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Highly regulated industries such as healthcare can reap significant benefits from new digital technologies. However, due to institutional constraints, adopting such technologies is a slow and difficult process. Technology providers need to legitimize their underlying technologies to the customers and other stakeholders in the field. Drawing on multiple case studies in the healthcare industry, this article demonstrates how technology providers deploy two legitimizing practices: solution selling and issue selling. These activities lead to the emergence of open innovation ecosystems that help technology providers overcome adoption barriers. [ABSTRACT FROM AUTHOR]

In a closed-loop supply chain, the reuse of spare parts from returned systems is a recovery process referred to as spare parts harvesting. The unpredictability of the parts supply capacity from returned systems is a challenge in healthcare industry as product returns depend on several factors and regulatory and legal requirements must be respected. The focus of this paper is to provide a forecasting method of harvested parts supply capacity in healthcare industry that combines statistical methods with field information and business knowledge to provide an informed forecast. We propose a dynamic forecasting process that gets updated monthly employing TSB-Croston, 12-month moving average, ARIMA, ARIMA with seasonality, and a new business knowledge based model. A prediction method of the inventory state changes is introduced. The forecasters judgment is transformed into validation rules for an automatic forecast adjustment. This method is evaluated on more than 1400 time series with intermittent behaviour representing General Electric Healthcare spare parts harvesting history. We evaluate the performance of our method compared to each tested model using a modified MAPE, MAE, MSE, and RMSE. By means of the designed method, the forecast performance is improved compared to all tested models. [ABSTRACT FROM AUTHOR]

The term "natural" is ubiquitous in advertising and branding, but limited research has investigated how consumers respond and relate to naturalness. Some researchers have documented preferences for natural products, specifically food, but there has been scant investigation of the psychological antecedents of such preferences, especially in the critical, multi-trillion-dollar domain of healthcare. Using publicly available country-level data from 41 countries and individual-level experimental and survey data from the lab and online panels, we find converging evidence that consumers do indeed differ in their preferences for relatively natural versus artificial healthcare options. These differences are influenced by the extent to which they subscribe to the Protestant Work Ethic (PWE)—a belief system that influences judgments and behaviors across diverse domains—such that people who subscribe strongly (vs. weakly) to the PWE are more likely to prefer natural healthcare options because they are more averse to external intervention in general. Further, belief in the PWE makes consumers more sensitive to the intrusiveness of an intervention than to its extent. Theoretical and substantive implications are discussed. [ABSTRACT FROM AUTHOR]

This study investigates how Quality Management (QM) programmes, particularly the Baldrige excellence framework, provide an approach to enhance healthcare organisational performance. Two independent methods were used to examine the short-term and long-term effects of winning the Baldrige award and the specific influence of common QM practices on results. The first method assesses the Baldrige Award's impact on hospital performance by examining patient survey data and shows that initial quality improvements are not sustained in the long term. The second method uses confirmatory semantic analysis (CSA), a text-mining method, to analyse 22 Baldrige award-winning applications to determine the relationship between QM practices and organisational results in healthcare settings. The results show that only three QM practices – measurement, analysis, and knowledge management (MAKM), leadership, and operations focus – significantly contribute to organisational performance. Furthermore, CSA findings highlight the dominant role of leadership in driving performance outcomes, with other factors in the framework showing nonsignificant mediation effects. By exploring both the overarching effectiveness of QM programmes across different time lengths and specific practices that contribute to performance, this research provides academic insights with practical application in the healthcare industry. Importantly, the findings highlight the nuanced relationship between QM initiatives and organisational excellence. [ABSTRACT FROM AUTHOR]

Digital platforms are often characterized as enablers of new ecosystems. However, platforms are sometimes introduced into pre-existing ecosystems, where a platform’s ability to harmonize with the ecosystem is critical for its success. This article draws on the case of digital healthcare platforms and introduces the concept of platform grafting, which denotes the process of integrating a new platform into a pre-existing ecosystem, leading to a coevolutionary process of adapting both the platform and the surrounding ecosystem. Dynamic capabilities are critical for successfully integrating the platform into the ecosystem, and this article provides a capabilities framework for understanding platform grafting. [ABSTRACT FROM AUTHOR]

Introduction: For general surgeons practising in rural areas, multiple factors influence care beyond skills learned in residency. The British Columbia Privileging Dictionary (BCPD) defines core and non-core procedures that shape the scope of general surgeons. Moreover, the Royal College has adopted a Competence by Design (CBD) curriculum which employs entrustable professional activities (EPAs) that list surgical skill residents must be proficient in by graduation. Our goal is to understand the current practice patterns of rural general surgeons in BC based on these policies and local factors. Methods: Medical service plan (MSP) data were collected from 2011 to 2021 based on general surgeons working in rural subsidiary agreement (RSA) communities. The MSP fee codes were organised into core or non-core procedures, as outlined by the BCPD. EPAs were assessed and compared to the non-core procedures. Results: From 2011 to 2021, 223,103 procedures were performed in rural sites in BC. On average, 90.97 (standard deviation = 20.78) of procedures done in all communities were BCPD core procedures. The most common non-core surgical care performed by general surgeons was in plastic surgery (n = 8035). Over 8 of procedures performed were not general surgery EPAs. Notably, none of the EPAs are considered non-core privileges and all EPAs have been performed in rural settings. Conclusion: General surgeons working in rural settings perform multiple procedures outside of EPAs which account for over 8 of their caseload and approximately 6 of procedures performed are non-core privileges. This provides some insight into the potential limitations of the BCPD on graduates hoping to practise in rural communities. As the CBD curriculum has been reported to provide a more flexible approach to learning, it may be tailored to suit residents' learning and career goals, including varied surgical skills to suit rural needs. Introduction: Pour les chirurgiens généraux exerçant en zone rurale, de multiples facteurs influencent les soins, et ce au-delà des compétences acquises en résidence. Le British Columbia Privileging Dictionary (BCPD) définit les procédures essentielles et non essentielles qui déterminent le champ d'action des chirurgiens généraux. En outre, le Collège royal a adopté un programme d'études intitulé « La compétence par conception » (CPC) qui utilise des activités professionnelles confiables (APC) qui énumèrent les compétences chirurgicales que les résidents doivent maîtriser avant d'obtenir leur diplôme. Notre objectif est de comprendre les modes de pratique actuels des chirurgiens généralistes ruraux en Colombie-Britannique en fonction de ces politiques et des facteurs locaux. Méthodes: Les données du Medical Service Plan (MSP, Plan de service médical) ont été recueillies entre 2011 et 2021 auprès des chirurgiens généralistes travaillant dans les communautés du « Rural Subsidiary Agreement » (RSA). Les codes d'honoraires du MSP ont été organisés en procédures essentielles ou non essentielles, comme indiqué par le BCPD. Les APC ont été évalués et comparés aux procédures non essentielles. Résultats: Entre 2011 et 2021, 223 103 procédures ont été réalisées dans des sites ruraux en Colombie-Britannique. En moyenne, 90,97 (écart-type = 20,78) des procédures effectuées dans toutes les communautés étaient des procédures de base du BCPD. Les soins chirurgicaux non essentiels les plus courants effectués par les chirurgiens généraux étaient la chirurgie plastique (n = 8035). Plus de 8 des procédures réalisées n'étaient pas des APC de chirurgie générale. Il est à noter qu'aucune des APC n'est considérée comme un privilège non essentiel et que toutes ont été réalisées en milieu rural. Conclusion: Les chirurgiens généraux travaillant en milieu rural pratiquent de nombreuses procédures en dehors de l'APC, représentant plus de 8 de leur charge de travail et environ 6 des procédures pratiquées sont des privilèges non essentiels. Cela donne une idée des limites potentielles du BCPD pour les diplômés qui espèrent exercer dans les communautés rurales. Étant donné que le programme d'études CPC est réputé offrir une approche plus souple de l'apprentissage, il peut être adapté aux objectifs d'apprentissage et de carrière des résidents, notamment en leur permettant d'acquérir des compétences chirurgicales variées pour répondre aux besoins des zones rurales. Keywords: Medical education, residency, rural surgery, Author(s): Rebecca M. Afford (corresponding author) [1]; Sara D. Bolin [1]; Madeleine E. Armstrong [1]; Tracy M. Scott [1]; Ahmer A. Karimuddin [1] INTRODUCTION General surgery residency in Canada is [...]

Introduction: We sought to streamline cataract surgery post-operative care when COVID-19 hit by discontinuing the 1-day post-operative visit. We wanted to know if this change was safe and beneficial to our patients by reducing patients' time and transportation burden, opening appointment slots allowing providers to see more patients and reducing greenhouse gas emissions. By minimising intraoperative use of dispersive viscoelastic, increasing irrigation/aspiration time at the end of the surgery and using intraocular pressure (IOP) lowering medications such as carbachol, brimonidine and acetazolamide routinely, we posit that post-operative day 1 IOP spikes can be avoided, thereby eliminating the need for the 1[sup.st] post-operative day visit. We also sought to show the positive environmental impact of eliminating that 1[sup.st] day. Methods: We retrospectively reviewed cataract surgeries performed before COVID-19 to determine the incidence of serious pathology discovered at the post-operative day 1 visit. Subsequently, we examined all the cataract surgeries performed in 2023 by our practice. Results: One hundred and ninety-three cataract surgeries performed before COVID-19 and 832 performed in 2023 were reviewed. We found that the post-operative day 1 visit after cataract surgery is unnecessary in most routine uncomplicated cases. Conclusion: By eliminating hundreds of post-operative day 1 visits for a busy rural practice annually, patients, their friends and relatives are spared an extra trip to the office (that can be 100 km each way), the office schedule is open to accommodate more patients, and the patients' carbon footprint of travel to the office is reduced. Introduction: Nous avons cherché à rationaliser les soins postopératoires de la chirurgie de la cataracte lors de l'arrivée de la Covid en supprimant la visite postopératoire d'un jour. Nous voulions savoir si ce changement était sécuritaire et bénéfique pour nos patients en réduisant le temps et la charge de transport des patients, en ouvrant des créneaux de rendez-vous permettant aux prestataires de voir plus de patients et en réduisant les émissions de gaz à effet de serre. En minimisant l'utilisation peropératoire de viscoélastique dispersif, en augmentant le temps d'irrigation/aspiration à la fin de l'opération et en utilisant systématiquement des médicaments abaissant la PIO, tels que le carbachol, la brimonidine et l'acétazolamide, nous pensons que les PIO postopératoire du premier jour peuvent être évitées, éliminant ainsi la nécessité d'une première visite de jour postopératoire. Nous avons également cherché à démontrer l'impact environnemental positif de l'élimination de ce premier jour. Méthodes: Nous avons examiné rétrospectivement opérations de la cataracte réalisées avant la Covid afin de déterminer l'incidence des pathologies graves découvertes lors de la visite postopératoire du premier jour. Par la suite, nous avons examiné toutes les opérations de la cataracte réalisées en 2023 par notre cabinet. Résultats: 193 opérations de la cataracte réalisées avant la Covid et 832 réalisées en 2023 ont été examinées. Nous avons constaté que la visite postopératoire du premier jour après la chirurgie de la cataracte n'est pas nécessaire dans la plupart des cas de routine sans complications. Conclusion: En éliminant des centaines de visites postopératoires du premier jour dans une région rural, les patients, leurs amis et leurs proches n'ont pas à SE rendre au cabinet (ce qui peut représenter des centaines de kilomètres aller-retour). L'emploi du temps du cabinet est libéré pour accueillir davantage de patients et l'empreinte carbone des patients liée à leur déplacement au cabinet est réduite. Keywords: Carbon footprint, cataract surgery, intraocular pressure spike, post-operative day 1, rural, Author(s): Gavin Bahadur (corresponding author) [1]; Lewis Macdonald [2]; Shawn Lin [3]; Cynthia Boxrud [3]; Ralph Crew [2] INTRODUCTION The American Academy of Ophthalmology Preferred Practice Pattern recommends that routine [...]

Introduction: We sought to determine the difference between Canadian CT Head Rule (CCHR) indicated imaging rates and actual imaging rates for patients with mild traumatic brain injuries (mTBIs) at a rural emergency department (ED) without in-house computed tomography (CT). In addition, we compared CCHR adherence at a hospital without CT to previous publications from centres with CT to determine if rural populations receive less CT imaging for minor head traumas when indicated by the CCHR. Methods: This retrospective chart review explored individuals who presented to a rural ED (no in-house CT scanner) with a primary diagnosis of mild head injury or concussion between 1 January 2017 and 31 December 2021. Information regarding CCHR criteria, transfer status and patient demographics was collected. Descriptive analyses were completed to determine the percentage of patients who received appropriate transfer for imaging, did not receive transfer for imaging when indicated and received unnecessary transfer. Results: A total of 124 charts met our inclusion criteria (17 [12.1] charts excluded), with 25.8 transferred to the nearest hospital for CT imaging. After applying the CCHR criteria to our charts, 62.1 were indicated for CT. Of the 62.1, only 35.1 were transferred for imaging (51.2 of high-risk and 16.7 of medium-risk). Conclusion: By exploring CT rates for mTBIs in a rural Canadian ED, we found low transfer rates (35.1) of CCHR-indicated patients for imaging needed to guide further healthcare decisions. This work highlights a discrepancy within the Canadian healthcare system between rural and urban centres and allows for opportunities to help narrow the gap in health care. Introduction: Nous avons cherché à déterminer la différence entre les taux d'imagerie indiqués par le Canadian CT Head Rule (CCHR, règlement canadien relatif à la tomodensitométrie de la tête) et les taux d'imagerie réels pour les patients souffrant de traumatismes craniocérébraux légers (TCCL) dans un service d'urgence rural ne disposant pas d'une tomographie par ordinateur interne. En outre, nous avons comparé l'adhésion au CCHR dans un hôpital sans tomographie par ordinateur à des publications antérieures provenant de centres avec tomographie par ordinateur afin de déterminer si les populations rurales reçoivent moins d'imagerie par tomodensitométrie pour les traumatismes crâniens mineurs lorsque le CCHR l'indique. Méthodes: Cette étude rétrospective des dossiers a exploré les personnes qui SE sont présentées à une urgence rurale (sans tomodensitomètre interne) avec un diagnostic primaire de traumatisme crânien léger ou de commotion cérébrale entre le 1[sup.er] janvier 2017 et le 31 décembre 2021. Les informations concernant les critères du CCHR, l'état de transfert et les données démographiques des patients ont été recueillies. Des analyses descriptives ont été réalisées pour déterminer le pourcentage de patients ayant reçu un transfert approprié pour l'imagerie, n'ayant pas reçu de transfert pour l'imagerie quand c'était indiqué et ayant reçu un transfert inutile. Résultats: Au total, 124 dossiers répondaient à nos critères d'inclusion [17 (12,1) dossiers exclus], dont 25,8 ont été transférés à l'hôpital le plus proche pour une imagerie par tomodensitométrie. Après avoir appliqué les critères du CCHR à nos dossiers, 62,1 d'entre eux étaient indiqués pour une tomodensitométrie. Sur ces 62,1, seuls 35,1 ont été transférés pour imagerie (51,2 de haut risque, 16,7 de risque moyen). Conclusion: En explorant les taux de tomodensitométrie pour les TCCL dans un service d'urgence rural canadien, nous avons constaté de faibles taux de transfert (35,1) des patients recommandés par le CCRH pour une imagerie nécessaire dans le but de guider les décisions de soins de santé ultérieures. Ce travail met en évidence un écart dans le système de santé canadien entre les centres ruraux et urbains et offre des opportunités pour aider à réduire l'écart dans les soins de santé. Keywords: Emergency imaging, emergency medicine, head injury, rural medicine, Author(s): Matthew D. Lavery (corresponding author) [1]; Rylen A. Williamson [1]; Jason Curran [2,3]; July Wilkey [4]; Kirk McCarroll [4] INTRODUCTION Between 2002 and 2018, more than 5 million emergency [...]

Author(s): Tayler Young [1]; Sarah M. Giles (corresponding author) [2,3] INTRODUCTION Traumatic dental injuries are common and account for 5 of bodily injuries in all ages.[sup.1] Tooth avulsion is 1 [...]

Cardiac mononuclear phagocytic cells (Cardiac MPCs) participate in maintaining homeostasis and orchestrating cardiac responses upon injury. However, the function of specific MPC subtypes and the related cell fate commitment mechanisms remain elusive in regenerative and nonregenerative hearts due to their cellular heterogeneities. Using spatiotemporal single-cell epigenomic analysis of cardiac MPCs in regenerative (P1) and nonregenerative (P10) mouse hearts after injury, we found that P1 hearts accumulate reparative [Arg1.sup.+] macrophages, while proinflammatory [S100a9.sup.+][Ly6c.sup.+] monocytes are uniquely abundant during nonregenerative remodeling. Moreover, blocking chemokine CXCR2 to inhibit the specification of the [S100a9.sup.+][Ly6c.sup.+]-biased inflammatory fate in P10 hearts resulted in elevated wound repair responses and marked improvements in cardiac function after injury. Single-cell RNA-Seq further confirmed an increased [Arg1.sup.+] macrophage subpopulation after CXCR2 blockade, which was accomplished by increased expression of wound repair- related genes and reduced expression of proinflammatory genes. Collectively, our findings provide instructive insights into the molecular mechanisms underlying the function and fate specification of heterogeneous MPCs during cardiac repair and identify potential therapeutic targets for myocardial infarction., Introduction Cardiovascular disease is the primary cause of global mortality (1). Upon myocardial infarction (MI), the heart undergoes a diverse range of reparative processes, including the initiation of proinflammatory responses, [...]

Certificate-of-Need (CON) laws restrict entry and/or expansion of healthcare facilities in 35 states. These laws require hospitals, nursing homes, ambulatory surgical centers (ASCs), and other healthcare providers to obtain regulatory [...]

Cardiopulmonary Resuscitation is defined by the Mayo Clinic as a lifesaving technique that is useful in many emergencies, such as a heart attack, stroke, choking, or drowning, in which someone's breathing and heartbeat have stopped. Under the guidelines put forth by the International Liaison Committee on Resuscitation (ILCOR) and the Emergency Cardiovascular Care Organization (ECC), the American Red Cross and American Heart Association currently require that an individual's CPR certification be renewed every two years. However, data has suggested that non-allied healthcare providers, such as school-based personnel, may require more regular training to maintain required CPR proficiency levels. Four hundred non-allied healthcare professionals from a school district in central Georgia were CPR-certified under the American Heart Association (AHA) Heart-Saver curriculum. Participants included 153 males and 247 females from elementary, middle, and high school settings. Participants included administrators, teachers, coaches, and staff. Two tenured college professors from the School of Health and Human Performance were responsible for teaching and certifying study participants. Each of these professors possessed a minimum of five years of CPR certification experience with the American Heart Association. Course sizes were limited to 12-15participants. All CPR certification courses were implemented under standardized, controlled circumstances. Following the initial certification, twenty-five percent of participants were randomly selected to be reassessed at either three, six, nine, or twelve months, respectively, to determine memory and skill degradation rates and patterns. Degradation of declarative and procedural knowledge was observed during subsequent retest sessions at each of the three-, six-, nine-, and twelve-month marks. Scores depreciated approximately 10% each three-month retesting period, to 88%, 79%, 69%, and 57%, respectively. Data suggest that after six months, participants failed to meet the AHA standards for demonstrating acceptable declarative and procedural knowledge related to CPR implementation. Due to the observed degradation in both declarative and procedural knowledge, it is apparent that a more periodic training and recertification process in CPR is required for school-based personnel. A more consistent and periodic approach to preparing school-based first responders may prove beneficial in maintaining CPR proficiency rates, which very well could save lives., Introduction CPR Certification Protocols Cardiopulmonary Resuscitation, or CPR, is defined by the Mayo Clinic as a lifesaving technique that is useful in many emergencies, such as a heart attack, stroke, [...]

Health-care technology is central to boosting the productivity and quality of health-care systems. In many sub- Saharan African countries, however, medical device management systems are weak or absent. The aim of this article is to illustrate, using a case study, how policy reforms can help ensure policy on health-care technology is translated into everyday practice and how an integrated systems approach can enhance the operation of medical device management. Between 2011 and 2023, a plan to improve medical device management systems in the United Republic of Tanzania was developed and implemented through Swiss-Tanzanian cooperation within the Health Promotion and System Strengthening Project. The availability of biomedical engineers was increased through new training courses and the creation of permanent positions in government. Moreover, additional district and regional maintenance and repair workshops were built, and a National Centre for Calibration and Training was established to ensure the correct functioning of medical devices. The introduction of an electronic medical device management system provided health facilities and the health ministry with data on the operational status of medical devices and the need for repairs and spare parts. Every level of government was encouraged to allocate more human and financial resources to medical device management. Following this decade-long effort, the percentage of functioning equipment increased substantially, and costs were reduced by repairing rather than replacing equipment. The project also demonstrated the value of an integrated, system-strengthening approach that considered personnel, maintenance and repair facilities, documentation and management, and government policy and budgeting. Les technologies jouent un role crucial dans le renforcement de la productivite et de la qualite des systemes de sante. Pourtant, dans de nombreux pays d'Afrique subsaharienne, les systemes de gestion des dispositifs medicaux sont limites, voire inexistants. Cet article a pour but d'illustrer, au moyen d'une etude de cas, comment les reformes peuvent contribuer a faire en sorte que les politiques en matiere de technologies sanitaires soient appliquees au quotidien, et comment une approche integree peut ameliorer la gestion des dispositifs medicaux. Entre 2011 et 2023, un plan visant a developper les systemes de gestion des dispositifs medicaux en Republique-Unie de Tanzanie a ete defini et mis en reuvre en collaboration avec la Suisse, dans le cadre du Projet de Promotion et de Renforcement du Systeme de Sante. De nouvelles formations et la creation de postes permanents au sein du gouvernement ont permis d'accroitre la disponibilite des ingenieurs biomedicaux. En outre, des ateliers supplementaires d'entretien et de reparation ont ete construits dans differentes regions et districts, tandis qu'un Centre National d'Etalonnage et de Formation a ouvert ses portes pour assurer le bon fonctionnement des dispositifs medicaux. Lintroduction d'un systeme electronique de gestion des dispositifs medicaux a fourni aux etablissements de soins de sante et au Ministere de la Sante des donnees concernant le statut operationnel de ces dispositifs, ainsi que les reparations et pieces detachees requises. Chaque niveau de pouvoir a ete encourage a attribuer davantage de ressources humaines et financieres a la gestion des dispositifs medicaux. Au terme de dix ans d'efforts, le pourcentage d'equipements en etat de marche a considerablement augmente et les couts ont diminue grace au recours a la reparation plutot qu'au remplacement. Le projet a egalement demontre l'importance d'une approche integree, qui consiste a renforcer le systeme en tenant compte du personnel, de l'entretien et des installations de reparation, de la documentation et de la gestion, mais aussi de la politique gouvernementale et du budget. La tecnologia aplicada a la atencion sanitaria es fundamental para impulsar la productividad y la calidad de los sistemas sanitarios. Sin embargo, en muchos paises del Africa subsahariana los sistemas de gestion de los productos sanitarios son deficientes o inexistentes. El objetivo de este articulo es ilustrar, mediante un estudio de caso, como las reformas politicas pueden ayudar a garantizar que la politica sobre tecnologia de la atencion sanitaria se convierta en una practica cotidiana y como un enfoque de sistemas integrados puede mejorar el funcionamiento de la gestion de los productos sanitarios. Entre 2011 y 2023, se elaboro un plan para mejorar los sistemas de gestion de los productos sanitarios en la Republica Unida de Tanzania, que se implemento a traves de la cooperacion suizo-tanzana en el marco del Proyecto de Promocion de la Salud y Fortalecimiento del Sistema. Se aumento la disponibilidad de ingenieros biomedicos mediante nuevos cursos de formacion y la creacion de puestos permanentes en el gobierno. Ademas, se construyeron talleres de mantenimiento y reparacion adicionales de distrito y regionales, y se establecio un Centro Nacional de Calibracion y Formacion para garantizar el correcto funcionamiento de los productos sanitarios. La introduccion de un sistema electronico de gestion de productos sanitarios proporciono a los centros sanitarios y al Ministerio de Sanidad datos sobre el estado operativo de los productos sanitarios y la necesidad de reparaciones y piezas de repuesto. Se animo a todos los niveles de gobierno a asignar mas recursos humanos y financieros a la gestion de los productos sanitarios. Tras este esfuerzo de una decada, el porcentaje de equipos en funcionamiento aumento notablemente y los costes se redujeron al reparar los equipos en lugar de sustituirlos. El proyecto tambien demostro el valor de un enfoque integrado de refuerzo del sistema que tenia en cuenta el personal, las instalaciones de mantenimiento y reparacion, la documentacion y la gestion, y la politica y los presupuestos gubernamentales., Introduction Health-care technology includes medical devices, procedures and systems, as well as medicines and vaccines, and involves the application of organized knowledge and skills. (1-3) Such technology plays a crucial [...]

An introduction to the special issue which features articles focusing on the theme of marketing in the health care industry is presented.

Hospital advertising has grown more than five-fold in the past two decades. However, unlike detailing and advertising for prescription drugs, the topic of hospital advertising has been understudied. This research introduces a customer-centric view to this market by investigating the role of advertising in patients' choice of high-tech medical procedures, with a focus on robotic surgery. The authors analyze approximately 140,000 individual patient records and television advertising data from Florida during 2011–2015 to investigate how hospital advertising of robotic surgery affects patients' choice of robotic surgery over more conventional laparoscopic and open surgeries. Using a variation of a designated market area border identification strategy, the authors find that this advertising leads to more robotic surgery choices. The advertising effect is especially strong for Medicaid patients, whose socioeconomic status tends to be lower. While robotic surgery is associated with a short-term health benefit (i.e., reduced length of hospital stay), it does not affect long-term health benefits and comes at a higher cost than other forms of surgery. Thus, understanding the effect of advertising robotic surgery has significant health, cost, and marketing implications for different stakeholders in the health care industry, such as patients, health care providers, surgical robot manufacturers, insurance providers, and policy makers. [ABSTRACT FROM AUTHOR]

Background: The aim of our work was to examine differences between trauma patients in rural and urban areas who presented to a tertiary trauma centre in the province of Saskatchewan, Canada. Methods: We identified a historical cohort of all level 1 trauma activations presenting to Royal University Hospital (RUH) from April 1, 2020, to March 31, 2022. We divided the cohort into 2 groups (urban and rural), according to the trauma location. The primary outcome of interest was 30-day mortality. Secondary outcomes of interest were hospital length of stay, readmission to hospital within 30 days of discharge, and complication rate. Results: Trauma patients in rural areas were younger (34.1 v. 37 yr; p = 0.002) and more likely to be male (80.3% v. 74.4%; p = 0.040), with higher Injury Severity Scores (12.3 v. 8.3; p < 0.0001). Trauma patients in urban areas were more likely to sustain penetrating trauma (42.5% v. 28.5%; p < 0.0001). We saw no differences in morbidity and mortality between the 2 groups, but the rural trauma group had longer median lengths of stay (5 v. 3 d; p < 0.0007). Conclusion: Although we identified key differences in patient demographics, injury type, and injury severity, outcomes were largely similar between the urban and rural trauma groups. This finding contradicts comparable studies within Canada and the United States, a difference that may be attributable to the lack of inclusion of prehospital mortality in the rural trauma group. The longer length of stay in trauma patients from rural areas may be attributed to disposition challenges for patients who live remotely. Contexte: Notre travail avait pour but d'analyser les diff rences entre les patient les de traumatologie provenant de milieux ruraux et urbains ayant consult dans un centre de traumatologie tertiaire de la province de la Saskatchewan, au Canada. M thodes: Nous avons constitu une cohorte historique de tous les cas d'activation de niveau 1 en traumatologie ayant consult l'H pital universitaire royal entre le 1er avril 2020 et le 31 mars 2022. Nous avons scind la cohorte en 2 groupes (milieux urbains et ruraux), selon le lieu de survenue du traumatisme. Le param tre principal tait la mortalit 30 jours. Les param tres secondaires taient la dur e du s jour hospitalier, la r hospitalisation dans les 30 jours suivant le cong , et le taux de complications. R sultats: La patient le de traumatologie provenant de r gions rurales tait plus jeune (34,1 c. 37 ans; p = 0,002) et plus susceptible d' tre de sexe masculin (80,3% c. 74,4%; p = 0,040) et de pr senter des indices de gravit des blessures plus lev s (12,3 c. 8,3; p < 0,0001). La patient le de traumatologie provenant de milieux urbains tait plus susceptible d'avoir subi un traumatisme p n trant (42,5% c. 28,5%; p < 0,0001). Nous n'avons observ aucune diff rence aux plans de la morbidit et de la mortalit entre les 2 groupes, mais la dur e m diane du s jour hospitalier du groupe provenant de milieux ruraux a t plus longue (5 c. 3 j; p < 0,0007). Conclusion: M me si nous avons observ des diff rences cl s aux plans des donn es d mographiques ainsi que du type et de la gravit des blessures, les param tres se sont r v l s assez semblables entre les patient les de traumatologie des milieux urbains et ruraux. Cette observation se d marque de celles d' tudes canadiennes et am ricaines comparables, ce qui pourrait s'expliquer par l'exclusion de la mortalit pr hospitali re dans le groupe de milieux ruraux. La dur e plus longue du s jour chez la patient le de traumatologie de milieux ruraux pourrait tre attribuable des enjeux relatifs l' tat de ces malades au moment de leur cong ., The province of Saskatchewan, Canada, has a geographically dispersed population, with about 60% living more than an hour away from a tertiary care centre and 48% living more than an [...]

Medical Economics is proud to present the 95th Physician Report. Our in-depth survey presents exclusive data collected from our physician audience on salaries, productivity, malpractice rates, the state of the [...]

Objective To demonstrate how the new internationally comparable instrument, the People's Voice Survey, can be used to contribute the perspective of the population in assessing health system performance in countries of all levels of income. Methods We surveyed representative samples of populations in 16 low-, middle- and high-income countries on health-care utilization, experience and confidence during 2022-2023. We summarized and visualized data corresponding to the key domains of the World Health Organization universal health coverage framework for health system performance assessment. We examined correlation with per capita health spending by calculating Pearson coefficients, and within-country income-based inequities using the slope index of inequality. Findings In the domain of care effectiveness, we found major gaps in health screenings and endorsement of public primary care. Only one in three respondents reported very good user experience during health visits, with lower proportions in low-income countries. Access to health care was rated highest of all domains; however, only half of the populations felt secure that they could access and afford high-quality care if they became ill. Populations rated the quality of private health systems higher than that of public health systems in most countries. Only half of respondents felt involved in decision-making (less in high-income countries). Within countries, we found statistically significant pro-rich inequalities across many indicators. Conclusion Populations can provide vital information about the real-world function of health systems, complementing other system performance metrics. Population-wide surveys such as the People's Voice Survey should become part of regular health system performance assessments. [phrase omitted] [phrase omitted] Objectif Montrer comment l'enquete People's Voice Survey, un nouvel instrument comparable au niveau international, peut etre utilise pour nourrir la perspective d'une evaluation des performances du systeme de sante par la population dans des pays de tous les niveaux de revenus. Methodes Nous avons interroge des echantillons representatifs d'habitants de 16 pays a revenu faible, intermediaire et eleve sur leur recours aux soins de sante, leur experience en la matiere et la confiance qu'ils y accordent sur la periode 2022-2023. Nous avons ensuite resume et visualise les donnees correspondant aux principaux domaines du cadre de l'Organisation mondiale de la Sante relatif a la couverture sanitaire universelle pour evaluer les systemes de sante. Enfin, nous avons examine la correlation avec les depenses individuelles en soins de sante en calculant les coefficients Pearson, ainsi que les disparites de revenus au sein de chaque pays a l'aide de l'indice de pente de l'inegalite. Resultats Dans le domaine de l'efficacite des soins, nous avons decele des lacunes considerables au niveau des examens medicaux et de l'approbation envers l'offre publique de soins de sante primaires. Seul un repondant sur trois a fait etat d'une excellente experience en tant que patient lors des visites sanitaires, le pourcentage etant moins eleve dans les pays a revenu faible. Tous domaines confondus, c'est l'acces aux soins de sante qui a recu la meilleure note; toutefois, a peine la moitie des personnes interrogees avaient la conviction de pouvoir beneficier de soins de qualite a prix abordable si elles venaient a tomber malades. La qualite des systemes de sante prives a ete jugee superieure a celle des systemes de sante publics dans la plupart des pays. Enfin, la moitie seulement des repondants se sent impliquee dans la prise de decisions (voire moins dans les pays a revenu eleve). Par ailleurs, nous avons trouve au sein de chaque pays des inegalites statistiquement significatives en faveur des categories les plus aisees et ce, pour de nombreux indicateurs. Conclusion Les populations peuvent fournir des informations vitales sur le fonctionnement reel des systemes de sante, ce qui permet de completer les autres mesures de performances. Les enquetes telles que People's Voice Survey, menees aupres de l'ensemble des habitants, devraient desormais etre integrees aux evaluations periodiques des performances des systemes de santes. [phrase omitted] Objetivo Demostrar como el nuevo instrumento de comparacion internacional, la People's Voice Survey, se puede utilizar para aportar la perspectiva de la poblacion al evaluar el desempeno del sistema sanitario en paises de todos los niveles de ingresos. Metodos Se encuestaron muestras representativas de poblaciones de 16 paises de ingresos bajos, medios y altos sobre la utilizacion de la atencion sanitaria, la experiencia y la confianza durante 2022 y 2023. Se resumieron y visualizaron los datos correspondientes a los ambitos clave del marco de cobertura sanitaria universal de la Organizacion Mundial de la Salud para la evaluacion del desempeno de los sistemas sanitarios. Se examino la correlacion con el gasto sanitario per capita calculando los coeficientes de Pearson y las desigualdades basadas en los ingresos dentro de los paises utilizando el indice de desigualdad de la pendiente. Resultados En el ambito de la eficacia de la atencion, se encontraron importantes deficiencias en los examenes de salud y en la aprobacion de la atencion primaria publica. Solo uno de cada tres encuestados declaro tener una experiencia de usuario muy buena durante las visitas sanitarias, con porcentajes mas bajos en los paises de ingresos bajos. El acceso a la atencion sanitaria fue el mejor valorado de todos los ambitos; sin embargo, solo la mitad de las poblaciones se sentian seguras de poder acceder y costearse una atencion de alta calidad en caso de enfermar. En la mayoria de los paises, la poblacion valoro mas la calidad de los sistemas sanitarios privados que la de los publicos. Solo la mitad de los encuestados se sentian implicados en la toma de decisiones (menos en los paises de ingresos altos). Dentro de los paises, se encontraron desigualdades estadisticamente significativas a favor de los mas ricos en muchos indicadores. Conclusion Las poblaciones pueden proporcionar informacion vital sobre el funcionamiento real de los sistemas sanitarios, como complemento de otras metricas de desempeno del sistema. Las encuestas poblacionales, como la People's Voice Survey, deberian formar parte de las evaluaciones periodicas del funcionamiento de los sistemas sanitarios., Introduction The notion that health systems should be people-centred seems unexceptional. Health systems are occupied with serving people, are funded by people and aim to improve people's health as their [...]

Objective To conduct a systematic review on the effects of multisectoral interventions for health on health system performance. Methods We conducted a systematic review according to the preferred reporting items for systematic review and meta- analysis protocols. We searched for peer-reviewed journal articles in PubMed[R], Scopus, Web of Science, Cumulated Index to Nursing and Allied Health Literature, and the Cochrane Database of Systematic Reviews on 31 August 2023 (updating on 28 February 2024). We removed duplicates, screened titles and abstracts, and then conducted a full-text eligibility and quality assessment. Findings We identified an initial 1118 non-duplicate publications, 62 of which met our inclusion and exclusion criteria. The largest proportions of reviewed studies focused on multisectoral interventions directly related to specific health outcomes (66.1%; 41 studies) and/or social determinants of health (48.4%; 30 studies), but without explicit reference to overall health system performance. Most reviewed publications did not address process indicators (83.9%; 52/62) or discuss sustainability for multisectoral interventions in health (72.6%; 45/62). However, we observed that the greatest proportion (66.1%; 41/62) considered health system goals: health equity (68.3%; 28/41) and health outcomes (63.4%; 26/41). Although the greatest proportion (64.5%; 40/62) proposed mechanisms explaining how multisectoral interventions for health could lead to the intended outcomes, none used realistic evaluations to assess these. Conclusion Our review has established that multisectoral interventions influence health system performance through immediate improvements in service delivery efficiency, readiness, acceptability and affordability. The interconnectedness of these effects demonstrates their role in addressing the complexities of modern health care. [phrase omitted] [phrase omitted] Objectif Realiser une revue systematique consacree a l'impact des interventions multisectorielles sur la performance des systemes de sante. Methodes Nous avons procede a une revue systematique en appliquant les elements de rapport privilegies dans les protocoles de revues systematiques et meta-analyses. Nous avons explore PubMed[R], Scopus, Web of Science, Cumulated Index to Nursing and Allied Health Literature, ainsi que la Base de donnees Cochrane des revues systematiques le 31 aout 2023 (mise a jour le 28 fevrier 2024), a la recherche d'articles de revue evalues par des pairs. Ensuite, nous avons supprime les doublons, passe les titres et resumes au crible, puis determine la qualite et l'admissibilite des articles complets. Resultats Nous avons initialement identifie 1118 publications non dupliquees; 62 d'entre elles repondaient a nos criteres d'inclusion et d'exclusion. Une grande partie des etudes examinees portaient sur des interventions multisectorielles en lien direct avec des resultats de sante specifiques (66,1%; 41 etudes) et/ou des determinants sociaux de la sante (48,4%; 30 etudes), sans toutefois faire explicitement reference a la performance globale des systemes de sante. La majorite des publications ne mentionnaient aucun indicateur de processus (83,9%; 52/62) et n'abordaient pas la durabilite des interventions multisectorielles dans le domaine de la sante (72,6%; 45/62). Nous avons neanmoins constate qu'en general, elles tenaient compte des objectifs relatifs aux systemes de sante (66,1%; 41/62): l'equite en sante (68,3%; 28/41) et les resultats de sante (63,4%; 26/41). Bien que la plupart (64,5%; 40/62) proposent des mecanismes visant a expliquer comment les interventions multisectorielles en matiere de sante pourraient amener aux resultats escomptes, aucune n'avait recours a des evaluations realistes pour les mesurer. Conclusion Notre revue nous a permis d'etablir que les interventions multisectorielles influencaient la performance des systemes de sante a travers des ameliorations immediates en termes d'efficacite, de disponibilite, d'acceptation et d'abordabilite des prestations de services. L'interdependance entre ces effets temoigne de l'importance qu'ils revetent lorsqu'il s'agit d'apprehender les rouages complexes des soins de sante modernes. [phrase omitted] Objetivo Realizar una revision sistematica sobre los efectos de las intervenciones multisectoriales en favor de la salud sobre el rendimiento de los sistemas sanitarios. Metodos Se realizo una revision sistematica de acuerdo con los items de informe preferidos para los protocolos de revision sistematica y metanalisis. Se realizaron busquedas de articulos de revistas con revision por pares en PubMed[R], Scopus, Web of Science, Cumulated Index to Nursing and Allied Health Literature y la Base de Datos Cochrane de Revisiones Sistematicas el 31 de agosto de 2023 (actualizacion el 28 de febrero de 2024). Se eliminaron los duplicados, se examinaron los titulos y los resumenes y, a continuacion, se realizo una evaluacion de la elegibilidad y la calidad del texto completo. Resultados Se identificaron 1118 publicaciones iniciales no duplicadas, 62 de las cuales cumplian los criterios de inclusion y exclusion. El mayor porcentaje de estudios revisados se centro en intervenciones multisectoriales directamente relacionadas con resultados sanitarios especificos (66,1%; 41 estudios) o determinantes sociales de la salud (48,4%; 30 estudios), pero sin referencia explicita al rendimiento general del sistema sanitario. La mayoria de las publicaciones revisadas no abordaron indicadores de proceso (83,9%; 52/62) ni discutieron la sostenibilidad de las intervenciones multisectoriales en salud (72,6%; 45/62). Sin embargo, se observo que el mayor porcentaje (66,1%; 41/62) tenia en cuenta los objetivos del sistema sanitario: equidad sanitaria (68,3%; 28/41) y resultados sanitarios (63,4%; 26/41). Aunque el mayor porcentaje (64,5%; 40/62) propuso mecanismos que explicaban como las intervenciones multisectoriales para la salud podian conseguir los resultados previstos, ninguno empleo evaluaciones realistas para evaluarlos. Conclusion La revision que se realizo ha demostrado que las intervenciones multisectoriales influyen en el rendimiento de los sistemas sanitarios a traves de mejoras inmediatas en la eficiencia, la disponibilidad, la aceptabilidad y la asequibilidad de la prestacion de servicios. La interconexion de estos efectos demuestra su funcion a la hora de abordar las complejidades de la atencion sanitaria moderna., Introduction There is unequivocal recognition that health and well-being are determined by non-medical factors, including structural, social and commercial determinants of health. (1) Addressing those determinants is a task for [...]

Objective To examine how a general inpatient satisfaction survey functions as a hospital performance measure. Methods We conducted a mixed-methods pilot study of the Hospital Consumer Assessment of Health Providers and Systems survey in Odisha, India. We divided the study into three steps: cognitive testing of the survey, item testing with exploratory factor analysis and content validity indexing. Cognitive testing involved 50 participants discussing their interpretation of survey items. The survey was then administered to 507 inpatients across five public hospitals in Odisha, followed by exploratory factor analysis. Finally, we interviewed 15 individuals to evaluate the content validity of the survey items. Findings Cognitive testing revealed that six out of 18 survey questions were not consistently understood within the Odisha inpatient setting, highlighting issues around responsibilities for care. Exploratory factor analysis identified a six-factor structure explaining 66.7% of the variance. Regression models showed that interpersonal care from doctors and nurses had the strongest association with overall satisfaction. An assessment of differential item functioning revealed that patients with a socially marginalized caste reported higher disrespectful care, though this did not translate into differences in reported satisfaction. Content validity indexing suggested that discordance between experiences of disrespectful care and satisfaction ratings might be due to low patient expectations. Conclusion Using satisfaction ratings without nuanced approaches in value-based purchasing programmes may mask poor- quality interpersonal services, particularly for historically marginalized patients. Surveys should be designed to accurately capture true levels of dissatisfaction, ensuring that patient concerns are not hidden. [phrase omitted] [phrase omitted] Objectif Examiner le fonctionnement d'une enquete generale de satisfaction des patients hospitalises en tant que mesure de la performance des hopitaux. Methodes Nous avons mene une etude pilote mixte de l'enquete Hospital Consumer Assessment of Health care Providers and Systems a Odisha, en Inde. Nous avons subdivise l'etude en trois etapes: tests cognitifs de Lenquete, test par items avec analyse factorielle exploratoire et indexation de la validite du contenu. Les tests cognitifs concernaient 50 personnes, qui ont discute de leur interpretation des questions de l'enquete. Lenquete a ensuite ete soumise a 507 patients hospitalises dans cinq hopitaux publics d'Odisha, puis a fait l'objet d'une analyse factorielle exploratoire. Enfin, nous avons interroge 15 personnes pour evaluer la validite du contenu des questions de Lenquete. Resultats Les tests cognitifs ont revele que six des 18 questions de Lenquete n'etaient pas toujours comprises par les patients hospitalises a Odisha, ce qui met en evidence les problemes lies aux responsabilites en matiere de soins. Une analyse factorielle exploratoire a permis d'identifier une structure a six facteurs expliquant 66,7% de la variance. Des modeles de regression ont mis en evidence que les soins interpersonnels prodigues par des medecins et des infirmieres avaient le plus grand impact sur la satisfaction globale. Une evaluation du fonctionnement differentiel des items a revele que les patients appartenant a une caste socialement marginalisee signalaient davantage d'irrespect dans les soins, bien que cela ne se traduise pas par des differences au niveau de la satisfaction declaree. L'indexation de la validite du contenu a suggere que la discordance entre les experiences d'irrespect dans les soins et les evaluations de satisfaction pourrait etre due a la faiblesse des attentes des patients. Conclusion L'utilisation devaluations de la satisfaction sans approches nuancees dans les programmes d'achat bases sur la valeur est susceptible de masquer des services interpersonnels de mauvaise qualite, en particulier pour les patients historiquement marginalises. Les enquetes doivent etre concues de maniere a saisir avec precision les veritables niveaux d'insatisfaction, en evitant de masquer les preoccupations des patients. [phrase omitted] Objetivo Examinar el funcionamiento de una encuesta general de satisfaccion de los pacientes hospitalizados como medida de rendimiento de los hospitales. Metodos Se realizo un estudio piloto de metodos mixtos de la encuesta de Evaluacion del consumidor hospitalario sobre proveedores y sistemas de atencion sanitaria en Odisha (I ndia). Se dividio el estudio en tres pasos: prueba cognitiva de la encuesta, prueba de elementos con analisis factorial exploratorio e indexacion de la validez del contenido. La prueba cognitiva consistio en que 50 participantes discutieran su interpretacion de los elementos de la encuesta. A continuacion, se administro la encuesta a 507 pacientes ingresados en cinco hospitales publicos de Odisha, tras lo cual se realizo un analisis factorial exploratorio. Por ultimo, se entrevisto a 15 personas para evaluar la validez de contenido de los elementos de la encuesta. Resultados Las pruebas cognitivas revelaron que seis de las 18 preguntas de la encuesta no se comprendian de forma coherente en el entorno hospitalario de Odisha, lo que evidenciaba problemas relacionados con las responsabilidades de la atencion. El analisis factorial exploratorio identifico una estructura de seis factores que explicaban el 66,7% de la varianza. Los modelos de regresion mostraron que la atencion interpersonal por parte de medicos y personal de enfermeria presentaba la mayor asociacion con la satisfaccion general. Una evaluacion del funcionamiento diferencial de los elementos revelo que los pacientes de una casta socialmente marginada informaron de una atencion mas irrespetuosa, aunque esto no se reflejo en diferencias en la satisfaccion declarada. La indexacion de la validez de contenido sugirio que la discordancia entre las experiencias de atencion irrespetuosa y los indices de satisfaccion podria deberse a las bajas expectativas de los pacientes. Conclusion El uso de indices de satisfaccion sin enfoques matizados en los programas de compras basadas en el valor puede enmascarar servicios interpersonales de mala calidad, en particular para pacientes historicamente marginados. Las encuestas deben disenarse para captar con precision los verdaderos niveles de insatisfaccion, de forma que no se oculten las preocupaciones de los pacientes., Introduction In 2018, the Indian government launched the world's largest health insurance scheme, Pradhan Mantri Jan Arogya Yojana. (1) The scheme aims to cover secondary and tertiary care for 500 [...]

Problem To prioritize key areas of action and investment for the next strategic cycle of national development plans (2026-2031) in Oman, we needed a holistic view of the country's health system and its main deficiencies and inefficiencies. Approach Informed by the World Health Organization framework, our team of seven national health ministry staff and two international experts conducted a rapid health system performance assessment. We used already available data to identify system bottlenecks and their potential root causes, verifying our findings with key informant interviews. Local setting Oman's 4.9 million population is relatively young (average age 28 years) but ageing, with a mounting burden of chronic diseases. While health-care services are free for Omani nationals, more than 1.5 million expatriates rely on out-of- pocket payments for health-care services. Strengthening primary health care, improving the quality of care, providing financial protection, and ensuring that public and private health-care providers operate within the same legal and procedural framework are recognized as key national priorities. Relevant changes Our assessment highlighted the need to extend health service coverage to the whole population, strengthen private health-care sector governance, improve health education, increase financial investment, and expand the country's capacity for data collection and analysis. Lessons learnt The assessment framework allowed us to identify areas where information is lacking and use already available data to analyse multiple health outcomes. As well as identifying issues that need to be addressed during the next policy development cycle, our findings have contributed towards the preparation of a more extensive assessment. [phrase omitted] [phrase omitted] Probleme Afin de hierarchiser les domaines d'action et d'investissement cles pour le prochain cycle strategique des plans de developpement nationaux (2026-2031) a Oman, une vision globale du systeme de sante du pays et de ses principales faiblesses et inefficacites etait necessaire. Approche S'inspirant du cadre de {'Organisation mondiale de la sante, notre equipe, composee de sept membres du personnel du ministere de la Sante et de deux experts internationaux, a procede a une evaluation rapide de la performance du systeme de sante. Nous avons utilise les donnees deja disponibles pour Identifier les goulets d'etranglement du systeme et leurs eventuelles causes premieres, et nous avons verifie nos conclusions a l'aide d'entretiens avec des informateurs cles. Environnement local La population d'Oman, qui compte 4,9 millions d'habitants, est relativement jeune (l'age moyen est de 28 ans), mais vieillissante, et le fardeau des maladies chroniques s'alourdit. Alors que les services de sante publique sont gratuits pour les Omanais, plus de 1,5 million d'expatries paient directement leurs soins de sante. Le renforcement des soins de sante primaires, l'amelioration de la qualite des soins, l'offre d'une protection financiere et la garantie que les prestataires de soins de sante publics et prives operent dans le meme cadre juridique et procedural sont reconnus comme des priorites nationales essentielles. Changements significatifs Notre evaluation a mis en evidence la necessite d'etendre la couverture des services de sante a l'ensemble de la population, de renforcer la gouvernance du secteur des soins de sante prives, d'ameliorer l'education a la sante, d'accroitre les investissements financiers et de developper les capacites du pays en matiere de collecte et d'analyse des donnees. Lecons tirees Le cadre devaluation nous a permis d'identifier les domaines ou des informations font defaut et d'utiliser les donnees deja disponibles pour analyser plusieurs resultats en matiere de sante. Outre l'identification des questions a traiter lors du prochain cycle d'elaboration des politiques, nos conclusions ont contribue a la preparation d'une evaluation plus approfondie. [phrase omitted] Situacion Para priorizar las areas clave de intervencion e inversion para el proximo ciclo estrategico de planes nacionales de desarrollo (2026-2031) en Oman, necesitabamos una vision holistica del sistema sanitario del pais y de sus principales deficiencias e ineficiencias. Enfoque Teniendo en cuenta el marco de la Organizacion Mundial de la Salud, nuestro equipo, formado por siete funcionarios de los ministerios de sanidad nacionales y dos expertos internacionales, realizo una evaluacion rapida del funcionamiento del sistema sanitario. Utilizamos los datos ya disponibles para identificar los obstaculos del sistema y sus posibles causas, y verificamos nuestros resultados con entrevistas a informantes clave. Marco regional La poblacion de Oman, de 4,9 millones de habitantes, es relativamente joven (edad media: 28 anos) pero esta envejeciendo, con una carga creciente de enfermedades cronicas. Mientras que los servicios sanitarios son gratuitos para los ciudadanos omanies, mas de 1,5 millones de expatriados pagan de su bolsillo los servicios sanitarios. El fortalecimiento de la atencion primaria, la mejora de la calidad de la atencion, la proteccion financiera y la garantia de que los proveedores de atencion sanitaria publicos y privados operan dentro del mismo marco legal y de procedimiento se reconocen como prioridades nacionales clave. Cambios importantes Nuestra evaluacion destaco la necesidad de ampliar la cobertura de los servicios sanitarios a toda la poblacion, reforzar la gobernanza del sector sanitario privado, mejorar la educacion sanitaria, aumentar la inversion financiera y ampliar la capacidad de recopilacion y analisis de datos del pais. Lecciones aprendidas El marco de evaluacion nos ha permitido identificar las areas en las que falta informacion y utilizar los datos ya disponibles para analizar multiples resultados sanitarios. Ademas de identificar cuestiones que deben abordarse durante el proximo ciclo de elaboracion de politicas, nuestros resultados han contribuido a la preparacion de una evaluacion mas amplia., Introduction Health systems are constantly changing; regular wide-ranging assessments of their performance help to identify and adjust priorities, (1,2) and inform actions for their robust and resilient transformation. Originally developed [...]

Background: Inguinal lymphadenectomy (ILND) has historically been associated with substantial morbidity. The objective of this study was to obtain contemporary ILND morbidity rates and to identify potentially preventable risk factors. Methods: We carried out a retrospective review of medical records for all superficial, deep, and combination groin dissections performed at a single, high-volume academic centre between January 2007 and December 2020. We collected data points for patient, disease, and surgery characteristics, and cancer outcomes. The outcome of interest was any complication within 30 days of surgery. Complications included wound infection, wound necrosis or disruption, seroma, drainage procedure, hematoma, and lymphedema. We performed multivariate logistic regression using SAS version 9.4. Results: We identified 139 patients having undergone 89 superficial, 12 deep, and 38 combined dissection types, respectively. Melanoma accounted for 84.9% of cases. Of these patients, 56.1% had an adverse postoperative event within 30 days. Increasing age (odds ratio [OR] 1.04, 95% confidence interval [CI] 1.01-1.07, p < 0.01) and number of positive lymph nodes harvested (OR 1.22, 95% CI 1.00-1.50, p = 0.05) were associated with more complications. Patients with deep dissection showed a lower likelihood of complications than those with superficial dissection (OR 0.15, 95% CI 0.03-0.84, p < 0.05). Conclusion: Complication rates after ILND remain high. We identified a number of risk factors, providing opportunities for better selection and prevention. Contexte : La lymphad nectomie inguinale (LI) a toujours t associ e une morbidit importante. Cette tude avait pour but de mesurer les taux de morbidit actuellement associ s la LI et d'en identifer les facteurs de risque potentiellement vitables. M thodes : Nous avons proc d une revue r trospective des dossiers m dicaux de tous les cas de curage inguinal superficiel, profond et complet effectu s dans un seul centre hospitalier universitaire achaland entre janvier 2007 et d cembre 2020. Nous avons recueilli des donn es relatives aux caract ristiques des malades, des maladies et des chirurgies, de m me que l'issue des cancers. Le param tre principal tait toute complication survenant dans les 30 jours suivant la chirurgie. Les complications incluaient infection, n crose ou d hiscence de la plaie, s rome, pose de drain, h matome et lymphoed me. Nous avons proc d une analyse de r gression logistique multivari e l'aide du logiciel SAS Enterprise 9.4. R sultats : Nous avons recens 139 personnes ayant subi un curage inguinal : 89 superficiels, 12 profonds et 38 complets. Un m lanome justifiait l'intervention dans 84,9% des cas. Parmi ces malades, 56,1% ont eu une complication postop ratoire dans les 30 jours suivants l'intervention. Un ge avanc (rapport des cotes [RC] 1,04, intervalle de confiance [IC] de 95% 1,01-1,07, p < 0,01) et le nombre de ganglions lymphatiques positifs r s qu s (RC 1,22, IC de 95% 1,00-1,50, p = 0,05) ont t associ s plus de complications. Les curages profonds ont t associ s une probabilit moindre de complications comparativement aux curages superficiels (RC 0,15, IC de 95% 0,03-0,84, p < 0,05). Conclusion : Les taux de complications suivant la lymphad nectomie inguinale restent lev s. Nous avons identif certains facteurs de risque qui sont autant d'occasions de mieux s lectionner les malades et d'am liorer la pr vention., Inguinal lymphadenectomy (ILND) is a surgical proced ure used for the management of regionally advanced or recurrent malignancies such as melanoma. (1,2) It is classified into different types, based on [...]

Background: The evidence on the benefits and drawbacks of involving neurosurgical residents in the care of patients who undergo neurosurgical procedures is heterogeneous. We assessed the effect of neurosurgical residency programs on the outcomes of such patients in a large single-payer public health care system. Methods: Ten population-based cohorts of adult patients in Ontario who received neurosurgical care from 2013 to 2017 were identified on the basis of procedural codes, and the cohorts were followed in administrative health data sources. Patient outcomes by the status of the treating hospital (with or without a neurosurgical residency program) within each cohort were compared with models adjusted for a priori confounders and with adjusted multilevel models (MLMs) to also account for hospital-level factors. Results: A total of 46 608 neurosurgical procedures were included. Operative time was 8%-30% longer in hospitals with neurosurgical residency programs in 9 out of 10 cohorts. Thirty-day mortality was lower in hospitals with neurosurgical residency programs for aneurysm repair (odds ratio [OR] 0.30, 95% confidence interval [CI] 0.20-0.44), cerebrospinal fluid shunting (OR 0.52, 95% CI 0.34-0.79), intra cerebral hemorrhage evacuation (OR 0.66, 95% CI 0.52-0.84), and posterior lumbar decompression (OR 0.32, 95% CI 0.15-0.65) in adjusted models. The mortality rates remained significantly different only for aneurysm repair (OR 0.19, 95% CI 0.05-0.69) and cerebrospinal shunting (OR 0.42, 95% CI 0.21-0.85) in MLMs. Length of stay was mostly shorter in hospitals with neurosurgical residents, but this finding did not persist in MLMs. Thirty-day reoperation rates did not differ between hospital types in MLMs. For 30-day readmission rates, only extracerebral hematoma decompression was significant in MLMs (OR 1.41, 95% CI 1.07-1.87). Conclusion: Hospitals with neurosurgical residents had longer operative times with similar to better outcomes. Most, but not all, of the differences between hospitals with and without residency programs were explained by hospital-level variables rather than direct effects of residents. Contexte : Les donn es relatives aux avantages et aux inconv nients de la participation des r sidentes et r sidents en neurochirurgie aux interventions de cette sp cialit sont h t rog nes. Nous avons valu l'effet des programmes de r sidence en neurochirurgie sur les r sultats chez les malades concern s au sein d'un volumineux syst me de sant universel payeur unique. M thodes : Dix cohortes populationnelles compos es de malades adultes ayant re u des soins en neurochirurgie en Ontario entre 2013 et 2017 ont t identif es partir des codes d'acte, et suivies au moyen des bases de donn es administratives sur la sant . Les r sultats chez les malades de chaque cohorte selon le statut de leur h pital (offrant ou non un programme de r sidence en neurochirurgie) ont t compar s des mod les ajust s pour tenir compte de variables de confusion a priori, et des mod les multiniveaux ajust s (MMN) pour tenir compte aussi de facteurs propres aux h pitaux. En tout, nous avons inclus 46 608 interventions neurochirurgicales. Le temps op ratoire a t 8%-30% plus long dans les h pitaux offrant un programme de r sidence en neurochirurgie dans 9 cohortes sur 10. La mortalit 30 jours a t moindre dans les h pitaux offrant un programme de r sidence en neuro chirurgie pour les r parations d'an vrisme (rapport des cotes [RC] 0,30, intervalle de confance [IC] de 95% 0,20-0,44), les d rivations du liquide c phalorachidien (RC 0,52, IC de 95% 0,34-0,79), le drainage des h morragies intrac r brales (RC 0,66, IC de 95% 0,52-0,84) et la d compression post rieure lombaire (RC 0,32, IC de 95% 0,15-0,65) dans les mod les ajust s. Les taux de mortalit sont demeur s significativement diff rents uniquement pour les r parations d'an vrisme (RC 0,19, IC de 95% 0,05-0,69) et les d rivations du liquide c phalorachidien (RC 0,42, IC de 95% 0,21-0,85) dans les MMN. La dur e des s jours a t majoritairement moindre dans les h pitaux offrant un programme de r sidence en neurochirurgie, mais cette observation ne se maintenait pas dans les MMN. Les taux de r intervention 30 jours n'ont pas diff r entre les types d'h pitaux dans les MMN. Les taux de r admission 30 jours n'ont t significatifs que pour les cas de d compression d'h matomes extrac r braux dans les MMN (RC 1,41, IC de 95% 1,07-1,87). Conclusion : Les temps op ratoires ont t plus longs dans les h pitaux offrant un programme de r sidence en neurochirurgie, et les r sultats ont t similaires ou meilleurs. La plupart des diff rences entre les h pitaux offrant ou non un programme de r sidence en neurochirurgie ont pu s'expliquer par des variables propres aux h pitaux plus que par un quelconque effet direct des programmes de r sidence en neurochirurgie., Evidence from studies that have examined resident influence on the outcome of surgical procedures, in general, is heterogenous. (1-6) This is expected because of the different natures and complexities of [...]

Background: Use of postoperative radiographs after surgical management of supracondylar humerus (SCH) fractures is often based on rote practice rather than evidence. The purpose of this study was to determine the frequency with which 3-week postoperative radiographs at the time of pin removal altered management plans in pediatric SCH fractures that were intraoperatively stable after closed reduction and percutaneous pinning (CRPP). Methods: We prospectively recruited pediatric patients with SCH fractures managed by CRPP at our institution from June 2020 until June 2022, and reviewed retro spective data on pediatric SCH fractures managed surgically at our institution between April 2008 and March 2015. Patients were assessed for post-CRPP fracture alignment and stability. For prospective patients, we asked clinicians to document their management decision at the 3-week follow-up visit before evaluating the postoperative radiographs. Our primary outcome was change in management because of radiographic findings. Results: Overall, 1066 patients in the retrospective data and 446 prospectively recruited patients met the inclusion criteria. In the prospective group, radiographic findings altered management for 2 patients (0.4%). One patient had slow callus formation and 1 patient was identified as having cubitus varus. Altered management included prolonged immobilization or additional radiographic follow-up. Radiographic findings altered management in 0 (0%) of 175 type II fractures, in 2 (0.9%) of 221 type III fractures, and in 0 (0%) of 44 type IV fractures. We obtained similar findings from retrospective data. Conclusion: Rote use of 3-week postoperative radiographs after surgical management of SCH fractures that are intraoperatively stable has minimal utility. Eliminating rote postoperative radiographs for SCH fractures can decrease the time and financial burdens on families and health care systems without affecting patient outcomes. Contexte : L'utilisation des radiographies postop ratoires apr s la r duction chirurgicale des fractures supracondyliennes de l'hum rus (SCH) se fonde souvent sur l'habitude plut t que sur des donn es probantes. Cette tude avait pour but de d terminer la fr quence laquelle les radiographies postop ratoires apr s 3 semaines, au moment du retrait de l'embrochage, modifaient la prise en charge des fractures SCH p diatriques qui taient stables l' tape perop ratoire, apr s r duction ferm e et embrochage percutan (RFEP). M thodes : Nous avons recrut de mani re prospective des enfants ayant subi une fracture SCH trait e par RFEP dans notre tablissement de juin 2020 juin 2022, et pass en revue les donn es r trospectives sur les fractures SCH p diatriques trait es chirurgicalement dans notre tablissement entre avril 2008 et mars 2015. Les jeunes ont t valu s en post-RFEP aux plans de l'alignement et de la stabilit des fractures. Pour le groupe prospectif, nous avons demand aux m decins de documenter leurs d cisions th rapeutiques la visite de suivi apr s 3 semaines avant d' valuer les radiographies postop ratoires. Notre param tre principal tait tout changement de la prise en charge motiv par les r sultats radiographiques. R sultats : En tout, 1066 jeunes de la cohorte r trospective et 446 de la cohorte prospective r pondaient aux crit res d'inclusion. Dans le groupe prospectif, les r sultats des radiographies ont modif la prise en charge chez 2 enfants (0,4%). L'un pr sentait une lente formation de callosit et l'autre, un cubitus varus. Les modifications de la prise en charge ont inclus la prolongation de l'immobilisation ou l'ajout d'examens radiographiques. Les r sultats radiographiques ont modif la prise en charge de 0 (0%) fracture de type II sur 175, de 2 (0,9%) fractures de type III sur 221, et de 0 (0%) fracture de type IV sur 44. Nous avons fait des observations similaires pour la cohorte r trospective. Conclusion : Les radiographies postop ratoires de routine 3 semaines apr s une r duction chirurgicale des fractures SCH qui taient stables l' tape perop ratoire sont peu utiles. Les liminer ferait gagner du temps aux parents et aux syst mes de sant et tout en r duisant leurs d penses, sans affecter les r sultats de l'intervention., The American Academy of Orthopaedic Surgeons' 2012 clinical practice guideline for the treatment of pediatric supracondylar humerus (SCH) fractures recommended surgical reduction with wire flxation for displaced fractures (moderate-strength recommendation). [...]

Background: Prescription opioid use places a considerable economic burden on health care systems. Older patients undergoing surgical procedures for painful conditions commonly receive opioids pre- and postoperatively, and are susceptible to adverse reactions. This study explores predictors of prolonged postoperative opioid use among older patients after lumbar spine surgery and the consequences in terms of health care utilization and costs. Methods: We conducted a retrospective population-based cohort study using Ontario administrative data from older adults undergoing spine surgery between 2006 and 2017. Data were analyzed from 90 days preoperatively to 1 year after hospital discharge, with last postoperative opioid prescriptions stratified into 90-day increments. We used multivariable ordinal logistic regression to identify predictors of long-term opioid use and generalized linear modelling to examine resource utilization and health care costs (2021 Canadian dollars). Results: Of 15 109 patients included, 40.8% received preoperative opioid prescriptions. Preoperative opioid use strongly predicted prolonged postoperative use (odds ratio [OR] 4.47, 95% confidence interval [CI] 4.16-4.79), with 48.3% of patients who received preoperative opioids continuing to use opioids for longer than 9 months, relative to 12.7% of those without preoperative use. Several other risk factors for prolonged use were identified. Patients receiving long-term postoperative opioids incurred greater health care costs relative to those with opioids prescribed for fewer than 90 days (OR 1.49, 95% CI 1.44-1.54). Conclusion: Among older adults undergoing spine surgery, preoperative opioid use was a strong predictor of prolonged postoperative use, which was associated with increased health care costs. These results form an important baseline for future studies evaluating strategies to reduce opioid use targeting older surgical populations. Contexte : L'utilisation d'opio des vendus sur ordonnance impose un tr s lourd fardeau aux syst mes de sant . On les prescrit souvent en p riode pr - et postop ratoire aux malades g s qui subissent des interventions chirurgicales pour des maladies douloureuses et cela comporte des risques de r actions ind sirables. Cette tude explore les pr dicteurs d'une utilisation prolong e des opio des en p riode postop ratoire chez des personnes g es op r es la colonne vert brale et son impact sur l'utilisation des ressources sanitaires et les co ts associ s. M thodes : Nous avons proc d une tude de cohorte populationnelle r trospective partir des donn es administratives de l'Ontario concernant les adultes g s ayant subi une chirurgie de la colonne entre 2006 et 2017. Les donn es ont t analys es pour la p riode allant de 90 jours avant l'intervention 1 an suivant le cong hospitalier, et les derni res ordonnances postop ratoires d'opio des ont t stratifi es par tranches de 90 jours. Nous avons utilis l'analyse de r gression logistique multivari e ordinale pour identifier les pr dicteurs d'une utilisation prolong e des opio des et un mod le lin aire g n ralis pour examiner l'utilisation des ressources sanitaires et les co ts associ s (dollars canadiens de 2021). R sultats : Parmi les 15 109 personnes incluses, 40,8% avaient re u une ordonnance d'opio des avant leur intervention. L'utilisation d'opio des en p riode pr op ratoire s'est r v l tre un fort pr dicteur d'utilisation postop ratoire prolong e (rapport des cotes [RC] 4,47, intervalle de confiance [IC] de 95% 4,16-4,79), et 48,3% des malades ayant re u des opio des en p riode pr op ratoire ont continu de les utiliser pendant plus de 9 mois, contre 12,7% des malades qui n'en avaient pas pris. Plusieurs autres facteurs de risque d'utilisation prolong e ont t identifi s. Les malades qui ont re u des opio des ont engendr des d penses en soins de sant plus lev es que les malades qui on en avait prescrit pour moins de 90 jours (RC 1,49, IC de 95% 1,44-1,54). Conclusion : Chez les adultes g s soumis une chirurgie de la colonne, l'utilisation pr op ratoire d'opio des a t un fort pr dicteur d'utilisation postop ratoire prolong e, qui a t associ e une hausse des co ts de soins de sant . Ces r sultats constituent une importante base de connaissances pour les futures tudes qui valueront des strat gies de r duction du recours aux opio des l'intention de la patient le chirurgicale g e., Opioid use in North America has been declared a public health crisis, with Canada and the United States currently positioned as the 2 largest consumers of prescription opioids in the [...]

Background: Understanding patterns of peripheral nerve injuries (PNIs) and brachial plexus injuries (BPIs) is essential to preventing and appropriately managing nerve injuries. We sought to assess the incidence, cause, and severity of PNIs and BPIs sustained by patients with trauma. Methods: We conducted a retrospective review of the Trauma Registry Database (January 2002 to December 2020) to identify patients with PNIs or BPIs. Results: We evaluated data from 24 905 patients with trauma; 335 (1.3%) sustained PNIs (81% male; mean age 36 yr, standard deviation [SD] 16 yr) and 64 (0.3%) sustained BPIs (84% male; mean age 35, SD 15 yr). Nerves in the upper extremities were more commonly affected than those in the lower extremities. Sharp injuries (39.4%) and motorcycle accidents (32.8%) were the most frequent causes of PNIs and BPIs, respectively. Other common causes of PNI were motor vehicle collisions (16.7%) and gunshot wounds (12.8%). Many patients with PNIs (69.0%) and BPIs (53%) underwent operative management. The most frequent reconstruction for PNI was primary nerve repair (66%), while nerve transfers (48%) were more frequently used for BPI. Conclusion: Nerve injuries in the trauma population have decreased over the last 3 decades with shifts in mechanisms of injury and use of imaging, electrodiagnostic tests, and surgery. Nerve injuries are often complex and time-sensitive to treat; understanding changes in trends is important to ensure optimal patient management. Contexte : Il est essentiel de comprendre le m canisme de survenue des l sions des nerfs p riph riques (LNP) et du plexus brachial (LPB) pour les pr venir et les traiter ad quatement. Nous avons voulu valuer l'incidence, la cause et la gravit des LNP et des LPB, chez des patient(e)s polytraumatis (e)s. M thodes : Nous avons proc d une revue r trospective de la base de donn es du Registre de traumatologie (janvier 2002 d cembre 2020) pour recenser les cas de LNP et de LPB. R sultats : Nous avons examin les donn es de 24 905 patient(e)s polytraumatis (e)s; 335 (1,3%) avaient subi des LNP (81% de sexe masculin; ge moyen 36 ans, carttype [ .-T.] 16 ans) et 64 (0,3%), des LPB (84% de sexe masculin; ge moyen 35 ans, .-T. 15 ans). Les nerfs des membres sup rieurs taient atteints plus souvent que les nerfs des membres inf rieurs. Les blessures caus es par un objet tranchant (39,4%) et les accidents de motocyclette (32,8%) ont t le plus souvent l'origine des LNP et des LPB, respectivement. Les autres causes fr quentes de LNP taient les accidents de la route (16,7%) et les blessures par balle (12,8%). De nombreux cas de LNP (69,0%) et de LPB (53%) ont t trait s chirurgicalement. La reconstruction la plus utilis e pour les LNP a t la r paration primaire (66%), tandis que le transfert nerveux (48%) a davantage t utilis pour les LPB. Conclusion : Le nombre de l sions nerveuses observ es en traumatologie a diminu depuis une trentaine d'ann es et leurs m canismes de survenue, le recours l'imagerie, les tests lectrodiagnostiques, et les techniques chirurgicales ont volu . Les l sions nerveuses sont souvent complexes et leur traitement est urgent; il est important de comprendre l' volution des tendances pour assurer leur prise en charge optimale., Peripheral nerve injury (PNI) may result in activity loss, pain, depression, disability, and reduced quality of life. (1-3) Most brachial plexus injuries (BPIs) affect young people and create a financial [...]

In 1923, just over 100 years ago, Edward William Archibald was appointed the first chair of surgery in McGill University's Faculty of Medicine. This milestone provides an opportunity to reflect on where the department has come from and how it has progressed to the present day. Although the size, breadth, and diversity of the department members have changed notably over the century, the core values of innovative clinical care, research, and education established a century ago continue to this day. To reflect his values, the Archibald Chair of Surgery was established in 1990 and is today held by the department chair., In 1923, just over 100 years ago, Edward William Archibald was appointed the first chair of surgery in McGill University's Faculty of Medicine. This milestone provides an opportunity to reflect [...]

Background: Immigrants and refugees face unique challenges navigating the health care system to manage severe arthritis, because of unfamiliarity, lack of awareness of surgical options, or access. The purpose of this study was to assess total knee arthroplasty (TKA) uptake, surgical outcomes, and hospital utilization among immigrants and refugees compared with Canadian-born patients. Methods: We included all adults undergoing primary TKA from January 2011 to December 2020 in Ontario. Cohorts were defined as Canadian-born or immigrants and refugees. We assessed change in yearly TKA utilization for trend. We compared differences in 1-year revision, infection rates, 30-day venous thromboembolism (VTE), presentation to emergency department, and hospital readmission between matched Canadian-born and immigrant and refugee groups. Results: We included 158 031 TKA procedures. A total of 11 973 (7.6%) patients were in the immigrant and refugee group, and 146 058 (92.4%) patients were in the Canadian-born group. The proportion of TKAs in Ontario performed among immigrants and refugees nearly doubled over the 10-year study period (p < 0.001). After matching, immigrants were at relatively lower risk of 1-year revision (0.9% v. 1.6%, p < 0.001), infection (p < 0.001), death (p = 0.004), and surgical complications (p < 0.001). No differences were observed in rates of 30-day VTE or length of hospital stay. Immigrants were more likely to be discharged to rehabilitation (p < 0.001) and less likely to present to the emergency department (p < 0.001) than Canadian-born patients. Conclusion: Compared with Canadian-born patients, immigrants and refugees have favourable surgical outcomes and similar rates of resource utilization after TKA. We observed an underutilization of these procedures in Ontario relative to their proportion of the population. This may reflect differences in perceptions of chronic pain or barriers accessing arthroplasty. Contexte : Les personnes immigrantes et r fugi es la recherche de soins pour une arthrite grave sont confront es des difficult s particuli res lorsqu'elles veulent s'y retrouver dans les m andres du syst me de sant , cause d'une m connaissance du syst me et des options th rapeutiques ou de probl mes d'acc s. Cette tude avait pour but d' valuer le recours l'arthroplastie pour proth se totale du genou (PTG), les r sultats chirurgicaux et le recours aux ressources hospitali res chez les personnes immigrantes et r fugi es comparativement aux malades n s au Canada. M thodes : Nous avons inclus tous les adultes soumis une intervention pour PTG primaire de janvier 2011 d cembre 2020 en Ontario. Les cohortes taient n es au Canada ou immigrantes et r fugi es. Nous avons valu les changements annuels du recours la PTG pour d gager une tendance. Nous avons compar les diff rences de taux de r vision 1 an et d'infection, de thromboembolie veineuse (TEV) 30 jours, les consultations aux services d'urgence, et les r admissions entre les groupes de patients n s au Canada et immigrants et r fugi s. R sultats : Nous avons inclus 158 031 cas de PTG. En tout, 11 973 (7,6%) appartenaient au groupe de personnes immigrantes et r fugi es, et 146 058 (92,4%), au groupe n au Canada. La proportion de PTG effectu es chez des personnes immigrantes et r fugi es en Ontario a presque doubl au cours de la p riode de 10 ans tudi e (p < 0,001). Apr s appariement, les personnes immigrantes taient expos es un risque relativement moindre de r vision 1 an (0,9% c. 1,6%, p < 0,001), d'infection (p < 0,001), de mortalit (p = 0,004), et de complications chirurgicales (p < 0,001). On n'a observ aucune diff rence quant au taux de TEV 30 jours ou quant la dur e du s jour hospitalier. Les personnes immigrantes taient plus susceptibles de recevoir leur cong pour aller en centre de r adaptation (p < 0,001) et moins susceptibles de consulter dans un service d'urgence (p < 0,001) que les personnes n es au Canada. Conclusion : Comparativement aux personnes n es au Canada, les personnes immigrantes et r fugi es obtiennent de bons r sultats chirurgicaux et des taux similaires d'utilisation des ressources apr s leur PTG. Nous avons observ une sous-utilisation de ces interventions par rapport leur proportion dans la population. Cela pourrait t moigner des diff rences de perception de la douleur chronique ou des probl mes d'acc s l'arthroplastie., Total knee arthroplasty (TKA) is a successful procedure performed more than 75 000 times a year in Canada. (1) Whereas the outcomes of this procedure are well documented, there has [...]

Background: Although robotic surgery has several advantages over other minimally invasive surgery (MIS) techniques for rectal cancer surgery, the uptake in Canada has been limited owing to a perceived increase in cost and lack of training. The objective of this study was to determine the impact of access to robotic surgery in a Canadian setting. Methods: We conducted a retrospective cohort study involving consecutive adults undergoing surgical resection for rectal cancer between 2017 and 2020. The primary exposure was access to robotic surgery. Outcomes included MIS utilization, short-term outcomes, total cost of care, and quality of surgical resection. We completed univariate and multivariate analyses. Results: We included 171 individuals in this cohort study (85 in the prerobotic period and 86 in the robotic period). The 2 groups had similar baseline characteristics. A higher proportion of individuals underwent successful MIS in the robotic phase (86% v. 46%, p < 0.001). Other benefits included a shorter mean length of hospital stay (5.1 d v. 9.2 d, p < 0.001). The quality of surgical resection was similar between groups. The total cost of care was $16 746 in the robotic period and $18 808 in the prerobotic period (mean difference -$1262, 95% confidence interval -$4308 to $1783; p = 0.4). Conclusion: Access to robotic rectal cancer surgery increased successful completion of MIS and shortened hospital stay, with a similar total cost of care. Robotic rectal cancer surgery can enhance patient outcomes in the Canadian setting. Contexte : M me si la chirurgie robotis e comporte plusieurs avantages par rapport d'autres techniques chirurgicales minimalement effractives (TCME) dans le contexte du cancer rectal, son adoption a t lente au Canada en raison d'une augmentation per ue des co ts et du manque de formation. L'objectif de la pr sente tude tait de mesurer l'impact de l'acc s la chirurgie robotis e dans le contexte canadien. M thodes : Nous avons proc d une tude de cohorte r trospective regroupant des cas cons cutifs de r section chirurgicale pour cancer rectal entre 2017 et 2020 chez des adultes. La variable d'exposition primaire tait l'acc s la chirurgie robotis e. Les param tres incluaient le recours des TCME, les r sultats br ve ch ance, le co t total des soins et la qualit de la r section chirurgicale. Nous avons effectu des analyses uni- et multivari es. R sultats : Nous avons inclus 171 personnes dans cette tude de cohorte (85 de la p riode pr robotisation et 86 de la p riode de robotisation). Les groupes pr sentaient des caract ristiques de d part similaires. Une proportion plus lev e de personnes (86% c. 46%, p < 0,001) de la p riode de robotisation a obtenu de bons r sultats. Parmi les autres avantages, mentionnons l'abr gement du s jour hospitalier (5,1 j c. 9,2 j, p < 0,001). La qualit de la r section chirurgicale a t la m me entre les groupes. Le co t total des soins a t de 16 746 $ pour la p riode de robotisation, contre 18 808 $ pour la p riode de pr robotisation (diff rence moyenne -1262 $, intervalle de confance de 95% -4308 $ 1783 $; p = 0,4). Conclusion : L'acc s la chirurgie robotis e pour le cancer rectal a donn lieu une am lioration des r sultats de la TCME et un abr gement du s jour hospitalier, tout en maintenant un co t total similaire. La chirurgie robotis e pour le cancer rectal peut am liorer les r sultats pour la patient le canadienne., Laparoscopic surgery for colorectal cancer has several advantages over open techniques, including decreased postoperative pain, shorter length of stay, decreased morbidity, and improved quality of life. (1,2) Although there were [...]

Letters of recommendation are increasingly important for the residency match. We assessed whether an artificial intelligence (AI) tool could help in writing letters of recommendation by analyzing recommendation letters written by 3 academic staff and AI duplicate versions for 13 applicants. The preferred letters were selected by 3 blinded orthopedic program directors based on a predetermined set of criteria. The first orthopedic program director selected the AI letter for 31% of applicants, and the 2 remaining program directors selected the AI letter for 38% of applicants, with the staff-written versions selected more often by all of the program directors (p < 0.05). The first program director recognized only 15% of the AI-written letters, the second was able to identify 92%, and the third director identified 77% of AI-written letters (p < 0.05)., Selecting qualified candidates for medical school or residency programs is a crucial and challenging undertaking that determines a person's career track and future. (1) Recent modifications in medical education and [...]

PART 1 TRADITIONAL MEDICARE Use internal billing edits to reduce denials With nearly 67 million people enrolled in traditional Medicare, it's not surprising that 98% of physicians are participating providers. [...]

After decades, dialogues on human resource management (HRM), intellectual capital (IC), and ambidexterity still continue, mirroring that the role of ambidextrous capability in translating the impact of HRM into superior performance remains unclarified. At this juncture, the current study proposes a novel theoretical framework to extend research on the relationship between IC‐enhancing HR practices and innovation. It is done sophisticatedly by examining how firm exploitative and exploratory capabilities mediate the relationship between different combinations of HR configurations and firm innovation. To this end, we designed rigorous time‐lagged research with three waves of data collection from the Iranian healthcare sector. Our analyses revealed that firm explorative and exploitative capabilities significantly mediate the relationship between human, social, and organizational capital‐enhancing HR configurations and firm innovation. More conspicuously, by unraveling interaction patterns among distinct HR configurations, our study revealed the intricacies of the functioning of IC‐enhancing HR practices in fueling firm ambidexterity. Hence, our study offers design options to navigate through exploitation and exploration in light of the firm's core innovation strategy. We discuss the theoretical and practical implications of our findings and suggest future research avenues. [ABSTRACT FROM AUTHOR]

Malpractice suits are something that doctors unfortunately need to be prepared for. After all, mistakes happen and sometimes patients don't end up with the desired results, so in their minds, [...]

In this editorial, I'm updating a post I wrote late on Labor Day. The information was so interesting I didn't want to wait, so I ran the story on NRL [...]

Earlier this year, pro-lifers had high hopes for the Supreme Court as the justices considered the legality of the government's 2000 approval and subsequent protocol changes in FDA v. AHM. [...]