BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has resulted in seismic changes in healthcare delivery.As a result of this,hospital footfall required to be reduced due to increased risk of transmission of in...BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has resulted in seismic changes in healthcare delivery.As a result of this,hospital footfall required to be reduced due to increased risk of transmission of infection.To ensure patients can safely access healthcare,we introduced orthopaedic clinic telephone consultations in our busy district general hospital.AIM To investigate patients’and clinicians’perspective of telephone consultations during COVID-19,and whether this method of consultation could be a viable option in the post-pandemic future.METHODS This is a single centre,prospective study conducted in a busy National Health Service district general hospital.In May 2020,100 non-consecutive adult patients were contacted by independent investigators within 48 h of their orthopaedic clinic telephone consultation to complete a telephone satisfaction questionnaire.The questions assessed satisfaction regarding various aspects of the consultation including overall satisfaction and willingness to use this approach long term.Satisfaction and perspective of 25 clinicians conducting these telephone consultations was also assessed via an online survey tool.RESULTS 93%of patients were overall satisfied with telephone consultations and 79%were willing to continue this method of consultation post-pandemic.Patients found telephone consultations to reduce personal cost and inconvenience associated with attending a hospital appointment.72%of clinicians reported overall satisfaction with this service and 80%agreed that telephone consultations should be used in the future.The majority found it less laborious in time and administration in comparison to face to face consultations.Patients and clinicians expressed their desire for video consultations as a method of further improving their experience with remote consultations.CONCLUSION Our study has shown that telephone consultations are a safe and rapid method of adaptation to the COVID-19 pandemic,achieving the aim of reducing hospital footfall.This method of consultation has resulted in immense clinician and patient satisfaction.Our findings suggest that this tool has benefits in post pandemic healthcare delivery.It has also highlighted that telephone consultations can act as a steppingstone to the introduction of the more complex platform of video consulting.展开更多
BACKGROUND Pediatric functional gastrointestinal disorders(FGIDs)are common and wellaccepted to be etiologically complex in terms of the contribution of biological,psychological,and social factors to symptom presentat...BACKGROUND Pediatric functional gastrointestinal disorders(FGIDs)are common and wellaccepted to be etiologically complex in terms of the contribution of biological,psychological,and social factors to symptom presentations.Nonetheless,despite its documented benefits,interdisciplinary treatment,designed to address all of these factors,for pediatric FGIDs remains rare.The current study hypothesized that the majority of pediatric patients seen in an interdisciplinary abdominal pain clinic(APC)would demonstrate clinical resolution of symptoms during the study period and that specific psychosocial variables would be significantly predictive of GI symptom improvement.AIM To evaluate outcomes with interdisciplinary treatment in pediatric patients with pain-related FGIDs and identify patient characteristics that predicted clinical outcomes.METHODS Participants were 392 children,ages 8-18[M=13.8;standard deviation(SD)=2.7],seen between August 1,2013 and June 15,2016 in an interdisciplinary APC housed within the Division of Gastroenterology in a medium-sized Midwestern children's hospital.To be eligible,patients had to be 8 years of age or older and have had abdominal pain for≥8 wk at the time of initial evaluation.Medical and psychosocial data collected as part of standard of care were retrospectively reviewed and analyzed in the context of the observational study.Logistic regression was used to model odds of reporting vs never reporting improvement,as well as to differentiate rapid from slower improvers.RESULTS Nearly 70%of patients followed during the study period achieved resolution on at least one of the employed outcome indices.Among those who achieved resolution during follow up,43%to 49%did so by the first follow up(i.e.,within roughly 2 mo after initial evaluation and initiation of interdisciplinary treatment).Patient age,sleep,ease of relaxation,and depression all significantly predicted the likelihood of resolution.More specifically,the odds of clinical resolution were 14%to 16%lower per additional year of patient age(P<0.001 to P=0.016).The odds of resolution were 28%to 42%lower per 1-standard deviation(SD)increase on a pediatric sleep measure(P=0.006 to P<0.040).Additionally,odds of clinical resolution were 58%lower per 1-SD increase on parent-reported measure of depression(P=0.006),and doubled in cases where parents agreed that their children found it easy to relax(P=0.045).Furthermore,sleep predicted the rapidity of clinical resolution;that is,the odds of achieving resolution by the first follow up visit were 47%to 60%lower per 1-SD increase on the pediatric sleep measure(P=0.002).CONCLUSION Outcomes for youth with FGIDs may be significantly improved by paying specific attention to sleep,ensuring adequate skills for relaxation,and screening of and referral for treatment of comorbid depression.展开更多
Background: Increasing workload in consultant-led clinics often means patients to wait a long time for clinic appointments. To address this, there is an increasing trend in developing nurse-led clinics across many spe...Background: Increasing workload in consultant-led clinics often means patients to wait a long time for clinic appointments. To address this, there is an increasing trend in developing nurse-led clinics across many specialities in the National Health Service. This study aims to assess whether the implementation of a nurse-led clinic in thoracic aortic surgery will optimise the utilisation of health care services and improve overall patient satisfaction. Methods: 80 follow-up patients were asked to complete a questionnaire following their appointment in an aortic clinic, which was led either by a consultant (n = 40) or an aortic specialist nurse (n = 40). All patients seen by a nurse in the clinic were assessed by a consultant surgeon prior to the clinic for suitability. No new patients were seen by a nurse. Any patient with an aortic dimension of 5 cm or greater was seen by the consultant. If there were any complicated clinical features, the patient was seen in the consultant-led clinic. Patients were asked questions about their time spent with the respective health care professionals across 12 categories (punctuality, preparedness, understanding of concerns, clarity of speech, listening, respect, explaining, letting you talk, putting you at ease, emotional support, advice and advice for next follow-up). Patients rated each category using an ordinal scale from 0 - 10. Results: Patient scores were greater in nurse-led clinics compared to consultant-led clinics across a number of categories although only punctuality reached significance (mean 9.2 vs. 6.8, p 0.05). Conclusion: Patients were highly satisfied with the nurse-led clinic across all categories, with greater satisfaction for punctuality. These findings suggest that a nurse-led clinic can be implemented for the management of carefully selected thoracic aortic surgery patient without reduction in patient satisfaction.展开更多
目的探讨多学科会诊(multiple disciplinary team,MDT)联合问题导向教学法(problem based learning,PBL)+案例教学法(case based learning,CBL)教学模式在肝癌临床教学中的应用效果。方法选择2019年10月—2022年6月入院实习的128名临床...目的探讨多学科会诊(multiple disciplinary team,MDT)联合问题导向教学法(problem based learning,PBL)+案例教学法(case based learning,CBL)教学模式在肝癌临床教学中的应用效果。方法选择2019年10月—2022年6月入院实习的128名临床医学专业学生为研究对象,采用抽签法将其分为对照组64名和观察组64名,对照组采取传统教学模式,观察组采取MDT联合PBL+CBL教学模式。对比两组学生考核成绩、对教学效果的认同度、教学满意度。结果观察组考核成绩得分[理论知识(89.01±6.39)分、病例分析(84.16±5.04)分、技能操作(85.19±6.08)分]均高于对照组[理论知识(80.14±5.63)分、病例分析(76.69±5.60)分、技能操作(75.93±5.47)分],差异有统计学意义(P<0.05)。观察组对MDT联合PBL+CBL教学模式能激发学习兴趣(95.31%)、加深对理论知识的理解(100.00%)、提升临床思维能力(93.75%)和临床分析能力(96.88%)、提高理论联系实践的能力(100%)、提升自学能力(96.88%)和团队协作能力(95.31%)的认同度均高于对照组(56.25%、60.94%、39.06%、62.50%、43.75%、35.94%、35.94%),差异有统计学意义(P<0.05)。观察组对教学的满意度(92.19%)高于对照组(51.56%),差异有统计学意义(P<0.05)。结论MDT联合PBL+CBL的肝癌临床教学模式能提高教学质量,提升学生的综合素质。展开更多
文摘BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has resulted in seismic changes in healthcare delivery.As a result of this,hospital footfall required to be reduced due to increased risk of transmission of infection.To ensure patients can safely access healthcare,we introduced orthopaedic clinic telephone consultations in our busy district general hospital.AIM To investigate patients’and clinicians’perspective of telephone consultations during COVID-19,and whether this method of consultation could be a viable option in the post-pandemic future.METHODS This is a single centre,prospective study conducted in a busy National Health Service district general hospital.In May 2020,100 non-consecutive adult patients were contacted by independent investigators within 48 h of their orthopaedic clinic telephone consultation to complete a telephone satisfaction questionnaire.The questions assessed satisfaction regarding various aspects of the consultation including overall satisfaction and willingness to use this approach long term.Satisfaction and perspective of 25 clinicians conducting these telephone consultations was also assessed via an online survey tool.RESULTS 93%of patients were overall satisfied with telephone consultations and 79%were willing to continue this method of consultation post-pandemic.Patients found telephone consultations to reduce personal cost and inconvenience associated with attending a hospital appointment.72%of clinicians reported overall satisfaction with this service and 80%agreed that telephone consultations should be used in the future.The majority found it less laborious in time and administration in comparison to face to face consultations.Patients and clinicians expressed their desire for video consultations as a method of further improving their experience with remote consultations.CONCLUSION Our study has shown that telephone consultations are a safe and rapid method of adaptation to the COVID-19 pandemic,achieving the aim of reducing hospital footfall.This method of consultation has resulted in immense clinician and patient satisfaction.Our findings suggest that this tool has benefits in post pandemic healthcare delivery.It has also highlighted that telephone consultations can act as a steppingstone to the introduction of the more complex platform of video consulting.
文摘BACKGROUND Pediatric functional gastrointestinal disorders(FGIDs)are common and wellaccepted to be etiologically complex in terms of the contribution of biological,psychological,and social factors to symptom presentations.Nonetheless,despite its documented benefits,interdisciplinary treatment,designed to address all of these factors,for pediatric FGIDs remains rare.The current study hypothesized that the majority of pediatric patients seen in an interdisciplinary abdominal pain clinic(APC)would demonstrate clinical resolution of symptoms during the study period and that specific psychosocial variables would be significantly predictive of GI symptom improvement.AIM To evaluate outcomes with interdisciplinary treatment in pediatric patients with pain-related FGIDs and identify patient characteristics that predicted clinical outcomes.METHODS Participants were 392 children,ages 8-18[M=13.8;standard deviation(SD)=2.7],seen between August 1,2013 and June 15,2016 in an interdisciplinary APC housed within the Division of Gastroenterology in a medium-sized Midwestern children's hospital.To be eligible,patients had to be 8 years of age or older and have had abdominal pain for≥8 wk at the time of initial evaluation.Medical and psychosocial data collected as part of standard of care were retrospectively reviewed and analyzed in the context of the observational study.Logistic regression was used to model odds of reporting vs never reporting improvement,as well as to differentiate rapid from slower improvers.RESULTS Nearly 70%of patients followed during the study period achieved resolution on at least one of the employed outcome indices.Among those who achieved resolution during follow up,43%to 49%did so by the first follow up(i.e.,within roughly 2 mo after initial evaluation and initiation of interdisciplinary treatment).Patient age,sleep,ease of relaxation,and depression all significantly predicted the likelihood of resolution.More specifically,the odds of clinical resolution were 14%to 16%lower per additional year of patient age(P<0.001 to P=0.016).The odds of resolution were 28%to 42%lower per 1-standard deviation(SD)increase on a pediatric sleep measure(P=0.006 to P<0.040).Additionally,odds of clinical resolution were 58%lower per 1-SD increase on parent-reported measure of depression(P=0.006),and doubled in cases where parents agreed that their children found it easy to relax(P=0.045).Furthermore,sleep predicted the rapidity of clinical resolution;that is,the odds of achieving resolution by the first follow up visit were 47%to 60%lower per 1-SD increase on the pediatric sleep measure(P=0.002).CONCLUSION Outcomes for youth with FGIDs may be significantly improved by paying specific attention to sleep,ensuring adequate skills for relaxation,and screening of and referral for treatment of comorbid depression.
文摘Background: Increasing workload in consultant-led clinics often means patients to wait a long time for clinic appointments. To address this, there is an increasing trend in developing nurse-led clinics across many specialities in the National Health Service. This study aims to assess whether the implementation of a nurse-led clinic in thoracic aortic surgery will optimise the utilisation of health care services and improve overall patient satisfaction. Methods: 80 follow-up patients were asked to complete a questionnaire following their appointment in an aortic clinic, which was led either by a consultant (n = 40) or an aortic specialist nurse (n = 40). All patients seen by a nurse in the clinic were assessed by a consultant surgeon prior to the clinic for suitability. No new patients were seen by a nurse. Any patient with an aortic dimension of 5 cm or greater was seen by the consultant. If there were any complicated clinical features, the patient was seen in the consultant-led clinic. Patients were asked questions about their time spent with the respective health care professionals across 12 categories (punctuality, preparedness, understanding of concerns, clarity of speech, listening, respect, explaining, letting you talk, putting you at ease, emotional support, advice and advice for next follow-up). Patients rated each category using an ordinal scale from 0 - 10. Results: Patient scores were greater in nurse-led clinics compared to consultant-led clinics across a number of categories although only punctuality reached significance (mean 9.2 vs. 6.8, p 0.05). Conclusion: Patients were highly satisfied with the nurse-led clinic across all categories, with greater satisfaction for punctuality. These findings suggest that a nurse-led clinic can be implemented for the management of carefully selected thoracic aortic surgery patient without reduction in patient satisfaction.
文摘目的探讨多学科会诊(multiple disciplinary team,MDT)联合问题导向教学法(problem based learning,PBL)+案例教学法(case based learning,CBL)教学模式在肝癌临床教学中的应用效果。方法选择2019年10月—2022年6月入院实习的128名临床医学专业学生为研究对象,采用抽签法将其分为对照组64名和观察组64名,对照组采取传统教学模式,观察组采取MDT联合PBL+CBL教学模式。对比两组学生考核成绩、对教学效果的认同度、教学满意度。结果观察组考核成绩得分[理论知识(89.01±6.39)分、病例分析(84.16±5.04)分、技能操作(85.19±6.08)分]均高于对照组[理论知识(80.14±5.63)分、病例分析(76.69±5.60)分、技能操作(75.93±5.47)分],差异有统计学意义(P<0.05)。观察组对MDT联合PBL+CBL教学模式能激发学习兴趣(95.31%)、加深对理论知识的理解(100.00%)、提升临床思维能力(93.75%)和临床分析能力(96.88%)、提高理论联系实践的能力(100%)、提升自学能力(96.88%)和团队协作能力(95.31%)的认同度均高于对照组(56.25%、60.94%、39.06%、62.50%、43.75%、35.94%、35.94%),差异有统计学意义(P<0.05)。观察组对教学的满意度(92.19%)高于对照组(51.56%),差异有统计学意义(P<0.05)。结论MDT联合PBL+CBL的肝癌临床教学模式能提高教学质量,提升学生的综合素质。
