Changing perceptions of telemedicine in a surgical outpatients clinic

Background/Aims Before the COVID-19 pandemic, telemedicine was not widely used in surgical departments. Despite its increased use during the pandemic, there is a lack of data on the patient perspective. This study investigated patients' views of telemedicine in a surgical outpatients clinic setting. Method A single-centre cross-sectional study was performed, involving patients who were due to attend the surgical outpatients clinic of one surgical team. Independent investigators contacted the patients by telephone after their virtual telephone consultation to administer the questionnaire. Patient satisfaction rates were recorded using the PSQ-18 questionnaire. Patient consultation preferences were recorded and analysed. Results A total of 223 patients participated in this study. The majority of patients' perceptions shifted in favour of virtual consultations after the onset of the pandemic (P<0.05). Sub-group analysis showed no significant differences between the preferences of older and younger patients before or after the onset of the pandemic. Overall, patients reported high satisfaction rates with their virtual consultations. Conclusions Patient perceptions are changing in favour of virtual telemedicine consultations. Training healthcare providers in this method of service delivery is essential to maintain a good quality of care.

Return to Work After Pectoralis Major Repair

Background: Pectoralis major repair (PMR) is an infrequent injury that occurs during resistance training, most commonly during the eccentric phase of muscle contraction. As the incidence of weight training continues to increase, it is important to understand the outcomes after PMR. Purpose: To evaluate the rate and duration of return to work in patients undergoing PMR. Study Design: Case series; Level of evidence, 4. Methods: Consecutive patients undergoing PMR from 2010 to 2016 at a single institution were retrospectively reviewed at a minimum of 1 year postoperatively. Patients completed a standardized and validated work questionnaire, as well as a visual analog scale for pain, American Shoulder and Elbow Surgeons survey, Single Assessment Numerical Evaluation, and a satisfaction survey. Results: Of the 60 eligible patients who had a PMR, 49 (81.7%) were contacted at the final follow-up. Of the 49 patients, 46 (93.9%) had been employed within 3 years before surgery (mean ± SD age, 40.4 ± 8.2 years; follow-up, 3.9 ± 2.8 years). Of these, 45 (97.8%) returned to work by 1.6 ± 2.1 months postoperatively, and 41 (89.1%) returned to the same level of occupational intensity. Patients who held sedentary, light-, medium-, or high-intensity occupations returned to work at a rate of 100.0%, 100.0%, 83.3%, and 66.7% by 0.8 ± 1.0, 0.8 ± 1.0, 1.3 ± 2.7, and 3.3 ± 2.7 months, respectively. Five of 6 patients (83.3%) with workers’ compensation returned to their previous occupations by 5.0 ± 1.6 months, while 100% of those without workers’ compensation returned to work by 1.1 ± 1.7 months ( P < .001). Overall, 44 patients (95.7%) were satisfied with the procedure, and 40 (87.0%) would have the operation again if presented the opportunity. A single patient (2.2%) required revision PMR. Conclusion: Approximately 98% of patients who underwent PMR returned to work by 1.6 ± 2.1 months postoperatively. Patients with higher-intensity occupations took longer to return to their preoperative levels of occupational intensity. Information regarding return to work is imperative in preoperative patient consultation to manage expectations.

Conducting a consultation and clinical assessment of the skin for advanced clinical practitioners

Advanced clinical practitioner (ACP) roles require a broad range of knowledge of both medical and surgical areas and the ability to work autonomously in a variety of settings. Despite around half of the UK adult population presenting with a skin condition requiring attention at some point, this is an area many ACPs feel unprepared to manage. However, due to the complexity and large number of potential diagnoses, it is imperative that ACPs develop their knowledge of skin conditions so that they can confidently conduct consultations with patients. This clinical review presents the key elements of patient consultation, history taking and assessment of the skin. This is designed to support novice ACPs, whether working in acute hospital settings or primary care, to develop an understanding of the key points that should be included when consulting with and assessing the skin of patients outwith the dermatology setting.

The impact of changing risk thresholds on the number of people in England eligible for urgent investigation for possible cancer: an observational cross-sectional study

Background Expediting cancer diagnosis may be achieved by targeted decreases in referral thresholds to increase numbers of patients referred for urgent investigation. Methods Clinical Practice Research Datalink data from England for 150,921 adults aged ≥40 were used to identify participants with features of possible cancer equating to risk thresholds ≥1%, ≥2% or ≥3% for breast, lung, colorectal, oesophago-gastric, pancreatic, renal, bladder, prostatic, ovarian, endometrial and laryngeal cancers. Results The mean age of participants was 60 (SD 13) years, with 73,643 males (49%). In 2016, 8576 consultation records contained coded features having a positive predictive value (PPV) of ≥3% for any of the 11 cancers. This equates to a rate of 5682/100,000 patients compared with 4601/100,000 Suspected Cancer NHS referrals for these cancers from April 2016–March 2017. Nine thousands two hundred ninety-one patient-consultation records had coded features equating to a ≥2% PPV, 8% more than met PPV ≥ 3%. Similarly, 19,517 had features with a PPV ≥ 1%, 136% higher than for PPV ≥ 3%. Conclusions This study estimated the number of primary-care patients presenting at lower thresholds of cancer risk. The resource implications of liberalising this threshold to 2% are modest and manageable. The details across individual cancer sites should assist planning of English cancer services.

Prognostic capabilities of proteomic analysis of seminal plasma in males with azoospermia

Introduction. According to research, seminal plasma is a rich source of biomarkers in male infertility including biomarkers of residual spermatogenesis in males with azoospermia. In many cases, extraction of seminal plasma does not require invasive procedures. Therefore, non-invasive test for identification of males with azoospermia and residual focal spermatogenesis can improve selection of patients for microdissection testicular sperm extraction (microTESE) and become a useful tool for patient consultation.The study objective is to evaluate capabilities of proteomic analysis of seminal plasma for identification of males with azoospermia and residual focal spermatogenesis in the testes who have higher chance for sperm extraction using the microTESE procedure.Materials and methods. Samples of seminal plasma of 36 males between 21 and 45 years of age (mean age 33.3 ± ± 3.9 years) were tested for proteomic composition. For proteomic analysis, proteins were hydrolyzed with trypsin. The obtained peptides were analyzed using chromatography-mass spectrometry complex composed of liquid chromatograph nano-HPLC Agilent 1100 and high-resolution mass spectrometer 7Т LTQ-FT Ultra. Proteomic analysis data were compared with results of the microTESE procedure.Results. In this study, proteomic composition of seminal plasma in azoospermia was assessed. Semi-quantitative analysis without markers using bottom-up approach identified 405 different proteins, and 174 of them were detected in all samples. The obtained quantitative parameters were sufficient to identify patients with focal spermatogenesis.Conclusion. Seminal plasma is a potential source of biological markers for prediction of sperm extraction success in patients with azoospermia. The presented results are preliminary, and further studies are needed to confirm the identified protein panel.

Changes in Televisit Modalities Due to the Covid-Pandemic in Chile: A Comparison of Patient Satisfaction.

BACKROUND: The corona virus 2019 (COVID-19) pandemic has impacted healthcare guidelines and modalities of patient consultation worldwide. The frequent cycles of quarantine confinement in Chile has caused mobility restrictions for both patients and physicians, which forced the Hospital Las Higueras de Talcahuano (HHT) to replace the assisted televisit modality with a more classic televisit program. This change may have impacted the satisfaction of patients.METHODS: Patient’s perception of satisfaction was evaluated through self-administered survey questionnaires, previously validated in the Spanish language. Cohorts were grouped according to two relational models:i) Assisted televisit, 503 neurology patients during the years 2018-2019; and ii) Televisit, 831 patients from different specialtiestreated during 2020. Perception of satisfaction was compared by gender, age, and type of televisit, and internal consistency (Cronbach alpha) and reliability (factorial analysis of main components) were assessed. RESULTS: Assisted televisit and televisit cohortswere composed by 64.2% and 67.6% women, respectively; patients under 65 years of age were 62.2% and 75%, respectively. Assisted televisit patients showed very high 94.4% (n=475) and high 5.2% (n=26) satisfaction levels, while televisit patients showed very high 22.3% (n=185), high 63.9% (n=531), and moderate 13.1% (n=109) satisfaction levels; this difference is statistically significant at p<0.001. Questionnaires showed excellent internal consistency, and all items showed point biserial correlations greater than 0.30. CONCLUSION: Lower perception of satisfaction due to the change in televisit relational modality underscores the importance of primary care professionals, who support the specialist inthe assisted televisit model. The results of this study suggest that assisted televisit contributes to delivering an integrative solution that helps to alleviate the fragmentation of the system.