Part Of Mainstream Practice Research Articles

The benefits of focal resurfacing implants over articular cartilage grafting in the knee

The surgical treatment of chondral and osteochondral defects within the knee is becoming increasingly more complex and challenging, with an ever-increasing selection of options available to the orthopaedic surgeon. Technological and innovative advancements often move at a greater pace than the associated clinical outcomes and research-based evidence. The treatment for these conditions is continually evolving and developing before it is possible to critically appraise the data on their success. These surgical treatments are either biological, where an attempt is made to regenerate the lost tissue, or non-biological, such as focal resurfacing, partial or total arthroplasty. Each of these treatment modalities has their own merits and drawbacks. Focal resurfacings have been around for a few decades, and their aim is to be the best of both options. While still not part of mainstream practice within the UK, their evidence base is growing, and the National Institute for Health and Care Excellence has issued a review on their use. This review aims to assess the options available for treating cartilage defects in the knee, with a focus on these novel focal resurfacing implants.

Survey of the patients' perspectives and preferences in adopting telepharmacy versus in-person visits to the pharmacy: a feasibility study during the COVID-19 pandemic

BackgroundFollowing the coronavirus disease 2019 (COVID-19) pandemic, the health authorities recommended the implementation of strict social distancing and complete lockdown regulations to reduce disease spread. The pharmacists quickly adopted telemedicine (telepharmacy) as a solution against this crisis, but awareness about this technology is lacking. Therefore, the purpose of this research was to explore the patients' perspectives and preferences regarding telepharmacy instead of traditional in-person visits.MethodsAn electronic questionnaire was designed and sent to 313 patients who were eligible for the study (from March to April 2021). The questionnaire used five-point Likert scales to inquire about motivations for adopting telepharmacy and in-person visits, their perceived advantages and disadvantages, and the declining factors of telepharmacy. Finally, the results were descriptively analyzed using SPSS 22.ResultsOf all 313 respondents, a total of 241 (77%) preferred appointments via telepharmacy while 72 (23%) preferred in-person services. There was a significant difference between the selection percentage of telepharmacy and in-person services (chi-square 91.42; p < 0.0001). Preference bout the telepharmacy system versus in-person visits to the pharmacy was associated with factors such as "reducing the incidence of contagious disease" (4.41; ± 0.78), "spending less time receiving pharmaceutical services” (4.24; ± 0.86)), and “traveling a shorter distance for receiving pharmaceutical services" (4.25; ± 0.86). "Reducing costs" (90.87%), "saving time" (89.21%), and "reducing the incidence of contagious disease" (87.13%) were the most important reasons for choosing telepharmacy services. Also, “face-to-face communication with the pharmacist” (25%), “low internet bandwidth” (25%), and “reduction of patients' anxiety and the increase of their peace of mind” (23.61%) were the most important reasons for choosing in-person visits.ConclusionSurvey data indicate that most participants are likely to prefer the use of telepharmacy, especially during crises such as the current COVID-19 pandemic. Telepharmacy can be applied as an important means and a crucial service to lessen the load on healthcare organizations and expand drug supply shelters in pharmacies. However, there are still substantial hurdles to overcome in order to successfully implement the telemedicine platform as part of mainstream practice.

Diagnosing and Managing the Malignant Axilla in Breast Cancer

The management of the malignant axilla remains a controversial topic. Although many issues have been resolved with the results of randomised controlled trials, there are still areas where evidence is lacking. This review will focus on the current diagnostic methods used to detect lymph node (LN) metastases as well as the impact of volume of LN disease on the choice of axillary management. The roles of surgical excision, radiotherapy and systemic therapy as treatment modalities for LN metastases will also be explored with particular emphasis on the use of neo-adjuvant chemotherapy (NACT). Lastly, new innovations in contrast-enhanced ultrasound (CEUS) will be discussed as a potential test for precise and personalised axillary staging. The results of the ACOSOG Z011 trial are widely accepted and axillary conservation is now part of mainstream practice in many parts of the World for patients with sentinel lymph node (SLN) metastases and clinical T1/ T2 N0 M0 tumours who had breast-conserving surgery alongside adjuvant whole breast radiotherapy and systemic therapy. Determining the volume of metastatic disease in the axilla is important for treatment decisions and de-escalation of axillary surgery after NACT in patients with biopsy proven pretreatment LN metastases may become part of routine practice for selected patients once long-term outcomes are known. Novel methods to identify LN metastases have been developed over the last 10 years including the use of injected microbubbles and CEUS to locate and biopsy sentinel lymph nodes (SLN). Technological advances including ultrafast and super-resolution ultrasound have the potential to increase the diagnostic accuracy of axillary CEUS. The main drawback to current axillary management is the lack of a reliable objective test to quantify LN metastases. The de-escalation of axillary surgery is timely but without an objective non-invasive imaging test to replace the axillary lymph node dissection (ALND), clinicians are reliant on predictive medicine rather than precision diagnostics to plan individual treatment. New innovations in CEUS have the potential to provide a reproducible non-invasive test, which can be used in the future to investigate LN metastases in patients with breast cancer.

Perceptions of video-based appointments from the patient's home: a patient survey.

We examined patient interest in a telehealth model in which the patient supplies the hardware and Internet connectivity to meet with a healthcare provider from his or her home via video call (video appointment). We hoped to understand prospectively the desirability, feasibility, and viability from the patient perspective. A phone survey was conducted of a random sample of patients who had been seen in the outpatient setting at a single institution. The sample was stratified by proximity to the local institution with oversampling for patients living outside a 120-mile radius. Out of 500 total patients, 301 patients responded, and 263 met the inclusion criteria. Of those 263 respondents, 38% indicated "very likely" to accept an invitation to see their provider via video, 28.1% "somewhat likely," and 33.8% "not at all likely." Of respondents, 75% have broadband, although only 36% reported having a Web camera. The primary factors affecting willingness to participate in a video appointment include comfort in setting up a video call, age, and distance participants would have traveled for an in-clinic appointment. Patient survey data indicate that most patients are likely to be accepting of telehealth care to the home using video call and that most have the required technology. Nevertheless, there are still significant hurdles to effectively implement this adaptation of telehealth care as part of mainstream practice.

Sustainable Tourism Development in Albania through Stakeholders Involvement

Tourism is an important subsystem of the Albanian economy, considering a key factor of regional development and economic growth. To ensure the long –term success of the tourism destination on the international tourism market, it has to operate according to the principles of sustainability. The focus of many contemporary studies from the tourism development literature has been on the need of implementing development policies that are based on the principles of sustainable development. The destination can be sustainable and competitive if it attempts to reach a compromise regarding the interests of all the stakeholders. Stakeholder engagement and participatory practice is increasingly becoming a part of mainstream practice and central public policy decision making and delivery related to sustainable tourism. Sustainable development and the application of its principles to Albanian tourism are more important now than ever. It should be examined from the points of view of the key stakeholders: tourists, the local people, the tourism businesses and the professionals involved in the tourism industry. Sustainable tourism development ensures guest satisfaction,steady profit coming from tourism related activities for tourism oriented businesses and growth of tourism in region, rise in standard of living of local people and protection of the environment. Partnership building in Albania is in its infancy and partnership work is essential to get the greatest benefits from the holistic sustainable tourism approach. Hall discussing policy issues regarding tourism states that: often, the problems of developing coordinated approaches towards tourism planning and policy problems, such as the meta problem of sustainability, are identified in organizational terms, e.g the creation of new organizations or the allocation of new responsibilities to existing ones. However, such a response does not by itself solve the problem of bringing various stakeholders and interests together which is an issue of establishing collaborative processes (Hall 1999, 278). The article examines the competitiveness of the Albanian destination from the viewpoints of the tourists, tourism business, local people and tourism experts. Considering each stakeholder`s role and protecting the interest of the target groups contributes in achieving and maintaining of sustainability in the tourism sector in Albania. The study aims identifying their attitudes towards sustainability and their points of connection as well that assist with promoting the interests of the target groups. It is critical to note that the participatory engagement of stakeholders is perhaps the most important component of the planning and development of the Albanian destination. It can be described as a process of maturity from initial stages to more developed and self-sustaining stages. Questionnaires were used for gathering data. They were designed for all four target groups. The questionnaires included both open-ended and closed questions. DOI: 10.5901/ajis.2014.v3n2p313

Nation-scale adoption of new medicines by doctors: an application of the Bass diffusion model.

BackgroundThe adoption of new medicines is influenced by a complex set of social processes that have been widely examined in terms of individual prescribers’ information-seeking and decision-making behaviour. However, quantitative, population-wide analyses of how long it takes for new healthcare practices to become part of mainstream practice are rare.MethodsWe applied a Bass diffusion model to monthly prescription volumes of 103 often-prescribed drugs in Australia (monthly time series data totalling 803 million prescriptions between 1992 and 2010), to determine the distribution of adoption rates. Our aim was to test the utility of applying the Bass diffusion model to national-scale prescribing volumes.ResultsThe Bass diffusion model was fitted to the adoption of a broad cross-section of drugs using national monthly prescription volumes from Australia (median R2 = 0.97, interquartile range 0.95 to 0.99). The median time to adoption was 8.2 years (IQR 4.9 to 12.1). The model distinguished two classes of prescribing patterns – those where adoption appeared to be driven mostly by external forces (19 drugs) and those driven mostly by social contagion (84 drugs). Those driven more prominently by internal forces were found to have shorter adoption times (p = 0.02 in a non-parametric analysis of variance by ranks).ConclusionThe Bass diffusion model may be used to retrospectively represent the patterns of adoption exhibited in prescription volumes in Australia, and distinguishes between adoption driven primarily by external forces such as regulation, or internal forces such as social contagion. The eight-year delay between the introduction of a new medicine and the adoption of the prescribing practice suggests the presence of system inertia in Australian prescribing practices.

0064: Engaging Clinicians in Actively Managing the Risk of Antenatal Missed and Mis-Diagnosis

The world is cluttered with guidelines established in good faith and providing useful advice, yet few have become part of mainstream practice. Evidence suggests key elements for successful implementation of guidelines include involvement of the target group in their development, and to include (eg.) educational interventions or self-audit processes in the guidelines.ObjectiveAvant Mutual Group Limited (Avant), Australia's largest medical defence organisation, completed an analysis of claims brought against members alleging negligent missed and mis-diagnosis of antenatal fetal abnormalities. Building on this, Avant engaged with experts in fetal ultrasound to develop a practical risk modification program, designed to improve outcomes in fetal anomaly screening by minimising the likelihood of diagnostic error.MethodA series of multidisciplinary workshops were convened by Avant. Participants identified factors contributing to missed or mis-diagnosis in fetal ultrasound and strategies to minimise their impact.ResultsThe outcome of these workshops was the Avant Fetal Ultrasound Risk Modification Program, comprising risk modification guidelines, risk indicators and practice implementation toolkits to support practices, establish practice patterns and implement risk modification strategies. Avant launched the Fetal Ultrasound Risk Modification Pilot Program in May 2008. Participants collected data over a defined period against specific risk indicators pertaining to practice patterns and outcomes. This pilot involved over 60 practitioners, 1000 scans and 40 practices.ConclusionThis risk modification model provides a unique opportunity for clinician engagement, harnessing of clinician knowledge and experience. This paper shares the experience of the pilot program and the benefits of this process for clinician engagement. The world is cluttered with guidelines established in good faith and providing useful advice, yet few have become part of mainstream practice. Evidence suggests key elements for successful implementation of guidelines include involvement of the target group in their development, and to include (eg.) educational interventions or self-audit processes in the guidelines. ObjectiveAvant Mutual Group Limited (Avant), Australia's largest medical defence organisation, completed an analysis of claims brought against members alleging negligent missed and mis-diagnosis of antenatal fetal abnormalities. Building on this, Avant engaged with experts in fetal ultrasound to develop a practical risk modification program, designed to improve outcomes in fetal anomaly screening by minimising the likelihood of diagnostic error. Avant Mutual Group Limited (Avant), Australia's largest medical defence organisation, completed an analysis of claims brought against members alleging negligent missed and mis-diagnosis of antenatal fetal abnormalities. Building on this, Avant engaged with experts in fetal ultrasound to develop a practical risk modification program, designed to improve outcomes in fetal anomaly screening by minimising the likelihood of diagnostic error. MethodA series of multidisciplinary workshops were convened by Avant. Participants identified factors contributing to missed or mis-diagnosis in fetal ultrasound and strategies to minimise their impact. A series of multidisciplinary workshops were convened by Avant. Participants identified factors contributing to missed or mis-diagnosis in fetal ultrasound and strategies to minimise their impact. ResultsThe outcome of these workshops was the Avant Fetal Ultrasound Risk Modification Program, comprising risk modification guidelines, risk indicators and practice implementation toolkits to support practices, establish practice patterns and implement risk modification strategies. Avant launched the Fetal Ultrasound Risk Modification Pilot Program in May 2008. Participants collected data over a defined period against specific risk indicators pertaining to practice patterns and outcomes. This pilot involved over 60 practitioners, 1000 scans and 40 practices. The outcome of these workshops was the Avant Fetal Ultrasound Risk Modification Program, comprising risk modification guidelines, risk indicators and practice implementation toolkits to support practices, establish practice patterns and implement risk modification strategies. Avant launched the Fetal Ultrasound Risk Modification Pilot Program in May 2008. Participants collected data over a defined period against specific risk indicators pertaining to practice patterns and outcomes. This pilot involved over 60 practitioners, 1000 scans and 40 practices. ConclusionThis risk modification model provides a unique opportunity for clinician engagement, harnessing of clinician knowledge and experience. This paper shares the experience of the pilot program and the benefits of this process for clinician engagement. This risk modification model provides a unique opportunity for clinician engagement, harnessing of clinician knowledge and experience. This paper shares the experience of the pilot program and the benefits of this process for clinician engagement.

Telehealth in Alaska: delivery of health care services from a specialist’s perspective

Integrating store-and-forward telemedicine into the ANMC ENT practice for remotely located patients has improved access for care as well as the quality of care for our patients. The involvement of the ANMC ENT department in the design of the telemedicine system was critical. Yet building the telemedicine service required creative measures to encourage use and careful management of our capacity to receive a growing number of cases. Cost savings due to avoided travel have been readily apparent, based on the high cost of travel in Alaska, The improvement in departmental productivity was an unexpected yet welcome outcome. Much of the current research in telemedicine appropriately focuses on the applicability of this modality to clinical problems. Our four years experience indicates that one of the challenges in the future will be to integrate telemedicine with the existing infrastructure of medicine so that it can more easily become part of mainstream practice.

Telehealth in Alaska: delivery of health care services from a specialist`s perspective

Integrating store-and-forward telemedicine into the ANMC ENT practice for remotely located patients has improved access for care as well as the quality of care for our patients. The involvement of the ANMC ENT department in the design of the telemedicine system was critical. Yet building the telemedicine service required creative measures to encourage use and careful management of our capacity to receive a growing number of cases. Cost savings due to avoided travel have been readily apparent, based on the high cost of travel in Alaska, The improvement in departmental productivity was an unexpected yet welcome outcome. Much of the current research in telemedicine appropriately focuses on the applicability of this modality to clinical problems. Our four years experience indicates that one of the challenges in the future will be to integrate telemedicine with the existing infrastructure of medicine so that it can more easily become part of mainstream practice.

Mainstream or margin? The current use of family group conferences in child welfare practice in the UK

ABSTRACTA decade has passed since family group conferences were initially introduced into the UK by Family Rights Group. Ten years on, this paper examines the extent to which family group conferences have developed and become embedded into current social work practice. Despite the initial interest by social work practitioners and the picture often painted of a growing radical movement, the degree to which family group conferencing has become part of mainstream practice has until now remained fairly anecdotal. A number of difficulties have been identified with implementing the model, including fitting it into an existing system and the challenge it poses to professionals to hand over power. Two surveys, the first undertaken in 1999 and the second in 2001, describe the current use of the model in the UK by Councils with Social Services Responsibilities (Councils). The surveys reveal the areas of practice within which family group conferences are being used, the size and capacity of projects and why some Councils have adopted the model whilst others remain hesitant. It concludes by considering why family group conferences remain on the margins of practice.

Can complementary and alternative therapies play a role in the emergency department?

Over the last few years there has been a lot of interest in complementary and alternative therapies, with many mainstream nursing and medical publications looking at the implementation of these therapies into day to day practice. In Australia, the public has embraced these therapies with an eagerness that has amazed many. Millions of dollars are being spent on alternative therapies every year. Have nurses been using alternative therapies in the work place? Where do nurses stand legally in the use these therapies? What requirements do the regulating bodies have for their implementation? How does the medical profession view complementary therapies and how will Doctors implement their use? Is it possible to use any of these therapies in the Emergency Department? This paper examines these and other related issues with the view that the emergency department has not been active in the introduction of these therapies to their detriment. There are a number of therapies suitable for introduction into the emergency department, and with the appropriate research these can be established as part of mainstream practice.