Acute Concussion vs Post-Concussion Syndrome (PCS): How Can We Prevent Progression?

ObjectiveTo contrast the presentation and recovery of acute concussion and post-concussion syndrome (PCS) in order to identify factors for PCS prevention.BackgroundConcussions are classified as acute (<90 days to resolution) or post-concussion syndrome (PCS, = 90 days to resolution). PCS poses a great burden to the individual and to public health. Further investigation is warranted for understanding the progression of acute concussion to PCS and potential mitigating strategies.Design/MethodsRetrospective chart review of concussion patients seen by Sports Medicine and Exercise Physicians over a five-year period. Outcome measures included demographics, wait-times, injury mechanisms, Sport Concussion Assessment Tool (SCAT) scores, management plans, and recovery timelines.ResultsFour hundred ninety-six patients (289 male/207 female, 19.7 ± 9.4 years) presented with 561 concussions in 1,471 visits. Acute concussions accounted for 88% of injuries and 12% were PCS. Females (RR = 1.4) and adults = 25 years (RR = 3.6) were more likely to be diagnosed with PCS. In both, injuries occurred most commonly in hockey, football, and soccer. Family physicians were the most frequent referral provider (58% acute, 76% PCS). Median injury-appointment time was 11.0 days (acute) compared to 182.0 days (PCS). Initial total SCAT symptom score was significantly greater (p < 0.001) in PCS (56.0 ± 33.0) compared to acute concussion (39.8 ± 31.9). Therapies (i.e., referral, medication, intervention) were prescribed in 44% of acute injury visits compared to 73% of PCS visits. Recovery timelines for return to work, school, and sport were significantly longer in PCS patients than in those with acute concussions (p < 0.05).ConclusionsOur findings of the incidence/presentation of PCS agree with previous literature. Athletes who are female and/or = 25 years may be at greater risk for PCS progression, requiring close monitoring and further injury prevention efforts. Considering the number of referrals from family physicians, further concussion education may better optimize initial management and shorten delays in seeking necessary sports medicine consultation.

EP.WE.52Telephone Pre-Surgical Assessments in Renal Transplant Surgery

Aims Patients listed for renal transplant require a pre-surgical assessment. This has traditionally involved an in-person appointment. During the Coronavirus Pandemic, these began to be offered as telephone appointments to reduce the number of hospital visits. This study aims to assess the effectiveness of these new telephone assessments and whether they should continue to be offered. Methods 20 patients from one renal transplant centre who had a telephone pre-transplant assessment between May and September 2020 were contacted and successfully completed a 12-question questionnaire. It was entirely voluntary and responses were anonymised. Results 80% of patients built a great rapport with their doctor and all felt able to ask questions. All patients received a set appointment time, although some occurred late and 75% received information leaflets through the post. Most patients received adequate information on the topics specified. Not enough information was given in 20-26% of cases on medications and follow-up post-transplant and SARS-COV-2 risks. 40% preferred a telephone appointment, mainly due to less SARS-COV-2 risk and less hassle. Whereas 55% would rather a face-to-face appointment, due to better abilities to communicate and build relationships. Ideas for improvements were suggested. Conclusions Telephone assessments provide a good alternative to in-person pre-transplant assessments. Many patients prefer them, especially with SARS-COV-2 risks, however many still favour face-to-face appointments. Telephone assessments should therefore continue to be offered, but patient preference should be prioritised. They can be improved by ensuring patients always receive enough information and leaflets, an appointment time window and a contact for further questions.

Virtual phone clinics in orthopaedics: evaluation of clinical application and sustainability

AimsAdoption of virtual clinics has been accelerated by the COVID-19 pandemic and they will continue to form an integral part of healthcare delivery. Our objective was to evaluate virtual clinics in orthopaedic practice and determine how to use them effectively and sustainably.MethodsWe surveyed 100 consecutive patients participating in orthopaedic virtual phone clinic (VPC) at an academic hospital to evaluate patient satisfaction against face-to-face (F2F) consultations and obtain suggestions for improving patient experience, and we surveyed 23 clinicians who conducted orthopaedic VPCs in 2020. Data were correlated with clinic outcomes, reason for consultation, diagnosis, patient age and clinician grade. Consultation duration, clinician-associated costs and reimbursement were analysed. Significance was tested using two-tailed Student’s t-test and Fisher’s exact test.ResultsPatient satisfaction (out of 5) for VPC was significantly lower than F2F (4.1 vs 4.5, p=0.0003), and a larger proportion of VPC scored <3 compared with F2F (11% vs 2%). Higher VPC scores were associated with appointments for delivering results and where patients felt clinical examination was not needed. Patients suggested introducing video capability, adhering to appointment time and offering the choice of VPC or F2F. Mean clinician satisfaction scores for VPC were 4.3/5 and suggested indications for VPC included: routine surveillance, communication of results, discussing/consenting for surgery and vulnerable patients. Integrating video, providing private rooms and offering patients time intervals for VPC were recommended. Current National Health Service VPC structures uses greater clinician resources and generates lower reimbursement than F2F consultations, resulting in 11.5% reduction in reimbursement.ConclusionVPC plays a valuable role when clinical evaluation has been performed or considered not necessary. Offering the choice of VPC or F2F, adding video capability and providing a time interval for VPC may reduce resource use and increase satisfaction. We recommend renegotiating VPC tariffs and cost-neutral modifications of clinic structure.

An Analysis between Patient Demographics and Non-attendances in General Surgery Clinics at an NHS Trust: An Audit

Background: Missed clinic appointments can have bearing on a multitude of factors including patient care, hospital management and resources. Aim: To assess the non-attendance rates to surgical clinics within our trust. Secondary outcomes will be to assess the correlation between travel distances to clinic, time of year, patient demographics, and whether the appointment is a new patient or follow-up, on DNA rate. Methods: Retrospective audit including all patients attending outpatient general surgical appointments at all 5 district general hospitals within the trust between the fiscal years of April 2016 to March 2018. Using case notes and electronic patient records, data on patient demographics, type of appointment, time of year and distance from hospital were collected. Results and Conclusions: There is correlation between DNAs and age, gender, ethnicity, subspecialty, and distance from hospital. The reasons behind DNAs will be multifactorial and efforts should be made to investigate the barriers to attendance.

Exploring the Factors of Intercity Ridesplitting Based on Observed and GIS Data: A Case Study in China

Ridesplitting, a form of ridesourcing in which riders with similar origins and destinations are matched, is an effective mode of sustainable transportation. In recently years, ridesplitting has spread rapidly worldwide and plays an increasingly important role in intercity travel. However, intercity ridesplitting has rarely been studied. In this paper, we use observe intercity ridesplitting data between Yinchuan and Shizuishan in China and building environment data based on a geographic information system (GIS) to analyse temporal, spatial and other characteristics. Then, we divide the study area into grids and explore the contributing factors that affect the intercity ridesplitting matching success rate. Based on these significant factors, we develop a binary logistic regression (BLR) model and predict the intercity ridesplitting matching success rate. The results indicate that morning peak, evening peak, weekends and weekdays, precipitation and snowfall, population density, some types of points of interest (POI), travel time and the advance appointment time are significant factors. In addition, the prediction accuracy of the model is more than 78%, which shows that the factors studied in this paper have good explanatory power. The results of this study can help in understanding the characteristics of intercity ridesplitting and provide a reference for improving the intercity ridesplitting matching success rate.

Preferences for chlamydia testing and management in Hong Kong: a discrete choice experiment

ObjectivesAs most chlamydia cases are asymptomatic, regular testing and timely management may be necessary for control. We aimed to determine the preferences of people living in Hong Kong for chlamydia testing and management services.MethodsAn online panel of sexually active individuals living in Hong Kong completed the survey with two discrete choice experiments (DCEs). The first DCE examined the preferred attributes of a chlamydia testing service (cost, location, appointment time, speed of results, delivery of results and availability of other STI testing). The second DCE examined the preferred attributes of a chlamydia management service (cost, access to patient-delivered partner therapy, location, travel time, type of person consulted and attitude of staff).ResultsIn total, 520 individuals participated: average age 36.8 years (SD 9.9), 40% males and 66% had a bachelor’s degree or higher. Choosing to test was most influenced by cost, followed by speed of results, delivery of results, extra STI testing, appointment available and the least important was the location of testing. Choosing to attend for management was most influenced by staff’s attitude, followed by cost, who they consult, access to patient-delivered partner therapy, travel time and the least important was treatment location.ConclusionTo design effective chlamydia testing and management services, it is vital to respond to patient needs and preferences. For people living in Hong Kong, cost and staff attitude were the most important factors for deciding whether to test or be managed for chlamydia, respectively.

Patient Perspectives on Telemedicine During the COVID-19 Pandemic

Background Patients received care over telemedicine during the COVID-19 pandemic, and their perspective is useful for hand surgeons. Methods Online surveys were sent October-November 2020 to 497 patients who received telemedicine care. Questions were free-response and multi-item Likert scales asking about telehealth in general, limitations, benefits, comparisons to in-person visits, and opinions on future use. Results The response rate was 26% (n = 130). Prior to the pandemic, 55% had not used telemedicine for hand surgery consultation. Patients liked their telemedicine visit and felt their provider spent enough time with them (means = 9/10). In all, 48% would have preferred in-person visits despite the pandemic, and 69% would prefer in-person visits once the pandemic concludes. While 43% had no concerns with telemedicine, 36% had difficulties explaining their symptoms. Telemedicine was easy to access and navigate (M = 9/10). However, 23% saw telemedicine of limited value due to the need for an in-person visit soon afterward. Of these patients, 46% needed an in-person visit due to inadequate physical examination. Factors that make telemedicine more favorable to patients included convenience, lack of travel, scheduling ease, and time saved. Factors making telemedicine less favorable included need for in-person examination or procedure, pain assessment, and poor connectivity. There was no specific appointment time the cohort preferred. Patient recommendations to improve telemedicine included decreasing wait times and showing patient queue, wait time, or physician status online. Conclusions Telemedicine was strongly liked by patients during the COVID-19 pandemic. However, nearly 70% of patients still preferred in-person visits for the future.

246 FRActure Clinic Treatment: a sURvey of patient Experience (FRACTURE)

Aim BOAST guidelines on fracture clinics suggest a standard of care that all patients with significant injury should expect to receive in a Trauma & Orthopaedics outpatient setting in the United Kingdom. Method A prospective analysis of 358 patients presenting to fracture clinic at Gloucestershire Hospitals NHS Foundation Trust from September to November 2020. Patients completed an anonymous questionnaire based on BOAST guidelines. Results Most patients received a written management plan (82%), but only some received a leaflet (36%) and definite information about their procedure (47%). Most patients felt a leaflet (72%) and information about procedures (87%) would be useful. Patients were generally seen early or within 30 minutes of their appointment time (77%), but some waited more than 30 minutes (23%). Most patients found X-rays easily (91%) and rated staff (97%) and fracture clinic experience (93%) as very good or good. Comments included noting an efficient and friendly service, with suggestions on providing more information on waiting times and procedures to be performed. Conclusions Our study showed high patient satisfaction with fracture clinic and particularly positive feedback about staff. Areas of improvement include providing more leaflets and information about practical procedures. Following this audit, we will produce leaflets on common conditions and record videos on common procedures such as application of casts, splints and removal of k-wires or sutures, which can be accessed by patients prior to their appointment. The audit could be repeated at a regional or national level to help centres assess the level of care provided.

Appointment scheduling system in multi doctor/multi services environment

Appointment scheduling systems are used by health care providers to manage access to their services. In this paper an algorithm and a web application for automatic appointment scheduling is presented. Both are implemented using the concept of booking appointments for patients for a specific service offered by each doctor. The purpose of the application is to make signing up for a specific service easier for patients and to improve health tourism in Croatia by maximizing doctor’s efficiency and minimize patient waiting time. Medical providers are added to the system, they add the services which they provide, and each service offered has its own duration time. Users register, search for services matching their parameters, and schedule an appointment for the requested service. Available appointments are generated using the presented algorithm, which is the main part of this paper. The algorithm searches the database and returns possible appointments. If patient has more than one appointment, possible appointments time can be before the existing appointment, between two appointments, or at the end of the last appointment. Thus, web application enables the patient to reserve desirable appointment time.

Application of a Cloud Video Conference Method for Recruiting Healthy Subjects Into an Early-Phase Clinical Trial During the COVID-19 Pandemic

Objective: Our objective is to explore the effect of applying cloud video conferencing methods to the informed consent process in an early-phase clinical trial during the COVID-19 pandemic.Methods: All participants who intended to participate in the trial were informed via a cloud video conference before signing the informed consent forms (ICF). Then, the attitudes of the participants with the cloud video conference and their understanding of the trial were evaluated using a questionnaire when they visited to sign the ICF onsite.Results: A total of 165 subjects participated in the cloud video conference process, and 142 visited the site to sign and date the ICFs at the center during the appointment time. The survey showed that nearly 100% of the subjects evaluated the video-based informed consent process as very good or good and gave correct answers to questions about the trial. Furthermore, 136 (95.8%) subjects believed that the knowledge about the trial derived via the video-based informed consent process was consistent with the onsite reality, and 139 (97.9%) subjects expressed their willingness to participate in an informed consent procedure undertaken through an online video conference.Conclusions: The video-based informed consent process achieved the same effects as an onsite informed consent process. The former saves time and cost of transportation for the subject and exhibits good public acceptance; especially in light of the COVID-19 pandemic, this process is conducive for reducing the risk of subject infection due to travel and would also help avoid crowding on site.