Suchergebnisse

During the 1850s and 1860s, white settlers perpetrated genocide against California Indians. Militia and regular troops supported by the state and federal governments committed acts of genocide as defined by the United Nations. Government officials, newspaper editors, and pioneers documented the genocide. History and social science textbooks ignore or barely mention murders, rapes, kidnappings, and enslavement of California Indians during the Gold Rush era. The California State Department of Education denies the genocide and textbook companies are silent of Indian genocide in spite of overwhelming evidence.

IntroductionMonitoring of joint replacement (JR) data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) has reduced revision rates and improved surgical practice. Outcome assessment post-arthroplasty is limited however, to revision (reoperation) surgery and mortality outcomes. The AOANJRR National Data Linkage project seeks to broaden the scope of outcomes investigation in Australia by linking registry and health administrative datasets.
Objectives and ApproachUsing linked registry and administrative data, the project seeks to describe and quantify national/regional trends and variation in major complications (infection, dislocation, arthrofibrosis, chronic pain, venous thromboembolism, cardiac events), malignancy and health service utilisation (readmissions, emergency encounters and inpatient rehabilitation) following hip, knee and shoulder joint replacement surgery. Evidence will be generated on how these outcomes are associated with and vary according to patient, surgical, implant, hospital and pharmacological factors.
As Australia lacks a national identifier, seven linkage agencies are probabilistically linking AOANJRR hip, knee and shoulder replacement data (1999-2017) with 20 datasets. Datasets include government-subsidised health services, procedural and prescription data. Hospital separations and emergency attendance data from Australia's eight jurisdictions together with national cancer registry and rehabilitation service data are also planned for linkage. Linked data are maintained in a secure remote access computing environment.
ResultsTo date, national Medicare Benefits Schedule, Pharmaceutical Benefits Scheme and the Australian Cancer Database data have been linked with >900,000 AOANJRR patients, representing 607.6 million health service records (1999-2018), 467.7 million prescriptions (2002-2018) and 184,000 cancer records, respectively. Remaining linked data will be available in mid-2020. Some initial summary results across a selected range of studies will be presented.
Conclusion / ImplicationsThis national data-linkage program will identify areas for improvement in joint replacement surgery and modifiable risk factors contributing to poor patient outcomes.

IntroductionPatient comobidity at time of primary joint replacement (JR) impacts on outcomes including revision and mortality. Understanding changes in comorbidity profiles is important when assessing change in outcomes over time. Most arthroplasty registries have limited comorbidity information due to their minimum dataset. One approach to obtaining additional comorbidity data is linking registry data with national administrative data.
Objectives and ApproachObjectives were to quantify pre-operative comorbidity profile of patients undergoing primary total hip replacement (THR) and total knee replacement (TKR) for osteoarthritis. Also, to examine temporal trends in individual comorbidities for THR and TKR patients.
National pharmaceutical dispensing data were linked with THR and TKR arthroplasty patients. Medication dispensing histories in 12-months preceding JR (2003-2017) for 237,333 THR and 394,965 TKR patients, were mapped to 47 comorbidity classes using the Rx-Risk-V measure - a pharmacy-based measure of comorbidity. Comorbidity scores were calculated by summing comorbidity categories for individual patients. Trends in comorbidity scores/categories were described, with comorbidity information presented by PBS beneficiary category (concessional/general), stratified by age (<65/≥65 years).
ResultsMedian (interquartile range) comorbidity scores were higher in concessional patients ≥65y, THR:5(3-6), TKR:5(3-7); <65y,TKR:5(3-6) but not THR:4(2-6). Comparative scores for general patients (both ages) were THR:4(2-6) and TKR:3(2-5). Trends in median comorbidity scores were consistent across study period, THR:4- 5(concessional)/2-3(general) and TKR:4-5(concessional)/4(general). Commonly identified comorbidities in younger concessional THR patients were pain, measured by opioid use (62.4%), inflammation/pain, measured by use of non-steroidal anti-inflammatories (62.2%), GORD (36.2%) and hypertension (36.1%). Individual comorbidities remained generally stable over time. However, increased patient proportions were seen in THR concessionals <65y for opioid pain (59.1%-71.1%), depression (24.5-42.5%), whilst inflammation/pain (82.1-56.1%) and antiplatelet use (≥65y:23.5-9.2%) declined.
Conclusion / Implicationsn THR or TKR patients no appreciable change in comorbidity score or comorbidity profile occurred over time. This suggests that improving JR outcomes over time are unlikely due solely to variation in patient comorbidity profiles.

IntroductionInfection is a major complication following joint replacement (JR) surgery. However, little data exist on baseline use of antibiotics following primary JR and how use changes with subsequent revision surgery.
Objectives & ApproachOur study objectives were to describe community use of antibiotics before and after primary total hip replacement (THR) and change in use pre and post revision procedure.
Registry data were linked with national medication dispensing data using probabilistic record linkage. Patients with THR for osteoarthritis in a private hospital between 1999 and 2017 were included. Three groups were analysed: patients with primary procedures revised for infection, revised for non-infection reasons and those not revised. Rate of antibiotic dispensing/month was calculated as number of patients dispensed at least one antibiotic in a given month divided by number of patients at-risk.
ResultsThere were 102,577 patients included in the non-revised group, 3,156 revised for non-infection and 520 revised for infection. Prior to primary THR, baseline antibiotic dispensing rate was 9-11%/month in all groups. Post-primary rates were similar (10-11%) for non-revised and revised non-infection patients but higher (16-17%) for revised-infection patients. In 1, 6 and 12 months preceding revision for infection, antibiotic use was 55%, 27% and 22%, respectively. For patients revised for non-infection, antibiotic use was 21%, 14%, 13%, respectively. One-month following revision for infection, 82% of patients were dispensed antibiotics, remaining high (38%) at 6-months and 28% at 12-months. In the revision non-infection group, antibiotic use was 48% first month post-surgery, reducing rapidly to 15% at 6-months.
Conclusion / ImplicationsNon-revision and revision non-infection patients had similar antibiotic dispensing before and after surgery. Revision infection patients however, maintained higher antibiotic dispensing post-primary, pre and post revision. This may reflect either ongoing infection, need for long-term suppressive therapy or reluctance of treating physicians to terminate treatment.

This book highlights indigenous American women throughout modern American history, countering past stereotypes by offering twenty original scholarly chapters featuring historical and biographical analyses of Native American women who excelled in education, health, medicine, and the arts.

This book highlights indigenous American women throughout modern American history, countering past stereotypes by offering twenty original scholarly chapters featuring historical and biographical analyses of Native American women who excelled in education, health, medicine, and the arts