Participation of disabled children and young people in decision making within social services departments: A survey of current and recent activities in England

A survey of all social services departments in England was undertaken in order to identify and investigate current work concerning the participation of disabled children within decision making regarding their own care and in service development. Developing a culture of, and good practice in, children's participation is integral to government policy. Results demonstrate that disabled children are being involved in a range of decision-making areas; however, participation is not yet embedded or sustained across all social services departments, and the involvement of disabled children at a higher strategic level is still rare. The participation of disabled children needs further development including more evidence on which factors can support and promote disabled children's effective participation

Listening and responding? Children's participation in health care within England

This article examines recent health policy developments in England in relation to children's rights under Article 12 and 13 of the United Nations Convention on the Rights of the Child (UNCRC). It draws on practice and research literature to explore evidence regarding: children's participation both within decisions about their own care and concerning the development of health services, their access to mechanisms that allow them a voice, the provision of and need for accessible information, and factors which prevent or facilitate children's participation. The paper does not explore in detail issues concerning children's consent or competence to participate

The Local Perspective: Health Care Delivery in Syracuse, NY

The traditional health care quality framework of structure, process, and outcome offers a perspective that we can use to look at the changes in the health system in Syracuse

The New Jim Crow and Administration of Justice: An Investigation of Change Through Race and the Disciplinary Mode

This thesis focuses on the meaning and definition of the Jim Crow law and its contemporary meaning and application to administration of justice in the United States. The Old Jim Crow accentuated the segregation of African Americans, who were treated separate but equal by race and the penal process. The New Jim Crow represents police brutality, white supremacy, the disregard of the 14th Amendment for some minorities, and the devastating replacement of Jim Crow with the massive incarceration of black people. This evaluation will also explain the historic emergence of the Jim Crow law as well as its compatibility with the application of the administration of justice practice in the 21st century. Additionally, this current study will scrutinize the causal linkage between race and the penal process in that recent transformation in the justice system has not changed the manner of treatment toward American racial minorities. Indeed, Jim Crow practices, long ago outlawed, are still in vogue and apparent throughout the criminal justice system methods. Furthermore, using historical documents, and content analysis, this research will demonstrate that the Jim Crow epoch regulations still permeate the justice systems in America in the disciplinary corridors of disproportionate representation of racial and ethnic minority group members in the area of arrest, prosecution, and incarceration. Finally, this research will utilize the conflict theoretical frame and other applicable criminological constructions to explain the overpopulation of minorities in the justice system

Patient Reported Outcomes in Arthritis, TJR, and Physical Activity Research

As part of the mini-symposium entitled Biomechanical Gait Analysis for Improving Clinical Outcomes: Applications for Orthopedics, Geriatrics and Community Based Research, this presentation discusses the importance of patient reported outcomes (PRO) in clinical research and the PRO/physical activity translational research in osteoarthritis and and total joint replacement at UMass Medical School

Using Interviews to Understand Patients’ Post-operative Pain Management Educational Needs Before and After Elective Total Joint Replacement Surgery

Objective: To better understand the education needs of patients electing to have TJR in managing their pain in the post-operative period after discharge from the hospital. Methods: An exploratory, descriptive, qualitative design. Convenience sample of people who reported that they had not received information about pain management prior to TJR surgery were recruited from 9 surgeon practices in 8 states to participate in telephone interviews, utilizing open-ended questions. Questions included: recollection of pre-op class attended and content; experiences with surgical pain after surgery and how it was managed; experiences with pain medicine; experience using non-medicine related pain reduction methods; suggestions for delivery of pain management information. Interviews were recorded and transcribed. Data were categorized using content analysis techniques. Results: Seventeen patients were interviewed. Although all remembered attending a pre-operative class prior to their joint replacement surgery, none remembered receiving information during that class about managing pain once they were discharged. All had been prescribed an opioid for pain management post-operatively; however no patients reported receiving any information regarding use of the medication other than the information on the pill bottle. Many had concerns regarding the use of opioids to control their pain, including side effects, such as constipation and the risk of addiction. The most common non-medicine method used to manage pain was the use of ice. Participants believed that information about pain management, including both non-medicine approaches and instructions for taking opioids would be helpful and should be delivered at multiple time points, including pre-operatively, at discharge, and within the first few days after discharge. Conclusion: With trends toward shorter hospital stays, home based pain management is a priority. Understanding the pain management education needs of patients considering elective TJR could inform interventions for this population as well as provide insight into the needs of other patients undergoing surgery

Predicting Early Failure in Total Knee Arthroplasty: A Critical Review of Oxinium Femoral Components

Introduction: Retrospectively, it has been shown that significant patient-reported pain 6 months following total knee arthroplasty (TKA) is associated with a 7 times greater revision rate at 5 years. Our goal is to use the FORCE-TJR registry to prospectively evaluate if postoperative pain and function scores can predict increased revision rate 5 years following TKA. Our preliminary analyses have focused on one implant reported by Australia to have a significantly high 5-year revision rate: Oxinium femoral components. Materials and Methods: FORCE-TJR matched implant catalog numbers to the international implant library to define TKA patients who received oxinium femoral components and all other implants. We defined 12-month KOOS pain and function (SF PCS) for patients with the study implant and all others (n=9187). Age, BMI, sex, pre-TKA pain, function, low back pain severity, and Charlson comorbidity index were compared for patients with moderate pain (KOOS pain\u3c75) vs. minimal pain (KOOS pain\u3e75) at 12 months postoperatively. Results: We observed that 27% of oxinium patients reported moderate pain vs. 21% of patients receiving all implants at 12 months postoperatively. Compared to patients with minimal pain, moderate pain patients had greater pre-op pain (KOOS=37 vs. 50; p\u3c 0.0002), poorer pre-op function (PCS=30 vs. 33; p\u3c0.04), and more moderate to severe low back pain (52% vs. 24%; p\u3c0.027). In addition, high 12-month pain patients had poorer 12-month function (PCS=37 vs. 45; p\u3c0.0000). Conclusion: These preliminary results indicate that moderate pain at 12-months post operatively is associated with poorer functional gain following TKA. Surgeons should recognize and potentially intervene on this group if improvement in their ultimate functional gain is desired. By continuing to follow this group of oxinium patients we will be able to determine if early pain and decreased function following TKA is associated with an increased revision rate

Defining an International Standard Set of Outcome Measures for Patients With Hip or Knee Osteoarthritis: Consensus of the International Consortium for Health Outcomes Measurement Hip and Knee Osteoarthritis Working Group

OBJECTIVE: To define a minimum Standard Set of outcome measures and case-mix factors for monitoring, comparing, and improving health care for patients with clinically diagnosed hip or knee osteoarthritis (OA), with a focus on defining the outcomes that matter most to patients. METHODS: An international working group of patients, arthroplasty register experts, orthopedic surgeons, primary care physicians, rheumatologists, and physiotherapists representing 10 countries was assembled to review existing literature and practices for assessing outcomes of pharmacologic and nonpharmacologic OA therapies, including surgery. A series of 8 teleconferences, incorporating a modified Delphi process, were held to reach consensus. RESULTS: The working group reached consensus on a concise set of outcome measures to evaluate patients\u27 joint pain, physical functioning, health-related quality of life, work status, mortality, reoperations, readmissions, and overall satisfaction with treatment result. To support analysis of these outcome measures, pertinent baseline characteristics and risk factor metrics were defined. Annual outcome measurement is recommended for all patients. CONCLUSION: We have defined a Standard Set of outcome measures for monitoring the care of people with clinically diagnosed hip or knee OA that is appropriate for use across all treatment and care settings. We believe this Standard Set provides meaningful, comparable, and easy to interpret measures ready to implement in clinics and/or registries globally. We view this set as an initial step that, when combined with cost data, will facilitate value-based health care improvements in the treatment of hip and knee OA