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Reverse total shoulder replacement versus anatomical total shoulder replacement for osteoarthritis: population based cohort study using data from the National Joint Registry and Hospital Episode Statistics for England

Objectives To answer a national research priority by comparing the risk-benefit and costs associated with reverse total shoulder replacement (RTSR) and anatomical total shoulder replacement (TSR) in patients having elective primary shoulder replacement for osteoarthritis.

Design Population based cohort study using data from the National Joint Registry and Hospital Episode Statistics for England.

Setting Public hospitals and publicly funded procedures at private hospitals in England, 2012-20.

Participants Adults aged 60 years or older who underwent RTSR or TSR for osteoarthritis with intact rotator cuff tendons. Patients were identified from the National Joint Registry and linked to NHS Hospital Episode Statistics and civil registration mortality data. Propensity score matching and inverse probability of treatment weighting were used to balance the study groups.

Main outcome measures The main outcome measure was revision surgery. Secondary outcome measures included serious adverse events within 90 days, reoperations within 12 months, prolonged hospital stay (more than three nights), change in Oxford Shoulder Score (preoperative to six month postoperative), and lifetime costs to the healthcare service.

Results The propensity score matched population comprised 7124 RTSR or TSR procedures (126 were revised), and the inverse probability of treatment weighted population comprised 12 968 procedures (294 were revised) with a maximum follow-up of 8.75 years. RTSR had a reduced hazard ratio of revision in the first three years (hazard ratio local minimum 0.33, 95% confidence interval 0.18 to 0.59) with no clinically important difference in revision-free restricted mean survival time, and a reduced relative risk of reoperations at 12 months (odds ratio 0.45, 95% confidence interval 0.25 to 0.83) with an absolute risk difference of −0.51% (95% confidence interval −0.89 to −0.13). Serious adverse events and prolonged hospital stay risks, change in Oxford Shoulder Score, and modelled mean lifetime costs were similar. Outcomes remained consistent after weighting.

Conclusions This study’s findings provide reassurance that RTSR is an acceptable alternative to TSR for patients aged 60 years or older with osteoarthritis and intact rotator cuff tendons. Despite a significant difference in the risk profiles of revision surgery over time, no statistically significant and clinically important differences between RTSR and TSR were found in terms of long term revision surgery, serious adverse events, reoperations, prolonged hospital stay, or lifetime healthcare costs.

Access to the data analysed in this study required permission from the National Joint Registry research subcommittee. Information on research data access requests to the National Joint Registry is available at <https://www.njrcentre.org.uk/research/research-requests/>. No additional data available.

United-kingdom , United-states , Australia , Bristol , City-of , British , Australian , American , Rafael-pinedo-villanueva , Epaminondas-markos-valsamis , Ian-koblbauer , Albert-prats-uribe

Maternal death rates in the UK have increased to levels not seen for almost 20 years – experts explain why

Maternal mortality in the UK is the highest for decades - as a barometer for a nation’s health, this is a statistic we cannot ignore

United-kingdom , Allison-felker , Marian-knight , Care-research , National-institute-for-health , Healthcare-quality-improvement-partnership , Child-population-health , Senior-researcher , Creative-commons , National-institute , Conversation-united ,

Ethnic minority groups less likely to receive early psychosis treatments

Ethnic minority groups less likely to receive early psychosis treatments
medicalxpress.com - get the latest breaking news, showbiz & celebrity photos, sport news & rumours, viral videos and top stories from medicalxpress.com Daily Mail and Mail on Sunday newspapers.

United-kingdom , Bangladesh , China , Bangladeshi , Chinese , British , Merle-schlief , Mental-health-policy-research-unit , National-institute-for-health , Healthcare-quality-improvement-partnership , National-clinical-audit-of-psychosis , Care-research

Study finds ethnic disparities in access to early psychological interventions for psychosis in England

People experiencing a psychotic episode for the first time are less likely to receive early psychological interventions in England if they are from an ethnic minority background, finds a new study led by UCL researchers.

United-kingdom , China , Bangladesh , British , Bangladeshi , Chinese , Danielle-ellis , Merle-schlief , Psychiatry-research , National-clinical-audit-of-psychosis , National-institute-for-health , Healthcare-quality-improvement-partnership

Suicide after leaving the UK Armed Forces 1996–2018: A cohort study

Cathryn Rodway and co-workers study risk of suicide in people who served in the United Kingdom armed forces.

United-kingdom , Afghanistan , Netherlands , Canada , United-states , Australia , Sweden , Northern-ireland , Craigavon , London , City-of , Iraq

Induction of labour at 39 weeks and adverse outcomes in low-risk pregnancies according to ethnicity, socioeconomic deprivation, and parity: A national cohort study in England

Author summary Why was this study done? Adverse perinatal outcomes are more common among women from deprived areas and ethnic minorities in England. There is debate about whether induction of labour (IOL) with birth at 39 weeks should be offered based on ethnicity or deprivation in low-risk pregnancies, as a means of reducing inequalities. What did the researchers do and find? We analysed a database of all maternity admissions in the English National Health Service (NHS) and measured the association between IOL at 39 weeks and adverse perinatal outcomes in low-risk pregnancies. We found evidence of a small benefit from induction overall in low-risk pregnancies, with 360 inductions associated with the avoidance of 1 adverse perinatal outcome. The benefits of induction were observed mainly in women from more socioeconomically deprived areas and in nulliparous women. What do these findings mean? An increased uptake of IOL with birth at 39 weeks, especially in women from more socioeconomically deprived areas and in nulliparous women, may help reduce inequalities in perinatal outcomes. The greater benefit from IOL with birth at 39 weeks in women from more socioeconomically deprived areas may be explained by an increased prevalence of maternal risk factors. Improved collection of routine data on the indication for induction and the presence of risk factors is required to corroborate the role that IOL at 39 weeks in women with a low-risk pregnancy can play in reducing inequalities in risk of adverse perinatal outcomes.

United-kingdom , Scotland , Health-research-authority , National-health-service , Demographics-service , Healthcare-quality-improvement-partnership , National-maternity , Royal-college-of-obstetricians , National-clinical-audit , Patient-outcomes-programme , Welsh-national-health-service

Report Shows Ministers Warned Suicide Would Kill More Children Than Covid

Report Shows Ministers Warned Suicide Would Kill More Children Than Covid
theepochtimes.com - get the latest breaking news, showbiz & celebrity photos, sport news & rumours, viral videos and top stories from theepochtimes.com Daily Mail and Mail on Sunday newspapers.

United-kingdom , Bristol , City-of , Newcastle-under-lyme , Staffordshire , Arabella-skinner , Dan-kitwood-getty , Russell-viner , Gareth-copley-getty , Royal-college-of-paediatrics , Oldfield-brow-primary-school-in-altrincham , University-of-liverpool

Association between surgeon volume and patient outcomes after elective shoulder replacement surgery using data from the National Joint Registry and Hospital Episode Statistics for England: population based cohort study

Association between surgeon volume and patient outcomes after elective shoulder replacement surgery using data from the National Joint Registry and Hospital Episode Statistics for England: population based cohort study
bmj.com - get the latest breaking news, showbiz & celebrity photos, sport news & rumours, viral videos and top stories from bmj.com Daily Mail and Mail on Sunday newspapers.

Northern-ireland , Craigavon , United-kingdom , United-states , Guernsey , Bristol , City-of , Kinross , Perth-and-kinross , British , American , Amar-rangan

Inequalities in provision of hip and knee replacement surgery for osteoarthritis by age, sex, and social deprivation in England between 2007–2017: A population-based cohort study of the National Joint Registry

Author summary Why was this study done? Joint replacements are among the more frequent elective surgeries performed in developed settings. In England, inequalities in provision of joint replacement surgery were reported more than a decade ago, followed by a national effort to reduce these inequalities. In a context of increasingly strained National Health Service funding and hospital budgets, alongside prolonged efforts to increase surgical capacity, it is unclear what impact these have had on inequalities in provision of joint replacement for osteoarthritis. What did the researchers do and find? We conducted an analysis of the National Joint Registry using all primary hip and knee replacements for osteoarthritis performed from 2007 to 2017 in England, merged with the Office for National Statistics official population statistics, to investigate inequalities in provision of surgery according to deprivation by patient area of residence, age, sex, and trends in these inequalities over time. Using 675,342 primary hip and 834,146 primary knee replacements, we found that inequalities in provision of surgery between the most (reference) and least affluent areas have remained large (hip: rate ratio (RR) = 0.58, 95% confidence interval [0.56, 0.60] in 2007, RR = 0.59 [0.58, 0.61] in 2017; knee: RR = 0.82 [0.80, 0.85] in 2007, RR = 0.81 [0.80, 0.83] in 2017), despite the use of outsourcing of surgery to the private sector. For hip replacement, Clinical Commissioning Groups (CCGs) with the highest concentration of deprived areas had lower overall provision of surgery, and CCGs with very few deprived areas had higher surgical provision. There has been an overall improvement in the absolute numbers of hip and knee replacement operation being performed; there is now less geographical variation in rates of surgery. For publicly funded surgery, no socioeconomic inequalities were observed for knee replacements, with a smaller inequality observed for hip replacements, whereas for privately funded surgery, strong inequalities were observed for both joints. What do these findings mean? This study found that socioeconomic inequalities in provision of joint replacement surgery are still prevailing. Care providers should take action to address unwarranted variation in the provision of joint replacement surgery.

Bristol , City-of , United-kingdom , Northern-ireland , Craigavon , Canada , United-states , Whitehouse , District-of-columbia , Texas , Canadian , Ceramtec-gmb

New figures provide latest data on veterans suicide

New figures provide latest data on veterans suicide
miragenews.com - get the latest breaking news, showbiz & celebrity photos, sport news & rumours, viral videos and top stories from miragenews.com Daily Mail and Mail on Sunday newspapers.

Manchester , United-kingdom , Northern-ireland , Craigavon , Scotland , Cathryn-rodway , Johnny-mercer , Population-health , Affairs-johnny-mercer , Armed-forces-suicide-bereavement , Healthcare-quality-improvement-partnership , University-of-manchester