The involvement of even multiple PAs during follow-up management of nonoperatively treated pediatric forearm fractures is not associated with an increase in the risk of malunion. These findings are consistent with previous published works that highlighted the safe and valuable role PAs can play in the management of common fractures.
Purpose:An unexpected return to clinic (URTC) visit can place a substantial financial burden on patients and families while stressing the health care system. Our SMART aim was to decrease the rate of URTC visits from 1.8 per 100 patient follow-up visits by 50% using quality improvement methodology.Methods:The rate of URTC visits was tracked at our tertiary care pediatric hospital from February 1, 2014, to May 31, 2015, using a weekly P-chart. Interventions were studied from January 1 to May 31, 2015. Pareto charts determined the common causes of URTC visits. Interventions were studied using Plan-Do-Study-Act cycles. Medical charges for URTC patient visits were collected and patients/families were given a cost survey to determine nonmedical costs associated with the clinic visits.Results:Cast issues (50.5%) were most common, followed by new symptom/complaints (29.5%), and persistent or worse symptoms (15.2%). Following interventions, URTC rates decreased from 1.8 to 0.7 (⇓62%) per 100 follow-up visits during the study period. Interventions were targeted toward cast use and improved patient education via standardized materials. The average URTC resulted in $350.38 of charges. Additionally, the average URTC cost families $70 for a half day of lost wages and travel expenses.Discussion:Applying quality improvement methodology to URTC visits by standardizing patient education and minimizing cast usage resulted in a substantial decrease in the number of patients returning to clinic, both for scheduled follow-ups and unexpectedly. This improvement resulted in a savings of more than $420 per visit saved, including medical and nonmedical costs.
Popular media, including films, television, comics, videogames, and books, are an increasingly important aspect of contemporary tourism. This is especially the case in Scotland, where popular culture led to the development of Scotland’s tourism industry. In this article, we will describe the phenomenon of media-related tourism in Scotland with respect to three selected case studies within Scotland: First, Glenfinnan Viaduct, made famous by the Harry Potter film series; Second, Doune Castle, used as a set for Monty Python, Game of Thrones and more recently, Outlander; Third, Abbotsford, home of Sir Walter Scott, a classical novelist now celebrating his 250th Birthday Anniversary. In examining these case studies, the article will consider how sustainable media tourism is. This approached is from the lens of media tourism and its impact on rural communities, concerns over local infrastructure, wider understandings of media tourism as a growing sub-sector, and the sustainability of the wider Scottish tourism industry in relation to the coronavirus pandemic.
With the release of the novel Outlander (1991) by American author Diana Gabaldon and the subsequent television adaptation in 2014, Scotland has experienced an exponential rise in screen tourism which is being dubbed the ‘Outlander effect’. While the steady influx of Outlander fans is mostly perceived as an economic boon, media outlets and heritage agencies have begun reporting damages to Scottish heritage sites due to increased Outlander-related tourism. The media coverage of these damages depicts the actions of ‘rampaging’, ‘loutish’, ‘crack-pot’, ‘selfie-mad’ Outlander fans which is proving to be a troubling colouration of Outlander fans in the media. This article examines the relationship between an online Outlander Facebook fan community called OutlandishUK and tourism to Scotland. Drawing from ethnographic and netnographic research, this article examines how online Facebook fan groups are embracing the role of being proactive online communities that engage fluidly with members of the media and regional interest groups to promote proper care of heritage sites in Scotland by the wider Outlander fandom. In contrast to the negative colouration of fans as vandals, the article suggests that it is through these collaborative efforts these fan groups are looking beyond fandom to act as guardians of Scottish heritage and facilitate regional tourism in Scotland.
The coronavirus pandemic (SARS-CoV-2) has been disastrous for cultural tourism worldwide as many cultural tourist venues are concentrated in cities and have had to close along with tourism-related facilities such as hospitality businesses and hotels. There has been a widespread fear of travel and social contact. The comparative research drawn upon in this paper suggests that new trends might be emerging with rural and natural attractions becoming more prominent and a rise in domestic tourism due to the problems of foreign travel. This is associated with increased use of individualised travel and self-catering facilities. There has been a resultant rediscovery of more local scenery and attractions. The greater use of information technology can enhance tourism under these conditions and this is likely a permanent shift. Our research shows how these shifts emerged over the course of different lockdowns. Comparative research suggests that new trends and directions might emerge instead of a post-pandemic reset to what existed before.
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