scholarly journals 426 An Evaluation of The Service of Endoscopic Trans-Sphenoidal Surgery for Excision of Pituitary Lesion During The SARS-Cov-19 Pandemic

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
C Cernei ◽  
S Sinha
Keyword(s):  
Pituitary Surgery ◽  
Mass Effect ◽  
Positive Outcome ◽  
Service Evaluation ◽  
Face To Face ◽  
Remote Services ◽  
Biopsychosocial Perspective ◽  
Pituitary Lesion

Abstract Introduction Since the start of SARS-CoV-2 pandemic many branches of medicine and surgery have undergone changes shifting the focus to prepare for an increase of COVID-19 related admissions. Halting all pituitary surgery services was not feasible particularly if patients present with acute or progressive visual loss due to the mass effect of the pituitary lesion, pituitary apoplexy, or lesions with aggressive features. Method An 11-point telephone questionnaire was used to evaluate the service provided between March and September 2020. On a 1-10 scale, patients scored their feelings about remote clinics, the support offered, the clarity of explanations, quality of interaction with their surgeon, and an overall assessment of remote clinics. Results 20 of the 21 patients who underwent transsphenoidal pituitary lesion resection between the 02/03/2020 and 14/09/2020 participated in the survey. They unanimously felt the introduction of remote consultations was necessary and felt safer. Their surgeon’s communication skills helped their experience the most. It allowed for easier attendances as they did not rely on family or long travelling times. Drawbacks involved the lack of face-to-face interaction particularly pre-operatively, as patients felt they missed the human factor, seeing their scans, and meeting their surgeon in person. Conclusions The pandemic has affected people from a biopsychosocial perspective leaving long-lasting effects on the economy and healthcare systems of the world. This service evaluation highlights a positive outcome in terms of patient experience. Moving forward, incorporating remote services as an option for follow-up cases would be welcomed by most patients in the survey.

scholarly journals 829 Is There an Ongoing Role For 'Telephone Triage Clinics' Post COVID-19?

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
B Holmes ◽  
U Mirza ◽  
C Manning ◽  
R Cooke ◽  
R Jugdey
Keyword(s):  
Common Theme ◽  
Telephone Triage ◽  
Telephone Consultation ◽  
Face To Face ◽  
Clinician Satisfaction ◽  
Set Up ◽  
Local Protocol ◽  
Telephone Questionnaire

Abstract Introduction COVID-19 has placed unprecedented demand on services at ELHT and it has become necessary to have telephone clinics to reduce the number of face-to-face clinics. A ‘telephone triage clinic’ was set up for referrals from A&E. Our project evaluated patient and clinician satisfaction on this. Method We carried out a retrospective telephone questionnaire with patients over a one-week period during the pandemic. We focussed on overall satisfaction of the consultation and quality of communication. Consultants were also surveyed for their opinion on the clinics. Results From 30 patients, 77% said they were ‘very satisfied’ with the overall experience. 80% of patients were ‘very satisfied’ with the overall length of the telephone consultation. 50% of patients felt the clinician was only ‘adequately’ able to assess them over the telephone. The consultants were less satisfied with the overall experience of telephone consultation. A common theme was that they felt ED documentation could be improved to help inform ongoing management. Conclusions Overall, patients were satisfied with the consultations. It has been successful in minimising face to face consultations however some presentations necessitate further evaluation. We need to identify those injuries appropriate for virtual follow up and design a local protocol for these.

scholarly journals Teledermatology in Times of COVID-19 Confinement: Comparing Patients’ and Physicians’ Satisfaction by the Standardized Brest Teledermatology Questionnaire

Dermatology ◽  
2021 ◽  
pp. 1-6
Author(s):  
Joachim W. Fluhr ◽  
Annie Gueguen ◽  
Delphine Legoupil ◽  
Emilie Brenaut ◽  
Claire Abasq ◽  
...  
Keyword(s):  
Main Question ◽  
Chronic Patients ◽  
Dermatology Department ◽  
Global Satisfaction ◽  
Technical Parameters ◽  
Face To Face ◽  
Almost All ◽  
Outpatient Settings

The French government imposed the first COVID-19 pandemic lockdown from March 17 until May 11, 2020. Only emergency cases and teledermatology (TD) were allowed in outpatient settings. A standardized questionnaire was developed to compare the satisfaction level of patients and their treating physicians. Our main question was whether the patients would perceive TD as a valid alternative for direct physical face-to-face consultation. Eighty-two patients and their 4 treating dermatologists from one dermatology department participated in the study (43 females, 39 males) with a mean age of 46.6 years (SD ±23.9). The reason for TD was a chronic disease in the majority (87.8%), and mainly as a follow-up (96.3%). Regarding satisfaction, almost all categories rated around 9 on a 0–10 verbal analogue scale. The same level of global satisfaction could be seen between the patients and the physicians as well as for the quality of the patient-physician relation and whether all questions could be addressed during the TC. Physicians showed significantly higher scores than patients only for the category of “length” of the consultation. Gender, age, as well as distance between the clinic and home of the patient were not influencing factors for satisfaction. Regarding the technical parameters, the evaluation was mostly comparable for patients and physicians, but overall lower than the relational satisfaction parameters, especially for image quality. Patients were significantly more motivated to continue the TD after the lockdown than their treating dermatologists. We see an interest for implementing TD in specialized centers with chronic patients coming from remote places for regular follow-ups. TD cannot replace in-person patient-physician interaction, but was helpful during the lockdown. As a result, TD might become part of dermatology training to prepare for future lockdown situations.

scholarly journals Education in Neurology Resident Documentation Using Payroll Simulation

2017 ◽  
Vol 9 (2) ◽  
pp. 231-236 ◽  
Author(s):  
John W. Liang ◽  
Vicki L. Shanker
Keyword(s):  
Medical Decision ◽  
Financial Loss ◽  
Income Loss ◽  
Face To Face ◽  
Number Of Patients ◽  
Specific Feedback ◽  
Didactic Lecture ◽  
E Mail

ABSTRACT Background Approaches for teaching neurology documentation include didactic lectures, workshops, and face-to-face meetings. Few studies have assessed their effectiveness. Objective To improve the quality of neurology resident documentation through payroll simulation. Methods A documentation checklist was created based on Medicaid and Medicare evaluation and management (E/M) guidelines. In the preintervention phase, neurology follow-up clinic charts were reviewed over a 16-week period by evaluators blinded to the notes' authors. Current E/M level, ideal E/M level, and financial loss were calculated by the evaluators. Ideal E/M level was defined as the highest billable level based on the documented problems, alongside a supporting history and examination. We implemented an educational intervention that consisted of a 1-hour didactic lecture, followed by e-mail feedback “paystubs” every 2 weeks detailing the number of patients seen, income generated, income loss, and areas for improvement. Follow-up charts were assessed in a similar fashion over a 16-week postintervention period. Results Ten of 11 residents (91%) participated. Of 214 charts that were reviewed preintervention, 114 (53%) had insufficient documentation to support the ideal E/M level, leading to a financial loss of 24% ($5,800). Inadequate documentation was seen in all 3 components: history (47%), examination (27%), and medical decision making (37%). Underdocumentation did not differ across residency years. Postintervention, underdocumentation was reduced to 14% of 273 visits (P < .001), with a reduction in the financial loss to 6% ($1,880). Conclusions Improved documentation and increased potential reimbursement was attained following a didactic lecture and a 16-week period in which individual, specific feedback to neurology residents was provided.

scholarly journals Combined treatment for acromegaly with long-acting somatostatin analogs and pegvisomant: long-term safety for up to 4.5 years (median 2.2 years) of follow-up in 86 patients

2009 ◽  
Vol 160 (4) ◽  
pp. 529-533 ◽  
Author(s):  
SJCMM Neggers ◽  
WW de Herder ◽  
JAMJL Janssen ◽  
RA Feelders ◽  
AJ van der Lely
Keyword(s):  
Combined Therapy ◽  
Combined Treatment ◽  
Somatostatin Analogs ◽  
Pituitary Surgery ◽  
Median Dosage ◽  
Previously Treated ◽  
Long Acting

BackgroundWe previously reported on the efficacy, safety, and quality of life (QoL) of long-acting somatostatin analogs (SSA) and (twice) weekly pegvisomant (PEG-V) in acromegaly and improvement after the addition of PEG-V to long-acting SSA.ObjectiveTo assess the long-term safety in a larger group of acromegalic patients over a larger period of time: 29.2 (1.2–57.4) months (mean (range)).DesignPegvisomant was added to SSA monotherapy in 86 subjects (37 females), to normalize serum IGF1 concentrations (n=63) or to increase the QoL. The median dosage was 60.0 (20–200) mg weekly.ResultsAfter a mean treatment period of 29.2 months, 23 patients showed dose-independent PEG-V related transient liver enzyme elevations (TLEE). TLEE occurred only once during the continuation of combination therapy, but discontinuation and re-challenge induced a second episode of TLEE. Ten of these patients with TLEE also suffered from diabetes mellitus (DM). In our present series, DM had a 2.28 odds ratio (CI 1.16–9.22; p=0.03) higher risk for developing TLEE. During the combined therapy, a clinical significant decrease in tumor size by more than 20% was observed in 14 patients. Two of these patients were previously treated by pituitary surgery, 1 with additional radiotherapy and all other patients received primary medical treatment.ConclusionLong-term combined treatment with SSA and twice weekly PEG-V up to more than 4 years seems to be safe. Patients with both acromegaly and DM have a 2.28 higher risk of developing TLEE. Clinical significant tumor shrinkage was observed in 14 patients during combined treatment.

scholarly journals An Effectiveness Study of a Digital Mindfulness-Based Program for Upper Secondary Education Students

Mindfulness ◽  
2020 ◽  
Vol 11 (11) ◽  
pp. 2494-2505
Author(s):  
Oskari Lahtinen ◽  
Christina Salmivalli
Keyword(s):  
Controlled Trial ◽  
Attrition Rate ◽  
Education Students ◽  
Online Questionnaire ◽  
Face To Face ◽  
Upper Secondary Education ◽  
Randomized Controlled ◽  
Upper Secondary

Abstract Objectives Mindfulness-based programs/interventions (MBPs) are emerging as treatments for anxiety and stress for adults and adolescents. MBPs can also be helpful as universal interventions for healthy subjects. Few studies have looked at how beneficial MBP effects transfer to digital MBPs. Methods The study was a randomized controlled trial with 1349 participants aged mostly 16–19. We compared a digital MBP vs. a waitlist condition. Online questionnaire data were collected pre-program, post-program, and at 3-month follow-up. Results Completing the MBP resulted in a small-to-moderate reduction in anxiety (F1,681 = 13.71, p < .01, d = .26), a small reduction in depression (F1,686 = 8.54, p < .01, d = .15), and a small increase in psychological quality of life (F1,708 = 3.94, p = .05, d = .16). Attrition rate for the MBP was 41.5%. Conclusions The results suggest that digital MBPs can be successful in delivering at least some of the benefits characteristic of face-to-face MBPs.

The Aphasia Action, Success, and Knowledge Programme: Results from an Australian Phase I Trial of a Speech-Pathology-Led Intervention for People with Aphasia Early Post Stroke

2017 ◽  
Vol 18 (3) ◽  
pp. 284-298 ◽  
Author(s):  
Brooke Ryan ◽  
Kyla Hudson ◽  
Linda Worrall ◽  
Nina Simmons-Mackie ◽  
Emma Thomas ◽  
...  
Keyword(s):  
Social Impact ◽  
Phase 1 ◽  
Family Members ◽  
Randomised Control Trial ◽  
Speech Pathology ◽  
Face To Face ◽  
Post Stroke ◽  
Level Of Satisfaction

Background: Speech pathologists work to optimise communication and reduce the emotional and social impact of communication disability in patients with aphasia but need evidence-based interventions to effectively do so.Objective: This phase 1 study aims to evaluate an Australian speech-pathology-led intervention called the Aphasia Action, Success, and Knowledge (Aphasia ASK) programme for patients with aphasia early post stroke.Methods: A convergent parallel mixed-methods design was utilised. The intervention included up to six individual face-to-face sessions with seven participants with aphasia and their nominated family member(s). Quantitative outcomes assessing mood, quality of life, and communication confidence were conducted for the participants with aphasia. Follow-up interviews were conducted with both participants with aphasia and family members to determine their perceptions of the programme.Results: Significant improvements were found in communication confidence and mood after treatment and the gains were maintained at 3-month follow-up. Participants with aphasia and their family members reported a good level of satisfaction with the programme.Conclusions: Findings suggest the Aphasia ASK programme is a suitable intervention with positive initial outcomes for people with aphasia. A larger scale evaluation with a greater variety of participants is now required. An Australian cluster randomised control trial is planned.

scholarly journals VA Video Telehealth and Training Programs During the COVID-19 Response

2021 ◽  
Author(s):  
Rhonda Johnston ◽  
Rita F. Kobb ◽  
Claire Marty ◽  
Padraic McVeigh
Keyword(s):  
Online Survey ◽  
Surgical Care ◽  
Office Visits ◽  
Face To Face ◽  
Patient Interaction ◽  
Telemedicine Consultation ◽  
Physician Patient ◽  
And Training

Study Design: An online survey modeled after the TeleENT Satisfaction Questionnaire and the Medical Communication Competence Scale (MCCS) were administered to gauge patient experience with electronic medical record-based telemedicine visits. Results: Participants noted several advantages of telemedicine visits over traditional in-office visits: shorter visits, saving money, and avoiding potential exposure during the pandemic. Thirty-six percent of the patients agreed that the quality of care was hindered by the lack of a physical exam, and 61.7% of the patients agreed that they prefer a face-to-face visit rather than telemedicine consultation. Most patients were satisfied with the care they received via telemedicine (Likert 6.19/7), and 95.8% of the patients would use telemedicine again. Participants self-reported an average saving of $108.70 when using telemedicine. When comparing the telemedicine cohort to the in-office control, the telemedicine patients noted an improved ability to communicate with their physician in 5 out of 8 domains of the MCCS. Conclusion: Surgical preoperative consultation, postoperative follow-up, and routine visits were conducted via telemedicine during the COVID-19 pandemic, representing a new direction for surgical appointments and consultations. This study shows that telehealth provides satisfactory care and increases access to surgical care for patients when external factors prevent the traditional physician–patient interaction. With better-perceived communication via telemedicine appointments, patients may subjectively feel that they can express their symptoms and gather information from the doctor regarding their diagnosis more efficiently.

scholarly journals Midwives' evaluation of their role in crowdsourcing activities to improve the maternity experience: part 2

2019 ◽  
Vol 27 (7) ◽  
pp. 420-426
Author(s):  
Sam Frewin ◽  
Sarah Church
Keyword(s):  
Quality Improvement ◽  
Maternity Care ◽  
Service Evaluation ◽  
Qualitative Approach ◽  
Structured Interviews ◽  
Shared Learning ◽  
Face To Face ◽  
Agents Of Change ◽  
Generic Qualitative

BackgroundAlthough all members of staff can be involved in improving the quality of maternity services, midwives can identify areas in need of improvement through their relationships with women and their families, and can influence care through activities such as crowdsourcing.AimsA service evaluation was undertaken to explore how midwives who attended the workshop viewed their involvement in crowdsourcing, and to examine whether midwives who attended the workshop considered themselves as agents of change for quality improvement in maternity care.MethodsA generic qualitative approach was selected. Data were collected using face-to-face, semi-structured interviews with six midwives who attended the workshop.FindingsFour key themes emerged from analysing the data: improving communication, experiencing different perspectives, shared learning, and positivity.ConclusionsInvolving stakeholders as a ‘crowd’ to find solutions to problems in care is successful and highly rewarding. Midwife participants took pride in sharing their ideas for improvement.

Follow-up of a cohort of patients with non-cystic fibrosis bronchiectasis for 1 year

2019 ◽  
Author(s):  
Simone Paulo Mateus ◽  
Raquel Esteves Brandão Salles ◽  
Walter Costa ◽  
Claudia Henrique da Costa ◽  
Agnaldo José Lopes ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cystic Fibrosis ◽  
Emergency Care ◽  
Poor Quality ◽  
Daily Activities ◽  
Progressive Damage ◽  
Telephone Contact ◽  
Face To Face

Abstract Background: Non-cystic fibrosis bronchiectasis (NCFB) leads to progressive damage that may limit a patient’s daily activities and modify his/her quality of life. Our objective was to evaluate the quality of life of patients with bronchiectasis during a 1 year follow-up using the EQ-5D-3L questionnaire. Methods: A total of 100 patients with NCFB were recruited and followed-up with face-to-face visits or by telephone contact every three months for 1 year. At the time of recruiting and at the end of 1 year, the EQ-5D-3L questionnaire was applied to evaluate the patients’ quality of life. Variables, such as exacerbation, emergency care, comorbidities, hemoptysis, colonization, and hospitalization were assessed. Results: Of the 100 patients, 99 patients completed the study and 72% were women. There were no marked limitations in the mobility and self-care domains during the follow-up. Thirty-two patients were extremely anxious or depressed at the end of the follow-up. The quality of life assessed using EQ-5D-3L had an initial mean score of 0.545 and of 0.589 after 1 year, which was statistically significant (p= 0.011). Conclusion: Patients with NCFB have a poor quality of life and the EQ-5D-3L questionnaire may be a tool for monitoring patients with bronchiectasis.

The quality of life after motorcycle traffic injuries: a cohort study in northwest of Iran

2020 ◽  
Author(s):  
Leili Abedi Gheshlaghi ◽  
Hamid Sharifi ◽  
Mehdi Noroozi ◽  
Mohsen Barouni ◽  
Homayoun Sadeghi-bazargan
Keyword(s):  
Quality Of Life ◽  
Estimating Equation ◽  
Demographic Variables ◽  
Generalized Estimating Equation ◽  
Factors Affecting ◽  
Face To Face ◽  
Rainy Weather ◽  
Northwest Of Iran

Abstract Background: Quality of life (QOL) after motorcycle accident is an important and dynamic concept but the conducted research about QOL's injured motorcyclists is much less. Therefore, in this study we investigated the QOL of injured motorcyclists up to three months after their accident and determining the associated factors.Methods: In present study, 190 injured motorcyclists who admitted at the two referral specialized hospitals (Emam Reza and Shohada) in Tabriz, between June 2018 and January 2019, and agreed to participate were included in the study. All injured motorcyclists were contacted through the telephone one and 171 of them (90%) three months after their accident to complete an EQ-5D-3L questionnaire. The baseline measurement (such as demographic variables, time and place of accident, vehicles and individuals), were gathered by using face to face interview in the hospitals. The QOL score in this study could vary between 1-3. The higher score showed the lower QOL. The Generalized Estimating Equation (GEE) models were used to determine the factors affecting these motorcyclists’ QOL .Results: The injured motorcyclist’s QOL was relatively better three months after the accident (mean ± Standard Deviation: 2.15 ± 0.65) in comparison with their status a month after the accident (mean ± SD: 1.78 ± 0.51) (p<0.001). The multivariable model showed that individuals whose pelvis (Coef: 0.29, (95% Confidence Intervals [CI]: 0.16, 0.42), P= 0.001) and knee (Coef: 0.26, (95% CI: 0.10, 0.42), P= 0.001) were injured, experienced a lower QOL. Also, those whose accident had happened in rainy weather experienced lower QOL (Coef: 0.33, (95% CI: 0.12, 0.53), P= 0.001). Those who were in an accident with a vehicle experienced a better QOL than others (Coef: -0.26, (95% CI: -0.43, -0.09), P=0.002).Conclusion: The results showed the QOL of the injured people was improving from the first follow-up to the second one. It is recommended that by designing multi-year cohort studies, the QOL of motorcyclists be assessed for a longer time in order to identify the effective factors that improve the QOL of injured motorcyclists.

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