RSS 1.0Walsall Healthcare NHS Trust
Walsall Healthcare NHS Trust provides local general hospital and community services to around 260,000 people in Walsall and the surrounding areas. We provide high quality, friendly and effective community health services from some 60 sites including health centres and GP surgeries. Covering Walsall and beyond, our multidisciplinary services include rapid response in the community and home-based care, so that those with long-term conditions and the frail elderly, can remain in their own homes to be cared for. Walsall Manor Hospital is an acute general hospital that has 550 acute beds and provides a wide range of services, including a 24-hour Urgent and Emergency Care Centre. Our Vision is, “To deliver exceptional care together to improve the health and wellbeing of our communities”. This community represents the research outputs of the entire Trust. The research is arranged under the existing organisational structure of the Trust.
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Recent Submissions
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QIP presentation – antibiotics prescription for community acquired pneumoniaNo abstract available.
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Hybrid closed loop insulin therapy versus standard therapy in pregnant women with type 1 diabetes: a systematic review and meta-analysis of randomized controlled trialsObjective: We aimed to explore the efficacy and safety of hybrid closed loop (HCL) systems compared to standard care (SC) in pregnant women with Type 1 Diabetes Mellitus (T1DM), pooling results from randomized controlled trials (RCTs). Data sources: We searched through multiple databases like PubMed, Cochrane, Embase, Web of Science, and Clinicaltrials.gov etc. from inception to September 2024 and found six relevant studies after screening. Study eligibility criteria: We included studies that were (1) RCTs; with patient population (2) pregnant patients with type 1 diabetes; intervention group receiving (3) HCL and control group receiving (4) SC; while reporting (5) outcomes of interest (endpoints). We pooled results pertaining to primary outcomes; time in range (TIR), nocturnal time in range (nTIR), and HbA1c; and relevant secondary outcomes. Study appraisal and synthesis methods: We used Rob 2: A revised Cochrane risk-of-bias tool for randomized trials for quality assessment of the included RCTs. We employed the DerSimonian-Laird random effects model using review manager 5.4 to analyze the pooled estimates and reported results as risk ratio; for dichotomous outcomes; or mean difference; for continuous outcomes. Results: Five RCTs (n = 274) with disparate populations were narrowed down for analysis. Pooled estimates for TIR (MD 4.95 %;-0.56 to 10.49)and HbA1c% (MD 0.09; -0.44 to 0.63) were statistically non-significant, while estimates for nTIR (MD 11.16 %; 7.15 to 15.15), % time < 63 mg/dL (MD -0.78; -1.36 to -0.20), % of time < 54 mg/dL (MD -0.22; -0.40 to -0.03), low blood glucose index (LBGI) (MD -0.30; -0.54 to -0.06), and glucose standard deviation (MD -3.05; -6.06 to -0.04) favored HCL over SC. No significant between-group differences were found in other secondary outcomes: % of time >140 mg/dL, % of time >180 mg/dL, mean glucose level, rate of serious adverse events, cesarian delivery, and severe hypoglycemia. Conclusions: HCL systems can improve glycemic control in pregnant women with T1DM with a tolerable adverse event profile, however more research is needed to draw a definitive conclusion.
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Evaluating the accuracy of android applications in monitoring environmental noise levelsObjective This study aimed to evaluate the accuracy of Android applications (apps) in measuring environmental noise levels, focusing on their potential use for occupational health assessments. Methods The top 10, highly rated, free Android apps were tested on a Samsung Galaxy A54 Smartphone (Samsung Group, Samsung Town, Seoul, South Korea) using pure tones at 100 Hz, 2000 Hz, and 4000 Hz, across four noise levels (25 dB, 40 dB, and 85 dB). Measurements were compared with a calibrated Precision Gold N09AQ environment meter (Maplin Electronics Ltd, Wath-Upon-Dearne, United Kingdom) in a controlled room. Data were analyzed using linear regression to determine R2 values for each app. Results The control meter showed the highest accuracy (R2 = 0.99). SPL Meter dB and sound Meter (KTW apps, Petaling Jaya, Selangor, Malaysia) and Sound Meter (Pony AI Inc.,Guangzhou, Guangdong, China) had the best performance (R2 = 0.98). Accuracy declined at higher noise levels, with Sound Meter (ABC Apps) showing the least accuracy (R2 = 0.85). User ratings did not correlate consistently with app performance. Conclusion Android apps offer potential as affordable noise measurement tools, with some apps demonstrating high accuracy at lower decibels. However, limitations such as reduced accuracy at higher decibels and lack of A-weighting for regulatory compliance hinder their use in professional settings. Further development and real-world testing are needed.
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DIVERT-Ca: unveiling the hidden link between acute diverticulitis and colorectal cancer risk-multicentre retrospective studyIntroduction: Colorectal cancer (CRC) is the third most common cancer worldwide, accounting for approximately 10% of all malignancies. Emerging trends of association with risk factors such as diverticulitis highlight the need for updated screening and follow-up protocols. We aimed to examine risk factors associated with the development of CRC within 12 months following an episode of acute diverticulitis, and identify areas to streamline follow-up. Methods: We performed a retrospective multicentre study of adult patients admitted in 2022 with computed tomography (CT) confirmed acute diverticulitis across four large NHS Trusts in the UK. Patient demographics, comorbidities, clinical presentation, vital signs, laboratory results, details of in-patient stay, and follow-up investigations were collected and analysed. Our primary outcome was the incidence of CRC within 12 months of index presentation with acute diverticulitis. Analysed secondary outcomes were potential patient risk factors associated with a diagnosis of CRC and follow-up protocols. All statistical analysis was performed using R (version 4.4) and P-values of < 0.05 were considered statistically significant. Results: A total of 542 patients with acute diverticulitis over the study period were included. The median age of our cohort was 62 (51-73) years, and 204 (37.6%) were male. Ten (1.8%) patients were diagnosed with CRC within the 12-month period. Hinchey grade Ib was significantly associated with CRC (OR 4.51, P = 0.028). Colonoscopic follow-up requests were associated with age between 40 and 60 years, mild white cell count (WCC) elevation, and a hospital stay of 3-7 days. Male gender, age between 18 and 40 years, and elevated C-reactive protein (CRP) were all strongly associated with CRC but not statistically significant. Follow-up was inconsistent with 53.7% of the cohort having luminal investigations. Conclusion: The incidence of CRC was in-keeping with published literature. Hinchey grade 1b was significantly associated with a subsequent CRC diagnosis. These findings emphasise the need for specialised radiological review of CT scans to detect underlying malignancy. Moreover, standardised follow-up protocols following an episode of acute diverticulitis are needed to avoid missing malignant lesions.
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SIMBA: online simulation for teaching medical cases to preclinical students - a pilot studyBackground: Medical education employs diverse teaching strategies, including blending lecture-based learning, small-group teaching (SGT) and, increasingly, simulation-based learning. Nonetheless, limitations in clinical application and participation persist. Simulation via Instant Messaging for Bedside Application (SIMBA) complements these methods by simulating real-world clinical scenarios. This pilot study compares SIMBA's effectiveness with SGT in endocrine topics for medical and pharmacy students. Methods: The SIMBA for students model was developed using Kern's six-step framework. SIMBA sessions, facilitated by trained moderators and senior experts, simulated outpatient consultations via WhatsApp. The study included SIMBA and SGT sessions from October 2020 to March 2022. Teaching effectiveness was assessed through postsession surveys and multiple-choice questions (MCQs). The study compared the MCQ scores and student satisfaction of SIMBA, SGT and combined SIMBA + SGT cohorts. Results: One hundred thirty (103 medical and 27 pharmacy) students participated in 14 SIMBA sessions, and 150 students responded to the post-SGT survey, with 38 attending both. Median MCQ scores were higher post-SIMBA (75.0%) compared with post-SGT (60.0%) (p < 0.0001). No significant difference was observed between SIMBA and SIMBA + SGT scores or SGT and SIMBA + SGT scores. SIMBA sessions were perceived as enjoyable (89.2%), intelligible (90.8%), engaging (81.5%), promoted new knowledge (90.0%) and enhanced comprehension (93.9%). 83.1% of students desired SIMBA to complement SGT. Conclusions: SIMBA demonstrated superior knowledge gain and student satisfaction compared to SGT. Its familiar technology and interactive format suit modern learning, offering a standardised and equitable experience. Integrating SIMBA into the curriculum could help overcome teaching limitations and better prepare students for clinical practice.
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Exploring the environmental sustainability of dermatology conferencesNo abstract available
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DEKODE - a cloud-based performance feedback model improved DKA care across multiple hospitals in the UKAim: A current gap in Diabetes-related ketoacidosis (DKA) research is understanding the factors contributing to variations in care and outcomes between people admitted with DKA. We aimed to create a system to facilitate gathering data on DKA management across multiple centres and identify trends in complications and outcomes associated with DKA. Research design and methods: Between January 2020 and December 2022, we set up a cloud-based Quality improvement project (QIP) that provided regular feedback to 11 hospitals in the United Kingdom (UK). Results: Of the 1977 episodes, we observed an increase in adherence in fluid prescription in hospitals C, D, E, F and G (C- 23% vs. 75% p = <0.001; D- 27% vs. 60%, p = <0.001; E- 17 vs. 79% p = <0.001; F- 16% vs. 57%, p = <0.001; G- 36% vs. 75% p = <0.001). Notable improvements in adherence to glucose monitoring were observed in hospitals B, D, and G (B- 11 vs. 38% p = <0.001; D- 36% vs. 56%, p = 0.05; G- 22% vs. 67% p = <0.001). Although we didn't observe significant changes in complications and outcomes among participating hospitals from the start to the end of the reported period, notable fluctuations were evident across quarters. These variations were relayed to the respective hospitals, underscoring how feedback and interventions could influence the care provided. This initiative also marks the initial move towards establishing and improving data collection practices in acute diabetes. Conclusions: We demonstrate a sustainable QIP that improves adherence to national guidelines in some indicators for DKA care and serves as an early warning system to identify adverse trends.
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Clinical findings in symptomatic patients with radiologically isolated sphenoid sinus disease : a systematic review and meta-analysisObjective: To explore the clinical presentations of isolated sphenoid sinus disease (ISSD). Setting and design: A literature search was conducted on 23 December 2023 across electronic databases including Medline, Embase, Web of Science, and Cochrane. We performed a meta-analysis of proportions using a random-effects model to determine the prevalence of clinical findings in patients who presented with symptoms and had ISSD on radiological imaging. Sensitivity and subgroup analyses were employed to investigate sources of heterogeneity. The PRISMA guideline was followed. Participants: This study included patients with clinically significant isolated sphenoid sinus opacification on cross-sectional imaging. Main outcome measure: The pooled prevalence of clinical symptoms and signs. Results: A total of 18 studies met the eligibility criteria, encompassing over 1000 patients. The prevailing symptoms were headache in 67.9% (95% CI 62.9-72.7), nasal symptoms 29.7% (95% CI 25.2-34.4), and visual disturbance 14.0% (95% CI 9.3-19.3). Subgroup analysis revealed a significant difference between neoplastic and inflammatory diagnoses concerning the development of visual symptoms (38.3% versus 15.5%, p = 0.0005). A negative nasendoscopic examination was found in 52.0% (95% CI 41.0-62.8) of cases. Conclusions: Headache emerged as the primary symptom of ISSD, followed by nasal and visual symptoms. Nasendoscopy had a high false negative rate, highlighting its limitation in assessing this condition. Our study highlights the key clinical findings associated with ISSD, which may indicate the need for imaging.
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Heart-breaking tumours : a case series of malignant pericardial effusionBackground: Malignant pericardial effusions are often linked to metastases from solid tumours, such as those in the lung or breast, or haematological diseases. Primary cardiac tumours are rare, occurring in only 0.02% of cases, with pericardial tumours comprising 6.7%-12.8% of all primary cardiac tumours. Case summary: In Case 1, a 49-year-old Black African male presented with chest pain and breathlessness after a COVID-19 vaccine. Initially treated for pericarditis, he returned with worsening symptoms. Echocardiography revealed pericardial effusion and cardiac tamponade. Imaging confirmed a right atrial mass diagnosed as malignant biphasic mesothelioma. He died 4 months after diagnosis. In Case 2, a 43-year-old Caucasian male developed breathlessness and fever post-COVID-19 vaccine. Imaging identified a large posterior pericardial mass, later diagnosed as synovial sarcoma. Chemotherapy yielded minor tumour reduction, but he succumbed to his illness, spending his final days in a hospice. Discussion: Initial clinical signs are critical in determining the origin of pericardial effusion. Malignancy should be suspected in cases with cardiac tamponade, unexplained haemorrhagic pericardial fluid, or recurrent symptoms. Negative cytology warrants further investigation with advanced imaging or biopsy to improve diagnostic sensitivity. Diagnosing rare tumours involves multiple imaging modalities, fluid analysis, biopsies, and an interdisciplinary approach, with pathological analysis being the gold standard. Treatment remains challenging due to the rapid progression of these tumours, with surgery often not feasible. A multi-pronged diagnostic approach is crucial, and clinicians must maintain suspicion for malignancy in persistent pericardial effusion cases, even in the context of other potential confounding factors.
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Managing thyroid hormone replacement after total thyroidectomy : guidance for family medicineThyroid hormones are among the most prescribed medications to patients worldwide and are commonly used to treat hypothyroidism. Thyroxine is also indicated after total thyroidectomy for Graves' disease or a multinodular goitre. In this commentary, we discuss and provide guidance for family medicine and primary care clinicians on how to navigate thyroid hormone replacement in patients after total thyroidectomy for cancer.
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Comparing the efficacy and safety of the Transperineal versus Transrectal prostate biopsy approach in the diagnosis of prostate cancer : a systematic review and meta-analysisProstate cancer (PCa) has high prevalence rates in men and is a leading cause of cancer-related death. Transrectal (TR) biopsy has traditionally been the gold standard for diagnosis, but transperineal (TP) biopsy is increasingly favoured due to its lower infection risk. However, debate remains regarding which method has superior cancer detection rates. This review compares the efficacy and safety of the TP as compared to the TR prostate biopsy approach, summarizing the largest body of evidence available to date. A literature search was performed on the PubMed, Google Scholar, Cochrane Library, and Embase databases. We searched from the inception of the databases up to August 2024 for relevant studies comparing the cancer detection rate of TP versus TR prostate biopsy and compared their complication rates. Twenty-one studies met the inclusion criteria. The pooled odds ratios with 95% confidence intervals were calculated to evaluate the differences between the TR and TP groups in the PCa detection rate. This meta-analysis included 21 studies (6 randomized control trials and 15 cohort studies) with a total of 13,818 patients (TP = 7917; TR = 5901), who were accrued between 2008 and 2024 and divided into the TR group and the TP group. The analysis revealed no significant difference in prostate cancer detection rates between the TP and TR approaches in both RCTs (OR 1.02, 95% CI (0.74, 1.41), p = 0.90) and cohort studies (OR 1.07, 95% CI (0.85, 1.35), p = 0.36). Complication profiles were largely comparable; TP demonstrated a significantly lower risk of urinary tract infections (OR 0.26, 95% CI (0.11, 0.61)) but no notable differences in acute urinary retention, haematuria, or rectal bleeding. Our findings advocate the TP approach as a safer biopsy alternative where feasible, particularly in infection-sensitive populations, without compromising diagnostic accuracy. MRI should complement biopsy strategies to enhance diagnostic precision. Future research should focus on standardized, large-scale RCTs to further refine and personalize prostate cancer diagnostic pathways.
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Safety and efficacy of remifentanil in patients undergoing bariatric and metabolic surgeries : a systematic reviewBackground and Aims: Obese patients undergoing bariatric and metabolic surgeries have a high chance of respiratory depression and could need admission to an intensive care unit or a high-dependency unit. Several studies have compared remifentanil to other opioids or non-opioids in these patients. This review investigated the efficacy and safety of remifentanil in bariatric and metabolic surgeries. Methods: After registering with PROSPERO, we searched PubMed/Medline, Ovid, CINAHL and the Cochrane Library with relevant keywords to find studies in which remifentanil was compared to other opioids or non-opioids in adult patients undergoing bariatric and metabolic surgeries. We used the risk of bias-2 tool to assess bias and Grading of Recommendation, Assessment, Development and Evaluation to determine the level of evidence. RevMan 5.4 was used to perform a quantitative meta-analysis. Results: Of the 121 articles retrieved from the database search, seven articles fulfilled the inclusion criteria. The overall bias was low in five studies and high in two studies. There was significant heterogeneity in the control group, which comprised opioids and also non-opioids like labetalol, dexmedetomidine and lignocaine. A quantitative meta-analysis was not reported due to a lack of comparable data for a meaningful quantitative meta-analysis. Conclusion: The results of this systematic review neither support nor refute the use of remifentanil in patients undergoing bariatric and metabolic surgeries, compared to other medications. Further studies are needed to investigate its efficacy and safety in these patients.
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Dermatologic surgery : an update on secondary intention healing and adjuncts : part 2Secondary intention healing (SIH) is utilised by various surgical specialities. The formation of granulation tissue is crucial for initiating the healing process, necessitating robust support at this stage. Numerous adjunct therapies are available, with new developments aimed at treating both acute and chronic wounds undergoing SIH. This article continues from part 1, examining the efficacy of various adjunct therapies in promoting SIH. This article continues from part 1, examining the efficacy of various adjunct therapies in promoting SIH.
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Prevalence of synchronous bilateral/contralateral tonsil carcinoma : a systematic review and meta-analysisThe purpose of this systematic review and meta-analysis was to identify the prevalence of synchronous contralateral tonsil carcinoma (SCTC) amongst patients with tonsil carcinoma or head and neck squamous cell carcinoma of unknown primary (HNSCCUP). Thirteen retrospective studies, comprising 2623 patients, were analysed, revealing an overall pooled SCTC prevalence of 4%, rising to 10% in HNSCCUP cases. HPV/p16 positivity was associated with SCTC prevalence of 3%, while HPV/p16 negativity was greater at 8%. Clinical or imaging evaluations often missed SCTC preoperatively, emphasising the importance of contralateral tonsillectomy. Morbidity varied among patients undergoing contralateral tonsillectomy. The prevalence of SCTC is significant in cases of HNSCCUP and tonsil malignancy, emphasising the importance of informed discussions regarding contralateral tonsillectomy. Tailored approaches considering individual patient and tumour characteristics are crucial, with contralateral tonsillectomy generally warranted in HNSCCUP. Further research, including prospective studies with standardised protocols, is needed to improve the understanding and management of SCTC, specifically the clinical significance of occult SCTC.
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Proximal humerus fractures : a review of anatomy, classification, management strategies, and complicationsProximal humerus fractures are prevalent in older adults, particularly women, primarily due to osteoporosis and increased fall risk. These fractures often result from low-energy falls in elderly patients, while in younger individuals, they are more likely to occur with high-energy trauma, which may involve additional injuries to soft tissue and neurovascular structures. Proper anatomical understanding, including key structures and blood supply, is crucial for effective management and to prevent complications. Several classification systems assist in guiding treatment for proximal humerus fractures, including Codman's, Neer's, Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) system, and the Codman-Hertel system, which helps predict ischemia risk. Evaluation of proximal humerus fractures begins with Advanced Trauma Life Support (ATLS) protocols, emphasizing a thorough shoulder assessment, particularly focusing on skin integrity in elderly patients. Neurological and vascular examinations are essential due to the common occurrence of nerve injuries, especially involving the axillary nerve. Imaging typically includes multiple standard views, with advanced imaging reserved for complex cases and for assessing associated soft tissue injuries. Treatment options range from conservative management for stable fractures to surgical intervention for more complex cases. Surgical choices include techniques like fixation, nailing, and various arthroplasty options, with some procedures potentially offering advantages for older adults with bone quality or soft tissue challenges. Rehabilitation is a vital component of recovery, with emphasis on early mobility and gradual strengthening to restore function, especially in older patients. Complications following open reduction and internal fixation (ORIF) for proximal humerus fractures can include issues such as non-union, malunion, osteonecrosis, infection, joint stiffness, and fixation failure. In cases where non-union or fixation failure occurs, revision surgery or arthroplasty may be necessary. Joint stiffness may require further intervention if physical therapy is insufficient, while symptomatic osteonecrosis might also need surgical management. Malunion is generally better tolerated in older patients but may require correction in younger individuals. Other surgical options, such as hemiarthroplasty (HA) and reverse shoulder arthroplasty (RSA), share similar risks, including infection, fractures, complications at the tuberosity, stiffness, and instability. RSA may be favored when there are tuberosity or rotator cuff issues. Closed reduction with percutaneous pinning carries a high risk of pin migration and malunion, which can result in deformities, pain, and dysfunction. Proper anatomical knowledge is essential to avoid neurovascular injury and to manage common issues such as pin-site infections effectively.
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Left atrial appendage closure with catheter ablation vs. ablation alone on outcomes of atrial fibrillation in heart failure with reduced ejection fraction : a propensity score-matched analysisBackground Combining left atrial appendage closure with catheter ablation (LAACCA) has been proposed as a potential approach to improving outcomes by simultaneously addressing arrhythmia and reducing stroke risk. This study compares the in-hospital outcomes of LAACCA vs. catheter ablation (CA) alone for atrial fibrillation (AFib) in patients with heart failure with reduced ejection fraction (HFrEF). Methods We analyzed adult hospitalizations with HFrEF and AFib who underwent LAACCA or CA alone from the 2016-2020 nationwide inpatient sample using validated ICD-10 codes. Propensity score matching, accounting for patient-, hospital-, and procedure-level covariates, illness severity, and baseline risk of mortality, was used to alleviate bias in nonrandomized treatment assignments. The primary endpoints included all-cause in-hospital mortality, hospital stay, and hospitalization costs. Secondary endpoints included postprocedural complication rates. Prolonged hospitalization was defined as hospital stay in the top decile of hospital stay in each cohort. All statistical analyses in the study were based on weighted hospital data. Results About 233,865 HFrEF patients were hospitalized for AFib. Approximately 27,945 (11.9%) underwent LAACCA, while 205,920 (88.1%) underwent CA only. The cohort comprised mostly males (151,077; 64.6%) (mean age: 67.4; SD: 4.3). The propensity score-matched cohort comprised 18,195 LAACCAs and 18,195 CAs; all covariate imbalances were alleviated. LAACCA was associated with a higher rate of prolonged hospital stay (7.6 vs 5.6 days; P<0.001), a higher mortality rate (209 (1.1%) vs. 160 (0.9%); P=0.011), and higher mean hospital costs ($289,960 vs. $183,932; P<0.001) compared with CA alone. LAACCA was associated with a higher incidence of acute myocardial ischemia (528 (2.9%) vs. 455 (2.5%); P=0.013), complete atrioventricular block (1,200 (6.6%) vs. 892 (4.9%); P=0.004), need for implantable device therapy (1,510 (8.3%) vs. 1,348 (7.4%); P=0.017), pneumothorax (328 (1.8%) vs. 91 (0.5%); P<0.0001), hemothorax (200 (1.1%) vs. 127 (0.7%); P<0.0001), pneumonia (983 (5.4%) vs. 546 (3.0%); P<0.0001), vascular access complications (346 (1.9%) vs. 255 (1.4%); P=0.046), and septicemia (309 (1.7%) vs. 182 (1.0%); P<0.001). CA was associated with a greater incidence of cardiac tamponade (237 (1.3%) vs. 382 (2.1%); P=0.010) and femoral artery pseudoaneurysm (364 (0.2%) vs. 91 (0.5%); P<0.001). Conclusion LAACCA was correlated with higher mortality odds compared to CA alone for atrial fibrillation in HFrEF.
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Evaluation of Patient-Initiated Follow-Up (PIFU) service in a Fracture clinic : a comprehensive service evaluation and patient satisfaction auditBackground Outpatient clinics are increasingly challenged by high patient volumes and rising "did not attend" (DNA) rates, leading to extended wait times and declines in patient satisfaction. Traditional follow-up (FU) models with routinely scheduled appointments contribute to inefficiencies, as stable patients may attend unnecessary visits, thus straining clinic resources. The patient-initiated follow-up (PIFU) model offers an alternative where patients schedule appointments only when necessary. This study evaluates PIFU's efficacy in improving outpatient services and patient satisfaction by reducing routine appointments and prioritizing patient-driven follow-up. Methods This service evaluation and patient satisfaction audit was conducted at the fracture clinic of Royal Shrewsbury Hospital over three months (December 2023-March 2024). Out of 3828 patients seen, 203 were assigned to PIFU based on criteria indicating stable conditions with minimal follow-up requirements. The remaining patients were either scheduled for routine follow-ups or discharged. Data were collected retrospectively from clinic records, and a structured questionnaire assessed patient satisfaction with the PIFU service. Results Among the 203 patients assigned to PIFU, 183 (90.15%) patients received an informational leaflet, with all respondents finding it easy to understand. However, only 41 (20.2%) of patients utilized the PIFU service, primarily for concerns about pain, healing, or complications. Satisfaction among PIFU users was high, with 163 (80.3%) patients rating the service 5/5. Non-users mostly cited no perceived need for follow-up. Demographic analysis indicated that patients aged 40-60 were predominant (n=132; 65.02%) among the PIFU cohort. Conclusion The PIFU model demonstrated the potential to alleviate clinic workload by reducing routine follow-ups while maintaining high patient satisfaction. Although utilization rates were low, those who engaged found the service beneficial, suggesting PIFU's value for patients comfortable with self-management. Improved patient education may enhance engagement, supporting the broader implementation of PIFU in outpatient settings. Further research is warranted to explore barriers to patient-initiated follow-up and refine eligibility criteria for optimal outcomes.
