76 This is (Probably) Not the Frailty Solution You are Looking For: Utilisation of A Novel Stand-Alone Community-Based Ambulatory Care Unit

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
L Dykes ◽  
C Jones
Keyword(s):  
Ambulatory Care ◽  
Point Of Care ◽  
Admission Rate ◽  
Plain Film ◽  
Service Planning ◽  
Community Based ◽  
Frail Patients ◽  
Plain Film Radiography ◽  
Emergency Transport ◽  
Care Package

Abstract Introduction/Aim Our organisation wished to expand its “Care Closer To Home” capability, especially for older and/or frail patients. Our novel Ambulatory Care Unit (ACU) in a community hospital, staffed by GPs & nurses, opened a year ago. The ACU has some Point of Care (POCT) diagnostics, access to plain-film radiography and OT/physio. During the planning of the unit,” acute frailty” was anticipated to be core business. We wished to determine whether this turned out to be the case. Method Interrogation of the ACU patient log (spreadsheet collated from Data Collection Forms) Dec 2018-Nov 2019. Results Conclusion/Discussion Recording of CFS by ACU staff was poor, limiting the validity of our results. Nevertheless, it is obvious that most patients seen in our ACU are not frail, and do not require therapies input. Those that are frail, however, have an acceptable conversion-to-admission rate of 8.6%, comfortably below the national target (20%). Barriers to greater utilisation of our service for frail patients may include lack of urgent but non-emergency transport options for the less mobile, lack of access to certain commonly-used tests (e.g. CT, troponin) and referrer anticipation of difficulty discharging the frail patient in crisis without a new or boosted care package and/or access to respite beds. These aspects of service planning need to be addressed if the potential utility of community-based units like ours for frail patients is to be maximised.

Clinical Reliability of point-of-care tests to support community based acute ambulatory care

2020 ◽  
Vol 19 (1) ◽  
pp. 4-14
Author(s):  
Jan Y Verbakel ◽  
◽  
Charlotte Richardson ◽  
Tania Elias ◽  
Jordan Bowen ◽  
...  
Keyword(s):  
Ambulatory Care ◽  
Clinical Chemistry ◽  
Point Of Care ◽  
Community Dwelling ◽  
Central Laboratory ◽  
Point Of Care Testing ◽  
Community Based ◽  
Sodium Potassium ◽  
Point Of Care Tests ◽  
Acceptable Agreement

Objective: To ensure clinicians can rely on point-of-care testing results, we assessed agreement between point-of-care tests for creatinine, urea, sodium, potassium, calcium, Hb, INR, CRP and subsequent corresponding laboratory tests. Participants: Community-dwelling adults referred to a community-based acute ambulatory care unit. Interventions: The Abbott i-STATTM (Hb, clinical chemistry, INR) and the AfinionTM Analyser (CRP) and corresponding laboratory analyses. Outcomes: Agreement (Bland-Altman) and bias (Passing-Bablok regression). Results: Among 462 adults we found an absolute mean difference between point-of-care and central laboratory analyses of 6.4g/L (95%LOA -7.9 to +20.6) for haemoglobin, -0.5mmol/L (95%LOA -4.5 to +3.5) for sodium, 0.2mmol/L (95%LOA -0.6 to +0.9) for potassium, 0.0mmol/L (95%LOA -0.3 to +0.3) for calcium, 9.0 μmol/L (95%LOA -18.5 to +36.4) for creatinine, 0.0mmol/L (95%LOA -2.7 to +2.6) for urea, -0.2 (95%LOA -2.4 to +2.0) for INR, -5.0 mg/L (95%LOA -24.4 to +14.4) for CRP. Conclusions: There was acceptable agreement and bias for these analytes, except for haemoglobin and creatinine.

scholarly journals Preliminary image findings of lower limb stress fractures to aid ultrasonographic diagnoses: A systematic review and narrative synthesis

Ultrasound ◽  
2021 ◽  
pp. 1742271X2199552
Author(s):  
Madeleine Schaper ◽  
James Harcus
Keyword(s):  
Systematic Review ◽  
Lower Limb ◽  
Injury Severity ◽  
Callus Formation ◽  
Plain Film ◽  
Stress Fractures ◽  
Doppler Imaging ◽  
Narrative Synthesis ◽  
Plain Film Radiography ◽  
Bony Callus

Introduction This systematic review investigates which image appearances are most common when diagnosing lower limb stress fractures using ultrasound imaging, with the aim of outlining an image critique guideline for operators to support confident diagnoses. Method A comprehensive literature search of medical databases and handsearching was undertaken to identify relevant studies. All studies were critically examined for quality using the CASP critical appraisal tool. Results from eight studies were combined and interpreted using a narrative synthesis. Findings A clear outline of common stress fracture appearances using ultrasound were identified in a combined total of 119 participants. Each finding was ranked according to its popularity. Periosteal thickening (78/119) and cortical disruption/irregularity (83/119) were noted in all eight studies. Hypervascularity of the periosteum visualised by colour Doppler imaging (66/119) was reported in six of the eight studies. Soft tissue hypervascularity (13/119), bony callus formation (5/119) and cortical break (22/119) were seen in three studies. Conclusions Based on the findings, we offer a guideline of the most significant preliminary image findings to be utilised by operators when examining athletes suspected of having lower limb stress fractures. The results show a gap in research for evaluating changes in appearance depending on the injury severity. Further research into distinguishing stress fractures from pathological involvement may in future reduce reliance on plain film radiography.

scholarly journals Initial screening of children with urinary tract infections: is plain film radiography and ultrasonography enough?

BMJ ◽  
1984 ◽  
Vol 288 (6420) ◽  
pp. 827-827 ◽  
Author(s):  
T Sherwood ◽  
R H Whitaker
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Plain Film ◽  
Initial Screening ◽  
Plain Film Radiography ◽  
Tract Infections

scholarly journals Regional Difference in Seroprevalence of SARS-CoV-2 in Tokyo: Results from the community point-of-care antibody testing

2020 ◽  
Author(s):  
Morihito Takita ◽  
Tomoko Matsumura ◽  
Kana Yamamoto ◽  
Erika Yamashita ◽  
Kazutaka Hosoda ◽  
...  
Keyword(s):  
Regional Difference ◽  
Point Of Care ◽  
Herd Immunity ◽  
Antibody Testing ◽  
Igg Antibody ◽  
Community Based ◽  
Entire Cohort ◽  
Control And Prevention ◽  
Specific Igg ◽  
Polymerase Chain

AbstractThe serosurvey is an alternative way to know the magnitude of the population infected by coronavirus disease 2019 (COVID-19) since the expansion of capacity of the polymerase chain reaction (PCR) to detect the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was delayed. We herein report seroprevalence of COVID-19 accessed in the two community clinics in Tokyo. The point-of-care immunodiagnostic test was implemented to detect the SARS-CoV-2 specific IgG antibody in the peripheral capillary blood. The overall positive percentage of SARS-CoV-2 IgG antibody is 3.83% (95% confidence interval: 2.76-5.16) for the entire cohort (n =1,071). The central Tokyo of 23 special wards exhibited a significantly higher prevalence compared to the other area of Tokyo (p =0.02, 4.68% [95%CI: 3.08-6.79] versus 1.83 [0.68-3.95] in central and suburban Tokyo, respectively). The seroprevalence of the cohort surveyed in this study is low for herd immunity, which suggests the need for robust disease control and prevention. A community-based approach, rather than state or prefectural levels, is of importance to figure out profiles of the SARS-COV-2 outbreak.

PDAs as Mobile-Based Health Information Deployment Platforms for Ambulatory Care

2008 ◽  
pp. 1022-1039
Author(s):  
Jason Sargent ◽  
Carole Alcock ◽  
Lois Burgess ◽  
Joan Cooper ◽  
Damian Ryan
Keyword(s):  
Ambulatory Care ◽  
Health Information ◽  
Point Of Care ◽  
Care Service ◽  
Development Project ◽  
Personal Digital Assistants ◽  
End User ◽  
Care Systems ◽  
A Current

This chapter discusses the broad theme of clinician-centric end-user acceptance toward the adoption of personal digital assistants (PDAs) as mobile-based health information deployment platforms within ambulatory care service settings. Personal digital assistants, ambulatory care, and point of care are defined and the interrelatedness of each discussed. Issues, controversies, and problems such as mapping existing workflows, security, and change management are identified, and solutions are suggested for the process of transforming predominantly paper-based ambulatory care systems into electronic point-of-care (ePOC) systems. A current research and development project, the ePOC PDA project, is used as a case study to highlight discussion points. The purpose of this chapter is to illustrate end-user implications and considerations when introducing ePOC systems into ambulatory care service settings and highlight ways and means of improving future levels of acceptance and support of ePOC systems for clinician end users.

scholarly journals Clinical evaluation of serial blood processing at point of care

1997 ◽  
Vol 43 (2) ◽  
pp. 360-362 ◽  
Author(s):  
Christopher A Estey ◽  
Robin A Felder
Keyword(s):  
Clinical Performance ◽  
Point Of Care ◽  
Turnaround Time ◽  
University Of Virginia ◽  
Community Based ◽  
Blood Separation ◽  
The North ◽  
Blood Specimens ◽  
The University

Abstract The Axial Separation Module (ASM™), which separates whole-blood specimens serially in Axial Process Containers (APC™), was evaluated for clinical performance at the University of Virginia Health Sciences Center (UVA HSC) in a community-based outpatient laboratory (North Ridge Clinic). We hypothesized that moving the task of blood separation to point of care would reduce specimen turnaround time within the main laboratory. Blood drawn into an APC was separated in the ASM at point of care at the North Ridge Clinic. Blood drawn into a Vacutainer Tube™was separated in a conventional centrifuge at the main laboratory. Turnaround time was calculated for the “chem 17” test from files stored in our laboratory information system. Blood serially separated at point of care yielded turnaround time savings for specimens originating from the North Ridge Clinic. Average turnaround time decreased by 24%. Phlebotomists found no appreciable workload increase from incorporating the ASM as a point-of-care blood separation device. Phlebotomists also found that they could immediately detect hemolysis. We concluded that serial separation at point of care reduces specimen turnaround time at the main laboratory. The ASM/APC was found to be better suited for point-of-care blood separation than a conventional centrifuge. We speculate that immediate blood separation has the potential to improve the quality of analytical results.

scholarly journals Transoral Approach to Open Reduction of a Traumatic Avulsion Fracture of the Genial Tubercle Associated With a Mandibular Symphysis Fracture: A Case Report and Literature Review

2020 ◽  
Vol 5 ◽  
pp. 247275122094940
Author(s):  
Danyon O. Graham ◽  
Edward Nguyen ◽  
Muammar Abu Serriah
Keyword(s):  
Avulsion Fracture ◽  
Surgical Intervention ◽  
Plain Film ◽  
Skin Incision ◽  
Transoral Approach ◽  
Diagnostic Challenge ◽  
Mandibular Symphysis ◽  
Posterior Displacement ◽  
Plain Film Radiography ◽  
Genial Tubercle

Genial tubercle fracture (GTF) is rare and represents a diagnostic challenge as plain film radiography often fails to identify the fractured segment. Traumatic avulsion of the genial tubercle in conjunction with mandibular symphysis fracture may lead to posterior displacement of the tongue with the potential for airway compromise and difficulty in speech and swallowing due to loss of tongue anterior suspension. Fine cut computed tomography (CT) scan is required to confirm the diagnosis and assist further management. To our knowledge, all published cases of surgical intervention in the management of avulsed genial tubercle combined with fracture of the mandibular symphysis used an extraoral approach via submental skin incision to expose the fractured segment. To the authors’ knowledge, this is the first report to describe a transoral approach in the surgical management of GTF associated with a mandibular fracture.

scholarly journals Neglected Pediatric Osteochondral Fracture Dislocation of the Patella

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Ta-Li Hsu ◽  
Shang-Ming Lin ◽  
Chih-Hung Chang ◽  
Tsung-Yu Lan
Keyword(s):  
Magnetic Resonance Imaging ◽  
Articular Cartilage ◽  
Plain Film ◽  
Fracture Dislocation ◽  
Resonance Imaging ◽  
Fracture Fragment ◽  
Osteochondral Fracture ◽  
Plain Film Radiography ◽  
Dislocation Of The Patella

Pediatric osteochondral fracture dislocation of the patella is sometimes difficult to diagnose on the basis of physical examination or plain film radiography. Magnetic resonance imaging plays an important role in its early diagnosis, and early treatment can prevent damage to the articular cartilage as well as decrease the dislocation rate. Currently, many treatment choices have been reported with good results, but there is no consensus on which treatment option may lead to the best outcome. Herein, we describe the case of a 14-year-old girl with neglected osteochondral fracture dislocation of the patella. The outcome was optimal on the basis of a 2-year postoperative follow-up; thus, we believe that fixation with headless screws is a simple and effective method if the fracture fragment is large enough.

Teeth in the maxillary sinus – imaging and management

1997 ◽  
Vol 111 (9) ◽  
pp. 820-824 ◽  
Author(s):  
Lipa Bodner ◽  
Ferit Tovi ◽  
Jacob Bar-Ziv
Keyword(s):  
Maxillary Sinus ◽  
Maxillary Antrum ◽  
Treatment Plan ◽  
Three Dimensional ◽  
Plain Film ◽  
Diagnosis And Treatment ◽  
Cross Sectional ◽  
Plain Film Radiography ◽  
Sinus Wall ◽  
Prediction Of Prognosis

AbstractPurposeTo evaluate the images obtained by CT in diagnosis and treatment plan of teeth in the maxillary sinus.MethodsTwelve patients with teeth in the maxillary sinus were studied by plain film radiography(PFR) and by CT with a dental software programme, which displays multiple panoramic and cross-sectional views of the mandible and maxilla. The three-dimensional morphology of the tooth, its inclination, proximity to the sinus wall, surgical planning and prediction of prognosis and complications were estimated on both PFR and on CT scans and scored.ResultsThe radiographical features interpreted from PFR were fair or poorly diagnosed whereas CT provided excellent features. The surgical approach of choice was based on CT interpretation.ConclusionCT is useful for diagnosis and treatment planning of teeth in the maxillary antrum.

scholarly journals Ambulatory Care Education: How Do Academic Medical Centers, Affiliated Residency Teaching Sites, and Community-Based Practices Compare?

2004 ◽  
Vol 79 (1) ◽  
pp. 69-77 ◽  
Author(s):  
Patricia A. Carney ◽  
M Scottie Eliassen ◽  
Catherine F. Pipas ◽  
Stephen H. Genereaux ◽  
David W. Nierenberg
Keyword(s):  
Ambulatory Care ◽  
Academic Medical Centers ◽  
Community Based ◽  
Care Education ◽  
Medical Centers ◽  
Academic Medical
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