RESUMO
Serious medical diagnostic errors lead to adverse patient outcomes and increased healthcare costs. The use of virtual online consultation platforms may lead to better-informed physicians and reduce the incidence of diagnostic errors. Our aim was to assess the usage characteristics of an online, physician-to-physician, no-cost, medical consultation platform, Medscape Consult, from November 2015 through October 2017. Physicians creating original content were noted as "presenters" and those following up as "responders". During the study period, 37,706 physician users generated a combined 117,346 presentations and responses. The physicians had an average age of 56 years and were from 171 countries on every continent. Over 90% of all presentations received responses with the median time to first response of 1.5 h. Overall, computer- and device-based medical consultation has the capacity to rapidly reach a global medical community and may play a role in the reduction of diagnostic errors.
RESUMO
UNLABELLED: Williams SB, Brand CA, Hill KD, Hunt SB, Moran H. Feasibility and outcomes of a home-based exercise program on improving balance and gait stability in women with lower-limb osteoarthritis or rheumatoid arthritis: a pilot study. OBJECTIVE: To evaluate the feasibility and gait stability and balance outcomes of a 4-month individualized home exercise program for women with arthritis. DESIGN: Pre-post interventional study. SETTING: General community. PARTICIPANTS: Women (N=49) (volunteers) with lower-limb osteoarthritis or lower-limb rheumatoid arthritis were enrolled. Only 39 subjects were eligible and completed the study. INTERVENTION: After completion of the initial assessment, all participants received home balance exercises from an experienced physiotherapist based on assessment findings and exercises available from commercially available kits. All measures were repeated 4 months later. MAIN OUTCOME MEASURES: Falls risk (Falls Risk of Older People-Community Setting) and balance measures. RESULTS: Thirty-nine women (mean age, 69.3y; 95% confidence interval, 65.7-72.9) completed the 4-month program. At baseline, 64% of participants reported falling in the preceding 12 months, and the average falls risk (Falls Risk of Older People-Community Setting) score was 14.5, with 42% rated as moderate risk (16-23). Participants achieved improved performance on most balance and related measures after the exercise program, including falls risk (P=.01), activity levels (P=.015), fear of falling (P=.022), functional reach test (P=.001), rising index for sit to stand (P=.001), step width in walking (P=.001), and body mass index (P=.006). CONCLUSIONS: An individualized balance training home exercise program is feasible for older women with osteoarthritis or rheumatoid arthritis and may improve stability during walking and other functional activities.
