Improving care quality with prison telemedicine: The effects of context and multiplicity on successful implementation and use.

BACKGROUND: Prison telemedicine can improve the access, cost and quality of healthcare for prisoners, however adoption in prison systems worldwide has been variable despite these demonstrable benefits. This study examines anticipated and realised benefits, barriers and enablers for prison telemedicine, thereby providing evidence to improve the chances of successful implementation. METHODS: A systematic search was conducted using a combination of medical subject headings and text word searches for prisons and telemedicine. Databases searched included: PubMed, Embase, CINAHL Plus, PsycINFO, Web of Science, Scopus and International Bibliography of the Social Sciences. Articles were included if they reported information regarding the use of/advocacy for telemedicine, for people residing within a secure correctional facility. A scoping summary and subsequent thematic qualitative analysis was undertaken on articles selected for inclusion in the review, to identify issues associated with successful implementation and use. RESULTS: One thousand, eight hundred and eighty-two non-duplicate articles were returned, 225 were identified for full text review. A total of 163 articles were included in the final literature set. Important considerations for prison telemedicine implementation include: differences between anticipated and realised benefits and barriers, differing wants and needs of prison and community healthcare providers, the importance of top-down and bottom-up support and consideration of logistical and clinical compatibility. CONCLUSIONS: When implemented well, patients, prison and hospital staff are generally satisfied with telemedicine. Successful implementation requires careful consideration at outset of the partners to be engaged, the local context for implementation and the potential benefits that should be communicated to encourage participation.

Using telemedicine to improve access, cost and quality of secondary care for people in prison in England: a hybrid type 2 implementation effectiveness study.

INTRODUCTION: People in prison tend to experience poorer health, access to healthcare services and health outcomes than the general population. Use of video consultations (telemedicine) has been proven effective at improving the access, cost and quality of secondary care for prisoners in the USA and Australia. Implementation and use in English prison settings has been limited to date despite political drivers for change. We plan to research the implementation of a new prison-hospital telemedicine model in an English county to understand what factors drive or hinder implementation and whether the model can improve healthcare outcomes as demonstrated in other contextual settings. METHODS AND ANALYSIS: We will undertake a hybrid type 2 implementation effectiveness study to gather evidence on both clinical and implementation outcomes. Data collection will be guided by the theoretical constructs of Normalisation Process Theory. We will prospectively collect data through: (1) prisoner/patient focus groups, interviews and questionnaires, (2) prison healthcare, hospital and wider prison staff interviews and questionnaires, (3) routine quality improvement and service evaluation data. Up to four prisons and three hospital settings in Surrey (England) will be included in the telemedicine research, dependent on their telemedicine readiness during the study period. Prisons proposed include male and female prisoners, remand (not yet sentenced) and sentenced individuals and different security categorisations. In addition, focus groups in five telemedicine naïve prisons will provide information on patient preconceptions and concerns surrounding telemedicine. ETHICS AND DISSEMINATION: This study has received National Health Service Research Ethics Committee, Her Majesty's Prison and Probation Service National Research Committee and Health Research Authority approval. Dissemination of results will take place through peer-reviewed journals, conferences and existing health and justice networks.

Genetic variants in or near ADH1B and ADH1C affect susceptibility to alcohol dependence in a British and Irish population.

Certain single nucleotide polymorphisms (SNPs) in genes encoding alcohol dehydrogenase (ADH) enzymes confer a significant protective effect against alcohol dependence syndrome (ADS) in East Asian populations. Recently, attention has focused on the role of these SNPs in determining ADS risk in European populations. To further elucidate these associations, SNPs of interest in ADH1B, ADH1C and the ADH1B/1C intergenic region were genotyped in a British and Irish population (ADS cases n = 1076: controls n = 1027) to assess their relative contribution to ADS risk. A highly significant, protective association was observed between the minor allele of rs1229984 in ADH1B and ADS risk [allelic P = 8.4 × 10(-6) , odds ratio (OR) = 0.26, 95 percent confidence interval, 0.14, 0.49]. Significant associations were also observed between ADS risk and the ADH1B/1C intergenic variant, rs1789891 [allelic P = 7.2 × 10(-5) , OR = 1.4 (1.2, 1.6)] and three non-synonymous SNPs rs698, rs1693482 and rs283413 in ADH1C. However, these associations were not completely independent; thus, while the ADH1B rs1229984 minor allele association was independent of those of the intergenic variant rs1789891 and the three ADH1C variants, the three ADH1C variants were not individually independent. In conclusion, the rare ADH1B rs1229984 mutation provides significant protection against ADS in this British and Irish population; other variants in the ADH gene cluster also alter ADS risk, although the strong linkage disequilibrium between SNPs at this location precluded clear identification of the variant(s) driving the associations.

Radiologic review of knee dislocation: from diagnosis to repair.

OBJECTIVE: This imaging-based article systematically reviews traumatic knee dislocations. After completion, the reader should be familiar with the definition, epidemiology, cause, and classification schemes associated with these injuries, as well as the importance of timely diagnostic imaging and an accurate, detailed description of findings, particularly as it relates to MRI interpretation. Finally, information our orthopedic surgical colleagues consider critical for the preoperative planning and reconstruction of the multiple ligament knee injury will be discussed. CONCLUSION: Although uncommon, traumatic knee dislocations are an important potentially limb-threatening injury, which if not emergently recognized and appropriately managed, can result in significant patient morbidity, joint dysfunction, chronic pain, and long-term disability. A radiologist familiar with the imaging appearance and potential neurovascular complications associated with these injuries can play an integral role in the multidisciplinary team that manages this increasingly recognized clinical entity.

Gender-specific pattern differences of the ossification centers in the pediatric elbow.

BACKGROUND: Only a limited number of studies have investigated the age ranges in which the secondary centers of the elbow appear and ossify. Knowledge of sequence, gender differences and age ranges can aid in accurate assessment of radiographs, especially in cases of injury. OBJECTIVE: To determine the sequence and general age ranges in which each ossification center both appears and fuses, and also to identify differences between genders. MATERIALS AND METHODS: This study included 412 sets of radiographs of children's elbows that were analyzed prospectively by a single experienced pediatric radiologist. The presence as well as state of fusion of each ossification center was noted. The ages of the children ranged from 2 months to 17 years. RESULTS: In girls, the radial head and medial epicondyle appeared at the same age. In boys, there was a trend towards the radial head appearing earlier than the medial epicondyle. There was no statistically significant difference between the age at which the trochlea and olecranon appeared. Our results demonstrate a statistically significant difference between genders in both appearance and fusion. All centers both appeared and fused earlier in girls, with the exception of the appearance of the capitellum. The sequence of appearance and fusion was similar between genders. CONCLUSION: Ossification centers at the elbow both appear and fuse earlier in females but the normal range in age for the times of appearance and fusion of these centers is quite wide for both sexes.