Preoperative Imaging and Online Photo Galleries: The #Key to Surgical Commitment

Importance Preoperative imaging provides an advantageous balance by helping patients to effectively communicate their aesthetic desires while allowing surgeons to establish realistic expectations of surgical outcomes. Objective To determine the role of preoperative imaging and the importance of online-based photo galleries in influencing a patient's decision to pursue cosmetic facial plastic surgery. Design, Setting, and Participants A retrospective study was conducted on 100 patients who underwent preoperative imaging prior to undergoing aesthetic facial plastic surgery from July 2019 to May 2020. An in-office physician-led clinical consultation followed by a preoperative imaging session was performed on each patient prior to surgical intervention. A 6-question survey was provided once to all patients between their 3- and 12-month postoperative time periods. Main Outcomes and Measures The importance of preoperative imaging and the influence of physician website and social media photo galleries regarding surgical decision-making was evaluated. Results A total of 100 participants (female [90; 90%]) and mean age 52.6 (range, 18–77) years were included. Nearly 60% of patients underwent facial rejuvenation procedures. All reported that preoperative in-office physician consultation in combination with the use of preoperative imaging were helpful in facilitating a commitment to surgical intervention. Sixty-nine (69%) patients endorsed the use of both the frontal and lateral imaging views, while 30 (30%) deemed a single angle to be superior. Seventy (70%) participants utilized online-based “before & after” photo galleries in the form of physician websites and/or social media platforms to assist in their decision to undergo surgical intervention. Conclusions and Relevance The combination of in-office physician consultation, preoperative imaging, and availability of website and/or social media photo galleries plays a key role in a patient's decision to pursue cosmetic surgery. Thus, implementation of all facets should become an integral part of any facial plastic surgeon's aesthetic practice.

Attitude and Knowledge of Patients with Multiple Sclerosis (MS) About COVID-19 as Provided by Physicians

Background: Coronavirus disease 2019 (COVID-19) has become a pandemic, and patients receiving immunosuppressive agents could be at a higher risk of the infection. Patients’ knowledge and behavior play a major role in their health. Physicians should provide patients with enough information regarding medication use, prevention strategies, and treatment choices in case of infection. Objectives: This study aimed to evaluate the attitude and knowledge of Iranian patients with multiple sclerosis (MS) about COVID-19, as provided by physicians. Methods: A google form was designed, and the patients consented to fill out the survey. The participants’ basic characteristics were collected. Moreover, they were asked about COVID-19 transmission routes and prevention strategies, their concerns regarding MS-related checkups during the COVID-19 pandemic, COVID-19 infection tests, COVID-19 symptoms, and information they received from their physicians about what to do in case of COVID-19 infection. Results: Four hundred and ten forms were collected. The mean age of the patients and the mean duration of the disease were 34.5 ± 8 and 7.2 ± 5.7 years, respectively. Nearly 80% of the respondents believed that patients with MS were at a higher risk of COVID-19 infection, and 75% of them thought that wearing a face mask could prevent the infection transmission. Moreover, only 21% of 410 the physicians informed their patients of when to stop their medication if they were suspected to have COVID-19, and 22% of them informed their patients of where to refer in case of COVID-19 suspicion. Nearly half of all physicians prescribed immune-boosting supplements, such as selenium, zinc, and vitamin D. Conclusions: The results showed that Iranian MS patients had good knowledge regarding COVID-19 prevention strategies and transmission routes. However, they received less information from their physicians regarding medication use control, centers for admission, and physician consultation in case of COVID-19 infection.

Characteristics and Outcomes of Physician-to-Physician Telephone Consultation Programs: Environmental Scan

Background Telephone consultations between physicians provide quick access to medical advice, allowing patients to be cared for by calling physicians in their local settings. Objective As part of a quality assurance study of a physician-to-physician consultation program in Alberta, Canada, this environmental scan aims to identify the characteristics and outcomes of physician-to-physician telephone consultation programs across several countries. Methods We searched 7 databases to identify English publications in 2007-2017 describing physician-to-physician consultations using telephones as the main technology. To identify Canadian programs, the literature search was supplemented with an additional internet search. Results The literature search yielded 2336 citations, of which 17 publications were included. Across 7 countries, 14 telephone consultation programs provided primary care providers with access to various specialists through hotlines, paging systems, or call centers. The programs reported on the avoidance of hospitalizations, emergency department visits and specialty visits, caller satisfaction with the telephone consultation, and cost avoidance. Conclusions Telephone consultation programs between health care providers have facilitated access to specialist care and prevented acute care use.

Patients Seeking Retreatment after Community Paramedic Assessment and Treatment: Piloting a Community Paramedic Unit Program in Southwest Finland

Community paramedic (CP) units are becoming more popular in enhancing a person’s access to the need for care assessment and treatment in acute but non-life-threatening health issues. Simultaneously CP units can reduce the strain on emergency departments (EDs) by treating patients effectively at home. The efficacy of CP units is proven in previous studies, but the details of conditions patients seek retreatment at the ED after a CP unit visit are largely unknown. This study aimed to categorize CP unit patients (n = 229) seeking retreatment after a CP unit visit and investigate links between CP unit actions and patients seeking retreatment. The study was based on a data set from a six-month CP unit pilot program in Finland. The main results show that 82% of the patients assessed and treated by the CP unit did not seek retreatment. Low back symptoms and nausea were the main problems patients presented to the ED within 96 h after the CP visit. On-call physician consultation (p = 0.335) or CP unit treatment time (p = 0.629) were not associated with the frequency of ED presentation. Further studies are needed in order to investigate which types of emergency medical missions are the most suitable for CP units. The findings of this study support the effectiveness of community paramedicine programs.

Changing Pattern of Shingles (Herpes Zoster) in Hill Tracts: A Study among Tribal Community of Bangladesh

Background: Herpes zoster infection (shingles) is a common painful disease in Bangladesh. Changing pattern of the disease presentation can cause delayed diagnosis, inappropriate treatment, prolongation of the disease with debilitating symptoms and post herpetic neuralgia. Objective: The study was done to evaluate the different changing clinical and dermatome pattern of shingles among tribal community in Hill tracts of Bangladesh. Materials and method: This descriptive hospital based study was carried out among 74 shingles patients using simple, direct, standardized questionnaire with history, clinical and dermatological examination from July 2015 to July 2016 in Rangamati General Hospital, Rangamati, Bangladesh. Results: August to October was the vulnerable period for Shingles (75.7%) with highest number of cases found in September (32.4%). Rural area (70.2%) is vulnerable than urban area. Lumbar region (39.1%) is the commonest dermatome involved during examination. Itching was the commonest complaint (41.9%) for physician consultation and 15% cases suffered reactivation within six months in the same dermatome region. Conclusion: As changing and different pattern of manifestations are common in shingles in Hill Tracts, these are to be considered by local and consultant physicians in the total management to decrease delayed complications and reactivation. Delta Med Col J. Jul 2019 7(2): 56-60

Pictures Do Influence the Decision to Transfer: Outcomes of a Telemedicine Program Serving an Eight-State Rural Population

Triaging burn patients is a daunting task because burn injuries are rare; this inexperience leads to uncertainty in treatment and referral algorithms. Our regional burn center’s catchment area includes eight states. Outlying facilities consult via telephone through the medical center’s transfer center. Referring provider assessments of depth or size of injury infrequently correlates with burn provider’s assessments. This causes over- and under-triage of patients managed outside of burn centers. A quality improvement telemedicine project was developed to allow burn providers to review photos with referring providers to determine best management, provide pertinent education, and initiate appropriate and timely resuscitation. Details tracked include date of service, consulting provider, follow-up education offered, and whether the image reviewed changed or confirmed the requested plan of care. Of the 155 cases between January 2017 and August 2018, 24.5% of patient images changed the initial transfer decision, and 75.5% confirmed the initial plan of care. Of the cases requiring change of plan, 60.5% were down-triaged to outpatient care and 39.5% were up-triaged to transfer. Implementation of this telemedicine program has increased efficiency of resource utilization, timely resuscitation, appropriate transfer of patients requiring admission, and real-time education. Findings suggest advanced practice providers’ assessments are similar to those of referring physicians. These observations may have significant implications on Emergency Medical Treatment and Labor Act (EMTALA) guidelines defining physician to physician consultation and support efficient use of available resources. Telemedicine facilitates access to specialized care and improves fiscal responsibility.

Characteristics and Outcomes of Physician-to-Physician Telephone Consultation Programs: Environmental Scan (Preprint)

BACKGROUND Telephone consultations between physicians provide quick access to medical advice, allowing patients to be cared for by calling physicians in their local settings. OBJECTIVE As part of a quality assurance study of a physician-to-physician consultation program in Alberta, Canada, this environmental scan aims to identify the characteristics and outcomes of physician-to-physician telephone consultation programs across several countries. METHODS We searched 7 databases to identify English publications in 2007-2017 describing physician-to-physician consultations using telephones as the main technology. To identify Canadian programs, the literature search was supplemented with an additional internet search. RESULTS The literature search yielded 2336 citations, of which 17 publications were included. Across 7 countries, 14 telephone consultation programs provided primary care providers with access to various specialists through hotlines, paging systems, or call centers. The programs reported on the avoidance of hospitalizations, emergency department visits and specialty visits, caller satisfaction with the telephone consultation, and cost avoidance. CONCLUSIONS Telephone consultation programs between health care providers have facilitated access to specialist care and prevented acute care use.