Towards a working methodology for using total hip and knee joint replacements to support identification

Hip and knee prostheses have occasionally been used to support identification of unknown persons along with other medical devices and implants. This paper looks at the specific issues around using hip and knee implants, suggesting a working methodology for their use in supporting identification during and after a post-mortem. The value of Total Knee Replacements (TKR) and Total Hip Replacements (THR) as a means of identification along with other implants is a very recent area of interest in Forensic Science considering the long history of implants. This together with the recent introduction of Joint Replacement Registries means that using hip and knee implants to support identification is likely to become automatic in the future but is not currently automatic. The paper looks at the accumulative collection of evidence as well as the range of issues including; the types and changes in early prostheses, examination of the body for external indications of implants, radiological recording prior to autopsy for confirmation of identification using matching of features with ante-mortem images, actual harvesting and collection of all parts of the joint replacement including cement and any other components, specific differences between TKR and THR. In developing an approach to the problems associated with identifications using TKRs and THRs a stepwise process and the full recording of all of the features associated with the implant as well as manufacturers details and identification numbers is suggested so that the cumulative nature of these features will help to narrow down possibilities towards a more certain identification and confirmation of that identification

Efficiency and Technological Change in Health Care Services in Ontario

This paper presents productivity measurement results for hospital services using panel data for Ontario hospitals between 2003 and 2006. The study uses the Malmquist Productivity index (MPI) obtained through the application of Data Envelopment Analysis (DEA) which is decomposed into efficiency change (ECH), i.e., movement towards the best practice frontier and technological change (TCH), i.e., movement of the frontier itself (Färe et al. [12]). The study also uses kernel density estimation techniques for analysis of efficiency distributions of the productivity scores and their components across different types of hospitals (e.g. small /large and rural /urban) and over time. Our results suggest that in addition to average productivity it is important to examine distributions of productivity and of its components which we find differs by hospital type and over time. We find that productivity growth occurred mostly through improvement in technology and in spite of declining efficiency. The results provide useful insight into the underlying mechanisms of observed changes in overall productivity, in technological change and in technical efficiency change in this vital sector of the health care market.

Can international health programmes be sustained after the end of international funding? The case of eye care interventions in Ghana

There is general agreement amongst major international policy makers that sustainability is a key component of health interventions in developing countries. However, there is little evidence on the factors enabling or constraining sustainability. Diffusion of innovation theory can help explain how the continuation of activities is related to the attributes of innovations. Innovations are characterised by five attributes: (i) relative advantage; (ii) compatibility; (iii) complexity; (iv) triability; and (v) observability. An eye care programme was selected as a case study. The programme was implemented in the Brong Ahafo region of Ghana and had been funded over a ten-year period by an international organisation

Prostate cancer in Asia: a collaborative report

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The public/private mix in Irish acute public hospitals: Trends and implications

The public/private mix in Irish health care is nowhere more evident than in the acute hospital system where both public and private patients can be treated in public hospitals by the same consultant. By undertaking new analyses of data from the Hospital In-Patient Enquiry Scheme, this study investigates this public/private mix and its impact on utilisation of hospital services. Demand- and supply-side factors were both found to be statistically significant in explaining the ratio of private to public discharges across hospitals and over time. Private discharges are found to have higher levels of utilisation of surgical procedures, even though the level of comorbidity did not appear to be any greater for this group. The analysis also found that 'excess utilisation' of public hospital facilities by private discharges in particular hospitals increased over the time period of the study. Despite limitations of available data and methods, this study provides useful insights into the factors driving private and public utilisation in the acute public hospital system in Ireland

Why most people with mental illness go untreated? economic perspectives and evidence from China

Due to the rapid economic growth and advancement in medical technology, many countries have experienced in the past decades an epidemiological transition from communicable to non- communicable dieses (NCDs). One of the challenges in the era of NCDs is the large treatment gap, measured by the difference between the need for treatment and the actual provision of treatment, among patients with NCDs. This paper investigates the causes of treatment gap in mental healthcare from the perspective of economics. Specifically, we hypothesizes that people with mental illness face four major hurdles in seeking appropriate healthcare, namely the high nonmonetary cost due to stigma, the high out-of-pocket payment due to insufficient public funds devoted to the mental health sector, the high time prices due to low mental healthcare resource availability, and the low treatment benefit due to slow technology diffusion. We then use China as a study setting to show the country-specific evidence. Our analysis supports the above theoretical argument on the four access barriers, which in turn sheds light on the effective approaches to mitigate the treatment gap. Four policy options are then discussed, including an information campaign for mental health awareness, increasing public investment in primary mental healthcare resources, transforming the healthcare system towards an integrated people-centered system and capitalizing on e-health technologies

EESRI

Hospitals; Estadístiques; Catalunya; Hospitals; Statistics; Catalonia; Hospitales; Estadísticas; CataluñaAnualment es du a terme l’Estadística d’establiments sanitaris amb règim d’internat (EESRI) amb els objectius d’acomplir els plans estadístics de Catalunya i de l’Estat espanyol, i de posar a disposició de tots els professionals de la salut, tant els relacionats amb la planificació i la gestió de recursos i de serveis hospitalaris com els relacionats amb la perspectiva assistencial o de la recerca, una bona font d’informació per poder aproximar-se a la realitat de l’activitat hospitalària catalana

EESRI

Hospitals; Estadístiques; Catalunya; Hospitals; Statistics; Catalonia; Hospitales; Estadísticas; CataluñaAnualment es du a terme l’Estadística d’establiments sanitaris amb règim d’internat (EESRI) amb els objectius d’acomplir els plans estadístics de Catalunya i de l’Estat espanyol, i de posar a disposició de tots els professionals de la salut, tant els relacionats amb la planificació i la gestió de recursos i de serveis hospitalaris com els relacionats amb la perspectiva assistencial o de la recerca, una bona font d’informació per poder aproximar-se a la realitat de l’activitat hospitalària catalana