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Sukharomana M, Charuvanij S. Implementation and assessment of a structured curriculum for a 4-week pediatric rheumatology rotation for pediatric residents. BMC MEDICAL EDUCATION 2024; 24:83. [PMID: 38263148 PMCID: PMC10804586 DOI: 10.1186/s12909-024-05043-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/07/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND General pediatricians often initially address children's musculoskeletal (MSK) issues and play a crucial role in triaging and managing patients' rheumatologic conditions. This study assessed the effectiveness of a structured curriculum in enhancing pediatric residents' knowledge, MSK examination skills, and confidence during a 4-week pediatric rheumatology rotation. METHODS Pediatric residents in their either second or third year who participated in the 4-week rheumatology rotation once across three academic years (July 2020-June 2023) were enrolled. Residents' knowledge, MSK examination skills, and confidence were assessed at pre- and post-rotation by using 25 multiple-choice questions, the Thai pediatric Gait Arms Legs Spine examination, and a questionnaire, respectively. The curriculum comprised instruction on MSK examinations, interactive lectures, case-based discussion, topic reviews, MSK radiology conference, clinical experience in rheumatology clinic and consultations, with self-guided learning with educational resources. RESULTS Fifty-eight pediatric residents (48 females, 10 males) with a mean age of 28.9 ± 0.8 years participated. Significant improvements were noted postrotation. Knowledge scores rose from 63.0 ± 12.2 to 79.7 ± 9.1 (mean difference 16.7 ± 10.3, p < 0.001). Similarly, MSK examination scores increased from 67.5 ± 14.4 to 93.6 ± 8.7 (mean difference 26.1 ± 14.6, p < 0.001). Residents also reported a marked increase in confidence across all evaluated areas, including history taking, MSK examination, arthrocentesis, and diagnosing and treating rheumatologic conditions (p < 0.001). CONCLUSIONS The 4-week structured curriculum in the pediatric rheumatology rotation significantly enhanced pediatric residents' knowledge, MSK examination skills, and confidence. These findings support the integration of pediatric rheumatology rotations into pediatric residency training programs.
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Affiliation(s)
- Maynart Sukharomana
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, 10700, Bangkoknoi, Bangkok, Thailand
| | - Sirirat Charuvanij
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, 10700, Bangkoknoi, Bangkok, Thailand.
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2
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Joshua F. Multifaceted uses for musculoskeletal ultrasound. Australas J Ultrasound Med 2023; 26:215. [PMID: 38098615 PMCID: PMC10716570 DOI: 10.1002/ajum.12372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Affiliation(s)
- Fred Joshua
- Macquarie UniversitySydneyNew South WalesAustralia
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3
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Davey A, Tapley A, van Driel M, Holliday E, Fielding A, Ball J, Mulquiney K, Fisher K, Spike N, Clarke L, Moad D, Ralston A, Patsan I, Mundy B, Turner A, Tait J, Tuccitto L, Roberts S, Magin P. The Registrar Clinical Encounters in Training (ReCEnT) cohort study: updated protocol. BMC PRIMARY CARE 2022; 23:328. [PMID: 36527002 PMCID: PMC9755776 DOI: 10.1186/s12875-022-01920-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 11/20/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND During vocational general practice training, the content of each trainee's (in Australia, registrars') in-consultation clinical experience is expected to entail a breadth of conditions that exemplify general practice, enabling registrars to gain competency in managing common clinical conditions and common clinical scenarios. Prior to the Registrar Clinical Encounters in Training (ReCEnT) project there was little research into the content of registrars' consultations despite its importance to quality of training. ReCEnT aims to document the consultation-based clinical and educational experiences of individual Australian registrars. METHODS ReCEnT is an inception cohort study. It is comprised of closely interrelated research and educational components. Registrars are recruited by participating general practice regional training organisations. They provide demographic information about themselves, their skills, and their previous training. In each of three 6-month long general practice training terms they provide data about the practice where they work and collect data from 60 consecutive patient encounters using an online portal. Analysis of data uses standard techniques including linear and logistic regression modelling. The ReCEnT project has approval from the University of Newcastle Human Research Ethics Committee, Reference H-2009-0323. DISCUSSION Strengths of the study are the granular detail of clinical practice relating to patient demographics, presenting problems/diagnoses, medication decisions, investigations requested, referrals made, procedures undertaken, follow-up arranged, learning goals generated, and in-consultation help sought; the linking of the above variables to the presenting problems/diagnoses to which they pertain; and a very high response rate. The study is limited by not having information regarding severity of illness, medical history of the patient, full medication regimens, or patient compliance to clinical decisions made at the consultation. Data is analysed using standard techniques to answer research questions that can be categorised as: mapping analyses of clinical exposure; exploratory analyses of associations of clinical exposure; mapping and exploratory analyses of educational actions; mapping and exploratory analyses of other outcomes; longitudinal 'within-registrar' analyses; longitudinal 'within-program' analyses; testing efficacy of educational interventions; and analyses of ReCEnT data together with data from other sources. The study enables identification of training needs and translation of subsequent evidence-based educational innovations into specialist training of general practitioners.
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Affiliation(s)
- Andrew Davey
- grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, The University of Newcastle, University Dr, Callaghan, NSW 2308 Australia ,NSW & ACT Research and Evaluation Unit, GP Synergy, Level 1, 20 McIntosh Dr, Mayfield West, NSW 2304 Australia
| | - Amanda Tapley
- grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, The University of Newcastle, University Dr, Callaghan, NSW 2308 Australia ,NSW & ACT Research and Evaluation Unit, GP Synergy, Level 1, 20 McIntosh Dr, Mayfield West, NSW 2304 Australia
| | - Mieke van Driel
- grid.1003.20000 0000 9320 7537Faculty of Medicine, General Practice Clinical Unit, The University of Queensland, 288 Herston Road, Brisbane, QLD 4006 Australia
| | - Elizabeth Holliday
- grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, The University of Newcastle, University Dr, Callaghan, NSW 2308 Australia
| | - Alison Fielding
- grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, The University of Newcastle, University Dr, Callaghan, NSW 2308 Australia ,NSW & ACT Research and Evaluation Unit, GP Synergy, Level 1, 20 McIntosh Dr, Mayfield West, NSW 2304 Australia
| | - Jean Ball
- grid.413648.cClinical Research Design and Statistical Support Unit (CReDITSS), Hunter Medical Research Institute (HMRI), Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305 Australia
| | - Katie Mulquiney
- grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, The University of Newcastle, University Dr, Callaghan, NSW 2308 Australia ,NSW & ACT Research and Evaluation Unit, GP Synergy, Level 1, 20 McIntosh Dr, Mayfield West, NSW 2304 Australia
| | - Katie Fisher
- grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, The University of Newcastle, University Dr, Callaghan, NSW 2308 Australia ,NSW & ACT Research and Evaluation Unit, GP Synergy, Level 1, 20 McIntosh Dr, Mayfield West, NSW 2304 Australia
| | - Neil Spike
- Eastern Victoria General Practice Training (EVGPT), 15 Cato Street, Hawthorn, VIC 3122 Australia ,grid.1008.90000 0001 2179 088XDepartment of General Practice and Primary Health Care, University of Melbourne, 200 Berkeley Street, Carlton, VIC 3053 Australia ,grid.1002.30000 0004 1936 7857Faculty of Medicine, Nursing and Health Sciences, School of Rural Health, Monash University, Churchill, VIC 3842 Australia
| | - Lisa Clarke
- General Practice Training Tasmania (GPTT), Level 3, RACT House, 179 Murray Street, Hobart, TAS 7000 Australia
| | - Dominica Moad
- grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, The University of Newcastle, University Dr, Callaghan, NSW 2308 Australia ,NSW & ACT Research and Evaluation Unit, GP Synergy, Level 1, 20 McIntosh Dr, Mayfield West, NSW 2304 Australia
| | - Anna Ralston
- grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, The University of Newcastle, University Dr, Callaghan, NSW 2308 Australia ,NSW & ACT Research and Evaluation Unit, GP Synergy, Level 1, 20 McIntosh Dr, Mayfield West, NSW 2304 Australia
| | - Irena Patsan
- grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, The University of Newcastle, University Dr, Callaghan, NSW 2308 Australia ,NSW & ACT Research and Evaluation Unit, GP Synergy, Level 1, 20 McIntosh Dr, Mayfield West, NSW 2304 Australia
| | - Benjamin Mundy
- grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, The University of Newcastle, University Dr, Callaghan, NSW 2308 Australia ,NSW & ACT Research and Evaluation Unit, GP Synergy, Level 1, 20 McIntosh Dr, Mayfield West, NSW 2304 Australia
| | - Alexandria Turner
- NSW & ACT Research and Evaluation Unit, GP Synergy, Level 1, 20 McIntosh Dr, Mayfield West, NSW 2304 Australia ,grid.1003.20000 0000 9320 7537Faculty of Medicine, General Practice Clinical Unit, The University of Queensland, 288 Herston Road, Brisbane, QLD 4006 Australia
| | - Jordan Tait
- NSW & ACT Research and Evaluation Unit, GP Synergy, Level 1, 20 McIntosh Dr, Mayfield West, NSW 2304 Australia
| | - Lucrezia Tuccitto
- Eastern Victoria General Practice Training (EVGPT), 15 Cato Street, Hawthorn, VIC 3122 Australia
| | - Sarah Roberts
- General Practice Training Tasmania (GPTT), Level 3, RACT House, 179 Murray Street, Hobart, TAS 7000 Australia
| | - Parker Magin
- grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, The University of Newcastle, University Dr, Callaghan, NSW 2308 Australia ,NSW & ACT Research and Evaluation Unit, GP Synergy, Level 1, 20 McIntosh Dr, Mayfield West, NSW 2304 Australia
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Allen MF, Allen DE. Pes Anserinus Bursitis: A Case Report. Cureus 2022; 14:e31354. [DOI: 10.7759/cureus.31354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2022] [Indexed: 11/13/2022] Open
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5
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Diarbakerli E, Thoreson O, Björklund M, Dahlberg LE, Englund M, Gerdhem P, Kvist J, Mohaddes M, Peolsson A, Rolfson O, Öberg B, Abbott A. Learning from the past to plan for the future: A scoping review of musculoskeletal clinical research in Sweden 2010-2020. Ups J Med Sci 2022; 127:8709. [PMID: 36337277 PMCID: PMC9602198 DOI: 10.48101/ujms.v127.8709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 08/01/2022] [Accepted: 08/05/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The aims of this study are to 1) determine the scope of musculoskeletal (MSK)-related clinical research in Sweden; 2) collate the amount of first-tier funding received; 3) discuss strategies and infrastructure supporting future MSK clinical trials in Sweden. METHODS A systematic scoping review protocol was applied in PubMed, Scopus, and SweCRIS databases. The articles were examined, and data were extracted in multiple stages by three blinded authors. RESULTS The search strategy resulted in 3,025 publications from 479 Swedish-affiliated authors. Primary health care was the basis for 14% of the publications, 84% from secondary health care, and 2% from occupational health care with a similar proportional distribution of first-tier research grant financing. Approximately one in six publications were randomized controlled trials (RCTs), while the majority were of observational cohort design. The majority of publications in primary and occupational health care were related to pain disorders (51 and 67%, respectively), especially diagnosis, prognosis, and healthcare organizational-related interventions (34%) and rehabilitation (15%) with similar proportional distribution of first-tier research grant financing. In secondary health care, rheumatic inflammatory disorder-related publications were most prevalent (30%), most frequently concerning diagnosis, prognosis, and healthcare organizational-related interventions (20%), attracting approximately half of all first-tier funding. Publications related to degenerative joint disorders (25%), fractures (16%), and joint, tendon, and muscle injuries (13%) frequently concerned surgical and other orthopedic-related interventions (16, 6, and 8%, respectively). Pain disorder-related publications (10%) as well as bone health and osteoporosis-related publications (4%) most frequently concerned diagnosis, prognosis, and healthcare organizational-related interventions (5 and 3%, respectively). CONCLUSIONS Swedish-affiliated MSK disorder research 2010-2020 was predominantly observational cohort rather than RCT based. There was skewed first-tier funding allocation considering prevalence/incidence and burden of disease. Use of infrastructure supporting register-based RCTs, placebo-controlled RCTs, and hybrid effectiveness-implementation studies on prevention and clinical intervention is important strategies for the future in all healthcare sectors.
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Affiliation(s)
- Elias Diarbakerli
- Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden
| | - Olof Thoreson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Martin Björklund
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
- Centre for Musculoskeletal Research, Department of Occupational Health Sciences and Psychology, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
| | - Leif E Dahlberg
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden
| | - Martin Englund
- Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Paul Gerdhem
- Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden
| | - Joanna Kvist
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine & Surgery, Karolinska Institute, Solna, Sweden
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University
| | - Maziar Mohaddes
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anneli Peolsson
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University
- Occupational and Environmental Medicine Center, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Linköping University, Linköping, Sweden
| | - Ola Rolfson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Birgitta Öberg
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University
| | - Allan Abbott
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University
- Department of Orthopaedics, Linköping University Hospital, SE 581 83 Linköping, Sweden
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Choi S, Ooi S, Carpenter E. A Cross-Sectional Study of Undergraduate Teaching of Trauma and Orthopaedics in the UK and the Relationship Between Medical Schools and Interest in Trauma and Orthopaedics as a Career. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2022; 9:23821205211072764. [PMID: 35036567 PMCID: PMC8755927 DOI: 10.1177/23821205211072764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/16/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Adequate exposure and teaching of Trauma and Orthopaedics (T&O) to medical students is fundamental in order to obtain sufficient knowledge and sustain their interest in T&O as a career. The primary aim is to assess the exposure and delivery of T&O at all medical schools in the UK. The secondary aim is to determine whether there are any associations between attending a particular medical school and having a strong interest in pursuing a career in T&O. METHODS To explore the primary aim, all 33 UK medical schools were investigated in the study, by means of a questionnaire distributed to medical students. This did not include 'new' medical schools, defined as those established from 2014 onwards. To investigate the secondary aim of exploring associations between students' and alumni's medical schools and their interest in T&O as a career, British Orthopaedic Training Association (BOTA) members were reviewed, using the General Medical Council register to identify the universities from which members had graduated. The authors have made the assumption that membership of BOTA signified an interest in T&O as a career. RESULTS Results were obtained for all 33 medical schools. The mean total teaching time specifically for T&O throughout medical school was 18 days, ranging from 3 to 60 days in total. 118 BOTA members were reviewed. No member of BOTA in the study had attended medical school in Keele, Liverpool, Plymouth or Lancashire. These universities taught below the national average number of days in T&O. DISUCSSION There is a large national variance in the number of compulsory teaching days provided for T&O. The authors advocate medical schools to aim for at least the national average in duration of T&O of 18 days.
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Sajid IM, Parkunan A, Frost K. Unintended consequences: quantifying the benefits, iatrogenic harms and downstream cascade costs of musculoskeletal MRI in UK primary care. BMJ Open Qual 2021; 10:e001287. [PMID: 34215659 PMCID: PMC8256731 DOI: 10.1136/bmjoq-2020-001287] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 06/07/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES The largest proportion of general practitioner (GP) magnetic resonance imaging (MRI) is musculoskeletal (MSK), with consistent annual growth. With limited supporting evidence and potential harms from early imaging overuse, we evaluated practice to improve pathways and patient safety. METHODS Cohort evaluation of routinely collected diagnostic and general practice data across a UK metropolitan primary care population. We reviewed patient characteristics, results and healthcare utilisation. RESULTS Of 306 MSK-MRIs requested by 107 clinicians across 29 practices, only 4.9% (95% CI ±2.4%) appeared clearly indicated and only 16.0% (95% CI ±4.1%) received appropriate prior therapy. 37.0% (95% CI ±5.5%) documented patient imaging request. Most had chronic symptoms and half had psychosocial flags. Mental health was addressed in only 11.8% (95% CI ±6.3%) of chronic sufferers with psychiatric illness, suggesting a solely pathoanatomical approach to MSK care. Only 7.8% (95% CI ±3.0%) of all patients were appropriately managed without additional referral. 1.3% (95% CI ±1.3%) of scans revealed diagnoses leading to change in treatment (therapeutic yield). Most imaged patients received pathoanatomical explanations to their symptoms, often based on expected age or activity-related changes. Only 16.7% (95% CI ±4.2%) of results appeared correctly interpreted by GPs, with spurious overperception of surgical targets in 65.4% (95% CI ±5.3%) who suffered 'low-value' (ineffective, harmful or wasteful) post-MRI referral cascades due to misdiagnosis and overdiagnosis. Typically, 20%-30% of GP specialist referrals convert to a procedure, whereas MRI-triggered referrals showed near-zero conversion rate. Imaged patients experienced considerable delay to appropriate care. Cascade costs exceeded direct-MRI costs and GP-MSK-MRI potentially more than doubles expenditure compared with physiotherapist-led assessment services, for little-to-no added therapeutic yield, unjustifiable by cost-consequence or cost-utility analysis. CONCLUSION Unfettered GP-MSK-MRI use has reached unaccceptable indication creep and disutility. Considerable avoidable harm occurs through ubiquitous misinterpretation and salient low-value referral cascades for two-thirds of imaged patients, for almost no change in treatment. Any marginally earlier procedural intervention for a tiny fraction of patients is eclipsed by negative consequences for the vast majority. Only 1-2 patients need to be scanned for one to suffer mismanagement. Direct-access imaging is neither clinically, nor cost-effective and deimplementation could be considered in this setting. GP-MSK-MRI fuels unnecessary healthcare utilisation, generating nocebic patient beliefs and expectations, whilst appropriate care is delayed and a high burden of psychosocial barriers to recovery appear neglected.
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Affiliation(s)
- Imran Mohammed Sajid
- NHS West London Clinical Commissioning Group, London, UK
- University of Global Health Equity, Kigali, Rwanda
| | - Anand Parkunan
- Healthshare Community NHS Musculoskeletal Services, London, UK
| | - Kathleen Frost
- NHS Central London Clinical Commissioning Group, London, UK
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Gilbert AW, Booth G, Betts T, Goldberg A. A mixed-methods survey to explore issues with virtual consultations for musculoskeletal care during the COVID-19 pandemic. BMC Musculoskelet Disord 2021; 22:245. [PMID: 33673844 PMCID: PMC7933396 DOI: 10.1186/s12891-021-04113-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/18/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To explore orthopaedic and musculoskeletal clinicians' views and experiences of legal, safety, safeguarding and security issues regarding the use of virtual consultations (VC) during the COVID-19 pandemic. A secondary objective was to suggest ways to overcome these issues. METHODS A mixed method cross-sectional survey was conducted, seeking the views and experiences of orthopaedic and musculoskeletal medically qualified and Allied Health Professionals in the United Kingdom. Descriptive statistical analysis was employed for quantitative data and a qualitative content analysis undertaken for qualitative data. Findings were presented in accordance with the four key issues. RESULTS Two hundred and ninety professionals (206 physiotherapists, 78 medically qualified professionals, 6 'other' therapists) participated in the survey. Of the 290 participants, 260 (90%) were not using VC prior to the COVID-19 pandemic, 248 respondents (86%) were unsure whether their professional indemnity insurance covered VC, 136 (47%) had considered how they would handle an issue of safeguarding whilst the remainder had not, 126 (43%) had considered what they would do if, during a virtual consultation, a patient suffered an injury (e.g. bang on their head) or a fall (e.g. mechanical or a medical event like syncope) and 158 (54%) reported they felt the current technological solutions are secure in terms of patient data. Qualitative data provided additional context to support the quantitative findings such as validity of indemnification, accuracy of diagnosis and consent using VC, safeguarding issues; and security and sharing of data. Potential changes to practice have been proposed to address these issues. CONCLUSIONS VC have been rapidly deployed since the onset of the COVID-19 pandemic often without clear guidance or consensus on many important issues. This study identified legal, safeguarding, safety and security issues. There is an urgent need to address these and develop local and national guidance and frameworks to facilitate ongoing safe virtual orthopaedic practice beyond the COVID-19 pandemic.
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Affiliation(s)
- Anthony W Gilbert
- Therapies Department, Royal National Orthopaedic Hospital, Stanmore, UK. .,School of Health Sciences, University of Southampton, Southampton, UK.
| | - Gregory Booth
- Therapies Department, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Tony Betts
- Therapies Department, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Andy Goldberg
- Institute of Orthopaedics and Musculoskeletal Sciences, University College London, London, UK.,Trauma and Orthopaedics Department, Wellington Hospital, London, UK.,MSK Lab, Imperial College London, London, UK
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Al Shammari M, Hassan A, Al Jawad M, Farea A, Almansour A, Al Yousif G, Sebiany A, Bin Bakr Z. Pancoast Tumor: The Overlooked Etiology of Shoulder Pain in Smokers. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e926643. [PMID: 32913177 PMCID: PMC7508304 DOI: 10.12659/ajcr.926643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Patient: Male, 60-year-old Final Diagnosis: Lung cancer Symptoms: Shoulder pain Medication:— Clinical Procedure: — Specialty: Oncology • Pulmonology
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Affiliation(s)
- Malak Al Shammari
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ali Hassan
- Department of Radiology, King Fahd Hospital of the Univeristy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mahdi Al Jawad
- Department of Radiology, King Fahd Hospital of the Univeristy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdulaziz Farea
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdulelah Almansour
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ghada Al Yousif
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdulaziz Sebiany
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Zahia Bin Bakr
- Department of Family Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia
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Chan M, Le CY, Dennett E, Defreitas T, Whittaker JL. Team-based musculoskeletal assessment and healthcare quality indicators: A systematic review. J Interprof Care 2019; 33:774-781. [PMID: 30686065 DOI: 10.1080/13561820.2019.1569603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The primary objective of this review was to describe health quality indicator (HQI) outcomes of team-based musculoskeletal (MSK) assessments aimed at directing patient care. Secondary objectives included determining the most commonly assessed HQIs, extent of team collaboration, and the healthcare practitioners that most commonly comprise MSK-assessment teams. This review was registered in the PROSPERO database and conducted according to PRISMA guidelines. Five databases were systematically searched to August 2017. Studies selected met a priori inclusion criteria and investigated an HQI outcome of a primary or intermediate care MSK team-based assessment aimed at directing treatment. Two independent raters assessed study quality [Downs and Black (DB) criteria] and level of evidence (Oxford Centre of Evidence-Based Medicine model). Ten studies were included. The majority were low-quality [median DB score 14/32 (range 6-18)] pre-experimental studies (level 4 evidence). Heterogeneity in methodology and HQIs precluded meta-analyses. Hospital length-of-stay (LOS; 3/10 studies) and pain level (3/10) were the most common HQIs investigated. Teams (9/10) were most commonly comprised of a physiotherapist and another healthcare practitioner. Most teams (8/10) demonstrated low-levels of collaboration. There is limited low-level evidence to suggest that team-based MSK assessments are associated with improved clinical outcomes (i.e., pain, quality-of-life) and shorter LOS.
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Affiliation(s)
- Michelle Chan
- Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, Canada
| | - Christina Y Le
- Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, Canada.,Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Elizabeth Dennett
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada
| | - Terry Defreitas
- Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, Canada.,Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Jackie L Whittaker
- Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, Canada.,Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
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Matsos M, Docherty-Skippen SM, Yelovich MC, Beattie KA. Factors that influence Canadian internal medicine residents’ choice to pursue a rheumatology career. Clin Rheumatol 2018; 38:229-234. [DOI: 10.1007/s10067-018-4222-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/10/2018] [Accepted: 07/16/2018] [Indexed: 12/21/2022]
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An evaluation of the clinical skills and experience within an orthopaedic Integrated Clinical Assessment and Treatment Service. BJGP Open 2017; 1:bjgpopen17X101217. [PMID: 30564691 PMCID: PMC6181100 DOI: 10.3399/bjgpopen17x101217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/11/2017] [Indexed: 11/08/2022] Open
Abstract
Background General practice in the UK is ‘in crisis’. With 20% of GP workload relating to musculoskeletal (MSK) problems, an orthopaedic Integrated Clinical Assessment and Treatment Service (ICATS) could help support assessment of these patients in primary care, alleviating pressure on GPs. However, practitioners in ICATS must be trained appropriately to ensure its effectiveness. Aim This evaluation aimed to identify the training levels of doctors in one Northern Ireland orthopaedic ICATS system, what their future training needs are, and suggestions for how this service could be improved to better support general practice. Design & setting A questionnaire study in an orthopaedic ICATS, Northern Ireland. Method All seven doctors working within the Southern Trust orthopaedic ICATS were asked to complete a questionnaire detailing their training and experience in MSK medicine. Their views on how the service could be improved were elicited. Results Six of seven questionnaires were returned. All responders were Members of the Royal College of General Practitioners (MRCGP), while five of six held a Diploma in Sports and Exercise Medicine (Dip SEM). Half of responders suggested that MSK ultrasound could be beneficial within ICATS. However, it was viewed that extensive training would be required before paediatric MSK patients could be included. Conclusion High levels of training and experience were reported by responders, suggesting ICATS provides a high-level MSK service. Furthermore, it was noted that inclusion of MSK ultrasound and paediatric patients into this service could be beneficial but not without undertaking further training. With appropriate funding and support the ICATS service has the potential to expand the clinical services it offers to general practice, helping to reduce work pressures in primary care at this time of crisis for UK general practice.
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Murphy DR, Schneider MJ, Bise CG, Justice B. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain. Ann Intern Med 2017; 167:833-834. [PMID: 29204612 DOI: 10.7326/l17-0471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Donald R Murphy
- From Care New England Health System and Alpert Medical School of Brown University, Providence, Rhode Island; University of Pittsburgh, Pittsburgh, Pennsylvania; and Excellus BlueCross BlueShield, Rochester, New York
| | - Michael J Schneider
- From Care New England Health System and Alpert Medical School of Brown University, Providence, Rhode Island; University of Pittsburgh, Pittsburgh, Pennsylvania; and Excellus BlueCross BlueShield, Rochester, New York
| | - Christopher G Bise
- From Care New England Health System and Alpert Medical School of Brown University, Providence, Rhode Island; University of Pittsburgh, Pittsburgh, Pennsylvania; and Excellus BlueCross BlueShield, Rochester, New York
| | - Brian Justice
- From Care New England Health System and Alpert Medical School of Brown University, Providence, Rhode Island; University of Pittsburgh, Pittsburgh, Pennsylvania; and Excellus BlueCross BlueShield, Rochester, New York
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Heron N. Musculoskeletal (MSK) and Sport and Exercise Medicine (SEM) in General Practice (GP): A Novel GP-based MSK and SEM Clinic for Managing Musculoskeletal symptoms in a GP. BMJ QUALITY IMPROVEMENT REPORTS 2016; 4:bmjquality_uu207172.w2905. [PMID: 26733320 PMCID: PMC4645797 DOI: 10.1136/bmjquality.u207172.w2905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 01/23/2015] [Indexed: 12/17/2022]
Abstract
Musculoskeletal (MSK) complaints are common within primary care (1) (2) (3) but some General Practitioners (GPs)/family physicians do not feel comfortable managing these symptoms (3), preferring to refer onto hospital specialists or Integrated Clinical Assessment and Treatment Services (ICATs). Long waiting times for hospital outpatient reviews are a major cause of patient inconvenience and complaints (4). We therefore aimed to establish a GP-ran MSK and sport and exercise medicine (SEM) clinic based within a Belfast GP surgery that would contribute to a sustainable improvement in managing these common conditions within primary care as well as reducing waiting times for patients with these conditions to see a specialist. This shift from hospital-based to community-based management is in-keeping with recent policy changes within the UK health-system, including Transforming Your Care within Northern Ireland (NI) (5). The GP-ran MSK and SEM clinic was held monthly within a Belfast GP practice, staffed by one GP with a specialist interest in MSK and SEM conditions and its performance was reviewed over a three month period. Parameters audited included cases seen, orthopaedic and x-ray referral rates and secondary care referrals comparing the GP practice's performance to the same time period in the previous year as well as patient satisfaction questionnaires.
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Heron N. A 'novel' model for integrating Sport and Exercise Medicine (SEM) and Musculoskeletal (MSK) management into primary care in the UK. BMJ Open Sport Exerc Med 2015; 1:e000027. [PMID: 27900125 PMCID: PMC5117016 DOI: 10.1136/bmjsem-2015-000027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Musculoskeletal (MSK) symptoms are common within primary care but some general practitioners (GPs)/family physicians do not feel comfortable managing these symptoms, preferring to refer onwards. We aimed to establish a reproducible GP-staffed MSK and sport and exercise medicine (SEM) clinic within primary care, in keeping with recent policy changes within the UK health system. METHODS A monthly MSK and SEM clinic was held within a Belfast GP practice, staffed by 1 GP with a specialist interest in MSK/SEM conditions, and its performance was reviewed over two 3-month periods. Parameters audited included diagnoses, patient satisfaction and secondary care referral rates. RESULTS 83 patients, 36 males and 47 females, were reviewed in the clinic and the main presenting joint was the shoulder. Patient self-reported satisfaction with the service was high. Comparing referral rates between August and October 2013 and the same period in 2014, overall referrals from the practice were reduced by 147, orthopaedic and rheumatology referrals were reduced by 2 and 3, while physiotherapy and X-ray referrals were reduced by 47 and 90, respectively. Comparing the referral rates between January and March 2014 and the same period in 2015, overall outpatient referrals were reduced by 152, orthopaedic and rheumatology referrals were reduced by 9 and 4, while physiotherapy and X-ray referrals were reduced by 41 and 3, respectively. DISCUSSION We present a novel, reproducible service model for managing MSK/SEM symptoms in primary care which could be commissioned by local groups. This model can make sound economic sense and deliver high patient satisfaction within primary care, reducing waiting times and the secondary care referral burden.
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Affiliation(s)
- Neil Heron
- Department of General Practice and Primary Care, Queen's University Belfast, Belfast, Northern Ireland; Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland; UKCRC Centre of Excellence for Public Health (NI), Queen's University Belfast, Belfast, Northern Ireland
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