Summary:
The Virtual Fracture Clinic (VFC) has proved beneficial in reducing footfall within the hospital setting, improving the cost of running a trauma service, while satisfying the majority of referred patients. The mandatory upscaling of telemedicine use, specifically the enhancement of the VFC, amidst the COVID-19 pandemic, was analyzed. The remit of the VFC within our hospital was expanded so as to include all referred ambulatory trauma. Outcomes of our VFC review over the 6-week period following the introduction of the national Irish COVID-19–related restrictions were gathered. These outcomes were analyzed and compared with the corresponding 6-week period from 2019. A 77.2% increase in the VFC referral volume was observed throughout the COVID-19–related period. Patients were directly discharged in 55.2% of cases in 2020, as opposed to 47.8% in 2019 (
P
= 0.044); referred directly for physiotherapy in 32.9% of cases in 2020, as opposed to 28.9% in 2019 (
P
= 0.173); and referred to a fracture clinic in 11.9% of cases in 2020, as opposed to 23.7% in 2019 (
P
< 0.001). Also, 3.0% of patients returned to the clinic after discharge in 2020, compared with 4.4% in 2019 (
P
= 0.237); 4.5% of patients were referred for surgery in 2020, as opposed to 2.2% in 2019 (
P
= 0.105). The VFC proved to be an efficient tool in managing ambulatory trauma throughout the pandemic. Upscaling the VFC to include all ambulatory trauma is a safe, effective method in reducing clinic attendances and hospital footfall, whilst ensuring that high care standards are maintained.
Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
INTRODUCTION:
Substance abuse is a growing problem among women, and is frequently accompanied by multiple gynecologic concerns. Residential substance abuse rehabilitation facilities offer an opportunity to address those concerns. The purpose of this report is to examine the impact of an all-volunteer, medical student-run clinic with faculty supervision within a non-profit, inner-city women's residential substance abuse rehabilitation facility.
METHODS:
625 clients were admitted, regardless of financial status, to a 70-bed residential substance abuse rehabilitation facility between 2016 and mid-2018. Data including Pap smears, Human Papillomavirus (HPV) infection, and sexually transmitted infection testing were analyzed.
RESULTS:
From January 2016 through August 2018, 175/625 (28.0%) clients accepted Pap testing. 52/175 (29.7%) had an abnormal result, defined as Trichomonas infection, HPV infection, or premalignant or malignant lesion. 240/625 (38.4%) clients accepted Gonorrhea/Chlamydia testing, and 6 were identified as having Gonorrhea or Chlamydia. In 2018 alone, Pap testing identified 7/44 (15.9%) clients as having premalignant or malignant lesions, including one case of squamous cell carcinoma. 9/24 (37.5%) had a high-risk HPV strain. 7/44 (15.9%) had Trichomonas. Clients also received counseling regarding personal health awareness and reduction of high-risk behaviors.
CONCLUSION:
The use of a student-run clinic to provide gynecologic services within a residential substance abuse rehabilitation facility has a major impact and is cost-efficient. Many clients have no other opportunity to obtain instruction on health awareness and high-risk behavior, as well as diagnosis and treatment of abnormal Pap smears and STIs. This model allows non-profit facilities to provide an otherwise unaffordable level of care.
This book explores the aesthetics of the objects and environments we encounter in daily life. Thomas Leddy stresses the close relationship between everyday aesthetics and the aesthetics of art, but places special emphasis on neglected aesthetic terms such as ‘neat,’ ‘messy,’ ‘pretty,’ ‘lovely,’ ‘cute,’ and ‘pleasant.’ The author advances a general theory of aesthetic experience that can account for our appreciation of art, nature, and the everyday.
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