Journal articles on the topic 'Orthopaedic nurse practitioner'
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Taylor, Anita. "A day in the life of orthopaedic and trauma practitioners: Orthopaedic Nurse Practitioner – Hip Fracture." International Journal of Orthopaedic and Trauma Nursing 19, no. 1 (February 2015): 50–51. http://dx.doi.org/10.1016/j.ijotn.2014.11.003.
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Stradling, Helen. "A day in the life of orthopaedic and trauma practitioners: Advanced Nurse Practitioner Sarcoma." International Journal of Orthopaedic and Trauma Nursing 19, no. 4 (November 2015): 222–23. http://dx.doi.org/10.1016/j.ijotn.2015.03.002.
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Gates, Sharon J. "Continuity of Care: The Orthopaedic Nurse Practitioner in Tertiary Care." Orthopaedic Nursing 12, no. 5 (September 1993): 48–50. http://dx.doi.org/10.1097/00006416-199309000-00011.
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Legrand, G., C. Guiguet-Auclair, S. Boisgard, O. Traore, J. P. Lanquetin, H. Viennet, N. Morin, Z. Cardinaud, A. Debost-Legrand, and L. Bernard. "Practice guidelines for intramuscular injection in mental health: A delphi method." European Psychiatry 64, S1 (April 2021): S721. http://dx.doi.org/10.1192/j.eurpsy.2021.1909.
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IntroductionIntramuscular injections (IMI) remain a frequent practice in mental health. The available guidelines for IMI in mental health only focus on the technical side of the practices. Moreover, no recent update has been performed to improve practice of IMI in mental healthObjectivesTo assess a formalized consensus agreement regarding the best practice concerning IMI in mental health and to develop practice guidelines.MethodsA two-round Delphi method was used. The scientific committee consisted in one psychiatrist, one orthopaedic surgeon, one infection control practitioner, one hospital pharmacist, one mental health nurse, one nurse exploring care relationship and one nurse educator. From literature review, each expert proposed specific recommendations. The panel experts were asked to rate the appropriateness and the applicability in current practice of each recommendation on a 9-point Likert scale. Panel members were recruited in five mental health institutions. The first round questionnaire was emailed to each respondent on February 2020 and the second one on June. Propositions were considered appropriate and applicable in current practice if the median was >=7. Agreement among experts were judged by the statistical measure of the Interpercentile RangeResultsFrom the first round, 46 recommendations were retained by 49 nurses. 27 propositions were retained after this second round by 32 nurses. The scientific committee added 12 other recommendations because of their importance in the literature and clinical practice.ConclusionsThis study provides consensus-based recommendations on IMI in mental health. Nursing staff need to be educated about the new guidelines from both the theoretical and clinical perspectivesDisclosureNo significant relationships.
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Lin, Carol, Sonja Rosen, Kathleen Breda, Naomi Tashman, Jeanne T. Black, Jae Lee, Aaron Chiang, and Bradley Rosen. "Implementing a Geriatric Fracture Program in a Mixed Practice Environment Reduces Total Cost and Length of Stay." Geriatric Orthopaedic Surgery & Rehabilitation 12 (January 1, 2021): 215145932098770. http://dx.doi.org/10.1177/2151459320987701.
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Introduction: Geriatric-orthopaedic co-management models can improve patient outcomes. However, prior reports have been at large academic centers with “closed” systems and an inpatient geriatric service. Here we describe a Geriatric Fracture Program (GFP) in a mixed practice “pluralistic” environment that includes employed academic faculty, private practice physicians, and multiple private hospitalist groups. We hypothesized GFP enrollment would reduce length of stay (LOS), time to surgery (TTS), and total hospital costs compared to non-GFP patients. Materials and Methods: A multidisciplinary team was created around a geriatric Nurse Practitioner (NP) and consulting geriatrician. Standardized geriatric focused training programs and electronic tools were developed based on best practice guidelines. Fracture patients >65 years old were prospectively enrolled from July 2018 – June 2019. A trained biostatistician performed all statistical analyses. A p < 0.05 was considered significant. Results: 564 operative and nonoperative fractures in patients over 65 were prospectively followed with 153 (27%) enrolled in the GFP and 411 (73%) admitted to other hospitalists or their primary care provider (non-GFP). Patients enrolled in the GFP had a significantly shorter median LOS of 4 days, compared to 5 days in non-GFP patients (P < 0.001). There was a strong trend towards a shorter median TTS in the GFP group (21.5 hours v 25 hours, p = 0.066). Mean total costs were significantly lower in the GFP group ($25,323 v $29085, p = 0.022) Discussion: Our data shows that a geriatric-orthopaedic co-management model can be successfully implemented without an inpatient geriatric service, utilizing the pre-existing resources in a complex environment. The program can be expanded to include additional groups to improve care for entire geriatric fracture population with significant anticipated cost savings. Conclusions: With close multidisciplinary team work, a successful geriatric-orthopaedic comanagement model for geriatric fractures can be implemented in even a mixed practice environment without an inpatient geriatrics service.
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Coventry, Linda L., Sharon Pickles, Michelle Sin, Amanda Towell, Margaret Giles, Kevin Murray, and Diane E. Twigg. "Impact of the Orthopaedic Nurse Practitioner role on acute hospital length of stay and cost-savings for patients with hip fracture: A retrospective cohort study." Journal of Advanced Nursing 73, no. 11 (June 2, 2017): 2652–63. http://dx.doi.org/10.1111/jan.13330.
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Spence, Brittany G., Joanne Ricci, and Fairleth McCuaig. "Nurse Practitioners in Orthopaedic Surgical Settings." Orthopaedic Nursing 38, no. 1 (2019): 17–24. http://dx.doi.org/10.1097/nor.0000000000000514.
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Zhao, John Z., Eitan M. Ingall, Siddhartha Sharma, Soheil Ashkani-Esfahani, Yuzuru Sakakibara, Anthony Yi, Christopher P. Miller, and John Y. Kwon. "The Lateral Drawer Test: A New Clinical Test to Assess Mortise Instability in Weber B Fibula Fractures." Foot & Ankle Orthopaedics 7, no. 3 (July 2022): 247301142211121. http://dx.doi.org/10.1177/24730114221112101.
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Background: Assessment of mortise stability is paramount in determining appropriate management of ankle fractures. Although instability is readily apparent in bimalleolar or trimalleolar ankle fractures, determination of instability in the isolated Weber B fibula fracture often requires further investigation. Prior authors have demonstrated poor predictive value of physical examination findings such as tenderness, ecchymosis, and swelling with instability. The goal of this study is to test the validity of a new clinical examination maneuver, the lateral drawer test, against the gravity stress view (GSV) in a cohort of patients with Weber B fibula fractures. Secondary goals included assessing pain tolerability of the lateral drawer test, as well as testing interobserver reliability. Methods: Sixty-two patients presenting with isolated fibula fractures were prospectively identified by an orthopaedic nurse practitioner or resident. Three nonweightbearing radiographic views of the ankle as well as a GSV were obtained. Radiographs were not visualized before conducting the lateral drawer test. Two foot and ankle fellowship–trained orthopaedic surgeons performed and graded the lateral drawer test. Radiographs were then examined and medial clear space (MCS) was measured. Visual analog scale (VAS) pain scores were obtained before and after testing. The results of the lateral drawer test were compared with radiographic measurements of MCS on GSV. A cadaveric experiment was devised to assess interobserver reliability of the lateral drawer test. Results: Thirty (48%) of 62 consecutively enrolled patients demonstrated radiographic instability with widening of the MCS ≥5 mm on GSV. When correlated with MCS measurement, the lateral drawer test demonstrated a sensitivity of 83%, specificity of 97%, positive predictive value (PPV) of 96%, and negative predictive value (NPV) of 86%. There was a strong correlation between the lateral drawer test grade and amount of MCS widening (Spearman correlation ρ = 0.82, P < .005). Patients tolerated the maneuver well with an average increase of 0.7 on the VAS pain scale. Testing of 2 observers utilizing the cadaveric model demonstrated a Cohen’s Kappa coefficient of 0.7 indicating moderate interobserver agreement. Conclusion: The lateral drawer test demonstrates high sensitivity, specificity, PPV, and NPV with moderate interobserver reliability compared with the MCS on GSV in patients presenting with Weber B fibula fractures. Although further external validation is required, the lateral drawer test may offer an adjunct tool via physical examination to help determine mortise stability. Level of Evidence: Level II, Prospective Cohort Study.
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Zhao, John Z., Caroline Williams, Kimberly K. Broughton, Christopher P. Miller, and John Y. Kwon. "The Lateral Drawer Test: A Novel Clinical Test to Assess Mortise Instability in Weber B Fibula Fractures." Foot & Ankle Orthopaedics 7, no. 1 (January 2022): 2473011421S0051. http://dx.doi.org/10.1177/2473011421s00515.
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Category: Trauma; Ankle Introduction/Purpose: Assessment of mortise stability is paramount in determining appropriate management of ankle fractures. While instability is readily apparent in bimalleolar or trimalleolar ankle fractures, determination of instability in the apparent isolated Weber B fibula fracture often requires further investigations such as stress radiography. While several authors have previously demonstrated poor predictive value of physical examination findings such as tenderness, ecchymosis and swelling with instability, no previous investigation has examined the ability of a translational test to determine deltoid ligament injury. The goal of this study is to test the validity of a novel clinical test, the lateral drawer test, in determining mortise instability in a cohort of patients with Weber B fibula fractures. Methods: Patients presenting with isolated fibula fractures were prospectively identified by an orthopaedic nurse practitioner or resident. Three views of the ankle as well as gravity stress views (GSV) were obtained. Prior to examining radiographs, two foot & ankle fellowship-trained orthopaedic surgeons (JYK, CPM) performed and graded the lateral drawer test. (Grade 0: no instability/symmetric to contralateral ankle, Grade I: translation < 5mm, Grade II: translation >= 5mm) While the surgeons were made aware of the presence of a Weber B fibula fracture, radiographs were not visualized prior to conducting the drawer test. Medial clear space (MCS) was measured. VAS pain scores were obtained before and after testing. The results of the lateral drawer test results were compared with radiographic measurements of MCS. Results: The study enrolled 57 consecutive patients with Weber B ankle fractures. Twenty-nine (51%) patients demonstrated radiographic instability with widening of the medial clear space >= 5 mm on GSV. When correlated with MCS measurement, the lateral drawer test demonstrated a sensitivity of 83.3%, specificity of 96%, positive predictive value (PPV) of 96% and negative predictive value (NPV) of 84% for determining instability. There was a strong correlation between the lateral drawer test grade and amount of MCS widening (⍴=0.82, p<0.001). Patients tolerated the lateral drawer test well with an average increase of 0.8 points on the VAS pain scale after testing. Conclusion: The lateral drawer test demonstrates high sensitivity, specificity, PPV and NPV for detecting instability in patients presenting with Weber B fibula fractures. While further validation is required in a larger cohort of patients, the lateral drawer test may offer an adjunct tool via physical examination to predict mortise stability.
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Zhao, John Z., Caroline Williams, Kimberly K. Broughton, Christopher P. Miller, and John Y. Kwon. "The Lateral Drawer Test: A Novel Clinical Test to Assess Mortise Instability in Weber B Fibula Fractures." Foot & Ankle Orthopaedics 5, no. 4 (October 1, 2020): 2473011420S0050. http://dx.doi.org/10.1177/2473011420s00505.
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Category: Ankle; Trauma Introduction/Purpose: Assessment of mortise stability is paramount in determining appropriate management of ankle fractures. While instability is readily apparent in bimalleolar or trimalleolar ankle fractures, determination of instability in the apparent isolated Weber B fibula fracture often requires further investigations such as stress radiography. While several authors have previously demonstrated poor predictive value of physical examination findings such as tenderness, ecchymosis and swelling with instability, no previous investigation has examined the ability of a translational test to determine deltoid ligament injury. The goal of this study is to test the validity of a novel clinical test, the lateral drawer test, in determining mortise instability in a cohort of patients with Weber B fibula fractures. Methods: Patients presenting with isolated fibula fractures were prospectively identified by an orthopaedic nurse practitioner or resident. Three views of the ankle as well as gravity stress views (GSV) were obtained. Prior to examining radiographs, two foot & ankle fellowship-trained orthopaedic surgeons (JYK, CPM) performed and graded the lateral drawer test. (Grade 0: no instability/symmetric to contralateral ankle, Grade I: translation < 5mm, Grade II: translation >= 5mm) While the surgeons were made aware of the presence of a Weber B fibula fracture, radiographs were not visualized prior to conducting the drawer test. Medial clear space (MCS) was measured. VAS pain scores were obtained before and after testing. The results of the lateral drawer test results were compared with radiographic measurements of MCS. Results: The study has thus far prospectively enrolled 14 consecutive patients with Weber B ankle fractures. Six (43%) patients demonstrated radiographic instability with widening of the medial clear space >= 5 mm on GSV. When correlated with MCS measurement, the lateral drawer test demonstrated a sensitivity of 83.3%, specificity of 100%, positive predictive value (PPV) of 100% and negative predictive value (NPV) of 88.9% for determining instability. There was a strong correlation between the lateral drawer test grade and amount of MCS widening (⍴=0.82, p=0.0003). Patients tolerated the lateral drawer test well with an average increase of 1.6 on the VAS pain scale after testing. Conclusion: The lateral drawer test demonstrates high sensitivity, specificity, PPV and NPV for detecting instability in patients presenting with Weber B fibula fractures. While further validation is required in a larger cohort of patients, the lateral drawer test may offer an adjunct tool via physical examination to predict mortise stability.
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Switzer, Julie A., and Lisa K. Schroder. "Mobile Outreach: An Innovative Program for Older Orthopedic Patients in Care Facilities." Geriatric Orthopaedic Surgery & Rehabilitation 10 (January 1, 2019): 215145931982647. http://dx.doi.org/10.1177/2151459319826476.
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Introduction: The worldwide incidence of fragility fractures is increasing and the greatest burden is borne by the oldest population. Mobile Outreach, an innovative orthopedic-based program providing on-site musculoskeletal care for individuals in nursing care facilities, was implemented as part of our Geriatric Orthopaedic Trauma Program. The objectives of this report are to describe characteristics of patients cared for through Mobile Outreach and to report specific services provided. Program Description: Based from a nonprofit, private hospital that serves as the community’s level 1 trauma center and teaching hospital, the Mobile Outreach Program is directed by an orthopedic surgeon with geriatric subspecialization and staffed by a full-time geriatric nurse practitioner. Patients receive care for musculoskeletal concerns and fracture assessments at their nursing care facilities by a Mobile Outreach care provider. Referral for care is from nursing care facilities or as scheduled postoperative follow-up. Results: In 2016, the program treated 458 patients (76% female) in the patients’ care settings for a total of 689 visits. The mean age was 81 years (standard deviation = 14; range 25-107). Care of patients included nonoperative fracture care in 100 (22%), postoperative fracture follow-up in 149 (33%), injections for pain management in 184 (40%), and other orthopedic care in 25 (5%). Visits occurred at 88 facilities, mean 7 visits per site (range 1-57). Conclusions: Mobile Outreach was implemented to improve postoperative fracture care in the elderly patients. The program also provides on-site nonoperative fracture care and care of frail elderly individuals with chronic musculoskeletal conditions. This report aims to establish the feasibility of a program focused on the provision of appropriate, coordinated care for older fracture patients in their care facility. Level of Evidence: Level V.
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Kidd, Vasco Deon, and Roderick S. Hooker. "Postgraduate Programs in Orthopaedic Surgery for Physician Assistants and Nurse Practitioners." Orthopaedic Nursing 40, no. 4 (July 2021): 235–39. http://dx.doi.org/10.1097/nor.0000000000000772.
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Gilbert, N., T. Galloway, and R. Green. "Foot care: who cares?" Reviews in Clinical Gerontology 8, no. 3 (August 1998): 197–202. http://dx.doi.org/10.1017/s0959259898008326.
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Foot disorders are common in elderly people and lead to significant difficulties in the form of immobility, pain and gait imbalance. Neuropathic changes associated with systemic disease, such as diabetes, carries the potential for ulcer development leading to possible foot or lower limb amputation. The role of the podiatric surgeon and the podiatrist/chiropodist in the prevention of foot problems in elderly patients is an important and often neglected element of health care for this group. Foot care is at present provided by podiatrists/chiropodists, nurses, orthotists, general practitioners, rheumatologists, geriatricians, casualty specialists, orthopaedic surgeons and podiatric surgeons. Sadly, foot care provision by these professionals is poorly co-ordinated. In most cases this is the result of the general lack of knowledge most professions have about the role of others; however, in at least one instance (orthopaedics), the issue is one of professional rivalry.
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Manning, Blaine T., Daniel D. Bohl, Charles P. Hannon, Michael L. Redondo, David R. Christian, Brian Forsythe, Shane J. Nho, and Bernard R. Bach. "Patient Perspectives of Midlevel Providers in Orthopaedic Sports Medicine." Orthopaedic Journal of Sports Medicine 6, no. 4 (April 1, 2018): 232596711876687. http://dx.doi.org/10.1177/2325967118766873.
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Background: Midlevel providers (eg, nurse practitioners and physician assistants) have been integrated into orthopaedic systems of care in response to the increasing demand for musculoskeletal care. Few studies have examined patient perspectives toward midlevel providers in orthopaedic sports medicine. Purpose: To identify perspectives of orthopaedic sports medicine patients regarding midlevel providers, including optimal scope of practice, reimbursement equity with physicians, and importance of the physician’s midlevel provider to patients when initially selecting a physician. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 690 consecutive new patients of 3 orthopaedic sports medicine physicians were prospectively administered an anonymous questionnaire prior to their first visit. Content included patient perspectives regarding midlevel provider importance in physician selection, optimal scope of practice, and reimbursement equity with physicians. Results: Of the 690 consecutive patients who were administered the survey, 605 (87.7%) responded. Of these, 51.9% were men and 48.1% were women, with a mean age of 40.5 ± 15.7 years. More than half (51.2%) perceived no differences in training levels between physician assistants and nurse practitioners. A majority of patients (62.9%) reported that the physician’s midlevel provider is an important consideration when choosing a new orthopaedic sports medicine physician. Patients had specific preferences regarding which services should be physician provided. Patients also reported specific preferences regarding those services that could be midlevel provided. There lacked a consensus on reimbursement equity for midlevel practitioners and physicians, despite 71.7% of patients responding that the physician provides a higher-quality consultation. Conclusion: As health care becomes value driven and consumer-centric, understanding patient perspectives on midlevel providers will allow orthopaedic sports medicine physicians to optimize efficiency and patient satisfaction. Physicians may consider these data in clinical workforce planning, as patients preferred specific services to be physician or midlevel provided. It may be worthwhile to consider midlevel providers in marketing efforts, given that patients considered the credentials of the physician’s midlevel provider when initially selecting a new physician. Patients lacked consensus regarding reimbursement equity between physicians and midlevel providers, despite responding that the physician provides a higher-quality consultation. Our findings are important for understanding the midlevel workforce as it continues to grow in response to the increasing demand for orthopaedic sports care.
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Harle, Daniel, Shazad Ilyas, Clare Darrah, Keith Tucker, and Simon Donell. "Community-Based Orthopaedic Follow-Up. Is it What Doctors and Patients Want?" Annals of The Royal College of Surgeons of England 91, no. 1 (January 2009): 66–70. http://dx.doi.org/10.1308/003588409x359105.
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INTRODUCTION The objective of this study was to investigate how patients, general practitioners (GPs) and orthopaedic trainees, feel about the proposed governmental changes to reduce orthopaedic out-patient clinics by having GPs and specialist nurses follow-up postoperative orthopaedic patients in the community. SUBJECTS AND METHODS The design was a cross-sectional questionnaire study including a teaching hospital and general practitioners in the Norfolk primary care trust. Participants were 73 orthopaedic postoperative patients who attended out-patients over a 1-week period in July 2007 who all responded. Of 250 GPs, 239 responded. Of 38 orthopaedic trainees at the level of senior house officer (post MRCS) and specialist registrar (Eastern Deanery Rotation and Pott Rotation), 30 responded RESULTS Of the 73 patients, 56 (77%) felt the surgeon was best suited to manage them postoperatively. Of these, 47 felt that it was very important that the surgical team saw them postoperatively. Also, 53 felt that their GP did not have sufficient knowledge and experience to deal with their current orthopaedic problem adequately. Only 12 GPs of 239 (5%) felt very confident assessing postoperative patients. Inadequate resources available to diagnose and treat postoperative complications was noted by 74% as the reason for not performing follow-up in primary care, and only 18% felt they should follow-up postoperative patients. All trainees felt that following up their own postoperative patients was important to their training. Conclusions Most patients, GPs, and orthopaedic trainees had serious doubts about the proposed governmental changes to reduce orthopaedic out-patient clinics by having GPs and specialist nurses follow-up postoperative orthopaedic patients in the community.
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Bryson, DJ, RS Aujla, D. Mahadevan, and SC Williams. "Specialist Orthopaedic Nurses: Frontline for Fracture Clinic Referrals." Bulletin of the Royal College of Surgeons of England 95, no. 9 (October 1, 2013): 1–4. http://dx.doi.org/10.1308/147363513x13690603820261.
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Emergency department (ED) and general practitioner (GP) referrals to orthopaedic fracture clinics are increasing. As a consequence, these clinics regularly operate at or beyond full capacity. In many institutions, all ED referrals are booked into and seen in the fracture clinic within 24 hours of presentation to the ED. A proportion of these appointments will prove unnecessary and, in other cases, review within several days of the injury will prove unnecessarily early. This precipitates lengthy delays, leading to inefficiency and patient dissatisfaction.
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Khajuria, A., R. Shah, H. Gbejuade, and S. Siddiqui. "Increasing Awareness of Compartment Syndrome amongst Orthopaedic Nurses and Trauma Nurse Practitioners at a District General Hospital: A Complete Audit Loop." International Journal of Surgery 47 (November 2017): S86. http://dx.doi.org/10.1016/j.ijsu.2017.08.434.
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Driscoll, John, and Ben Teh. "The potential of reflective practice to develop individual orthopaedic nurse practitioners and their practice." Journal of Orthopaedic Nursing 5, no. 2 (May 2001): 95–103. http://dx.doi.org/10.1054/joon.2001.0150.
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Flynn, Sandra. "A day in the life of orthopaedic and trauma practitioners: Trauma clinical nurse specialist." International Journal of Orthopaedic and Trauma Nursing 18, no. 2 (May 2014): 107–8. http://dx.doi.org/10.1016/j.ijotn.2013.11.006.
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Flynn, Sandra. "A day in the life of orthopaedic and trauma practitioners: Trauma clinical nurse specialist." International Journal of Orthopaedic and Trauma Nursing 18, no. 1 (February 2014): 45–46. http://dx.doi.org/10.1016/j.ijotn.2013.11.007.
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Taylor, Anita, and Lynda Staruchowicz. "The Experience and Effectiveness of Nurse Practitioners in Orthopaedic Settings: A Comprehensive Systematic Review." JBI Library of Systematic Reviews 10, Suppl (2012): 1–22. http://dx.doi.org/10.11124/jbisrir-2012-249.
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Longworth, A., D. Davies, R. Amirfeyz, and G. Bannister. "Notes and Letters in Orthopaedic Surgery Revisited: Can Surgeons Change?" Bulletin of the Royal College of Surgeons of England 92, no. 3 (March 1, 2010): 86–88. http://dx.doi.org/10.1308/147363510x486697.
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Outpatient clinic letters are a widely used and effective means of communication between doctors and nurses. In the literature there was an absence of professional guidelines detailing how outpatient letters should be constructed. A previous study highlighted the importance of effective communication by identifying information deemed important by clinicians and recording it in a structured letter format. General practitioners (GPs) and orthopaedic surgeons perceived diagnosis, treatment, management plan, date of injury, current condition and findings on physical examination to be most important. Nursing staff favoured a clear management plan, particularly any requirement for investigations on arrival at clinic.
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Schoch, Peter A., and Lisa Adair. "Successfully reforming orthopaedic outpatients." Australian Health Review 36, no. 2 (2012): 233. http://dx.doi.org/10.1071/ah11040.
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Since 2005, Barwon Health has successfully reformed its orthopaedic outpatient service to address the following issues: increasing number of referrals, inefficient referral management and triage, long waiting times for non-urgent appointments, high ‘Did Not Attend’ (DNA) rates and poor utilisation of conservative therapies before referral to surgeon. Numerous strategies have been implemented including: waiting list audits, triage guidelines, physiotherapy-led clinics, a DNA policy, an orthopaedic lead nurse role and a patient-focussed booking system. There has been a 66% reduction in the number of patients waiting for their first appointment; an 87% reduction in the waiting time from referral to first appointment; a 10% reduction in new patient DNAs; and more efficient referral management and communication processes. Patients are now seen in clinically appropriate time frames and offered earlier access to a wider range of conservative treatments. What is known about the topic? Demand for public outpatient services continues to increase. New resource and budget availability is limited, so organisations must continually look for ways to utilise existing resources as efficiently and effectively as possible to deliver timely and appropriately patient care. What does this paper add? Further evidence that redesign work that addresses both the administrative and clinical aspects of outpatient services can achieve positive and sustainable outcomes. Alternative models of care such as physiotherapy-led screening clinics, which utilise the skills of a range of health professionals, can supplement traditional medical-led clinics to provide high quality patient care and reduce the workload on consultants. Administrative changes such as patient focussed bookings can be implemented without compromising patient care and may simultaneously reduce the administrative load for the organisation and encourage patients to become more active and responsible participants in their own care. What are the implications for practitioners? Redesign work needs to consider both the clinical and administrative aspects of outpatient care, in order to implement sustainable change that positively affects the patient journey. The effects of change on upstream and downstream providers needs to be considered before changes are made. Transparency of the change of management process is vital, no matter how confronting this may be for stakeholders, to ensure decisions are based on fact, rather than hearsay or historical practice.
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Sadri, Amir, Ian J. Braithwaite, Hani B. Abdul-Jabar, and Khaled M. Sarraf. "Understanding of intra-operative tourniquets amongst orthopaedic surgeons and theatre staff – a questionnaire study." Annals of The Royal College of Surgeons of England 92, no. 3 (April 2010): 243–45. http://dx.doi.org/10.1308/003588410x1251883644060.
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INTRODUCTION Pneumatic tourniquets are used frequently in orthopaedic theatres to provide a bloodless field whilst operating on the extremities. Their use has given rise to complications and preventable damage due to over-pressurisation and prolonged application. We designed a questionnaire to assess the knowledge on tourniquet use among operating department assistants (ODAs) and specialist registrars (SpRs) in orthopaedic surgery. SUBJECTS AND METHODS A questionnaire was constructed using set guidelines from the Association of periOperative Registered Nurses (AORN) for recommended practice of tourniquet application. This was distributed to orthopaedic registrars with varying levels of experience and ODAs from five different NHS hospitals. The unpaired, two tailed t-test was used to test for statistical significance of results. RESULTS A total of 54 completed questionnaires were collected for analysis. The study population included 29 orthopaedic SpRs and 25 ODAs. The mean score for the orthopaedic SpRs as a group was 41.3% (SD 6.85; range, 29.0–54.8%). The mean score for the ODAs was 46.7% (SD 9.64; range, 23.3–62.9%) with a P-value of 0.024. CONCLUSIONS Most surgeons are taught how to use pneumatic tourniquets by their senior colleagues as no formal teaching is given. Most of the complications are infrequent and preventable. However, their consequences can be devastating to the patient with medicolegal implications. Our results show suboptimal knowledge of tourniquets and their use among SpRs and ODAs. This study highlights the need for amendments in training to improve the knowledge and awareness of medical practitioners on the application and use of tourniquets to prevent adverse events and improve patient safety.
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Shah, Roshni, Francesca Garcia, Yashar Deylamipour, and Matthew Edwards. "1739 Improving the management of paediatric angulated upper limb fractures in the emergency department." Emergency Medicine Journal 39, no. 12 (November 22, 2022): A968.2—A969. http://dx.doi.org/10.1136/emermed-2022-rcem2.11.
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BackgroundUpper limb fractures are common to the Paediatric Emergency Department (PED). Most angulated and/or displaced fractures are traditionally referred to the orthopaedic team to admit for manipulation under anaesthesia (MUA). The Emergency Department (ED) believes that their manipulations and associated analgaesia are sub-optimal to those performed/given in theatre. This means a higher number of avoidable overnight paediatric admissions, long waiting times while fasting, and the theoretical risks of general anaesthesia and surgery.AimsReduce the number of hospital admissions for MUA from the PED by managing suitable upper limb fractures safely and appropriately. Encourage long-term changes in clinician readiness to manipulate suitable paediatric injuries.ObjectivesIncrease number of patients identified with upper limb fractures suitable for manipulation in PEDReduce number of patients in this cohort requiring admission to hospital for MUAMethod and DesignA Plan-Do-Study-Act methodology was implemented. Adherence to our local policy was measured, specifically: inclusion/exclusion criteria, modes of analgesia and presence of a senior Orthopaedic doctor.From October 2020 -June 2021, interventions were undertaken: a teaching package for Emergency Nurse Practitioners and doctors, posters placed in the PED, meetings with key stakeholders including the orthopaedic team and the introduction of a new departmental guideline. Data was collected between June 2021–September 2021 to see if results were maintained.Results and ConclusionResultsRate of manipulations in PED increased from 41% to 78% in the 3rd cycle; improving to 86.36% after interventions stopped. Of those manipulated in PED, 73.68% were discharged from the department. Admissions for MUA decreased from 85% to 70% in the 3rd cycle; decreasing to 36.36% after interventions stopped.The project showed success in improving management of paediatric angulated upper limb fractures. By identifying appropriate fractures, involving the senior orthopaedic team and providing adequate analgesia, admission for general anaesthesia can be avoided.
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Lim, JW, H. Rehman, S. Gaba, H. Sargeant, IM Stevenson, and DE Boddie. "Orthopaedic assessment unit: a service model for the delivery of orthopaedic trauma care in a major trauma centre during the global pandemic (COVID-19)." Annals of The Royal College of Surgeons of England 103, no. 3 (March 2021): 167–72. http://dx.doi.org/10.1308/rcsann.2020.7069.
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Introduction We describe a new service model, the Orthopaedic Assessment Unit (OAU), designed to provide care for trauma patients during the COVID-19 pandemic. Patients without COVID-19 symptoms and isolated musculoskeletal injuries were redirected to the OAU. Methods We prospectively reviewed patients throughput during the peak of the global pandemic (7 May 2020 to 7 June 2020) and compared with our historic service provision (7 May 2019 to 7 June 2019). The Mann–Whitney and Fisher Exact tests were used to test the statistical significance of data. Results A total of 1,147 patients were seen, with peak attendances between 11am and 2pm; 96% of all referrals were seen within 4h. The majority of patients were seen by orthopaedic registrars (52%) and nurse practitioners (44%). The majority of patients suffered from sprains and strains (39%), followed by fractures (22%) and wounds (20%); 73% of patients were discharged on the same day, 15% given follow up, 8% underwent surgery and 3% were admitted but did not undergo surgery. Our volume of trauma admissions and theatre cases decreased by 22% and 17%, respectively (p=0.058; 0.139). There was a significant reduction of virtual fracture clinic referrals after reconfiguration of services (p<0.001). Conclusions Rapid implementation of a specialist OAU during a pandemic can provide early definitive trauma care while exceeding national waiting time standards. The fall in trauma attendances was lower than anticipated. The retention of orthopaedic staff in the department to staff the unit and maintain a high standard of care is imperative.
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Knobe, Karin, and Erik Berntorp. "Haemophilia and Joint Disease: Pathophysiology, Evaluation, and Management." Journal of Comorbidity 1, no. 1 (January 2011): 51–59. http://dx.doi.org/10.15256/joc.2011.1.2.
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In patients with haemophilia, regular replacement therapy with clotting factor concentrates (prophylaxis) is effective in preventing recurrent bleeding episodes into joints and muscles. However, despite this success, intra-articular and intramuscular bleeding is still a major clinical manifestation of the disease. Bleeding most commonly occurs in the knees, elbows, and ankles, and is often evident from early childhood. The pathogenesis of haemophilic arthropathy is multifactorial, with changes occurring in the synovium, bone, cartilage, and blood vessels. Recurrent joint bleeding causes synovial proliferation and inflammation (haemophilic synovitis) that contribute to end-stage degeneration (haemophilic arthropathy); with pain and limitation of motion severely affecting patients’ quality of life. If joint bleeding is not treated adequately, it tends to recur, resulting in a vicious cycle that must be broken to prevent the development of chronic synovitis and degenerative arthritis. Effective prevention and management of haemophilic arthropathy includes the use of early, aggressive prophylaxis with factor replacement therapies, as well as elective procedures, including restorative physical therapy, analgesia, aspiration, synovectomy, and orthopaedic surgery. Optimal treatment of patients with haemophilia requires a multidisciplinary team comprising a haematologist, physiotherapist, orthopaedic practitioner, rehabilitation physician, occupational therapist, psychologist, social workers, and nurses.
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Prasad, N., D. Sunderamoorthy, J. Martin, and JM Murray. "Secondary Prevention of Fragility Fractures: Are We Following the Guidelines?" Annals of The Royal College of Surgeons of England 88, no. 5 (September 2006): 470–74. http://dx.doi.org/10.1308/003588406x116891.
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INTRODUCTION The aim of this study was to determine whether orthopaedic surgeons follow the British Orthopaedic Association (BOA) guidelines for secondary prevention of fragility fractures. PATIENTS AND METHODS A retrospective audit was conducted on patients with neck of femur fractures treated in our hospital between October and November 2003. A re-audit was conducted during the period August to October 2004. RESULTS There were 27 patients in the initial study period. Twenty-six patients (96%)had full blood count measured with LFT and bone-profile measured in 18 patients (66%). Only nine patients (30%)had treatment for osteoporosis (calcium and vitamin D). Only one patient was referred for DEXA scan. Steps were taken in the form of creating better awareness among the junior doctors and nurse practitioners of the BOA guidelines. In patients above 80 years of age, it was decided to use abbreviated mental score above 7 as a clinical criteria for DEXA referral. A hospital protocol based on BOA guidelines was made. A re-audit was conducted during the period August to October 2004. There were 37 patients. All had their full blood count and renal profile checked (100%). The bone-profile was measured in 28 (75.7%) and LFT in 34 (91.9%)patients. Twenty-four patients (65%) received treatment in the form of calcium + vitamin D (20) and bisphosphonate (4). DEXA-scan referral was not indicated in 14 patients as 4 were already on bisphosphonates and for 10 patients their abbreviated mental score was less than 7. Among the remaining 23 patients, 9 patients (40%) were referred for DEXA scan. This improvement is statistically significant (P = 0.03, chi square test). DISCUSSION AND CONCLUSIONS The re-audit shows that, although there is an improvement in the situation, we are still below the standards of secondary prevention of fragility fractures with 60% of femoral fragility fracture patients not being referred for DEXA scan. A pathway lead by a fracture liaison nurse dedicated to osteoporotic fracture patients should improve the situation.
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Thakker, Amit, Natasha Briggs, Azusa Maeda, Julie Byrne, John Roderick Davey, and Timothy D. Jackson. "Reducing the rate of post-surgical urinary tract infections in orthopedic patients." BMJ Open Quality 7, no. 2 (April 2018): e000177. http://dx.doi.org/10.1136/bmjoq-2017-000177.
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Urinary tract infection (UTI) is the fourth leading cause of healthcare-associated infections, with approximately 70%–80% being attributed to the inappropriate use of indwelling catheters. In many cases, indwelling catheters are used inappropriately without any valid indication, creating potentially avoidable and significant patient distress, discomfort, pain and activity restrictions, together with substantial care burden, cost and hospitalisation. In the Division of Orthopedic Surgery at Toronto Western Hospital (TWH), we identified UTI rate reduction as a quality improvement priority. Patients who underwent total hip and knee joint replacements and hip fracture repairs at TWH were monitored for the incidence of UTI and the usage of catheters. The data collected as part of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) revealed UTI rate of 2.1% among 666 patients who were treated between January and June 2016. Data collected through a custom field in the ACS NSQIP workstation further revealed that indwelling catheters were overused, with 55.2% of patients receiving indwelling catheters in the same time period. These data were presented to the orthopaedic leadership group and surgeons at TWH in July 2016 to set the quality improvement target and create the working group. Nursing staff was provided education to strictly follow the institutional catheter-associated UTI prevention guidelines and change ideas based on the guidelines were implemented in July 2016. As a result, the rate of UTI decreased to 1.1% and the use of indwelling catheter decreased to 19.8% among 883 patients who were treated between July 2016 and March 2017. The study indicated that a systematic approach, engaging all front-line staff including nurse educators and nurse practitioners, helps to facilitate implementation of practice changes. We expect that ongoing reminders and education ensure that the changes are sustainable.
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Gelfer, Yael, Donato G. Leo, Aisling Russell, Anna Bridgens, Daniel C. Perry, and Deborah M. Eastwood. "The outcomes of idiopathic congenital talipes equinovarus." Bone & Joint Open 3, no. 1 (January 1, 2022): 98–106. http://dx.doi.org/10.1302/2633-1462.31.bjo-2021-0192.r1.
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Aims To identify the minimum set of outcomes that should be collected in clinical practice and reported in research related to the care of children with idiopathic congenital talipes equinovarus (CTEV). Methods A list of outcome measurement tools (OMTs) was obtained from the literature through a systematic review. Further outcomes were collected from patients and families through a questionnaire and interview process. The combined list, as well as the appropriate follow-up timepoint, was rated for importance in a two-round Delphi process that included an international group of orthopaedic surgeons, physiotherapists, nurse practitioners, patients, and families. Outcomes that reached no consensus during the Delphi process were further discussed and scored for inclusion/exclusion in a final consensus meeting involving international stakeholder representatives of practitioners, families, and patient charities. Results In total, 39 OMTs were included from the systematic review. Two additional OMTs were identified from the interviews and questionnaires, and four were added after round one Delphi. Overall, 22 OMTs reached ‘consensus in’ during the Delphi and two reached ‘consensus out’; 21 OMTs reached ‘no consensus’ and were included in the final consensus meeting. In all, 21 participants attended the consensus meeting, including a wide diversity of clubfoot practitioners, parent/patient representative, and an independent chair. A total of 21 outcomes were discussed and voted upon; six were voted ‘in’ and 15 were voted ‘out’. The final COS document includes nine OMTs and two existing outcome scores with a total of 31 outcome parameters to be collected after a minimum follow-up of five years. It incorporates static and dynamic clinical findings, patient-reported outcome measures, and a definition of CTEV relapse. Conclusion We have defined a minimum set of outcomes to draw comparisons between centres and studies in the treatment of CTEV. With the use of these outcomes, we hope to allow more meaningful research and a better clinical management of CTEV. Cite this article: Bone Jt Open 2022;3(1):98–106.
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Caniano, Donna A., and Stanley J. Hamstra. "Program Strengths and Opportunities for Improvement Identified by Residents During ACGME Site Visits in 5 Surgical Specialties." Journal of Graduate Medical Education 8, no. 2 (May 1, 2016): 208–13. http://dx.doi.org/10.4300/jgme-d-15-00322.1.
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ABSTRACT There is limited information about how residents in surgical specialties view program strengths and opportunities for improvement (OFIs).Background This study aggregated surgical residents' perspectives on program strengths and OFIs to determine whether there was agreement in perspectives among residents in 5 surgical specialties.Objective Resident consensus lists of program strengths and areas for improvement were aggregated from site visits reports during 2012 and 2013 for obstetrics and gynecology, orthopaedic surgery, otolaryngology, plastic surgery, and surgery programs. Four trained individuals coded each strength or OFI in 1 of 3 categories: (1) factors common to all specialties; (2) program or institutional resources; and (3) factors unique to surgical specialties. Themes were classified as most frequent when listed by residents in more than 20% of the programs and less frequent when listed by residents in less than 20% of the programs.Methods This study included a total of 359 programs, representing 27% to 49% of the Accreditation Council for Graduate Medical Education accredited programs in the 5 specialties. The most frequent strengths were progressive autonomy, collegiality, program leadership, and operative volume. Improving research and didactics, increasing faculty teaching and attendance at educational sessions, and increasing the number of nurse practitioners and physician assistants were common OFIs.Results Factors identified as important by surgical residents related to their learning environment, their educational program, and program and institutional support. Across programs in the study, similar attributes were listed as both program strengths and OFIs.Conclusions
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Baker, Paul, Lucksy Kottam, Carol Coole, Avril Drummond, Catriona McDaid, and Amar Rangan. "Development of an occupational advice intervention for patients undergoing elective hip and knee replacement: a Delphi study." BMJ Open 10, no. 7 (July 2020): e036191. http://dx.doi.org/10.1136/bmjopen-2019-036191.
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ObjectiveTo obtain consensus on the content and delivery of an occupational advice intervention for patients undergoing primary hip and knee replacement surgery. The primary targets for the intervention were (1) patients, carers and employers through the provision of individualised support and information about returning to work and (2) hospital orthopaedic teams through the development of a framework and materials to enable this support and information to be delivered.DesignModified Delphi study as part of a wider intervention development study (The Occupational advice for Patients undergoing Arthroplasty of the Lower limb (OPAL) study: Health Technology Assessment Reference 15/28/02) (ISRCTN27426982).SettingFive stakeholder groups (patients, employers, orthopaedic surgeons, general practitioners, allied health professionals and nurses) recruited from across the UK.ParticipantsSixty-six participants.MethodsStatements for the Delphi process were developed relating to the content, format, delivery, timing and measurement of an occupational advice intervention. The statements were based on evidence gathered through the OPAL study that was processed using an intervention mapping framework. Intervention content was examined in round 1 and intervention format, delivery, timing and measurement were examined in round 2. In round 3, the developed intervention was presented to the stakeholder groups for comment.ConsensusFor rounds 1 and 2, consensus was defined as 70% agreement or disagreement on a 4-point scale. Statements reaching consensus were ranked according to the distribution of responses to create a hierarchy of agreement. Round 3 comments were used to revise the final version of the developed occupational advice intervention.ResultsConsensus was reached for 36 of 64 round 1 content statements (all agreement). In round 2, 13 questions were carried forward and an additional 81 statements were presented. Of these, 49 reached consensus (44 agreement/5 disagreement). Eleven respondents provided an appraisal of the intervention in round 3.ConclusionsThe Delphi process informed the development of an occupational advice intervention as part of a wider intervention development study. Stakeholder agreement was achieved for a large number of intervention elements encompassing the content, format, delivery and timing of the intervention. The effectiveness and cost-effectiveness of the developed intervention will require evaluation in a randomised controlled trial.Trial registration numberInternational Standard Randomised Controlled Trials Number Trial ID: ISRCTN27426982
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Fernandes, Linda, Kåre B. Hagen, Johannes W. J. Bijlsma, Oyvor Andreassen, Pia Christensen, Philip G. Conaghan, Michael Doherty, et al. "EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis." Annals of the Rheumatic Diseases 72, no. 7 (April 17, 2013): 1125–35. http://dx.doi.org/10.1136/annrheumdis-2012-202745.
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The objective was to develop evidence -based recommendations and a research and educational agenda for the non-pharmacological management of hip and knee osteoarthritis (OA). The multidisciplinary task force comprised 21 experts: nurses, occupational therapists, physiotherapists, rheumatologists, orthopaedic surgeons, general practitioner, psychologist, dietician, clinical epidemiologist and patient representatives. After a preliminary literature review, a first task force meeting and five Delphi rounds, provisional recommendations were formulated in order to perform a systematic review. A literature search of Medline and eight other databases was performed up to February 2012. Evidence was graded in categories I–IV and agreement with the recommendations was determined through scores from 0 (total disagreement) to 10 (total agreement). Eleven evidence-based recommendations for the non-pharmacological core management of hip and knee OA were developed, concerning the following nine topics: assessment, general approach, patient information and education, lifestyle changes, exercise, weight loss, assistive technology and adaptations, footwear and work. The average level of agreement ranged between 8.0 and 9.1. The proposed research agenda included an overall need for more research into non-pharmacological interventions for hip OA, moderators to optimise individualised treatment, healthy lifestyle with economic evaluation and long-term follow-up, and the prevention and reduction of work disability. Proposed educational activities included the required skills to teach, initiate and establish lifestyle changes. The 11 recommendations provide guidance on the delivery of non-pharmacological interventions to people with hip or knee OA. More research and educational activities are needed, particularly in the area of lifestyle changes.
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Snooks, Helen, Jenna Jones, Alan Watkins, and Leigh Keen. "PP32 Pathway to portfolio: from idea to full trial funding." Emergency Medicine Journal 38, no. 9 (August 19, 2021): A13.3—A14. http://dx.doi.org/10.1136/emermed-2021-999.32.
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BackgroundNIHR funding is provided to studies which will produce evidence to inform policy and practice in healthcare. Exploratory or feasibility work can be difficult to find funding for. We present the timeline and steps in the process from first having an idea for research through to gaining funding for a definitive trial.ObjectiveTo determine costs and effects of Fascia Iliaca Compartment Block delivered by paramedics at the scene of injury for suspected hip fracture.MethodsLiterature reviewDevelopment and testing of tool to support identification of hip fracture by paramedicsFeasibility trial (RAPID 1)Proposal for definitive trial (RAPID 2)ResultsFunding was gained from local NHS ‘Pathway to Portfolio’ resources to carry out the first stages of the programme; then a grant was won through the Welsh ‘Research for Patient and Public Benefit’ scheme to undertake a feasibility study. Finally, NIHR HTA funding was awarded to carry out a definitive trial, in five ambulance services.2015 – 16: A systematic review of the literature found that the effectiveness of FICB carried out by paramedics at the scene of injury is unknown, although nurse practitioners have been found to deliver this intervention safely in the Emergency Department.2015 – 16: A tool for identifying hip fracture at the scene of injury was developed by orthopaedic clinicians and tested by ambulance service staff. Sensitivity and positive predictive value were high.2015 – 18: Feasibility trial progression criteria related to methods and intervention safety and acceptability were met.2019 – 20: A full trial proposal was submitted, shortlisted, rejected, amended, resubmitted and funded.2020 – 2025: The RAPID 2 trial is now underway, with paramedic training and patient recruitment due to start in June 2021.ConclusionsResearch funding systems can work to help to progress from idea to full trial, although timescales can be lengthy.
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McGurn, B., J. McDicken, H. McKee, D. Docharty, A. Duffty, M. Bailey, G. McCallum, B. MacInnes, and K. Morrow. "45 Implementing A Frailty at the Front Door Service in the Emergency Department." Age and Ageing 49, Supplement_1 (February 2020): i11—i13. http://dx.doi.org/10.1093/ageing/afz185.08.
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Abstract Background University Hospital Hairmyres is a small District General Hospital in Lanarkshire Scotland. We have an active Care of the Elderly Department with a well-established Acute Care of the Elderly (ACE) team of Advanced Nurse Practitioners, supported by Consultants. This team delivers Comprehensive Geriatric Assessment (CGA) to frail older people in acute medical receiving as well as offering liaison to medical, surgical and orthopaedic wards. Local problem and intervention: Our patients were not always being managed by the correct professionals in a timely manner, leading to delays especially in the Emergency Department (ED). We set up a Frailty at the Front Door (FAFD) service to address this, commencing July 2018. Supported by additional consultant sessions, we re-focused the ACE team on assessing and managing frail patients in the ED. The aim was to get the right patient to the right place at the right time and to manage acutely ill people at home where this was safe. Where admission was required we aimed to admit directly to a specialty bed, bypassing acute receiving wards. Methods We routinely collect important data including number of frail patients, %patients receiving CGA within 24 hours, number of discharges. To assess the impact of our change we analysed the data by plotting on run charts and statistical process control charts. In addition we assessed the effect on referrals from medical specialties and the number of direct-to-specialty admissions. Results After the 22 July 2018 we noticed a significant increase in patients screened for frailty, and a significant increase in discharges. We were able to reliably sustain over 95% of frail patients getting CGA within 24 hrs. There was an increased use of hospital at home. There was a reduction in referrals from medical wards (median = 10/week before, 5/week after intervention). Between August 2018 and May 2019 we were able to admit 163 patients directly to specialty beds. There was no change in re-admission rate. Conclusions We successfully changed our service to have consultant delivered Frailty at the Front Door, assessing more frail patients. Most importantly, we have an improved patient pathway, both managing more people at home but also reducing ward moves by achieving direct to specialty admissions. CGA can be safely delivered in the ED.
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McLeod, Tamara Valovich, Traci Snedden, Eric Post, Tracy Zaslow, Shelly Fetchen-DiCesaro, Denise Mohrbacher, and David Bell. "Pediatric HEALTHCARE Provider Awareness, Confidence, and Use of Sports Specialization Recommendations and Application towards Youth Athlete Counseling." Orthopaedic Journal of Sports Medicine 9, no. 7_suppl3 (July 1, 2021): 2325967121S0014. http://dx.doi.org/10.1177/2325967121s00149.
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Background: Sport specialization is increasingly common in many youth sports and has been linked to increased injury, overtraining, and burnout. Several organizations have developed safe sport recommendations in an effort to mitigate injury risk. Healthcare providers (HCPs) can be a source of education for parents and athletes on safe sports practices, but the awareness, confidence, and use of these recommendations among HCPs who work with youth athletes is limited. Hypothesis/Purpose: To evaluate the awareness, confidence, and use of sports specialization and safe sport recommendations of HCPs who work with pediatric athletes. Methods: A cross-sectional online survey was developed to assess pediatric HCP awareness of, confidence in, and clinical use of sports specialization recommendations. The survey included 1) personal demographics, 2) professional demographics, 3) knowledge and perceptions of sport specialization, 4) awareness, confidence, and use of recommendations, and 5) HCP program training and professional development background specific to sports specialization. Survey links were sent by email to 5000 secondary school athletic trainers and 297 PRiSM members during October 2019-January 2020. The survey was open for 4 weeks, with a reminder email sent after 2 weeks. Data was analyzed with descriptive statistics. Results: The survey was accessed by 620 HCPs (access rate=11.7%) and completed by 508 HCPs (completion rate=81.9%). Respondents (279 females, 228 males; age=37.2±10.5 years) included athletic trainers (74.5%, n=379), physicians (16.9%, n=86, physical therapists (6.7%, n=35), nurse practitioners (1.0%, n=5), and physician assistants (0.1%, n=4) with 11.2±9.1 years of experience providing care to pediatric athletes. Three-fourths of respondents (n=373) were aware of recommendations from the National Athletic Trainers’ Association, but fewer were aware of those from the American Academic of Pediatrics (42.3%, n=212), American Medical Society for Sports Medicine (40.3%, n=200), American Orthopaedic Society for Sports Medicine (45.2%, n=225), International Olympic Committee (14.2%, n=69), Major League Baseball (30.6%, n=151), USA Hockey (13.6%, n=66), and National Basketball League (9.3%, n=45). The percentage of respondents who were confident in knowledge of (Table 1) and used (Table 2) each organization’s recommendation are provided in the tables. Table 3 presents the degree to which various reasons limit the use of sports specialization recommendations. Conclusion: Healthcare providers are aware of sport specialization recommendations and believe they are associated with decreased risk of injury. However, barriers to applying the recommendations most cited were the inability of parents and children to change specialization behaviors. Future research should focus on implementation of recommendations to enact behavior change. Tables [Table: see text][Table: see text][Table: see text]
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Drover, Anne. "Which Clinical Exam findings are most predictive of an abnormal hip ultrasound in the newborn? A chart review from a Canadian pediatric hospital." Paediatrics & Child Health 23, suppl_1 (May 18, 2018): e42-e42. http://dx.doi.org/10.1093/pch/pxy054.109.
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Abstract BACKGROUND Developmental dysplasia of the hips is a condition that if not detected early and managed properly can lead to lifelong morbidity. The incidence of DDH in most developed countries is reported to be 1.5 to 20 cases per 1000 births. The Canadian Task Force on Preventive Health Care reports fair evidence to include a serial clinical examination of the hips by a trained clinician in the periodic health examination of all infants until they are walking independently. The indications for ultrasound examination are less clear. Guidelines for the clinical exam cite indications of imaging to be unstable hip, hip laxity, hip click and asymmetric skin folds. Given that some of these findings are extremely common it is likely that a large number of normal hips are being imaged unnecessarily. OBJECTIVES The purpose of this project is to determine which clinical findings are most predictive of an abnormal hip on ultrasound. It is hoped that this will assist the paediatrician or family doctor to balance unnecessary testing with the fear of missing an abnormal hip. DESIGN/METHODS All hip ultrasounds performed at a Canadian children’s hospital during 2016/17 on infants less than one year were reviewed for indication and outcome. The birth rate for the same year was 2,861. A total of 528 hip ultrasounds were performed. 156 ultrasounds were ordered by Paediatric Orthopaedic specialists and thus were not reviewed, leaving 372 ultrasounds for review. Ultrasounds were classified by age category at the time of imaging: <14 days, 14–28 days, 29–60 days, 61 days-6 months, 6 months-1 year. Tests were ordered by paediatricians, neonatologists, family doctors and nurse practitioners. The indications for ultrasound were categorized into 9 categories; hip click, hip laxity, unstable hip (positive Barlow, dislocatable hip), asymmetric skin folds, breech presentation, family history of DDH, hip click + breech, hip laxity + breech, or no indication given. When multiple terms were noted on requisition a hierarchy was followed with hip laxity>hip click>asymmetric skin folds. Ultrasound reports reported as normal or abnormal. RESULTS The primary indication for hip ultrasound was asymmetric skin folds, (N-132); followed by Hip laxity (N-101), Hip click (N-72), Unstable hip (positive Barlow, dislocatable hip) (N-31), no indication noted (N-23), Breech presentation (N-8), Family History of DDH (N-3) and other (N-2). The ultrasound findings with asymmetric skin folds revealed 100% of tests were normal (132/132) on first ultrasound regardless of baby’s age at imaging. For Hip laxity, 93% (94/101) ultrasounds were normal following second ultrasound and for hip click, 99% (71/72) were normal following second ultrasound. For those ultrasounds that were performed for hip click and hip laxity (N-173), only one ultrasound would have been required if performed at greater than 8 weeks of age. In the unstable hip, 82% (28/34) were normal following second ultrasound. None of the ultrasounds performed for risk factors such as family history or breech presentation were abnormal but when combined with a lax hip exam 3 were reported as abnormal. In our study, a diagnosis of DDH was given to 15/2,861 newborns. Of these 15; the clinical finding was 7/16 hip laxity alone, 6/16 unstable hip, 3/16 hip laxity + breech. CONCLUSION Though practitioners must continue to be vigilent in clinical hip surveillance, symmetric skin folds and isolated hip click are low yield indications for hip ultrasound in the newborn. For hip laxity or unstable hip, waiting until 8 weeks improves the reliability of the ultrasound result and thus reducing unnecessary retesting. The breech presentation alone did not increase diagnosis but when combined with exam was predictive.
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De la Torre-Aboki, J., I. Pitsillidou, J. Uson Jaeger, E. Naredo, L. Terslev, M. Boesen, H. Pandit, et al. "AB1362-HPR COMMON PRACTICE IN DELIVERY OF INTRA-ARTICULAR THERAPIES IN RMDS BY HEALTH PROFESSIONALS: RESULTS FROM A EUROPEAN SURVEY." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1968.2–1968. http://dx.doi.org/10.1136/annrheumdis-2020-eular.96.
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Background:Intra-articular therapies (IAT) are routinely used in rheumatic and musculoskeletal diseases (RMDs); however large variability exists regarding current practice of delivery amongst health professionals.Objectives:To inquire about common practice aspects to inform the EULAR Taskforce for the IAT of arthropathies.Methods:A steering committee prepared a 160-item questionnaire based on the information needs of the Taskforce. The survey was disseminated via EULAR professional associations and social media and it was open to any health professional treating persons with RMDs, regardless of using IAT personally.Results:The survey was answered by 186 health professionals from 26 countries, the large majority of whom (77%) were rheumatologists, followed by nurses (12%), general practitioners (2%) and orthopaedic surgeons (2%). The two collectives that perform IAT routinely are rheumatologists (97%) and orthopaedic surgeons (89%), with other professionals <50%. Specific training was compulsory for 32%. The most frequent indication for IAT is inflammatory arthritis (76%), followed by osteoarthritis (74%), crystal arthritis (71%) and bursitis (70%); and all joints are injected, with knee (78%) and shoulder (70%) being the most frequent. When questioned about specific contexts, such as pre-surgical, diabetic or hypertensive patients, variability among respondents was evident, with around 30 to 69% of professionals considering it acceptable to inject glucocorticoids (GC), while in others there was less variability (prosthetic or septic joints, <1%). GCs are the most used compounds, followed by hyaluronic acid and saline/dry puncture. Only 66 (36%) use ultrasound to guide IAT. In their opinion, to be accurately in the joint is moderately to largely important for large joints (80%) and very important in small joints. The maximum number of injections to perform safely in the same joint within one year was “2 to 3” for 65% (2% thought there is “No limit”). The majority reported that they informed patients about side-effects (73%), benefits (72%), and the nature of the procedure (72%), and less frequently about other aspects; with 10% obtaining written consent and 56% oral consent (mandatory only for 32%). Other questions help to understand the setting and procedures followed, including use of local anaesthetics and care after injection.Conclusion:Although often performed in clinical practice for RMDs, there is apparent variability in several elements related to delivery of this treatment. This information, together with patient input, will help design current recommendations where research evidence is not available.Acknowledgments:Eular Taskforce grant CL109Disclosure of Interests:Jenny de la Torre-Aboki: None declared, IRENE Pitsillidou: None declared, Jacqueline Uson Jaeger: None declared, Esperanza Naredo: None declared, Lene Terslev: None declared, Mikael Boesen Consultant of: AbbVie, AstraZeneca, Eli Lilly, Esaote, Glenmark, Novartis, Pfizer, UCB, Paid instructor for: IAG, Image Analysis Group, AbbVie, Eli Lilly, AstraZeneca, esaote, Glenmark, Novartis, Pfizer, UCB (scientific advisor)., Speakers bureau: Eli Lilly, Esaote, Novartis, Pfizer, UCB, Hemant Pandit Grant/research support from: Glaxo Smith Kline (GSK) for work on Diclofenac Gel, Speakers bureau: Bristol Myers Squibb for teaching their employees about hip and knee replacement, Ingrid Möller: None declared, Maria Antonietta D’Agostino Consultant of: AbbVie, BMS, Novartis, and Roche, Speakers bureau: AbbVie, BMS, Novartis, and Roche, Willm Uwe Kampen: None declared, Terence O’Neill: None declared, Michael Doherty Grant/research support from: AstraZeneca funded the Nottingham Sons of Gout study, Consultant of: Advisory borads on gout for Grunenthal and Mallinckrodt, Francis Berenbaum Grant/research support from: TRB Chemedica (through institution), MSD (through institution), Pfizer (through institution), Consultant of: Novartis, MSD, Pfizer, Lilly, UCB, Abbvie, Roche, Servier, Sanofi-Aventis, Flexion Therapeutics, Expanscience, GSK, Biogen, Nordic, Sandoz, Regeneron, Gilead, Bone Therapeutics, Regulaxis, Peptinov, 4P Pharma, Paid instructor for: Sandoz, Speakers bureau: Novartis, MSD, Pfizer, Lilly, UCB, Abbvie, Roche, Servier, Sanofi-Aventis, Flexion Therapeutics, Expanscience, GSK, Biogen, Nordic, Sandoz, Regeneron, Gilead, Sandoz, Valentina Vardanyan: None declared, Elena Nikiphorou: None declared, Sebastian C Rodriguez-García Speakers bureau: Novartis Farmaceutica, S.A., Merck Sharp & Dohme España, S.A., Sanofi Aventis, UCB Pharma, Raul Castellanos-Moreira: None declared, Loreto Carmona Grant/research support from: Novartis Farmaceutica, SA, Pfizer, S.L.U., Merck Sharp & Dohme España, S.A., Roche Farma, S.A, Sanofi Aventis, AbbVie Spain, S.L.U., and Laboratorios Gebro Pharma, SA (All trhough institution)
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O’Rourke, Naomi. "The Orthopaedic Nurse Practitioner: breaking tradition to fill gaps in care delivery through varied scopes of practice." International Journal of Orthopaedic and Trauma Nursing, December 2020, 100843. http://dx.doi.org/10.1016/j.ijotn.2020.100843.
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Thomas, N., A. Stankard, N. Cosgrave, B. Conlon, P. Monahan, T. Halpin, D. Britton, et al. "92 CONTINUING TO ‘BE HIP’: ORTHOGERIATRIC SERVICE IMPROVEMENTS IN 2021." Age and Ageing 51, Supplement_3 (October 25, 2022). http://dx.doi.org/10.1093/ageing/afac218.076.
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Abstract Background Scotland first demonstrated that adherence to nationally agreed hip fracture standards improve patient survival, reduces the duration of admission, and reduces the need for high dependency care. Our study aims to assess adherence to the Irish Hip Fracture Standards (IHFS) in our hospital for 2021 amidst the COVID-19 pandemic, translating to improved clinical outcomes for our patients. Methods The IHF database was retrospectively analysed, comparing quarters 1-4 in 2021 with our 2020 results. Results IHFS1, patient time to the ward < 4hours, was maintained at 67% in 2021 versus 71% overall in 2020. There was improvement in IHFS2, time to surgery within 48 hours, up to 73% in 2021 versus 66% in 2020. IHFS3 was 4% in 2021 versus 3% overall in 2020. Further improvements were noted for IHFS4, with 95% of patients reviewed by a Geriatrician in 2021 versus 87% in 2020. IHFS5 also improved with 97% of patients receiving a bone health assessment in 2021 versus 87% in 2020. Moreover, IHFS6, improved with 97% of patients undergoing a specialised falls assessment in 2021 versus 87% in 2020. Conclusion The improvement in 2021 figures is reflective of the return of redeployed services during the COVID-19 pandemic inclusive of the Orthogeriatric Service, the Fracture Liaison Service Advanced Nurse Practitioner, the Trauma Co-ordinator, and the specialist Orthopaedic ward complete with its Orthopaedic nurses and Multi-Disciplinary Team, and improved Emergency Department pathways. These continued improvements in the IHFS further emphasise that success is dependent on a team that is joined at the hip
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Noonan, C., S. Coveney, T. Coughlan, and S. Kennelly. "334 FASTTRAX - A FRACTURE RESPONSE SERVICE FOR NURSING HOME RESIDENTS." Age and Ageing 51, Supplement_3 (October 25, 2022). http://dx.doi.org/10.1093/ageing/afac218.292.
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Abstract Background Nursing Home Residents (NHR) are the frailest group of older people and require a gerontologically attuned approach to care. The new FastTrax fracture response service has been developed as a result of a Quality Improvement (QI) project to evaluate the need for this service. The data leading to the development of this pathway is presented here. FastTraX ensures NHR receive optimal orthopaedic and gerontological care without necessity for emergency department (ED) presentation. Methods A retrospective, medical chart review was completed on all NHRs who presented over12-months to a level-4 hospital ED following a fall/injury. Included patients were nursing home residents with suspected fracture discussed with the on-call orthopaedic service. Patients who required more complex imaging other than plain film or with known/suspected head trauma were excluded. Data collected included demographics, clinical and imaging details, and care outcomes. Results In 2021, there were sixty-nine (mean age 80.3, 82.6% female) NHR presentations to the ED with fracture/ injury where orthopaedic opinion was sought following x-ray. Just-under half, 49.2 % (34/69) of patients were admitted, all of whom had confirmed fractures. However, 32.3% (11/34) of admitted NHRs were conservatively treated with an average length-of-stay of 3.6 days before discharge to NH. 6/34 (17.6%) of admitted NHRs died, and 5 of those deaths occurred post-operatively. Of the 50.7% (35/69) discharged directly back to NH from ED, 45.7% (16/35) of those had no fracture, whereas 54.2% (19/35) were discharged for conservative management. Therefore, potentially only 29/69 (33%) ED presentations required definitive orthopaedic/gerontological intervention necessitating admission and two-thirds are potentially avoidable. Conclusion The new FastTraX fracture response service is an Advanced-Nurse Practitioner (rANP) co-ordinated integrated service combining use of on-site mobile radiological diagnostics in the NH, a fast-track ambulatory orthopaedic-consult clinic, and specialist gerontological care delivered in timely response to support NH staff in avoiding ED transfer where appropriate.
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Batty, Jane. "An evaluation of the role of the advanced nurse practitioner on an elective orthopaedic ward from the perspective of the multidisciplinary team." International Journal of Orthopaedic and Trauma Nursing, October 2020, 100821. http://dx.doi.org/10.1016/j.ijotn.2020.100821.
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Stankard, A., N. Thomas, N. Cosgrave, B. Conlon, P. Monaghan, T. Halpin, D. English, et al. "258 RISING TO THE CHALLENGE: ORTHOGERIATRIC SERVICE IMPROVEMENT AND COVID-19." Age and Ageing 51, Supplement_3 (October 25, 2022). http://dx.doi.org/10.1093/ageing/afac218.227.
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Abstract Background Nationally agreed hip fracture standards have contributed to the improvement of outcomes in hip fracture patients. In 2020, our hospital was awarded “The Golden Hip” for achieving highest compliance with Irish Hip Fracture Standards (IHFS) nationally for 2019. Methods Data from the Irish Hip Fracture Database (IHFD)was retrospectively analysed to assess our performance in 2020 versus 2019 in hip fracture patients over sixty. Multiple quality improvement interventions were put in place throughout 2019 to ensure improvement in IHFS1-6 compliance: Creation of the Hip Fracture Pathway Subgroup, IHFS 1 Breaches Audit, Orthogeriatric input at Orthopaedic inductions, weekly Multi-disciplinary Team meetings, a Nutritional Hip Fracture Pathway and addition of the Fracture Liaison Service Advanced Nurse Practitioner. Results There were 239 hip fracture patients in 2020 vs 249 in 2019. IHFS1 compliance improved with the percentage of patients admitted to the Orthopaedic ward within 4 hours increasing to 71% in 2020 from 56% in 2019. There was improvement in IHFS2-time to surgery <48 hours- 66% in 2020 vs 60% in 2019. IHFS3-pressure ulcer rate-was at the national average, 3% in 2020 vs 2% in 2019. IHFS4 (reviewed by a Geriatrician), IHFS5 (received a bone health assessment) and IHFS6 (received a specialised falls assessment) were lower overall; 87% in 2020 vs 98% in 2019. For all quarters (Q),43% of patients met all IHFS in our hospital in 2020 vs 32% in 2019, resulting in €90,000 in Best Practice Tariff funding. Conclusion Lower results for IHFS 4,5 and 6 reflect the arrival of the COVID-19 pandemic which led to redeployment of the Orthogeriatric Service and redeployment of the MDT from end of Q1 to Q3. When services in 2020 were preserved,1 in 2 hip fracture patients met all IHFS, vs 1 in 3 patients in 2019. Despite the pandemic, we continued to achieve the highest level of IHFS compliance nationally, being awarded a second consecutive “Golden Hip” for 2020.
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Rapley, Tim, Carl May, Nicola Smith, and Helen E. Foster. "‘Snakes & Ladders’: factors influencing access to appropriate care for children and young people with suspected juvenile idiopathic arthritis – a qualitative study." Pediatric Rheumatology 19, no. 1 (March 23, 2021). http://dx.doi.org/10.1186/s12969-021-00531-3.
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Abstract Background Many children and young people with juvenile idiopathic arthritis (JIA) experience delay in diagnosis and access to right care. The reasons for delay are multi-factorial and influenced by patient and family, clinician and organisational factors. Our aim was to explore the experiences of care, from initial symptoms to initial referral to paediatric rheumatology. Methods We analysed one-to-one and joint qualitative interviews with families of children with JIA (n = 36) presenting to a regional paediatric rheumatology service in the UK. We interviewed 51 family members (including mothers, fathers, patients, grandmothers and an aunt) and 10 health professionals (including orthopaedic surgeons, paediatricians, paediatric immunologist, General Practitioner and nurse) and a teacher involved in the care pathway of these JIA patients. Interviews were audio-recorded and analysed according to the standard procedures of rigorous qualitative analysis - coding, constant comparison, memoing and deviant case analysis. Results The median age of the children was 6 years old (range 1–17), with a spread of JIA subtypes. The median reported time to first PRh MDT visit from symptom onset was 22 weeks (range 4-364 weeks). Three key factors emerged in the pathways to appropriate care: (i) the persistence of symptoms (e.g. ‘change’ such as limp or avoidance of previously enjoyed activities); (ii) the persistence of parents help-seeking actions (e.g. repeat visits to primary and hospital care with concern that their child is not ‘normal’; iii) the experience and skills of health professionals resulting in different trajectories (e.g. no-real-concern-at-this-point or further-investigation-is-required). JIA was more likely to be considered amongst health practitioner if they had prior experiences of a child with JIA (moreso with a ‘protracted pathway’) or exposure to paediatric rheumatology in their training. Conversely JIA was more likely to be overlooked if the child had comorbidity such as learning disability or a chronic illness. Conclusions Care pathways are often ‘turbulent’ prior to a diagnosis of JIA with physical and emotional distress for families. There is need for greater awareness about JIA amongst health care professionals and observations of change (from family and non-health care professionals such as teachers) are key to trigger referral for paediatric rheumatology opinion.
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Sambhwani, S., M. Baba, D. Hirschowitz, S. Shrestha, and H. Khairandish. "905 Improving Confidence in Plastering Across Specialties: A Hands-on Approach." British Journal of Surgery 109, Supplement_6 (August 19, 2022). http://dx.doi.org/10.1093/bjs/znac269.481.
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Abstract Aim Plaster of Paris casts form one the most basic yet effective treatment for acute orthopaedic fractures and often form a permanent treatment methodology. Patients with fractures present at all times of the day to acute services and require prompt stabilisation. Casts however do present some risks including compartment syndrome and skin ulcerations. Our quality improvement aimed to improve confidence in healthcare providers across different specialities in managing plasters. Method Focussed workshops conducted by expert plaster technicians under the supervision of an experienced orthopaedic consultant were conducted for upper and lower limb injuries. Additional workshops encompassing plaster safety and other trauma splints were delivered. Candidates ranged across different grades and included nurse practitioners and qualified doctors. Confidence scores (out of five) measured on a Likert scale were obtained from 25 participants. Results Knowledge about plasters including type of plaster matched to injury improved from a mean score of 3 to 4.5. Confidence in applying upper limb plasters improved from a mean score 3 to 4.7 and applying lower limb plasters improved from a mean score of 3.25 to 4.8. Confidence in plaster safety including acute conditions and safe removal improved from a mean score of 2 to 4.6. Confidence in applying acute splints improved from a mean score of 1.5 to 4.3. Conclusions Our quality improvement project improve the confidence in practitioners managing acute orthopaedic patients with an emphasis on plaster safety and acute splints. It has been formally adopted on a regular basis as a teaching program.
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Hassan, Sami, Abdul Aziz, Nicholas D. Downing, and Ryan W. Trickett. "Sensitivity and Specificity of Radiographs in the Diagnosis of Little and/or Ring Carpometacarpal Joint Injuries." Journal of Hand and Microsurgery, April 9, 2020. http://dx.doi.org/10.1055/s-0040-1709213.
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Abstract Introduction Little and ring finger carpometacarpal joints (CMCJs) injuries are commonly missed due to misinterpretation of radiographs. We aimed to determine the sensitivity and specificity of four different radiographic views. Materials and Methods Radiographs (posteroanterior [PA], lateral [LAT], pronated oblique [POL], and supinated oblique [SOL] views) showing normal findings or little/ring finger CMCJ injuries were shown to two cohorts of orthopaedic trainees and a cohort of emergency nurse practitioners. Results The POL view performed best in all three testing scenarios. The SOL view performed least well. The combination of a PA, true LAT, and POL identified 78% of injuries correctly. In no cases did the SOL view correctly identify an injury when the other three views had been interpreted as normal. Conclusion We recommend a combination of the PA, POL, and LAT views in diagnosing these injuries. Where doubt remains, cross-sectional imaging is essential.
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Ellerton, Laura, Ryan Kelly, Fatemeh Keshtkar, Simon Mercer, and Tim Parr. "82 Surgeons Don’t Just Operate: Improving Junior Surgical Practitioners’ Non-Technical Skills Outside of the Operating Theatre Using High-Fidelity Simulation." International Journal of Healthcare Simulation, December 23, 2021. http://dx.doi.org/10.54531/keyw7406.
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The non-technical skills of surgeons play a significant role in patient confidence, experience and safety The aim of the study was to improve non-technical skills and confidence of junior surgical practitioners regarding DNACPR conversations and obtaining operative consent.We have developed a speciality-specific course to address the educational deficit surrounding non-technical skills outside of the operating theatre, focussing on DNACPR and consent, for junior surgical practitioners. It was piloted at Aintree University Hospital with their Orthopaedic Department. We combined lectures and workshops delivered by subject matter specialists with simulated scenarios. The simulated scenarios were debriefed by human factors specialists using the gold standard validated NOTSS tool The pilot course in June was a resounding success; candidate confidence scores increased significantly across both skills and knowledge surrounding capacity, consent and DNACPR. All attending candidates have recommended the course to their peers and suggested integration into the Foundation training curriculum. However, identifying and implementing courses appropriate for all foundation doctors with such a specialized course would be challenging. Most foundation doctors have at least one placement in a surgical specialty. Therefore, it is more realistic to adjust the course to become less specialized, encompassing all the surgical specialities, to target all foundation doctors initially instead of juniors in each speciality. Following the capture of foundation doctors, the second phase of implementation will return to speciality-specific courses to address the learning needs of non-medical practitioners, such as Physician Associates and Advanced Nurse Practitioners, working in surgical departments.
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Fuggle, Nicholas R., Andrea Singer, Nicholas Harvey, Jean-Yves Reginster, Cyrus Cooper, and Susan Greenspan. "P113 How has COVID-19 affected the treatment of osteoporosis? The answers from a global survey." Rheumatology 60, Supplement_1 (April 1, 2021). http://dx.doi.org/10.1093/rheumatology/keab247.109.
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Abstract Background/Aims The COVID-19 pandemic has had profound effects on the health of the global population both directly, via the sequelae of the infection, and indirectly, including the relative neglect of chronic disease management. Together the International Osteoporosis Federation and National Osteoporosis Foundation sought to ascertain the impact on osteoporosis management. Methods Questionnaires were electronically circulated to a sample of members of both learned bodies and included information regarding the location and specialty of respondents, current extent of face to face consultations, alterations in osteoporosis risk assessment, telemedicine experience, alterations to medication ascertainment and delivery, and electronic health record (EHR) utilisation. Responses were collected, quantitative data analysed, and qualitative data assessed for recurring themes. Results Responses were received from 209 healthcare workers from 53 countries, including 28% from Europe, 24% from North America, 19% from the Asia Pacific region, 17% from the Middle East, and 12% from Latin America. Most respondents were physicians (85%) with physician assistants, physical therapists and nurses/nurse practitioners represented in the sample. The main three specialties represented included rheumatology (40%), endocrinology (22%) and orthopaedics (15%).In terms of the type of patient contact, 33% of respondents conducted telephone consultations and 21% video consultations. Bone mineral density assessment by dual-energy x-ray absorptiometry (DXA) usage was affected with only 29% able to obtain a scan as recommended. The majority of clinicians (60%) had systems in place to identify patients receiving subcutaneous or intravenous medication, and 43% of clinicians reported difficulty in arranging appropriate osteoporosis medications during the COVID-19 crisis. Conclusion To conclude through surveying a global sample of osteoporosis healthcare professionals, we have observed an increase in telemedicine consultations, delays in DXA scanning, interrupted supply of medications and reductions in intravenous medication delivery. Disclosure N.R. Fuggle: None. A. Singer: None. N. Harvey: None. J. Reginster: None. C. Cooper: None. S. Greenspan: None.
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Silva, L. B., K. A. A. Gouvea, C. R. A. Oliveira, M. A. Percope, A. L. P. Ribeiro, J. A. Q. Oliveira, and M. S. Marcolino. "Remote orthopaedic consultations for primary care patients by a large-scale telemedicine service." European Journal of Public Health 30, Supplement_5 (September 1, 2020). http://dx.doi.org/10.1093/eurpub/ckaa166.075.
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Abstract Backgrounds Telemedicine was implemented in Brazil to support primary care practitioners. As orthopedic complaints are frequent in primary health care (PHC), this study aimed to analyze the profile of orthopedic teleconsultations requested by PHC health professionals. Methods This observational, transversal study analyzed consecutive orthopedic teleconsultations from March/17 to July/19. Teleconsultations were classified as: character (educational or assistance), focus of the doubt (diagnosis, treatment or rehabilitation) and the location of involvement (muscle, bone, joint). Sex of the patients, professional category of the professionals who requested and the ones who responded teleconsultations, and Human Development Indexes (HDI) of the cities were accessed. Results Throughout the study, 415 teleconsultations were accessed from 112 municipalities with an HDI average of 0.651. The professionals who requested most of the teleconsultations were nurses (47%) and physicians (35%) and the ones who answered were mostly internal medicine physicians (61%) and orthopedists (34%). Most doubts were related to assistance of a specific patient (66%). Of those, the majority were female (59%). In 68% of the teleconsultations, there was a request for assistance in patient treatment, 38% for diagnosis and 25% for rehabilitation. Doubts were more often related to bones (46%) and joints (24%). Of those who specified the complaint, 17% were about general pain,14% low back pain and 4% fracture. The main subspecialties were spine (23%), foot (19%) and knee (11%). In 9% of cases, there was an indication for referral for in-person orthopaedic consultation. Conclusions Teleconsultation helps to identify the most frequent doubts in PHC. Most of those were solved in PHC with no need for referral, what evidenced the great potential of using teleconsultations in clinical practice, as a useful tool to qualify the referral to the specialist. Key messages Importance of telehealth tools for a public health system, especially for a country where the distance is a barrier to access healthcare services. Teleconsultation have been proven to be an effective strategy to qualify the referral to the specialist.
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Gotting, Laura M. "P84 Implementation of advanced practice rheumatology clinics." Rheumatology 59, Supplement_2 (April 1, 2020). http://dx.doi.org/10.1093/rheumatology/keaa111.082.
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Abstract Background Ashford and St Peters NHS Trust implement an iMSK Service with an aim to deliver biopsychosocial assessment and care across Orthopaedics, Pain and Rheumatology settings. Our impression was the Rheumatology Service could be assisted by the implementation of Advanced Clinical Practitioners Clinics considering the benefits that had been offered to Orthopaedic and Pain Services. The Rheumatology Service had high waiting times to see a Consultant, were understaffed in relation to national recommended ratio of Consultant to catchment population and were motivated to promote a biopsychosocial approach to patient care. There were poor links between Rheumatology and the MSK Triage Service as well as the Physiotherapy Service which were recognised as areas for improvement and integration for both patient and staff. The plan was to improve the efficiency of pathway into Rheumatology, reduce unnecessary contacts for the patient and offer best practice advice at first contact. An aim to reduce non-inflammatory referrals to consultants, in turn reducing overall waiting times for inflammatory presentations. Methods We researched and benchmarked against existing services, learning from experiences and various models of implementation. We audited our MSK triage process, to include numbers of referrals into the Rheumatology Service. We developed an ACP Triage Criteria as a multi-disciplinary team to highlight our skillset and best fit to the service needs. We observed the existing MDT in clinic to include consultant and nurse specialists as well as undertaking injection, bloods and radiology training. We collaborated with the service managers to implement ACP clinics for the assessment of non-inflammatory presentations and widespread pain. We are collecting PREM data with the 'CARE' patient satisfaction questionnaire, as well as clinical outcome data collection to include the Widespread Pain Index, Symptom Severity Score and evaluation of patient onward referral destination and management plan. Results We have seen over 60 patients and continue to collate our data. Over 50% of patients have been discharged at first appointment to confidently begin a self-management approach to their care. We have referred only 2 patients onto rheumatology consultant appointments - therefore saving a minimum of 35 Consultant Hours within our service in a 3-month period. We have had 100% positive feedback for patient's who have completed satisfaction questionnaires PREM data after appointment. Conclusion We continue to collect and analyse our data but can already highlight a positive trend for successful implementation of ACP's into the Rheumatology Service within only a 3 month period. We feel this is a starting point for the further development of a Widespread Pain Pathway across the MSK Service to further incorporate integration of Rheumatology, Pain and Physiotherapy Services in the prevention of duplicate or unnecessary appointments and reduction in the ‘revolving door patients’ across all 3 services. Disclosures L.M. Gotting None.