Prehospital use of the traction splint for suspected mid-shaft femur fractures

2019 ◽  
Vol 11 (9) ◽  
pp. 390-395
Author(s):  
Ian Ronald Howland ◽  
Ian Lucas Howard ◽  
Yugan Pillay ◽  
Beverley Dawn Ludick ◽  
Nicholas Raymond Castle
Keyword(s):  
Patient Care ◽  
Femur Fracture ◽  
Prehospital Care ◽  
Effective Means ◽  
Training Session ◽  
Improve Patient Care ◽  
Care Providers ◽  
Intervention Period ◽  
Femur Fractures ◽  
Retrospective Audit

Introduction: A retrospective audit of electronic patient care records (ePCRs) highlighted the infrequent use of the traction splint for the management of femur fractures. The aim of this study was to improve the use of the traction splint for patients presenting with a mid-shaft femur fracture in the absence of contraindications, by means of introducing a purpose-designed trauma CPD training course. Methods: An intervention consisting of a simulation-based mandatory trauma CPD training session for all operational prehospital care providers was implemented over a 3-month period, supported by a pre- and post-implementation staff survey regarding staff perceptions of using a traction splint. Following the intervention period, a repeat retrospective audit of the ePCR database was conducted to identify any improvement in the use of the traction splint. Results: The use of the traction splint for a femur fracture in the pre-intervention stage was found to be underutilised (Median 16%). Following the intervention period, however, traction splint use increased significantly (Median 50%). An improvement was also noted in staff perception and understanding of the management of femur fractures. Conclusion: This study found that focused trauma training is an effective means to improve patient care. Training should be ongoing in order to maintain skills and knowledge needed for management of femur fractures.

Critical Aspects of a Sustainable Clinical Research Program in the Community-Based Oncology Practice

2019 ◽  
pp. 176-184 ◽  
Author(s):  
Jennifer L. Ersek ◽  
Stephanie L. Graff ◽  
Francis P. Arena ◽  
Neelima Denduluri ◽  
Edward S. Kim
Keyword(s):  
Clinical Research ◽  
Patient Care ◽  
Health Care Providers ◽  
Research Program ◽  
Improve Patient Care ◽  
Care Providers ◽  
Community Based ◽  
Technological Infrastructure ◽  
Community Based Research ◽  
Research Programs

Increasing enrollment into clinical trials is a top priority across the field of oncology. Because the vast majority of those afflicted with cancer receive their care in the community, creating strong clinical research programs in the community-based setting is important. This article comprehensively outlines the most important elements of creating and sustaining a successful community-based research program. Establishing a clear mission and defining the scope of the research program in collaboration with key physicians and administrative leadership are critical to success. Standard operating procedures should detail operational processes. Ensuring sound financial planning and protected physician time are crucial for a healthy program. Providing mentorship opportunities to investigators and other team members will provide necessary guidance for junior investigators and long-term program stability. Prioritizing provider and patient volunteer engagement through education and awareness will potentially improve enrollment and research ownership. Incorporating administrative and clinical research staff and health care providers, including physicians, advanced practice providers, and pharmacists, will result in a multidisciplinary and unified approach and may also promote research as a routine part of patient care. Regular safety and scientific meetings will reduce regulatory complications and, most importantly, improve patient care. Other keys to a successful program include establishing a diverse trial portfolio, collaboration between different institutions, and ensuring appropriate technological infrastructure. Serial programmatic review provides opportunities to refine suboptimal practices and recognize successful strategies. Community-based research programs are critical to improve access to optimal cancer care. Implementation of successful programs is possible with a collaborative and multidisciplinary approach.

APRN Palliative Care Externship: Potential impact on oncology nursing palliative care delivery.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 149-149
Author(s):  
Constance Dahlin ◽  
Patrick J. Coyne ◽  
Brian Cassel
Keyword(s):  
Palliative Care ◽  
Patient Care ◽  
Care Delivery ◽  
Improve Patient Care ◽  
Rural Practice ◽  
Oncology Nursing ◽  
Advanced Practice ◽  
Care Providers ◽  
Positive Effects ◽  
Improve Patient

149 Background: Understanding primary palliative care is essential for advanced practice nurses, no matter where they practice. Limitations resulting from the variability of APRN state practice acts, financial considerations, and expenses, challenge post-graduate education for APRNs. With the shortage of health care providers, it is necessary to consider innovative programs to offer this education. Although there are many palliative educational opportunities, there are few abilities to translate the education into practice. Few are focused on the APRN, particularly for community and rural practice where many oncology patients are located and receive care. Methods: The APRN Externship selected 48 externs who completed the week long course. Topics includes pain and symptom assessment and management; fostering communication skills; building understanding of community resources such as hospice, palliative care, and home care; incorporating palliative care into an oncology practice, introducing concepts of business and finance in palliative care; and developing of safe practice with policy, procedure, and guideline development with a focus on rural providers. Externs complete pre course and post course testing along with completing goals to improve patient care. Results: Through an IRB approved process, utilizing both quantitative and qualitative evaluation, we followed the effect of the externship on externs. Externs performed both pre-course as well as 1 month and 6 month post-course testing. They also completed a report on achievement of clinical goals to improve patient care delivery. Conclusions: APRN Palliative Externs reported positive effects from the externship experience to clinical practice. The qualitative and quantitative data has demonstrated sustained effect towards improving palliative care within advanced practice nursing. The APRN palliative externship model could serve as a model to promote better palliative care education for oncology APRNs thereby improving palliative care delivery within oncology nursing.

A COMPARATIVE STUDY TO DETERMINE THE KNEE JOINT FUNCTIONAL OUTCOME IN PATIENTS WITH FEMUR SHAFT FRACTURES MANAGED OPERATIVELY OR CONSEVATELY AT NDOLA HOSPITAL:complete enumeration (Preprint)

2019 ◽  
Author(s):  
Ripedah Nakana
Keyword(s):  
Knee Joint ◽  
Functional Outcome ◽  
Road Traffic ◽  
Femur Fracture ◽  
Conservative Group ◽  
Femur Fractures ◽  
Shaft Fractures ◽  
Significant Difference ◽  
Femur Shaft ◽  
Femur Shaft Fractures

BACKGROUND According to WHO, It has been reported that there has been a rise in road traffic accidents globally due to many factors. Consequently this has contributed to an increase in fracture of the femur in hospitals. The annual incidence of these Fractures has been estimated to be 10 per 100,000 persons and this incidence has been noticed to be higher among the youths decreasing after the age of 40 and then increasing in the elderly. These fractures are either managed conservatively or operatively. OBJECTIVE the aim of this study was to determine if there is a significant difference in knee joint functional outcome in patients with femur shaft fractures managed operatively and conservatively at Ndola Teaching Hospital at the orthopedics clinic and physiotherapy. This in future might help to place emphasis on government to sensitize the right measures needed to improve on the functional outcome of a knee joint in patients with femur fracture who are treated operatively or conservatively METHODS the method used for the study was a complete enumeration of all patients with femur fractures that were admitted at orthopedic ward, visited the orthopedic clinic and physiotherapy sessions at NTH between the period of July 2019 to September 2019. Data collected will be analyzed using a statistical data software called Statistical Package of Social Sciences (SPSS). The independent variable that will be considered in the study are age, DOI, DOA, femur shaft fractures, treatment and others that that will meet the selection Criteria. The dependent variable will be “Knee Joint Functional Outcome”. RESULTS Results did not show statistically significant difference in knee functional outcome for two methods (conservative or operative). In the current study it was noted that there was much reduction in swelling in the operative in comparison to the conservative group. We may therefore conclude that the operative management promises a better outcome especially when done on time. However it seemed the operative procedure was not preferred for any conservative approach however the study has shown an in depth feasibility study to affirm such findings in order to inform on policy or management paradigim shift. CONCLUSIONS There is need for further intervention in the management of femur fracture which complicates to poor knee joint function

scholarly journals 145. Monthly Antibiotic Prescribing Peer Comparison Combined with In-person Education Decreases Antibiotic Prescribing for Acute Respiratory Infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S83-S83
Author(s):  
Shelby J Kolo ◽  
David J Taber ◽  
Ronald G Washburn ◽  
Katherine A Pleasants
Keyword(s):  
Primary Care ◽  
Respiratory Infections ◽  
Primary Care Providers ◽  
The United States ◽  
Delivery Mode ◽  
Antibiotic Prescribing ◽  
Acute Respiratory Infections ◽  
Care Providers ◽  
Intervention Period ◽  
Provider Education

Abstract Background Inappropriate antibiotic prescribing is an important modifiable risk factor for antibiotic resistance. Approximately half of all antibiotics prescribed for acute respiratory infections (ARIs) in the United States may be inappropriate or unnecessary. The purpose of this quality improvement (QI) project was to evaluate the effect of three consecutive interventions on improving antibiotic prescribing for ARIs (i.e., pharyngitis, rhinosinusitis, bronchitis, common cold). Methods This was a pre-post analysis of an antimicrobial stewardship QI initiative to improve antibiotic prescribing for ARIs in six Veterans Affairs (VA) primary care clinics. Three distinct intervention phases occurred. Educational interventions included training on appropriate antibiotic prescribing for ARIs. During the first intervention period (8/2017-1/2019), education was presented virtually to primary care providers on a single occasion. In the second intervention period (2/2019-10/2019), in-person education with peer comparison was presented on a single occasion. In the third intervention period (11/2019-4/2020), education and prescribing feedback with peer comparison was presented once in-person followed by monthly emails of prescribing feedback with peer comparison. January 2016-July 2017 was used as a pre-intervention baseline period. The primary outcome was the antibiotic prescribing rate for all classifications of ARIs. Secondary outcomes included adherence to antibiotic prescribing guidance for pharyngitis and rhinosinusitis. Descriptive statistics and interrupted time series segmented regression were used to analyze the outcomes. Results Monthly antibiotic prescribing peer comparison emails in combination with in-person education was associated with a statistically significant 12.5% reduction in the rate of antibiotic prescribing for ARIs (p=0.0019). When provider education alone was used, the reduction in antibiotic prescribing was nonsignificant. Conclusion Education alone does not significantly reduce antibiotic prescribing for ARIs, regardless of the delivery mode. In contrast, education followed by monthly prescribing feedback with peer comparison was associated with a statistically significant reduction in ARI antibiotic prescribing rates. Disclosures All Authors: No reported disclosures

scholarly journals Prehospital identification of Covid-19: an observational study

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Douglas Spangler ◽  
Hans Blomberg ◽  
David Smekal
Keyword(s):  
Predictive Value ◽  
Prehospital Care ◽  
The Novel ◽  
Test Results ◽  
Care Providers ◽  
Care Systems ◽  
Primary Hospital ◽  
Novel Coronavirus ◽  
Rule Out ◽  
Descriptive Statistical Analysis

Abstract Background The novel coronavirus disease 2019 (Covid-19) pandemic has affected prehospital care systems across the world, but the prehospital presentation of affected patients and the extent to which prehospital care providers are able to identify them is not well characterized. In this study, we describe the presentation of Covid-19 patients in a Swedish prehospital care system, and asses the predictive value of Covid-19 suspicion as documented by dispatch and ambulance nurses. Methods Data for all patients with dispatch, ambulance, and hospital records between January 1–August 31, 2020 were extracted. A descriptive statistical analysis of patients with and without hospital-confirmed Covid-19 was performed. In a subset of records beginning from April 14, we assessed the sensitivity and specificity of documented Covid-19 suspicion in dispatch and ambulance patient care records. Results A total of 11,894 prehospital records were included, of which 481 had a primary hospital diagnosis code related to-, or positive test results for Covid-19. Covid-19-positive patients had considerably worse outcomes than patients with negative test results, with 30-day mortality rates of 24% vs 11%, but lower levels of prehospital acuity (e.g. emergent transport rates of 14% vs 22%). About half (46%) of Covid-19-positive patients presented to dispatchers with primary complaints typically associated with Covid-19. Six thousand seven hundred seventy-six records were included in the assessment of predictive value. Sensitivity was 76% (95% CI 71–80) and 82% (78–86) for dispatch and ambulance suspicion respectively, while specificities were 86% (85–87) and 78% (77–79). Conclusions While prehospital suspicion was strongly indicative of hospital-confirmed Covid-19, based on the sensitivity identified in this study, prehospital suspicion should not be relied upon as a single factor to rule out the need for isolation precautions. The data provided may be used to develop improved guidelines for identifying Covid-19 patients in the prehospital setting.

scholarly journals Improving continuity of patient care across sectors: study protocol of the process evaluation of a quasi-experimental multi-centre study regarding an admission and discharge model in Germany (VESPEERA)

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e031245
Author(s):  
Johanna Forstner ◽  
Aline Kunz ◽  
Cornelia Straßner ◽  
Lorenz Uhlmann ◽  
Stephanie Kuemmel ◽  
...  
Keyword(s):  
General Practice ◽  
Patient Care ◽  
Process Evaluation ◽  
Study Protocol ◽  
Care Providers ◽  
Total N ◽  
Outcomes Evaluation ◽  
Quasi Experimental ◽  
Discharge Model ◽  
General Practices

IntroductionHospital stays are critical events as they often disrupt continuity of care. This process evaluation aims to describe and explore the implementation of the VESPEERA programme (Improving continuity of patient care across sectors: An admission and discharge model in general practices and hospitals, Versorgungskontinuitaet sichern: Patientenorientiertes Einweisungs- und Entlassmanagement in Hausarztpraxen und Krankenhauesern). The evaluation concerns the intervention fidelity, reach in targeted populations, perceived effects, working mechanisms, feasibility, determinants for implementation, including contextual factors, and associations with the outcomes evaluation. The aim of the VESPEERA programme is the development, implementation and evaluation of a structured admission and discharge programme in general practices and hospitals.Methods and analysisThe process evaluation is linked to the VESPEERA outcomes evaluation, which has a quasi-experimental multi-centre design with four study arms and is conducted in hospitals and general practices in Germany. The VESPEERA programme comprises several components: an assessment before admission, an admission letter, a telephonic discharge conversation between hospital and general practice before discharge, discharge information for patients, structured planning of follow-up care after discharge in the general practice and a telephone monitoring for patients with a risk of rehospitalisation. The process evaluation has a mixed-methods design, incorporating interviews (patients, both care providers who do and do not participate in the VESPEERA programme, total n=75), questionnaires (patients and care providers who participate in the VESPEERA programme, total n=475), implementation plans of hospitals, data documented in general practices, claims-based data and hospital process data. Data analysis is descriptive and explorative. Qualitative data will be transcribed and analysed using framework analysis based on the Consolidated Framework for Implementation Research. Associations between the outcomes of the program and measures in the process evaluation will be explored in regression models.Ethics and disseminationEthics approval has been obtained by the ethics committee of the Medical Faculty Heidelberg prior to the start of the study (S-352/2018). Results will be disseminated through a final report to the funding agency, articles in peer-reviewed journals and conferences.Trial registration numberhttp://www.drks.de/DRKS00015183.Trial statusThe study protocol on hand is the protocol V.1.1 from 18 June 2018. Recruitment for interviews started on 3 September 2018 and will approximately be completed by the end of May 2019.

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