Virtual arthroplasty clinic: a single centre experience: commentary on progress, cost savings and patient retention.

BACKGROUND: The COVID pandemic highlights utility of remote patient follow-up. We observe a Virtual Clinic (VC) follow-up model for arthroplasty used at a metropolitan hospital. Patients aged <70 that exhibit no issues in face-to-face review (F2F) progress to VC. We aimed to review VC's cost-effectiveness, and identify potential improvements to patient allocation and retention. METHOD: A retrospective database was collated of all hip and knee joint arthroplasties performed at Frankston Hospital over a 12-month period in 2017-2018. Patient encounters were followed from operation to discharge from F2F and, if appropriate, VC (involving imaging and a paper-based qualitative questionnaire). VC attendance was compared to that of the year in which it was introduced (2014). The Clinical Costings Department provided average hospital spending for each of these modes of follow-up. RESULTS: Of 516 joint arthroplasties performed, 500 attended outpatient clinic (OPC). There were 884 F2F appointments (average 1.7 per person, range 0-12). One-hundred-and-fifty-four arthroplasties were correctly assigned to subsequent VC as per protocol (30%). Completed VC responses were received for 86 arthroplasties (56% response rate). In the period studied, VC attendance increased significantly compared to the year following introduction (36-56%, p < 0.05), with the questionnaire revealing a high-level of patient satisfaction for this method of follow-up. Over the period studied, we estimate VC has saved $250 000 and 300 review hours from OPC. CONCLUSION: Implementing VC for follow-up of arthroplasty may demonstrate a method of saving hospital resources. Appropriate early enrolment of patients to reduce F2F burden, and VC retention, should be encouraged.

The long-term quality of life outcomes in adolescents with Hirschsprung disease.

BACKGROUND: Postoperative outcomes for Hirschsprung disease (HD) remain variable, with many patients affected by constipation and/or fecal incontinence. The long-term impact upon quality of life (QoL) for HD patients is unclear. We measured long-term QoL outcomes in adolescents with HD using validated questionnaires. METHODS: Patients with HD, managed at a large tertiary pediatric institution between 1997 and 2004, were identified. Patients and/or their proxy completed validated questionnaires. Results were compared with published healthy population controls. Two questionnaires assessed QoL: Pediatric Quality of Life Inventory (PedsQL) and Fecal Incontinence and Constipation Quality of Life (FICQOL). Three measures assessed functional outcomes: Baylor Continence Scale, Cleveland Clinic Constipation Scoring System, and Vancouver Dysfunctional Elimination Symptom Survey. RESULTS: Interviews were completed for 58 (70% response rate) patients [M:F, 49:9; median age, 14.5 years (11.1-18.7)]. No significant differences were found in general QoL scores between patients and healthy controls (84.84 versus 81.49, p = 0.28). Disease-specific questionnaires revealed reduced QoL in patients and families, with 17% of parents reporting the bowel dysfunction stopped their child from socializing and 47% of parents experiencing some degree of anxiety/depression regarding their child's bowel condition. Fecal incontinence (r = -0.59, p < 0.01), constipation (r = -0.36, p = 0.01), and dysfunctional elimination (r = -0.59, p < 0.01) all negatively correlated with QoL scores. CONCLUSIONS: In this study, generic QoL in the adolescent HD population was comparable to healthy populations. However, children with HD have ongoing bowel dysfunction which negatively impacts upon their QoL. LEVEL OF EVIDENCE: Prognosis study:- level II (prospective cohort study).

Australian students' perspective on interventional radiology education: A prospective cross-institutional study.

INTRODUCTION: As interventional radiology (IR) adopts an increasingly pivotal role within therapeutic medicine, it is essential that medical students gain exposure to IR so as future doctors, they can fulfil the growing demand for interventional radiologists (IRs) and make appropriate referrals to IRs. Nonetheless, several international studies have reported no or little representation of IR in medical schools. Our study aims to assess the current awareness, exposure, knowledge and attitudes about IR among Australian medical students, so as to provide preliminary data on whether IR teaching in Australian medical schools needs improvement. METHODS: A prospective cross-sectional study was conducted via web-based and in-person distribution of a voluntary, anonymous questionnaire. RESULTS: A total of 237 complete responses were received from approximately 1400 clinical-based students (17% response rate); 38% of respondents had never witnessed an IR procedure, 39% witnessed 1-2 and the remainder, 3-5. Few students reported adequate teaching or knowledge in IR (7% and 5% respectively). Of the 32% of the students considering a career in IR, males predominated (25% of females vs. 59% of males, OR = 0.48, 95%, CI = 0.27-0.83, P = 0.008). Most students agree that IR should be in the university curriculum (59%) and is key to improving healthcare (74%). Senior students were more likely to report adequate teaching (P < 0.001) and believe that IR teaching is important (P = 0.001). CONCLUSIONS: Australian medical students have a strong appreciation for IR despite having suboptimal teaching, exposure and knowledge in IR. In order to complement and sustain the rapid uptake of IR techniques in modern medicine, university curricula require a greater focus on IR.

Potential application of gasification to recycle food waste and rehabilitate acidic soil from secondary forests on degraded land in Southeast Asia.

Gasification is recognized as a green technology as it can harness energy from biomass in the form of syngas without causing severe environmental impacts, yet producing valuable solid residues that can be utilized in other applications. In this study, the feasibility of co-gasification of woody biomass and food waste in different proportions was investigated using a fixed-bed downdraft gasifier. Subsequently, the capability of biochar derived from gasification of woody biomass in the rehabilitation of soil from tropical secondary forests on degraded land (adinandra belukar) was also explored through a water spinach cultivation study using soil-biochar mixtures of different ratios. Gasification of a 60:40 wood waste-food waste mixture (w/w) produced syngas with the highest lower heating value (LHV) 5.29 MJ/m(3)-approximately 0.4-4.0% higher than gasification of 70:30 or 80:20 mixtures, or pure wood waste. Meanwhile, water spinach cultivated in a 2:1 soil-biochar mixture exhibited the best growth performance in terms of height (a 4-fold increment), weight (a 10-fold increment) and leaf surface area (a 5-fold increment) after 8 weeks of cultivation, owing to the high porosity, surface area, nutrient content and alkalinity of biochar. It is concluded that gasification may be an alternative technology to food waste disposal through co-gasification with woody biomass, and that gasification derived biochar is suitable for use as an amendment for the nutrient-poor, acidic soil of adinandra belukar.