The case for orthopaedic medicine in Israel

Majd H, Moradi A. Investigating a Newly Developed Educational Orthopedic Application for Medical Interns in a Before-after Quasi-clinical Trial Study

BACKGROUND

In COVID 19 era, the literature on e-learning, or particularly m-learning, has considerably increased focusing on the subject of medical knowledge transfer. Considering the importance of orthopedic knowledge for general practitioners and the inadequacy of the orthopedics internship duration in Mashhad University of Medical Sciences (MUMS), we have developed and investigated a smartphone orthopedic educational application named "Orthobox".

METHODS

In a quasi-clinical before-after trial study, we investigated the benefits of Orthobox application for medical interns attending MUMS orthopedic departments. A total of 120 students (64 and 56 students in control and case groups respectively) were recruited. The application consists of five main parts of medication, common order samples, common prescriptions, cast and splint types, and educational movies. Students who passed the course without getting access to the application (control group) and students who were also using application during the course (case group) were defined, and comparison was done between them objectively through final exam score comparison and subjectively through Visual Analogue Scale (VAS) questionnaire score comparison. Besides, using case group students' activity report provided by the application panel, correlational analysis was done on their amount of activity on each of the main parts of the application and the corresponding question exam and VAS score separately.

RESULTS

The case group of the study generally achieved higher final exam scores, mainly on Order question score (P value<0.001). Total VAS scores were also greater in case group (P value =0.001). It has also been identified that there is a notable positive trend between student's amount of usage of the application and their final exam scores through correlational analysis. This correlation was not significant about students' application visit numbers and VAS scores.

CONCLUSION

These results suggest that m-learning has got the potential to improve students' medical knowledge and skills by organizing must-to-learn content specified for intern students of orthopedics on one hand, and cause more satisfaction in students about their education on the other hand.

TRIAL REGISTRATION

This study was not registered because it is a quasi-clinical trial study.

LEVEL OF EVIDENCE

Level III (Evidence obtained from well-designed controlled trials without randomization (i.e. quasi-experimental).

Delayed discharges from a tertiary teaching hospital in Israel- incidence, implications, and solutions

Objectives

The Israeli health system is facing high workloads with average occupancy in certain hospital wards of around 100%. Since there is a shortage of hospitalization beds in institutions for continuous, long-term care, transferring patients from the general hospitals’ wards is often delayed. This situation has many significant ramifications, to the waiting patients themselves, to other patients who are waiting to be treated and to the entire organization. In this study, we describe the phenomenon of the “detained patients” - its extent, characteristics, significance, and possible solutions.

Materials and methods

Rambam Health Care Campus is a tertiary medical center serving the population of the northern part of Israel. In recent years, the hospital management documents data regarding the “detained patients”. We reviewed hospital data of detained patients over a period of nine months. The data concerning adult patients awaiting transfer to an institution for continuous care, between May 2019 and January 2020, were obtained retrospectively from the computerized database of the social service.

Results

During the study period, 12,723 adult patients were discharged. Of those, 857 patients (6.74%) were transferred to one of the facilities providing prolonged institutional care. For that group of patients, median inpatient waiting time from the decision to discharge until the transfer was 8 days (IQR 6–14), translating to 10,821 waiting days or 1202 hospitalization days per month. These hospitalization days account for 9.35% of the total hospitalization days during the study period. The “detained patients” were hospitalized in internal medicine wards (32%), orthopedic (30%), and neurology/neurosurgery (26%) departments. At any given moment, about 40 hospitalized patients were waiting for long-term care facilities.

Conclusions

Health-care systems must adapt to the current patients’ case-mix to achieve optimal utilization of hospital beds and maximal operational efficiency. The number of long-term care beds should be increased, the coordination between general hospitals, health maintenance organizations and long-term facilities improved, and patients that may require long term care after the acute phase of their illness should be early identified and addressed. Meanwhile, establishment of organic units for waiting patients and reorganization of the hospital structure should be considered.

It's a pain in the neck! Who can help me?

Orthopaedic surgery is a long established surgical specialty. Practitioners complete training which focuses on those musculo-skeletal conditions for which surgery is the preferred treatment option. Diagnosis and assessment are performed to exclude those for whom surgical intervention is not indicated. Finestone and others argue in their recent IJHPR paper that we need a subspecialty to cater for these patients - medical orthopaedics. They explain that almost all of the very many patients who seek help for musculo-skeletal conditions do not need surgery, and that orthopaedic surgeons are ill equipped to deal with their complaints and have little to offer. Their paper sets out the case for a new discipline of medical orthopaedics to complement the discipline of orthopaedic surgery.This commentary examines the case for a new approach to musculo skelketal conditions. It discusses the steps which might be needed to decide whether any new discipline should be established, and goes on to set the terms for a debate on the merits of a multidisciplinary approach compared to a purely medical one. Leadership in clinical disciplines has historically rested with medically qualified health professionals. Nowadays this has given way to an understanding that health problems, especially long term conditions, commonly benefit from different expertises coming together. For musculoskeletal conditions, might this be an example where the best outcome would be to look beyond a medically led model?This is a commentary on http://www.ijhpr.org/content/2/1/42/.