyond the current COVID-19 pandemic. The dermatologists rated their confidence in making the clinical diagnosis on a scale from 1-10 for every case. RESULTS Of 437 participants, 419 (95.9%) were satisfied with this mode of teledermatology. An overwhelming majority (n=428, 97.9%) felt safe consulting the dermatologist via teleconsultation and not having to visit the hospital during the COVID-19 pandemic. In addition, 269 (61.6%) patients agreed that they would be happy to use a teledermatology service beyond the COVID-19 pandemic. The dermatologists’ confidence score in making an accurate diagnosis ranged from 3 to 10, with a mean of 9.20 (SD 1.12). CONCLUSIONS The high levels of patient satisfaction and dermatologists’ confidence scores indicate that direct care mobile phone–based teledermatology may be a useful tool in providing dermatological services in appropriate settings and its use should continue to be explored beyond the COVID-19 pandemic.

THE PERFORMANCE DIFFERENCES BETWEEN HIGH AND LOW SALES TURNOVER COMMUNITY PHARMACIES

Background: Pharmacy managers will make various efforts to increase their income. In spite of this, pharmacies that have the same facilities can generate greatly varied incomes.Aims: The purpose of this study was to determine the difference between high sales turnover pharmacies and low sales turnover pharmacies as observed through employee motivation, organizational culture, and patient satisfaction.Methods: This study used an analytical design with a questionnaire and checklist. Consumers were selected using the purposive sampling system to assess patient satisfaction. All employees were sampled to assess work motivation and organizational culture. Data analysis was performed using descriptive, bivariate, and multivariate testing.Results: Direct observation of pharmaceutical services from the two outlets shows that there were differences in the time it takes for pharmacist to retrieve the drug, the time for providing drug information, collecting information from patients, and the type of drug information provided, as well as employee motivation, organizational culture, and patient satisfaction.Conclusion: Services at pharmacies with high sales turnover are different from pharmacies with low sales turnover. Empathy has the greatest effect on sales turnover, followed by reliability, responsiveness, assurance, and tangible dimensions. Outlets that have high sales turnover have better organizational culture and higher employee motivation when compared to outlets that have low sales turnover. Keywords: motivation, organizational culture, patient satisfaction, sales turnover

The Uro-Oncology Multi-disciplinary team (MDT) Clinic – Clinical and Patient-Reported Outcomes From Implementing a New Model of Care

Introduction A multi-disciplinary approach has often been advocated to improve the delivery of oncological care, as compared to a mono-disciplinary and linear approach. Our study elucidates the clinical and patient-reported outcomes from a urologic-oncology multi-disciplinary team (MDT) clinic in a regional general hospital. Materials and Methods Patients who attended a uro-oncology MDT clinic which was started in January 2019 were identified. This service was specifically catered to patients who were histologically diagnosed with urological cancers. The MDT service comprised a multi-disciplinary tumour board followed by outpatient clinical consults with representatives from urology, medical and radiation oncology. Demographic variables, disease characteristics and treatment rendered were analysed. A survey was administered to assess patient satisfaction. Results Fifty patients with a median age of 70 years with complete case records were identified. The cancer types included prostate cancers (46%), urothelial cancers (26%) and renal cell carcinoma (12%) as the most frequent urological cancers. The median time from MDT to therapy initiation was 8 days. Among those with prostate, urothelial, renal and testicular malignancies, 71% (32/45) of our patients received treatment that were in accordance to guideline recommendations. A post-clinic survey showed that patients were satisfied with the information provided during the clinic and this also facilitated decision and time to initiation of therapy. Conclusion A multi-disciplinary service comprising a tumour board followed by a one-stop clinic provides patients with multi-disciplinary care, improved access to subsequent therapy, better time efficiency and high patient satisfaction scores. More studies are warranted to demonstrate its oncological outcomes.

Resection and reconstruction of idiopathic scrotal elephantiasis: surgical approach and quality of life assessment

Scrotal elephantiasis (SE) is a condition considered rare in western industrialised countries but common in filaria prone regions. If no apparent causes are found for SE, it is called idiopathic SE. Medical and conservative therapies are ineffective against idiopathic SE, and surgical intervention is mandatory to treat this disabling condition. Nevertheless, it remains unclear whether surgical intervention improves quality of life among patients with idiopathic SE. Herein, we report a case of a 41-year-old man who underwent acute scrotal resection and reconstruction, secondary to haemorrhage from his idiopathic SE. The aim of this study was to describe the operative approach and assess patient satisfaction after surgical treatment. The patient had no recurrence of SE after surgical treatment at 6 months follow-up and had considerable improvements assessed by general and disease-specific quality of life questionnaires.

Non-Surgical Touch-Up with Hyaluronic Acid Fillers Following Facial Reconstructive Surgery

The use of hyaluronic acid (HA) injectable fillers has become increasingly widespread in facial recontouring and rejuvenation. We report our experiences to emphasize the role of HA fillers as tools beyond aesthetic treatments in cases of post-surgical facial sequelae. HA fillers are generally used for aesthetic rejuvenation, but one potential new horizon could be their application in trauma, reconstructive, and craniofacial surgery. This study was conducted retrospectively, evaluating medical reports of patients treated at the Maxillofacial Surgery Unit, University of Campania “Luigi Vanvitelli”, Naples, for lip incompetence, trauma, oncological, reconstructive, and craniosynostosis surgery sequelae. Visual analog scale (VAS) evaluation was performed to assess patient satisfaction. No major complications (i.e., impending necrosis or visual loss) were reported. Bruising and swelling was reported for 48 h after lip injection. At the immediate VAS evaluation, 67% of the patients were “extremely satisfied” and 33% “satisfied”. In those 33%, VAS scores changed to “extremely satisfied” at 6–9 weeks and 3–6 months of VAS evaluation (contextually to improvement in tissue flexibility, elasticity, and aesthetic appearance). Results indicate that this minimally invasive approach achieves a high level of aesthetic enhancement, improving patient satisfaction. The concept of HA filler applications could be a frontier that may be applicable to other areas of reconstructive facial plastic surgery.

Comparison of the Assessment of Patient Satisfaction Using Active and Passive Feedback

ABSTRACT Introduction The outpatient department of any hospital is the first direct point of contact to the patients with the hospital. To understand the difficulties faced by the patients and to understand their perceptions, it is important to assess patient satisfaction. This study was designed to compare the difference in patient satisfaction responses and outcomes using two methods: active feedback collection (AFC) and passive feedback collection (PFC). Methods The study was conducted for a period of 2 months using a validated, structured questionnaire in four languages. To differentiate the questionnaires, those for PFC were marked P and those for AFC as A. The questionnaire consisted of 21 questions. PFC was obtained when patients voluntarily filled out the feedback forms placed at different locations, and AFC was obtained by systematically approaching randomly selected patients. Results Of the 809 patients who participated in the study, 131 were passive and 678 active. The study revealed that the satisfaction level was higher in the AFC group. It was observed that 82% of those in the PFC group and 35% of those in the AFC group had given specific written comments. The negative comments were higher in the PFC group than in the AFC group. Conclusions The AFC method gives a good overview of the patients' journeys through the system and it can be used for systemic feedback collection. The PFC method provides an avenue to get more written suggestions and adverse comments that could help in planning remedial measures. The study showed that both methods collect complementary information for the managers to facilitate improvement of services.

Improving Digital Patient Care: Lessons Learned from Patient-Reported and Expert-Reported Experience Measures for the Clinical Practice of Multidimensional Walking Assessment

Background: Walking assessment (WA) enables meaningful patient mobility assessment. In this context, patient satisfaction with WA can influence assessment compliance and indirectly affect outcomes. One opportunity to assess patient satisfaction is patient-reported and expert-reported experience measures (PREM). Research on PREMs and WA in daily clinical multiple sclerosis (MS) practice does not exist yet. Methods: We surveyed people with MS about their experience and assessed healthcare professionals’ experience via an interview after patients completed WA. Results: Gait parameters were related to perceived difficulty and strain during performance. Less impaired patients perceived the WA to be less difficult and exhausting but were less likely to use WA results for themselves. Men and patients with higher impairment would perform WA more frequently. A good workflow, a fully performed WA with standardized testing, fully functional measurement systems, support and safeguarding by staff in case of falls, direct feedback after the testing, and patients’ motivation are identified by the experts as necessary factors for a successful WA. Conclusions: As patients’ experience has an impact on patients’ outcomes, long-term monitoring of PREMs should become an integral part of the healthcare service to identify and avoid problems early.

Exo-rehabilitation of patients with spastic hemiparesis: high technology

AIM: Walking disorders are a frequent consequence of stroke. New technologies, such as the use of robotic exoskeletons, can help with recovery, but their effectiveness has not yet been sufficiently proven. MATERIALS AND METHODS: Forty-two patients with spasticity and walking disorders (stroke duration from 1.5 to 4 years) were included in the study. The Tardieu Scale, Modified Ashworth scale, Medical Research Council Scale, 10 Meter Walk Test, Rivermead Mobility Index, Berg Balance Test, Rankin scale, and a Visual Analog Scale (to assess patient satisfaction with treatment) were used in assessments. The patients were randomized into 2 groups (n = 22 20): the first group received exoskeleton walk training with the powered exoskeleton, ExoAtlet, and the second group received physical therapy sessions, each for 1 hour daily over 10 days. Clinical evaluations of patients were performed at 3 timepoints: baseline (Day 1), and 12. RESULTS: Comparison of both groups at the second timepoint showed significantly better results (p 0.05) in the first group vs the second group. Walking speed increased due to balance training, correction of postural disorders, spastic muscle stretching, and stretch reflex suppression. CONCLUSION: The wearable powered ExoAtlet exoskeleton is a promising technology for improving walking (2 tables, bibliography: 13 refs).