Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Apr 2012
Comparative StudyIs percutaneous repair better than open repair in acute Achilles tendon rupture?
Open repair of Achilles tendon rupture has been associated with higher levels of wound complications than those associated with percutaneous repair. However, some studies suggest there are higher rerupture rates and sural nerve injuries with percutaneous repair. ⋯ Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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A variety of reforms to traditional approaches to provider payment and benefit design are being implemented in the United States. There is increasing interest in applying these financial incentives to orthopaedics, although it is unclear whether and to what extent they have been implemented and whether they increase quality or reduce costs. ⋯ There is insufficient literature reporting the effects of various financial incentive models under implementation in orthopaedics to know whether they increase quality or reduce costs. National concerns about cost will continue to drive experimentation, and all anticipated innovations will require improved collaboration and data collection and reporting.
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Clin. Orthop. Relat. Res. · Apr 2012
Is the dislocation rate higher after bipolar hemiarthroplasty in patients with neuromuscular diseases?
Patients with neuromuscular disease reportedly have a higher incidence of postoperative dislocation after bipolar hemiarthroplasty. Although the literature has focused on a high prevalence of preoperative neurologic conditions in patients who had dislocations after bipolar hemiarthroplasties, the relative incidence of dislocation in patients with neuromuscular disease and without is unclear. ⋯ Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · Apr 2012
The use of three strategies to improve quality of care at a national level.
Improving the quality of care is essential and a priority for patients, surgeons, and healthcare providers. Strategies to improve quality have been proposed at the national level either through accreditation standards or through national payment schemes; however, their effectiveness in improving quality is controversial. ⋯ Although the cost-effectiveness of these three strategies is unknown, quality of care could be enhanced by implementing pay-for-performance, surgical safety checklists, and explicit practice guidelines. However, this review identified that the effectiveness of these strategies is highly context-specific.