scholarly journals 923 Accuracy of Assessment in Hand Trauma; Pre COVID-19 Face to Face Assessment Compared to Virtual Assessment During COVID-19 Lockdown

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S Westley ◽  
H Creasy ◽  
R Mistry
Keyword(s):  
Telephone Call ◽  
Initial Assessment ◽  
Accurate Assessment ◽  
Hand Trauma ◽  
Face To Face ◽  
Queen Victoria ◽  
Set Up ◽  
Operation Note ◽  
Similar Accuracy ◽  
Virtual Clinic

Abstract Introduction The Queen Victoria Hospital (QVH) was designated a cancer and trauma hub during the COVID-19 pandemic. With this, a new virtual hand trauma clinic was set up. We assess accuracy of assessment within this virtual set-up with comparison to pre COVID-19 face-to-face assessment. Method Two weeks of clinic sessions during and pre lockdown were analysed. Initial assessment was compared with the patient's operation note. Results In the pre COVID-19 two-week period 129 face-to-face appointments were analysed. Of 99 patients that required surgery 77 (78%) had an accurate assessment. 6 were overestimated, 12 were underestimated. 189 patients were seen over two weeks during lockdown via telephone or video call. Accuracy of assessment increased with seniority of the clinician. Of 126 patients that required an operation 109 (87%) had an accurate assessment; all structures injured were correctly predicted. 12 were overestimated, 5 had their injury underestimated. Conclusions The new virtual clinic allowed patients to be remotely assessed during lockdown, reducing footfall and unnecessary journeys. We found that virtual clinic assessments are accurate, and no patient underwent an unnecessary procedure. Using a telephone call plus photo gave similar accuracy as a video call. Virtual assessment was more accurate than face-to-face assessment.

scholarly journals Using telemedicine and wearable technology to establish a virtual clinic for people with Parkinson’s disease

2020 ◽  
Vol 9 (3) ◽  
pp. e001000
Author(s):  
Lauren Evans ◽  
Biju Mohamed ◽  
Edward Christopher Thomas
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Value Added ◽  
Treatment Decision ◽  
Wearable Technology ◽  
Time Saving ◽  
Face To Face ◽  
Administration Time ◽  
Set Up ◽  
Virtual Clinic

BackgroundTo develop an effective, patient-centred and sustainable service, we set up a virtual clinic (VC) for patients with Parkinson’s disease, combining phone consultations and reports from wearable technology. The Parkinson’s Kinetigraph (PKG) is a wrist-worn device providing objective motor assessment, generating a report used by clinicians to optimise medication regimens.InterventionsA pilot study of VC was designed using quality improvement methodology. For a VC appointment, patients were phoned by a clinician. After discussing symptoms and reviewing the PKG report, the clinician could decide on any medication changes or other interventions and relay this to the patient’s general practitioner in a clinic letter. Patient feedback was gathered via questionnaires and data collected on the outcomes and timings of the consultations.ResultsOver 12 clinics, 61 patients had VC appointments. Of questionnaire respondents, 89% were satisfied with VC (n=41). At VC, the clinician was able to make a treatment decision comparable to a face-to-face clinic in 79% of cases (n=48). Reasons appointments were deemed unsuccessful included issues with the PKG, speech or hearing problems and complex phase of disease. VC appointments, including administration time, last on average 22 min. This compares to 20 min face-to-face appointments but these do not include administration time.ConclusionsWe have demonstrated a safe and effective VC template. Most VC appointments are equivalent to face-to-face clinic in terms of treatment outcome. Success could be further improved by appropriate patient selection. Using VC is time saving and can result in releasing face-to-face appointment slots for those in urgent need or newly referred patients. Further cost analysis is required; the cost of the PKG alone is more expensive than a face-to-face appointment, but this does not take into account other value added, such as patient convenience and satisfaction, and reduced need for ambulance transport.

scholarly journals P067 Virtual care: the future, but to what extent?

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Zoe Rutter-locher ◽  
Nikita Arumalla ◽  
Zoe Bright ◽  
Toby Garrood
Keyword(s):  
Healthcare Providers ◽  
Patient Survey ◽  
Outpatient Setting ◽  
Face To Face ◽  
Virtual Care ◽  
Potential Strategy ◽  
Set Up ◽  
Feedback Data ◽  
The Uk ◽  
Virtual Clinic

Abstract Background/Aims  The COVID-19 pandemic has necessitated profound changes to the delivery of healthcare in the UK. Our aim was to analyse whether a move to virtual care is beneficial and sustainable in a rheumatology outpatient setting. Methods  Data on volume of unscheduled access to an outpatient rheumatology service and questionnaire feedback responses from patients and rheumatology clinicians on virtual consultations, was analysed. Results  During the COVID-19 pandemic period of March - July 2020, our department saw a majority of face to face outpatient rheumatology clinic appointments transferred to virtual (telephone/video) with a significant reduction in the number of scheduled clinics. In addition, the volume of telephone appointments booked online by patients saw a 27.2% rise (n = 2248) compared to March - July 2019 (n = 1767), with a 23.7% increase in telephone helpline calls in the 2020 period (n = 3246) compared to 2019 (n = 2624) and over a 300% increase in email helpline activity. Questionnaire responses were obtained from 382 patients (Table 1). 86% of patients felt they got a lot out of a virtual appointment, but 13% would prefer not to use it again. Of the 16 healthcare providers that responded, 12 (75%) were satisfied with the virtual clinic set up, but only 2/16 (13%) felt the same could be achieved for patients in a virtual setting compared to a face-to-face visit. The lack of clinical examination was a major limitation for clinicians 12/16 (75%) and was similarly identified amongst patient feedback (42/260) (16%). Conclusion  Virtual care with the provision for patient-led care allows convenience for the patient with high patient satisfaction, however this is not necessarily an approach that suits all. Clinicians must beware the non-complaining patient, and careful selection of those suitable for virtual care may be needed. Our model of patient led care using telephone appointments booked online by patients coupled with telephone/email helplines is a potential strategy for other centers to develop. Ongoing patient and healthcare provider feedback, data on the effect on clinical outcomes and detailed quality improvement cycles are vital to adjust services over the coming months. P067 Table 1:Results of patient survey on Virtual Clinic experienceDemographicsGenderFemale293 (77%)AgeAge 16-64269 (70%)Age 65-80+94 (25%)RaceWhite British233 (60%)BAME72 (18%)ConsultationsModeTelephone366 (96%)Video11 (3%)TypeNew45 (13%)Follow up333 (87%)ClinicianDoctor324 (85%)Nurse32 (8%)AHP26 (7%)Time from appointment to contactOn time or early195(51%)Up to 15 minutes57 (15%)15-30 minutes36 (9%)>30 minutes41 (11%)Length of appointment<15 minutes184 (48%)15-30 minutes164 (43%)>30 minutes23 (6%)FeedbackWas the length of the appointment right?About right352 (92%)Too short19 (5%)Did you get everything out of this appointment as you would in a face-to-face session?Yes, definitely206 (54%)Yes, to some extent121 (32%)No49 (13%)Did you feel involved in the decision made about your care?Yes, definitely277 (73%)Yes, to some extent57 (15%)No21 (6%)Did you feel you received the information you required?Yes, definitely251 (66%)Yes, to some extent92 (24%)No16 (4%)How would you rate the appointment?Very good/good327 (86%)Neither good nor poor24 (6%)Poor/very poor14 (4%)Would you prefer to use this again for your next appointment?Yes, definitely124 (32%)Yes, to some extent182 (48%)No61 (16%)*Missing data if patient did not respond to the questions. Disclosure  Z. Rutter-locher: None. N. Arumalla: None. Z. Bright: None. T. Garrood: None.

scholarly journals Face-to-Face Communication in Aphasia: The Influence of Conversation Partner Familiarity on a Collaborative Communication Task

2021 ◽  
Vol 6 ◽  
Author(s):  
Willemijn Doedens ◽  
Arpita Bose ◽  
Lydia Lambert ◽  
Lotte Meteyard
Keyword(s):  
Language Impairment ◽  
Common Ground ◽  
Collaborative Communication ◽  
Face To Face ◽  
Communication Task ◽  
Instructor Role ◽  
Set Up ◽  
Similar Accuracy ◽  
Conversation Partner ◽  
Everyday Communication

Aphasia is language impairment due to acquired brain damage. It affects people’s ability to communicate effectively in everyday life. Little is known about the influence of environmental factors on everyday communication for people with aphasia (PWA). It is generally assumed that for PWA speaking to a familiar person (i.e. with shared experiences and knowledge) is easier than speaking to a stranger (Howard, Swinburn, and Porter). This assumption is in line with existing psycholinguistic theories of common ground (Clark, 1996), but there is little empirical data to support this assumption. The current study investigated whether PWA benefit from conversation partner (CP) familiarity during goal-directed communication, and how this effect compared to a group of neurologically healthy controls (NHC). Sixteen PWA with mild to severe aphasia, sixteen matched NHC, plus self-selected familiar CPs participated. Pairs were videotaped while completing a collaborative communication task. Pairs faced identical Playmobile rooms: the view of the other’s room was blocked. Listeners attempted to replicate the 5-item set-up in the instructor’s room. Roles were swapped for each trial. For the unfamiliar condition, participants were paired with another participant’s CP (PWA were matched with another PWA’s CP based on their aphasia profile). The outcomes were canonical measures of communicative efficiency (i.e. accuracy, time to complete, etc.). Results showed different effects in response to the unfamiliar partner for PWA compared to NHC: In the instructor role, PWA showed faster trial times with the unfamiliar partner, but similar accuracy scores in both conditions. NHC, on the other hand, showed similar trial times across CPs, but higher accuracy scores with the unfamiliar partner. In the listener role, PWA showed a pattern more similar to NHC: equal trial times across conditions, and an improvement in accuracy scores with the unfamiliar partner. Results show that conversation partner familiarity significantly affected communication for PWA dyads on a familiar task, but not for NHC. This research highlights the importance of identifying factors that influence communication for PWA and understanding how this effect varies across aphasia profiles. This knowledge will ultimately inform our assessment and intervention of real-world communication.

scholarly journals 829 Is There an Ongoing Role For 'Telephone Triage Clinics' Post COVID-19?

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
B Holmes ◽  
U Mirza ◽  
C Manning ◽  
R Cooke ◽  
R Jugdey
Keyword(s):  
Common Theme ◽  
Telephone Triage ◽  
Telephone Consultation ◽  
Face To Face ◽  
Clinician Satisfaction ◽  
Set Up ◽  
Local Protocol ◽  
Telephone Questionnaire

Abstract Introduction COVID-19 has placed unprecedented demand on services at ELHT and it has become necessary to have telephone clinics to reduce the number of face-to-face clinics. A ‘telephone triage clinic’ was set up for referrals from A&E. Our project evaluated patient and clinician satisfaction on this. Method We carried out a retrospective telephone questionnaire with patients over a one-week period during the pandemic. We focussed on overall satisfaction of the consultation and quality of communication. Consultants were also surveyed for their opinion on the clinics. Results From 30 patients, 77% said they were ‘very satisfied’ with the overall experience. 80% of patients were ‘very satisfied’ with the overall length of the telephone consultation. 50% of patients felt the clinician was only ‘adequately’ able to assess them over the telephone. The consultants were less satisfied with the overall experience of telephone consultation. A common theme was that they felt ED documentation could be improved to help inform ongoing management. Conclusions Overall, patients were satisfied with the consultations. It has been successful in minimising face to face consultations however some presentations necessitate further evaluation. We need to identify those injuries appropriate for virtual follow up and design a local protocol for these.

scholarly journals The potential impacts of a digital preoperative assessment service on appointments, travel-related CO2 emissions, and user experience: a case study (Preprint)

2021 ◽  
Author(s):  
Madison Milne-Ives ◽  
John Leyden ◽  
Inocencio Maramba ◽  
Ray Jones ◽  
Arunangsu Chatterjee ◽  
...  
Keyword(s):  
Co2 Emissions ◽  
Preoperative Assessment ◽  
Service Evaluation ◽  
Primary Objective ◽  
Face To Face ◽  
Patient Feedback ◽  
Potential Benefits ◽  
Set Up ◽  
Evaluation Of Data

BACKGROUND The NHS cannot keep up with the demand for operations and procedures. Preoperative assessments, which can last 30 minutes to 2 hours, could be conducted online to save patient and clinician time, reducing wait times for operations. MyPreOp is a cloud-based platform where patients can set up an account and complete their preoperative questionnaires. This data is reviewed by a nurse, who determines if they need a subsequent face-to-face appointment. OBJECTIVE The primary objective was to describe the potential impact of MyPreOp® (Ultramed Ltd, Penryn, UK) the number of face-to-face appointments. Secondary objectives were to examine the time spent on preoperative assessments completed using MyPreOp in everyday use in NHS Trusts and user ratings of usability and acceptability. METHODS A case study service evaluation of data collected by the MyPreOp system from two NHS Trusts (Guy’s and St Thomas’ and Royal United Hospitals Bath) and the private BMI Bath Clinic during the four-month period of September to December 2020. MyPreOp is delivered by the hospital conducting the preoperative assessment but is typically completed at home at the patients’ convenience. Participants were adults of any age and health status at the participating hospitals who used MyPreOp to complete a preoperative assessment before a scheduled surgery. The primary outcome was the number of face-to-face appointments avoided by patients who used MyPreOp. Secondary outcomes were the length of time spent by nurses completing preoperative assessments, associated travel-related CO2 emissions, and quantitative user feedback. RESULTS Data from 2,500 participants was included. Half of the patients assessed did not need a further face-to-face appointment and required a median of only 5.3 minutes of nurses’ time. The reduction in appointments was associated with a small saving of CO2e emissions (9.05 tonnes). Patient feedback was generally positive: 80% of respondents rated MyPreOp as easy or very easy to use and 85% thought the overall experience was good or very good. CONCLUSIONS This evaluation demonstrated potential benefits of MyPreOp. However, further research using rigorous scientific methodology and a larger sample of NHS Trusts and users is needed to provide strong evidence of MyPreOp’s efficacy, usability, and cost-effectiveness.

The assessment of cognitive function in the elderly using videoconferencing

1998 ◽  
Vol 4 (1_suppl) ◽  
pp. 36-38 ◽  
Author(s):  
Chris Ball ◽  
Alison Puffett
Keyword(s):  
Cognitive Function ◽  
Inner City ◽  
The Elderly ◽  
Structured Interview ◽  
The Other ◽  
Initial Assessment ◽  
Face To Face ◽  
Number Of Patients ◽  
Old Age Psychiatry ◽  
Videoconferencing System

People over the age of 65 were recruited from an inner-city old-age psychiatry service. Subjects had a structured interview (the CAMCOG test) by videoconferencing, and also face to face, by an investigator blind to the results of the test in the other mode. Reassessments were carried out within one week of the initial assessment. Eleven subjects were initially enrolled in the study and eight completed both modes. The number of patients in this study is very small but the results suggest that the CAMCOG test can be used reliably over a videoconferencing system without major modification.

Building consensus on user participation in social work: A conversation analysis

2018 ◽  
Vol 19 (1) ◽  
pp. 20-40
Author(s):  
Terry TF Leung ◽  
Barry CL Lam
Keyword(s):  
Conversation Analysis ◽  
Service Management ◽  
Panel Discussion ◽  
User Participation ◽  
Service Users ◽  
Welfare Service ◽  
Face To Face ◽  
Communicative Ethics ◽  
The Face ◽  
Set Up

Summary In order to understand how mutual understanding was achieved in discursive interactions between the welfare service users and service practitioners, conversation analysis was conducted in four discussion panels set up for building consensus on the appropriate structure for user participation in service management. Conversations in eight panel discussion meetings were audio-taped for analysing the talks-in-interaction therein. Drawing on the conversation analysis, the article uncovers the dynamics of consensus building among participants from different epistemic communities. Findings The study identifies the extent of divergence in views among stakeholders, which could have been obscured by the pressure to acquiesce in platform of face-to-face coordination. In the contest for truth between the welfare service users and service practitioners, personal experience has not been accepted as legitimate resource for supporting truth claims. Having limited argument resources on issues of service management, the welfare service users perceived argumentation in panel discussion a threatening venture that they chose to avoid. Avoidance was also a strategy that panel participants employed to maintain mundane interactions in the face of looming dissents. The article argues that the Habermasian communicative ethics are not panacea to the problem of coordination between the welfare service users and service practitioners. An agonistic model of democracy is called for to shift the objective of communication from gauging consensus to encouraging articulation of disagreements in the intricate user participation project. Application The article provides a new direction for developing the user participation imperative to address necessary pluralities among stakeholders of welfare services.

Smartphone-based DIY home microsurgical training with 3D printed microvascular clamps and Japanese noodles

2021 ◽  
Author(s):  
Zhi Yang Ng ◽  
Calum Honeyman ◽  
Alexandre G Lellouch ◽  
Ankur Pandya ◽  
Theodora Papavasiliou
Keyword(s):  
Back Wall ◽  
Internal Validation ◽  
Middle Income ◽  
Face To Face ◽  
Middle Income Countries ◽  
Video Recordings ◽  
Low Middle Income Countries ◽  
Konjac Flour ◽  
3D Printed ◽  
Set Up

We have recently incorporated simple modifications of the konjac flour noodle model to enable DIY home microsurgical training by (i) placing a smartphone on a mug to act as a microscope with at least 3.5-5x magnification, and (ii) rather than cannulating with a 22G needle as described by others, we have found that cannulation with a 23G needle followed by a second pass with an 18G needle will create a lumen (approx. 0.83 mm) without an overly thick and unrealistic “vessel” wall. The current set-up however, did not allow realistic evaluation of anastomotic patency as the noodles became macerated after application of standard microvascular clamps, which also did not facilitate practice of back-wall anastomoses. In order to simulate the actual operative environment as much as possible, we introduced the use of 3D printed microvascular clamps. These were modified from its previous iteration (suitable for use in silastic and chicken thigh vessels) and video recordings were submitted for internal validation by senior surgeons. A “wet” operative field where the knojac noodle lumen can be distended or collapsed, unlike other non-living models, was noted by senior surgeons. With the 3D clamps, the noodle could now be flipped over for back-wall anastomosis and allowed patency testing upon completion as it did not become macerated, unlike that from clinical microvascular clamps. The perceived advantages of this model are numerous. Not only does it comply with the 3Rs of simulation-based training, it can also reduce the associated costs of training by up to a hundred-fold or more when compared to a traditional rat course, and potentially, be extended to low-middle income countries (LMICs) without routine access to microsurgical training for capacity development. That it can be utilised remotely also bodes well with the current limitations on face to-face training due to COVID restrictions and lockdowns.

scholarly journals Non-destructive investigation of polymer-metal bonds using a VibroMap1000 holographic vibrometer

2019 ◽  
Vol 299 ◽  
pp. 04010
Author(s):  
Zawadzki Pawel ◽  
Meijer Frans ◽  
Stachowska Ewa ◽  
Legutko Stanisław
Keyword(s):  
Processing System ◽  
Accurate Assessment ◽  
Non Destructive Testing ◽  
Data Processing System ◽  
Destructive Testing ◽  
Frequency Scanning ◽  
Polymer Metal ◽  
Set Up ◽  
Non Destructive ◽  
Metal Bonds

We developed a method to test polymer-metal bonds using a VibroMap1000 holographic vibrometer. The set-up and the data processing system allow non-destructive testing of polymer-metal bonds for samples of a specific size and structure. Frequency scanning from 200 Hz - 20 kHz provides characteristics of the sample. Because the method is non-destructive the sample can be studied afterwards with other methods too. These combined with the measurements of the holographic vibrometer, can create a complete and accurate assessment of the state of polymer-metal bonds. We present some preliminary results.

Is a virtual clinic model a safe and effective way for assessing patients referred with suspiciously blurred optic discs? The blurred disc clinic

2020 ◽  
pp. 112067212097604
Author(s):  
Joanna M Jefferis ◽  
Nigel Griffith ◽  
Daniel Blackwell ◽  
Ruth Batty ◽  
Simon J Hickman ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Optic Disc ◽  
Direct Contact ◽  
Visual Fields ◽  
Referral Letter ◽  
Face To Face ◽  
The Face ◽  
Optic Discs ◽  
Eye Clinic ◽  
Virtual Clinic

Background: There are increasing numbers of referrals to ophthalmology departments due to blurred optic disc margins. In light of this and the COVID-19 pandemic we aimed to assess whether these patients could be safely assessed without direct contact between the clinician and patient. Methods: We retrospectively reviewed the records of consecutive patients seen in our ‘blurred disc clinic’ between August 2018 and October 2019. We then presented anonymous information from their referral letter, their visual fields and optic nerve images to two consultant neuro-ophthalmologists blinded to the outcome of the face-to-face consultation. In the simulated virtual clinic, the two consultants were asked to choose an outcome for each patient from discharge, investigate or bring in for a face-to-face assessment. Results: Out of 133 patients seen in the blurred disc clinic, six (4.5%) were found to have papilloedema. All six were identified by both neuro-ophthalmologists as needing a face-to-face clinic consultation from the simulated virtual clinic. One hundred and twenty (90%) patients were discharged from the face-to-face clinic at the first consultation. The two neuro-ophthalmologists chose to discharge 114 (95%) and 99 (83%) of these respectively from the simulated virtual clinic. The virtual clinic would have potentially missed serious pathology in only one patient who had normal optic discs but reported diplopia at the previous face-to-face consultation. Conclusions: A virtual clinic model is an effective way of screening for papilloedema in patients referred to the eye clinic with suspicious optic discs. Unrelated or incidental pathology may be missed in a virtual clinic.

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