FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W3048143380> ?p ?o ?g. }

• W3048143380 endingPage "2624" @default.
• W3048143380 startingPage "2622" @default.
• W3048143380 abstract "Where Are We Now? The coronavirus 2019 (COVID-19) pandemic necessitated a reduction in traditional clinics to ameliorate the spread of the virus. This led to a rapid adoption of virtual clinics to provide routine orthopaedic care for nonemergent situations [1, 7]. However, prior to the work in this month’s Clinical Orthopaedics and Related Research® [6], to my knowledge, no systematic evaluations of the efficacy, safety, or utility of any telehealth programs other than for the treatment of stable fractures have been performed. It was previously recognized that the routine follow-up of patients with stable fractures in traditional fracture clinics resulted in unnecessary care [2]. This was reduced by instituting virtual clinics into the clinical care pathway, leading to more-efficient care and more patients being provided an appropriate level of treatment [2]. The systematic review on virtual fracture clinics by Murphy and colleagues [6] is a timely overview relevant to the current unprecedented transition to such clinic visits. While the reviewed studies showed that virtual fracture clinics are cost-effective when the fractures treated are well-defined, stable, and have evidence-based “national standards” protocols for treatment, there was a learning curve in their implementation. Taken as a whole, the reports also emphasize the importance of well-developed safety mechanisms for early detection and timely treatment of unanticipated clinical events. There are two main concepts in their paper that provide guidance in the instituting of virtual clinics. The first is that the orthopaedists need to be able to develop very specific care pathways that define the appropriate injuries for assignment to a virtual clinic, with expected milestones for recovery and warning signs for when care should revert to an in-person clinic. The second is the establishment of a close working relationship between the emergency department and orthopaedics, so that patients receive the appropriate information initially and have suitable expectations for their ongoing treatment. Where Do We Need To Go? The key clinical issue to be addressed in considering a move to virtual clinic visits is safety. Primarily, this revolves around the questions of accurate identification of who is appropriate for a virtual follow-up, and how to identify those patients who are falling off the expected healing course early enough to make the applicable treatment changes. Given the spectrum of injuries and diseases that are being considered for virtual clinic visits [7], it will be important to develop precise care pathways for each condition that takes into account the potential for a significant adverse outcome. As an example, while treatment of an isolated lateral malleolar fracture can be easily handled through virtual clinics, suspected bimalleolar-equivalent fractures (lateral malleolar fracture with deltoid ligament disruption) must be specifically ruled-out via gravity stress or external rotation stress testing to ensure close follow-up and possibly surgery. This will require detailed protocols that are uniformly understood and practiced in emergency and orthopaedics departments. Similar to what has been done for stable ankle fractures [3] and metatarsal fractures [4], the next step in this evolution will be the extension of the virtual fracture clinic to other orthopaedic conditions. In particular, the need for a physical examination must be rigorously analyzed to assess what it adds to the clinical assessment. Given that much of orthopaedic practice is based on the physical exam, this concept is jarring. It is clear from the experience treating well-defined specific injuries noted above that there are instances where the examination can be done virtually (the patient palpating the fractured area) or is superfluous. However, prospective studies to better delineate the contribution of the physical examination to the treatment of specific conditions should be done to provide foundational standards for the evolution of virtual clinics. Using current validated outcomes measures (such as DASH, HOOS, and KOOS) in the virtual visit can both discern the contributions of the physical examination to the overall treatment plan, and ensure that the virtual care model is not compromising outcomes. It will also be critical to include virtual clinics in overall quality assurance activities to ensure that care standards are being met. As noted by Murphy and colleagues [6], some patients treated virtually will not heal as expected. This emphasizes the need to establish criteria for transferring a patient to a traditional clinic visit. The potential barriers to shifting care to the in-person clinic (a lack of available clinic slots and administrative incentives to persist with virtual visits are two such examples) need to be identified and removed. We need to achieve a better understanding of the nuances in treating patients virtually. Basic guidelines for how to conduct virtual visits have been published [1]. Topics covered include: how to dress for the visit, setting up the home environment to make the virtual visit as effective as it can be, the need for punctuality (by both provider and patient), technology tips (placement of the phone/webcam for best visualization of the affected area), and how to choose between phone or video technology. Although useful as a starting point, experience with this methodology should lead to improvements. It will be important to establish professional standards of care specific to virtual visits, recognizing that the ability to detect subtle clinical findings may be limited by the nature of the virtual examination, and so we may see more incomplete physical examinations. It is no coincidence that all 18 of the studies cited by the authors of the current study are from either the Untied Kingdom or Ireland, both of which have well-developed national health systems with unified national standards for care that can be implemented locally. The lack of a similar clinically driven standards-setting process in the United States leads to variation in local care benchmarks, which may be problematic. The next question to be addressed is whether the technology is widely available to the patient population for the method of virtual visits to be implemented? In many places, 25% or more of patients do not have access to broadband internet and/or smartphones. Any video-based virtual clinic program in such situations has to be accompanied by a viable telephone-only option to avoid disenfranchising a sizable part of the community. The first things that need to be clearly established are the goals for establishing any virtual clinics. Cost savings cannot be the sole motivation. In a patient-centered healthcare system, the development of virtual clinics has to begin with the patient. Does it make access easier, more convenient, less expensive (in time and money)? Does it offer the opportunity for the patient to receive adequate care with the opportunity for them to have their concerns, questions, fears addressed. Is there a mechanism to quickly see the patient in person if something is not going as it should? These questions all require precise answers if a virtual clinic is to be successful. This will require a thorough understanding of the patients (socioeconomic environment, distance from the healthcare provider, and comorbidities) and conditions being addressed. Care-delivery pathways should be created with the input and cooperation of the clinicians, support staff, patients, and administrators. The clinical outcomes of virtual clinics should be periodically reviewed to assure that the quality measures adopted are continuing to be met. And, although the specific solutions each practice realizes will be distinct, academic centers should publish their findings, so as to educate the broader community about what did, and did not, work as planned. How Do We Get There? A concerted effort to identify those conditions that are best suited to the institution of virtual clinics will involve both basic science (to help identify potential candidate conditions based on their underlying biomechanics or biology), and clinical research. The latter will be essential to verify that the natural history of healing such injuries is compatible with the limited opportunity for examination in virtual clinics. In the current study [6], the mean quality rating for the studies reviewed was moderate, suggesting that there is a large opportunity for improvement in this area of study. The most frequent shortcomings in the studies was the lack of control for confounding variables (age, sex, and comorbidities) and inadequate outcomes measures. These are the types of issues that would be inherently addressed in prospective studies. For the types of injuries being considered for virtual clinics, such studies would not be expected to require the long-term follow-up that can make prospective studies difficult to complete. Reimbursement policies supporting virtual visits have been temporarily implemented during the COVID-19 pandemic [5]. Unlike countries with a national health service, the fee-for-service model that exists in the United States has not traditionally supported the use of virtual visits at a level that is financially sustainable. This will have to be addressed at a national political level if providers are to be expected to balance the ongoing needs of their patients against the requirement for social distancing that will be with us for the foreseeable future. Not all fractures heal uneventfully. Although a truism, it needs to be explicitly stated in the context of treating patients virtually. This can be due to a misdiagnosis at the time of presentation in the emergency department, lack of follow-up on patients to ensure that they are managing his or her injury, or for unknown reasons. All can happen in either a virtual or in-person fracture clinic. What is different is the (perceived) barrier to addressing the situation in a virtual clinic. Having an explicit protocol to expeditiously transfer patients to the in-person clinic is critical to maintaining quality of care and minimizing adverse outcomes." @default.
• W3048143380 created "2020-08-13" @default.
• W3048143380 creator A5065232848 @default.
• W3048143380 date "2020-07-28" @default.
• W3048143380 modified "2023-09-24" @default.
• W3048143380 title "CORR Insights®: Are Virtual Fracture Clinics During the COVID-19 Pandemic a Potential Alternative to Delivering Fracture Care? A Systematic Review" @default.
• W3048143380 cites W2588753064 @default.
• W3048143380 cites W2608164240 @default.
• W3048143380 cites W2750811595 @default.
• W3048143380 cites W3019570274 @default.
• W3048143380 cites W3041553626 @default.
• W3048143380 doi "https://doi.org/10.1097/corr.0000000000001436" @default.
• W3048143380 hasPubMedCentralId "https://www.ncbi.nlm.nih.gov/pmc/articles/7571926" @default.
• W3048143380 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/32769542" @default.
• W3048143380 hasPublicationYear "2020" @default.
• W3048143380 type Work @default.
• W3048143380 sameAs 3048143380 @default.
• W3048143380 citedByCount "0" @default.
• W3048143380 crossrefType "journal-article" @default.
• W3048143380 hasAuthorship W3048143380A5065232848 @default.
• W3048143380 hasBestOaLocation W30481433801 @default.
• W3048143380 hasConcept C116675565 @default.
• W3048143380 hasConcept C127413603 @default.
• W3048143380 hasConcept C142724271 @default.
• W3048143380 hasConcept C159047783 @default.
• W3048143380 hasConcept C17744445 @default.
• W3048143380 hasConcept C187320778 @default.
• W3048143380 hasConcept C199539241 @default.
• W3048143380 hasConcept C2779134260 @default.
• W3048143380 hasConcept C2779473830 @default.
• W3048143380 hasConcept C3006700255 @default.
• W3048143380 hasConcept C3007834351 @default.
• W3048143380 hasConcept C3008058167 @default.
• W3048143380 hasConcept C43369102 @default.
• W3048143380 hasConcept C524204448 @default.
• W3048143380 hasConcept C71924100 @default.
• W3048143380 hasConcept C89623803 @default.
• W3048143380 hasConceptScore W3048143380C116675565 @default.
• W3048143380 hasConceptScore W3048143380C127413603 @default.
• W3048143380 hasConceptScore W3048143380C142724271 @default.
• W3048143380 hasConceptScore W3048143380C159047783 @default.
• W3048143380 hasConceptScore W3048143380C17744445 @default.
• W3048143380 hasConceptScore W3048143380C187320778 @default.
• W3048143380 hasConceptScore W3048143380C199539241 @default.
• W3048143380 hasConceptScore W3048143380C2779134260 @default.
• W3048143380 hasConceptScore W3048143380C2779473830 @default.
• W3048143380 hasConceptScore W3048143380C3006700255 @default.
• W3048143380 hasConceptScore W3048143380C3007834351 @default.
• W3048143380 hasConceptScore W3048143380C3008058167 @default.
• W3048143380 hasConceptScore W3048143380C43369102 @default.
• W3048143380 hasConceptScore W3048143380C524204448 @default.
• W3048143380 hasConceptScore W3048143380C71924100 @default.
• W3048143380 hasConceptScore W3048143380C89623803 @default.
• W3048143380 hasIssue "11" @default.
• W3048143380 hasLocation W30481433801 @default.
• W3048143380 hasLocation W30481433802 @default.
• W3048143380 hasLocation W30481433803 @default.
• W3048143380 hasLocation W30481433804 @default.
• W3048143380 hasLocation W30481433805 @default.
• W3048143380 hasOpenAccess W3048143380 @default.
• W3048143380 hasPrimaryLocation W30481433801 @default.
• W3048143380 hasRelatedWork W3017171836 @default.
• W3048143380 hasRelatedWork W3025176011 @default.
• W3048143380 hasRelatedWork W3027835066 @default.
• W3048143380 hasRelatedWork W3032320397 @default.
• W3048143380 hasRelatedWork W3033635008 @default.
• W3048143380 hasRelatedWork W3152606407 @default.
• W3048143380 hasRelatedWork W4280491013 @default.
• W3048143380 hasRelatedWork W4308017287 @default.
• W3048143380 hasRelatedWork W3107152225 @default.
• W3048143380 hasRelatedWork W3183300108 @default.
• W3048143380 hasVolume "478" @default.
• W3048143380 isParatext "false" @default.
• W3048143380 isRetracted "false" @default.
• W3048143380 magId "3048143380" @default.
• W3048143380 workType "article" @default.