Experiences from the SARS-CoV-2 Pandemic: How One Orthopaedic Practice Pivoted to Serve Their Community.

In this chapter, the authors describe the essential need of mental health and psychosocial support for people accommodated in mandatory quarantine and isolation facilities during the outbreak of COVID-19 pandemic in Namibia through a multi-sectoral response. Namibia recorded its first two index cases on 13 March 2020 when a married couple arrived in the Windhoek district in Namibia from Madrid, Spain on 11 March 2020. Namibia has since March 2020 provided supervised quarantine services to 12,128 persons in facilities around the country. The Ministry of Health and Social Services provides mental health and psychosocial support services, which were critical in the short and long-term response to COVID-19 pandemic. Public health measures were developed in line with WHO guidelines to contain the virus. These measures include the need of setting up quarantine and isolation facilities. Recommendations for future research in strengthening mental health and psychosocial support services and coping strategies are provided in the chapter.

State Health Departments are at the helm of addressing the myriad needs during the COVID-19 pandemic, including those of vulnerable populations who do not have a place to self-isolate or quarantine to prevent the spread. An estimated 5,000 Arkansas residents face homelessness and are at increased risk of contracting and spreading COVID-19. Additionally, those living in multigenerational families face similar challenges. We share our experiences and lessons learned in planning, executing, and maintaining a quarantine and isolation facility for vulnerable population during the COVID-19 pandemic. A 29-bed quarantine and isolation facility was instituted and maintained by the Arkansas Department of Health to meet the quarantine and isolation needs of vulnerable populations. Outcomes and conclusions: As the COVID-19 pandemic persists, need for a facility to meet quarantine and isolation requirements of vulnerable population is not just a critical mitigation strategy but is an ethical imperative.

AMA Opposes Use of Ketamine, ‘Excited Delirium’ for Law Enforcement Purposes

The Howard Springs Quarantine Facility (HSQF) is located in tropical Northern Australia and has 875 blocks of four rooms (3,500 rooms in total) spread over 67 hectares. The HSQF requires a large outdoor workforce walking outdoor pathways to provide individual care in the ambient climate. The personal protective equipment (PPE) required for the safety of quarantine workers varies between workgroups and limits body heat dissipation that anecdotally contributes to excessive sweating, which combined with heat stress symptoms of fatigue, headache, and irritability, likely increases the risk of workplace injuries including infection control breaches. The purpose of this study was the description of qualitative and quantitative assessment for HSQF workers exposed to tropical environmental conditions and provision of evidenced-based strategies to mitigate the risk of heat stress in an outdoor quarantine and isolation workforce. The study comprised two components - a cross-sectional physiological monitoring study of 18 workers (eight males/ten females; means: 41.4 years; 1.69m; 80.6kg) during a single shift in November 2020 and a subjective heat health survey completed by participants on a minimum of four occasions across the wet season/summer period from November 2020 through February 2021. The physiological monitoring included continuous core temperature monitoring and assessment of fluid balance. The mean apparent temperature across first-half and second-half of the shift was 34.7°C (SD = 0.8) and 35.6°C (SD = 1.9), respectively. Across the work shift (mean duration 10.1 hours), the mean core temperature of participants was 37.3°C (SD = 0.2) with a range of 37.0°C - 37.7°C. The mean maximal core temperature of participants was 37.7°C (SD = 0.3). In the survey, for the workforce in full PPE, 57% reported feeling moderately, severely, or unbearably hot compared to 49% of those in non-contact PPE, and the level of fatigue was reported as moderate to severe in just over 25% of the workforce in both groups. Heat stress is a significant risk in outdoor workers in the tropics and is amplified in the coronavirus disease 2019 (COVID-19) frontline workforce required to wear PPE in outdoor settings. A heat health program aimed at mitigating risk, including workplace education, limiting exposure times, encouraging hydration, buddy system, active cooling, and monitoring, is recommended to limit PPE breaches and other workplace injuries in this workforce.

Compliance With Recommendations for Universal Precautions Among Prehospital Providers

Waste pickers are the riskiest group for disease transmission through waste, so have Personal Protective Equipment (PPE) is needed as a tool used by workers to protect themselves against potential dangers and work accidents. Although there are no definitive data on the existence of accidents or occupational diseases in TPS or TPA, the risk of health problems or the spread of disease due to exposure to various types of waste is very possible. Likewise with the waste pickers who are in the Temporary Shelter (TPS) in the Kelurahan Langkai City of Palangka Raya. The purpose of community service activities is to assist in the application of PPE by providing education and socialization about the possibility of potential hazards and workplace accidents as garbage collectors and the risk of exposure to diseases that can be transmitted through waste, training, and demonstrations about the use of Personal Protective Equipment (PPE) when work and hand over a set of PPE tools to the scavengers. Community service activities carried out on 39 waste pickers in several TPS located in Kelurahan langkai city of Palangka Raya

A-10 Virginians Report Unequal Access to Appropriate Licensed Healthcare Providers for Concussion

Background: The Information Team at Community and Public Health (the public health division of the Canterbury District Health Board), was approached by the Canterbury Regional Isolation and Quarantine (C-RIQ) leadership who were concerned by incidents of stigma and discrimination being reported to them by staff working within the Canterbury Managed Isolation and Quarantine facilities (MIQF). In order to inform next steps by the C-RIQ leadership in supporting their workforce, a rapid literature review and a survey of Canterbury MIQF staff was undertaken in late 2020.

Advanced practice professionals, including physician assistants (PAs) and nurse practitioners (NPs), play an important role in providing high-quality orthopaedic care. This role has been highlighted by projections of nationwide shortages in orthopaedic surgeons, with rural areas expected to be most affected. Given that approximately half of rural counties have no practicing orthopaedic surgeons and that advanced practice professionals have been shown to be more likely to practice in rural areas compared to physicians in other medical disciplines, orthopaedic advanced practice professionals may be poised to address orthopaedic care shortages in rural areas, but the degree to which this is true has not been well characterized. (1) What percentage of rural counties have no orthopaedic caregivers, including surgeons and advanced practice professionals? (2) Is the density of advanced practice professionals greater than that of orthopaedic surgeons in rural counties? (3) Do orthopaedic advanced practice professionals only practice in counties that also have practicing orthopaedic surgeons? (4) Are NPs in states with full practice authority more likely to practice in rural counties compared with NPs in restricted practice authority states? We identified orthopaedic surgeons and advanced practice professionals using the 2019 Medicare Provider Utilization and Payment Data, as this large dataset has been shown to be the most complete source of claims data nationwide. Each professional's ZIP Code was matched to counties per the US Postal Service ZIP Code Crosswalk Files. The total number and density of physician and advanced practice professionals per 100,000 residents were calculated per county nationwide. Counties were categorized as urban (large central metropolitan, large fringe metropolitan, medium metropolitan, and small metropolitan) or rural (micropolitan and noncore) using the National Center for Health Statistics Urban-Rural Classification Scheme. Comparisons between rural and urban county caregivers were conducted with the chi-square test and odds ratios. Population densities were compared with the Wilcoxon rank sum test. A bivariate density map was made to visualize the nationwide distribution of orthopaedic caregivers and determine the percentage of rural counties with no orthopaedic caregivers as well as whether orthopaedic advanced practice professionals practiced in counties not containing any surgeons. Additionally, to compare states with NP's full versus restricted practice authority, each NP was grouped based on their state to determine whether NPs in states with full practice authority were more likely to practice in rural counties. We identified a group of 31,091 orthopaedic caregivers, which was comprised of 23,728 physicians, 964 NPs, and 6399 PAs (7363 advanced practice professionals). A total of 88% (20,879 of 23,728) of physicians and 87% (6427 of 7363) of advanced practice professionals were in urban counties, which is comparable to nationwide population distributions. A total of 39% (1237 of 3139) of counties had no orthopaedic professionals (defined as orthopaedic surgeons or advanced practice professionals) in 2019. Among these counties, 82% (1015 of 1237) were rural and 18% (222 of 1237) were urban. The density of advanced practice professionals providing orthopaedic services compared with the density of orthopaedic surgeons was higher in rural counties (18 ± 70 versus 8 ± 40 per 100,000 residents; p = 0.001). Additionally, 3% (57 of 1974) of rural and 1% (13 of 1165) of urban counties had at least one orthopaedic advanced practice professional, but no orthopaedic surgeons concurrently practicing in the county. There was no difference between the percentage of rural counties with an NP in states with full versus restricted practice authority for NPs (19% [157 of 823] versus 26% [36 of 141], OR 1.45 [95% CI 0.99 to 2.2]; p = 0.08). As advanced practice professionals tended to only practice in counties which contain orthopaedic surgeons, our analysis suggests that plans to increase the number of advanced practice professionals alone in rural counties may not be sufficient to fully address the demand for orthopaedic care in rural areas that currently do not have orthopaedic surgeons in practice. Rather, interventions are needed to encourage more orthopaedic surgeons to practice in rural counties in collaborative partnerships with advanced practice professionals. In turn, rural orthopaedic advanced practice professionals may serve to further extend the accessibility of these surgeons, but it remains to be determined what the total number and ratio of advanced practice professionals and surgeons is needed to serve rural counties adequately. To increase rural orthopaedic outreach, state legislatures may consider providing financial incentives to hospitals who adopt traveling clinic models, incorporating advanced practice professionals in these models as physician-extenders to further increase the coverage of orthopaedic care. Furthermore, the creation of more widespread financial incentives and programs aimed at expanding the experience of trainees in serving rural populations are longer-term investments to foster interest and retention of orthopaedic caregivers in rural settings.

A Total Knee Arthroplasty Preoperative Optimization Program Managed by an Advanced Practice Provider (Physician Assistant) Decreases Complications and Cost: A Pilot Study

Konin JG, Wiksten DL, Isear JA Jr, Brader H. Thorofare, NJ 08086, Slack Inc, 2006, spiralbound, 400 pp, illus, ISBN: 1-55642-741-7, $38.95. This text, authored by both physical therapists and athletic trainers, is intended to provide a condensed guide for the examination of people with orthopedic injuries. In my opinion, this goal has been surpassed. Designed as a “pocket-style” manual, the 400 pages in this third edition push the definition of “pocket guide,” but make up for the additional size with an abundance of information. Designed for physical therapists, athletic trainers, physicians, physician assistants, and occupational therapists, this text covers a plenitude of orthopedic tests. Like other texts of this kind, the special tests in this book are organized into 12 sections according to the major spinal segments and peripheral joints. A total of 155 special tests are offered, ranging from as few as 3 for the temporomandibular joint and thoracic spine sections to as many as 34 for the shoulder. In addition to the joint-by-joint arrangement, an alphabetical index at the end of the text allows …

Wednesday, September 26, 2018 2:00 PM – 3:00 PM Integrating Technology into Practice: 57. The impact of online physician rating websites on orthopedic clinical practice

An 18-year-old college football linebacker reported to the training room physician's office in early September complaining of an irregular heartbeat and lightheadedness while weightlifting. He also noted mild fever and chills and rapid fatigability during practice. He said that he had had a skin eruption several weeks earlier. He denied chest pain or pressure, near syncope or syncope, shortness of breath, or history of palpitations.

This study assessed human immunodeficiency virus (HIV)-related services in county jails and staff perceptions of HIV-infected inmates and their care. A statewide telephone questionnaire was administered to detention officers and health care workers providing medical services in North Carolina jails. Eighty-five percent of participating facilities employed one or more on-site medical personnel, including physicians (51%), physician assistants (14%), and nurses (71%). Only 25% of jails tested more than one inmate for HIV per month. In 75% of jails, initial medical screening was performed in a common area. Officers administered medical screening forms at 93% of jails and distributed medications at 81%. Ninety-three percent of officers and 94% of medical staff agreed with this statement: "If an inmate is taking medications in jail, other inmates will know about it." Overall, our data indicate that few North Carolina jail inmates are tested for HIV. Greater protection of confidentiality may improve screening and treatment of HIV-infected inmates.

Inadequate access to medical care in underserved and geographically isolated rural communities may limit the delivery of quality screening care to miners. Use of mobile screening clinics, manned by a physician assistant or nurse practitioner, is one way to improve their access. Miners demonstrate a high level of satisfaction with services provided by the mobile screening clinic. The addition of telemedicine to mobile screening clinics allows miners to have access to university-based specialist care and provides an opportunity to specialists to tele-mentor other providers. Although inadequately studied, limited data suggest that miners accept telemedicine consultation. We expect that the innovative use of mobile screening clinics with telemedicine technology might allow efficient utilization of resources to meet the medical screening needs of a large number of miners in geographically remote locations in the United States.