scholarly journals Orthopedic Research: A golden opportunity to improve patient outcomes

2021 ◽  
Vol 55 (3) ◽  
Author(s):  
Site Administrator ◽  
Czar Louie Gaston
Keyword(s):  
Patient Care ◽  
Patient Outcomes ◽  
Fracture Liaison Service ◽  
The Philippines ◽  
Evidence Based ◽  
The Core ◽  
Fracture Liaison Services ◽  
Randomized Controlled ◽  
Fracture Liaison ◽  
Improve Patient

Research has been one of the core pillars of the Department of Orthopedics of the Philippine General Hospital over its now 50 years of existence. The department established one of the earliest resident’s research contests in the hospital in 1983 and its graduates regularly publish in peer reviewed journals and present their results in international conferences.1 Residents are required to complete 2 original studies prior to graduation and encouraged to document their clinical cases fully for future observational studies. Despite the apparent fascination, questions remain for a lot of trainees and clinicians. “Why do research? How does it  help our patients?” Skepticism abounds as even clinically sound and well-made studies oftentimes do not lead to policy and practice changes needed to improve patient care.2 Given contrarian evidence from randomized controlled trials (RCTs), practices of most established surgeons do not change.3 Hope remains however as evidence-based practice in orthopedics is growing and here to stay.4 Surgeons who accurately examine and diagnose their patient, keep medical records, analyze the medical literature for the best treatment, and explain the available options are subconsciously practicing the scientific methods of observation, documentation, analysis, and reporting conclusions which are the basis of all scientific research. Incorporating research education not just to residency training programs but also to continuing medical education (CME) courses for surgeons may help develop the skills to comprehend new studies and incorporate them into patient care. Reassuringly for the elder surgeon, even old dogs have been shown to learn new tricks for their practice, just not as fast as the younger generation.5 The challenge now presented to Philippine medical practitioners is to develop clinical research that will translate into improved care for patients. As majority of literature dictating treatment for musculoskeletal disorders come from developed countries, case series or observational cohorts reporting local data in our setting is greatly important in guiding patient care.6 The fundamental goal is to produce high quality studies or new breakthroughs that engage discussion amongst a wide audience and lead to system changes that eventually enhance patient outcomes.7 As part of the celebration of the PGH Department of Orthopedics 50th golden anniversary, this orthopedic issue of the ACTA MEDICA PHILIPPINA represents work from the different orthopedic subspecialities of the department and its graduates. Pioneering studies on brachial plexus injuries, computer navigated spine surgery, rotationplasty, artificial intelligence, pedagogy, and much more highlight the growth of orthopedics in the Philippines. A study on one of the newest fields in Philippine orthopedics, orthogeriatrics, exemplifies the importance of blazing a new trail. The publication by Reyes et al. on a multidisciplinary orthogeriatric approach to the treatment of fragility hip fractures has shown improved outcomes consistent with the positive results of other fracture liaison services in Asia and worldwide.8,9 Their work has since led to the UPM-PGH Orthogeriatric Multidisciplinary Fracture Management Model and Fracture Liaison Service being adopted by PGH as a clinical pathway and has served as a model for other hospitals in the Philippines to improve their care of patients with fragility hip fractures. With the follow-through from the initial clinical study to administrative and policy changes, this example aptly illustrates the power of research to effect significant improvements in clinical outcomes and inspires all of us to continue to strive for better care for our patients.   Czar Louie Gaston, MD, FPOA Department of Orthopedics Philippine General Hospital University of the Philippines Manila   REFERENCES College of Medicine University of the Philippines Manila. Orthopedics [Internet]. [cited 2021 May]. Available from: https://cm.upm.edu.ph/p/orthopedics/ Buchbinder R, Maher C, Harris IA. Setting the research agenda for improving health care in musculoskeletal disorders. Nat Rev Rheumatol. 2015 Oct;11(10):597-605. doi: 10.1038/nrrheum.2015.81. Epub 2015 Jun 16. PMID: 26077917. Sonntag J, Landale K, Brorson S, Harris IA. Can the results of a randomized controlled trial change the treatment preferences of orthopaedic surgeons? Bone Jt Open. 2020 Sep 11;1(9):549-555. doi: 10.1302/2633-1462.19.BJO-2020-0093.R1. PMID: 33215153; PMCID: PMC7659699. Griffin XL, Haddad FS. Evidence-based decision making at the core of orthopaedic practice. Bone Joint J. 2014 Aug;96-B(8):1000-1. doi: 10.1302/0301-620X.96B8.34614. PMID: 25086112. Niles SE, Balazs GC, Cawley C, Bosse M, Mackenzie E, Li Y, et al. Translating research into practice: is evidence-based medicine being practiced in military-relevant orthopedic trauma? Mil Med. 2015 Apr;180(4):445-53. doi: 10.7205/MILMED-D-14-00296. PMID: 25826350. Elliott IS, Sonshine DB, Akhavan S, Slade Shantz A, Caldwell A, Slade Shantz J, et al. What factors influence the production of orthopaedic research in East Africa? A qualitative analysis of interviews. Clin Orthop Relat Res. 2015 Jun;473(6):2120-30. doi: 10.1007/s11999-015-4254-5. Epub 2015 Mar 21. PMID: 25795030; PMCID:PMC4419000. Tchetchik A, Grinstein A, Manes E, Shapira D, Durst R. From research to practice: Which research strategy contributes more to clinical excellence? Comparing high-volume versus high-quality biomedical research. PLoS One. 2015 Jun 24;10(6):e0129259. doi: 10.1371/journal.pone.0129259. PMID: 26107296; PMCID: PMC4480880. Chang LY, Tsai KS, Peng JK, Chen CH, Lin GT, Lin CH, et al. The development of Taiwan Fracture Liaison Service network. Osteoporos Sarcopenia. 2018 Jun;4(2):47-52. doi: 10.1016/j.afos.2018.06.001. Epub 2018 Jun 7. PMID: 30775542; PMCID: PMC6362955. Barton DW, Piple AS, Smith CT, Moskal SA, Carmouche JJ. The clinical impact of fracture liaison services: A systematic review. Geriatr Orthop Surg Rehabil. 2021 Jan 11;12:2151459320979978. doi: 10.1177/2151459320979978. PMID: 33489430; PMCID: PMC7809296

scholarly journals P115 Improved reporting of vertebral fractures by radiologists: a success story!

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Muhammad Amjad Nazir ◽  
Muhammad Safwan Jamal ◽  
Darren Hart ◽  
Jacqueline Shipley ◽  
Susie Warren ◽  
...  
Keyword(s):  
Patient Care ◽  
Vertebral Fractures ◽  
Improve Patient Care ◽  
Fracture Liaison Service ◽  
Radiology Report ◽  
Radiology Reports ◽  
Primary Care Teams ◽  
Management Advice ◽  
Fracture Liaison ◽  
Improve Patient

Abstract Background/Aims  Vertebral fractures (VF) are the most common type of osteoporotic fracture and affect >20% women over the age of 80. However, the majority remain undiagnosed. Even when imaging has been performed, VF are under-reported by radiologists. This results in a missed opportunity for treatment to reduce fracture risk and morbidity. We conducted this project to improve the reporting of VF (incidental or symptomatic), thus enabling our fracture liaison service to identify cases more easily and optimise patient care. Methods  Using SYNAPSE (imaging software), cohorts of patients aged more than 75 years of age who had CT scans of chest/abdomen/pelvis in 2012 and 2017 were selected. Images were reviewed by a single rheumatologist with an interest in osteoporosis, looking for the presence of VF. For patients with VF, radiology reports were reviewed to assess whether there was documentation of this. Results  There was improvement in the reporting of VF between 2012 and 2017 (see Table 1) but identification remained suboptimal. Specific use of the term “fracture” remained in the minority. The data was presented to our radiologists in December 2017 along with information about the importance of identifying and treating patients with VF. Agreement was reached for the radiologists to include a code (FLS) in reports where a non-pathological VF was identified. Searches for the presence of the code through the hospital’s radiology information system have allowed easy identification of VF cases. Letters are sent to Primary Care teams informing them that we have identified an incidental VF along with suggested management advice. This project has substantially increased the number of VF identified (in patients aged >50) by our fracture liaison service over time. 82 cases of VF were identified in 2017 (pre-intervention), 350 cases in 2018, and 848 cases in 2019. P115 Table 1:No. of patients, nVF identified in audit, n (%)Terminology alluding to fracture in radiology report, n (% of identified fractures)Use of the word “fracture” in radiology report, n (% of identified fractures)Mention of osteoporosis or osteopaenia, n (% of identified fractures)2012 cohort10315 (15)5 (33)1 (7)3 (20)2017 cohort10226 (25)18 (69)8 (31)4 (15) Conclusion  Collaboration with our radiologists through education and the use of a code in radiology reports has resulted in a sustained and dramatic increase in the number of VF annually identified by our fracture liaison service. We strongly recommend that other services adopt this approach to help them achieve national audit targets and improve patient care. Disclosure  M. Nazir: None. M. Jamal: None. D. Hart: None. J. Shipley: None. S. Warren: None. S. Hardcastle: None. T. Ahmed: None.

scholarly journals 1235 A Multi-Site Review of Second Hip Fractures Across 6 Dublin Teaching Hospitals

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
B Murphy ◽  
C Downey ◽  
S Flannery ◽  
T Daly ◽  
S Conway ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Patient Outcomes ◽  
Hip Fractures ◽  
Healthcare Expenditure ◽  
Significant Proportion ◽  
Teaching Hospitals ◽  
Fracture Liaison Services ◽  
Bone Protection ◽  
Fracture Liaison ◽  
Improve Patient

Abstract Introduction Hip fractures are a common presentation to Irish hospitals with 3,701 hip fractures recorded by 16 hospitals in the Irish Hip Fracture Database (IHFD) in 2019. Second hip fractures (HF2) make up a significant proportion of hip fractures and represent an opportunity to prevent subsequent fragility fracture. Method Hip fracture datasheets from 2019 in six Dublin hospitals were analysed. Results 1,284 hip fractures in total were recorded in 2019 in these six hospitals. 112 of these were second hip fractures (8.72%). 24.1% of patients had a HF2 in year 1 post their first hip fracture (HF1). 14.3% of patients had a HF2 in Year 2, 8% in Year 3, 8.9% in Year 4 and 6.3% in Year 5. 17.9% of patients had an HF2 at an unknown time in relation to their HF1. 57.6% of all patients with any hip fracture were started on bone protection medications (BPMs) during their admission. 18.9% continued a pre-admission prescription. 7% of all patients were previously assessed and determined not to require BPM. 6.9% of patients were awaiting outpatient department (OPD) assessment for bone protection. 8.6% had no assessment for bone protection conducted. Of all patients with an HF2, 48.2% were started on BPMs on admission with their HF2. 33% continued BPMs started pre-admission. Discussion In 2019, approximately 1 in 10 hip fractures were second hip fractures. Evidence suggests that fracture liaison services represent a viable, economic means of preventing second hip fractures to improve patient outcomes and reduce healthcare expenditure.

Conceptualizing Narrative Health and Medicine to Develop Cultural Competence to Improve Communication During the COVID-19 Pandemic

2021 ◽  
Vol 8 (1) ◽  
pp. 32-36
Author(s):  
Kent Willis ◽  
Colleen Marzilli
Keyword(s):  
Healthcare Professional ◽  
Cultural Competence ◽  
Severe Acute Respiratory Syndrome ◽  
Patient Care ◽  
Patient Outcomes ◽  
Healthcare Professionals ◽  
Important Concept ◽  
Healthcare Environment ◽  
Health Narrative ◽  
Improve Patient

Narrative health is a technique that healthcare professionals can use to connect with patients. The events of 2020, including the global severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have identified that patient care is largely dependent upon relationships within the healthcare environment. Relationships in the healthcare environment are established through a trusting exchange between the patient and provider, and one technique to develop this relationship and trust is through narrative health. Narrative health provides the exchange of information between patient and provider in a discussion-like manner, or narrative health. This strategy promotes cultural competence amongst the healthcare professional team and improves communication between the patient and provider. Narrative health is an important concept for healthcare professionals to understand, and narrative health should be a part of any healthcare professional’s toolbox, especially in vulnerable times like the COVID pandemic. The inclusion of narrative health in practice has the potential to improve patient outcomes and empower healthcare professionals and patients.

Lower extremity osteoarthritis: optimising musculoskeletal health is a growing global concern: a narrative review

2018 ◽  
Vol 53 (13) ◽  
pp. 806-811 ◽  
Author(s):  
Richard D Leech ◽  
Jillian Eyles ◽  
Mark E Batt ◽  
David J Hunter
Keyword(s):  
Patient Outcomes ◽  
Key Management ◽  
Structural Changes ◽  
Healthcare Professionals ◽  
Disease Process ◽  
Evidence Based ◽  
Musculoskeletal Health ◽  
Proactive Approach ◽  
Global Concern ◽  
Improve Patient

The burden of non-communicable diseases, such as osteoarthritis (OA), continues to increase for individuals and society. Regrettably, in many instances, healthcare professionals fail to manage OA optimally. There is growing disparity between the strength of evidence supporting interventions for OA and the frequency of their use in practice. Physical activity and exercise, weight management and education are key management components supported by evidence yet lack appropriate implementation. Furthermore, a recognition that treatment earlier in the disease process may halt progression or reverse structural changes has not been translated into clinical practice. We have largely failed to put pathways and procedures in place that promote a proactive approach to facilitate better outcomes in OA. This paper aims to highlight areas of evidence-based practical management that could improve patient outcomes if used more effectively.

scholarly journals Implementation of a Quality Improvement Role for Unlicensed Assistive Personnel and Effects on Infection Prevention

2021 ◽  
Vol 1 (S1) ◽  
pp. s73-s74
Author(s):  
Natalie Schnell ◽  
Lauren DiBiase ◽  
Amy Selimos ◽  
Lisa Stancill ◽  
Shelley Summerlin-Long ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Data Collection ◽  
Patient Care ◽  
Patient Outcomes ◽  
Infection Prevention ◽  
Central Line ◽  
Direct Patient Care ◽  
Evidence Based ◽  
Infection Rates ◽  
Process Measure

Background: Care bundles comprise evidence-based practices and interventions that are easily and consistently implemented while improving patient outcomes. As patient acuity and task overload continue to increase, infection prevention bundle and process measure compliance and data collection may become a lower priority for registered nurses (RNs). In early 2019, a certified nursing assistant (CNA) began full-time quality liaison work on a 53-bed inpatient adult oncology unit at UNC Medical Center to provide targeted compliance data collection and to correct deficits in real time when possible and within the appropriate scope of practice. Methods: The quality liaison CNA is highly motivated, with a relevant clinical background and effective communication skills. After conducting a gap analysis, the unit developed specific responsibilities for several areas of quality improvement, including infection prevention. In addition to rounding on all patients daily, the quality liaison (1) performs direct patient care tasks like Foley catheter care, (2) conducts patient education on topics such as chlorhexidine gluconate treatments, (3) performs all relevant process measure audits, and (4) easily relays missed or needed care to RNs with a door sign created as part of this initiative. High-risk findings, such as a loose central-line dressing, prompt immediate communication to the RN, with follow-up and escalation when necessary. Results: Patients and staff received the quality liaison well, and the increased attention to care bundle components and auditing ensured consistent, evidence-based care along with accurate and reliable data collection. Compared to the previous calendar year, the number of central-line audits on the unit increased by >1,400 by the end of 2019. Patient outcomes improved, and during 1 fiscal year, the unit achieved rate reductions between 40% and 55% for central-line–associated bloodstream infections, catheter-associated urinary tract infections, and healthcare-associated C. difficile infections. Staffing and logistical challenges imposed by the COVID-19 global pandemic have hampered this work because the quality liaison was redeployed to direct patient care intermittently. Correspondingly, from July to October 2020, the same infection rates increased between 30% and 353%. Conclusions: Having a designated quality liaison is an effective means to achieving quality improvements while remaining an integral member of the patient care team. As staffing has improved on this unit, the quality liaison has refocused efforts, and infection rates are beginning to improve. Given the success of the quality liaison role in improving quality outcomes on this unit, the hospital is exploring expansion of this model to additional units.Funding: NoDisclosures: None

Interprofessional Education

2018 ◽  
pp. 520-541
Author(s):  
Rebecca Moote
Keyword(s):  
Patient Care ◽  
Student Learning ◽  
Interprofessional Education ◽  
Improve Patient Care ◽  
Collaborative Practice ◽  
Evidence Based ◽  
High Quality ◽  
Design And Implementation ◽  
Assessment Strategies ◽  
Improve Patient

Interprofessional education (IPE) is recognized as an important component in the education of healthcare students. The goal of bringing students together to learn with, from, and about each other is to ultimately impact collaborative practice and improve patient care. Over the last 20 years there has been increased focus on the design and implementation of IPE experiences. Several IPE collaborative organizations and IPE centers have been formed to provide evidence-based recommendations and guidelines. Strategies have been created for designing and implementing high quality IPE activities, developing faculty in IPE, overcoming student stereotypes, determining assessment strategies, and identifying barriers to IPE. This chapter will focus on each of these elements and provide specific recommendations on how to create and implement IPE that improves student learning.

Integration of Podiatric Medicine Within the Fracture Liaison Services Model

2020 ◽  
Vol 110 (1) ◽  
Author(s):  
Tyler MacRae ◽  
David W. Shofler
Keyword(s):  
Health Care ◽  
Patient Outcomes ◽  
Health Care Costs ◽  
Metabolic Disorders ◽  
Models Of Care ◽  
Treatment Of Osteoporosis ◽  
Fracture Liaison Services ◽  
Fracture Management ◽  
Care Costs ◽  
Fracture Liaison

Underlying bone metabolic disorders are often neglected when managing acute fractures. The term fracture liaison services (FLS) refers to models of care with the designated responsibility of comprehensive fracture management, including the diagnosis and treatment of osteoporosis. Although there is evidence of the effectiveness of FLS in reducing health-care costs and improving patient outcomes, podiatric practitioners are notably absent from described FLS models. The integration of podiatric practitioners into FLS programs may lead to improved patient care and further reduce associated health-care costs.

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