Three months in a high-volume tertiary orthopaedic trauma unit: What is a registrar worth?

BACKGROUND: South Africa has a high burden of traumatic injuries that is predominantly managed in the public healthcare system, despite the relative disparity in human resources between the public and private sectors. Because of budget and theatre time constraints, the trauma waiting list often exceeds 50 - 60 patients who need urgent and emergent surgery in high-volume orthopaedic trauma centres. This situation is exacerbated by other surgical disciplines using orthopaedic theatre time for life-threatening injuries because of lack of own theatre availability. One of the proposed solutions to this problem is outsourcing of some of the cases to private medical facilities. OBJECTIVES: To establish the volume of work done by an orthopaedic registrar during a 3-month trauma rotation, and to calculate the implant and theatre costs, as well as compare the salary of a registrar with the theoretical private surgeon fees for procedures performed by the registrar in the 3-month period. METHODS: In a retrospective study, the surgical logbook of a single registrar during a 3-month rotation, from 14 January to 14 April 2019, was reviewed. Surgeon fees were calculated for these procedures, according to current medical aid rates, without additional modifier codes being added. RESULTS: During the 3-month study period, a total of 157 surgical procedures was performed, ranging from total hip arthroplasty to debridement of septic hands. Surgeon fees amounted to ZAR186 565.10 per month ‒ double the gross salary of a registrar. Total implant costs amounted to ZAR1 272 667. Theatre costs were ZAR1 301 976 for the 3-month period. CONCLUSIONS: Although this analysis was conducted over a short period, it highlights the significant amount of trauma work done by a single individual at a high-volume tertiary orthopaedic trauma unit. With increasing budget constraints, pressure on theatre time and a growing population, cost-effective expansion of resources is needed. From this study, it appears that increasing capacity in the state sector could be cheaper than private outsourcing, although a more in-depth analysis needs to be conducted.

Financial burden of orthopaedic gunshot-related injury management at a major trauma centre.

BACKGROUND: Violence and injuries are a significant global public health concern, and have a substantial emotional, physical and economic impact on society. In South Africa (SA), the Western Cape Injury Mortality Profile shows that homicides increased from 38 deaths per 100 000 in 2010 to 52 deaths per 100 000 in 2016. This increase is directly related to an increase in firearm-related homicides, which doubled from 2010 to 2016. Previous research estimated the average cost per gunshot wound (GSW)-related orthopaedic patient at USD2 940. GSW-related patient numbers as well as treatment costs have escalated exponentially over the past few years. OBJECTIVES: To calculate the financial costs involved in managing gunshot-related orthopaedic injuries both surgically and non-surgically at a tertiary centre in SA. METHODS: After ethics approval, a retrospective review of all GSW patients seen in the emergency unit at Tygerberg Hospital in 2017 was undertaken. Patient records yielded data on the following parameters: injury site and characteristics, imaging modalities, orthopaedic management, hospital admission and duration of hospitalisation, theatre episodes, orthopaedic implants and blood products administered. Cost analysis was performed using this information. RESULTS: A total of 389 patients (360 male and 29 female), average age (range, standard deviation) 28 (3 - 69, 9.50) years, were treated during the study period. Patient records identified a total of 449 orthopaedic injuries. A total of 187 patients were admitted, with 175 requiring surgical fixation. The conservatively calculated cost of managing this patient group was ZAR10 227 503. The average management cost per patient was ZAR26 292, with an average of ZAR46 670 per case requiring surgical management and ZAR8 810 for non-surgical cases (the average USD-ZAR exchange rate in 2017 was USD1-ZAR13.30). CONCLUSIONS: The total cost of managing 389 patients with gunshot-related orthopaedic injuries at a tertiary hospital was ZAR10 227 503. Improved understanding of these costs will help the healthcare system better prioritise orthopaedic trauma funding and training and highlights the urgent need for cost-saving measures, specifically primary prevention initiatives.

Multifocal Electroretinography in Assessment of Macular Function after Internal Limiting Membrane Peeling in Macular Hole Surgery.

PURPOSE: Internal limiting membrane (ILM) peeling is important for macular hole (MH) surgery but may have secondary effects visible on spectral domain optical coherence tomography (OCT) and multifocal electroretinography (mfERG). We relate integrity of inner and outer macular layers with functional results with mfERG. METHODS: Nonrandomized prospective study of 33 consecutive eyes of 33 patients with macular hole who underwent vitrectomy with ILM peeling. Best-corrected visual acuity was assessed, and integrity of external layers was measured using OCT. Each component of mfERG, N1 and P1 amplitude and latency, was also measured. RESULTS: All eyes showed macular hole closure. Visual acuity improved from 20/400 to 20/40 in the Snellen visual acuity chart (P < 0.001), and OCT external lines were intact in 19 eyes and disrupted in 14 eyes. Postoperatively, N1 and P1 amplitudes in ring 1 increased compared to preoperative values (P < 0.001 for both). Latency remained delayed for both N1 and P1 wave. In the group of 19 eyes with integrity of outer retinal layers, N1 amplitude in ring 1 was superior to the group of 14 patients with disrupted outer retinal layers (P=0.042). CONCLUSIONS: In macular hole surgery, structure analysis in OCT is one of the important outcomes for the retinal surgeon. Functional results are parallel with anatomic results, but visual gain is limited. The limited recovery in mfERG suggests an alteration of retinal physiology that could explain limited vision recover.

A DFT study of infrared spectra and Monte Carlo predictions of the solvation shell of Praziquantel and ß-cyclodextrin inclusion complex in liquid water.

In this paper, we report a theoretical study of the inclusion complexes of Praziquantel (PZQ) and ß-cyclodextrin (ß-CD) in liquid water. The starting geometry has been carried out by molecular mechanics simulations, and afterwards optimized in B3LYP level with a 6-311G(d) basis set. Monte Carlo simulations have been used to calculate the solvation shell of the PZQ/ß-CD inclusion complexes. Moreover, the vibrational frequencies and the infrared intensities for the PZQ/ß-CD complex were computed using the B3LYP method. It is demonstrated that this combined model can yield well-converged thermodynamic data even for a modest number of sample configurations, which makes the methodology particularly adequate for understanding the solute-solvent interaction used for generating the liquid structures of one solute surrounded by solvent molecules. The complex solvation shell showed an increase of the water molecule level in relation to the isolated PZQ molecule because of the hydrophilic effect of the CD molecule. The infrared spectra showed that the contribution that originated in the PZQ molecule was not predominant in the upper-wave number region in the drug/ß-CD. The movement that purely originated in the PZQ molecule was localized in the absorption band, ranging from 1328 to 1688cm(-1).

Factors influencing edentulous patients' preferences for prosthodontic treatment.

The aim of this study was to identify factors influencing edentulous patients' preferences for treatment using conventional or implant dentures (ID). A consecutive sample of 112 patients was selected in a university facility. All patients responded to a questionnaire concerning preferences about treatment and factors influencing preferences for conventional complete dentures (CD), implant-retained overdentures (IRO) and fixed implant-supported prostheses (FISP). Subsequently, a set of 21 questions was presented, and patients were requested to rate the importance of various potential reasons influencing their choice of treatment. Preference for CD was more prevalent for maxilla (52·7%) and mandible (41·1%). Fixed implant-supported prostheses and IRO were preferred for the mandible (FISP=37·5%; IRO=21·4%) rather than maxilla (FISP=27·7%; IRO=19·6%). The most preferred treatment option among the subjects when evaluating both arches was the implant-supported fixed or removable prosthesis (FISP/IRO). A preference for combined upper and lower CD was also commonly reported (39·3%). Factor analysis identified six components that accounted for 72·2% of the total variance: (i) psychosocial benefits, (ii) functional performance, (iii) technical and financial concerns, (iv) post-insertion complaints, (v) removability and (vi) longevity. Technical and financial concerns (cost, complexity, surgery risks and duration of treatment) were more relevant for those who preferred ID (P<0·001). With the exception of post-insertion complaints, all mean scores of component factor loadings were positive for ID. Conventional complete dentures are associated with lower expected outcomes by patients, and cost-related issues are the major factors associated with the preferences for implant treatment of edentulous patients.

Optimization of 2D image reconstruction for positron emission mammography using IDL.

The Clear-PEM system is a prototype machine for Positron Emission Mammography (PEM) under development within the Portuguese PET-Mammography consortium. We have embedded 2D image reconstruction algorithms implemented in IDL within the prototype's image analysis package. The IDL implementation of these algorithms proved to be accurate and computationally efficient. In this paper, we present the implementation of the MLEM, OSEM and ART 2D iterative image reconstruction algorithms for PEM using IDL. C and IDL implementations are compared using realistic Monte Carlo simulated data. We show that IDL can be used for the easy implementation of image reconstruction algorithms for emission tomography.

An economic opportunity survey of small dairy farms in Paraguay.

Participatory rural appraisal (PRA) in 15 small farms and an economic opportunity survey (EOS) in 13 were carried out in the Cordillera basin of Paraguay to identify production constraints and the best ways to achieve economic gain. PRA showed farmers' perception was that nutrition was the main constraint. The EOS showed that over 70% of the milk produced was sold in the neighbourhood. The average number of adult cows (lactating and dry cows) per farm ranged from 15 to 120, of which 62.2% to 80% were lactating cows. Milk production per cow on one day ranged from 8.5 to 18.2 litres and average lactation length was more than 300 days. Average age at first calving varied from 31 to 39 months. The highest economic opportunity was observed for increased milk production. Age at first calving and calf production interval were also found to be important constraints. Ultrasonography survey of the ovaries 20 maiden heifers over six months showed inadequate activity. Partially budgeted interventions were instituted to improve nutrition and management of maiden heifers, in-calf cows and those in early lactation. More forages were grown. PRA and EOS were shown to be useful tools in identifying production constraints.

Assessment of the diet of 0- to 6-year-old children in municipal schools in a Brazilian city.

Diet control is one of the important factors in the prevention of dental caries because food functions as substratum for fermentation and, consequently, for the formation of the organic acids that demineralize the tooth surface. This study aims to descriptively assess school diet and the associated caries-preventive methods applied to children in all municipal nursery schools of a Brazilian city (Aragatuba/SP). For this, a questionnaire with open and closed questions was used. The results showed that all schools serve school meal, which is composed mainly of sugar, carbohydrates, and proteins. The students enjoy the meal very much because for most of them, the meal served at school is the only source of food. It was observed that 90% of the schools offer other kinds of food besides the main school meal. The snacks served such as cakes, white hominy, and milk fudge are composed of sweet and highly cariogenic foods. It was also verified that in 13.30% of the schools, the daily supervised dental hygiene, an important procedure that should not be neglected, is not carried out. This procedure introduces the children to healthy habits that are added to those acquired in the family environment. It was concluded that the school diet is potentially cariogenic and, in association with the lack of daily dental hygiene, this potential may become even higher.