scholarly journals Design and implementation of an acute Trauma and Orthopaedic ePlatform (TOP) referral system utilising existing secure technology during the COVID-19 pandemic

2020 ◽  
Vol 1 (6) ◽  
pp. 293-301
Author(s):  
Tom Vincent McIntyre ◽  
Enda Gerard Kelly ◽  
Trevor Clarke ◽  
Connor J. Green
Keyword(s):  
Point Of Care ◽  
Management Plan ◽  
Secure Messaging ◽  
Musculoskeletal Infection ◽  
Fracture Clinic ◽  
Face To Face ◽  
Significant Difference ◽  
Management Plans ◽  
Electronic Referral ◽  
Definitive Management

Introduction Virtual fracture clinics (VFCs) are being increasingly used to offer safe and efficient orthopaedic review without the requirement for face-to-face contact. With the onset of the COVID-19 pandemic, we sought to develop an online referral pathway that would allow us to provide definitive orthopaedic management plans and reduce face-to-face contact at the fracture clinics. Methods All patients presenting to the emergency department from 21March 2020 with a musculoskeletal injury or potential musculoskeletal infection deemed to require orthopaedic input were discussed using a secure messaging app. A definitive management plan was communicated by an on-call senior orthopaedic decision-maker. We analyzed the time to decision, if further information was needed, and the referral outcome. An analysis of the orthopaedic referrals for the same period in 2019 was also performed as a comparison. Results During the study period, 295 patients with mean age of 7.93 years (standard error (SE) 0.24) were reviewed. Of these, 25 (9.8%) were admitted, 17 (5.8%) were advised to return for planned surgical intervention, 105 (35.6%) were referred to a face-to-face fracture clinic, 137 (46.4%) were discharged with no follow-up, and seven (2.4%) were referred to other services. The mean time to decision was 20.14 minutes (SE 1.73). There was a significant difference in the time to decision between patients referred to fracture clinic and patients discharged (mean 25.25 minutes (SE 3.18) vs mean 2.63 (SE 1.42); p < 0.005). There were a total of 295 referrals to the fracture clinic for the same period in 2019 with a further 44 emergency admissions. There was a statistically significant difference in the weekly referrals after being triaged by the VFC (mean 59 (SE 5.15) vs mean 21 (SE 2.17); p < 0.001). Conclusion The use of an electronic referral pathway to deliver a point of care virtual fracture clinic allowed for efficient use of scarce resources and definitive management plan delivery in a safe manner. Cite this article: Bone Joint Open 2020;1-6:293–301.

scholarly journals Design and implementation of an acute Trauma and Orthopaedic ePlatform (TOP) referral system utilising existing secure technology during the COVID-19 pandemic

2020 ◽  
Vol 1 (6) ◽  
pp. 293-301
Author(s):  
Tom Vincent McIntyre ◽  
Enda Gerard Kelly ◽  
Trevor Clarke ◽  
Connor J. Green
Keyword(s):  
Point Of Care ◽  
Management Plan ◽  
Secure Messaging ◽  
Musculoskeletal Infection ◽  
Fracture Clinic ◽  
Face To Face ◽  
Significant Difference ◽  
Management Plans ◽  
Electronic Referral ◽  
Definitive Management

Introduction Virtual fracture clinics (VFCs) are being increasingly used to offer safe and efficient orthopaedic review without the requirement for face-to-face contact. With the onset of the COVID-19 pandemic, we sought to develop an online referral pathway that would allow us to provide definitive orthopaedic management plans and reduce face-to-face contact at the fracture clinics. Methods All patients presenting to the emergency department from 21March 2020 with a musculoskeletal injury or potential musculoskeletal infection deemed to require orthopaedic input were discussed using a secure messaging app. A definitive management plan was communicated by an on-call senior orthopaedic decision-maker. We analyzed the time to decision, if further information was needed, and the referral outcome. An analysis of the orthopaedic referrals for the same period in 2019 was also performed as a comparison. Results During the study period, 295 patients with mean age of 7.93 years (standard error (SE) 0.24) were reviewed. Of these, 25 (9.8%) were admitted, 17 (5.8%) were advised to return for planned surgical intervention, 105 (35.6%) were referred to a face-to-face fracture clinic, 137 (46.4%) were discharged with no follow-up, and seven (2.4%) were referred to other services. The mean time to decision was 20.14 minutes (SE 1.73). There was a significant difference in the time to decision between patients referred to fracture clinic and patients discharged (mean 25.25 minutes (SE 3.18) vs mean 2.63 (SE 1.42); p < 0.005). There were a total of 295 referrals to the fracture clinic for the same period in 2019 with a further 44 emergency admissions. There was a statistically significant difference in the weekly referrals after being triaged by the VFC (mean 59 (SE 5.15) vs mean 21 (SE 2.17); p < 0.001). Conclusion The use of an electronic referral pathway to deliver a point of care virtual fracture clinic allowed for efficient use of scarce resources and definitive management plan delivery in a safe manner. Cite this article: Bone Joint Open 2020;1-6:293–301.

Diagnostic accuracy and clinical management by realtime teledermatology. Results from the Northern Ireland arms of the UK Multicentre Teledermatology Trial

1998 ◽  
Vol 4 (2) ◽  
pp. 95-100 ◽  
Author(s):  
M A Loane ◽  
R Corbett ◽  
S E Bloomer ◽  
D J Eedy ◽  
H E Gore ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Clinical Management ◽  
Low Cost ◽  
Treatment Plan ◽  
Management Plan ◽  
Face To Face ◽  
Management Plans ◽  
Video Link ◽  
The Uk ◽  
Management Recommendations

Diagnostic accuracy and management recommendations of realtime teledermatology consultations using low-cost telemedicine equipment were evaluated. Patients were seen by a dermatologist over a video-link and a diagnosis and treatment plan were recorded. This was followed by a face-to-face consultation on the same day to confirm the earlier diagnosis and management plan. A total of 351 patients with 427 diagnoses participated. Sixty-seven per cent of the diagnoses made over the video-link agreed with the face-to-face diagnosis. Clinical management plans were recorded for 214 patients with 252 diagnoses. For this cohort, 44 of the patients were seen by the same dermatologist at both consultations, while 56 were seen by a different dermatologist. In 64 of cases the same management plan was recommended at both consultations; a sub-optimum treatment plan was recommended in 8 of cases; and in 9 of cases the video-link management plans were judged to be inappropriate. In 20 of cases the dermatologist was unable to recommend a suitable management plan by video-link. There were significant differences in the ability to recommend an optimum management plan by video-link when a different dermatologist made the reference management plan. The results indicate that a high proportion of dermatological conditions can be successfully managed by realtime teledermatology.

scholarly journals 1518 The Use of OrthoPathway, Decision Support Software, To Reduce Variation in Practice, Optimise Patient Care and Reduce Face-To-Face Appointments in Trauma and Orthopaedics

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M Jones ◽  
W Griffiths-Jones
Keyword(s):  
Emergency Department ◽  
Decision Support ◽  
Web Application ◽  
Clinical Pathways ◽  
Management Plan ◽  
National Guidelines ◽  
Fracture Clinic ◽  
Face To Face ◽  
Musculoskeletal Problems

Abstract Introduction Musculoskeletal problems account for 3.5million Emergency Department attendances annually. Front-line staff are under pressure, faced with complex decisions with limited supportive tools. Without adequate support there is greater variation in practice, poor patient outcomes, longer Emergency Department stays and unnecessary follow-up. OrthoPathway is a web application that enables the production of editable decision support pathways. We have published over 50 Consultant designed, locally approved, interactive pathways. Patient-facing staff can use these to follow national guidelines, by answering questions to establish appropriate treatments. Method New and follow-up fracture clinic patients were audited over a one-week period. Clinic letters and clerking documents were analysed to identify the diagnosis and management plan. From information and radiographs available OrthoPathway was used to generate a management plan, used as the audit standard. Results 78 new patients and 83 follow-up patients were seen in fracture clinic over a one-week period. Clinical pathways were available on OrthoPathway for 42% of new patients and 40% of follow-up patients. Variation in practice was seen in 42% of new patients and 59% of follow-up patients. The associated saving in appointments was 11 and 21 and in the new and follow-up patients, respectively. Conclusions We have shown that OrthoPathway has the potential to reduce face-to-face appointments by 20%, with its current utilisation. Through the deployment of a full set of pathways we anticipated a reduction of greater than 40%, which is particularly pertinent given the current COVID-19 pandemic. This highlights the benefits of Consultant approved decision support pathways published on OrthoPathway.

scholarly journals Contiguous urban rivers should not be necessarily submitted to the same management plan: the case of Tietê and Pinheiros Rivers (São Paulo-Brazil)

2011 ◽  
Vol 83 (4) ◽  
pp. 1465-1480 ◽  
Author(s):  
Davi G. F. Cunha ◽  
Doron Grull ◽  
Murilo Damato ◽  
José R. C. Blum ◽  
Sergio Eiger ◽  
...  
Keyword(s):  
Monitoring Program ◽  
Industrial Effluents ◽  
Management Plan ◽  
Sao Paulo ◽  
Special Importance ◽  
São Paulo ◽  
Tietê River ◽  
Environmental Recovery ◽  
Significant Difference ◽  
Management Plans

The management of urban water resources plays an important role for developing countries. The Tietê and Pinheiros Rivers (São Paulo, Brazil) are affected by domestic and industrial effluents and by the diffuse pollution. This research aimed to quantify 134 variables in the water of Tietê and Pinheiros Rivers (approximately 7,200 and 6,600 analyses, respectively) from August 2007 to December 2008. The idea was to verify if the fact that both rivers are located in the same basin is enough to consider the application of a single management plan for both. Data showed that the rivers presented significant anthropogenic interference. The results suggested that such rivers must be subjected to individual management plans since there were exclusive occurrences (variables that were only detected in one of the rivers). Moreover, there was a statistically significant difference between rainy and dry periods for eleven variables (p*<0.05, ANOVA), reinforcing the special importance of the temporal component within the monitoring program. It is expected that this study subsidize environmental recovery programs in the Tietê River, to which is recommendable to focus on prosecution of illegal wastewater releases, and in the Pinheiros River, to which special attention is suggested to the pollution derived from the pesticides load to the water body.

Teleconsultation in orthopaedic surgery: A systematic review and meta-analysis of patient and physician experiences

2020 ◽  
pp. 1357633X2095099
Author(s):  
Christina Melian ◽  
David Kieser ◽  
Christopher Frampton ◽  
Michael C Wyatt
Keyword(s):  
Systematic Review ◽  
Healthcare Costs ◽  
Orthopaedic Surgery ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Office Visits ◽  
Face To Face ◽  
Significant Difference ◽  
Management Plans ◽  
Length Of Visit

Introduction The primary purpose of this review was to evaluate patient and physician preference and satisfaction for teleconsultation in orthopaedic surgery compared to traditional face-to-face consultation. In addition, we evaluated the effects of teleconsultation on patient length of visit, healthcare costs, range of motion (ROM), pain, quality of life (QOL), and ongoing management plans. Methods A systematic review of MEDLINE, Embase, Web of Science, and Cochrane Library was conducted according to PRISMA guidelines. Randomised control trials and case control studies comparing teleconsultation with traditional, face-to-face consultation in the management of orthopaedic conditions were included. The primary outcome measures were patient and physician preference and satisfaction. Secondary outcomes included patient length of visit, healthcare costs, ROM, pain, QOL, and ongoing management plans. Results A total of 13 articles meeting the eligibility criteria were included for systematic review and 8 for meta-analysis. There was no significant difference in patient satisfaction, length of visit, or time spent with the physician between the telemedicine and in-office control group. The mean difference of patient preference for telemedicine was significantly higher in the telemedicine group compared to the in-office visit group (OR 1.44, 95% CI 1.12–1.87, p = 0.005). Discussion Telemedicine was not inferior to face-to-face office visits in regard to patient and physician preference and satisfaction. Therefore, it would be an effective adjunct to face-to-face office visits, serving as a mechanism of triage and long-term continuity of care.

scholarly journals Accuracy of periocular lesion assessment using telemedicine

2021 ◽  
Vol 28 (1) ◽  
pp. e100287
Author(s):  
Swan Kang ◽  
Mohammad Dehabadi ◽  
Dawn A Sim ◽  
Peter B M Thomas ◽  
Doris Appiah Ewusi ◽  
...  
Keyword(s):  
Case Series ◽  
Management Plan ◽  
Kappa Coefficient ◽  
High Rate ◽  
Series Data ◽  
Nurse Specialist ◽  
Face To Face ◽  
Diagnosis And Management ◽  
Management Plans ◽  
Eyelid Lesions

ObjectivesTo assess the agreement in diagnosis and management plans reached between clinicians reviewing eyelid lesions remotely and in face-to-face clinics.MethodsIn this single-centre observational case series, data were prospectively collected on 50 consecutive adults referred with eyelid lesions suitable to be seen by a nurse. A proforma was completed to gather salient information. A nurse specialist saw patients in face-to-face clinics and collected information using the proforma, devising a diagnosis and management plan. Photographs of the eyelid lesions were taken by a medical photographer. A subsequent remote review was completed by an oculoplastic consultant using the proforma information and photographs in the absence of the patient. The diagnosis and management plan constructed by the nurse specialist were compared with those reached by the consultant.ResultsComplete data were available for 44 consecutive cases. There was an overall 91% agreement (40 cases out of 44) between the diagnoses reached by the nurse specialist, and the remote reviewer; kappa coefficient 0.88 (95% CI 0.76 to 0.99). There was an overall 82% agreement (36 out of 44 cases) in the management plans devised by the nurse-led clinic and remote reviewer; kappa coefficient 0.74 (95% CI 0.58 to 0.90). The average time taken for a remote reviewer to reach a diagnosis and management plan was 1 min and 20 s.ConclusionsThis study evaluated the feasibility of assessing eyelid lesions using asynchronous telemedicine. There was overall a high rate of concordance in the diagnosis reached, and management devised between the clinic and remote review.

No Significant Difference in Service Learninng Online

2012 ◽  
Vol 16 (4) ◽  
Author(s):  
Sue Y. McGorry
Keyword(s):  
Higher Education ◽  
Service Learning ◽  
Institutions Of Higher Education ◽  
Management Skills ◽  
Program Outcomes ◽  
Online Delivery ◽  
Leadership And Management ◽  
Business Programs ◽  
Face To Face ◽  
Significant Difference

Institutions of higher education are realizing the importance of service learning initiatives in developing awareness of students’ civic responsibilities, leadership and management skills, and social responsibility. These skills and responsibilities are the foundation of program outcomes in accredited higher education business programs at undergraduate and graduate levels. In an attempt to meet the needs of the student market, these institutions of higher education are delivering more courses online. This study addresses a comparison of traditional and online delivery of service learning experiences. Results demonstrate no significant difference in outcomes between the online and face-to-face models.

scholarly journals Land-Use Impact on Stand Structure and Fruit Yield of Tamarindus indica L. in the Drylands of Southeastern Ethiopia

Life ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 408
Author(s):  
Gizachew Zeleke ◽  
Tatek Dejene ◽  
Wubalem Tadesse ◽  
Pablo Martín-Pinto
Keyword(s):  
Land Use ◽  
Stand Structure ◽  
Fruit Production ◽  
Tree Density ◽  
Fruit Yield ◽  
Tamarindus Indica ◽  
Land Use Types ◽  
Significant Difference ◽  
Management Plans ◽  
Baseline Information

In this study, we evaluated stand status, dendrometric variables, and fruit production of Tamarind (Tamarindus indica L.) trees growing in bushland and farmland-use types in dryland areas of Ethiopia. The vegetation survey was conducted using the point-centered quarter method. The fruit yield of 54 trees was also evaluated. Tree density and fruit production in ha were estimated. There was a significant difference in Tamarind tree density between the two land-use types (p = 0.01). The mean fruit yield of farmland trees was significantly higher than that of bushland trees. However, Tamarind has unsustainable structure on farmlands. Differences in the dendrometric characteristics of trees were also observed between the two land-use types. Predictive models were selected for Tamarind fruit yield estimations in both land-use types. Although the majority of farmland trees produced <5000 fruit year−1, the selection of Tamarind germplasm in its natural ranges could improve production. Thus, the development of management plans to establish stands that have a more balanced diameter structure and thereby ensure continuity of the population and fruit yields is required in this area, particularly in the farmlands. This baseline information could assist elsewhere in areas that are facing similar challenges for the species due to land-use change.

scholarly journals 145 Point of care lung ultrasound in patient triage: integration of ultrasound into a streaming pathway for COVID-19

2020 ◽  
Vol 37 (12) ◽  
pp. 839.1-839
Author(s):  
Dominic Craver ◽  
Aminah Ahmad ◽  
Anna Colclough
Keyword(s):  
Point Of Care ◽  
District General Hospital ◽  
Training Programme ◽  
Service Evaluation ◽  
University Hospital ◽  
Junior Doctors ◽  
Point Of Care Ultrasound ◽  
Face To Face ◽  
Point Of Care Diagnostics ◽  
Audit Data

Aims/Objectives/BackgroundRapid risk stratification of patients is vital for Emergency Department (ED) streaming during the COVID-19 pandemic. Ideally, patients should be split into red (suspected/confirmed COVID-19) and green (non COVID-19) zones in order to minimise the risk of patient-to-patient and patient-to-staff transmission. A robust yet rapid streaming system combining clinician impression with point-of-care diagnostics is therefore necessary.Point of care ultrasound (POCUS) findings in COVID-19 have been shown to correlate well with computed tomography (CT) findings, and it therefore has value as a front-door diagnostic tool. At University Hospital Lewisham (a district general hospital in south London), we recognised the value of early POCUS and its potential for use in patient streaming.Methods/DesignWe developed a training programme, ‘POCUS for COVID’ and subsequently integrated POCUS into streaming of our ED patients. The training involved Zoom lectures, a face to face practical, a 10 scan sign off process followed by a final triggered assessment. Patient outcomes were reviewed in conjunction with their scan reports.Results/ConclusionsCurrently, we have 21 ED junior doctors performing ultrasound scans independently, and all patients presenting to our department are scanned either in triage or in the ambulance. A combination of clinical judgement and scan findings are used to stream the patient to an appropriate area.Service evaluation with analysis of audit data has found our streaming to be 94% sensitive and 79% specific as an indicator of COVID 19. Further analysis is ongoing.Here we present both the structure of our training programme and our integrated streaming pathway along with preliminary analysis results.

scholarly journals COVID-19 Seroprevalence among Healthcare Workers of a Large COVID-19 Hospital in Rome Reveals Strengths and Limits of Two Different Serological Tests

2021 ◽  
Vol 18 (5) ◽  
pp. 2650
Author(s):  
Giuseppe Vetrugno ◽  
Daniele Ignazio La Milia ◽  
Floriana D’Ambrosio ◽  
Marcello Di Pumpo ◽  
Roberta Pastorino ◽  
...  
Keyword(s):  
Blood Test ◽  
Healthcare Workers ◽  
Point Of Care ◽  
Venous Blood ◽  
Administrative Staff ◽  
Serological Tests ◽  
Predictive Values ◽  
Work From Home ◽  
Significant Difference ◽  
Sensitivity Specificity

Healthcare workers are at the forefront against COVID-19, worldwide. Since Fondazione Policlinico Universitario A. Gemelli (FPG) IRCCS was enlisted as a COVID-19 hospital, the healthcare workers deployed to COVID-19 wards were separated from those with limited/no exposure, whereas the administrative staff were designated to work from home. Between 4 June and 3 July 2020, an investigation was conducted to evaluate the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin (IgG) antibodies among the employees of the FPG using point-of-care (POC) and venous blood tests. Sensitivity, specificity, and predictive values were determined with reverse-transcription polymerase chain reaction on nasal/oropharyngeal swabs as the diagnostic gold standard. The participants enrolled amounted to 4777. Seroprevalence was 3.66% using the POC test and 1.19% using the venous blood test, with a significant difference (p < 0.05). The POC test sensitivity and specificity were, respectively, 63.64% (95% confidence interval (CI): 62.20% to 65.04%) and 96.64% (95% CI: 96.05% to 97.13%), while those of the venous blood test were, respectively, 78.79% (95% CI: 77.58% to 79.94%) and 99.36% (95% CI: 99.07% to 99.55%). Among the low-risk populations, the POC test’s predictive values were 58.33% (positive) and 98.23% (negative), whereas those of the venous blood test were 92.86% (positive) and 98.53% (negative). According to our study, these serological tests cannot be a valid alternative to diagnose COVID-19 infection in progress.

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