1
|
Seuren LM, Shaw S. How Informal Carers Support Video Consulting in Physiotherapy, Heart Failure, and Cancer: Qualitative Study Using Linguistic Ethnography. J Med Internet Res 2024; 26:e51695. [PMID: 38819900 PMCID: PMC11179022 DOI: 10.2196/51695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/24/2023] [Accepted: 04/19/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Informal carers play an important role in the everyday care of patients and the delivery of health care services. They aid patients in transportation to and from appointments, and they provide assistance during the appointments (eg, answering questions on the patient's behalf). Video consultations are often seen as a way of providing patients with easier access to care. However, few studies have considered how this affects the role of informal carers and how they are needed to make video consultations safe and feasible. OBJECTIVE This study aims to identify how informal carers, usually friends or family who provide unpaid assistance, support patients and clinicians during video consultations. METHODS We conducted an in-depth analysis of the communication in a sample of video consultations drawn from 7 clinical settings across 4 National Health Service Trusts in the United Kingdom. The data set consisted of 52 video consultation recordings (of patients with diabetes, gestational diabetes, cancer, heart failure, orthopedic problems, long-term pain, and neuromuscular rehabilitation) and interviews with all participants involved in these consultations. Using Linguistic Ethnography, which embeds detailed analysis of verbal and nonverbal communication in the context of the interaction, we examined the interactional, technological, and clinical work carers did to facilitate video consultations and help patients and clinicians overcome challenges of the remote and video-mediated context. RESULTS Most patients (40/52, 77%) participated in the video consultation without support from an informal carer. Only 23% (12/52) of the consultations involved an informal carer. In addition to facilitating the clinical interaction (eg, answering questions on behalf of the patient), we identified 3 types of work that informal carers did: facilitating the use of technology; addressing problems when the patient could not hear or understand the clinician; and assisting with physical examinations, acting as the eyes, ears, and hands of the clinician. Carers often stayed in the background, monitoring the consultation to identify situations where they might be needed. In doing so, copresent carers reassured patients and helped them conduct the activities that make up a consultation. However, carers did not necessarily help patients solve all the challenges of a video consultation (eg, aiming the camera while laying hands on the patient during an examination). We compared cases where an informal carer was copresent with cases where the patient was alone, which showed that carers provided an important safety net, particularly for patients who were frail and experienced mobility difficulties. CONCLUSIONS Informal carers play a critical role in making video consultations safe and feasible, particularly for patients with limited technological experience or complex needs. Guidance and research on video consulting need to consider the availability and work done by informal carers and how they can be supported in providing patients access to digital health care services.
Collapse
Affiliation(s)
- Lucas Martinus Seuren
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Sara Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
2
|
Silvestre J, Thompson TL, Flynn JM. Nationwide Effect of COVID-19 on Cases Performed During Pediatric Orthopaedic Surgery Fellowship Training in the United States. J Am Acad Orthop Surg 2024; 32:92-97. [PMID: 37738635 DOI: 10.5435/jaaos-d-22-00340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/21/2023] [Indexed: 09/24/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic negatively affected surgical training in the United States. We hypothesized that reported case volume during pediatric orthopaedic surgery fellowship training would decrease markedly during the 2019 to 2020 academic year, which corresponded with the COVID-19 outbreak. METHODS The Accreditation Council for Graduate Medical Education provided nationwide case logs for accredited pediatric orthopaedic surgery fellows (2017 to 2021). Annual reported case volumes were extracted and summarized as means ± SD. Parametric tests were used to compare annual case volumes. RESULTS A total of 149 pediatric orthopaedic fellows from 23 accredited fellowships were included. A 16% year-over-year (YoY) decrease was noted in the reported case volume during the 2019 to 2020 academic year (238 ± 80 vs. 255 ± 60, P < 0.001). Nonacute case categories had the most notable YoY percentage decreases: Soft Tissue: Transfer, Lengthen, Release (-42%); Clubfoot (-34%); and Foot and Ankle Deformity (-31%). Acute case categories had the most notable YoY percentage increases: Trauma Lower Limb (12%) and Trauma Upper Limb (10%). A subsequent 42% YoY increase was noted in the reported case volume during the 2020 to 2021 academic year. DISCUSSION A 16% YoY decrease was noted in the reported case volume during the 2019 to 2020 academic year, which corresponded to widespread economic shutdowns during the initial COVID-19 outbreak. Nonacute cases experienced the greatest negative effect. The results from this study may inform the orthopaedic surgery community on the effect of future national emergencies, such as viral outbreaks.
Collapse
Affiliation(s)
- Jason Silvestre
- From the Children's National Hospital, Washington, DC (Silvestre), the Howard University College of Medicine, Washington, DC (Thompson), and the Children's Hospital of Philadelphia, Philadelphia, PA (Flynn)
| | | | | |
Collapse
|
3
|
Chuen VL, Dholakia S, Kalra S, Watt J, Wong C, Ho JMW. Geriatric care physicians' perspectives on providing virtual care: a reflexive thematic synthesis of their online survey responses from Ontario, Canada. Age Ageing 2024; 53:afad231. [PMID: 38243403 DOI: 10.1093/ageing/afad231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 08/25/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND During the COVID-19 pandemic, telemedicine was widely implemented to minimise viral spread. However, its use in the older adult patient population was not well understood. OBJECTIVE To understand the perspectives of geriatric care providers on using telemedicine with older adults through telephone, videoconferencing and eConsults. DESIGN Qualitative online survey study. SETTING AND PARTICIPANTS We recruited geriatric care physicians, defined as those certified in Geriatric Medicine, Care of the Elderly (family physicians with enhanced skills training) or who were the most responsible physician in a long-term care home, in Ontario, Canada between 22 December 2020 and 30 April 2021. METHODS We collected participants' perspectives on using telemedicine with older adults in their practice using an online survey. Two researchers jointly analysed free-text responses using the 6-phase reflexive thematic analysis. RESULTS We recruited 29 participants. Participants identified difficulty using technology, patient sensory impairment, lack of hospital support and pre-existing high patient volumes as barriers against using telemedicine, whereas the presence of a caregiver and administrative support were facilitators. Perceived benefits of telemedicine included improved time efficiency, reduced travel, and provision of visual information through videoconferencing. Ultimately, participants felt telemedicine served various purposes in geriatric care, including improving accessibility of care, providing follow-up and obtaining collateral history. Main limitations are the absence of, or incomplete physical exams and cognitive testing. CONCLUSIONS Geriatric care physicians identify a role for virtual care in their practice but acknowledge its limitations. Further work is required to ensure equitable access to virtual care for older adults.
Collapse
Affiliation(s)
- Victoria L Chuen
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto ON, Canada
| | - Saumil Dholakia
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- GeriMedRisk, Waterloo, ON, Canada
| | - Saurabh Kalra
- Department of Family Medicine, McMaster University, Kitchener, ON, Canada
| | - Jennifer Watt
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto ON, Canada
- Division of Geriatric Medicine, Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada
| | - Camilla Wong
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto ON, Canada
- Division of Geriatric Medicine, Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada
| | - Joanne M-W Ho
- GeriMedRisk, Waterloo, ON, Canada
- Divison of Geriatric Medicine, Department of Medicine, McMaster University, Kitchener, ON, Canada
- Schlegel Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada
| |
Collapse
|
4
|
Garcia-Lopez E, Halvorson R, Shapiro L. Novel Tools to Approach and Measure Outcomes in Patients with Fractures. Hand Clin 2023; 39:627-639. [PMID: 37827615 DOI: 10.1016/j.hcl.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
Upper extremity fractures are prevalent and pose a great burden to patients and society. In the US alone, the annual incidence of upper extremity fractures is 67.6 fractures per 10,000 persons. While the majority of patients with upper extremity fractures demonstrate satisfactory outcomes when treated appropriately (the details of which are discussed in prior articles), the importance of follow-up and outcome measurement cannot be understated. Outcome measurement allows for accountability and improvement in clinical outcomes and research. The purpose of this article is to describe recent advances in methods and tools for assessing clinical and research outcomes in hand and upper extremity care. Three specific advances that are broadly changing the landscape of follow-up care of our patients include: 1) telemedicine, 2) patient-reported outcome measurement, and 3) wearables/remote patient monitoring.
Collapse
Affiliation(s)
- Edgar Garcia-Lopez
- Department of Orthopaedics, University of California San Francisco, 500 Parnassus Avenue, MU-320W, San Francisco, CA 94143-0728, USA
| | - Ryan Halvorson
- Department of Orthopaedics, University of California San Francisco, 500 Parnassus Avenue, MU-320W, San Francisco, CA 94143-0728, USA
| | - Lauren Shapiro
- Department of Orthopaedics, University of California San Francisco, 1500 Owens Street, San Francisco, CA 94158, USA.
| |
Collapse
|
5
|
Arvidsson L, Hägglund B, Petersson L, Arvidsson E, Tägil M. Virtual Follow up After Distal Radius Fracture Surgery-Patient Experiences During the COVID-19 Pandemic. J Patient Exp 2023; 10:23743735231188819. [PMID: 37528953 PMCID: PMC10387677 DOI: 10.1177/23743735231188819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
The majority of patients with a distal radius fracture (DRF) are elderly, a group known to experience difficulties with new technology, partly due to a low level of digital literacy. At the beginning of the coronavirus disease 2019 pandemic, during the spring 2020, patients that underwent DRF surgery had regular follow-ups replaced by video calls from their surgeon and physiotherapist. Afterward, patients answered questionnaires regarding health and digital literacy and took part in semistructured interviews regarding the experience of the virtual follow-up. By systemic text condensation, 2 major categories were identified: (1) The video call-new, but surprisingly simple: All but 1 found it easier than expected, and (2) Video calls-the patient's choice: All but 1 patient preferred video calls to physical visits for follow-up. This is the first mixed methods study to assess patients' experiences of digital follow-up after DRF surgery. This study indicates that digital follow-up was highly appreciated, even among patients with low levels of digital literacy. Digital technologies must be made suitable even for patients with inadequate levels of digital literacy.
Collapse
Affiliation(s)
- Linnea Arvidsson
- Department of Orthopaedics, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden
| | - Benjamin Hägglund
- Department of Orthopaedics, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden
| | - Lena Petersson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Eva Arvidsson
- Futurum, Jönköping, Sweden
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Magnus Tägil
- Department of Orthopaedics, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
| |
Collapse
|
6
|
Touzani R, Dembele E, Schultz E, Rouquette A, Seguin L, Dufour JC, Bannier M, Mancini J. The French General Population's Perception of New Information and Communication Technologies for Medical Consultations: National Survey. J Med Internet Res 2023; 25:e45822. [PMID: 37327032 PMCID: PMC10337435 DOI: 10.2196/45822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/06/2023] [Accepted: 05/15/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND The development of telehealth and telemedicine, in the form of increased teleconsultation and medical telemonitoring, accelerated during the COVID-19 health crisis in France to ensure continued access to care for the population. Since these new information and communication technologies (ICTs) are diverse and likely to transform how the health care system is organized, there is a need better to understand public attitudes toward them and their relationship with peoples' current experience of health care. OBJECTIVE This study aimed to determine the French general population's perception of the usefulness of video recording/broadcasting (VRB) and mobile Health (mHealth) apps for medical consultations in France during the COVID-19 health crisis and the factors associated with this perception. METHODS Data were collected for 2003 people in 2 waves of an online survey alongside the Health Literacy Survey 2019 (1003 in May 2020 and 1000 in January 2021) based on quota sampling. The survey collected sociodemographic characteristics, health literacy levels, trust in political representatives, and perceived health status. The perceived usefulness of VRB in medical consultations was measured by combining 2 responses concerning this technology for consultations. The perceived usefulness of mHealth apps was measured by combining 2 responses concerning their usefulness for booking doctor appointments and for communicating patient-reported outcomes to doctors. RESULTS The majority (1239/2003, 62%) of respondents considered the use of mHealth apps useful, while only 27.6% (551/2003) declared VRB useful. The factors associated with the perceived usefulness of both technologies were younger age (≤ 55 years), trust in political representatives (VRB: adjusted odds ratio [aOR] 1.68, 95% CI 1.31-2.17; mHealth apps: aOR 1.88, 95% CI 1.42-2.48), and higher (sufficient and excellent) health literacy. The period of the beginning of the COVID-19 epidemic, living in an urban area, and being limited in daily activities were also associated with perceiving VRB positively. The perceived usefulness of mHealth apps increased with the level of education. It was also higher in people who had 3 or more consultations with a medical specialist. CONCLUSIONS There are important differences in attitudes toward new ICTs. Perceived usefulness was lower for VRB than for mHealth apps. Moreover, it decreased after the initial months of the COVID-19 pandemic. There is also the possibility of new inequalities. Hence, despite the potential benefits of VRB and mHealth apps, people with low health literacy considered them to be of little use for their health care, possibly increasing their difficulties in accessing health care in the future. As such, health care providers and policy makers need to consider those perceptions to guarantee that new ICTs are accessible and beneficial to all.
Collapse
Affiliation(s)
- Rajae Touzani
- Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Equipe CANBIOS Labellisée Ligue 2019, Marseille, France
- Institut Paoli-Calmettes, SESSTIM U1252, Marseille, France
| | - Elodie Dembele
- Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Equipe CANBIOS Labellisée Ligue 2019, Marseille, France
| | - Emilien Schultz
- Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Equipe CANBIOS Labellisée Ligue 2019, Marseille, France
- Médialab, Sciences Po, 75007 Paris, France, Paris, France
| | - Alexandra Rouquette
- Public Health and Epidemiology Department, AP-HP, Bicêtre Hôpitaux Universitaires Paris Sud, Le Kremlin-Bicêtre, France
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM U1018, Villejuif, France
| | - Lorène Seguin
- Institut Paoli-Calmettes, Département d'Oncologie Médicale, Marseille, France
| | - Jean-Charles Dufour
- APHM, Hop Timone, BioSTIC, Biostatistique et Technologies de l'Information et de la Communication, Marseille, France
| | - Marie Bannier
- Institut Paoli-Calmettes, Département de Chirurgie Oncologique, Marseille, France
| | - Julien Mancini
- Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Equipe CANBIOS Labellisée Ligue 2019, Marseille, France
- APHM, Hop Timone, BioSTIC, Biostatistique et Technologies de l'Information et de la Communication, Marseille, France
| |
Collapse
|
7
|
Warner J. The impact of COVID-19 on burn referrals received via telemedicine. Burns 2023; 49:455-460. [PMID: 35523656 DOI: 10.1016/j.burns.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/28/2022] [Accepted: 04/18/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Burn referrals make up a significant proportion of the referrals received by the on-call Plastics surgery team at University Hospital Plymouth (UHP). UHP is a burns facility that takes referrals that are< 10% total body surface area (TBSA) in adults and< 5% in children. Since switching to a telemedicine service in 2018, this has had the benefit of not needing to see the patient face-to-face. It allows for direct advice given over the phone enabling immediate treatment to be administered. In addition it prevents unnecessary referrals. The COVID-19 pandemic has meant that more people are spending time at home and this study aims to see if this has had an impact on the number of referrals received. METHODS Data was collected retrospectively over 2 years 2019 and 2020 from MDSAS telemedicine service. The outcome of each referral was recorded as advice given, seen in outpatients or patient admitted. The total for each year was calculated and compared. Also recorded was the age of the patient, the referring unit, the type of burn and the TBSA. RESULTS A 19.3% increase in referrals received during the year of 2020. The most common age group for a burn referral was the 0-5 years age group; the number of referrals increased by 8.4% in this age group in the year of lockdown. Scalds and contact burns remained the highest mechanism of injury. TBSA of 0.5% was the most common TBSA over both years. Over 47% of referrals travelled from over 30 miles away. The majority of referrals were either seen in outpatients or given advice only. Burn referrals were most commonly over-estimated, 23.2% of burn referrals in 2019 and 20.9% in 2020 were over estimated by> 1% TBSA. 5.5% of referrals were under-estimated. CONCLUSION There was an increase in the number of referrals during COVID-19. Overall there were a very low number of inappropriate referrals. The telemedicine system has impacted positively in time efficiency especially during COVID-19. It has meant that advice can be given without seeing the patient directly leading to both benefits for the patient and the department.
Collapse
Affiliation(s)
- Jennifer Warner
- University Hospital Plymouth NHS Trust, Derriford Road, Plymouth PL6 8DH, UK.
| |
Collapse
|
8
|
Ziedas A, Castle JP, Abed V, Swantek A, Chaides S, Elhage K, Fife J, Moutzouros V, Makhni EC. Associating Social Determinants of Health With PROMIS CAT Scores and Health Care Utilization After ACL Reconstruction. Orthop J Sports Med 2023; 11:23259671221139350. [PMID: 36683912 PMCID: PMC9850131 DOI: 10.1177/23259671221139350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/15/2022] [Indexed: 01/18/2023] Open
Abstract
Background The term "social determinants of health" (SDOH) refers to social and economic factors that influence a patient's health status. The effect of SDOH on the Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive test (CAT) scores and postoperative resource utilization in patients with anterior cruciate ligament reconstruction (ACLR) have yet to be thoroughly studied. Purpose To investigate the impact SDOH have on PROMIS CAT outcomes and postoperative resource utilization in patients with ACLR. Study Design Cohort study; Level of evidence, 3. Methods The electronic medical record was used to identify the SDOH for patients who underwent ACLR by 1 of 3 sports medicine fellowship-trained orthopaedic surgeons between July 2017 and April 2020. PROMIS CAT measures of Physical Function (PROMIS-PF), Pain Interference (PROMIS-PI), and Depression (PROMIS-D) were completed at the preoperative, 6-month postoperative, and 12-month postoperative time points. Postoperative health care utilization was recorded as well. Independent 2-group t tests and Wilcoxon rank-sum tests were used to analyze mean differences between patient groups based on SDOH. Results Two-hundred and thirty patients who underwent ACLR were included (mean age, 27 years; 59% male). Compared with White patients, Black patients were represented more frequently in the lowest median household income (MHI) quartile (63% vs 23%, respectively; P < .001). White patients were represented more frequently in the highest area deprivation index (ADI) quartile when compared with Black patients (67% vs 12%, respectively; P = .006). Significantly worse PROMIS-PF, PROMIS-PI, and PROMIS-D scores at all 3 time points were found among patients who were Black, female, smokers, and in the lower MHI quartiles, with higher ADI and public health care coverage. In terms of resource utilization, Black patients attended significantly fewer postoperative physical therapy visits when compared with their respective counterparts. Those in the lower MHI quartiles attended significantly fewer postoperative imaging encounters, and female patients attended significantly more postoperative virtual encounters than male patients. Conclusion Specific SDOH variables, particularly those that reflect racial and socioeconomic disparities, were associated with differences in postoperative health care utilization and ACLR outcomes as measured by PROMIS CAT domains.
Collapse
Affiliation(s)
| | | | - Varag Abed
- Henry Ford Health System, Detroit, Michigan, USA
| | | | | | | | | | | | - Eric C. Makhni
- Henry Ford Health System, Detroit, Michigan, USA.,Eric C. Makhni, MD, MBA, Henry Ford Health System, 2799 W Grand
Boulevard, Detroit, MI 48202, USA (
)
| |
Collapse
|
9
|
Fabrés Martín C, Ventura Parellada C, Herrero Antón de Vez H, Ordoñez Urgiles CE, Alonso-Rodríguez Piedra J, Mora Guix JM. Telemedicine approach for patient follow-up after total knee and reverse total shoulder arthroplasty: a pilot study. Int J Comput Assist Radiol Surg 2023; 18:595-602. [PMID: 36422767 PMCID: PMC9686457 DOI: 10.1007/s11548-022-02784-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 10/20/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE The study aimed to demonstrate the reduction in postoperative follow-up visit time for patients receiving total knee arthroplasty (TKA) or reverse total shoulder arthroplasty (RTSA) by implementing a novel asynchronous telemedicine system compared to face-to-face visits. The range of motion interobserver agreement and patient satisfaction were evaluated in the telemedicine group. METHODS A randomized controlled trial was conducted with a total of 28 patients with a mean age of 71 years (range 13.3). Patients were distributed into two study groups, TKA (n = 14) and RTSA (n = 14), and each group was randomly allocated into a face-to-face or virtual follow-up visit group. For the virtual group, software was designed including patient-specific model items (X-ray, range of motion and functional scores) for each arthroplasty. Functional assessment was conducted using the International Knee Documentation Committee (IKDC) score for TKA and American Shoulder and Elbow score (ASES) and Simple Shoulder Test (SST) for RTSA. The range of motion interobserver concordance was conducted in the virtual follow-up groups via an intraclass correlation coefficient. Finally, a satisfaction survey was performed in the virtual follow-up groups. Mann-Whitney U test was used for statistical analysis. RESULTS Mean time differences between face-to-face and virtual follow-ups were 502.5 s (95% CI 387.8-617.1; p < 0.002) in the RTSA group and 710 s (95% CI 597.91-822; p < 0. 002) in the TKA group. The range of motion interobserver concordance in the virtual group was 0.974 for TKA and 0.804 for RTSA. Finally, virtual follow-up satisfaction using the telematic method was 8.9 out of 10. CONCLUSION The results of this study showed that a virtual follow-up using asynchronous telemedicine systems could reduce visit times, allow a correct articular range of motion evaluation and maintain satisfaction perception for patients. Asynchronous telemedicine could be an efficient method to conduct postoperative follow-up after knee and shoulder arthroplasty.
Collapse
Affiliation(s)
- Carles Fabrés Martín
- Department of Orthopedic Surgery, Consorci Sanitari de Terrassa, Terrassa, Spain.
| | | | - Hugo Herrero Antón de Vez
- Clinic for Plastic, Reconstructive, Hand and Burn Surgery, München Klinik Bogenhausen, Munich, Germany
| | | | | | - José María Mora Guix
- Department of Orthopedic Surgery, Consorci Sanitari de Terrassa, Terrassa, Spain
| |
Collapse
|
10
|
Ferorelli D, Moretti L, Benevento M, Mastrapasqua M, Telegrafo M, Solarino B, Dell’Erba A, Bizzoca D, Moretti B. Digital Health Care, Telemedicine, and Medicolegal Issues in Orthopedics: A Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15653. [PMID: 36497728 PMCID: PMC9735483 DOI: 10.3390/ijerph192315653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/17/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
The use of technologies in medicine has great potential to reduce the costs of health care services by making appropriate decisions that provide timely patient care. The evolution of telemedicine poses a series of clinical and medicolegal considerations. However, only a few articles have dealt with telemedicine and orthopedics. This review assesses the ethical and medicolegal issues related to tele-orthopedics. A systematic review was performed including papers published between 2017 and 2021 focusing on the main medicolegal and clinical-governance aspects of tele-orthopedics. Most of the articles were published during the COVID-19 pandemic, confirming the impetus that the pandemic has also given to the spread of telemedicine in the orthopedic field. The areas of interest dealt with in the scientific evidence, almost exclusively produced in the USA, Europe, the UK, and Canada, are quality, patient satisfaction, and safety. The impact of telemedicine in orthopedics has not yet been fully evaluated and studied in terms of the potential medicolegal concerns. Most of the authors performed qualitative studies with poor consistency. Authorizations and accreditations, protection of patient confidentiality, and professional responsibility are issues that will certainly soon emerge.
Collapse
Affiliation(s)
- Davide Ferorelli
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari, 70121 Bari, Italy
| | - Lorenzo Moretti
- Orthopedics and Trauma Unit, AOUC Policlinico di Bari, Department DiBraiN, University of Bari “Aldo Moro”, 70121 Bari, Italy
| | - Marcello Benevento
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari, 70121 Bari, Italy
| | - Maurizio Mastrapasqua
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari, 70121 Bari, Italy
| | - Michele Telegrafo
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari, 70121 Bari, Italy
| | - Biagio Solarino
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari, 70121 Bari, Italy
| | - Alessandro Dell’Erba
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari, 70121 Bari, Italy
| | - Davide Bizzoca
- Orthopedics and Trauma Unit, AOUC Policlinico di Bari, Department DiBraiN, University of Bari “Aldo Moro”, 70121 Bari, Italy
| | - Biagio Moretti
- Orthopedics and Trauma Unit, AOUC Policlinico di Bari, Department DiBraiN, University of Bari “Aldo Moro”, 70121 Bari, Italy
| |
Collapse
|
11
|
Muschol J, Heinrich M, Heiss C, Hernandez AM, Knapp G, Repp H, Schneider H, Thormann U, Uhlar J, Unzeitig K, Gissel C. Economic and Environmental Impact of Digital Health App Video Consultations in Follow-up Care for Patients in Orthopedic and Trauma Surgery in Germany: Randomized Controlled Trial. J Med Internet Res 2022; 24:e42839. [PMID: 36333935 PMCID: PMC9732751 DOI: 10.2196/42839] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/01/2022] [Accepted: 11/04/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Following the Riyadh Declaration, digital health technologies were prioritized in many countries to address the challenges of the COVID-19 pandemic. Digital health apps for telemedicine and video consultations help reduce potential disease spread in routine health care, including follow-up care in orthopedic and trauma surgery. In addition to the satisfaction, efficiency, and safety of telemedicine, its economic and environmental effects are highly relevant to decision makers, particularly for the goal of reaching carbon neutrality of health care systems. OBJECTIVE This study aims to provide the first comprehensive health economic and environmental analysis of video consultations in follow-up care after knee and shoulder interventions in an orthopedic and trauma surgery department of a German university hospital. The analysis is conducted from a societal perspective. We analyze both economic and environmental impacts of video consultations, taking into account the goal of carbon neutrality for the German health care system by 2030. METHODS We conducted a prospective randomized controlled trial comparing follow-up care with digital health app video consultations (intervention group) to conventional face-to-face consultations in the clinic (control group). Economic impact included the analysis of travel and time costs and production losses. Examination of the environmental impact comprised the emissions of greenhouse gases, carbon monoxide, volatile hydrocarbons, nitrogen oxides, and particulates, and the calculation of environmental costs. Sensitivity analysis included calculations with a higher cost per ton of carbon dioxide equivalent, which gives equal weight to the welfare of present and future generations. RESULTS Data from 52 patients indicated that, from the patients' point of view, telemedicine helped reduce travel costs, time costs, and production losses, resulting in mean cost savings of €76.52 per video consultation. In addition, emissions of 11.248 kg of greenhouse gases, 0.070 kg of carbon monoxide, 0.011 kg of volatile hydrocarbons, 0.028 kg of nitrogen oxides, and 0.0004 kg of particulates could be saved per patient through avoided travel. This resulted in savings of environmental costs between €3.73 and €9.53 per patient. CONCLUSIONS We presented the first comprehensive analysis of economic and environmental effects of telemedicine in the follow-up care of patients in orthopedic and trauma surgery in Germany. Video consultations were found to reduce the environmental footprint of follow-up care; saved travel costs, travel time, and time costs for patients; and helped to lower production losses. Our findings can support the decision-making on the use of digital health during and beyond the COVID-19 pandemic, providing decision makers with data for both economic and environmental effects. Thanks to the pragmatic design of our study, our findings can be applied to a wide range of clinical contexts and potential digital health applications that substitute outpatient hospital visits with video consultations. TRIAL REGISTRATION German Clinical Trials Register DRKS00023445; https://tinyurl.com/4pcvhz4n.
Collapse
Affiliation(s)
- Jennifer Muschol
- Department of Health Economics, Justus Liebig University Giessen, Giessen, Germany
| | - Martin Heinrich
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen, Giessen, Germany
| | - Christian Heiss
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen, Giessen, Germany
| | - Alher Mauricio Hernandez
- Bioinstrumentation and Clinical Engineering Research Group, Bioengineering Department, Engineering Faculty, Universidad de Antioquia, Medellín, Colombia
| | - Gero Knapp
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen, Giessen, Germany
| | - Holger Repp
- Department of Health Economics, Justus Liebig University Giessen, Giessen, Germany
| | - Henning Schneider
- Institute of Medical Informatics, Justus Liebig University Giessen, Giessen, Germany
| | - Ulrich Thormann
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen, Giessen, Germany
| | - Johanna Uhlar
- Institute of Medical Informatics, Justus Liebig University Giessen, Giessen, Germany
| | - Kai Unzeitig
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen, Giessen, Germany
| | - Christian Gissel
- Department of Health Economics, Justus Liebig University Giessen, Giessen, Germany
| |
Collapse
|
12
|
Patient Preferences Regarding Telemedicine to In-person Consultation: A Questionnaire-Based Survey. Indian J Orthop 2022; 56:2202-2209. [PMID: 36189122 PMCID: PMC9510221 DOI: 10.1007/s43465-022-00750-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 09/08/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Telemedicine has been evolving over the last two decades; however, with the advent of the COVID 19 pandemic, its utility and acceptance have drastically increased. Most studies report increasing acceptability and satisfaction rates. This study aimed to assess patient preferences regarding telemedicine to in-person consultations and to attempt to assess the factors driving these preferences. MATERIAL AND METHODS A questionnaire-based cross-sectional study was conducted for patients who had both teleconsultation and in-person consultation in the orthopedic outpatient. After obtaining consent to participate in the study, the patients were divided into broad clinical categories and responses were recorded regarding the treatment of illness by the doctor and opinions regarding telemedicine. Most questions were in yes/no or a Likert-based questionnaire. Mean, median, percentage and proportions were used for statistical analysis of the data. RESULTS The study group included 264 patients, with the majority with fractures and dislocations. Most patients (55.7%) were comfortable using the software for teleconsultation, and half the respondents found telemedicine convenient. A large percentage of the study group preferred in-person consultation to teleconsultation (58.7%), and the primary reasons for discontinuing teleconsultation were dissatisfaction during the interaction with the doctor and poor connectivity to telecommunication networks. CONCLUSION Telecommunication has high acceptance and satisfaction, but many factors limit its acceptance in developing countries.
Collapse
|
13
|
Grata-Borkowska U, Sobieski M, Drobnik J, Fabich E, Bujnowska-Fedak MM. Perception and Attitude toward Teleconsultations among Different Healthcare Professionals in the Era of the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11532. [PMID: 36141806 PMCID: PMC9517420 DOI: 10.3390/ijerph191811532] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/30/2022] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
Teleconsultation has become one of the most important and sometimes the only possible forms of communication between healthcare professionals (HCPs) and their patients during the COVID-19 pandemic. The perceptions and attitudes of HCPs to teleconsultations may affect the quality of the therapeutic process provided using them. Therefore, this study aimed to understand the attitudes to and perceptions of medical teleconsultation among various HCPs during the COVID-19 pandemic. We analyzed data from a dedicated questionnaire on preferences, attitudes, and opinions about teleconsultation, which was filled by 780 Polish HCPs. Most of the HCPs were doctors and nurses (69% and 19%, respectively); most of the doctors were family physicians (50.1%). During the pandemic, teleconsultation and face-to-face contact were reported as the preferred methods of providing medical services with similar frequency. Doctors and nurses displayed the most positive attitude toward teleconsultation while the paramedics and physiotherapists took the least positive view of it. The most frequently indicated ratio of the optimal number of teleconsultations to in-person visits in primary health facilities care was 20%:80%. Most HCPs appreciate the value of teleconsultation, and more than half of them are willing to continue this form of communication with the patient when necessary or desirable.
Collapse
Affiliation(s)
| | - Mateusz Sobieski
- Department of Family Medicine, Wroclaw Medical University, 51-141 Wroclaw, Poland
| | - Jarosław Drobnik
- Department of Family Medicine, Wroclaw Medical University, 51-141 Wroclaw, Poland
- Department of Epidemiology and Health Education, Wroclaw Medical University, 50-372 Wroclaw, Poland
| | - Ewa Fabich
- Jan Mikulicz-Radecki University Teaching Hospital, 50-556 Wroclaw, Poland
| | | |
Collapse
|
14
|
Moisan P, Barimani B, Martineau P. Difficult access to medical care in times of COVID-19: late presentation of locked anterior shoulder dislocation: a case report. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:380-383. [PMID: 35502193 PMCID: PMC9044717 DOI: 10.1016/j.xrrt.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Philippe Moisan
- McGill University, Faculty of Medicine, Montreal, QC, Canada
| | - Bardia Barimani
- Division of Orthopedic Surgery, McGill University, Montreal, QC, Canada
| | - Paul Martineau
- Division of Orthopedic Surgery, McGill University, Montreal, QC, Canada
| |
Collapse
|
15
|
Gribkova Y, Davis CH, Greenbaum AA, Lu S, Berger AC. Effect of the COVID‐19 pandemic on surgical oncology practice—Results of an SSO survey. J Surg Oncol 2022; 125:1191-1199. [PMID: 35249232 PMCID: PMC9088533 DOI: 10.1002/jso.26839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 02/21/2022] [Indexed: 11/24/2022]
Abstract
Background and Objectives The COVID‐19 pandemic significantly affected healthcare delivery, shifting focus away from nonurgent care. The aim of this study was to examine the impact of the pandemic on the practice of surgical oncology. Methods A web‐based survey of questions about changes in practice during the COVID‐19 pandemic was approved by the Society of Surgical Oncology (SSO) Research and Executive Committees and sent by SSO to its members. Results A total of 121 SSO members completed the survey, 77.7% (94/121) of whom were based in the United States. Breast surgeons were more likely than their peers to refer patients to neoadjuvant therapy (p = 0.000171). Head and neck surgeons were more likely to refer patients to definitive nonoperative treatment (p = 0.044), while melanoma surgeons were less likely to do so (p = 0.029). In all, 79.2% (95/120) of respondents are currently using telemedicine. US surgeons were more likely to use telemedicine (p = 0.004). Surgeons believed telemedicine is useful for long‐term/surveillance visits (70.2%, 80/114) but inappropriate (50.4%, 57/113) for new patient visits. Conclusion COVID‐19 pandemic resulted in increased use of neoadjuvant therapy, delays in operative procedures, and increased use of telemedicine. Telemedicine is perceived to be most efficacious for long‐term/surveillance visits or postoperative visits.
Collapse
Affiliation(s)
- Yelizaveta Gribkova
- Rutgers Robert Wood Johnson University Medical School New Brunswick New Jersey USA
| | - Catherine H. Davis
- Rutgers Robert Wood Johnson University Medical School New Brunswick New Jersey USA
- Division of Surgical Oncology Rutgers Cancer Institute of New Jersey New Brunswick New Jersey USA
| | - Alissa A. Greenbaum
- Rutgers Robert Wood Johnson University Medical School New Brunswick New Jersey USA
- Division of Surgical Oncology Rutgers Cancer Institute of New Jersey New Brunswick New Jersey USA
| | - Shou‐en Lu
- Department of Biostatistics Rutgers University School of Public Health New Brunswick New Jersey USA
| | - Adam C. Berger
- Rutgers Robert Wood Johnson University Medical School New Brunswick New Jersey USA
- Division of Surgical Oncology Rutgers Cancer Institute of New Jersey New Brunswick New Jersey USA
| |
Collapse
|
16
|
85-Year-Old Postsurgical Complex Patient Successfully Managed Remotely at the Novel Mayo Clinic’s Hospital at Home. Case Rep Vasc Med 2022; 2022:1439435. [PMID: 35251735 PMCID: PMC8896952 DOI: 10.1155/2022/1439435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 02/11/2022] [Indexed: 12/02/2022] Open
Abstract
An 85-year-old male presented to the podiatry clinic following a 1st to 5th left toe amputation as a complication of severe peripheral arterial disease and nonhealing wound despite endovascular intervention with an angiogram. At the visit, cellulitis with gangrene of the surgical site was noted. The patient was admitted to the brick and mortar (BAM) hospital and taken to surgery for a transmetatarsal amputation of the left limb. In the immediate postoperative period, the incisional margins appeared dusky creating concern for flap viability. The medical team recommended a vascular bypass versus a below-knee amputation. However, given the age, comorbidities, and nutritional status, the family refused further surgical intervention. As such, Mayo Clinic's home hospital program, Advanced Care at Home (ACH), was consulted for continued nonsurgical acute management at home. The patient was transferred to ACH and transported home three days after BAM admission to continue IV antibiotic therapy and wound care. Discharge from ACH occurred 11 days after admission to the BAM hospital. This case highlights the importance of developing health care alternatives to traditional hospitalization and demonstrates that ACH can manage highly complex, elder postoperative patients from the comfort of their homes.
Collapse
|
17
|
Management of resources for orthopedic oncology and trauma patients during COVID-19 pandemic: A retrospective cohort study. SRP ARK CELOK LEK 2022. [DOI: 10.2298/sarh210318027o] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction/Objective. This study aims to evaluate changes in surgical
strategy and orthopedic epidemiology, and to compare the frequency of
surgeries before and during the COVID-19 pandemic. Methods. For periods
from April 1 to May 31 in years 2019 and 2020, retrospective data on patient
demographics and types of orthopedic surgical procedures were obtained from
hospital databases in a tertiary referral hospital. Results. During the
COVID-19 pandemic, the most common orthopedic surgical procedures performed
were trauma surgery (n = 81), while other procedures were referred to
oncology (n = 19), biopsy (n = 11), debridement (n = 10), amputation (n =
6), surgery of dysplastic hip (n = 5) and knee ligament repair (n = 1). The
majority of trauma cases were hip fracture surgeries (n = 23). The mean age
of patients was 70.5 years. Sixty-three patients were female and seventy
were male. Only one patient had a history of COVID-19 infection. In the same
period during the year before the pandemic, 86 patients had trauma surgery,
while 49 had oncological surgery and the mean patient?s age was 54.5.
Sixty-two patients were female, and seventy-three were male in this group.
The number of tumor surgeries before the pandemic was higher compared to the
same period during the pandemic (p < 0.05). Conclusion. During the
pandemic, although all orthopedic surgeries decreased, the rate of
osteoporotic hip fractures surgery was similar as in pre-pandemic state.
This finding emphasizes the increased need to implement preventive measures
regarding hip fractures during lockdown periods. The relation of hip and
spine osteoporotic fractures surgery was not different before and during the
pandemic.
Collapse
|
18
|
Choemprayong S, Charoenlap C, Piromsopa K. Exploring Usability Issues of a Smartphone-Based Physician-to-Physician Teleconsultation App in an Orthopedic Clinic: Mixed Methods Study. JMIR Hum Factors 2021; 8:e31130. [PMID: 34931991 PMCID: PMC8726029 DOI: 10.2196/31130] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/02/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background Physician-to-physician teleconsultation has increasingly played an essential role in delivering optimum health care services, particularly in orthopedic practice. In this study, the usability of a smartphone app for teleconsultation among orthopedic specialists was investigated to explore issues informing further recommendations for improvement in the following iterations. Objective This study aimed to explore usability issues emerging from users’ interactions with MEDIC app, a smartphone-based patient-centered physician-to-physician teleconsultation system. Methods Five attending physicians in the Department of Orthopedics in a large medical school in Bangkok, Thailand, were recruited and asked to perform 5 evaluation tasks, namely, group formation, patient registration, clinical data capturing, case record form creation, and teleconsultation. In addition, one expert user was recruited as the control participant. Think aloud was adopted while performing the tasks. Semistructured interviews were conducted after each task and prior to the exit. Quantitative and qualitative measures were used to identify usability issues in 7 domains based on the People At the Centre of Mobile Application Development model: effectiveness, efficiency, satisfaction, learnability, memorability, error, and cognitive load. Results Several measures indicate various aspects of usability of the app, including completion rates, time to completion, number of clicks, number of screens, errors, incidents where participants were unable to perform tasks, which had previously been completed, and perceived task difficulty. Major and critical usability issues based on participant feedback were rooted from the limitation of screen size and resolution. Errors in data input (eg, typing errors, miscalculation), action failures, and misinterpretation of data (ie, radiography) were the most critical and common issues found in this study. A few participants did not complete the assigned tasks mostly owing to the navigation design and misreading/misunderstanding icons. However, the novice users were quite positive that they would be able to become familiar with the app in a short period of time. Conclusions The usability issues in physician-to-physician teleconsultation systems in smartphones, in general, are derived from the limitations of smartphones and their operating systems. Although some recommendations were devised to handle these usability issues, usability evaluation for additional development should still be further investigated.
Collapse
Affiliation(s)
- Songphan Choemprayong
- Department of Library Science, Faculty of Arts, Chulalongkorn University, Bangkok, Thailand.,Behavioral Research and Informatics in Social Science Research Unit, Sasin School of Management, Chulalongkorn University, Bangkok, Thailand
| | - Chris Charoenlap
- Department of Orthopaedic, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Krerk Piromsopa
- Department of Computer Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
19
|
Jarragh A, Lari A, Al-Shatti A, Alloughani E, Alawadhi K. Traumatic orthopedic consultations in COVID-19 inpatients - A cross sectional analysis of results and a review of lessons in tele-orthopedics. Ann Med Surg (Lond) 2021; 73:103155. [PMID: 34900245 PMCID: PMC8653516 DOI: 10.1016/j.amsu.2021.103155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/02/2021] [Accepted: 12/02/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction COVID-19 has led to intricate global challenges, among these, the impact on emergency and elective orthopedic services. Patients with COVID-19 often complain of musculoskeletal symptoms. The subsequent orthopedic consultations require careful assessment of possible inpatient trauma and to rule out any injuries that require active management. Methods A retrospective cross-sectional analysis involving 13,580 admitted patients in a national quarantine center between March 2020 and April 2021. All patients with orthopedic consultations were included in the study, and were assessed by orthopedic surgeons in person. Patients were further evaluated for age, sex, presence of trauma, cause for consultation, diagnosis and management. Results Seventy-five orthopedic consultations were included, 44% females and 56% males. Of the 75 consultations, 29 (38%) were related to a history of inpatient trauma. Of the 29 cases, 11 sustained fractures of the distal radius, proximal humerus, femoral neck, clavicle and ankle. Four of which were treated operatively. Discussion and conclusion Inpatient orthopedic consultations must be assessed carefully to avoid misdiagnoses. Elderly or frail patients are more likely to both; sustain trauma and fractures. Potential limitations of tele-orthopedics may be apparent here, especially in the presence of technological incompetence and high likelihood of fractures.
Collapse
Affiliation(s)
- Ali Jarragh
- Department of Orthopedic Surgery, Jaber Alahmed Alsabah Hospital, Kuwait
| | - Ali Lari
- Department of Orthopedic Surgery, AlRazi Hospital, Kuwait
| | | | | | | |
Collapse
|
20
|
Cole PA, Lezak BA, Schroder LK, Cole PA. Global orthopaedic trauma surgeons highlight telenomics during the COVID-19 era: A case for advancing telemedicine in orthopaedics. J Clin Orthop Trauma 2021; 17:182-185. [PMID: 33814860 PMCID: PMC7997301 DOI: 10.1016/j.jcot.2021.03.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/16/2021] [Accepted: 03/16/2021] [Indexed: 11/19/2022] Open
Abstract
The Coronavirus (COVID-19) pandemic sparked rapid widespread adoption of telemedicine throughout specialties, including orthopaedics. A succession of factors, starting with payers, followed by provider adoption, and reciprocated by patient approval, created newly accepted telehealth practices that have moved from trial to norm in a short time span. Orthopaedic surgeons believe telehealth will endure as a permanent change to their practice beyond the COVID-19 era, however, many permanent changes must take place by payers, providers, and patients to sustain telehealth into the future. The goal of this paper is to highlight the indelibility of telemedicine adoption in orthopaedic practices globally, characterize the chain of events that led to its large-scale adoption, and catalyze discussion around actionable next steps to sustain its benefits.
Collapse
Affiliation(s)
- Peter A. Cole
- Miami Herbert Business School, Coral Gables, FL, USA
| | - Bradley A. Lezak
- Miller School of Medicine, University of Miami, Miami, FL, USA
- Corresponding author. University of Miami Miller School of Medicine Miami, FL, USA.
| | - Lisa K. Schroder
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
- Department of Orthopaedic Surgery, Regions Hospital, St. Paul, MN, USA
| | - Peter A. Cole
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
- Department of Orthopaedic Surgery, Regions Hospital, St. Paul, MN, USA
- Health Partners Orthopaedics & Sports Medicine, Bloomington, MN, USA
| |
Collapse
|