Awareness, Perceptions and Beliefs About Physiotherapy Profession Among Orthopedists and Neurosurgeons Working in the Main Hospitals of the Ministry of Health in Gaza Strip

Background: - Healthcare professions have rapidly developed due to advancements in technology along with innovations over years, and Physiotherapists are considered as a key-member of collaborative inter-professional teams due to their broad scope of practice. - Increasing disabilities in Palestine due to occupation and other reasons, life expectancy and the special circumstances made it one of the most imperative socioeconomic medical issues in Gaza Strip. This emphasizes the need for the development and recognition of physiotherapy in multidisciplinary healthcare structures. - In order to deliver effective care, communication, cooperation and agreement between physicians and physiotherapist is essential. - If a physician were well informed about physiotherapy abilities in helping the treatments, prevent complications and decrease hospital stays, that would decrease the burden on the healthcare system. - Lack of knowledge about physiotherapy among medical professionals affects several aspects, including patients, the role of physiotherapy as a part of the healthcare teams, and the outcomes. Objectives: - The aim of the study was to identify awareness, perception and believes about physiotherapy among orthopedists and neurosurgeons. Methods: - A cross-sectional study was conducted between January – June 2019 at the three main hospitals of the Ministry of Health in Gaza Strip. The study population included Orthopedists and Neurosurgeons who work according to the settings. - The total collected samples were 67, and participants of the study were recruited through a Non-Probability convenience sample. - Data was collected through a questionnaire, that was designed in English, with four main parts, a total of 30 items, then data analysis using the (SPSS-V.22) and several statistical operations were done including Cross tabulation using chi-squarer with significance value was defined as p≤0.05. Results: - Results of this study showed that the awareness of orthopedists and neurosurgeons about physiotherapy was 95.5%. The study showed that 54.7% of these physicians received their knowledge through their studying. The study showed that 78.1% of physicians believe that the intervention of physiotherapy is in therapeutic exercises, while 57.8% believe that the biggest intervention is the use of electrical modalities, and 60.9% believe that it is manual therapy. The study found that 96.9% of physicians believe that physiotherapy plays an important role in the treatment plan for the patient. And 71.9% of the physicians believe that the physiotherapist has the right to return the patient to the physician due to misdiagnosis. The study indicated that 90.6% of physicians believe it is important to discuss the patient's discharge with a physiotherapist, and shocking result was that 95.3% of physicians say that they write on the referral what should a physiotherapist do to a patient, and that is a huge violation of the physiotherapists right of making their own decision. Conclusions: - There is a close association between orthopedists and neurosurgeons about physiotherapy. The study has shown that they have a clear awareness, perception and beliefs about physiotherapy. - This relationship should be supported and developed to provide the best possible treatment to patients

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children <18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p<0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p<0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p<0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Recent advances in the management of priapism [version 1; referees: 2 approved]

Priapism is an uncommon urological emergency that can lead to permanent impotence if prompt presentation and medical intervention is not performed. It is a breakdown of the usual physiological mechanisms controlling penile tumescence and detumescence, leading to a prolonged penile erection (>4 hours) that is unrelated to sexual stimulation. Currently, there are three accepted subtypes: ischaemic, non-ischaemic, and stuttering priapism, which is also known as recurrent ischemic priapism. The aim of treatment is the immediate resolution of the painful erection and the preservation of cavernosal smooth muscle function in order to prevent cavernosal fibrosis, which can lead to penile shortening and permanent erectile dysfunction

Treatment of carcinoma in situ of the glans penis with topical chemotherapy agents

Background: The use of topical agents in the treatment of carcinoma in situ (CIS) of the penis has been well described in the literature. Previous studies have been limited by small sample size and imprecise end points. Objective: Establish the response rate of 5-fluorouracil (5-FU) and imiquimod (IQ) in the treatment of penile CIS in a large contemporary series in a supranetwork centre. Design, setting, and participants: Retrospective review of all primary and recurrent cases of penile CIS treated with 5-FU and IQ identified from a prospective database over a 10-yr period. Therapy was standardised in all cases with application to the lesion for 12 h every 48 h for 28 d. Intervention: 5-FU was the first-line therapy, and IQ was the second-line topical agent. Outcome measurements and statistical analysis: The primary end point was defined as complete response (CR; ie, resolution of lesion), partial response (PR; ie, lesion reduced in size and or visibility), or no response (NR; ie, no improvement in lesion size and or visibility). The secondary end points included local toxicity and adverse events. No statistical analysis or software was used. Results and limitations: A total of 86 patients were diagnosed with CIS of the penis over the 10-yr period. Forty-four (51%) received topical chemotherapy. The mean follow-up was 34 mo. CR to topical chemotherapy was seen in 25 (57%), PR was seen in 6 (13.6%), and NR was seen in the remaining 13 (29.5%) patients. Local toxicity was experienced by 10% of patients, and 12% had an adverse event following application of 5-FU. The retrospective design and short follow-up were the major limitations of this study. Conclusions: Topical chemotherapy agents are moderately effective first-line therapy in the treatment of penile CIS. Toxicity and adverse events were few with our treatment protocol. The issues of long-term surveillance and assessment of partial responders remain a challenge. Topical chemotherapy should remain a first-line treatment option for penile CIS. © 2012 European Association of Urology.Link_to_subscribed_fulltex