Fracture-related infection: Analysis of healthcare utilisation and associated costs.

AIMS: A consensus definition of fracture related infection (FRI) has been created with the aim of standardising diagnosis and eliminating heterogeneity that prevents accurate comparison between existing studies. FRI remains one of the most challenging complications in musculoskeletal trauma surgery and carries with it a significant cost burden. A review of UK finances has not been completed utilising consensus diagnostic criteria. The goal of this study was to investigate the hospital-associated healthcare cost related to the treatment of FRI within an NHS major trauma centre. METHOD: Through retrospective case-control analysis, 1240 patients with close fractures were identified. Of those, 21 patients with FRI were compared to 63 uninfected patients. Patients were matched based on fracture location, type of procedure and proximity in age. The costs assessed included hospitalisation, imaging, outpatient consultation, pharmaceuticals and procedure charges. Cost data was retrieved from healthcare resource group (HRG) guidelines, NHS Business Service Authority's (NBSA) prescription rates and internal costing. RESULTS: The FRI group were found to incur a 2.51 increase in total medial healthcare cost compared to the control group (£22,058 vs £8798 [p < 0.001]), which was primarily due to increased procedural costs (£13,020 vs £6291 [p < 0.001]) and length of hospital stay (£7552 vs £2124 [p < 0.001]). CONCLUSION: Whilst diagnosis of FRI has a more rigorous definition following the new consensus, prevalence and cost outcomes are similar to previous studies. Given the deficiency in funding and ongoing challenges of resource allocation to the NHS, it is prudent to incorporate studies such as this into stratifying departmental budgets and quality improvement. LEVEL OF EVIDENCE: III.

An analytical retrospective study to determine the prevalence of childhood obesity and assess the effectiveness of current surveillance.

BACKGROUND: The childhood obesity epidemic is a public health crisis. Most surveillance occurs in primary care, yet there is limited guidance for the detection and management of childhood obesity. AIMS AND METHODOLOGY: We sought to establish the overweight and obesity prevalence in children aged 4-11 years old in a single primary care centre. Furthermore, we assessed whether appropriate weight management referrals were considered and determined the average duration since children last had their height and weight measured. FINDINGS: We detected overweight or obesity status in 29.0% of our cohort, and only one-third (31.1%) of eligible children had evidence that appropriate weight management referral was considered. The average duration since last height and weight measurement was 20.3 months. DISCUSSION: Childhood obesity requires an effective and inclusive solution, and in this report, we explore whether increased surveillance is necessary and how we might achieve this.

Personality Disorders in Black People: less prevalent or the result of healthcare inequalities?

The prevalence of personality disorders (PDs) in black people has consistently been reported as significantly lower than in their white equivalents. If this result is accurate, then it may reveal important clues as to the aetiology of personality disorders, which could provide invaluable insights as to how we should support these patients. However, if this result does not reflect the truth, then important questions must be answered as to why black people with personality disorders are under- represented. There has been limited investigations into what may cause a discrepancy in the PD prevalence between ethnicities. This review aims to determine whether the lower prevalence of PDs in black people is likely to be accurate, and if it isn't, explore some of the potential causes for the difference. This is an important issue to address as may reveal pertinent inequalities in healthcare.