scholarly journals Teleconsultation in the management of elective orthopaedic and spinal conditions during the COVID-19 pandemic: A prospective cohort study of patient experiences (Preprint)

2021 ◽  
Author(s):  
Christina Melian ◽  
Christopher Frampton ◽  
Michael Charles Wyatt ◽  
David Kieser
Keyword(s):  
Cohort Study ◽  
Patient Preference ◽  
Outpatient Clinic ◽  
Group Analysis ◽  
Office Visits ◽  
Remote Communication ◽  
Chi Square ◽  
Telephone Consultation ◽  
Patient Satisfaction Scores ◽  
Telephone Group

BACKGROUND The global adoption of teleconsultation has been expedited as a result of the COVID-19 pandemic. By allowing remote communication, teleconsultation may help limit the spread of the virus while maintaining the crucial patient-provider relationship. OBJECTIVE To evaluate the value of teleconsultation compared to in-person visits in the management of elective orthopaedic and spinal procedures. METHODS This was a prospective observational cohort study of 853 patients receiving orthopaedic and spinal care at a private outpatient clinic in New Zealand. Patients were randomly divided into two groups: (1) patients receiving telephone consultation remotely; and (2) patients receiving in-person office consultations at the outpatient clinic. All patients received telephone consultations for four weeks during the mandated COVID-19 lockdown, followed by four weeks of telephone or in-person consultation. Patient preference, satisfaction, and duration of visit were recorded. Comparisons of patient preference between groups, visit type, sex, and location were performed using Chi-square tests; similarly, satisfaction scores and visit durations were compared using a general linear model. RESULTS We report that 91% of patients in the telephone group preferred teleconsultation over in-person office visits during the COVID-19 lockdown (p=0.000). A combined-group analysis shows that 55.3% of all patients preferred teleconsultation compared to 31.2% who preferred in-person office visits (p=0.000). Patients in the telephone group reported significantly higher satisfaction scores (9.95 +/- 0.04, 95% CI [9.87-10.03]) compared to patients in the in-person group (9.53 +/- 0.04, 95% CI [9.45-9.62]; p=0.000). Additionally, in-person consultations were significantly longer in duration compared to telephone consultations, with a mean visit time of 6.70 min +/-0.18, 95% CI [6.32-7.02] compared to 5.10 min +/-0.17, 95% CI [4.73-5.42], respectively (p=0.000). CONCLUSIONS Patients who utilize telephone consultations are more likely to prefer it over traditional, in-person visits in the future. This increased preference, coupled with higher patient satisfaction scores and shorter duration of visits, suggests that teleconsultation has a role in orthopaedic surgery, which may even extend beyond the COVID-19 pandemic. CLINICALTRIAL N/A

scholarly journals Teleconsultation in the Management of Elective Orthopaedic and Spinal Conditions During the COVID-19 Pandemic

2020 ◽  
Author(s):  
Christina Melian ◽  
Christopher Frampton ◽  
Michael Charles Wyatt ◽  
David Kieser
Keyword(s):  
Patient Preference ◽  
Outpatient Clinic ◽  
Group Analysis ◽  
Office Visits ◽  
Remote Communication ◽  
Chi Square ◽  
Telephone Consultation ◽  
Patient Satisfaction Scores ◽  
Observational Cohort ◽  
Telephone Group

Abstract Purpose: The global adoption of teleconsultation has been expedited as a result of the COVID-19 pandemic. By allowing remote communication, teleconsultation may help limit the spread of the virus while maintaining the crucial patient-provider relationship. The purpose of this study is to evaluate the value of teleconsultation compared to in-person visits in the management of elective orthopaedic and spinal procedures.Methods: This was a prospective observational cohort study of 853 patients receiving orthopaedic and spinal care at a private outpatient clinic in New Zealand. Patients were randomly divided into two groups: (1) patients receiving telephone consultation remotely; and (2) patients receiving in-person office consultations at the outpatient clinic. All patients received telephone consultations for four weeks during the mandated COVID-19 lockdown, followed by four weeks of telephone or in-person consultation. Patient preference, satisfaction, and duration of visit were recorded. Comparisons of patient preference between groups, visit type, sex, and location were performed using Chi-square tests; similarly, satisfaction scores and visit durations were compared using a general linear model. Results: We report that 91% of patients in the telephone group preferred teleconsultation over in-person office visits during the COVID-19 lockdown (p=0.000). A combined-group analysis shows that 55.3% of all patients preferred teleconsultation compared to 31.2% who preferred in-person office visits (p=0.000). Patients in the telephone group reported significantly higher satisfaction scores (9.95 +/- 0.04, 95% CI [9.87-10.03]) compared to patients in the in-person group (9.53 +/- 0.04, 95% CI [9.45-9.62]; p=0.000). Additionally, in-person consultations were significantly longer in duration compared to telephone consultations, with a mean visit time of 6.70 min +/-0.18, 95% CI [6.32-7.02] compared to 5.10 min +/-0.17, 95% CI [4.73-5.42], respectively (p=0.000).Conclusion: Patients who utilize telephone consultations are more likely to prefer it over traditional, in-person visits in the future. This increased preference, coupled with higher patient satisfaction scores and shorter duration of visits, suggests that teleconsultation has a role in orthopaedic surgery, which may even extend beyond the COVID-19 pandemic.

Patients with shoulder pain referred to specialist care; treatment, predictors of pain and disability, emotional distress, main symptoms and sick-leave: a cohort study with a six-months follow-up

2020 ◽  
Vol 20 (4) ◽  
pp. 775-783
Author(s):  
Kaia B. Engebretsen ◽  
Jens Ivar Brox ◽  
Niels Gunnar Juel
Keyword(s):  
Clinical Trials ◽  
Cohort Study ◽  
Sick Leave ◽  
Shoulder Pain ◽  
Emotional Distress ◽  
Outpatient Clinic ◽  
Treatment Duration ◽  
Specialist Care ◽  
Yellow Flags

AbstractObjectivesRecommendations for referral of patients with shoulder pain from primary to specialist care are mainly clinical. Several patients are referred without meeting these criteria for referral, whereas some are referred for a second opinion although surgery is not recommended. The aims of this study were to describe a shoulder pain cohort in specialist healthcare according to demographic data, clinical, and psychological factors; evaluate changes in pain and disability, distress and main symptoms from baseline to six-month follow-up; and to assess predictors of pain and disability, changes in the main symptoms and sick-leave at six-months. Results were compared to previous randomised trials conducted at the same clinic in patients with subacromial shoulder pain.MethodsThis prospective study included 167 patients from an outpatient clinic in specialist healthcare with shoulder pain for more than 6 weeks. Clinical (pain duration, intensity, pain sites), sociodemographic (age, gender, educational level, work status) and psychological variables (emotional distress (HSCL-10), fear of pain, screening of “yellow flags”, health-related quality of life) were collected. Shoulder pain and disability (SPADI-score) were assessed and the patients were asked about their outcome expectation and to predict their status of their shoulder problem the next month. They underwent a clinical interview, a clinical assessment of shoulder function and orthopaedic tests for diagnostic purposes. After six months they received a questionnaire with main variables.ResultsOf the 167 patients (55% women), 50% had symptoms for more than 12 months and 37 (22%) were on sick-leave. Characteristics were in general comparable to patients previously included in clinical trials at the same department. The SPADI-score was 46 (23) points. Mean emotional distress was within the normal range (1.7 (SD 0.6)). More than 80% had received treatment before, mainly physiotherapy in addition to the GPs treatment. One hundred and thirty-seven patients (82%) were re-referred to physiotherapy, 74 (44%) in the outpatient clinic specialist healthcare, and 63 (38%) in primary care. One hundred and eighteen (71%) answered the follow-up questionnaire. Mean change in SPADI-score was 10.5 points (95% CI (6.5–14.5)), and 29% of the patients improved more than the smallest detectable difference (SDD). The percentage sick-listed was 19.5%, and mean change in main symptoms (−9 to +9) was 3.4 (SD 3.9). The subgroup of patients receiving physiotherapy in outpatient specialist care did not show any significant change in the main variables. The prediction models suggested that a lower level of education, more fear of pain and a high baseline SPADI-score, predicted a higher SPADI-score at follow-up. A high baseline HSCL-10 score was the only significant predictor for a high HSCL-10 score. At follow-up, less pain at rest predicted more change in main symptoms and more yellow flags (a higher score on the Örebro screening test) predicted sick-leave.ConclusionsWithin the limitations of a cohort study, patients with persistent shoulder pain referred to an outpatient specialist clinic had similar baseline characteristics but shorter treatment duration, inferior clinical results and predictors somewhat different compared with previous clinical trials conducted at the same clinic. The study raises some questions about the effectiveness of the routines in daily clinical practice, the selection of patients, the treatment duration and content.

scholarly journals Outpatient Clinic in Obesity Care During COVID-19 Outbreak: Physically Far, Virtually Near. Brief Correspondence on a Single Center Experience: Cohort Study

2021 ◽  
Author(s):  
Francesco Pizza ◽  
Dario D’Antonio ◽  
Chiara Dell’Isola ◽  
Francesco Saverio Lucido ◽  
Claudio Gambardella
Keyword(s):  
Cohort Study ◽  
Outpatient Clinic ◽  
Single Center ◽  
Single Center Experience

scholarly journals Predictors of brain infarction in adult patients on extracorporeal membrane oxygenation: an observational cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Riccardo Iacobelli ◽  
Alexander Fletcher-Sandersjöö ◽  
Caroline Lindblad ◽  
Boris Keselman ◽  
Eric Peter Thelin ◽  
...  
Keyword(s):  
Cohort Study ◽  
Extracorporeal Membrane Oxygenation ◽  
Brain Infarction ◽  
Multivariable Analysis ◽  
Group Analysis ◽  
Observational Cohort Study ◽  
Adult Patients ◽  
Membrane Oxygenation ◽  
Observational Cohort ◽  
Va Ecmo

AbstractNon-hemorrhagic brain infarction (BI) is a recognized complication in adults treated with extracorporeal membrane oxygenation (ECMO) and associated with increased mortality. However, predictors of BI in these patients are poorly understood. The aim of this study was to identify predictors of BI in ECMO-treated adult patients. We conducted an observational cohort study of all adult patients treated with venovenous or venoarterial (VA) ECMO at our center between 2010 and 2018. The primary endpoint was a computed tomography (CT) verified BI. Logistic regression models were employed to identify BI predictors. In total, 275 patients were included, of whom 41 (15%) developed a BI. Pre-ECMO Simplified Acute Physiology Score III, pre-ECMO cardiac arrest, VA ECMO and conversion between ECMO modes were identified as predictors of BI. In the multivariable analysis, VA ECMO demonstrated independent risk association. VA ECMO also remained the independent BI predictor in a sub-group analysis excluding patients who did not undergo a head CT scan during ECMO treatment. The incidence of BI in adult ECMO patients may be higher than previously believed and is independently associated with VA ECMO mode. Larger prospective trials are warranted to validate these findings and ascertain their clinical significance.

Prospective, comparative, cohort study comparing the rhinogram, Sino-Nasal Outcome Test-20 and Heath-Related Quality of Life questionnaire

2010 ◽  
Vol 124 (6) ◽  
pp. 623-630 ◽  
Author(s):  
P M Patel ◽  
S Maskell ◽  
R Heywood ◽  
N Eze ◽  
J Hern
Keyword(s):  
Quality Of Life ◽  
Cohort Study ◽  
Outcome Measures ◽  
Outcome Measure ◽  
Life Questionnaire ◽  
Chi Square ◽  
Quality Of Life Questionnaire ◽  
Related Quality ◽  
Comparative Cohort Study

AbstractBackground:Many outcome measures exist for rhinosinusitis. However, few are used in the clinical setting due to their long completion times.Objective:To assess the validity, reliability and responsiveness of the rhinogram, compared with two validated rhinosinusitis outcome measures: the Sino-Nasal Outcome Test-20 and the Heath-Related Quality of Life questionnaire.Methods:Fifty-one patients were entered into a prospective, comparative, cohort study using all three outcome measures one week pre-operatively and three months post-operatively. Outcome scores were then correlated using non-parametric Spearman's rank correlation and chi-square testing for the diagnostic criteria of all three outcome measures.Results:Statistically significant correlations were found between all three outcome measures for all symptom scores, individually as well as combined (p < 0.01 for all calculations). Comparison of the diagnostic accuracy of the rhinogram, compared with the Sino-Nasal Outcome Test-20 and the Heath-Related Quality of Life questionnaire, showed statistical significance (p < 0.05; chi-square test).Conclusion:The rhinogram is a reliable, valid and responsive rhinosinusitis outcome measure which can assist patient diagnosis and management in the clinical setting. Due to its quick completion time, this outcome measure could be used in rhinology out-patient clinics.

scholarly journals Urinary manifestations in African American and Caucasian inflammatory bowel disease patients: a retrospective cohort study

BMC Urology ◽  
2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Jake Herbert ◽  
Emily Teeter ◽  
Landen Shane Burstiner ◽  
Ralfi Doka ◽  
Amor Royer ◽  
...  
Keyword(s):  
African American ◽  
Cohort Study ◽  
African Americans ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Chi Square ◽  
Bowel Diseases ◽  
Tertiary Healthcare ◽  
Inflammatory Bowel ◽  
Tract Infections

Abstract Background Inflammatory bowel diseases (IBD), like ulcerative colitis (UC) and Crohn’s disease (CD), are associated with urinary extra-intestinal manifestations, like urolithiasis and uncomplicated urinary tract infections (UTIs). The literature reviewed for this study identifies an increased association of CD and urolithiasis against the general population as well as UC. Furthermore, the rates in which urinary comorbidities manifest have not been well characterized in cross-race analyses. The purpose of this study is to establish the prevalence of common urinary extra-intestinal manifestations in CD and UC and to further determine at what rate these affect the African American and Caucasian populations. Methodology This is a retrospective cohort study using de-identified data collected from a research data base that included 6 integrated facilities associated with one tertiary healthcare center from 2012 to 2019. The electronic chart records for 3104 Caucasian and African American IBD patients were reviewed for frequency of urolithiasis and uncomplicated UTI via diagnosed ICD-10 codes. Comparison between data groups was made using multivariate regressions, t-tests, and chi square tests. Results Our study included 3104 patients of which 59% were female, 38% were African American, and 43% were diagnosed with UC. Similar proportions of UC and CD diagnosed patients developed urolithiasis (6.0% vs 6.7%, p = 0.46), as well as uncomplicated UTIs (15.6% vs. 14.9%, p = 0.56). Similar proportions of African American and Caucasian patients developed urolithiasis (5.4% vs 7.0%, p = 0.09), but a higher proportion of African Americans developed uncomplicated UTIs (19.4% vs 12.6%, p ≤ 0.001). Conclusion We found similar rates of urolithiasis formation in both UC and CD in this study. Furthermore, these rates were not significantly different between African American and Caucasian IBD populations. This suggests that UC patients have an elevated risk of urolithiasis formation as those patients with CD. Additionally, African Americans with IBD have a higher frequency of uncomplicated UTI as compared to their Caucasian counterparts.

scholarly journals Age differences in clinical features and outcomes in patients with COVID-19, Jiangsu, China: a retrospective, multi-center cohort study

2020 ◽  
Author(s):  
Huanyuan Luo ◽  
Songqiao Liu ◽  
Yuancheng Wang ◽  
Penelope A. Phillips-Howard ◽  
Yi Yang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Hospital Stay ◽  
Older Patients ◽  
Adverse Outcomes ◽  
Trend Test ◽  
Chronic Obstructive ◽  
Chi Square ◽  
Chi Square Test

Objectives To determine the age-specific clinical presentations and incidence of adverse outcomes among patients with COVID-19 in Jiangsu, China. Design and setting This is a retrospective, multi-center cohort study performed at twenty-four hospitals in Jiangsu, China. Participants From January 10 to March 15, 2020, 625 patients with COVID-19 were involved. Results Of the 625 patients (median age, 46 years; 329 [52.6%] males), 37 (5.9%) were children (18 years or less), 261 (40%) young adults (19-44 years), 248 (39.7%) middle-aged adults (45-64 years), and 79 (12.6%) elderly (65 years or more). The incidence of hypertension, coronary heart disease, chronic obstructive pulmonary disease, and diabetes comorbidities increased with age (trend test, P < .0001, P = 0.0003, P < .0001, and P < .0001 respectively). Fever, cough, and shortness of breath occurred more commonly among older patients, especially the elderly, compared to children (Chi-square test, P = 0.0008, 0.0146, and 0.0282, respectively). The quadrant score and pulmonary opacity score increased with age (trend test, both P < .0001). Older patients had significantly more abnormal values in many laboratory parameters than younger patients. Elderly patients contributed the highest proportion of severe or critically-ill cases (33.0%, Chi-square test P < 0.001), intensive care unit (ICU) (35.4%, Chi-square test P < 0.001), and respiratory failure (31.6%, Chi-square test P = 0.0266), and longest hospital stay (21 days, ANOVA-test P < 0.001). Conclusions Elderly (≥65) patients with COVID-19 had the highest risk of severe or critical illness, intensive care use, respiratory failure, and the longest hospital stay, which may be due partly to that they had higher incidence of comorbidities and poor immune responses to COVID-19.

scholarly journals Using family atopy scores to identify the risk of atopic dermatitis in infants

2014 ◽  
Vol 54 (6) ◽  
pp. 330
Author(s):  
Melisa Anggraeni ◽  
Ketut Dewi Kumara Wati ◽  
Ketut Tangking
Keyword(s):  
Atopic Dermatitis ◽  
Cohort Study ◽  
Pregnant Woman ◽  
Environmental Factors ◽  
Antenatal Care ◽  
Early Life ◽  
Early Interventions ◽  
Chi Square

Background Atopic dermatitis is the first manifestation ofallergic disease in early life. Early interventions may prevent thedevelopment of allergy disease. Allergy trace cards have beenused to identify the level of allergic risk, based on family atopyscores. Because environmental factors may also influence thedevelopment of atopic dermatitis, the usefulness of the allergytrace card needs to be reevaluated.Objective To compare the incidence of atopic dermatitis ininfants aged 0-4 months with total family atopy scores of > 0 tothose with scores of 0.Methods We conducted this cohort study from June 1, 2012 toDecember 31, 2012 at Sanglah Hospital, Denpasar. Family atopyscore was tabulated from all pregnant woman in the ObstetricOutpatient Clinic and the Maternity Room. Subjects were dividedinto two groups based on their total family atopy score: those withscores > 0 and those with scores of 0. The appearance of atopicdermatitis symptoms in the infants were evaluated until theyreached 4 months of age. The incidence of atopic dermatitis intwo groups was compared using Chi-square test.Results The incidence of atopic dermatitis in this study was 10.9%.The group with total family atopy scores of 0 had a significantlyhigher incidence of atopic dermatitis than the group with scores> 0 (adjusted RR 22.5; 95%CI 8.8 to 57.0; P = 0.001).Conclusion The incidence of atopic dermatitis is higher ininfants with total family atopy score > 0 and this group has a 22.5times higher risk of atopic dermatitis compared to infants withtotal family atopy score of 0. Allergy trace cards are relevant indifferentiating the risk of atopy with regards to development ofatopic dermatitis. We suggest that family atopy scores be evaluatedduring antenatal care in order to limit the development of atopicdermatitis in infants.

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