What are the medicolegal implications of virtual clinics?

2021 ◽  
pp. 1-6
Author(s):  
JA Street ◽  
MR Ricks
Keyword(s):  
Patient Satisfaction ◽  
Physical Examination ◽  
Clinical Assessment ◽  
Literature Search ◽  
Clinical Care ◽  
Patient Interaction ◽  
Change In Practice ◽  
Areas Of Concern

Recently there has been increased interest in the use and development of virtual clinics, particularly in the wake of the COVID-19 pandemic. The need to provide clinical care, while minimising patient interaction, has led to wider adoption of both telephone and online consultations, with the potential complications and pitfalls that accompany such a change in practice. A literature search was performed using the Pubmed, MEDLINE and Embase databases, from database inception up to 25 January 2021. A total of 21 papers were identified as discussing virtual clinical assessment and the medicolegal implications. The main areas of concern included consent, misdiagnosis, lack of physical examination, privacy and patient satisfaction. This article assesses these areas and suggests techniques to address them.

A Review on Post Pregnancy Healer Herbs

2019 ◽  
Vol 15 (2) ◽  
pp. 102-108 ◽  
Author(s):  
Rashmi Saxena Pal ◽  
Yogendra Pal ◽  
Pranay Wal
Keyword(s):  
Literature Search ◽  
Review Article ◽  
The Body ◽  
Medical Supervision ◽  
Areas Of Concern

Background: Postpartum is an important phase of life after childbirth. It needs to be highly important as in terms of health in future life. This time brings lots of complications with it. Lots of aspects need to be looked after as the care of the new mom is essential to bring back her stamina and strength. Objective: The objective of this review article is to explore the heeding power hidden in nature for returning back to the mothers to the pre-pregnancy state. There are various areas of concern after postpartum to heal up the body overall, such as to heal up the uterus, providing galactagogues, nutritives, maintenance of hormones and restoring back the strength and tone of the abdomen. Materials and Methods: A literature search has been done on the various herbs, which fulfill the various desired aspects to be looked after post pregnancy. Results: There are various herbs present in nature, regarding their hidden potential still the awareness is not up to the mark. This review highlights the various plants which have been proven to be useful in dealing the post-pregnancy issues. They deal with all the aspects of complications and issues occurring post pregnancy. They heal the uterus which has undergone so many types of changes, maintains the balance of hormones back, besides providing nutrition and increasing the production of milk, they also restore back the tone and strength of the walls of the abdomen. Conclusion: These herbs are full-fledged with the phytoconstituents that heal the whole system after delivery. The need of present time is to take patiently these as the source of medicines regularly under medical supervision to overcome the various concerned problems of post pregnancy.

scholarly journals A Unique Case of Replantation of Previously Replanted Fingers

2021 ◽  
Author(s):  
Ravindra Bharathi ◽  
Praveen Bhardwaj ◽  
Vigneswaran Varadharajan ◽  
Hari Venkatramani ◽  
S Raja Sabapathy
Keyword(s):  
Patient Satisfaction ◽  
Literature Search ◽  
Standard Of Care ◽  
Unique Case ◽  
High Patient Satisfaction ◽  
Finger Amputation ◽  
Accepted Standard ◽  
Technical Challenges

AbstractReplantation of digital amputations is now the accepted standard of care. However, rarely will a replantation surgeon be presented with amputated fingers which have been previously replanted. In our literature search, we could find only one publication where a replanted thumb suffered amputation and was successfully replanted again. We report the technical challenges and the outcome of replanting two fingers which suffered amputation 40 months after the initial replantation and were successfully replanted again. Replantation was critical since the amputated fingers were the only two complete fingers in that hand which had initially suffered a four-finger amputation. The second-time replantation of previously replanted fingers is reported to allay the concern of the reconstructive surgeon when faced with this unique situation of “repeat amputation of the replanted finger.” Second-time replantation is feasible and is associated with high-patient satisfaction. Replantation must be attempted especially in the event of multiple digit amputations.

scholarly journals P071 Survey of rheumatology patient satisfaction with telephone consultations during the COVID-19 pandemic

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Mia Rodziewicz ◽  
Terence O'Neill ◽  
Audrey Low
Keyword(s):  
Patient Satisfaction ◽  
Physical Examination ◽  
Management Plan ◽  
Service Development ◽  
Telephone Consultation ◽  
Face To Face ◽  
Communication Difficulties ◽  
Strongly Agree ◽  
The Uk

Abstract Background/Aims  Rheumatology departments were required to switch rapidly from face-to-face (F2F) to remote consultations during the COVID-19 pandemic in the UK. We conducted a patient satisfaction survey on the switch to inform future service development. Methods  All patients [new (NP), follow-up (FU)] were identified between 1st to 5th June 2020. Patients who attended or did not attend (DNA) a pre-booked F2F consultation or cancelled were excluded. Of the remainder, half the patients was surveyed by phone using a standardised questionnaire and the other half was posted the same questionnaire. Both groups were offered the opportunity to complete the survey online. Patients were surveyed on the organisation and content of the consultation, whether they were offered a subsequent F2F appointment and future consultation preference. Results  233 consultations were scheduled during the study period. After 53 exclusions (34 pre-booked F2F, 16 DNA, 3 cancellations), 180 eligible consultations were surveyed (85 via mailshot, 95 by telephone). 75/180 patients (42%) responded within 1 month of the telephone consultation (20 NP, 47 FU, 8 missing). The organisation of the switch was positively perceived (Table). Patients were highly satisfied with 4 of the 5 consultation domains but were undecided whether a physical assessment would have changed the outcome of the consultation (Table). After the initial phone consultation, 7 of 20 NP and 19 of 47 FU were not offered subsequent F2F appointments at the clinicians’ discretion. Of those not offered subsequent F2F appointments, proportionally more NP (3/7, 43%) would have liked one, compared to FU (5/19, 26%). Reasons included communication difficulties and a desire for a definitive diagnosis. 48/75 (64%) would be happy for future routine FU to be conducted by phone “most of the time" or "always”; citing patient convenience and disease stability. Caveats were if physical examination was required or if more serious issues (as perceived by the patient) needed F2F discussion. Conclusion  Patients were generally satisfied with telephone consultations and most were happy to be reviewed again this way. NPs should be offered F2F appointments for first visits to maximise patient satisfaction and time efficiency. P071 Table 1:Median age, yearsFemale; n (%)Follow-up; n (%)All eligible for survey; n = 18056122 (68)133 (74)Sent mailshot; n = 855459 (69)65 (76)Surveyed by phone; n = 955663 (66)68 (72)Responder by mail; n = 166911 (69)13 (82)Responder by phone; n = 525437 (71)34 (65)Responder by e-survey; n = 7495 (71)UnknownOrganisation of the telephone consultation, N = 75Yes, n (%)No, n (%)Missing, n (%)Were you informed beforehand about the phone consultation?63 (84)11 (15)1 (1)Were you called within 1-2 hours of the appointed date and time?66 (88)6 (8)3 (4)Domains of the consultation, N = 75Strongly disagree, n (%)Disagree, n (%)Neutral, n (%)Agree, n (%)Strongly agree, n (%)Missing, n (%)During the call, I felt the clinician understood my problem3 (4)1 (1)1 (1)20 (27)49 (65)1 (1)During the call, I had the opportunity to ask questions regarding my clinical care1 (1)02 (3)16 (21)55 (73)1 (1)A physical examination would have changed the outcome of the consultation16 (21)18 (24)20 (27)11 (15)10 (13)0The clinician answered my questions to my satisfaction2 (3)06 (8)18 (24)49 (65)0At the end of the consultation, the clinician agreed a management plan with me3 (4)2 (3)6 (8)24 (32)39 (52)1 (1)Future consultations, N = 75Never, n (%)Sometimes, n (%)Most of the time, n (%)Always, n (%)Missing, n, (%)In the future, would you be happy for routine FU to be conducted by phone?5 (7)20 (27)16 (21)32 (43)2 (3) Disclosure  M. Rodziewicz: None. T. O'Neill: None. A. Low: None.

Abstract 18599: Clinical Assessment of Hemodynamic Profiles Predict Readmission and Mortality in Diastolic Heart Failure Patients

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Mohammed Siddiqui ◽  
Salpy V Pamboukian ◽  
Jose A Tallaj ◽  
Michael Falola ◽  
Sula Mazimba
Keyword(s):  
Heart Failure ◽  
Clinical Assessment ◽  
Diastolic Heart Failure ◽  
Clinical Care ◽  
Systolic Heart Failure ◽  
Health Care Expenditures ◽  
Left Ventricular ◽  
Readmission Rates ◽  
Heart Failure Patients ◽  
Increased Risk

Background: Reducing 30 day readmission rates for patients with heart failure (HF) has been a recent focus of lowering health care expenditures. Hemodynamic profiles (HP) have been associated with clinical outcomes in chronic systolic HF. The relationship of HP to outcomes in acute decompensated diastolic HF (DHF) has not been defined. Methods: This case-control study of 1892 DHF patients discharged alive from an academic hospital between 2002-2012 with left ventricular function greater or equal to 45% were categorized into 4 groups: Profile A, no evidence of congestion and hypoperfusion (dry-warm); Profile B, congestion with adequate perfusion (wet-warm); Profile C, congestion with hypoperfusion (wet-cold); and Profile L, hypoperfusion without congestion (dry-cold). All cause readmissions at 30 days and 1 year and mortality at 30 days and 1 year were examined. Statistical analysis using multivariable Cox Proportional hazard model was performed adjusting for demographic, clinical, care and hospital characteristics. Results: Of the 1892 patients, 1196 (63%) were females; mean age was 68 (±14) years. There were 724(38%), 1000 (53%), 88(5%) and 80 (4%) patients in the hemodynamic profiles A, B, C and L respectively. Profiles B and C were associated with an increased risk for 30-day all-cause HF readmission compared to profiles A and L: Hazard ratio (HR) [1.38 (95% C.I 1.17-1.61)], [1.39 (95% C.I 1.18-1.62)] for B and C profiles respectively. Profiles C and L were associated with increased mortality at 1 year: HR [1.46 (95% CI 1.06-1.89)] and [1.31 (95% CI 1.01-1.64)] for A and L profiles respectively (Table). Conclusions: Clinical assessment of HP can help identify DHF patients at increased risk of readmission and mortality, similar to systolic heart failure patients.

Challenging Conversations in Palliative Care

2018 ◽  
Author(s):  
Kimberson Tanco ◽  
Daniel Epner
Keyword(s):  
Palliative Care ◽  
Patient Satisfaction ◽  
Wide Spectrum ◽  
Clinical Care ◽  
Physician Communication ◽  
Critical Element ◽  
Medical Conditions ◽  
Sitting Posture ◽  
Routine Clinical Care ◽  
Communication Techniques

Palliative care specialists manage a variety of difficult medical and psychosocial situations across a wide spectrum of medical conditions. Patient–physician communication is a critical element for the provision of quality palliative care and improving patient satisfaction. It is essential for palliative care clinicians to be aware of the various challenging conversions they will encounter in their routine clinical care and to develop the necessary skill set to adequately address these. Several communication techniques, such as a sitting posture during a conversion, proper use of silence, listening, and recognizing emotional movements and responding to them, are important so as to improve clinical care for patients and their families.

Lung Ultrasonography: An Emerging Practice

2020 ◽  
Vol 37 (1) ◽  
pp. 59-68
Author(s):  
Melissa Kuchenmeister
Keyword(s):  
Computed Tomography ◽  
Physical Examination ◽  
Literature Search ◽  
Pleural Space ◽  
Lung Ultrasonography ◽  
Sonographic Appearance ◽  
Lung Abnormalities ◽  
Midwestern University ◽  
Over Time ◽  
All Treatment

Objective: Sonography of the chest has traditionally been focused on chest wall and pleural space. Over time, clinicians have developed a practice of bedside lung ultrasonography (LUS) to supplement physical examination. In the wake of the SARS-COV-2 (COVID-19) pandemic, clinicians have increasingly turned to LUS as a tool to assess a patient’s condition. Methods: A literature search was performed using Google Scholar with access to articles through a major Midwestern university. Results: Computed tomography (CT) and radiographs are not always available in all treatment centers. While LUS may be limited, it is important to correlate findings with compatible imaging modalities. This review summarizes lung pathologies and the sonographic appearance of lung abnormalities. Conclusions: Radiology professionals have largely questioned the practice and findings of LUS. However, now, as the most qualified experts in the use of ultrasound, sonographers and radiologists have a duty to be educated in the use of LUS.

Patient and Provider Perceptions of a Patient Navigation Program to Improve Postpartum Care Among Publicly Insured Women

2019 ◽  
Author(s):  
Fengling Hu ◽  
Angelina Strohbach ◽  
Noelle G. Martinez ◽  
Melissa A. Simon ◽  
Lynn M. Yee
Keyword(s):  
Patient Satisfaction ◽  
Low Income ◽  
Patient Navigation ◽  
Clinical Care ◽  
Comparative Method ◽  
Interpersonal Relationship ◽  
Program Satisfaction ◽  
Provider Perceptions ◽  
Navigation Program ◽  
Publicly Insured

Abstract Objective This study was aimed to assess patient and provider perceptions of a postpartum patient navigation program. Study Design This was a mixed-method assessment of a postpartum patient navigation program. Navigating New Motherhood (NNM) participants completed a follow-up survey including the Patient Satisfaction with Interpersonal Relationship with Navigator (PSN-I) scale and an open-ended question. PSN-I scores were analyzed descriptively. Eighteen provider stakeholders underwent in-depth interviews to gauge program satisfaction, perceived outcomes, and ideas for improvement. Qualitative data were analyzed by the constant comparative method. Results In this population of low-income, minority women, participants (n = 166) were highly satisfied with NNM. The median PSN-I score was 45 out of 45 (interquartile range [IQR]: 43–45), where a higher score corresponds to higher satisfaction. Patient feedback was also highly positive, though a small number desired more navigator support. Provider stakeholders offered consistently positive program feedback, expressing satisfaction with NNM execution and outcomes. Provider stakeholders noted that navigators avoided inhibiting clinic workflow and eased clinic administrative burden. They perceived NNM improved multiple clinical and satisfaction outcomes. All provider stakeholders believed that NNM should be sustained long-term; suggestions for improvement were offered. Conclusion A postpartum patient navigation program can perceivably improve patient satisfaction, clinical care, and clinic workflow without burden to clinic providers.

scholarly journals Enthesitis in psoriatic arthritis (Part 3): clinical assessment and management

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_1) ◽  
pp. i21-i28 ◽  
Author(s):  
Philip Mease
Keyword(s):  
Quality Of Life ◽  
Physical Examination ◽  
Clinical Assessment ◽  
Janus Kinase ◽  
Clinical Feature ◽  
Phosphodiesterase 4 ◽  
Significant Efficacy ◽  
Synthetic Dmards ◽  
The Impact

Abstract Enthesitis is a common clinical feature of PsA, which is characterized by inflammation at the site of insertion of tendons, ligaments and joint capsule fibres into bone. Enthesitis is relatively unique to the spondyloarthritides, setting this group of diseases apart from other rheumatological conditions. The pathophysiological underpinnings of this clinical domain, and the imaging assessment of it, are described in accompanying articles in this supplement. The focus of this article is on the assessment of enthesitis by physical examination, the impact of enthesitis on function and quality of life, the impact of concomitant FM on clinical assessment, and the evidence for therapy of enthesitis garnered in trials of biologic and targeted synthetic DMARDs. Several physical examination measures of enthesitis have been developed and have proved reliable in assessment of enthesitis. Enthesitis has a significant deleterious impact on function and quality of life. The presence of concomitant FM in ≤20% of patients may result in artefactual worsening of assessment of disease severity and hinder achievement of the goal of low disease activity or remission. Several targeted therapies, which, for example, target the TNF, IL-17, IL-23, phosphodiesterase 4 or Janus kinase pathways, have shown significant efficacy in the treatment of enthesitis, resulting in improvement of function and quality of life for patients with PsA.

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