Can a patient-focussed bookings approach reduce patient non-attendance in postnatal and continence physiotherapy?

BACKGROUND: There are unique life-stage and psychosocial barriers to attendance for women referred for postnatal and continence physiotherapy. These barriers affect access to care, clinic utilization and patient waiting lists. In a patient-focused bookings system, the patient is invited to contact the health service to book their appointment at a time and day that suits them, increasing patient choice and engagement in the booking process. METHODS: A patient-focussed bookings approach was implemented in outpatient women's health and continence physiotherapy clinics across four sites of a public health service in Australia. Waiting time, attendance, clinic utilization and response data were collected for 6 months after implementation to assess feasibility and effectiveness compared to the same 6 months of the preceding year. RESULTS: Non-attendance to initial appointments decreased from 23.64%, to 13.04%, with 26.2% more new patients seen and a 14.74% reduction in waiting times during implementation. Response rates did not appear to be affected by whether patients understood English and patients were satisfied with the new bookings approach. CONCLUSIONS: Patient-focused bookings can be effectively implemented in a postnatal and continence physiotherapy outpatient setting, resulting in reduced non-attendance and wait times and improved clinic utilization.

Non-surgical options to autologous finger transplants.

This case report describes the rehabilitation path of a man who sustained severe burns to his body and extremities as a result of a bushfire. The fingers of both hands were amputated except the thumbs and although he was a candidate for autologous transplant, declined this option for various reasons. Bilateral prostheses were made and resulted in a significant improvement in functional outcome without the need for surgery. Prostheses are practical alternatives to surgery and should be considered in selected patients.

Functional prognosis in stroke: use of somatosensory evoked potentials.

Median nerve somatosensory evoked potentials (SEPs) were performed on 35 patients with acute stroke and correlated with functional outcome as measured by placement, length of stay and an activities of daily living index (Barthel Index). There was a statistically significant correlation of both SEP and sensory examination at the 0.05 level to eventual functional outcome. SEPs were better than age, sex and side of CVA in predicting functional outcome as measured by these scores. SEPs and sensory examination are interrelated but SEPs offer the advantages of objectivity, the ability to quantify results and the use in unconscious or dysphasic patients.

Failure of the omnicardiogram to predict coronary artery disease in patients with normal resting electrocardiograms.

Seventy-two male patients over the age of 35 had normal resting twelve lead eletrocardiograms (ECG's). All patients were studied by invasive techniques including complete right and left sided cardiac catheterization, selective coronary arteriography, and left ventricular angiography. All patients had been referred because of chest pain with a presumed diagnosis of coronary artery obstruction and myocardial ischemia. Omnicardiograms were generated from the twelve lead ECG's and diagnosed as "abnormal" or "normal" by observers having no knowledge of the cardiac catheterization findings. Of 72 patients studied, 21 were free of coronary artery disease. Of these, 14 (66%) had "abnormal" omnicardiographic reports. Seven (33%) had "normal" omnicardiograms, indicating an incidence of false positive "abnormal" omnicardiographic reports as 66%. Fifty-one patients had hemodynamically significant coronary artery disease. In this group, 19 (38%) were reported as "normal" by omnicardiogram, an incidence of false negative diagnosis of 38%. When the patients with coronary artery disease were classified as to single, double, or triple coronary obstruction, it was evident that the omnicardiogram had failed to separate patients with more extensive disease. Of the 32 patients with "abnormal" omnicardiograms, 56% had double or triple vessel disease, while of the 19 patients with "normal" omnicardiograph reports, 78% had double or triple vessel disease. Similarly, the omnicardiograms failed to identify the patients with abnormal left ventricular angiography. Of 19 patients with coronary artery disease and "normal" omnicardiograms, only 8 (42%) had normal ventricular angiography. However, of the 32 patients with coronary disease and "abnormal" omnicardiograms, only 11 (34%) had abnormal ventriculogram. The omnicardiogram cannot be considered a useful technique for predicting the presence or severity of coronary artery disease or for the identification of abnormal left ventricular function in patients with known coronary artery disease.