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1.
Acta Ortop Mex ; 35(1): 3-10, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-34480432

RESUMO

INTRODUCTION: Healthcare pressure has changed the acquisition of knowledge during residency training. The aim of this study was to analyze the clinical and research training, and level of satisfaction, during orthopedic and traumatology residency in different hospitals of the Spanish National Health Service. MATERIAL AND METHODS: An online survey was distributed between 06/25/2020 and 07/31/2020. Demographic, institution, clinical and research variables were analyzed. Satisfaction was graded in a scale from 0 to 5. RESULTS: 120 residents answered the survey, having a mean age of 27 years and being 58% male. Distribution of residents by year was 26 R5 (21.7%), 24 R4 (20.0%), 45 R3 (37.5%), 25 R2 (20.9%). Only 37.5% answered that they did not have any clinical activity the next day after medical guard, and 45% answered that they performed clinical activity outside of working hours. A total of 56.7% answered that their orthopedic training program did not include research training. No resident had specific time assigned to research activities. Mean satisfaction value was 2.4 points. CONCLUSIONS: Clinical activity shows aspects incompatible with current legislation. Orthopedic programs need improvements with regard to research training. A significant percentage of residents are unsatisfied with their training.


Assuntos
Procedimentos Ortopédicos , Traumatologia , Adulto , Feminino , Hospitais , Humanos , Masculino , Satisfação Pessoal , Pesquisa , Espanha , Medicina Estatal
2.
BMC Med Educ ; 21(1): 474, 2021 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-34488738

RESUMO

BACKGROUND: In health professions, the curriculum that must be met in order to obtain the academic certificate is based on the development of the so-called competencies. The broad content of the Practicum of the Degree of Physiotherapy has led to the creation of multiple types of evaluation, which makes it difficult for faculty members to reach a consensus on competencies. The aim of this study was to develop and validate content of a rubric for the evaluation of acquired competencies related to physiotherapeutic performance and intervention in traumatology within the Practicum of the Degree of Physiotherapy. METHODS: Following the Delphi methodology, a group of experts from all over the Spanish territory participated in the study. Through on-line questionnaires, several sequential rounds were established, alternated by controlled feedback until obtaining a consensus in the opinion of the experts, which allowed elaborating the final rubric. RESULTS: Initially, 16 experts were contacted, of whom 10 worked and completed the final content of the rubric. For the 3 rounds that were conducted, the initial 142 interventions of the initial proposition, which correspond to specific competencies, were reduced to the final 29 items that compose the specific evaluation rubric presented in this study. CONCLUSIONS: This rubric is an evaluation instrument with valid content for the assessment of specific competencies of Traumatology in the Practicum of the Degree of Physiotherapy.


Assuntos
Medicina , Traumatologia , Competência Clínica , Currículo , Técnica Delfos , Humanos , Modalidades de Fisioterapia
3.
Zhonghua Kou Qiang Yi Xue Za Zhi ; 56(9): 833-839, 2021 Sep 09.
Artigo em Chinês | MEDLINE | ID: mdl-34496530

RESUMO

An update version of the International Association of Dental Traumatology (IADT) guidelines for the management of traumatic dental injuries has been released in June 2020 (http://www.dentaltraumaguide.org). In this current revision, IADT has put forward a "core outcome set" (COS) for the diagnosis and treatment of dental trauma both in children and adults. The COS was developed and underpinned by a systematic review of the outcomes in the literature of dental trauma treatment. An outcome that was relevant to all traumatic dental injuries (TDI) was identified as "generic outcome" and those related only to one or more particular TDI were then included as "injury-specific outcomes". The aims of the present article are to help the dental clinicians in learning the latest version of the guideline so that they may quickly and accurately grasp the essence of the updated content and to assist them to choose the optimized treatment plan after judging and evaluating the specific clinical circumstances so as to maximize the chance of a favorable outcome.


Assuntos
Avulsão Dentária , Fraturas dos Dentes , Traumatismos Dentários , Traumatologia , Criança , Humanos , Avulsão Dentária/terapia , Traumatismos Dentários/terapia
6.
Chirurg ; 92(10): 897-903, 2021 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-34251478

RESUMO

Quality assessment is gaining in importance in sports orthopedics and traumatology. Structural, process and results quality are differentiated as central quality dimensions in healthcare. Structural quality is understood to mean the capabilities of the institution involved in patient care with its human and material resources. Structural quality can be documented using institutional certificates (e.g. knee center of the German Knee Society, DKG) or personal certificates (e.g. DKG knee surgeon). Process quality evaluates all medical, nursing and administrative activities that are involved in the care process. The outcome quality describes changes in the patient's state of health that can be attributed to medical, nursing and physiotherapeutic measures. The measurement of the outcome quality can be broken down into objective and subjective parameters. In terms of subjective parameters patient reported outcome measures (PROM) play a major role. Another quality initiative in recent years can be seen in healthcare research. In this context medical registers play a role in which long-term healthcare data are prospectively collated and involves data on the quality of the process and outcome. The outcome quality is also the focus of value-based reimbursement systems.


Assuntos
Procedimentos Ortopédicos , Ortopedia , Cirurgiões , Traumatologia , Humanos , Volta ao Esporte
7.
J Trauma Acute Care Surg ; 91(2S Suppl 2): S9-S18, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34324469

RESUMO

ABSTRACT: As a Major in the US Army Medical Corps, Darrell A. Campbell, MD, led Team 13 of the Third Auxiliary Surgical Group in Europe in World War II. The team began work on June 7, 1944, in a clearing station tent near the beach at Normandy. Subsequently, over the next 7 months, it was assigned to mobile hospitals in 15 different locations in France, Belgium, Luxembourg, and Germany. Major Campbell kept the log books used to record all of the operations done by his team during this time and brought them home where three were discovered more than 70 years later. These log books contain descriptions of more than 500 consecutive operations done by Team 13. They provide a unique insight into the activities of the surgeons who worked to save lives on the front lines of battle in the European Theater of Operations between June and December 1944 and form the basis for this historical perspective.This is an article on the history of surgery.


Assuntos
Medicina Militar/história , Traumatologia/história , II Guerra Mundial , Europa (Continente) , História do Século XX , Hospitais Militares/história , Humanos , Estados Unidos , Lesões Relacionadas à Guerra/história , Lesões Relacionadas à Guerra/cirurgia
8.
J Occup Health ; 63(1): e12255, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34288276

RESUMO

OBJECTIVES: Cases of injury on duty (IOD) are common in Hong Kong, but literature on this group of patients is limited. This study aims to describe local IOD cases' epidemiological characteristics and identify factors affecting return to work (RTW) outcomes. METHODS: This is a retrospective epidemiological study of IOD patients in the orthopedic and traumatology center of Yan Chai Hospital in 2016, using the hospital's electronic clinical record analysis and reporting system; 323 out of the 10 730 patients (M:F = 206:117; mean age 46.9 ± 11.3) were included. Data on demographics, the injury episode, administrative procedures, treatment and rehabilitation were collected. Outcomes were measured by "RTW" and "time to RTW from injury." RESULTS: Around 80% of patients had a successful RTW and the mean time to RTW was 10.6 ± 9.0 months. Patients who were female, divorced or widowed and living alone in a public rental flat were less likely to RTW. Psychiatric consultations (OR 13.70, P < .001), legal disputes (OR 8.20, P < .001) and more than 5 months of waiting time for physiotherapy (OR 3.89, P = .002) were the strongest among the numerous risk factors for non-RTW. An increase in one visit to the general outpatient clinic and the presence of legal disputes had lengthened the time to RTW by 4.8 days (P < .001) and 18.0 months (P < .001), respectively. CONCLUSIONS: Several demographic, psychosocial and administrative factors were negatively associated with RTW in the local population. Recommendations were made for healthcare providers and policymakers accordingly.


Assuntos
Saúde do Trabalhador/estatística & dados numéricos , Traumatismos Ocupacionais/reabilitação , Ortopedia/estatística & dados numéricos , Retorno ao Trabalho/estatística & dados numéricos , Traumatologia/estatística & dados numéricos , Adulto , Feminino , Hong Kong , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos Ocupacionais/psicologia , Razão de Chances , Estudos Retrospectivos , Retorno ao Trabalho/psicologia , Fatores de Risco
9.
Semergen ; 47(5): 305-314, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-34112593

RESUMO

OBJECTIVE: The objective of this study is to analyse the current system of virtual consultations between the levels of Primary and Specialised Care in the field of Traumatology and Orthopaedic Surgery (TOS) in our healthcare area. MATERIAL AND METHOD: A retrospective observational study was carried out on 90 consecutive patients who had a non-face-to-face consultation between 3 January 2017 and 10 February 2017 and subsequently a face-to-face consultation. All the patients belonged to the same healthcare area attached to the Nuestra Señora de Candelaria University Hospital. The data on the diagnostic orientation, medical history provided and complementary tests were evaluated by 2 observers, one with training in Family and Community Medicine and the other with specialised training in TOS, and compared with those obtained in the final face-to-face assessment. RESULTS: The results showed a low inter-judge agreement regarding the diagnostic orientation, anamnesis, exploration and complementary tests provided in the virtual consultation request. It was considered that only 59% for one observer (Family and Community Medicine) and 47.7% for the other (specialised care) had sufficient information for decision-making. Furthermore, 35.2% required more than one face-to-face assessment consultation until diagnosis and in 45.5% it was necessary to request new complementary tests. In 30.7%, there was no concordance in the suggested and final diagnosis. In 51.9%, no therapeutic action other than that carried out by Primary Care was carried out and 34.1% of the patients were referred to the Rehabilitation department. CONCLUSIONS: The current model of virtual consultations in TOS does not seem adequate to respond to this new healthcare model. The number of unnecessary referrals is very high despite the previous virtual assessment by a specialist in TOS. The Family and Community Medicine specialist should have more diagnostic resources and coordination between Primary and Specialised Care is necessary to determine, in the area of TOS, the type of consultations and conditions for which this system should be implemented to obtain adequate coordination and improve communication between both levels of care.


Assuntos
Procedimentos Ortopédicos , Traumatologia , Humanos , Atenção Primária à Saúde , Encaminhamento e Consulta , Especialização
12.
Rev. venez. cir. ortop. traumatol ; 53(1): 35-41, jun. 2021. tab
Artigo em Espanhol | LILACS, LIVECS | ID: biblio-1252919

RESUMO

El acortamiento y la rotación del peroné son las deformidades más frecuentemente encontradas cuando se presentan maluniones postraumáticas del tobillo resultando en ensanchamiento de la mortaja e inestabilidad astragalina, con consecuentes cambios artrósicos. Los pacientes acuden por presentar dolor y limitación en sus actividades diarias y deportivas. En el presente estudio retrospectivo se hace una evaluación de los resultados clínicos y radiológicos de 9 pacientes que se sometieron a tratamiento quirúrgico posterior a maluniones de fracturas de peroné, en los cuales se realizaron osteotomías de alargamiento y desrotación para reconstrucción del tobillo, en la Unidad de Cirugía de Pie y Tobillo del Hospital Universitario de Caracas, entre junio de 2014 y agosto del 2019. Se realizaron mediciones radiológicas pre y postoperatorias de los ángulos de inclinación astragalina, talocrural y bimaleolar, y se reportaron los cambios degenerativos articulares. Para la evaluación clínica y funcional se aplicó la Escala Análoga Visual (VAS) para el dolor, y la Escala AOFAS de retropié, evidenciándose mejoría en cuanto a dolor, función y alineación. El objetivo del tratamiento fue restituir la longitud inicial del peroné, mediante osteototomías oblicuas en el sitio de la fractura anterior, o transversas suprasindesmales, con lo cual también se corrige la alineación del astrágalo, y de esta manera prevenir o disminuir los síntomas y signos inherentes a degeneración articular progresiva(AU)


The shortening and rotation of the fibula are the most frequent deformities found when post-traumatic ankle malunions occur, resulting in widening of the mortise and talus instability, with consequent arthritic changes. Patients have pain and limitation in their daily activities and sports. In the present retrospective study, an evaluation of the clinical and radiological results of 9 patients who underwent surgical treatment after fibular fracture malunions was performed, in which osteotomies of lengthening and de-rotation were performed for reconstruction of the ankle, in the Unit of Foot and Ankle Surgery at the University Hospital of Caracas, between June 2014 and August 2019. Pre and postoperative radiological measurements of the astragaline, talocrural and bimaleolar inclination angles were performed, and degenerative joint changes were reported. For the clinical and functional evaluation, the Visual Analog Scale (VAS) was applied for pain, and the AOFAS Hindfoot Scale, evidencing improvement in pain, function, and alignment. The objective of the treatment was to restore the initial length of the fibula by means of oblique osteotomies at the site of the previous fracture or suprasindesmal transverse osteotomy, which also corrects the alignment of the talus and thus prevents or decreases the symptoms and signs inherent to joint progressive degeneration(AU)


Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Idoso , Osteotomia , Alongamento Ósseo , Fraturas Mal-Unidas , Traumatologia , Fraturas Ósseas , Fíbula/cirurgia
13.
Rev. venez. cir. ortop. traumatol ; 53(1): 27-34, jun. 2021. tab
Artigo em Espanhol | LILACS, LIVECS | ID: biblio-1252908

RESUMO

Las técnicas quirúrgicas mínimamente invasivas ayudan a que el proceso natural de la consolidación ósea ocurra proporcionando estabilidad biomecánica suficiente para obtener los mejores resultados. El objetivo de este trabajo es mostrar los resultados clínicos y radiológicos del tratamiento de las fracturas diafisiarias de tibia con osteosíntesis mínimamente invasiva con placa por cara lateral. Se realizó un estudio clínico observacional, prospectivo, longitudinal y no concurrente. Se incluyeron pacientes mayores de 18 años, de ambos sexos, con diagnósticos de fracturas diafisiarias de tibia 42A, 42B ó 42C, abiertas o cerradas. Se estableció tiempo de seguimiento mínimo de 6 meses. Se incluyeron 23 pacientes, 82,60% de sexo masculino. Promedio de edad de 21±5,63(16­49) años. La fractura más frecuente fue la 42B2 en 26,00% de los casos, y 34,80% fracturas fueron abiertas. A las 12 semanas, 65,10% habían alcanzado consolidación Montoya III; y para la semana 16, 91,30% de los pacientes. De acuerdo a la escala ASAMI, se alcanzaron resultados excelentes en 100,00% pacientes para la semana 16. No se presentaron complicaciones como infección, aflojamiento séptico o aséptico del implante, ni fatiga del mismo. El uso de la técnica MIPO para tratamiento de fracturas diafisiarias de la tibia, por cara lateral es una técnica efectiva y segura, con alta tasas de consolidación, mínimas complicaciones y buenos resultados finales(AU)


Minimally invasive surgical techniques help the natural bone healing process to occur, by providing enough biomechanical stability to obtain the best results. The objective is to show the clinical and radiological results of the treatment of diaphyseal tibial fractures with minimally invasive osteosynthesis with lateral plating. An observational, prospective, longitudinal and non-concurrent clinical study was made. Patients older than 18 years, both sexes, with diagnoses of open or closed tibial shaft fractures 42A, 42B or 42C, were included. A minimum follow-up time of 6 months was established. 23 patients were included, 82,60% male. Average age of 21 years. The most frequent fracture was 42B2 in 26,00% cases, and 34,80% were open fractures. At 12 weeks, 65,10% had reached Montoya III consolidation criterias; and for week 16, 91,30% of the patients. According to the ASAMI scale, excellent results were achieved in 100,00% patients. There were no complications such as infection, septic or aseptic loosening of the implant, or fatigue of the implant. The use of the MIPO technique for the treatment of diaphyseal fractures of the tibia on the lateral aspect is an effective and safe technique, with high rates of union, minimal complications and good final results(AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Dispositivos de Fixação Ortopédica , Fraturas da Tíbia , Fixação Interna de Fraturas , Lâmina de Crescimento , Traumatologia , Procedimentos Ortopédicos
14.
Rev. venez. cir. ortop. traumatol ; 53(1): 10-19, jun. 2021. ilus
Artigo em Espanhol | LILACS, LIVECS | ID: biblio-1252872

RESUMO

El manejo de pseudoartrosis infectadas, osteomielitis y defectos óseos representa un reto enorme para el cirujano ortopedista. Hace diez años, Masquelet presentó la técnica de inducción de membrana como alternativa al manejo de las complicaciones mencionadas arriba con excelentes tasas de consolidación y erradicación del proceso infeccioso. Estudiamos una de serie de 14 casos, prospectiva, con seguimiento clínico y radiológico mínimo de 2 años (enero 2015-diciembre 2018), donde evaluamos múltiples variables en pacientes a quienes se les realizó el protocolo de Masquelet. Obtuvimos una tasa de consolidación de 85,7% (12/14). Con un tiempo promedio para alcanzarla de 6,1 meses (3-9m). Todos los pacientes que lograron la consolidación se encontraban libres de infección al final del seguimiento. Por su reproducibilidad y alta tasa de consolidación, consideramos la técnica de inducción de membrana, como una excelente opción en el manejo de pseudoartrosis infectadas complejas(AU)


The management of infected nonunions, osteomyelitis, and bone defects represents an enormous challenge for the orthopedic surgeon. Ten years ago, Masquelet presented the membrane induction technique as an alternative to the management of the complications afore mentioned with excellent rates of consolidation and eradication of the infectious process. We prospectively studied a series of 14 cases, with a clinical and radiological follow-up of at least 2 years (january 2015-december 2018). Where we evaluated multiple variables in patients who underwent the Masquelet protocol. We obtained a consolidation rate of 85.7% (12/14). With an average time to reach it of 6.1 months (3-9m). All patients who achieved union were free of infection at the end of follow-up. Due to its reproducibility and high consolidation rate, we consider the membrane induction technique an excellent option in the management of complex infected nonunions(AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Osteomielite/complicações , Pseudoartrose/complicações , Transplante Ósseo , Procedimentos Ortopédicos , Doenças Ósseas , Traumatologia
16.
J Trauma Acute Care Surg ; 91(2S Suppl 2): S40-S45, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-33938509

RESUMO

ABSTRACT: The objective of this project was to identify and develop software for an augmented reality application that runs on the US Army Integrated Visual Augmentation System (IVAS) to support a medical caregiver during tactical combat casualty care scenarios. In this augmented reality tactical combat casualty care application, human anatomy of individual soldiers obtained predeployment is superimposed on the view of an injured war fighter through the IVAS. This offers insight into the anatomy of the injured war fighter to advance treatment in austere environments.In this article, we describe various software components required for an augmented reality tactical combat casualty care tool. These include a body pose tracking system to track the patient's body pose, a virtual rendering of a human anatomy avatar, speech input to control the application and rendering techniques to visualize the virtual anatomy, and treatment information on the augmented reality display. We then implemented speech commands and visualization for four common medical scenarios including injury of a limb, a blast to the pelvis, cricothyrotomy, and a pneumothorax on the Microsoft HoloLens 1 (Microsoft, Redmond, WA).The software is designed for a forward surgical care tool on the US Army IVAS, with the intention to provide the medical caregiver with a unique ability to quickly assess affected internal anatomy. The current software components still had some limitations with respect to speech recognition reliability during noise and body pose tracking. These will likely be improved with the improved hardware of the IVAS, which is based on a modified HoloLens 2.


Assuntos
Realidade Aumentada , Medicina Militar , Traumatologia , Lesões Relacionadas à Guerra/cirurgia , Diagnóstico por Imagem , Previsões , Humanos , Iluminação , Medicina Militar/métodos , Medicina Militar/tendências , Software , Interface para o Reconhecimento da Fala , Traumatologia/métodos , Traumatologia/tendências , Estados Unidos
17.
Bone Joint J ; 103-B(5): 898-901, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33934660

RESUMO

AIMS: This study reviews the past 30 years of research from the Canadian Orthopedic Trauma Society (COTS), to identify predictive factors that delay or accelerate the course of randomized controlled trials in orthopaedic trauma. METHODS: We conducted a methodological review of all papers published through the Canadian Orthopaedic Trauma Society or its affiliates. Data abstracted included: year of publication; journal of publication; study type; number of study sites; sample size; and achievement of sample size goals. Information about the study timelines was also collected, including: the date of study proposal to COTS; date recruitment began; date recruitment ended; and date of publication. RESULTS: In total, 22 studies have been published through the COTS working group, 13 of which are randomized controlled trials (RCTs). In total, 1,423 individual patients have been involved in COTS studies, a mean of 110 patients per trial (22 to 424). Each study was conducted across a mean of approximately six centres (1 to 11) and took nearly ten years (mean 119.9 months (59 to 188)) from presentation of concept to publication. The mean length of enrolment was 63 months (26 to 113) and the mean time from cessation of enrolment to publication 51 months (19 to 78). Regardless of sample size, the only factor associated with a decreased length of enrolment was a higher number of clinical sites (p = 0.041). Neither study sample size nor length of enrolment were associated with total time to publication. CONCLUSION: Over the last three decades, COTS has developed a multinational strategy to produce high-quality evidence in the field of orthopaedic trauma through 13 multicentre RCTs. Future efficiencies can be realized by recruitment of more clinical sites, improving connectivity between the sites, and the promotion of national streamlined ethics processes. Cite this article: Bone Joint J 2021;103-B(5):898-901.


Assuntos
Ortopedia , Publicações Periódicas como Assunto , Editoração/estatística & dados numéricos , Traumatologia , Canadá , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Sociedades Médicas
18.
Rev Esp Cir Ortop Traumatol ; 65(5): 374-381, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34055108

RESUMO

Introduction: The COVID-19 pandemic has led to the confinement of approximately one third of the world population, causing a drastic change in the activities of daily life with many repercussions at the health, economic and social levels. Objectives: The objective of the present work is to present the epidemiological variations in the production of fractures in the period of mandatory confinement in our reference population. Methods: Analytical retrospective comparative study of two groups of patients: Group A: patients admitted before the state of alarm that forced confinement in the period from January 13 to March 13 compared to Group B: patients admitted in the two months of confinement, until the de-escalation period began, March 13-May 13. Epidemiological variables including age, personal history, type of fracture, mechanism of injury, outpatient rate, and hospital stay were recorded. Results: A total of 190 patients were included. 112 in the pre-confinement period and 78 in the confinement (30% decrease). The mean age (p = 0.007) and falls at home (p < 0.001) were higher in the confinement group. The postoperative (p = 0.006) and overall (p < 0.001) hospital stay were significantly less in the confinement group. No differences were found in the anatomical location of the lesion, sex, comorbidities, mechanism of injury, outpatient rate, or death. Conclusions: Based on the results of our study, the period of forced confinement due to the COVID-19 pandemic has produced a drastic decrease in the total number of fractures admitted to the traumatology service of a third level hospital. On the other hand, osteoporotic hip fractures have not varied in their incidence and a decrease in the average postoperative and overall stay has been observed.


Assuntos
COVID-19/prevenção & controle , Fraturas Ósseas/epidemiologia , Hospitalização/tendências , Quarentena , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Fraturas Ósseas/etiologia , Fraturas Ósseas/prevenção & controle , Fraturas Ósseas/terapia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores de Proteção , Pesquisa Qualitativa , Estudos Retrospectivos , Fatores de Risco , Espanha/epidemiologia , Centros de Atenção Terciária/tendências , Traumatologia , Adulto Jovem
19.
Ann R Coll Surg Engl ; 103(6): 390-394, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33974459

RESUMO

The COVID-19 pandemic is the most serious health crisis of our time. Global public measures have been enacted to try to prevent healthcare systems from being overwhelmed. The trauma and orthopaedic (T&O) community has overcome challenges in order to continue to deliver acute trauma care to patients and plan for challenges ahead. This review explores the lessons learnt, the priorities and the controversies that the T&O community has faced during the crisis. Historically, the experience of major incidents in T&O has focused on mass casualty events. The current pandemic requires a different approach to resource management in order to create a long-term, system-sustaining model of care alongside a move towards resource balancing and facilitation. Significant limitations in theatre access, anaesthetists and bed capacity have necessitated adaptation. Strategic changes to trauma networks and risk mitigation allowed for ongoing surgical treatment of trauma. Outpatient care was reformed with the uptake of technology. The return to elective surgery requires careful planning, restructuring of elective pathways and risk management. Despite the hope that mass vaccination will lift the pressure on bed capacity and on bleak economic forecasts, the orthopaedic community must readjust its focus to meet the challenge of huge backlogs in elective caseloads before looking to the future with a robust strategy of integrated resilient pathways. The pandemic will provide the impetus for research that defines essential interventions and facilitates the implementation of strategies to overcome current barriers and to prepare for future crises.


Assuntos
COVID-19/epidemiologia , Prioridades em Saúde , Procedimentos Ortopédicos , Ferimentos e Lesões/cirurgia , Procedimentos Cirúrgicos Ambulatórios , Atenção à Saúde/organização & administração , Atenção à Saúde/estatística & dados numéricos , Prioridades em Saúde/organização & administração , Prioridades em Saúde/normas , Humanos , Procedimentos Ortopédicos/estatística & dados numéricos , Traumatologia/organização & administração , Traumatologia/normas
20.
Artigo em Inglês | MEDLINE | ID: mdl-33995713

RESUMO

The COVID pandemic has made telematic consultations a basic tool in daily practice. Aims: The main objective of the study is to assess the results of the application of telematic consultations to limit the mobility of patients.The operational objectives are; to propose a consultation plan, to know how attendance limits consultations and to define which pathologies benefit the most from this plan. Methods: A scheme is proposed with the creation of pre-scheduled clinic to assess suitability and the possibility of carrying them out in a single non face-to-face act. Results: Phone call to 5619 patients were made with a lack of response of 19%The cases of 74% of the patients that answered were resolved virtually. There is a difference between units, obtaining a higher answering rate from patients appointed to specific clinic units, OR = 0.60, or to general trauma ones, OR = 0.67. The lowest answering rate was obtained from those derived from the emergency department.Twenty per cent of the consultations were not accompanied by complementary tests that would have favored the resolution in a single act. The general trauma consultations, OR = 0.34, postoperative control, OR = 0.49, and specific unit ones, OR = 0.40, were the ones that better met this requirement.Out of the remaining patients, the general trauma consultations, OR = 0.50, and those referred to units, OR = 0.54, were the ones that had a higher resolution rate without in- person consultation. Conclusions: The cases of 74% of the patients who answered the phone call were resolved virtually.Cases of 20% of the patients cannot be solved in a single act because they are derived without complementary tests.Osteosynthesis and postoperative arthroscopic follow-up consultations are the ones that need to be carried out in person the most.


Assuntos
COVID-19 , Departamentos Hospitalares , Ortopedia/métodos , Consulta Remota , Traumatologia/métodos , Humanos , Consulta Remota/organização & administração , Consulta Remota/estatística & dados numéricos
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