scholarly journals P115 Improved reporting of vertebral fractures by radiologists: a success story!

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Muhammad Amjad Nazir ◽  
Muhammad Safwan Jamal ◽  
Darren Hart ◽  
Jacqueline Shipley ◽  
Susie Warren ◽  
...  
Keyword(s):  
Patient Care ◽  
Vertebral Fractures ◽  
Improve Patient Care ◽  
Fracture Liaison Service ◽  
Radiology Report ◽  
Radiology Reports ◽  
Primary Care Teams ◽  
Management Advice ◽  
Fracture Liaison ◽  
Improve Patient

Abstract Background/Aims  Vertebral fractures (VF) are the most common type of osteoporotic fracture and affect >20% women over the age of 80. However, the majority remain undiagnosed. Even when imaging has been performed, VF are under-reported by radiologists. This results in a missed opportunity for treatment to reduce fracture risk and morbidity. We conducted this project to improve the reporting of VF (incidental or symptomatic), thus enabling our fracture liaison service to identify cases more easily and optimise patient care. Methods  Using SYNAPSE (imaging software), cohorts of patients aged more than 75 years of age who had CT scans of chest/abdomen/pelvis in 2012 and 2017 were selected. Images were reviewed by a single rheumatologist with an interest in osteoporosis, looking for the presence of VF. For patients with VF, radiology reports were reviewed to assess whether there was documentation of this. Results  There was improvement in the reporting of VF between 2012 and 2017 (see Table 1) but identification remained suboptimal. Specific use of the term “fracture” remained in the minority. The data was presented to our radiologists in December 2017 along with information about the importance of identifying and treating patients with VF. Agreement was reached for the radiologists to include a code (FLS) in reports where a non-pathological VF was identified. Searches for the presence of the code through the hospital’s radiology information system have allowed easy identification of VF cases. Letters are sent to Primary Care teams informing them that we have identified an incidental VF along with suggested management advice. This project has substantially increased the number of VF identified (in patients aged >50) by our fracture liaison service over time. 82 cases of VF were identified in 2017 (pre-intervention), 350 cases in 2018, and 848 cases in 2019. P115 Table 1:No. of patients, nVF identified in audit, n (%)Terminology alluding to fracture in radiology report, n (% of identified fractures)Use of the word “fracture” in radiology report, n (% of identified fractures)Mention of osteoporosis or osteopaenia, n (% of identified fractures)2012 cohort10315 (15)5 (33)1 (7)3 (20)2017 cohort10226 (25)18 (69)8 (31)4 (15) Conclusion  Collaboration with our radiologists through education and the use of a code in radiology reports has resulted in a sustained and dramatic increase in the number of VF annually identified by our fracture liaison service. We strongly recommend that other services adopt this approach to help them achieve national audit targets and improve patient care. Disclosure  M. Nazir: None. M. Jamal: None. D. Hart: None. J. Shipley: None. S. Warren: None. S. Hardcastle: None. T. Ahmed: None.

scholarly journals Orthopedic Research: A golden opportunity to improve patient outcomes

2021 ◽  
Vol 55 (3) ◽  
Author(s):  
Site Administrator ◽  
Czar Louie Gaston
Keyword(s):  
Patient Care ◽  
Patient Outcomes ◽  
Fracture Liaison Service ◽  
The Philippines ◽  
Evidence Based ◽  
The Core ◽  
Fracture Liaison Services ◽  
Randomized Controlled ◽  
Fracture Liaison ◽  
Improve Patient

Research has been one of the core pillars of the Department of Orthopedics of the Philippine General Hospital over its now 50 years of existence. The department established one of the earliest resident’s research contests in the hospital in 1983 and its graduates regularly publish in peer reviewed journals and present their results in international conferences.1 Residents are required to complete 2 original studies prior to graduation and encouraged to document their clinical cases fully for future observational studies. Despite the apparent fascination, questions remain for a lot of trainees and clinicians. “Why do research? How does it  help our patients?” Skepticism abounds as even clinically sound and well-made studies oftentimes do not lead to policy and practice changes needed to improve patient care.2 Given contrarian evidence from randomized controlled trials (RCTs), practices of most established surgeons do not change.3 Hope remains however as evidence-based practice in orthopedics is growing and here to stay.4 Surgeons who accurately examine and diagnose their patient, keep medical records, analyze the medical literature for the best treatment, and explain the available options are subconsciously practicing the scientific methods of observation, documentation, analysis, and reporting conclusions which are the basis of all scientific research. Incorporating research education not just to residency training programs but also to continuing medical education (CME) courses for surgeons may help develop the skills to comprehend new studies and incorporate them into patient care. Reassuringly for the elder surgeon, even old dogs have been shown to learn new tricks for their practice, just not as fast as the younger generation.5 The challenge now presented to Philippine medical practitioners is to develop clinical research that will translate into improved care for patients. As majority of literature dictating treatment for musculoskeletal disorders come from developed countries, case series or observational cohorts reporting local data in our setting is greatly important in guiding patient care.6 The fundamental goal is to produce high quality studies or new breakthroughs that engage discussion amongst a wide audience and lead to system changes that eventually enhance patient outcomes.7 As part of the celebration of the PGH Department of Orthopedics 50th golden anniversary, this orthopedic issue of the ACTA MEDICA PHILIPPINA represents work from the different orthopedic subspecialities of the department and its graduates. Pioneering studies on brachial plexus injuries, computer navigated spine surgery, rotationplasty, artificial intelligence, pedagogy, and much more highlight the growth of orthopedics in the Philippines. A study on one of the newest fields in Philippine orthopedics, orthogeriatrics, exemplifies the importance of blazing a new trail. The publication by Reyes et al. on a multidisciplinary orthogeriatric approach to the treatment of fragility hip fractures has shown improved outcomes consistent with the positive results of other fracture liaison services in Asia and worldwide.8,9 Their work has since led to the UPM-PGH Orthogeriatric Multidisciplinary Fracture Management Model and Fracture Liaison Service being adopted by PGH as a clinical pathway and has served as a model for other hospitals in the Philippines to improve their care of patients with fragility hip fractures. With the follow-through from the initial clinical study to administrative and policy changes, this example aptly illustrates the power of research to effect significant improvements in clinical outcomes and inspires all of us to continue to strive for better care for our patients.   Czar Louie Gaston, MD, FPOA Department of Orthopedics Philippine General Hospital University of the Philippines Manila   REFERENCES College of Medicine University of the Philippines Manila. Orthopedics [Internet]. [cited 2021 May]. Available from: https://cm.upm.edu.ph/p/orthopedics/ Buchbinder R, Maher C, Harris IA. Setting the research agenda for improving health care in musculoskeletal disorders. Nat Rev Rheumatol. 2015 Oct;11(10):597-605. doi: 10.1038/nrrheum.2015.81. Epub 2015 Jun 16. PMID: 26077917. Sonntag J, Landale K, Brorson S, Harris IA. Can the results of a randomized controlled trial change the treatment preferences of orthopaedic surgeons? Bone Jt Open. 2020 Sep 11;1(9):549-555. doi: 10.1302/2633-1462.19.BJO-2020-0093.R1. PMID: 33215153; PMCID: PMC7659699. Griffin XL, Haddad FS. Evidence-based decision making at the core of orthopaedic practice. Bone Joint J. 2014 Aug;96-B(8):1000-1. doi: 10.1302/0301-620X.96B8.34614. PMID: 25086112. Niles SE, Balazs GC, Cawley C, Bosse M, Mackenzie E, Li Y, et al. Translating research into practice: is evidence-based medicine being practiced in military-relevant orthopedic trauma? Mil Med. 2015 Apr;180(4):445-53. doi: 10.7205/MILMED-D-14-00296. PMID: 25826350. Elliott IS, Sonshine DB, Akhavan S, Slade Shantz A, Caldwell A, Slade Shantz J, et al. What factors influence the production of orthopaedic research in East Africa? A qualitative analysis of interviews. Clin Orthop Relat Res. 2015 Jun;473(6):2120-30. doi: 10.1007/s11999-015-4254-5. Epub 2015 Mar 21. PMID: 25795030; PMCID:PMC4419000. Tchetchik A, Grinstein A, Manes E, Shapira D, Durst R. From research to practice: Which research strategy contributes more to clinical excellence? Comparing high-volume versus high-quality biomedical research. PLoS One. 2015 Jun 24;10(6):e0129259. doi: 10.1371/journal.pone.0129259. PMID: 26107296; PMCID: PMC4480880. Chang LY, Tsai KS, Peng JK, Chen CH, Lin GT, Lin CH, et al. The development of Taiwan Fracture Liaison Service network. Osteoporos Sarcopenia. 2018 Jun;4(2):47-52. doi: 10.1016/j.afos.2018.06.001. Epub 2018 Jun 7. PMID: 30775542; PMCID: PMC6362955. Barton DW, Piple AS, Smith CT, Moskal SA, Carmouche JJ. The clinical impact of fracture liaison services: A systematic review. Geriatr Orthop Surg Rehabil. 2021 Jan 11;12:2151459320979978. doi: 10.1177/2151459320979978. PMID: 33489430; PMCID: PMC7809296

Abstract 11119: Real-Time Nanopore Sequencing for Bacterial Pneumonia After Out-of-Hospital Cardiac Arrest, a Pilot Proof-of-Concept Study

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Alexandra Weissman ◽  
Mariam Bramah Lawani ◽  
Thomas Rohan ◽  
Clifton W CALLAWAY
Keyword(s):  
Patient Care ◽  
Pathogen Detection ◽  
Bacterial Pathogen ◽  
Improve Patient Care ◽  
Antibiotic Administration ◽  
Nanopore Sequencing ◽  
Proof Of Concept ◽  
Chi Square ◽  
Significant Difference ◽  
Improve Patient

Introduction: Pneumonia is common after OHCA but is difficult to diagnose in the first 72 hours following ROSC, this results in early untargeted antibiotic administration based on non-specific imaging and laboratory findings. Antibiotic resistance is rising, is influenced by untargeted antibiotic administration, and can increase patient morbidity and mortality as well as healthcare costs. Precision methods of bacterial pathogen detection in OHCA patients are needed to improve patient care. This proof-of-concept pilot study aimed to assess feasibility of bacterial pathogen sequencing and comparability of sequencing results to clinical culture after OHCA. Methods: Blood and bronchoalveolar lavage (BAL) were obtained from residual clinical specimens collected within 12 hours of ROSC. Bacterial DNA was extracted using the Qiagen PowerLyzer PowerSoil DNA kit, sequenced using the MinION nanopore sequencer, and analyzed with Oxford Nanopore Technologies’ EPI2ME bioinformatics software. Sequencing results were compared to culture results using McNemar’s chi-square statistic. Study-defined pneumonia was based on presence of at least two characteristics within 72 hours of ROSC: fever (temperature ≥38°C); persistent leukocytosis >15,000 or leukopenia <3,500 for 48 hours; persistent chest radiography infiltrates for 48 hours per clinical radiology read; bacterial pathogen cultured. Results: We enrolled 38 consecutive OHCA subjects: mean age 61.8 years (18.0); 16 (42%) female; 25 (66%) White, 7 (18%) Black, 6 (16%) “Other” race; 7 subjects (18%) survived and 31 (82%) died; 16 (42%) subjects had pneumonia. Sequencing results were available in 12 hours while culture results were available in 48-72 hours after collection. There was a non-significant difference in the proportion of the same pathogens identified for each method per McNemar’s chi-square: p = 0.38, difference of 0.095 (-0.095, 0.286). Conclusions: Nanopore sequencing detects pathogenic bacteria comparable to clinical microbiologic culture and in less time. This technology can produce a paradigm shift in early bacterial pathogen detection in OHCA survivors, which can improve patient care. The technology is applicable to other patient populations and for viral and fungal pathogens.

Fetal Occipital Encephalocele: A Case Report

2021 ◽  
pp. 875647932110668
Author(s):  
Amanda Hogan ◽  
Natalie Ullmer
Keyword(s):  
Case Report ◽  
Patient Care ◽  
Treatment Planning ◽  
Neural Tube ◽  
Neural Tube Defects ◽  
Three Dimensional ◽  
Improve Patient Care ◽  
Two Dimensional ◽  
Occipital Encephalocele ◽  
Improve Patient

Encephaloceles are considered neural tube defects, but their exact cause is unknown. The outcome is dismal, and essential management and counseling are needed for patients. Two-dimensional and three-dimensional sonography can be used to detect encephaloceles as early as 11 weeks, assist in treatment planning, and improve patient care. This case report presents an occipital encephalocele diagnosed by sonography and followed until delivery.

scholarly journals Using patient-reported outcome measurement to improve patient care

2017 ◽  
Vol 29 (6) ◽  
pp. 874-879 ◽  
Author(s):  
John Øvretveit ◽  
Lisa Zubkoff ◽  
Eugene C Nelson ◽  
Susan Frampton ◽  
Janne Lehmann Knudsen ◽  
...  
Keyword(s):  
Patient Care ◽  
Outcome Measurement ◽  
Improve Patient Care ◽  
Patient Reported Outcome ◽  
Patient Reported ◽  
Improve Patient
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