EP.WE.20At a glance: the impact of COVID-19 on Emergency General Surgery

Aim This study investigated the impact of COVID-19 on emergency general surgery practice, in a district general hospital in the United Kingdom, particularly on referrals, diagnosis, investigations, management pathways, outcomes, patient behaviour and consultant practice. Methods Retrospective data collection from two cohorts: 112 patients admitted over one week in pre-COVID period and 90 patients admitted over one week during the COVID period. We used patient questionnaire and a consultant questionnaire to collect data on patient behaviour and consultant practice. Results Almost four times and seven times increase in performed X-rays (CXRs)and CT-thorax-abdomen-pelvis (TAPs) respectively. The COVID period saw 6.5% increase in conservative and 6.2% reduction in surgical management, and about 50% decline in length of stay (LoS) in conservatively managed patients. 71% of patients’ decisions to attend hospital were not affected and 78.6% of consultant surgeons preferred to manage patients conservatively during the COVID period. Conclusion Overall, there were delayed patients’ presentations to hospital at almost twice, increase in paediatric referrals, a surge in performed scans, and a reduction in hospital stay in patients who were managed conservatively. Patient behaviour to attend hospital was not heavily influenced by COVID, but consultant practice certainly changed towards more conservative choices. Future studies should explore the impact on paediatric referrals and long-term effects on surgical training. This study's manuscript has been accepted for publication in the Surgical Practice Journal.

Expectations and behaviour of older adults with neurological disorders regarding general practitioner consultations: an observational study

Background Patients’ relationship with their GPs is linked to adherence, patient behaviour and satisfaction with healthcare. Several factors pertaining to this relationship have already been identified, however expectations and preferences vary depending on age and diagnosis. Chronically ill elderly patients constitute a group of patients with specific needs that are not yet understood. Methods For this observational study, 100 (44 female, mean age 72.72 + − 8.28 years) patients were interviewed. Multiple linear or binary logistic regression as well as analysis of variance was used to understand the link between factors pertaining to GP relationship and patient behaviour, and principal component analysis was performed to understand the underlying structure of patients’ needs. Results Patients attribute high importance to their GP’s opinion of them. On average, what the GP thinks about the patients is almost as important as what their partners think. Patients primarily want to be perceived as engaged, friendly and respected individuals, and it is important for patients to be liked by their GP. This importance is linked to active preparation; 65% of the patients prepared actively for GP consultations. Expectations regarding GP consultations can be split into two components: a medical aspect with a subfactor concerning emotional support, and a social component. Prominent factors influencing the relationship are the possibility to talk about emotions and mental well-being, trust, and GP competency. Satisfaction and trust were mainly linked to medical competency. Being able to show emotions or talk about mental well-being enhances perceived GP competence, satisfaction, and active patient preparation. However, a focus on the social component such as frequent talking about private topics reduces both perceived GP competency as well as active patient preparation. Conclusion Older patients take GP consultations seriously, and their expectations regarding GP consultations focus on medical competence and care as well as empathetic listening and understanding. Older persons seek a deeper connection to their GPs and are willing to be active and cooperative. As the patient–GP relationship influences health outcomes, treatment of older patients should be adjusted to enable this active participation.

Obedience to collaboration: compliance, adherence and concordance

A literature review was conducted to ascertain the historical and current use of the terms ‘compliance,’ ‘adherence’ and ‘concordance’ in relation to prescribing. Although there is agreement that compliance is not appropriate in the context of patient behaviour, it is still used. The implications for clinician-patient relationship and engagement are considered. The competencies that guide prescribing practitioners in the United Kingdom embrace concepts of adherence and concordance but do not mention ‘compliance’. Caution is given against changing vocabulary only.

Mistreatment by patients: An analysis of the patient-related social stressors among Slovenian healthcare workers

Introduction Healthcare workers (HCWs) are often exposed to mistreatment by patients, which has negative effects on both staff and institutions. To take appropriate action to help HCWs in this context, patient-related social stressors (PSS) should be explored. The purpose of the research was to identify the most pronounced patient behaviour contributing to the social stress (SS) of HCWs, and compare PSS between different HCWs and different types of healthcare institutions. Methods 750 HCWs from Slovenian public health centres and hospitals participated in the online survey. Although the non-probability sampling was used, the sample was representative according to gender and HCW type (doctors, nurses and other HCWs). Results The results show that the most pronounced patient behaviour contributing to the SS of HCWs are attitudes and behaviour of patients that are challenging in terms of what is – from the HCWs’ point of view – considered as acceptable and reasonable (disproportionate patient expectations), and unpleasant, humourless, and hostile patients. HCWs in primary institutions meet less verbally aggressive and unpleasant patients than in tertiary ones. Although among all HCWs less educated ones are more exposed to inappropriate behaviour, doctors are those HCWs who experience more inappropriate behaviour. Conclusion Managers should enable HCWs to get comprehensive patient service training, oriented towards improving relationship management and patient-HCW relationships.

Non-adherence in difficult-to-treat rheumatoid arthritis from the perspectives of patients and rheumatologists: a concept mapping study

Objectives Treatment non-adherence is more frequent among difficult-to-treat (D2T) than among non-D2T RA patients. Perceptions of non-adherence may differ. We aimed to thematically structure and prioritize barriers to (i.e. causes and reasons for non-adherence) and facilitators of optimal adherence from the patients’ and rheumatologists’ perspectives. Methods Patients’ perceptions were identified in semi-structured in-depth interviews. Experts selected representative statements regarding 40 barriers and 40 facilitators. Twenty D2T and 20 non-D2T RA patients sorted these statements during two card-sorting tasks: first, by order of content similarity and, second, content applicability. Additionally, 20 rheumatologists sorted the statements by order of content applicability to the general RA population. The similarity sorting was used as input for hierarchical cluster analysis. The applicability sorting was analysed using descriptive statistics, prioritized and the results compared between D2T RA patients, non-D2T RA patients and rheumatologists. Results Nine clusters of barriers were identified, related to the healthcare system, treatment safety/efficacy, treatment regimen and patient behaviour. D2T RA patients prioritized adverse events and doubts about effectiveness as the most important barriers. Doubts about effectiveness were more important to D2T than to non-D2T RA patients (P = 0.02). Seven clusters of facilitators were identified, related to the healthcare system and directly to the patient. All RA patients and rheumatologists prioritized a good relationship with the healthcare professional and treatment information as the most helpful facilitators. Conclusions D2T RA patients, non-D2T RA patients and rheumatologists prioritized perceptions of non-adherence largely similarly. The structured overviews of barriers and facilitators provided in this study may guide improvement of adherence.

Associated Of Nurses Motivation With Implementation Of Nurses Therapeutic Communications In Mitra Medika Hospital Medan

Background: Communication is a tool for nurses to influence patient behaviour in implementing nursing care. Communication can be done verbally or non-verbally. Verbal means words both orally and in writing, while non-verbal means without words. Objective: This study aimed to determine the relationship between Nurse Motivation and the Application of Therapeutic Communication for Nurses in the Inpatient Room of Mitra Medika Hospital, Medan, in 2020. Method: This study used an analytic survey research design with a cross-sectional approach, using the continuity correction test. The population in this study were nurses who worked at Mitra Medika Hospital Medan by totaled 74 respondents. The sample wer takem from all numbers of population by using total population. The type of data was primary data. The data analysis was univariate analysis and bivariate analysis. Results: there was a relationship between the motivation of nurses and the application of therapeutic communication by nurses in Mitra Medika Hospital Medan in 2020 with p-value = .003. Conclusion: relationship between the motivation of nurses and the application of therapeutic communication by nurses in Mitra Medika Hospital Medan in 2020.