The 2011 National Hip Fracture Database (NHFD) Report has shown our institute has the fewest number of patients meeting the 36-hour target to theatre in the UK (9%) but well above the national average for review by geriatrician (42.5%) at 76%. We believe our timely medical input means patients9 are more physiologically normalised prior to surgery. We aimed to review our postoperative results to see if our patients had significantly different morbidity and mortality compared to the rest of the UK. We reviewed 152 patients between the period September 2009 and September 2010. All of the patients were prospectively identified and their information was added to our hip fracture database. Using the auditing software we reviewed the patients9 outcomes and compared them to national averages using figures from the NHFD. Of the 152 patients identified 13% met the 36-hour target. The average time to theatre for the study group was 89 hours. 83% of the group had a pre-operative assessment by a geriatrician. The primary reason for surgical delay was a lack of space on a theatre list (61.2%) followed by being medical unfit (16.4%). The average length of acute hospital stay was 16.4 days matching the national average while 30 Day mortality at 7.9% was (0.5%) lower than NHFD figures. We continue to try and improve our time to surgery for hip fracture patients and accept this is mostly related to limited theatre access. Deficient resources due to Northern Ireland9s exclusion from the best practice tariff means we are unable to compete with the top performing units in the NHFD. While it makes humanitarian sense to expedite surgery, evidence used to determine the 36-hour target is quoted as “low quality” or “very low quality”. Our data shows no significant difference in outcomes compared to national figures.

The management of hip fracture in adults: does surgical delay result in worse outcomes?

Telehealth visits have become an integral model of healthcare delivery since the COVID-19 pandemic. This rapid expansion of telehealthcare delivery has forced faculty development and trainee education in telehealth to occur simultaneously. In response, academic medical institutions have quickly implemented clinical training to teach digital health skills to providers across the medical education continuum. Yet, learners of all levels must still receive continual assessment and feedback on their skills to align with the telehealth competencies and milestones set forth by the Association of American Medical Colleges (AAMC) and the Accreditation Council for Graduate Medical Education (ACGME). This paper discusses key educational needs and emerging areas for faculty development in telehealth teaching and assessment of telehealth competencies. It proposes strategies for the successful integration of the AAMC telehealth competencies and ACGME milestones into medical education, including skills in communication, data gathering, and patient safety with appropriate telehealth use. Direct observation tools in the paper offer educators novel instruments to assess telehealth competencies in medical students, residents, and peer faculty. The integration of AAMC and ACGME telehealth competencies and the new assessment tools in this paper provide a unique perspective to advance clinical practice and teaching skills in telehealthcare delivery. 

https://link.springer.com/content/pdf/10.1007/s11606-022-07564-8.pdf

Telehealth Competencies in Medical Education: New Frontiers in Faculty Development and Learner Assessments

Abstract Background Given the rapid advances in communication technology and the need that emerged from the COVID-19 pandemic, telehealth initiatives have been widely used worldwide. This masterclass aims to provide an overview of telerehabilitation for musculoskeletal conditions, synthesizing the different terminologies used to describe telehealth and telerehabilitation, its effectiveness and how to use it in clinical practice, barriers and facilitators for the implementation in health services, and discuss the need of a curriculum education for the near future. Main body Telerehabilitation refers to the use of information and communication technologies provided by any healthcare professionals for rehabilitation services. Telerehabilitation is a safe and effective option in the management of musculoskeletal conditions in different models of delivery. There are many technologies, with different costs and benefits, synchronous and asynchronous, that can be used for telerehabilitation: telephone, email, mobile health, messaging, web-based systems and videoconferences applications. To ensure a better practice of telerehabilitation, the clinician should certify safety and access, and appropriateness of environment, communication, technology, assessment, and therapeutic prescription. Despite the positive effect of telerehabilitation in musculoskeletal disorders, a suboptimal telerehabilitation implementation may have happened due to the COVID-19 pandemic, especially in countries where telehealth was not a reality, and clinicians lacked training and guidance. This emphasizes the need to identify the necessary curriculum content to guide future clinicians in their skills and knowledge for telerehabilitation. There are some challenges and barriers that must be carefully accounted for to contribute to a health service that is inclusive and relevant to health professionals and end users. Conclusions Telerehabilitation can promote patient engagement in health care and plays an important role in improving health outcomes in patients with musculoskeletal conditions. Digital health technologies can also offer new opportunities to educate patients and facilitate the process of behavior change to a healthy lifestyle. Currently, the main needs in telerehabilitation are the inclusion of it in health curriculums in higher education and the development of cost-effectiveness and implementation trials, especially in low- and middle-income countries where access, investments and digital health literacy are limited. 

https://archivesphysiotherapy.biomedcentral.com/counter/pdf/10.1186/s40945-022-00155-0

The state of the art in telerehabilitation for musculoskeletal conditions

Objectives: This study aimed to explore satisfaction and attitudes of patients towards the use of telerehabilitation during the COVID-19 pandemic and to report the experience of physical therapists (PTs) with the use of telerehabilitation. Subjects and Methods: A modified Telemedicine Satisfaction and Usefulness Questionnaire was used to assess the satisfaction and attitudes of musculoskeletal patients who had received telerehabilitation services during the COVID-19 pandemic. Face-to-face semi-structured interviews were conducted with eight PTs to explore their experiences with telerehabilitation, including difficulties and benefits. Results: Out of 53 patients who received telerehabilitation, 46 questionnaires were completed, with a response rate of 86.8%. In general, the patients were satisfied with and had positive attitudes towards the telerehabilitation services. The majority (89.2%) of the patients felt more involved in their care via telerehabilitation and a majority (93.5%) believed that video call sessions were a convenient form of telerehabilitation during the COVID-19 pandemic. Seven out of 8 PTs reported benefits of telerehabilitation (i.e., reduced patients’ waiting lists and improved access to physical therapy care). Also, they were in favour of continuing using telerehabilitation to support the conventional physical therapy care, despite the lack of technological infrastructure. Conclusion: The patients as well as the PTs were generally satisfied with their telerehabilitation experiences. Using telerehabilitation in Kuwait was favoured as an adjunct method during and after the COVID-19 pandemic. However, with extensive training, optimal allocation of resources, and the development of local guidelines, telerehabilitation would become an effective mean for the health delivery system in Kuwait.

/pdf/telerehabilitation-during-the-covid-19-pandemic-patients-and-2wht1r95.pdf

Telerehabilitation during the COVID-19 Pandemic: Patients and Physical Therapists’ Experiences

The COVID-19 pandemic has accelerated many changes in medicine including the transition from providing care in person to providing care via technology enabled telemedicine. The benefits of telemedicine visits with a Pediatric Rehabilitation Medicine (PRM) provider, also known as telerehabilitation medicine visits, are numerous. Telerehabilitation medicine provides an opportunity to deliver timely, patient and family-centric rehabilitation care while maintaining physical distance and reducing potential COVID-19 exposure for our patients, their caregivers and medical providers. Telerehabilitation medicine also allows for access to PRM care in rural areas or areas without medical specialty, virtual in-home equipment evaluation, and reduced travel burden. Because of these and many other benefits, telerehabilitation medicine will likely become part of our ongoing model of care if barriers to telemedicine continue to be lowered or removed. This paper is intended to establish a foundation for pediatric telerehabilitation medicine visit efficiency and effectiveness in our current environment and into the future.

Pediatric telerehabilitation medicine: Making your virtual visits efficient, effective and fun.

The Telemedicine Musculoskeletal Examination.

The Telemedicine Hand Examination.

Pseudogout flare after platelet-rich plasma injection: A case series.

A 65-year-old man with multiple myeloma presented for an ultrasound-guided intraarticular left hip injection. The patient was seen 1 week prior for 2 months of left groin pain. He denied trauma but thought the pain started after discontinuing an oral corticosteroid regimen. Severity ranged from 4 to 5 out of 10, worsened with weightbearing, and improved with rest. Acetaminophen and oxycodone did not relieve his pain. He denied catching, snapping, weakness, paresthesias, or pain radiation. Regarding his multiple myeloma, he had received multiple chemotherapy regimens in the past 5 years and was currently enrolled in a chemotherapy trial. In addition, the patient was pancytopenic due to chemotherapy. Physical examination demonstrated no tenderness. Eighty degrees of hip flexion and any hip internal rotation were painful. Strength and neurovascular testing were normal. Stinchfield and flexion-adduction-internal rotation maneuvers were positive with minimal maneuvering. Hip radiographs demonstrated degenerative changes of bilateral hips, but were read as negative for fracture. He was diagnosed with left hip osteoarthritis and referred for an ultrasound-guided left hip joint injection. Pre-scanning in an oblique sagittal plane in line with the femoral head and neck revealed a large atypical-appearing cleft across the majority of the anterior surface of the femoral head-neck junction (Figure 1). Due to concern for pathological fracture, impending fracture, or active myelomatous lesion, the injection was postponed. Magnetic resonance imaging (MRI) of the pelvis was obtained, which demonstrated a subacute pathologic fracture of the left femoral neck with mild posteromedial displacement and apex anterior angulation of the femoral head (Figure 2). Extensive osseous metastatic disease was also present in the visualized axial and appendicular skeleton. The patient was subsequently admitted to the hospital for orthopedic evaluation. Due to his thrombocytopenia and neutropenia, however, surgical fixation would require holding his chemotherapy for 3 to 4 weeks to prevent infection and allow healing. The patient preferred to continue his chemotherapy and opted for nonoperative management. He was advised to remain toe-touch weight-bearing Figure 1. Ultrasound in oblique sagittal plane in line with the left femoral head and neck. An atypical cleft was noted near the femoral headneck junction.

Pathologic Hip Fracture Demonstrated on Ultrasound.

Sonographic Evaluation of a Snapping Brachialis Muscle.

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