1295 Virtual Fracture Clinic: An Audit of Referral Quality and Service Effectiveness

Aim

Assessment of referral quality to the virtual fracture clinic (VFC) at the Liverpool University Hospital foundation trust compared to the standards set out by the Glasgow virtual fracture clinic pathway. As a secondary aim the effectiveness of the VFC in diverting patients not requiring further clinical management away from face-to-face specialist physical fracture clinics (PFC) was assessed.

Method

Outcomes of 1st attendances were collected for standard PFC's before the implementation of the VFC at our centre. This data was comparatively analysed to the outcomes of 1st ‘attendances' of VFCs post-service implementation. To assess VFC referral quality fracture type was recorded and compared to the standard set out by the Glasgow virtual fracture pathway which states that a selection of simple stable fractures should be discharged from ED directly with patient advice and telephone support.

Results

We analysed 529 PFC first attendances and 402 VFC first attendances. We saw a variety of simples stable fractures (21%) in the VCF including: Distal radial, Fifth metatarsal, Minor radial head, Fifth metacarpal, Mallet finger, which could have been managed with direct ED discharge and telephone support. 19.4% of PFC attendance resulted in discharge without a change in management as compared to 22.1% of 1st attendances for the VFC.

Conclusions

The VFC clinic has shown itself as an effective service in re-directing patients from face-to-face appointments, evidenced by the comparative rates of patient discharge on first attendance. This study has laid the foundation for improving referral quality to the VFC. Collaborative efforts between Orthopaedics and ED could improve VFC clinic efficiency further.

Farmers' perceptions, knowledge, and management of coffee pests and diseases and their natural enemies in Chiapas, Mexico

Small farmers' perceptions of coffee Coffea arabica L. herbivores and their natural enemies, how those perceptions relate to field infestation levels, and pest management practices being implemented by members from two organic and nonorganic coffee grower organizations in the Soconusco region, southeastern Mexico, were analyzed through an interview survey, diagnostic workshops, and field sampling. The terms pest, disease, and damage were commonly used as synonyms. The major phytophagous species, as perceived by the interviewees, were Hypothenemus hampei (Ferrari), and to a lesser extent the fungi Corticium koleroga Cooke (Höhnel) and Hemileia vastatrix Berkeley & Broome. Among the nonorganic farmers, other nonpest-related constraints were regarded as more important. Awareness of the existence of natural enemies was low, despite more organic farmers have used the ectoparasitoid bethylid Cephalonomia stephanoderis Betrem against H. hampei. Labor supplied by household members was most frequent for pest control; only organic farmers exchanged labor for this purpose. The levels of infestation by H. hampei, Leucoptera coffeella Guérin-Méneville, and C. koleroga were lower within the organic coffee stands. However, a low effectiveness for pest control was commonly perceived, probably due to a feeling, among the organic farmers, of a low impact of their pest management extension service, whereas a lack of motivation was prevalent among the nonorganic farmers, shown by a concern with their low coffee yields and the emigration of youth. The importance of understanding farmers' perceptions and knowledge of pests and their natural enemies and the need for participatory pest management approaches, are discussed.

[Poisoning by paralytic molluscan toxins in Oaxaca]

Toxic Red Tides are caused by marine dinoflagellates which synthesize neurotoxins that accumulate in bivalve mollusks. Upon ingestion, these shellfish can cause paralysis and death. During the month of December, 1989, 99 cases of Paralytic Shellfish Poisoning in the areas of Salina Cruz and Huatulco, Oaxaca, were reported; three of which died. The majority of the cases involved the ingestion of oysters and clams. A short time later, the Red Tide was reported appearing. One hundred and fifteen seafood samples were analyzed through a biologic test in mice to determine the quantity of saxitoxin. Oysters and clams showed levels reaching 4 000 U.R. Laboratory analysis of seawater found very high quantities of Gimnodinium catenatum and Gonyaulax catenella. The control measures consisted of the prohibition of the harvest and sale of all bivalve mollusks as well as a public warning to avoid the consumption of such shellfish.