Orthopaedics

A national review of adult elective orthopaedic services in England: Getting it right first time – British Orthopaedic Association – 16 March 2015

Posted on March 18, 2015. Filed under: Orthopaedics |

A national review of adult elective orthopaedic services in England: Getting it right first time – British Orthopaedic Association – 16 March 2015

Executive summary

Final report

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Arthritis and other musculoskeletal conditions across the life stages – AIHW – 16 May 2014

Posted on May 21, 2014. Filed under: Orthopaedics, Rheumatology | Tags: |

Arthritis and other musculoskeletal conditions across the life stages – AIHW – 16 May 2014

“Arthritis and other musculoskeletal conditions affect an estimated 6.1 million Australians (approximately 28% of the total population) across all ages. Due to their diverse nature, there is considerable variation in the prevalence, treatment and management, and quality of life of people with these conditions across various life stages. This report describes these impacts in the following age groups: childhood (0–15), young adulthood (16–34), middle years (35–64), older Australians (65–79) and Australians aged 80 or over.”

ISSN 1833-0991; ISBN 978-1-74249-569-9; Cat. no. PHE 173; 125pp

Media release: Arthritis, back pain, osteoporosis across life stages profiled in new report – AIHW – 16 May 2014

“The prevalence, treatment and experiences of people affected by arthritis, back pain, osteoporosis and other musculoskeletal conditions have been quantified in a new report released today by the Australian Institute of Health and Welfare (AIHW).

The report, Arthritis and other musculoskeletal conditions across the life stages, looks at these conditions across various stages of life.

‘Arthritis and other musculoskeletal conditions are common, affecting an estimated 6.1 million Australians (28% of the total population) in 2011-12. Our report looks more closely at the age profile of these conditions and their impact,’ said AIHW spokesperson Louise York.”

… continues

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National Hip Fracture Database: Anaesthesia Sprint Audit of Practice (ASAP) – Royal College of Physicians – 31 March 2014

Posted on April 4, 2014. Filed under: Anaesthesiology, Orthopaedics, Surgery | Tags: |

National Hip Fracture Database: Anaesthesia Sprint Audit of Practice (ASAP) – Royal College of Physicians – 31 March 2014

Media release: Professionals are divided over best care for hip fracture patients, latest audit results show

“The latest report from the Falls and Fragility Fracture Programme (FFFAP) National Hip Fracture Database (NHFD) shows that just over half of patients are receiving pain relieving anaesthetic (known as a ‘nerve block’) as part of their care for hip fracture.

The National Hip Fracture Database Anaesthesia Sprint Audit of Practice (ASAP) (PDF 2MB) results, published today, show that 56% of hip fracture patients receive a peri-operative nerve block for pain relief and 44% of patients do not. The audit recommends that this type of pain relieving anaesthetic should be offered to all hospital patients who suffer hip fracture.

The Anaesthetic Sprint Audit of Practice (ASAP) was commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit programme. ASAP marks a successful collaboration between several professional organisations. The NHS Hip Fracture Perioperative Network (HipPen), British Orthopaedic Association (BOA), British Geriatrics Society (BGS), Royal College of Physicians (RCP) and Association of Anaesthetists of Great Britain and Ireland (AAGBI) have worked together to explore anaesthesia within hip fracture care using data collected by members of the HipPen.”

.. continues on the site

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Variations in outcome and costs among NHS providers for common surgical procedures: econometric analyses of routinely collected data – Health Services and Delivery Research – January 2014

Posted on January 10, 2014. Filed under: Health Economics, Orthopaedics, Surgery | Tags: |

Variations in outcome and costs among NHS providers for common surgical procedures: econometric analyses of routinely collected data – Health Services and Delivery Research – January 2014

DOI 10.3310/hsdr02010 NHS National Institute for Health Research

Street A, Gutacker N, Bojke C, Devlin N, Daidone S. Variations in outcome and costs among NHS providers for common surgical procedures: econometric analyses of routinely collected data. Health Serv Deliv Res 2014;2(1)

“Background: It is important that NHS resources are used to their full extent, but efforts to reduce costs may have an adverse effect on patient outcomes. Our research is designed to provide a better understanding of the inter-relationship between costs and health outcomes among NHS providers (hospitals) for common surgical procedures.

Objectives: In England, patient-reported outcomes measures (PROMs) are collected from patients undergoing one of four elective procedures: unilateral hip replacement, unilateral knee replacement, groin hernia repair and varicose vein surgery. We identify variation in patient-reported outcomes (PROs) across hospitals, assess the relationship between the cost and outcomes among NHS hospitals for these procedures, and determine the extent to which variations in outcomes and costs are due to differences in hospital performance.

Data sources: We link Hospital Episode Statistics (HES) data with reference cost data and PROM data for patients having the four treatments between April 2009 and March 2010.

Methods: The first part of the empirical analysis focuses on variation in different dimensions of self-reported health status. We argue that each of the EuroQol-5D questionnaire (EQ-5D; European Quality of Life-5 Dimensions) dimensions should be assessed separately. Our graphical summary of the differential impact that hospitals have on PROs indicates the probability of reporting a given health outcome and shows how these probabilities vary across EQ–5D dimensions and hospitals. The second part of the empirical analysis focuses on the performance of hospitals and the inter-relationship between PROs and resource use.

Results: We find that poorer post-treatment health status is associated with lower initial health status, higher weighted Charlson score, more diagnoses and lower socioeconomic status. We find significantly unexplained variation among hospitals in outcomes for patients undergoing hip replacement, knee replacement or varicose vein surgery, but not for hernia patients. For all four treatments we find significant unexplained variation in resource use among hospitals, whether measured by cost of treatment or length of stay. This suggests that hospitals can improve their utilisation of resources.

Limitations: Our analyses are based on the HES. If data are missing from the medical record, or extracted and coded inaccurately, HES will contain errors. Hospitals should minimise these errors. Our study suffers from a large number of missing data, mainly because some hospitals were better than others at administering the baseline survey.”

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Osteoporosis costing all Australians: a new burden of disease analysis: 2012 to 2022 – Osteoporosis Australia – December 2013

Posted on December 11, 2013. Filed under: Chronic Disease Mgmt, Health Economics, Orthopaedics |

Osteoporosis costing all Australians: a new burden of disease analysis: 2012 to 2022 – Osteoporosis Australia – December 2013

“This report updates previous burden of disease analysis undertaken in 2001 and 2007, and shows little progress is being made in preventing and managing osteoporosis in Australia. With an ageing population, it is now critical that real steps are taken to address this silent and often underdiagnosed disease affecting women and men that is costing governments, the community and comes at a great personal cost to the individuals affected.

The new information in this report on the current and future costs of osteoporosis in Australia will aid government policy makers, funding bodies, clinicians, researchers and health care organisations in assessing the importance of reducing osteoporosis and osteoporosis – related fractures, promoting bone health and in identifying future resource needs.”

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National clinical audit of back pain management – Royal College of Physicians – 22 May 2012

Posted on May 23, 2012. Filed under: Occupational Hlth Safety, Orthopaedics | Tags: , |

National clinical audit of back pain management – Royal College of Physicians – 22 May 2012

“A new report released today highlights the need for all NHS staff to be given good advice about back pain. Musculoskeletal problems such as back pain account for 40% of sickness absence amongst NHS staff and costs approximately £400 million per year.

The Royal College of Physicians’ (RCP) National clinical audit of back pain management looked at how occupational health professionals cared for NHS staff who are experiencing back pain. It found that the care and management occupational health professionals give to staff suffering with back problems has improved in the three years since the previous audit in 2008.

However, in half of the 5,524 cases included in the audit, sufferers required clearer information about back pain. This included the fact that in most cases back pain is likely to get better spontaneously and that it is important to return to work as soon as possible. This advice applies even if they are experiencing some pain. If they do not, they risk developing chronic pain and disability.”

… continues on the site

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Hip fracture for adults quality standard – NICE – 27 March 2012

Posted on March 30, 2012. Filed under: Clin Governance / Risk Mgmt / Quality, Orthopaedics | Tags: |

Hip fracture for adults quality standard – NICE – 27 March 2012

About this

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Venous Thromboembolism Prophylaxis in Orthopedic Surgery – Research Review – AHRQ – 13 March 2012

Posted on March 29, 2012. Filed under: Orthopaedics, Pharmacy | Tags: |

Venous Thromboembolism Prophylaxis in Orthopedic Surgery – Research Review – AHRQ – 13 March 2012

AHRQ = Agency for Healthcare Research and Quality, Effective Health Care Program, Comparative Effectiveness Review Number 49

“Objectives. This is an evidence report prepared by the University of Connecticut/Hartford Hospital Evidence-based Practice Center (EPC) examining the comparative efficacy and safety of prophylaxis for venous thromboembolism in major orthopedic surgery (total hip replacement [THR], total knee replacement [TKR], and hip fracture surgery [HFS]) and other nonmajor orthopedic surgeries (knee arthroscopy, injuries distal to the hip requiring surgery, and elective spine surgery).”

… continues

Sobieraj DM, Coleman CI, Tongbram V, Lee S, Colby J, Chen WT, Makanji SS, Ashaye A, Kluger J, White CM. Venous Thromboembolism in Orthopedic Surgery. Comparative Effectiveness Review No. 49. (Prepared by the University of Connecticut/Hartford Hospital Evidence-based Practice Center under Contract No. 290-2007-10067-I.) AHRQ Publication No. 12-EHC020-EF. Rockville, MD: Agency for Healthcare Research and Quality. March 2012. http://www.effectivehealthcare.ahrq.gov/reports/final.cfm.

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Analgesics for Osteoarthritis: An Update of the 2006 Comparative Effectiveness Review – Agency for Healthcare Research and Quality [US] – October 2011

Posted on October 31, 2011. Filed under: Orthopaedics | Tags: |

Analgesics for Osteoarthritis: An Update of the 2006 Comparative Effectiveness Review – Agency for Healthcare Research and Quality [US] – October 2011

Chou R, McDonagh MS, Nakamoto E, Griffin J. Analgesics for Osteoarthritis: An Update of the 2006 Comparative Effectiveness Review. Comparative Effectiveness Review No. 38. (Prepared by the Oregon Evidence-based Practice Center under Contract No. HHSA 290 2007 10057 I) AHRQ Publication No.  11(12)-EHC076-EF. Rockville, MD: Agency for Healthcare Research and Quality. October 2011

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Use of antiresorptive agents for osteoporosis management – AIHW – 26 August 2011

Posted on August 30, 2011. Filed under: Orthopaedics | Tags: , |

Use of antiresorptive agents for osteoporosis management – AIHW – 26 August 2011

“There is no cure for osteoporosis but antiresorptive drugs can reduce further bone loss and slow down disease progression. This report provide information on both the individual and community use of antiresorptive drugs for managing osteoporosis as well as trends in the supply of and expenditure for these medications.”

ISBN 978-1-74249-192-9; Cat. no. PHE 148; 48pp

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National Osteoporosis Society 25th anniversary report – A fragile future

Posted on June 30, 2011. Filed under: Orthopaedics |

National Osteoporosis Society 25th anniversary report – A fragile future

Media release

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Pain Management Interventions for Elderly Patients With Hip Fracture – AHRQ – Clinician Guide, Research Review, Consumer Guide – 17 May 2011

Posted on May 30, 2011. Filed under: Orthopaedics | Tags: , |

Pain Management Interventions for Elderly Patients With Hip Fracture – Clinician Guide – 17 May 2011
Key Clinical Issue
What are the comparative effectiveness, benefits, and adverse events associated with interventions for acute-pain management, as compared to usual care, in elderly patients with hip fractures from low-impact injury?

Pain Management Interventions for Hip Fracture – Research Review – Final – 17 May 2011

Managing Pain From a Broken Hip: A Guide for Adults and Their Caregivers – Consumer Guide – 17 May 2011

all from AHRQ – Agency for Healthcare Research and Quality

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National Audit of Falls and Bone Health in Older People – Royal College of Physicians – May 2011

Posted on May 23, 2011. Filed under: Aged Care / Geriatrics, Orthopaedics | Tags: , |

National Audit of Falls and Bone Health in Older People – Royal College of Physicians – May 2011

“The audit shows that there is unacceptable variation in the quality of NHS services for care and prevention of falls and fractures. In many areas, there is a major gap between what NHS organisations state what they provide, in terms of commissioning, protocols or structure; and what clinical audit reveals in terms of actual care provided. The audit shows that older patients with fractures do not routinely receive key aspects of care for falls prevention or bone health, needlessly exposing them to a greater risk of further falls and fractures.

The audit was commissioned by the Healthcare Quality Improvement Partnership (HQIP) and carried out by the Royal College of Physicians’ Clinical Effectiveness and Evaluation Unit (CEEU). Information on nearly 10,000 patients came from all NHS Acute Trusts, or equivalent, in England, Wales and Northern Ireland, as well as Primary Care Organisations, Mental Health Trusts and a sample of care homes.”

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The national hip fracture database national report 2010 – Royal College of Surgeons – 2 September 2010

Posted on September 7, 2010. Filed under: Orthopaedics | Tags: |

The national hip fracture database national report 2010 – Royal College of Surgeons – 2 September 2010

Biggest ever hip fracture audit shows improvements in care, but significant geographical variations

A report from the world’s largest and fastest-growing national hip fracture audit, published today (Thursday 2nd September) reveals that NHS hip fracture patients – often some of the most elderly and vulnerable patients in the NHS – are now getting far greater access to specialist care by geriatricians, as well as osteoporosis screening, assessment for the likelihood of future falls and bone protection drugs – which alone can reduce fracture incidence by up to 50%, potentially saving £millions to the NHS. However, the report also flags up significant variations in care quality provision between hospitals, with some patients not being assessed by appropriate doctors, having unacceptable delays before surgery, and missing out on osteoporosis care and falls prevention.”  … continues

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Life with Arthritis in Canada : A personal and public health challenge – Public Health Agency of Canada – July 2010

Posted on July 23, 2010. Filed under: Orthopaedics, Rheumatology | Tags: , |

Life with Arthritis in Canada : A personal and public health challenge – Public Health Agency of Canada – July 2010

ISBN: 978-1-100-15986-7    (PDF 2.9 MB)

Extract
“This report, Life with Arthritis in Canada: A personal and public challenge is the second national surveillance report on arthritis. Using the most recent data sources available, it provides an overview of arthritis in the Canadian population and its wide-ranging impact. It also suggests approaches for reducing the risk of developing some types of arthritis (osteoarthritis and gout) in addition to minimizing disability and improving the quality of life of those living with any type of arthritis.”

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New Study Finds Rotator Cuff Injuries Treatable, but Evidence Unclear Whether Surgery Is Preferable – July 2010 – AHRQ

Posted on July 8, 2010. Filed under: Orthopaedics | Tags: |

New Study Finds Rotator Cuff Injuries Treatable, but Evidence Unclear Whether Surgery Is Preferable
Press Release Date: July 5, 2010

“Injuries to the rotator cuff are treatable, but it is unclear which treatment option—surgery or nonsurgical treatments such as exercise or medication—is best, according to a new comparative effectiveness report published by the Department of Health & Human Services’ (HHS) Agency for Healthcare Research and Quality (AHRQ).

Tears to the shoulder’s rotator cuff, which is composed of four muscle-tendon units, are common among older adults. Rotator cuff tears can cause significant pain and limit arm motion.

The report, prepared for AHRQ by the University of Alberta Evidence-based Practice Center and published today in Annals of Internal Medicine, examined treatment and rehabilitative options for rotator cuff tears. It found that all treatments, either surgical or nonsurgical, result in improvement, but found few differences between interventions. It also did not find evidence indicating ideal timing of surgery.”  …continues on the site

In conjunction with the new report, AHRQ will soon publish plain-language summary guides about treating rotator cuff tears for patients, clinicians and policymakers. Summary guides on numerous clinical topics and other information and background on the Effective Health Care Program can be found” [on the site].

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Organising quality and effective spinal services for patients: a report for local health communities by the Spinal Taskforce [UK] – 24 March 2010

Posted on May 6, 2010. Filed under: Orthopaedics |

Organising quality and effective spinal services for patients: a report for local health communities by the Spinal Taskforce [UK] 24 March 2010

Document type: Report
Author: Spinal Taskforce for Department of Health
Published date: 24 March 2010

“This report is intended to assist the NHS in developing and delivering effective spinal services, creating a set of productive services that deliver quality, timely and clinically appropriate care that meets patients’ needs and expectations.

The report was originally commissioned in response to the national work on delivering 18 week pathways, but goes wider in suggesting how effective organisation will benefit the quality of care that patients receive.

 It looks at the effective organisation of spinal services for a wide population to support those planning and commissioning services across an SHA, PCTs and clinical and managerial teams within provider units. The document describes the main types of patients being referred for spinal treatment and advises on how to organise services to meet the needs of these groups, paying particular attention to quality, clinical outcomes and cost-effectiveness.

It will particularly help support the implementation of specific NICE guidelines on lower back pain and cancer of the spine (spinal metastases).”

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Fracture prevention services: An economic evaluation – UK Department of Health – November 2009

Posted on December 22, 2009. Filed under: Health Economics, Orthopaedics | Tags: , |

Fracture prevention services – An economic evaluation – UK Department of Health – November 2009

“This economic evaluation assesses the costs and benefits of services to reduce fractures among older people. Local communities can use this to develop their own proposals.

There is strong evidence about the impact and cost benefit arguments for fracture prevention interventions, based on systematic implementation of national guidance on secondary prevention of osteoporotic fractures and other interventions for a targeted at-risk population.

The following is a summary of the main findings of an economic model for the impact of a fracture liaison service, as described in the guide Falls and fractures: effective interventions in health and social care1.

In this model, over a 5 year period £290,708 is saved in NHS acute and community services and local authority social care costs, against an additional £234,181 revenue costs (falling both in year 1 and covering drug therapy for five years spent by the NHS on this patient cohort). This is for an annual patient cohort of 797 hip, humerus, spine and forearm fractures, anticipated from a 320,000 population.

At a national level, this equates to approximately £8.5 million saving over 5 years.”  … continues

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NHS Institute for Innovation and Improvementices Focus on: Musculoskeletal Interface Services – November 2009

Posted on December 4, 2009. Filed under: Orthopaedics | Tags: , |

NHS Institute focuses on services for musculoskeletal conditions
26 November 2009

“The NHS Institute for Innovation and Improvement has launched a new publication to support the NHS in improving community-based access to specialist services for patients suffering from musculoskeletal (MSK) conditions such as chronic back pain, osteoporosis and other bone, joint, spinal and muscular diseases.

The publication, Focus On: Musculoskeletal Interface Services, highlights the key characteristics of best practice for MSK interface services and is aimed at commissioner and provider organisations aiming to set up an MSK interface service or develop an existing service.” … continues on the website

Focus on: Musculoskeletal Interface Services
NHS Institute for Innovation and Improvement

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New NICE guidelines to help millions of people with low back pain – 27 May 2009

Posted on May 27, 2009. Filed under: Orthopaedics, Physiotherapy | Tags: , |

2009/031 New NICE guidelines to help millions of people with low back pain

“Millions of people with low back pain will benefit from new guidance issued to the NHS on the most effective ways to treat this often painful and distressing condition.

The National Institute for Health and Clinical Excellence (NICE) and the National Clinical Guideline Centre today (Wednesday 27 May) publish a guideline to improve the early management of persistent non-specific low back pain.  This covers people who have been in pain longer than six weeks but less than one year, where the pain may be linked to structures in the back such as the joints, muscles and ligaments.  Setting out a range of effective mainstream and complementary treatments, the guideline recommends what care and advice the NHS should offer to people affected by low back pain.” … continues on the website

Full text of the low back pain guideline (36.35 Kb 10 sec @ 28.8Kbps)

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Spinal cord injury 1999 – 2005 report published 28 April 2009 by AIHW

Posted on April 29, 2009. Filed under: Orthopaedics | Tags: , |

Spinal cord injury 1999 – 2005 report published 28 April 2009 by the Australian Institute of Health and Welfare

NISU briefing no. 14
Authored by Henley G.
Published 28 April 2009; ISSN 1833-024X; AIHW cat. no. INJCAT 124

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AHRQ Releases New Evidence Report on Back Pain – February 2009

Posted on April 8, 2009. Filed under: Complementary & Altern Care, Orthopaedics, Physiotherapy | Tags: |

US Agency for Healthcare Research & Quality – Complementary and Alternative Medicine in Back Pain Utilization, was conducted by AHRQ’s McMaster University Evidence-based Practice Center and funded by the National Institutes of Health’s National Center for Complementary and Alternative Medicine.

Structured Abstract

Objectives: This systematic review was undertaken to evaluate which complementary and alternative medicine (CAM) therapies are being used for persons with back pain in the United States.
Data Sources: MEDLINE®, EMBASE®, CINAHL® and Cochrane Central® and a variety of CAM specific databases were searched from 1990 to November 2007. A grey literature search was also undertaken, particularly for clinical practice guidelines (CPG) related to CAM.
Review Methods: Standard systematic review methodology was employed. Eligibility criteria included English studies of adults with back pain, and a predefined list of CAM therapies.
Results: A total of 103 publications were evaluated; of these 29 did not present CAM therapy use stratified for back pain. There were a total of 65 utilization studies, 43 of which were American. Four publications evaluated the concurrent use of four or more CAM therapies and these suggest that chiropractic/manipulation is the most frequently used modality followed by massage and acupuncture. A limited number of publications evaluated utilization rates within multiple regions of the back and show that CAM was used least for treating the thoracic spine and most for the low back. However, rates of use of massage were similar for neck and lower back regions. Concurrent use of different CAM or conventional therapies was not well reported.
From 11 eligible CPG, only one (for electro-acupuncture) provided recommendations for frequency of use for low back pain of all acuity levels.
Eighteen cost publications were reviewed and all but one publication (cost-effectiveness) were cost identification studies. There is limited information on the impact of insurance coverage on costs and utilization specific to back pain.
Conclusions: There are few studies evaluating the relative utilization of various CAM therapies for back pain. For those studies evaluating utilization of individual CAM therapies, the specific characteristics of the therapy, the providers, and the clinical presentation of the back pain patients were not adequately detailed; nor was the overlap with other CAM or conventional treatments.

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