‘Big data’ is a term for data sets that are so large or complex that traditional data processing applications are inadequate. Billions of dollars have been spent on attempts to build predictive tools from large sets of poorly controlled healthcare metadata. Companies often sell reports at a physician or facility level based on various flawed data sources, and comparative websites of ‘publicly reported data’ purport to educate the public. Physicians should be aware of concerns and pitfalls seen in such data definitions, data clarity, data relevance, data sources and data cleaning when evaluating analytic reports from metadata in health care. Cite this article: Bone Joint J 2017;99-B:1571–6

Aims. The aims of this study were to investigate whether 1) multispecialist tertiary intervention for complex spinal pain lead to reductions in spine-related healthcare costs and 2) baseline characteristics are related to health care consuming costs. Patients and methods. A cost study in a natural prospective cohort was carried out to investigate healthcare data of patients admitted to the Groningen Spine Center (GSC) ranging from two years prior to referral until two year after discharge. GSC intervention consisted of a multi-professional and -specialist based diagnosis and treatment. Patients (18 and 80 years) were included, suffering from specific as well as multifactorial spinal pain. Clinical data was merged with Health Care Insurance data and included questionnaires on demographics, work, pain, disability, quality of life and psychosocial functioning. Univariable (paired sample t-tests) and multivariable analyses (pooled OLS Regression and fixed effects models) were carried out. Results. Included were 997 patients (mean age 52 years) filing a total of 700.533 health care declarations. The findings suggest that the intervention had a significant negative effect on spine-related healthcare costs (predominantly on medical specialist and allied care). Reduction in healthcare costs after treatment was predicted by lower age, lower duration, lower BMI, high education, high job satisfaction, low physical workload, high mental health, better coping, lower pain intensity, high EQ-5D score and low financial worries at baseline (all p<0.01). Conclusion. This observational study showed that spine-related healthcare consuming can be effectively reduced after tertiary multi-specialist intervention for patients with complex spinal pain. The results are robust when controlling for background characteristics and are unlikely to be driven by regression to the mean. No conflicts of interest. No funding obtained

During the last decade primary total hip arthroplasty surgery (THA) has increased with 30% in Sweden. Current law guarantees the patient a right to treatment within 90 days. The public health system has had difficulties meeting the increasing demand. Therefore, in 2012 a systematic review of the patients planned for THA was initiated at Sahlgrenska University Hospital's joint replacement unit. In late 2013 the value-based health care (VBHC) management was introduced in our unit. In 2012 a systematic approach based on the Fast-Track concept was implemented in the joint replacement unit. In 2013 a workgroup consisting of health care professionals involved in the treatment of THA patients was created to improve chosen outcome parameters. During 2011–2016 the number of elective THA has increased from 317 to 486. The cost per patient has decreased from 75,000 SEK to 65,000 SEK. Length of stay has decreased from 5.9 days to 2.5 days. Satisfaction with outcome of surgery one year after THA increased from 76% to 88%. The number of adverse events decreased from 29% to 11%. Number of re-operations within 2 years decreased from 2,7% to 1,9%. Fast-Track and VBHC management was initially received with modest enthusiasm in our unit, and was regarded as means to increase production whilst possibly endanger the well-being of the patients. By using continuous feedback using the data collected it was possible to effectively communicate to patients and caregivers that the patients benefitted from the implementation. VBHC primary aim is to improve patient outcomes and synergetically improve cost and process measurements. This should be appealing to both caregivers and administrators. Focusing on improvement of outcomes after THA combined with VBHC management has contributed to improvement in quality of care and availability of treatment whilst decreasing cost per patient

Aims: Among the Medical Services complex missions in the context of the Olympic event an important issue is to ensure the basic and emergency health care assistance to the athletes, the Olympic Family members, the Olympic staffs, the IOC members, the media staffs, the spectators and to all of the other persons participating to the Olympic events. The base of this program is of organizing a system able of furnishing a quality standard of care which must not be inferior to the one offered daily to the resident population and at the same time the Olympic event must not impact on the quality of care provided to the resident population. Methods: In Salt Lake City, during the XIX Winter Olympic Games, 11986 medical care have been provided. Among the acute visits there have been 231 athletes injuries with 14 athletes hospitalized and 1023 non-athletes injuries. Results: For an easy manage of the system it has been decided to divide the territory of competence in two areas: the Torino urban area and the alpine area. It will be identiþed, for each area, an ofþce district, responsible for all the territories included. Separate resources for the medical assistance will be implemented in the competition area and in spectator areas. The main instrument of the whole system will be the þrst aid teams, made up of members of the regional health care system, the voluntary services, the alpine and speleological rescue corps of Piemonte, the security and rescue service of the sport centers and any other accredited bodies. The dimension of the area involved, together with the need to guarantee timely rescue, stabilization and hospitalization activities, call for the creation of helicopter bases. Conclusions: The greatness of this project will certainly allow to leave a legacy to the host city which will enrich the quality of the health care organization at the service of the residents not only of structures and buildings but also of knowledge and speciþc experiences

We compare two applications of minimally invasive hip arthroplasty (MISTHA) with regards to early complication rate and consumption of health care resources. Complications are associated with both manifestations of MIS surgical technique. Two- incision MIS THA is associated with fewer days in hospital in comparison with one incision MIS THA, however requires a greater amount of operating room resources. This paper is among the first to compare two- incision with one incision MISTHA. Two- incision MISTHA may benefit efforts to reduce health resource utilization associated with hip arthroplasty procedures providing that operating room resource consumption and complication rates are not excessive. A comparative cohort study to evaluate two-incision versus single-incision minimally invasive hip arthroplasty: assessment of early complication rate and health care resource utilization. To evaluate and compare two applications of minimally invasive hip arthroplasty (MISTHA) with regards to early complication rate and consumption of health care resources. One hundred and sixty-five patients received MISTHA from 2002–2004 at a tertiary referral hospital. Patients received two incision (sixty-six patients) or one incision surgery (ninety-nine patients) which was performed according to standard technique. T-test, chi square, fisher’s exact test were used to compare cohorts of MISTHA patients with regards to early complications and consumption of health care resources while in hospital. At baseline the two cohorts were not different with regards to age, gender, comorbid status, BMI, and pre-operative WOMAC, Oxford-12, SF-12 (p> .05). Major and minor complication rates were similar in the two cohorts (p> .05). Utilization of operating room resources was greater with the two incision group (mean twentyfive minutes more OR time) however length of stay (mean two days less in hospital) and post-operative analgesic use was significantly reduced (p< .05). Complications and operating room resource consumption were highest early in the surgeons’ experience with these procedures. Complications are associated with both manifestations of MIS surgical technique. Two- incision MISTHA is associated with fewer days in hospital, however requires a greater amount of operating room resources. This paper is among the first to compare two- incision with one incision MISTHA. Two- incision MISTHA may benefit efforts to reduce health resource utilization associated with hip arthroplasty procedures providing that operating room resource consumption and complication rates are not excessive

Introduction: The addition of recombinant human bone morphogenetic protein-2 (rhBMP-2) showed significant reduction of secondary intervention, fracture healing time and infection rates compared with intramedullary nailing alone in open tibia fractures. However, the upfront price of approx. 3000 € is a barrier to its regular use. The goal of the study was to determine potential cost savings and cost-effectiveness of rhBMP-2 in grade III open tibia fractures from the perspective of the UK National Health Service (NHS) and the German Health Care System and to derive conclusions for other European health care systems. Materials and Methods: Clinical data from a previously published randomised controlled study with 450 patients (“BESTT study”) were used to generate total treatment costs for each patient for the control and the 1.5 mg/ml BMP-2 group based on the current German-DRG and the NHS for UK. The analysis was performed from a health care system and a societal perspective for a one year time horizon. Furthermore, assessment of the cost-effectiveness of BMP-2 was done by utility analysis. Results: The use of BMP-2 for grade III open tibia fractures is leading to cost savings of 3183 € per case and, therefore, to net savings for the German health care system. The main driver for cost savings is faster fracture healing with faster resumption of work and reduced expenses for sickness leave payments. For the UK rhBMP-2 is a cost-effective strategy with a cost-effectiveness ratio of approx. £11,000/QALY which is well below the standard £30,000 benchmark for the NHS. From a societal perspective, rhBMP-2 is a cost-saving treatment. Conclusions: BMP-2 leads to net savings in grade III open tibia fractures in Germany which can be expected for other European countries where sickness payments are provided by health care insurers. For countries like UK where sickness are provided by third parties BMP-2 is a cost-effective treatment strategy from a health care system perspective and a cost-saving treatment from a societal perspective

Aim. Research projects are a compulsory part of the postgraduate curriculum in most Academic Departments. To not only fulfil study requirements, but to ensure noteworthy and accurate results meticulous and reliable data collection is necessary. Our aim was to better understand what preferences health care professionals have in undertaking data collection. Methods. We did a choice based conjoint analysis with an online data collection survey. This study type allows the evaluation of the relative importance of component attributes. We used 4 major criteria to evaluate preferences when performing data collection. These were: 1. Time to complete the form, 2. Remuneration and recognition, 3. Study design and 4. Responsibilities at the time of collection. We sent electronic questionnaires to doctors in the Orthopaedic, Ophthalmology and Plastic Surgery Departments at a Johannesburg Academic Institution. Results. We received 68 responses. In general the most the most alluring trait to a data collection form is Tick Box Answer format. This is followed by the need to be recognized as a co-author on publication and the completion of forms in a time other than during work. The amount of time it takes is the least important. Recognition as a co-author of a study was more important than financial remuneration. The major difference between the 34 Orthopaedic respondents and the rest was that they were less likely to complete forms in their spare time and are less concerned with the time taken. Regressional analysis shows that data collection design must be tailored to specific groups as there are preference differences. NO DISCLOSURES

Introduction: Previous studies have shown that advice given to patients with low back pain (LBP) by health care practitioners (HCPs) such as physiotherapists (PTs) and general practitioners (GPs) is not in line with guidelines about encouraging early return to work. The aim of this study was to describe the attitudes, beliefs and reported practice behaviour of UK GPs and PTs about LBP and to explore associations between these. Methods: A national cross-sectional survey of GPs and PTs (n=4000), including an attitudes measure, the Pain Attitudes and Beliefs Scale (PABS.PT), which measures ‘biomedical and behavioural orientations of HCPs. A vignette describing a patient with non-specific LBP, who had a four-week absence from work, was used to capture reported clinical management. This presentation will focus on the findings about work advice. Results: Response rates were 22% (n=446) for GPs and 55% (n=1091) for PTs. Almost one third of GPs (32%) and one in four PTs (25%) reported that they would advise the vignette patient to remain off work. The HCPs advising the vignette patient to remain off work had significantly higher biomedical (F. 1,988. =78.85, p< 0.001) and lower behavioural (F. 1,981. =31.89, p< 0.001) scores on the PABS.PT than those suggesting a return to work. Conclusion: An association between attitudes and reported practice behaviour was apparent, with HCPs operating within a predominantly biomedical framework being more likely to advise a patient with back pain to stay off work. Further research should explore how HCPs’ attitudes might be changed and whether this results in changes in work recommendations

Background

Work disability due to low back pain (LBP) is a global concern, resulting in significant healthcare costs and welfare payments. In recognition of this, recent UK policy calls for healthcare to become more ‘work-focused’. However, an ‘evidence-policy’ gap has been identified, resulting in uncertainty about how this is to be achieved. Clear, evidence-based recommendations relevant to both policy-makers and healthcare practitioners are required.

Background

Establishing the diagnosis in a child presenting with an atraumatic limp can be challenging. There is particular difficulty distinguishing septic arthritis (SA) from transient synovitis (TS) and consequently clinical prediction algorithms have been devised to differentiate the conditions using the presence of fever, raised erythrocyte sedimentation rate (ESR), raised white cell count (WCC) and inability to weight bear. Within Europe measurement of the ESR has largely been replaced with assessment of C-reactive protein (CRP) as an acute phase protein. We have evaluated the utility of including CRP in a clinical prediction algorithm to distinguish TS from SA.

Total Knee Artroplasty (TKA) is becoming more and more popular, even in the younger active age group. In this age group however the results are not that reproducible as in the older age group. People are more limited in their activities of daily living and complain more about pain, stifness and swelling. At the end and in general the younger age group is less satisfied than the older patients.

The last decade minimal invasive solutions with modified instruments, Gender Knees, the use of navigation in TKA, ligament-based techniques, fast rehab protocols etc have all been introduced to make the results of TKA better. These are all elements that indeed can make the patient better. However the most important on the short term and the long term is the use of the correct implant size and the correct implantation of the prosthetic components.

Since January 2011 we routinely use patient specific instruments in TKA patients under 60y that are very active or in older less active patients with important anatomic malformations. A CT-based system that scans the hip-knee-ankle is used. The data are sent to an engineer and a digital proposal is sent back to the surgeon that can approve the different measurements performed. Once approved the patient specific cutting blocks are sent to the surgeon. In our department we use the Advance Medial Pivot Knee System as our standard knee system since its introduction thirteen years ago. Since then more than 2000 implantations have been performed. This experience has made it possible to critically evaluate the patient specific cutting block technique.

The first results are very satisfying. During surgery less ligamentous releases had to be performed, there was in all cases an optimal patellofemoral tracking without any release, there was less blood loss and surgery time was decreased. At all times during surgery we were very satisfied how we could verify all surgical steps and this is in our opinion very important. During the first postoperative days the patients experienced less pain (routine VAS recorded), there was a faster return to full ROM and patients asked to go home earlier.

After two months patients are routinely followed up and they undergo a clinical and radiographic exam. All prosthetic components were implanted the way we had planned it. The overall axes were restored and up till now no complications were noticed. All patients experienced a fast recovery with full ROM at 2 months, no complaints about pain or swelling and very interestingly no residual intra-articular swelling which is often seen in these active and younger patient group. Patients are also asked to fill in a patient-based outcome measurements (KOOS) questionnaire.

In our opinion it is a very easy and promising system for the experienced surgeon. Younger and less experienced surgeons however should be warned that they cannot blindly trust the system. We surgeons have to control what the engineer has proposed before and during surgery.

Purpose: Only 20% of women presenting with fragility fracture are subsequently investigated for Osteoporosis (OP). Blurred lines of responsibility between the orthopedic surgeons (OS) and the general practitioners may partly explain this situation. OPTIMUS is a 3 year health management program, lead by an OS and a rheumatologist, whose objective is to improve the rate of initiation of and persistence on treatment of OP in patients sustaining a fragility fracture visiting an OS at the Centre hospitalier universitaire de Sherbrooke.

Method: All outpatients aged 50 years and older in which a fragility fracture is suspected by the OS are informed by a nurse practitioner about the OPTIMUS program. The first 200 patients seen at the Hôtel-Dieu site of the CHUS represent the control group. Inpatients with hip fragility fracture are evaluated by a rheumatologist. After signed consent, outpatient participants are randomized to one out of two intervention groups: The Minimal Intervention group includes nurse counseling and written general information transmitted to both patient and treating physician. Same information is given in the Intensive Intervention group. Blood tests and osteodensitometry are also performed and results transmitted to the treating physician along with personalized guidelines for treatment of the patient’s OP. In both interventions, patients are reached by phone at fixed intervals. Additional rounds of intervention are repeated as needed to increase the rates and persistence of appropriate treatment.

Results: Over the first 6 months, the OS team identified 300 patients, 30% of which suffered from hip fracture. Acceptance rates to OPTIMUS management program were close to 95% with direct contact as compared to 50% with delayed phone contact. 5% of outpatients could not name a treating physician and thus had to be seen in rheumatology. The results during the first 18 months of the project will assess the feasibility of OPTIMUS’ interventions.

Conclusion: There is a substantial care gap in the management of OP, despite the availability of diagnostic modalities and effective treatment. Involving orthopedic surgeons as key leaders of a multidisciplinary team implementing a systematic approach to identify patient with OP should help to close this care gap.

Joint arthroplasty is a common surgical procedure, with over 185,000 primary hip and knee arthroplasties performed in England, Wales and Northern Ireland in 2014. After total hip or knee arthroplasty, about 1% of patients develop deep prosthetic joint infection (PJI), which usually requires further major operations to clear the infection. Although PJI affects only a small percentage of patients it is one of the most devastating complications associated with this procedure. Research evidence has focussed on clinical effectiveness of revision surgery while there has been less focus on the impact on patients and support needs. Using a systematic review approach, the aim of this study was to assess support needs and evaluate what interventions are routinely offered to support patients undergoing treatment for PJI following hip or knee arthroplasty.

We systematically searched MEDLINE, Embase, Web of Science, PsycINFO, Cinahl, Social Science Citation Index, and The Cochrane Library from 1980 to February 15, 2015 for observational (prospective cohort, nested case-control, case-control, and retrospective cohort) studies, qualitative studies, and clinical trials that report on the support needs and interventions for patients being treated for PJI or other major adverse occurrences following joint arthroplasty. Data were extracted by two independent investigators and consensus reached with involvement of a third.

Of 4,161 potentially relevant citations, we identified one case-control, one prospective cohort and two qualitative studies for inclusion in the synthesis. Patients report that PJI and treatment had a profoundly negative impact affecting physical, emotional, social and economic aspects of their lives. No study evaluated support interventions for PJI or other major adverse occurrences following hip and knee arthroplasty.

The interpretation of study results is limited by variation in study design, outcome measures and the small number of relevant eligible studies. Findings show that patients undergoing treatment for PJI have extensive physical, psychological, social and economic support needs. Our review highlights a lack of evidence about support strategies for patients undergoing treatment for PJI and other adverse occurrences. There is a need to design, implement and evaluate interventions to support these patients.

Introduction: Guidelines for the management of LBP recommend diagnostic triage where most cases are classified ‘non-specific’, although studies have suggested this term is unsatisfactory to patients and practitioners. We aimed to describe the explanations for LBP used by general practitioners (GPs) and physiotherapists (PTs) in the UK.

Methods: Content analysis of an open question in a cross-sectional survey of GPs and PTs, based on a vignette of a patient with non-specific LBP. Respondents provided their explanation for the patient’s LBP in the language they would use with the patient. A coding schedule was developed (AB and NF) and applied to all data (AB).

Results: Survey response was 22% (n=446) for GPs and 55% for PTs (n=1091, 580 had seen a patient with LBP in the preceding 6 months were analysed). Responses to the open question were provided by 430 GPs and 560 PTs. Both professions used predominantly biomedical explanations (68% GPs, 51% PTs) such as tissue labels (e.g. ‘muscle’, ’disc’), ‘degeneration’ and ‘wear and tear’. PTs often gave lifestyle factors as reasons for LBP, with ‘work’ (19% PTs) and ‘posture’ (26% PTs) the most common. Only 2.8% of GPs and 6.4% of PTs would explain that the cause of LBP is unknown and use of the term ‘non-specific LBP’ was rare (0.9% GPs, 1.6% PTs).

Conclusion: Explanations for LBP used by GPs and PTs remain predominantly biomedical. The term ‘non-specific LBP’ is used very rarely. Further research needs to investigate appropriate language that explains non-specific LBP that is acceptable to both practitioners and patients.

Aims

The aim of this study was to describe variation in hip fracture treatment in Norway expressed as adherence to international and national evidence-based treatment guidelines, to study factors influencing deviation from guidelines, and to analyze consequences of non-adherence.

The objectives of this study are to evaluate the impact of the CoVID-19 pandemic on the development of relevant emerging digital healthcare trends and to explore which digital healthcare trend does the health industry need most to support HCPs. A web survey using 39 questions facilitating Five-Point Likert scales was performed from 1.8.2020 – 31.10.2020. Of 260 participants invited, 90 participants answered the questionnaire. The participants were located in the Hospital/HCP sector in 11.9%, in other healthcare sectors in 22.2%, in the pharmaceutical sector in 11.1%, in the medical device and equipment industry in 43.3%. The Five-Point Likert scales were in all cases fashioned as from 1 (strongly disagree) to 5 (strongly agree). As the top 3 most impacted digital health care trends strongly impacted by CoVID-19, respondents named:. - remote management of patients by telemedicine, mean answer 4.44. - shared data governance under patient control, mean answer 3.80. - new virtual interaction between HCP´s and medical industry, mean answer 3.76. Respondents were asked which level of readiness of the healthcare system currently possess to cope with the current trend impacted by CoVID-19. - Digital and efficient healthcare logistics, mean answer 1.54. - Integrated health care, mean answer 1.73. - Use of big data and artificial intelligence, mean answer 2.03. Asked if collaborative research in the form of digital data platforms for research data sharing and increasing collaboration with multi-centric consortia would have a positive impact on the healthcare sector, the agreement was high with a value of mean 4.10 on the scale. We can conclude that the impact of COVID-19 appears to be a high agreement of necessary advances in digitalization in the health care sector and in the collaboration of HCPs with the health care industry. Health care professional are unsure, in how far the national health care sector is capable of transformation in healthcare logistics and integrated health care

Musculoskeletal (MSK) injuries are one of the leading causes of disability worldwide. Despite improvements in trauma-related morbidity and mortality in high-income countries over recent years, outcomes following MSK injuries in low and middle-income countries, such as South Africa (SA), have not. Despite governmental recognition that this is required, funding and research into this significant health burden are limited within SA. This study aims to identify research priorities within MSK trauma care using a consensus-based approach amongst MSK health care practitioners within SA. Members from the Orthopaedic Research Collaborative (ORCA), based in SA, collaborated using a two round modified Delphi technique to form a consensus on research priorities within orthopaedic trauma care. Members involved in the process were orthopaedic healthcare practitioners within SA. Participants from the ORCA network, working within SA, scored research priorities across two Delphi rounds from low to high priority. We have published the overall top 10 research priorities for this Delphi process. Questions were focused on two broad groups - clinical effectiveness in trauma care and general trauma public health care. Both groups were represented by the top two priorities, with the highest ranked question regarding the overall impact of trauma in SA and the second regarding the clinical treatment of open fractures. This study has defined research priorities within orthopaedic trauma in South Africa. Our vision is that by establishing consensus on these research priorities, policy and research funding will be directed into these areas. This should ultimately improve musculoskeletal trauma care across South Africa and its significant health and socioeconomic impacts