scholarly journals 246 FRActure Clinic Treatment: a sURvey of patient Experience (FRACTURE)

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
O Javed ◽  
M Khan ◽  
M Foxall-Smith ◽  
A Hafez ◽  
W Mason
Keyword(s):  
Waiting Times ◽  
National Level ◽  
Standard Of Care ◽  
Management Plan ◽  
Outpatient Setting ◽  
X Rays ◽  
Fracture Clinic ◽  
The United Kingdom ◽  
Appointment Time ◽  
K Wires

Abstract Aim BOAST guidelines on fracture clinics suggest a standard of care that all patients with significant injury should expect to receive in a Trauma & Orthopaedics outpatient setting in the United Kingdom. Method A prospective analysis of 358 patients presenting to fracture clinic at Gloucestershire Hospitals NHS Foundation Trust from September to November 2020. Patients completed an anonymous questionnaire based on BOAST guidelines. Results Most patients received a written management plan (82%), but only some received a leaflet (36%) and definite information about their procedure (47%). Most patients felt a leaflet (72%) and information about procedures (87%) would be useful. Patients were generally seen early or within 30 minutes of their appointment time (77%), but some waited more than 30 minutes (23%). Most patients found X-rays easily (91%) and rated staff (97%) and fracture clinic experience (93%) as very good or good. Comments included noting an efficient and friendly service, with suggestions on providing more information on waiting times and procedures to be performed. Conclusions Our study showed high patient satisfaction with fracture clinic and particularly positive feedback about staff. Areas of improvement include providing more leaflets and information about practical procedures. Following this audit, we will produce leaflets on common conditions and record videos on common procedures such as application of casts, splints and removal of k-wires or sutures, which can be accessed by patients prior to their appointment. The audit could be repeated at a regional or national level to help centres assess the level of care provided.

The Leadership Capital Index

2017 ◽  
Keyword(s):  
Civil Rights ◽  
Academic Discipline ◽  
National Level ◽  
Leadership Studies ◽  
Chief Executives ◽  
Tony Blair ◽  
The United Kingdom ◽  
Lyndon Johnson ◽  
Angela Merkel ◽  
Invasion Of Iraq

This edited book will make an important, timely, and innovative contribution to the now flourishing academic discipline of political leadership studies. We have developed a conceptual framework of leadership capital and a diagnostic tool—the Leadership Capital Index (LCI)—to measure and evaluate the fluctuating nature of leadership capital. Differing amounts of leadership capital, a combination of skills, relations, and reputation, allow leaders to succeed or fail. This book brings together leading international scholars to engage with the concept of “leadership capital” and apply the LCI to a variety of comparative case studies. The LCI offers a comprehensive yet parsimonious and easily applicable ten-point matrix to examine leadership authority over time and in different political contexts. In each case, leaders “spend” and put their “stock” of authority and support at risk. United States president, Lyndon Johnson, arm-twisting Congress to put into effect civil rights legislation, Tony Blair taking the United Kingdom into the invasion of Iraq, Angela Merkel committing Germany to a generous reception of refugees: all ‘spent capital’ to forge public policy they believed in. We are interested in how office-holders acquire, consolidate, risk, and lose such capital. This volume concentrates predominantly on elected ‘chief executives’ at the national level, including majoritarian and consensus systems, multiple and singular cases. We also consider some presidential and sub-national cases. The purpose of the exercise is indeed exploratory: the chapters are a series of plausibility probes, to see how the LCI framework ‘performs’ as a descriptive and analytical tool.

scholarly journals Circulating regulatory T cells predict efficacy and atypical responses in lung cancer patients treated with PD-1/PD-L1 inhibitors

2021 ◽  
Author(s):  
Da Hyun Kang ◽  
Chaeuk Chung ◽  
Pureum Sun ◽  
Da Hye Lee ◽  
Song-I Lee ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Patients ◽  
Advanced Nsclc ◽  
Checkpoint Inhibitors ◽  
Standard Of Care ◽  
Treg Cells ◽  
University Hospital ◽  
X Rays ◽  
Lung Cancer Patients ◽  
National University

Abstract Background Immune checkpoint inhibitors (ICIs) have become the standard of care for a variety of cancers, including non-small cell lung cancer (NSCLC). In this study, we investigated the frequency of pseudoprogression and hyperprogression in lung cancer patients treated with ICIs in the real world and aimed to discover a novel candidate marker to distinguish pseudoprogression from hyperprogression soon after ICI treatment. Methods This study included 74 patients with advanced NSCLC who were treated with PD-1/PD-L1 inhibitors at Chungnam National University Hospital (CNUH) between January 2018 and August 2020. Chest X-rays were examined on day 7 after the first ICI dose to identify changes in the primary mass, and the response was assessed by computed tomography (CT). We evaluated circulating regulatory T (Treg) cells using flow cytometry and correlated the findings with clinical outcomes. Results The incidence of pseudoprogression was 13.5%, and that of hyperprogression was 8.1%. On day 7 after initiation of treatment, the frequency of CD4+CD25+CD127loFoxP3+ Treg cells was significantly decreased compared with baseline (P = 0.038) in patients who experienced pseudoprogression and significantly increased compared with baseline (P = 0.024) in patients who experienced hyperprogression. In the responder group, the frequencies of CD4+CD25+CD127loFoxP3+ Treg cells and PD-1+CD4+CD25+CD127loFoxP3+ Treg cells were significantly decreased 7 days after commencement of treatment compared with baseline (P = 0.034 and P < 0.001, respectively). Conclusion Circulating Treg cells represent a promising potential dynamic biomarker to predict efficacy and differentiate atypical responses, including pseudoprogression and hyperprogression, after immunotherapy in patients with NSCLC.

493 Evaluation of Patient Waiting Times for Plain Radiographs Whilst Attending Outpatient Clinics in A Tertiary Orthopaedic Centre

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
Z Hayat ◽  
E Kinene ◽  
S Molloy
Keyword(s):  
Waiting Time ◽  
Waiting Times ◽  
Time Frame ◽  
Outpatient Clinics ◽  
Contributing Factors ◽  
Time Data ◽  
Work Related ◽  
Mean Waiting Time ◽  
Appointment Time ◽  
Related Stress

Abstract Introduction Reduction of waiting times is key to delivering high quality, efficient health care. Delays experienced by patients requiring radiographs in orthopaedic outpatient clinics are well recognised. Method To establish current patient and staff satisfaction, questionnaires were circulated over a two-week period. Waiting time data was retrospectively collected including appointment time, arrival time and the time at which radiographs were taken. Results 84% (n = 16) of radiographers believed patients would be dissatisfied. However, of the 296 patients questioned, 56% (n = 165) were satisfied. Most patients (89%) felt the waiting time should be under 30 minutes. Only 36% were seen in this time frame. There was moderate negative correlation (R=-0.5); higher waiting times led to increased dissatisfaction. Mean waiting time was 00:37 and the maximum 02:48. Key contributing factors included volume of patients, staff shortages (73.7%), equipment shortages (57.9%) and incorrectly filled request forms. Eight (42.1%) had felt unwell from work related stress. Conclusions A concerted effort is needed to improve staff and patient opinion. There is scope for change post COVID. Additional training and exploring ways to avoid overburdening the department would benefit. Numerous patients were open to different days or alternative sites. Funding requirements make updating equipment, expanding the department and recruiting more staff challenging.

scholarly journals A Retrospective Review of Patients with Radiological Missed Fractures in an Emergency Department in Hong Kong

2003 ◽  
Vol 10 (4) ◽  
pp. 215-222 ◽  
Author(s):  
VCH Ng ◽  
FL Lau
Keyword(s):  
Emergency Department ◽  
Management Plan ◽  
Lower Limbs ◽  
X Rays ◽  
Accident And Emergency ◽  
Assessment And Treatment ◽  
Spinal Region ◽  
Accident And Emergency Department ◽  
Clinical Records ◽  
Christian Hospital

Aim To review the clinical spectrum and outcome of radiological missed fractures in the Accident and Emergency Department of United Christian Hospital (UCH) in 2002. Method In UCH, radiologists report all X-Rays taken in the Accident and Emergency Department (AED) within 48 hours. The study period was from 1st January 2002 to 31st December 2002. AED notes, relevant clinical records and all X-rays of patients with suspected missed fractures as reported by radiologists were reviewed for information on clinical features, treatments and outcomes. Results A total of 286 cases of missed fractures were found. Fourteen (4.9%) involved the skull and maxillofacial region, 83 (29.0%) involved the chest region, 53 (18.5%) involved the spinal region, 72 (25.2%) involved the upper limbs and 64 (22.4%) involved the lower limbs. Of these 286 cases, 137 (47.9%) were followed up in AED, 90 (31.5%) were referred to specialist clinics for further management, 26 (9.1%) required admission to hospital for further assessment and treatment, and 33 (11.5%) defaulted follow up. Furthermore, 87 (30.4%) of these 286 missed fractures required a change in management plan: 3 missed fractures required operative intervention (internal fixation) and 84 missed fractures required some form of external immobilisation. This group of patient did not lodge any complaint or claim. Conclusion A&E doctors missed quite a number of fractures that might result in significant morbidity. However, a reporting system by radiologists within 48 hours from discharge can pick up all these missed fractures, and may prevent complaints and litigations.

scholarly journals National and regional trends in MRI utilization in the face of the ongoing COVID-19 pandemic

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Osnat Luxenburg ◽  
Mor Saban ◽  
Vicki Myers ◽  
Sharona Vaknin ◽  
Noga Boldor ◽  
...  
Keyword(s):  
Waiting Times ◽  
National Level ◽  
Metropolitan Region ◽  
Third Wave ◽  
Policy Makers ◽  
Unequal Distribution ◽  
Elective Surgical Procedures ◽  
Regional Trends ◽  
The Face ◽  
Magnetic Resonance Imaging Mri

Abstract Background and purpose Marked reductions in imaging exams have been documented during the COVID-19 pandemic. The study aimed to examine the effect of the two waves of COVID-19 on magnetic resonance imaging (MRI) utilization at the national and regional level. Materials and methods A retrospective-archive study was conducted in Israel, comparing March–December 2020 with March–December 2018 and 2019. Data on MRI utilization were obtained from the national MRI registry, while data on confirmed COVID-19 cases, by place of residence, were obtained from the Israeli Ministry of Health open COVID-19 database. Results The number and rate of MRI examinations decreased during the first COVID-19 wave, with the steepest drop in April 2020: 47.5% relative decrease compared to April 2019, and 42.2% compared to 2018. This was followed by a compensatory increase between the waves and a return to almost pre-pandemic levels of use, with just a modest decrease, during the second, more intense COVID wave, compared with the previous year. Existing differences between regions increased during the pandemic. The rate ratio of MRI exams between Tel-Aviv and the Northern periphery increased from 2.89 in April 2019 to 3.94 in April 2020. Jerusalem metropolitan region, with the largest burden of COVID disease, demonstrated only a modest decrease (1%) in MRI utilization during the first 10 months of the pandemic. Conclusions At the national level, time trends in reduced MRI utilization followed the first wave of COVID-19, and were accompanied by increased regional disparities. These changes were not explained by differences in the burden of COVID-19 disease but might be explained by unequal distribution of MRI scanners among regions. Reduced utilization was not evident during the second wave, nor at the beginning of the third wave, despite higher COVID-19 case load, demonstrating adaptation to the new normal. Patterns of MRI utilization might help policy-makers and healthcare managers predict the behavior of imaging as well as other sectors, such as elective surgical procedures, during an ongoing pandemic. This forecast might help to manage the lasting effects of the pandemic, including extended waiting times, in the months and years following its remission. In preparation for future national emergencies, timely and detailed data on MRI utilization can serve as a “sensor” for a wide array of diagnostic and interventional medical activities, providing policy-makers with an updated snapshot to guide their response at the regional and national levels.

An investigation into the extent of Lodox imaging usage in South Africa: Radiographer’s perspective

2021 ◽  
Author(s):  
Julius Muchui Thambura ◽  
Jeanette G.E du Plessis ◽  
Cheryl M E McCrindle ◽  
Tanita Cronje
Keyword(s):  
South Africa ◽  
Waiting Times ◽  
Cross Sectional Study ◽  
Trauma Patients ◽  
X Rays ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Imaging Protocol ◽  
X Ray ◽  
X Ray Imaging

Abstract Introduction Anecdotal evidence suggests that medical professionals in trauma units are requesting additional regional images using conventional x-ray systems, even after trauma patients have undergone full-body Lodox scans. Patients are then exposed to additional radiation, additional waiting times and an increased medical bill. This study aimed at investigating the extent to which Lodox systems were used in trauma units (n=28) in South Africa. Method In this descriptive cross-sectional study, the researcher invited one radiographer from the 28 hospitals in South Africa that use Lodox systems. Radiographers who were most experienced in using the Lodox system completed an online questionnaire. Results Twenty (71.43% n=20) out of twenty-eight radiographers responded. Most hospitals (90%, n=18) were referring patients for additional conventional x-ray images. Radiographers indicated that conventional x-rays were requested for the chest (27.80%, 10/36), the abdomen (16.67%, 6/36), the spine (13.89%, 5/36) and the extremities and skull (19.44%, 7/36). Additionally, radiographers reported using Lodox to perform procedures and examinations usually performed on conventional x-ray systems when conventional x-ray systems were not operational. Conclusion Currently, it is not clear if the use of conventional x-ray imaging following Lodox is necessary, but the results suggest that the practice is commonplace, with healthcare workers in most hospitals (90%, n=18) requesting additional x-ray imaging. The researcher thus recommends that an imaging protocol for Lodox imaging systems should be developed to guide the referral of the patients for further imaging.

THE CONFRONTATION OF THE PARTIES TO THE SEPARATIST CONFLICT BY MEANS OF «SOFT POWER» (ON THE EXAMPLE OF CATALONIA AND SCOTLAND)

2021 ◽  
Vol 16 (4) ◽  
pp. 119-132
Author(s):  
E.A. TYURIN ◽  
◽  
E.N. SAVINOVA ◽  
О.V. PEREVERZEVA ◽  
◽  
...  
Keyword(s):  
United Kingdom ◽  
International Relations ◽  
Research Methods ◽  
Soft Power ◽  
National Level ◽  
Power Characteristic ◽  
Main Research ◽  
Power Resources ◽  
The United Kingdom ◽  
Legal Grounds

The article attempts to apply the concept of «soft power», characteristic of international relations, to analyze the struggle of participants in separatist conflicts at the national level. The purpose of the study is to consider the «soft power» resources and tools of each of the parties to the conflict between Catalonia and Spain and the conflict between Scotland and the United Kingdom. The main research methods are general logical, institutional and comparative. It is concluded that in the countries under consideration, in the conditions of the manifestation of separatism, the «soft power» has obvious socio-cultural, political, institutional and legal grounds. According to the authors, despite the specifics of the «soft power» confrontation, in each of the cases considered, culture in its various manifestations, image strategies of the parties to the conflict, as well as the institution of the monarchy are crucial.

Abstract P841: The Impact of a Dedicated Pediatric Stroke Discharge Plan Upon Parent Preparedness for Clinic: Before and After the Start of Covid-19

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Cindy Nederveld ◽  
Vivian Thompson ◽  
Jacqueline Murray ◽  
Jennifer L Armstrong ◽  
Megan Barry ◽  
...  
Keyword(s):  
Multidisciplinary Care ◽  
Clinic Visit ◽  
Outpatient Setting ◽  
Pediatric Stroke ◽  
Chi Square ◽  
Discharge Plan ◽  
Before And After ◽  
Appointment Time ◽  
Chi Square Analysis ◽  
The Impact

Background: The Colorado Pediatric Stroke Program provides comprehensive, multidisciplinary care for pediatric stroke patients and their families. The team, which includes dedicated inpatient and outpatient nurse coordinators, instituted a plan to support the transition from the inpatient to outpatient setting. Purpose: A survey was used to determine family preparedness for clinic and ease of scheduling their appointment. The data were collected before and after enacting remote scheduling and telehealth visits due to the COVID-19 pandemic. Methods: Our team provided educational materials and an outpatient appointment time to families at time of discharge starting in 2019. In January 2020, the stroke clinic staff surveyed parents and guardians about their preparedness for clinic. Telehealth encounters were initiated due to COVID-19 in March 2020, with staff conducting RedCAP surveys by telephone. The survey measured several components of visit preparedness and satisfaction including: understanding of diagnosis, reason for referral prior to clinic visit, familiarity with the stroke team prior to clinic visit, and ease in appointment scheduling. We compared results before and after March 2020 via two-tailed chi-square analysis or two-tailed Fischer’s test. Results: Prior to telehealth, families favorably reported responses with 92% (47/52) knowing the reason for referral, 86% (42/49) receiving educational material prior to clinic, and 84% (42/50) reporting familiarity with our team. All patients (50/50) reported that scheduling was easy. Only scheduling ease had a significant change during the pandemic, with 11% (2/11) of patients reporting difficulties with scheduling after starting telehealth ( P=0.03 ). Conclusion: Childhood stroke is a disease with significant morbidity and mortality, requiring close follow-up care. Families report robust preparedness for clinic after the implementation of a comprehensive discharge plan. Although small numbers, remote scheduling and telehealth transition may present previously unseen barriers to scheduling during the pandemic. During abrupt changes in clinical operations additional scheduling resources may be needed to ensure continuity of care.

A Student Perspective of Intramural Sport Risk Management Procedures

2005 ◽  
Vol 29 (1) ◽  
pp. 22-32 ◽  
Author(s):  
John Miller ◽  
Frank R. Veltri ◽  
Andy Gillentine
Keyword(s):  
Risk Management ◽  
Standard Of Care ◽  
Management Plan ◽  
Management Program ◽  
Risk Management Plan ◽  
Student Perspective ◽  
Intramural Sports ◽  
Emergency Procedures ◽  
Management Procedures ◽  
Intramural Sport

One of the best ways for an intramural sports program to ensure that an ordinary and reasonable standard of care is adhered to, as well as guarding against litigation, is communication of a risk management program. While having a risk management plan has been widely stressed, no previous research has been conducted from a participant's viewpoint. Thus, the purpose of this study was to determine the effectiveness of university intramural risk management plans from the participant's perception. The primary results of this study indicate that the majority of the intramural sport participants responded that they had never: a) noticed an intramural supervisor being present while the activity was taking place; b) been informed about the potential for participant injury; c) noticed signage relating to emergency procedures at the area of the activity; d) knew of a risk management plan for intramural sports; d) noticed emergency equipment at the site of the activity; and e) been informed about the possession of First Aid/CPR certification or equivalent by the supervisor.

Bone-mounted Miniature Robotic Guidance for Pedicle Screw and Translaminar Facet Screw Placement: Part 2—Evaluation of System Accuracy

2007 ◽  
Vol 60 (suppl_2) ◽  
pp. ONS-129-ONS-139 ◽  
Author(s):  
Daisuke Togawa ◽  
Mark M. Kayanja ◽  
Mary K. Reinhardt ◽  
Moshe Shoham ◽  
Alin Balter ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Three Dimensional ◽  
Contralateral Side ◽  
X Rays ◽  
Average Deviation ◽  
Computed Tomographic ◽  
Entry Points ◽  
External Frame ◽  
K Wires ◽  
Preoperative Plan

Abstract Objective: To evaluate the accuracy of a novel bone-mounted miniature robotic system for percutaneous placement of pedicle and translaminar facet screws. Methods: Thirty-five spinal levels in 10 cadavers were instrumented. Each cadaver's entire torso was scanned before the procedure. Surgeons planned optimal entry points and trajectories for screws on reconstructed three-dimensional virtual x-rays of each vertebra. Either a clamp or a minimally invasive external frame was attached to the bony anatomy. Anteroposterior and lateral fluoroscopic images using targeting devices were obtained and automatically registered with the virtual x-rays of each vertebra generated from the computed tomographic scan obtained before the procedure. A miniature robot was mounted onto the clamp and external frame and the system controlled the robot's motions to align the cannulated drill guide along the planned trajectory. A drill bit was introduced through the cannulated guide and a hole was drilled through the cortex. Then, K-wires were introduced and advanced through the same cannulated guide and left inside the cadaver. The cadavers were scanned with computed tomography after the procedure and the system's accuracy was evaluated in three planes, comparing K-wire positions with the preoperative plan. A total of fifty-five procedures were evaluated. Results: Twenty-nine of 32 K-wires and all four screws were placed with less than 1.5 mm of deviation; average deviation was 0.87 ± 0.63 mm (range, 0-1.7 mm) from the preoperative plan in this group. Sixteen of 19 K-wires were placed with less than 1.5 mm of deviation. There was one broken and one bent K-wire. Another K-wire was misplaced because of collision with the previously placed wire on the contralateral side of the same vertebra because of a mistake in planning, resulting in a 6.5-mm deviation. When this case was excluded, average deviation was 0.82 ± 0.65 mm (range, 0-1.5 mm). Conclusion: These results verify the system's accuracy and support its use for minimally invasive spine surgery in selected patients.

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