Delayed referral for orchidopexy: Scrutinising the causes

Orchidopexy for undescended testis is recommended at a younger age than heretofore; our study aimed to assess delays, and their causes, by retrospective analysis of data from a single tertiary care centre over one year (2015–2016). Almost 80% of children were brought after 1 year of age, mostly because of delayed referral by primary physicians (60%), or missed diagnosis by parents or primary physicians (20%). Misconception about the risk of surgery below 1 year was significant (15%). A timely referral is encouraged.

Management of Low Back Pain in Primary Healthcare Settings: Physician’s Knowledge and Practices Based on Red Flags of Low Back Pain in Jazan Region – A Cross-sectional Study

Introduction: This study assessed the primary healthcare physicians’ knowledge and practices toward the red flags of low back pain (LBP) and factors associated with awareness. Methodology: This cross-sectional study was conducted between October 2020 and June 2021 in primary healthcare (PHC) settings in Jazan, Kingdom of Saudi Arabia. Questionnaires were electronically distributed among 261 primary physicians with a 96.1% response rate. Result: Of the 261 physicians included, 56% were male, 49.4% were aged between 35 and 44 years, and 76.9% were non-Saudi. Moreover, 49% of the physicians had one to nine years of experience and 33.1% indicated that they deal with >30 patients with back pain per month. Furthermore, it was found that 86.9% of the participants were aware of the overall red flags of LBP. Job category and the number of cases were significant factors of perceived awareness. The highest level of self-reported awareness was among consultants. The rate of referral patients with nonspecific back pain was highest among general practitioners. More than 95% of the participants would refer patients to hospital if they noticed the presence of red flags for LBP. Conclusion: Awareness of physicians practicing in PHCs through the red flags of LBP in Jazan is good, and recognition of the need for the referral of a patient with suspected critical illness is good as well.

Luxembourg

This chapter offers an in-depth look at health politics and the compulsory health insurance system in Luxembourg, which historically was based on a long tradition of mutual aid society funds, as well as coverage by the large company fund of the main employer in the previously dominant steel sector. An unusually high proportion of the compulsorily-insured in Luxembourg are cross-border commuting workers. The chapter traces the development of the Luxembourgish healthcare system, characterized by its consensual mode of decision-making, the Quadripartite, which tends to rule out radical change. Since the early 1990s, health policy reform efforts have focused on consolidating the plurality of sickness funds into a unified scheme, introducing direct third-party payment for low-income persons, and efforts to introduce a highly controversial gatekeeping function for primary physicians. Other healthcare issues have been long-term care, cost containment, as well as assisted suicide, which caused a constitutional crisis.

Awareness of Dysphagia in Hospitalized Patients and Its Impact

Background and aims: Acute illness might affect the swallowing function. However, there have been limited studies regarding dysphagia awareness in hospitalized patients, factors associated with dysphagia, and its outcomes. Methods: Consecutive patients in an internal medicine ward whom primary physicians prescribed oral diet were prospectively evaluated their swallowing problems by using a water swallow test (WST) and swallowing disturbance questionnaire (SDQ) within 48 hours after admission. Patients characteristics, nutritional status, readmission, and mortality rates were evaluated and compared between patients with and without impaired swallowing. Results: Among 131 enrolled patients (61 males, mean age 58±21 years), 20 patients (15.3%) had abnormal SDQ and 38 patients (29%) had abnormal WST. 19/20 patients with abnormal SDQ had abnormal WST while 19/38 patients with abnormal WST (50.0%) had abnormal SDQ. Patients with swallowing problems by either abnormal SDQ or WST were significantly older than those without (p<0.05). After adjusting for age, underlying neurological disorders (OR 2.96, 95%CI 1.03-8.47; p=0.04), admission diagnosis of pneumonia (OR 5.29, 95%CI 1.47-19.0, p=0.01), and moderate-to-severe malnutrition (OR 4.14, 95%CI 1.67-10.3, p=0.002) were significantly associated with abnormal WST, while malnutrition (OR 9.88, 95%CI 2.36-41.4; p=0.002) was independently associated with abnormal SDQ. For the follow-up period of 14 months, five patients (26.3%) who had abnormal SDQ/WST had aspiration pneumonia and 2 of them died while one patient with normal SDQ and WST (0.9%) had aspiration pneumonia (p<0.001). Conclusion: Dysphagia is an underrecognized problem in hospitalized patients. This problem was associated with underlying neurological diseases, malnutrition, the current diagnosis, and readmission due to pneumonia. Screening for dysphagia is recommended in hospitalized patients, particularly in patients at risk.

Pathway to Holistic Care of Psychiatric Illness in National Servicemen Presenting in Primary Healthcare

This is a case study of a 22-year-old National Serviceman presenting with the main complaint of insomnia. This case demonstrates possible gaps in the integration of care between public and National Service healthcare. We illustrate a pathway which primary physicians may use to improve communication with National Service healthcare.

How Are We Managing Patients with Hyperuricemia and Gout: A Cross Sectional Study Assessing Knowledge and Attitudes of Primary Care Physicians?

Background: Studies show that hyperuricemia is an element of the pathophysiology of many conditions. Therefore, the aim of this study was to assess primary care physicians’ knowledge and attitudes toward asymptomatic hyperuricemia and gout management. Methods: A survey-based cross-sectional study was conducted to assess the primary physicians’ attitudes, knowledge, and patient management regarding hyperuricemia and gout. Results: A total of 336 primary care physicians were included. Physicians who read at least one scientific paper covering the topic of hyperuricemia in the past year scored significantly higher in knowledge questions (N = 152, 6.5 ± 2.05 vs. N = 183, 7.04 ± 2.14, p = 0.019). Only around half of physicians correctly identified drugs that can lower or elevate serum uric acid levels. Furthermore, the analysis of correct answers to specific questions showed poor understanding of the pathophysiology of hyperuricemia and possible risk factors. Conclusions: This study identified gaps in primary care physicians’ knowledge essential for the adequate management of patients with asymptomatic hyperuricemia and gout. As hyperuricemia and gout are among the fastest rising non-communicable diseases, greater awareness of the available guidelines and more education about the causes and risks of hyperuricemia among primary care physicians may reduce the development of diseases that have hyperuricemia as risk factors.

Perceived Barriers to Primary Care Services Utilization and its Associations with Overall Satisfaction of Patients in Saudi Arabia: A Cross-Sectional Questionnaire-Based Study

Introduction: Primary care plays an integral role in modern healthcare systems. More so in a country that is currently undergoing a reform of its health system. Their remains barriers that hinder patients from seeking medical assistance from primary physicians. This study aims to examine the overall satisfaction of patients toward Primary Healthcare Centers (PHCs) in Saudi Arabia, as well as its association with potential barriers from a sample of patients who presented at the emergency department (ED) for non-urgent cases. Methods: This cross-sectional study sampled 403 patients from King Fahd Hospital of the University. A piloted questionnaire was utilized that included questions on sociodemographics, satisfaction of PHCs, as well as organizational, socioeconomic, access, and patient-doctor relationship barriers using a Likert-scale item response. Chi-squared and Fisher’s Exact tests were used to compare categorical variables, and multivariable logistic regression was used to assess the association between overall satisfaction and all factors and barriers. Results: The sample consisted of 48.1% males and 51.9% females. Only 5.2% of the patients were hospitalized. Of the total sample, 28.3% reported being always satisfied with PHC services. The most reported barriers were organizational barriers and socioeconomic barriers. The regression analysis found that being a female, highly educated, have high organizational, and patient-doctor relationship were independent predictors for low overall satisfaction with PHCs. Conclusion: Findings from this study should allow healthcare planners and policy makers to reduce the impact of these barriers by finding solutions that would target them. This may include strictly implementing policies such as proper implementing of triaging in EDs as well as promoting services that are being provided free of charge at these centers.

Separate Consent for Anesthetic Practice: Need of the Moment

Decades of refinement and modifications have led the modern anaesthetic practice to be conducted so smoothly and safely, that sometimes we take for granted the enormous amount of risks involved with it. Furthermore, with the evolution of monitoring techniques, and discovery of safer drugs, anesthesia has facilitated the conduction of complex surgeries on sicker patients, and older patients. The expansion to critical care and pain management services has added another dimension to this field, with anesthesiologists not just working as facilitators for another procedure, but acting as primary physicians. Anesthesiologists are among the few clinicians, who are involved in patient morbidity and mortality in their daily routine. With the ever-changing ethical and legal background, the significance of obtaining a separate consent for anesthesia needs to be timely evaluated. In this review, we have discussed the significance of a separate consent for anesthesia and highlight its various aspects.

Correction of neonatal auricular deformities with DuoDERM: A simple technique

Ear moulding in neonates has been shown to successfully correct congenital auricular anomalies. There are several available moulding techniques. However, commercially available moulding devices (e.g., EarWell and Ear Buddy) can be costly, and their alternatives have limited customizability. We present a technique using cost-effective and customizable materials for moulding common anomalies (Stahl’s ear, constricted ear, and prominent ear). DuoDERM Extra-thin, Steri-strips, and 3M Kind Removal Silicone tape are used to splint the ear in a preferred position. The DuoDERM is rolled into a putty, placed in the ear, and secured with tapes. This treatment is initiated in the clinic, with weekly splint changes carried out at home by caregivers, and intermittent follow-up appointments. DuoDERM moulding is a safe, inexpensive, highly customizable, and simple way to correct auricular deformities. Primary physicians/paediatricians should embed moulding into their practice, starting treatment as early as possible in the neonatal period.