Telehealth in surgery: an umbrella review.

BACKGROUND: Telehealth use has increased worldwide during the COVID-19 pandemic. However, hands-on requirements of surgical care may have resulted in slower implementation. This umbrella review (review of systematic reviews) evaluated the perceptions, safety and implementation of telehealth services in surgery, and telehealth usage in Australia between 2020 and 2021. METHODS: PubMed was searched from 2015 to 2021 for systematic reviews evaluating real-time telehealth modalities in surgery. Outcomes of interest were patient and provider satisfaction, safety, and barriers and facilitators associated with its use. Study quality was appraised using the AMSTAR 2 tool. A working group of surgeons provided insights into the clinical relevance to telehealth in surgical practice of the evidence collated. RESULTS: From 2025 identified studies, 17 were included, which were of low to moderate risk of bias. Patient and provider satisfaction with telehealth was high. Time savings, decreased healthcare resource use and lower costs were reported as key advantages of the service. Inability to perform comprehensive examinations was noted as the primary barrier. In Australia, peak telehealth usage coincided with the introduction of temporary telehealth services and increased lockdown measures. CONCLUSIONS: Patients and providers are broadly satisfied with telehealth and its benefits. Barriers may be overcome via multidisciplinary collaboration. Telehealth may benefit surgical care long-term if implemented correctly both during and after the COVID-19 pandemic.

Development and validation of 2 probe-hybridization quantitative PCR assays for rapid detection of a pathogenic Coxiella species in captive psittacines.

Avian coxiellosis is an emerging cause of morbidity and mortality among captive psittacines, and the utility of a rapid detection test using easily obtained samples is paramount in a clinical setting. New sequences were obtained from 3 genes: groEL, dnaK, and rpoB. We developed probe-hybridization quantitative PCR (qPCR) assays using groEL and dnaK genes. Samples, including splenic aspirates, liver aspirates, whole blood, and choanal, conjunctival, and cloacal swabs, were collected from 4 psittacine species including 3 blue-and-gold macaws (Ara ararauna), 2 scarlet-chested parrots (Neophema splendida), 1 Timneh African grey parrot (Psittacus timneh), and 1 yellow-naped Amazon parrot (Amazona auropalliata). Retrospective review of postmortem findings from 3 of these psittacines included splenomegaly, hepatitis, and/or transmission electron microscopy confirmation consistent with previous reports of avian coxiellosis. There was 100% agreement between these assays and consensus PCR with sequencing. A Wilcoxon rank-sum test found a strong correlation between groEL and dnaK cycle threshold values (p < 0.001), validating these assays for detection of this avian Coxiella sp.

Sources of information used by patients prior to elective surgery: a scoping review.

OBJECTIVE: To describe the range and nature of available research regarding sources of information that patients access to inform their decisions about elective surgery. DESIGN: Scoping review. DATA SOURCES: Peer-reviewed studies published until February 2019 from the six scientific literature databases were searched and included in the study: Medline, PubMed, CINAHL, Academic Search Premier, EMBASE and SCOPUS. Web searches for grey literature were conducted in Google, South Australia Department of Health, Commonwealth Department of Health (Australia) and My Aged Care from the Department of Social Services (Australia). ELIGIBILITY CRITERIA: Studies with a focus on elective surgery information sources oriented to patients were eligible for inclusion. Only studies written in English were sought and no publication date or study restrictions were applied. DATA EXTRACTION AND SYNTHESIS: Included literature was described by National Health and Medical Council hierarchy of evidence, and data were extracted on country and year of publication, type of literature, who provided it and any information on end users. Information sources were categorised by type and how information was presented. RESULTS: A pool of 1039 articles was reduced to 26 after screening for duplicates and non-relevant studies. Face-to-face exchanges were the most likely source of information prior to elective surgery (59.3%), printed information (55.6%) followed by e-learning (51.9%) and multimedia (14.8%). The face-to-face category included information provided by the physician/general practitioners/specialists, and family and friends. Printed information included brochures and pamphlets, e-learning consisted of internet sites or videos and the use of multimedia included different mixed media format. CONCLUSION: There is considerable variability regarding the types of information patients use in their decision to undergo elective surgery. The most common source of health information (face-to-face interaction with medical personnel) raises the question that the information provided could be incomplete and/or biased, and dependent on what their health provider knew or chose to tell them.

ASPIRE for quality: a new evidence-based tool to evaluate clinical service performance.

BACKGROUND: Evaluation of clinical performance is important in allied health but without a structured approach, the measuring or monitoring of allied health performance poses a number of challenges. This highlights the need for an evidence-based evaluation tool to assist allied health practitioners in clinical performance evaluation. METHODS: The ASPIRE framework was delivered to local health networks (LHN) in South Australia. Three sites participated in the pilot by providing a team to collaborate with the authors in organising and undertaking a performance evaluation. Evaluation of ASPIRE was conducted via self-administered questionnaire and a semi-structured interview with the evaluation team. Themes were identified from the responses taken from the questionnaire and interviews. RESULTS: All practitioners found ASPIRE useful or very useful and claimed that it helped quite a lot or a lot in the process of undertaking performance evaluation. They all rated ASPIRE as excellent or very good in terms of its appropriateness to their department, ease of implementation and pace of delivery. The interview findings verified the results of the questionnaire and added richness to the evaluation. CONCLUSION: A pilot test of ASPIRE in allied health settings showed that users found ASPIRE easy to use and appropriate in addressing patient outcomes and improved their level of confidence and motivation to evaluate clinical performance. Issues arose in terms of time constraints and identifying suitable performance indicators. Future implementation of performance evaluations using the ASPIRE framework should take these issues in consideration to allow the tool to be refined and be relevant for use.

Clinical audit for occupational therapy intervention for children with autism spectrum disorder: sampling steps and sample size calculation.

A priori sample size calculations are used to determine the adequate sample size to estimate the prevalence of the target population with good precision. However, published audits rarely report a priori calculations for their sample size. This article discusses a process in health services delivery mapping to generate a comprehensive sampling frame, which was used to calculate an a priori sample size for a targeted clinical record audit. We describe how we approached methodological and definitional issues in the following steps: (1) target population definition, (2) sampling frame construction, and (3) a priori sample size calculation. We recommend this process for clinicians, researchers, or policy makers when detailed information on a reference population is unavailable.

Early indications that low mental quality of life scores in recently unwell older people predict downstream functional decline.

BACKGROUND: Accurately detecting markers of early functional decline (FD) are essential to support older people to successfully age in place; however, these markers are poorly understood. We tested the hypothesis that compromised mental quality of life after a minor health crisis could be an early predictor of FD. METHODS: This longitudinal observational cohort study was conducted in the emergency department (ED) of a large Australian hospital and in the community. Data were collected from 148 community-dwelling people aged 65+ years, who provided data at recruitment (baseline), and at 1 month and 3 months post discharge from the ED. Short Form-12 mental quality of life component scores (MCS) were regressed with patient descriptors taken at baseline (age, sex, socioeconomic status, education, Mini-Mental State Examination, and primary language), and over-time estimates of FD taken at baseline, and at 1 and 3 months post discharge (instrumental activities of daily living, frequency of falls and hospitalizations, use of gait aids, receipt of community services, living status, and requiring a carer). RESULTS: MCS at 1 month (MCS1) post ED discharge was significantly associated with instrumental activities of daily living at 1 (r=0.45, P<0.001) and 3 months (r=0.401, P=0.001) post ED discharge, but not at baseline (r=0.010, P>0.05). Subjects with lower than the population median MCS showed a significant linear decline in total instrumental activities of daily living scores over 3 months (P=0.025). There was no linear trend over time in the relationship between MCS1 with frequency of falls (P=0.20) or hospitalizations (P=0.42); however, there was a significant difference at 3 months post ED discharge for falls (P=0.036) and hospitalizations (P=0.039) between low and high MCS1 groups. There were no significant confounders. CONCLUSION: Low MCS scores 1 month after a minor health crisis appear to significantly predict downstream FD. This finding needs to be tested in a larger sample.

Radial nerve measurements in nonsymptomatic upper extremities of Filipinos: A cross-sectional study.

INTRODUCTION: Despite reports on the association of radial nerve (RN) size and lateral epicondylalgia (LE), Filipino normative values on RN size in healthy elbows are not established. An association with upper extremity anthropometric measurements is likewise not reported. METHODS: Musculoskeletal ultrasound measurements of the RN at the level of the lateral epicondyle (RN-LE), posterior interosseous nerve at the level of the radial head and supinator (PIN-RH and PIN-sup), and superficial RN (SRN) in the elbows of healthy Filipinos were made in Manila from January-September 2011. RESULTS: A total of 198 elbows of 99 healthy participants aged 43 years (range, 33-48 years) [median(IQR)] were investigated. Men have larger PIN-RH, PIN-sup, and SRN compared with women. Arm length was associated with PIN-RH, PIN-sup, and SRN (P < 0.05). Activities and elbow circumference measurements (at 2 levels) were associated with PIN-RH. CONCLUSIONS: RN reference values can now be used for comparison in elbows with LE.

Synthesizing complex data on functional decline in older people using partial least squares (PLS) analysis.

RATIONALE, AIMS AND OBJECTIVES: Declining capacity to function safely and independently in the community is a manifestation of ageing. Multiple measures are used to define and predict functional decline. This paper explores the use of partial least squares (PLS) analysis to understand the interaction between overtime measures of functional decline. METHODS: Comprehensive information was captured on individuals aged 65+ who presented at a large metropolitan Australian hospital Emergency Department (ED) for a complaint, which did not result in a hospital admission. They were followed-up by telephone 1 and 3 months, post-ED discharge. Information was collected each time on home situations (living alone, using community services, using a gait aid and having a formal carer), recent falls, hospitalizations and instrumental activities of daily living (IADLs). PLS analysis was applied to identify overtime relationships between measures. RESULTS: Valid information was provided by 147 individuals at all three time points. The eight individual IADL items clustered clearly around physical, mental or combined mental and physical IADLs. These clusters were strongly related to increased use of community supports, gait aid and carer, and living alone. The relationship was less convincingly for hospitalizations, and falls were not explained well. CONCLUSION: PLS analysis offers a novel and comprehensive way of analysing complex health data, which allows sense to be made of relationships over a 3-month period. This analysis provides a better understanding of declining function over time, than could be provided by current health modelling methods.