The impact of Victorian COVID-19 lockdowns on the presentation and management of acute appendicitis.

BACKGROUNDS: The COVID-19 pandemic presents ongoing challenges for healthcare. Stay at Home orders ('lockdowns') and community fears have been suggested to create reluctance to seek healthcare. We aimed to determine whether the rates of perforated appendicitis and negative appendicectomy have been affected by the pandemic, and to analyse the effect of lockdowns on the management of acute appendicitis in Victoria. METHODS: We conducted a retrospective audit of emergency appendicectomies performed under adult General Surgery units at Monash Health in Victoria from January 2019 to September 2021, including 242 days of lockdown. RESULTS: 2459 patients were included. Fewer patients had perforated appendicitis during the second lockdown (6.3% versus 10.7% baseline; p = 0.027). The rate of negative appendicectomy was reduced during the first lockdown (4.1% versus 14.9% baseline; p = 0.002) and during intervals between lockdown in 2021 (9.8%; p = 0.010). There was no difference in the rate of perforated appendicitis or negative appendicectomy at other times. Time to surgery and number of appendicectomies performed were also not significantly different. Fewer appendicectomies were performed after hours during lockdowns and in 2021 more generally compared to baseline (p < 0.05). CONCLUSION: The lower negative appendicectomy rate during the first lockdown may reflect increased pre-operative imaging or clinical observation for undifferentiated presentations. There was a reduction in perforated appendicitis during the second lockdown, and no significant difference at other times. Contrary to other studies, lockdowns associated with the COVID-19 pandemic may not create a reluctance to seek healthcare in all regions.

Life, liberty and the therapeutic relationship: examining the place of compulsory treatment in modern psychiatry.

OBJECTIVES: Compulsory treatment in psychiatry is controversial and its use has been increasingly critiqued following the United Nations Convention on the Rights of Persons with Disabilities in 2006. This essay seeks to explore whether the restriction of personal liberty and autonomy that compulsory treatment requires can be justified on ethical or medical grounds. CONCLUSIONS: Compulsory treatment is not without potential harms to the doctor-patient therapeutic relationship and patient engagement with mental health services. However, we contend that the clinical and societal benefits of compulsory treatment justify its practice and that, paradoxically, compulsory treatment is necessary for the restoration of a patient's autonomy rather than its dispossession.

Medical scribes have no impact on the patient experience of an emergency department.

OBJECTIVE: We aimed to evaluate patient perceptions of medical scribes in the ED and to test for scribe impacts on ED Net Promoter Scores, Press Ganey Surveys and other patient-centred topics. METHODS: Exploratory semi-structured interviews were conducted in the ED during wait times after scribed consultations. Interview results were used to derive topics relating to scribes. Items addressing these topics from validated surveys were combined with items from widely used patient satisfaction questionnaires. Questionnaires were administered in the ED by face-to-face approach while patients were waiting for admission/discharge or test results. Patients and doctors were blinded to the purpose of the questionnaire. The survey evaluated for non-inferiority of scribed consultations, using Net Promoter Scores, Press Ganey questions and questions specific to the presence of the scribe. RESULTS: Patient interviews did not identify any negative views regarding the presence of scribes during consultations. Thematic saturation was achieved after seven interviews. Two hundred and fifty-eight patients were approached to complete the questionnaire, and 215 participated (83%); 95 and 118 participants in the scribed and non-scribed groups, respectively. There was no difference between scribed and non-scribed consultations on the following measures of satisfaction: the Net Promoter Score, Press Ganey questions, quality of information received from doctors, communication, privacy concerns or inhibition about revealing private information and room crowding. CONCLUSION: We found no evidence that scribes reduce patient satisfaction during emergency consultations, nor prompt discomfort that might cause a patient to withhold information.