COVID-19 and Orthopaedic International Humanitarianism.

As the world continues to adjust to life with COVID-19, one topic that requires further thought and discussion is whether elective international medical volunteerism can continue, and, if so, what challenges will need to be addressed. During a pandemic, the medical community is attentive to controlling the disease outbreak, and most of the literature regarding physician involvement during a pandemic focuses primarily on physicians traveling to areas of need to help treat the disease. As a result, little has been written about medical volunteerism that focuses on medical treatment unrelated to the disease outbreak. In a world-wide pandemic, many factors are to be considered in determining whether, and when, a physician should travel to another region to provide care and training for medical issues not directly related to the pandemic. Leaders of humanitarian committees of orthopaedic surgery subspecialties engaged with one another and host orthopaedic surgeons and a sponsoring organization to provide thoughtful insight and expert opinion on the challenges faced and possible pathways to provide continued orthopaedic support around the globe. Although this discussion focuses on international orthopaedic care, these suggestions may have a much broader application to the international medical community as a whole.

Volunteering Internationally: Why, Where and How.

Oral health volunteers have an important role in addressing oral health care shortages around the world, but to be effective they need to understand and prepare for the challenges of working overseas.

Use of a transitional minimum data set (TMDS) to improve communication between nursing home and emergency department providers.

OBJECTIVE: To study the adoption of a transitional minimum data set (TMDS) and its effectiveness in conveying essential clinical data elements between skilled nursing facility (SNF) and emergency department (ED) staff. DESIGN: Retrospective medical record review of patients transferred from one SNF to one ED over a 14-month period before and after the implementation of the TMDS, to determine whether it improved data transfer compared with prior practice. SETTINGS: One urban 140-bed SNF, averaging 17 ED transfers per month, and their affiliated ED at a major tertiary care hospital in Boston, MA. PARTICIPANTS: The medical records of 74 residents transferred from the SNF to the ED comprised the study data. INTERVENTION: A Transition of Care Minimum Data Set necessary for ED care was developed based on a literature review and expert panel consensus. From this, a TMDS tool was derived. The nursing facility staff was trained on the use of the TMDS tool (Resident Transfer Form and transfer packet), which was sent with each patient at the time of transfer from the SNF to the ED. MEASUREMENTS: Effectiveness of data transfer was determined by the proportion of TMDS items received by the ED following implementation of the TMDS in comparison with prior care. Adoption rate of the TMDS tool was determined by the proportion of hospital medical records that contained a paper copy of the resident transfer form. RESULTS: Following the implementation of the TMDS there was statistically significant improvement in data transfer of 15 of 30 TMDS items. Among these items were the following: patient's family notified of transfer, contact information for the MD/NP at the SNF, contact information for obtaining more patient information from the SNF, resuscitation status, baseline cognitive and functional status, isolation precautions and risk alerts, and whether the SNF could accept the patient back after treatment in the ED. The Resident Transfer Form was found in the hospital medical record of 73% of patients. There were anecdotal reports of hospital provider satisfaction with the TMDS and RTF. CONCLUSION: The TMDS was associated with marked improvement in the transfer of essential clinical information. Educational efforts are warranted to increase consistency of usage.

Nongovernmental organizations in musculoskeletal care: Orthopaedics Overseas.

Injuries are a major worldwide contributor to morbidity and mortality. The negative impact caused by such injuries is disproportionately heavy in developing countries. Such disparities are caused by a complex array of problems, including a lack of physical resources, poor infrastructure, and a shortage of trained health professionals. Overcoming such deficits in care will require the involvement of organizations that can offer broad-based solutions. These organizations must bridge the gap between private and public institutions to establish a systems-based approach to program development and institution-building. They must provide not just an adequate level of care, but a transfer of knowledge that leads to sustainable and cost-effective intervention. Orthopedics Overseas is an example of such an organization. We examine the development of Orthopedics Overseas and describe their interventions in Uganda as a case-study to show the unique position they have to affect change.