No time to waste, the impact of the COVID-19 pandemic on hip, knee, and shoulder arthroplasty surgeries in the Netherlands and Denmark

AimsThis study aimed to investigate the estimated change in primary and revision arthroplasty rate in the Netherlands and Denmark for hips, knees, and shoulders during the COVID- 19 pandemic in 2020 (COVID-period). Additional points of focus included the comparison of patient characteristics and hospital type (2019 vs COVID-period), and the estimated loss of quality-adjusted life years (QALYs) and impact on waiting lists.MethodsAll hip, knee, and shoulder arthroplasties (2014 to 2020) from the Dutch Arthroplasty Reg-ister, and hip and knee arthroplasties from the Danish Hip and Knee Arthroplasty Registries, were included. The expected number of arthroplasties per month in 2020 was estimated using Poisson regression, taking into account changes in age and sex distribution of the general Dutch/Danish population over time, calculating observed/expected (O/E) ratios. Country-specific proportions of patient characteristics and hospital type were calculated per indication category (osteoarthritis/other elective/acute). Waiting list outcomes including QALYs were estimated by modelling virtual waiting lists including 0%, 5% and 10% extra capacity.ResultsDuring COVID-period, fewer arthroplasties were performed than expected (Netherlands: 20%;Denmark: 5%), with the lowest O/E in April. In the Netherlands, more acute indica-tions were prioritized, resulting in more American Society of Anesthesiologists grade III to IV patients receiving surgery. In both countries, no other patient prioritization was present. Relatively more arthroplasties were performed in private hospitals. There were no clinically relevant differences in revision arthroplasties between pre- COVID and COVID-period. Esti-mated total health loss depending on extra capacity ranged from: 19,800 to 29,400 QALYs (Netherlands): 1,700 to 2,400 QALYs (Denmark). With no extra capacity it will take > 30 years to deplete the waiting lists.ConclusionThe COVID- 19 pandemic had an enormous negative effect on arthroplasty rates, but more in the Netherlands than Denmark. In the Netherlands, hip and shoulder patients with acute indications were prioritized. Private hospitals filled in part of the capacity gap. QALY loss due to postponed arthroplasty surgeries is considerable.

Exploring resilience: How five secondary schools resiliently shaped school-family partnerships with parents of disadvantaged students during the COVID-19 pandemic

This study investigated how Dutch secondary schools have shown resilience during the COVID-19 pandemic, by safeguarding and shaping school-family partnerships with parents of students who were at risk of educational disadvantage. We focused on three mechanisms of resilience (e.g., cognitive responding, behavioural responding, contextual reinforcement) and three dimensions of school -family partnerships (e.g., basic condition for learning, communication, home involvement). We applied a multiple case study design and collected data through group interviews with school board members, teachers, students, and parents in five schools. The results showed that schools responded resiliently in shaping basic conditions for learning and communication with parents of disadvantaged students in particular. However, it was difficult for schools to encourage parents of disadvantaged students to support their children in learning at home. Further, a strong cognitive response and a strong internal or external network of the school were important preconditions for shaping educational partnership with parents of disadvantaged students.