Have advances in surgical implants and techniques in hemiarthroplasty for intracapsular hip fractures improved patient outcomes compared to THA? A systematic review and meta-analysis of the evidence.

INTRODUCTION: Hip fractures are common orthopaedic hospital admissions and result in considerable morbidity and mortality in the patients affected. The aim of this study is to review how advances in surgical implants and techniques have impacted on outcomes of Hemiarthroplasty (HA) vs Total Hip Arthroplasty (THA) for displaced intracapsular neck of femur fractures. METHODS: A systematic review and meta-analysis of randomised controlled trials was performed and reported in accordance with the Preferred Reporting Items for Systematic Reviews & Meta-analyses (PRISMA) statement. We included all studies that were prospective randomised controlled trials comparing the outcomes THA versus HA in patients with displaced intracapsular neck of femur fractures. RESULTS: 13 randomised controlled trial met the eligibility criteria; the overall pooled sample size was 3050 patients. The evidence suggests that the short-term functional outcomes favour THA, without strong evidence of a clinically significant benefit. More recent larger RCTs suggest limited functional improvement conferred by THA vs. HA, whilst the risks of complications may outweigh these small gains. Overall, THA is associated with higher dislocation rates without a significant need for re-operation, but no increase in infection or need for transfusion over HA. Consultant or equivalent supervision has a positive effect on outcomes in both groups. CONCLUSION: The literature supports a change in direction, this meta-analysis confirms HA surgery has equivalent clinical outcomes and possibly a lower mortality in octogenarians and provides further evidence for the stratification of THA treatment in displaced intracapsular neck of femur fractures is urgently required.

The Journey to Comprehensibility: Court Forms as the First Barrier to Accessing Justice.

The article explores the comprehensibility of court forms by providing a quantitative overview and a qualitative analysis of such syntactic characteristics as length and structure of sentences and noun phrases. The analysis is viewed in the broader context of genre characteristics of court forms, their role within legal proceedings, and their function for eliciting narratives from court users. The findings show that while the elicitation strategies are not always coherently aligned with the guidance sections, the guidance itself condenses legal and procedural information into overly complex and verbose syntactic constructions. Comprehensibility barriers are thus created through breaks in information flow, ambiguous syntactic constructions, missing information and misalignment between questions and guidance. Such comprehension challenges have a negative impact on the potential of court users to effectively engage with legal proceedings.

An Experience-Centered Approach to Training Effective Data Scientists.

Like medicine, psychology, or education, data science is fundamentally an applied discipline, with most students who receive advanced degrees in the field going on to work on practical problems. Unlike these disciplines, however, data science education remains heavily focused on theory and methods, and practical coursework typically revolves around cleaned or simplified data sets that have little analog in professional applications. We believe that the environment in which new data scientists are trained should more accurately reflect that in which they will eventually practice, and we propose here a data science master's degree program that takes inspiration from the residency model used in medicine. Students in the suggested program would spend their time working on a practical problem with an industry, government, or nonprofit partner, supplemented with coursework in data science methods and theory. We also discuss how this program can also be implemented in shorter formats to augment existing professional master's programs in different disciplines. This approach to learning by doing is designed to fill gaps in our current approach to data science education and ensure that students develop the skills they need to practice data science in a professional context and under the many constraints imposed by that context.

Value-based healthcare analysis of joint replacement surgery for patients with primary hip osteoarthritis.

Background: A quarter of the population present at least once a year with a musculoskeletal disorder. Primary hip osteoarthritis is a high-volume condition with significant clinical need and population-level costs. There remains much variation in patient outcomes and care delivery costs for this condition. Aims: The study aimed to gauge if pathway redesign based on the principles of value-based healthcare (VBHC) could increase value. The aim was to calculate the value of treatment for primary hip osteoarthritis through measuring outcomes that matter to patients, as well as the costs of delivering them. Additionally it aimed to compare two care pathways to identify which elements may better promote the delivery of high-value clinical care. Methods: Two care models were evaluated: the first being a traditional model with multiple entry points and without pathway standardisation, and the second an intentionally designed standardised multidisciplinary pathway. Mandated National Health Service patient-reported outcomes were assessed but were restructured into a patient-centred format to assess the impact on pain, function and psychological outcomes. Patient-level pathway economic evaluation was performed. Using these data, outcomes were mapped against cost to calculate value. Results: There were no significant differences in clinical outcomes between the two models. The intentionally designed model delivered better value care, having lower pathway costs. This model produced a small but inconsistent positive financial margin. Conclusions: Intentionally designed, integrated elective services offer an opportunity to develop and evaluate VBHC models. Analysis of two care pathways from a VBHC perspective demonstrated that an intentionally designed pathway had higher value. The higher value pathway maximised the benefits of having physiotherapists and orthopaedic surgeons working side by side. Developing and measuring patient-orientated outcomes and performing accurate economic evaluation are the key to understanding and achieving better value care.