How do patients trade-off surgeon choice and waiting times for total joint replacement: a discrete choice experiment.

OBJECTIVE: Patients face significant waiting times for hip and knee total joint replacement (TJR) in publicly funded healthcare systems. We aimed to assess how surgeon selection and reputation affect patients' willingness to wait for TJR. DESIGN: We assessed patient preferences using a discrete choice experiment questionnaire with 12 choice scenarios administered to patients referred for TJR. Based on qualitative research, pre- and pilot-testing, we characterized each scenario by five attributes: surgeon reputation, surgeon selection, waiting time to surgeon visit (initial consultation), waiting time to surgery, and travel time to hospital. Preferences were assessed using hierarchical Bayes (HB) analysis and evaluated for goodness-of-fit. We conducted simulation analyses to understand how patients value surgeon reputation and surgeon selection in terms of willingness to wait for surgeon visit and surgery. RESULTS: Of 422 participants, 68% were referred for knee TJR. The most important attribute was surgeon reputation followed by waiting times, surgeon selection process and travel time. Patients appear willing to wait 10 months for a visit with an excellent reputation surgeon before switching to a good reputation surgeon. Patients in the highest pain category were willing to wait 7.3 months before accepting the next available surgeon, compared to 12 months for patients experiencing the least pain. CONCLUSIONS: Our findings confirm that patients value surgeon reputation in the context of wait times and surgeon selection. We suggest opportunities to reduce wait times by explicitly offering the next available surgeon to increase patient choice, and by reporting surgeon performance to reduce potential misinformation about reputation.

Effects of Electrical Stimulation and Conditioning Periods upon Pre-Rigor Beef Samples Cooked with a Microwave Oven 1.

Thirty beef carcasses were used to evaluate the effects of electrical stimulation and conditioning periods and microwave cooking upon sensory and shear properties of pre-rigor semitendinosus muscle samples. The intact muscle was removed from the right side within 45 min post-exsanguination and was electrically (ES) stimulated [100 impulses (1 s on and 1 s off, A.C., 110V, <5 amps)], while the remaining paired muscle served as the control (NS). After electrical stimulation, the muscle was cross-sectioned into three portions. A 2.54-cm thick sample was removed from the central portions of the ES and NS muscles and cooked immediately in a microwave oven to an internal temperature of 66°C. The remaining two similar sized portions were conditioned at 13°C for 2 h or 4 h before cooking. Three cores (1.27 cm) were removed from each sample parallel to the muscle fiber, and all cores were sheared twice. Samples from the conditioning periods were frozen, thawed, reheated and evaluated for palatability traits by a 10-member trained panel. Results indicate higher sensory panel ratings (P<.05) for tenderness, connective tissue and flavor intensity and lower shear force (WBS and Instron) values and longer sarcomeres from ES. With the conditioning periods used, microwave cooking was too rapid for pre-rigor muscle, as exemplified by the high shear values (6.4 and 7.8 kg/1.27 cm for ES and NS, respectively) which indicates a very tough sample of meat. Cooking yield was highest for muscle samples cooked immediately after slaughter. Roasts conditioned for 4 h before cooking had higher (P<.05) juiciness and flavor intensity scores than roasts held for 2 h, regardless of stimulation treatments.