scholarly journals NHS Scotland reduces the postcode lottery for hip arthroplasty: an ecological study of the impact of waiting time initiatives

2014 ◽  
Vol 107 (6) ◽  
pp. 237-245 ◽  
Author(s):  
Graham Kirkwood ◽  
Allyson M Pollock ◽  
Colin Howie ◽  
Sarah Wild
Keyword(s):  
Waiting Time ◽  
Hip Arthroplasty ◽  
Ecological Study ◽  
The Impact

scholarly journals An ecological study of NHS funded elective hip arthroplasties in England from 2003/04 to 2012/13

2019 ◽  
Vol 112 (7) ◽  
pp. 292-303
Author(s):  
Shailen Sutaria ◽  
Graham Kirkwood ◽  
Allyson M Pollock
Keyword(s):  
Hip Arthroplasty ◽  
Ecological Study ◽  
Relative Difference ◽  
Risk Selection ◽  
Private Provision ◽  
Private Providers ◽  
Affluent Area ◽  
Hip Arthroplasties ◽  
The Impact ◽  
Relative Slope

Objectives To examine the impact of NHS-funded private provision on NHS provision, access and inequalities. Design Ecological study using routinely collected NHS inpatient data. Setting England. Participants All individuals undergoing an NHS-funded elective hip arthroplasty in England from 2003/2004 to 2012/2013. Main outcome measures Annual crude and standardised rates of hip arthroplasties per 100,000 population performed by NHS and private providers between 2004/2005 and 2012/2013. Results Age standardised rates of hip arthroplasty increased from 116.4 (95% CI 115.4–117.4) to 148.7 (147.6–149.8) per 100,000 between 2004/2005 and 2012/2013. Provision shifted from NHS providers to private providers from 2007/2008; NHS provision decreased 8.6% and private provision increased 188% between 2007/2008 and 2012/2013. There is evidence of risk selection; private sector hip arthroplasties on NHS patients from the most affluent areas increased 228% from 10.8 (10.2–11.5) to 35.4 (34.3–36.5) per 100,000 compared to an increase of 186% from 8.8 (8.1–9.4) to 25.2 (24.1–26.4) per 100,000 among patients from the least affluent areas between 2007/2008 and 2012/2013. There was no statistically significant (p > 0.05) widening in any measure of inequality (absolute, relative difference and slope and relative slope of index inequality) in hip arthroplasty rates between 2004/2005 and 2012/2013. Conclusion Private provision substituted for NHS provision and did not add to overall provision favouring patients living in the most affluent area. Continuing the trend towards private provision and reducing NHS provision is likely to result in risk selection and widening inequalities in provision of elective hip arthroplasty in England.

scholarly journals Crise Económica em Portugal: Evolução da Incidência de Depressão e Correlação com o Desemprego

2020 ◽  
Vol 33 (13) ◽  
Author(s):  
Inês Laplanche Coelho ◽  
Mafalda Sousa-Uva ◽  
Nuno Pina ◽  
Sara Marques ◽  
Carlos Matias-Dias ◽  
...  
Keyword(s):  
Social Vulnerability ◽  
Ecological Study ◽  
Preventive Measures ◽  
Portuguese Population ◽  
Sentinel Network ◽  
Unemployment Rates ◽  
Positive Correlation ◽  
National Statistics ◽  
Using Data ◽  
The Impact

Introduction: Previous studies have found an increase in the incidence rate of depression between 2007 – 2013 in Portugal, with a positive correlation with the unemployment rate, namely, in men. So, it was hypothesized that this increase is related with the situation of economic crisis. This study aimed to investigate if the correlation between unemployment rates and the incidence of depression is maintained in the post-crisis period of economic recovery in Portugal (2016 – 2018).Material and Methods: An ecological study was carried out, using data from the General Practitioners Sentinel Network concerning depression incidence (first episodes and relapses) and data from the National Statistics Institute on unemployment rates in the Portuguese population. The correlation coefficient was estimated using linear regression and the results were disaggregated by sex.Results: Between 2016 and 2018, there was a consistent decrease in the incidence of depression in both sexes. During the 1995 – 2018 period, a positive correlation was observed between unemployment and depression, with a coefficient of 0.833 (p = 0.005) in males and of 0.742 (p = 0.022) in females.Discussion: The reduction in the incidence of depression in both sexes observed between 2016 – 2018 corroborates a positive correlation between unemployment and depression in the Portuguese population, previously observed between 2007 – 2013.Conclusion: This study highlights the need to monitor the occurrence of mental illness in the Portuguese population, especially in moments of greatest social vulnerability in order to establish preventive measures, as a way to mitigate the impact of future economic crises.

scholarly journals The Impact of Longer Consultation Time: A Simulation-Based Approach

2020 ◽  
Vol 11 (05) ◽  
pp. 857-864
Author(s):  
Abdulrahman M. Jabour
Keyword(s):  
Waiting Time ◽  
Quality Care ◽  
Working Hours ◽  
Discrete Events ◽  
Simulation Based ◽  
Patient Waiting Time ◽  
Free Environment ◽  
The Impact ◽  
Consultation Time ◽  
Patient Waiting

Abstract Background Maintaining a sufficient consultation length in primary health care (PHC) is a fundamental part of providing quality care that results in patient safety and satisfaction. Many facilities have limited capacity and increasing consultation time could result in a longer waiting time for patients and longer working hours for physicians. The use of simulation can be practical for quantifying the impact of workflow scenarios and guide the decision-making. Objective To examine the impact of increasing consultation time on patient waiting time and physician working hours. Methods Using discrete events simulation, we modeled the existing workflow and tested five different scenarios with a longer consultation time. In each scenario, we examined the impact of consultation time on patient waiting time, physician hours, and rate of staff utilization. Results At baseline scenarios (5-minute consultation time), the average waiting time was 9.87 minutes and gradually increased to 89.93 minutes in scenario five (10 minutes consultation time). However, the impact of increasing consultation time on patients waiting time did not impact all patients evenly where patients who arrive later tend to wait longer. Scenarios with a longer consultation time were more sensitive to the patients' order of arrival than those with a shorter consultation time. Conclusion By using simulation, we assessed the impact of increasing the consultation time in a risk-free environment. The increase in patients waiting time was somewhat gradual, and patients who arrive later in the day are more likely to wait longer than those who arrive earlier in the day. Increasing consultation time was more sensitive to the patients' order of arrival than those with a shorter consultation time.

scholarly journals The influence of bone quality on radiological outcome in 50 consecutive acetabular fractures treated with a pre-contoured anatomic suprapectineal plate

2021 ◽  
Author(s):  
Maximilian J. Hartel ◽  
Tareq Naji ◽  
Florian Fensky ◽  
Frank O. Henes ◽  
Darius M. Thiesen ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Bone Mass ◽  
Bone Quality ◽  
Hip Arthroplasty ◽  
Mass Density ◽  
Acetabular Fractures ◽  
Bone Mass Density ◽  
Radiological Outcome ◽  
Total Hip ◽  
The Impact

Abstract Purpose To investigate the range of indications of an anatomical-preshaped three-dimensional suprapectineal plate and to assess the impact of the bone mass density on radiologic outcomes in different types of acetabular fractures. Patients and methods A consecutive case series of 50 acetabular fractures (patient age 69 ± 23 years) treated with suprapectineal anatomic plates were analyzed in a retrospective study. The analysis included: Mechanism of injury, fracture pattern, surgical approach, need for additional total hip arthroplasty, intra- or postoperative complications, as well as bone mass density and radiological outcome on postoperative computed tomography. Results Most frequently, anterior column fracture patterns with and without hemitransverse components as well as associated two column fractures were encountered. The anterior intrapelvic approach (AIP) was used in 98% (49/50) of the cases as primary approach with additional utilization of the first window of the ilioinguinal approach in 13/50 cases (26%). Determination of bone density revealed impaired bone quality in 70% (31/44). Postoperative steps and gaps were significantly greater in this subgroup (p < 0.05). Fracture reduction quality for postoperative steps revealed anatomic results in 92% if the bone quality was normal and in 46% if impaired (p < 0.05). In seven cases (14%), the plate was utilized in combination with acute primary arthroplasty. Conclusion A preshaped suprapectineal plate provides good radiological outcomes in a variety of indications in a predominantly geriatric cohort. Impaired bone quality has a significantly higher risk of poor reduction results. In cases with extensive joint destruction, the combination with total hip arthroplasty was a valuable option.

scholarly journals The impact of reducing the femoral stem length in total hip arthroplasty during gait

2021 ◽  
Author(s):  
Anatole Vilhelm Wiik ◽  
Adeel Aqil ◽  
Bilal Al-Obaidi ◽  
Mads Brevadt ◽  
Justin Peter Cobb
Keyword(s):  
Total Hip Arthroplasty ◽  
Gait Analysis ◽  
Hip Arthroplasty ◽  
Femoral Stem ◽  
Short Stem ◽  
Stem Length ◽  
Practical Consideration ◽  
Total Hip ◽  
Long Stem ◽  
The Impact

Abstract Aim The length of the femoral stem in total hip arthroplasty (THA) is a practical consideration to prevent gait impairment. The aim of this study was to determine if reducing the femoral stem length in THA would lead to impaired gait biomechanics. Methods Patients uniformly with the same brand implant of differing lengths (100 mm vs 140–166 mm) were taken retrospectively from a prospective trial introducing a new short stem. Twelve patients without any other disorder to alter gait besides contralateral differing length stem THA were tested at differing gradients and speed on a validated instrumented treadmill measuring ground reaction forces. An anthropometrically similar group of healthy controls were analysed to compare. Results With the same posterior surgical approach, the offset and length of both hips were reconstructed within 5 mm of each other with an identical mean head size of 36 mm. The short stem was the last procedure for all the hips with gait analysis occurring at a mean of 31 and 79 months postoperatively for the short and long stem THA, respectively. Gait analysis between limbs of both stem lengths demonstrated no statistical difference during any walking condition. In the 90 gait assessments with three loading variables, the short stem was the favoured side 51% of the time compared 49% for the long stem. Conclusion By testing a range of practical walking activities, no lower limb loading differences can be observed by reducing the femoral stem length. A shorter stem demonstrates equivalence in preference during gait when compared to a reputable conventional stem in total hip arthroplasty.

The Impact of Study Period on Perioperative Outcomes Following Hip Arthroplasty

2015 ◽  
Vol 30 (7) ◽  
pp. 1167-1171
Author(s):  
Denis Nam ◽  
Ryan M. Nunley ◽  
Staci R. Johnson ◽  
John C. Clohisy ◽  
Robert L. Barrack
Keyword(s):  
Hip Arthroplasty ◽  
Perioperative Outcomes ◽  
The Impact
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