scholarly journals Telemedicine use in orthopaedics: Experience during the COVID-19 pandemic

2021 ◽  
pp. 1357633X2110410
Author(s):  
Brian Z Chin ◽  
Nazrul Nashi ◽  
Shuxun Lin ◽  
Kevin Yik ◽  
Gamaliel Tan ◽  
...  
Keyword(s):  
Disease Transmission ◽  
Healthcare Delivery ◽  
Outpatient Setting ◽  
Face To Face ◽  
Roles And Responsibilities ◽  
Orthopaedic Patients ◽  
High Satisfaction ◽  
Single Centre Experience ◽  
Satisfaction Rates

Introduction With a recent resurgence of the 2019 coronavirus disease (COVID-19) cases globally, an increasing number of healthcare systems are adopting telemedicine as an alternative method of healthcare delivery in a bid to decrease disease transmission. Continued care of orthopaedic patients in the outpatient setting during the coronavirus disease of 2019 era can prove challenging without a systematic workflow, adequate logistics, and careful patient selection for teleconsultation. The aim of this paper is to describe our single-centre experience with the application of telemedicine in our orthopaedic practice, and its effectiveness in maintaining outpatient follow-up of orthopaedic patients. Methodology We describe our centre's telemedicine model of care for orthopaedic patients on the outpatient follow-up – which includes workforce assembly, population health and target patients, logistics and communications, and overall workflow – with roles and responsibilities of involved people portrayed in detail. Results Feedback from both patients and orthopaedic surgeons reflected high satisfaction rates with care provided, noting minimal communication and clinical barriers compared to face-to-face consultations. Whilst not without limitations, our protocol allowed for rapid adoption of telemedicine in line with a national-wide initiative to digitize healthcare. Discussion The implementation of teleconsultation services at our orthopaedic centre has provided an effective method of healthcare delivery while enforcing social distancing measures – which proves vital in combating the spread of COVID-19 and ushering in a new normal.

scholarly journals Improving communication on medical ward rounds with patients who speak limited English with implementation of medical communication charts

2021 ◽  
Vol 10 (3) ◽  
pp. e001389
Author(s):  
Amrita Naomi D'Souza ◽  
Ana Canoso ◽  
Laura-Jane Smith
Keyword(s):  
Healthcare Delivery ◽  
Physical Symptoms ◽  
Ward Round ◽  
Medical Ward ◽  
Language Therapy ◽  
College Hospital ◽  
Medical Communication ◽  
Face To Face ◽  
High Satisfaction ◽  
Ward Rounds

AimTo improve communication on the medical ward round with patients with limited English through implementation of a medical communication chart.Local problemKing’s College Hospital (KCH), London, is situated in Southwark in which 11% of households have no members that speak English as a first language, 4.1% of London’s population report they do not speak English well. Language barriers impair healthcare delivery including during daily ward rounds. This has been exacerbated by the need for PPE during the SARS-CoV2 pandemic. Effective communication between healthcare teams and patients is essential for high quality, patient-centred care. Communication tools commonly used include online, telephone and face-to-face translation services but these have limitations.MethodsFace-to-face patient questionnaires were conducted in the pre-QIP (baseline) group to assess communication on medical ward rounds. Medical communication charts were designed by adapting pre-existing aids commonly used by speech and language therapy. Charts were translated into commonly spoken languages among KCH inpatients. Patients with limited English were selected from both COVID-19 and non-Covid wards. Preintervention and postintervention questionnaires were completed in three Plan–Do–Study–Act (PDSA) cycles.ResultsAt baseline, patients agreed or strongly agreed that the ward round addressed physical symptoms (8/8), concerns or anxieties (7/8), ongoing needs (7/8). Only two of eight doctors felt they could communicate effectively with patients. In PDSA 1, four of five patients reported high satisfaction in communicating physical symptoms, anxieties or concerns preintervention with five of five postchart implementation. Five of five patients reported high satisfaction in communicating ongoing needs preintervention but only three of five postintervention. In PDSA 2, two of five patients reported increased satisfaction in communicating physical symptoms, concerns or anxieties with four of four doctors reporting improved satisfaction in communication in PDSA 2 and two of three doctors reporting higher satisfaction in communication in PDSA 3.ConclusionUsing communication charts in patients with limited English can improve bidirectional communication on medical ward rounds.

scholarly journals 1314. HOME CARE: Reaching Our Lost to Follow-up Patients and Overcoming Barriers to Care Utilizing Nontraditional Care Models

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S474-S475
Author(s):  
Erin Goldman ◽  
Sheronda Union ◽  
Tammie McClendon ◽  
Jennifer Veltman
Keyword(s):  
Healthcare Delivery ◽  
Care Program ◽  
Outpatient Setting ◽  
Standards Of Care ◽  
People Living With Hiv ◽  
Virologic Suppression ◽  
Healthcare Delivery System ◽  
Mental Health Barriers ◽  
Care Models

Abstract Background Of the 11098 people living with HIV in southeast Michigan, over 30% are out of care, with transportation being the most commonly identified barriers. To address this barrier and re-engage patients into care, we introduced an HIV homecare program. The objective of this study was to describe the implementation of the homecare program and document the outcomes of patients enrolled. Methods In 2016, WSUPG ID clinic saw 1990 patients and had additional 95 clients who were virally unsuppressed and lost to care for 12 months. We called all 95 of these clients and offered homecare. We also advertised our program internally, to the Detroit Public Health Departments’ Data to Care Program (Link up Detroit), and to community-based organizations. Referred patients were seen by a NP/MA team supervised by an infectious disease attending. HIV medical care delivered in home utilized same standards of care as for outpatient setting, including lab draws and counseling. Patients also had the ability to text/call provider directly on the program cell phone. This project was funding through a Part A Ryan White MAI grant. Results Of the 95 clients out-of-care, 38 (40%) were unreachable, 41 (43%) were reachable and 16 (17%) did not qualify (relocation, incarcerated, deceased, in-care at the time of call). 5 (5%) enrolled in homecare and additional 29 patients were referred to our program. A total of 34 patients enrolled from September 20, 2017 to September 20, 2018. Among the 34 clients, mental health barriers were the most frequently reported (depression in 20, schizophrenia or bipolar in 7, anxiety in 23, and history of trauma in 11). Of the 34 clients, 24 have achieved virologic suppression at least once during their enrollment. Among the 26 clients with 6+ months of follow-up, 17 have achieved virologic suppression. Conclusion Homecare offers a new, innovative healthcare delivery system which is effective at achieving viral suppression in a challenging patient population and is a successful strategy to re-engage patients in care. Disclosures All authors: No reported disclosures.

scholarly journals 16 Outcomes of a novel 5-week individualized multidisciplinary outpatient (day-patient) treatment programme for functional (psychogenic) neurological symptoms

2020 ◽  
Vol 91 (8) ◽  
pp. e14.1-e14
Author(s):  
P Petrochilos ◽  
M Elmalem ◽  
C Selai ◽  
D Patel ◽  
K Hayward ◽  
...  
Keyword(s):  
Health Status ◽  
Social Functioning ◽  
Functional Performance ◽  
Outpatient Setting ◽  
Neurological Symptoms ◽  
Treatment Programme ◽  
Global Improvement ◽  
Face To Face ◽  
Improve Health

AimWe report the results of a novel 5-week treatment programme, delivered by a multi-disciplinary team, with individualised sessions to treat functional neurological symptoms in a neuropsychiatric outpatient setting. The primary aims of this MDT programme were to (a) reduce symptoms (b) improve health and social functioning (c) improve functional performance (d) improve health status.MethodTreatment involved individual sessions of neuropsychiatry, cognitive behavioural therapy, physiotherapy, occupational therapy, education and family meetings. Outcome measures were collected at the beginning and end of treatment and at a 6 month face to face follow-up. These were both patient and clinician reported. The aims were assessed by the following measures: symptom reduction (PHQ15, PHQ9, GAD7, SPIN, Rosenberg, CGI); health and social functioning (HONOS, WSAS); functional performance (COPM); and improvements in health status (EQ5DL). Results: Analyses were conducted on 78 patients who started and completed the programme and attended a 6 month face to face review. There were high baseline levels of disability compared to EQ5DL population norms and high rates of disability and psychopathology as indicated by the WSAS and mental health indices (PHQ9, GAD7, SPIN, Rosenberg’s self-esteem). At baseline, 92.3% met the IAPT caseness threshold for depression (PHQ9 >10) and 71% met the IAPT caseness threshold for anxiety (GAD7 >8). A repeated measures Freidman’s ANOVA over 3 timepoints (admission, discharge and 6 month follow-up) followed by Dunn-Bonferroni post hoc tests indicated statistically significant improvements from admission to discharge and admission to 6 months follow up. These improvements were seen in in somatic symptoms (PHQ15), depression (PHQ9) and anxiety (GAD7) symptoms, health and social functioning (HONOS), functional performance (COPM), health status (EQ5D-5L and EQ5D-EL VAS) and patient ratings of clinical global improvement (CGI). There was a high acceptance of this neuropsychiatry led MDT programme indicated by the patient reported visual analogue scale for benefit of programme averaging at 90%.ConclusionAn MDT can effectively deliver an outpatient programme for FNS which can serve as an alternative to an inpatient programme for patients with fewer or no nursing needs, for those whose preference is an outpatient setting or for those seeking to minimise disruption to work or family life. There may be potential cost reductions for institutions compared to inpatient treatment depending on local calculations. In the future, earlier identification and treatment of co-morbidities may modify some predisposing and perpetuating factors.

SHADOW study: Comparison of conventional clinical follow-up with clinician led video follow-up in newly diagnosed patients with intermediate and high grade glioma receiving adjuvant temozolomide therapy.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 2024-2024 ◽  
Author(s):  
Vijay Maruti Patil ◽  
Nikhil Pande ◽  
Arun Chandrasekharan ◽  
Raees Tonse ◽  
Chandrakanth MV ◽  
...  
Keyword(s):  
High Grade Glioma ◽  
Kappa Coefficient ◽  
Molecular Testing ◽  
High Grade ◽  
Adjuvant Temozolomide ◽  
High Satisfaction ◽  
Alternative Approach ◽  
Lost To Follow Up ◽  
Satisfaction Rates

2024 Background: In patients with gliomas, nurse led telephonic follow-up was associated with high satisfaction rates and was a valid alternative approach to conventional hospital based follow-up. However, other alternative forms of follow-up have not been studied in patients on active treatment. Methods: SHADOW was a prospective, randomized trial (CTRI/2017/01/007626). Adult intermediate to high grade glioma patients on adjuvant temozolomide with facilities for live video call were invited. After their consent, patients underwent a video follow-up (VF) 4 days prior to clinical follow-up (CF). The decisions taken during the VF and CF were noted in 5 domains, relating to temozolomide decisions (primary endpoint), concurrent medications, need for imaging, molecular testing and rehabilitation. Clinicians performing VF or CF were randomly assigned and were blinded for the other arm decisions. Patients satisfaction and costs incurred in each type of follow-up was documented. The planned sample size was 65, assuming an alpha of 0.05, a kappa coefficient of 0.9 with a one sided CI for lower limit of 0.6 and assuming a 20% lost to follow up rate. Agreement analysis was performed for calculation of Cohen's kappa coefficient. Results: 112 patients were screened and 65 were accrued. All patients underwent both VF and CCF. The concurrence in decision of administering temozolomide between VF and CCF was 100% (Cohen kappa = 1.0, 95%CI 1.0-1.0, p < 0.00). In concurrent medication domain (k = 0.66,95% CI 0.04 -1, p < 0.00), imaging domain (k = 1.0, 95%CI 1.0-1.0, p < 0.00), rehabilitation domain (k = 1.0, 95%CI 1.0-1.0, p < 0.00) and molecular testing domain (k = 0.65, 95% CI 0.20-1, p < 0.00), the agreement was substantial. The satisfaction rate was 100% post video follow up and was 98.5 % post clinical follow up. The median cost incurred in VF was 58.15 USD (IQR 43.38-91.69) while that incurred in CCF was 131.23 USD (IQR 68.8-256 (p < 0.00)). Conclusions: The decisions taken regarding administration of adjuvant TMZ were similar between VF and CCF. Hence, it's practical and economical to substitute CCF with VF during adjuvant TMZ administration. Clinical trial information: CTRI/2017/01/007626.

Mini-Slings: Do They Stand the Test of Time? A 10-Year Cohort

2020 ◽  
pp. 1-5
Author(s):  
Margarida Manso ◽  
Francisco Botelho ◽  
Carlos Silva ◽  
Francisco Cruz
Keyword(s):  
De Novo ◽  
Treatment Success ◽  
Anticholinergic Drugs ◽  
Patient Global Impression ◽  
High Satisfaction ◽  
Patient Reported ◽  
De Novo Urgency ◽  
Satisfaction Rates ◽  
Mini Sling

<b><i>Introduction:</i></b> It is known that failures after midurethral slings increase with the follow-up time. Nevertheless, data concerning mini-slings are sparse. To clarify this statement, we analyze a mini-sling cohort with a median follow-up of 10 years. Although the brand used, MiniArc<sup>®</sup>, is no longer available, an identical device, Solyx™, can still be used, which makes the analysis of the cohort clinically relevant. <b><i>Material and Methods:</i></b> A total of 172 women with predominant stress urinary incontinence (SUI) were consecutively treated with the mini-sling MiniArc<sup>®</sup> from 2006 until 2013. They were reevaluated in 2018. The primary outcome, treatment success, was defined as no self-reported SUI symptoms and no reintervention. Secondary outcomes included the response to patient-reported outcomes. Adverse events were assessed. <b><i>Results:</i></b> After a median follow-up time of 113 months, 115 (66.9%) women were available for reevaluation. Forty-four (38.3%) women self-reported SUI. Seventeen women had been reoperated, 14 (12.2%) due to the reappearance of SUI and 3 due to complications. Altogether, MiniArc<sup>®</sup> had an overall success rate of 47.0% at 10 years. Among those not reoperated, 63.3% stated that they were much better or very much better in Patient Global Impression of Improvement (PGI-I) and 71.4% affirmed that their continence problem was normal or mild in Patient Global Impression of Severity (PGI-S). Almost 85% would repeat the surgery. Reoperation due to complications was rare (2.6%). De novo urgency appeared in 30.6% of the patients and it was managed with anticholinergic drugs with favorable outcomes. <b><i>Discussion/Conclusion:</i></b> This report adds evidence to the long-term outcomes of mini-slings, confirming that they can cure or improve SUI and give patients high satisfaction rates, at the expense of low morbidity.

scholarly journals Bearing surfaces in primary total hip arthroplasty

2018 ◽  
Vol 3 (5) ◽  
pp. 217-224 ◽  
Author(s):  
Luigi Zagra ◽  
Enrico Gallazzi
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Bearing Surface ◽  
Total Hip ◽  
High Satisfaction ◽  
Long Term Follow Up ◽  
Satisfaction Rates

Total hip arthroplasty (THA) is widely considered one of the most successful surgical procedures in orthopaedics. It is associated with high satisfaction rates and significant improvements in quality of life following surgery. On the other hand, the main cause of late revision is osteolysis and wear, often a result of failure of bearing surfaces. Currently, several options are available to the surgeon when choosing the bearing surface in THA (ceramic-on-ceramic (CoC), ceramic-on-polyethylene (CoPE), metal-on-polyethylene (MoPE)), each with advantages and drawbacks. Very few studies have directly compared the various combinations of bearings at long-term follow-up. Randomized controlled trials show similar short- to mid-term survivorship among the best performing bearing surfaces (CoC, CoXLPE and MoXLPE). Selection of the bearing surface is often ‘experience-based’ rather than ‘evidence-based’. The aim of this paper is therefore to evaluate the main advantages and drawbacks of various types of tribology in THA, while providing practical suggestions for the surgeon on the most suitable bearing surface option for each patient.Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.180300.

scholarly journals Results of minimally invasive Achilles tendon scraping and plantaris tendon removal in patients with chronic midportion Achilles tendinopathy: A longer-term follow-up study

2019 ◽  
Vol 7 ◽  
pp. 205031211882264 ◽  
Author(s):  
Anna Ruergård ◽  
Christoph Spang ◽  
Håkan Alfredson
Keyword(s):  
Minimally Invasive ◽  
Achilles Tendon ◽  
Treatment Time ◽  
Achilles Tendinopathy ◽  
Colour Doppler ◽  
Follow Up Study ◽  
Plantaris Tendon ◽  
High Satisfaction ◽  
Satisfaction Rates

Background: Treatment with ultrasound and colour Doppler–guided minimally invasive Achilles tendon scraping and plantaris tendon removal has shown promising short-term results in patients with chronic painful midportion Achilles tendinopathy. Methods: In a follow-up study, 182 consecutive patients (241 tendons) who had undergone Achilles tendon scraping and plantaris tendon removal were contacted on telephone by an independent investigator. The patients who answered the telephone call were included, and they answered a questionnaire on telephone and then also sent their written answers. The questionnaire included information about patient satisfaction with the result of the treatment, time to return to full Achilles tendon loading activity, and a pain score (Visual Analogue Scale-VAS). Results: The follow-up period was 5.8 years (mean) (range of 2–13 years) after surgery. Altogether, 110 patients (136 Achilles tendons), 52 years (mean)(range 18-73) old at surgery could be reached and were included. In total, 81 tendons were operated with the Achilles scraping procedure alone, and for 55 Achilles operations also a plantaris tendon removal was performed. For 93% of the operated tendons, the patients were satisfied with the surgical outcome and the VAS had decreased from 74 preoperatively to 8 postoperatively. Nine male patients (9 tendons), five operated with scraping + plantaris removal, had remaining tendon pain during loading and were not satisfied. Their VAS score ranged from 22 to 91. For 21% of the operated tendons, some occasional mild discomfort not preventing from full tendon loading, was reported. There were no differences in pain reduction and satisfaction rates between men and women, and between Achilles scraping alone and scraping plus plantaris removal. Conclusion: Ultrasound and colour Doppler–guided surgical Achilles tendon scraping and plantaris tendon removal in patients with chronic painful midportion Achilles tendinopathy show remaining good clinical outcomes and high satisfaction rates in this longer-term follow-up.

scholarly journals P220 Patient-entered symptoms scores collected using a new IBD patient portal correlate closely with clinical assessment and can optimise delivery of IBD care

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S274-S275
Author(s):  
S Carlson ◽  
P Harrow ◽  
S McCartney
Keyword(s):  
Disease Activity ◽  
Severe Disease ◽  
Healthcare Delivery ◽  
Clinic Visit ◽  
Clinical Impression ◽  
Patient Portal ◽  
Face To Face ◽  
Patient Reported ◽  
Symptom Scores

Abstract Background Patient healthcare portals can empower IBD patients by allowing access to their electronic health record and provide opportunities for active participation in their care. We built 3 patient-entered symptom questionnaires in EPIC MyChart using existing validated IBD symptom scores (HBI, SCCAI, IBD Control). Patients were invited to complete these prior to clinic using the MyChart patient portal. In this study we examine the feasibility and accuracy of patient entered scores compared to the physician’s impression of disease activity and the potential impact on healthcare delivery. Methods Between September 2020 and January 2021 consecutive patients were invited to complete 2 questionnaires reporting disease activity on the EPIC MyChart portal using the IBD Control (Bodger et al. 2014) and either HBI or SCCAI (for Crohn’s disease and UC respectively). Only patients who completed these scores were included in this study. A retrospective review of the notes was completed to determine the physician’s impression of disease activity and actions taken by the physician in the outpatient clinic. Results 107 patients with Crohn’s and 80 with UC were included in the study. 60% of CD and 56% of UC patients were in remission by HBI (&lt;5) or SCCAI (&lt;3). Patient reported disease activity correlated well with clinical impression of disease activity. 88% of CD patients and 98% of UC patients in HBI or SCCAI remission were also deemed to be in remission on physician’s clinical impression (r= 0.54, p &lt;0.001 and r= 0.74, p &lt;0.001). Both CD and UC had lower rates of remission by IBD Control (49% and 53%). This score also captures fatigue and mood. Furthermore, the IBD Control identified a specific question to be addressed at the upcoming clinic visit for 76% of patients with CD and 64% with UC. Importantly, 24% of all UC patients (n=19) in remission by SCCAI and IBD Control, had no questions they wanted addressed, and all of these patients had no further actions triggered by clinic attendance. Conversely in the 18% patients with moderate to severe disease by HBI or SCCAI, 50% required a blood test or calprotectin prior to further clinical decisions. Conclusion Patient-entered symptom scores correlate closely with physician’s impression of disease activity and patients are able to accurately record these using the EPIC MyChart portal. Importantly, it is possible to identify a cohort of patients who are well, where there are opportunities to optimise follow-up, and conversely a group of patients with active disease where key investigations can be arranged prior to clinical review to prevent delays in treatment. These patients can also be prioritised for face-to-face clinics, at a time when reducing social contacts is imperative.

EP.TH.893Virtual Clinic follow-up in Laparoscopic Fundoplication Surgery

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Chenchen Ji ◽  
Benjamin Mitchell ◽  
Christine Tan ◽  
Simon Toh
Keyword(s):  
Financial Incentives ◽  
Laparoscopic Fundoplication ◽  
Elective Surgery ◽  
Surgical Care ◽  
Physical Review ◽  
Outpatient Clinics ◽  
Face To Face ◽  
High Satisfaction ◽  
Virtual Clinic

Abstract Aims There are clinical and financial incentives to reduce follow-up NHS clinics after elective surgery. 55% of our laparoscopic anti-reflux procedures are day-cases procedures. To reduce consultant clinic workload and unnecessary face-to-face patient reviews, we introduced a laparoscopic surgical care practitioner (LSCP) based Virtual Clinic. Methods Patients were telephoned on day 1 and 5 to ensure they were managing their diet without significant post-operative symptoms. This was followed by a Virtual Clinic follow-up at 6-8 weeks, using a universal list of questions and template, and an electronic letter with outcomes recorded. 149 patients underwent laparoscopic fundoplication surgery from September 2016 – May 2018. All follow-up clinics, both virtual and face-to-face, were recorded electronically. These were reviewed, data collected and analysed. Results Between September 2016 – May 2018, 149 patients had laparoscopic fundoplication surgery at our trust with the following clinic outcomes: Conclusions Our LSCP Virtual Clinics discharged 50 out of 149 (33%) patients with no need for face-to-face clinic time, and no detriment to patient care. Those requiring further follow-up were patients who had difficulty managing dietary changes, or experiencing symptoms like dysphagia, often needing physical review and further investigations. Furthermore, patients have expressed high satisfaction with this service. Virtual clinic follow-up is safe, patient-friendly, and reduces both clinical and financial load on NHS outpatient clinics.

Sign in / Sign up

Export Citation Format

Share Document