Patterns of knee osteoarthritis management in general practice:a retrospective cohort study using electronic health records

Objective: This study determined patterns of knee osteoarthritis (OA) management by general practitioners (GPs) using routine healthcare data from Dutch general practices from 2011 to 2019. Design: A retrospective cohort study was conducted using the Integrated Primary Care Information database between 2011 and 2019. Electronic health records (EHRs) of n = 750 randomly selected knee OA patients (with either codified or narrative diagnosis) were reviewed against eligibility criteria and n = 503 patients were included. Recorded information was extracted on GPs’ management from six months before to three years after diagnosis and patterns of management were analysed.Results: An X-ray referral was the most widely recorded management modality (63.2%). The next most widely recorded management modalities were a referral to secondary care (56.1%) and medication prescription or advice (48.3%). Records of recommendation of/referral to other primary care practitioners (e.g. physiotherapists) were found in only one third of the patients. Advice to lose weight was least common (1.2%). Records of medication prescriptions or recommendation of/referral to other primary care practitioners were found more frequently in patients with an X-ray referral compared to patients without, while records of secondary care referrals were found less frequently. Records of an X-ray referral were often found in narratively diagnosed knee OA patients before GPs recorded a code for knee OA in their EHR. Conclusion: These findings emphasize the importance of better implementing non-surgical management of knee OA in general practice and on initiatives for reducing the overuse of X-rays for diagnosing knee OA in general practice.</p

Patterns of knee osteoarthritis management in general practice:a retrospective cohort study using electronic health records

Objective: This study determined patterns of knee osteoarthritis (OA) management by general practitioners (GPs) using routine healthcare data from Dutch general practices from 2011 to 2019. Design: A retrospective cohort study was conducted using the Integrated Primary Care Information database between 2011 and 2019. Electronic health records (EHRs) of n = 750 randomly selected knee OA patients (with either codified or narrative diagnosis) were reviewed against eligibility criteria and n = 503 patients were included. Recorded information was extracted on GPs’ management from six months before to three years after diagnosis and patterns of management were analysed.Results: An X-ray referral was the most widely recorded management modality (63.2%). The next most widely recorded management modalities were a referral to secondary care (56.1%) and medication prescription or advice (48.3%). Records of recommendation of/referral to other primary care practitioners (e.g. physiotherapists) were found in only one third of the patients. Advice to lose weight was least common (1.2%). Records of medication prescriptions or recommendation of/referral to other primary care practitioners were found more frequently in patients with an X-ray referral compared to patients without, while records of secondary care referrals were found less frequently. Records of an X-ray referral were often found in narratively diagnosed knee OA patients before GPs recorded a code for knee OA in their EHR. Conclusion: These findings emphasize the importance of better implementing non-surgical management of knee OA in general practice and on initiatives for reducing the overuse of X-rays for diagnosing knee OA in general practice.</p

Multiple criteria decision making applications in environmentally conscious manufacturing and product recovery

In order to ensure environmentally responsible production and disposal of products, local governments are imposing stricter environmental regulations, some of which even require manufacturers to take back their products at the end of the product’s useful life. These government regulations, together with increasing environmental awareness, have forced manufacturers to invest in environment-conscious manufacturing. The multiple Criteria Decision Making Techniques presented in this book can be employed to solve the problems of environment-conscious manufacturers in product design, logistics, disassembly and remanufacturing. © 2018 by Taylor & Francis Group, LLC

Disassembly line balancing with sequencing decisions: A mixed integer linear programming model and extensions

Due to the acceleration of technological developments and shortening of product life cycles, product recovery has gained great importance in recent years. Disassembly line balancing (DLB) problem is one of the most important problems encountered during disassembly operations in product recovery. In this study, a single model and complete DLB problem with balancing issues, hazardousness of parts, demand quantities and direction changes is considered. Majority of DLB studies in the literature solve this problem using heuristics or metaheuristics which do not guarantee the optimality. Although a few studies present mathematical formulations for some variants of this problem, they prefer to solve the problem by using heuristics or metaheuristics due to the non-linear structure and combinatorial nature of the problem. In this study, a generic mixed integer linear programming (MILP) model is developed for the investigated problem and its performance is tested through a series of benchmark instances. The computational results demonstrate that the proposed MILP model is able to solve test instances with up to 30 tasks. Hence, it can effectively be utilized to evaluate the optimality performance of DLB approaches. Moreover, several extensions on the MILP model regarding to line balancing, hazardousness and demand of parts and direction changes are proposed and their effects are analyzed through computational studies. © 2019 Elsevier Lt

Anderhalvelijnszorg voor knie- en heupartrose

Om het aantal verwijzingen naar tweedelijnszorg orthopedie terug te dringen zijn in Nederland diverse anderhalvelijnszorgpilotprojecten voor knie- en heupartrose opgezet. In een aantal van deze projecten leveren orthopeden consulten in de huisartsenpraktijk. Uit een evaluatie van 3 van deze pilotprojecten blijkt dat ze de multidisciplinaire communicatie en de toegankelijkheid van de zorg verbeterden. Bovendien vergrootten ze de kennis en vaardigheden van zorgverleners. Deze vorm van zorg had ook gevolgen voor het aantal verwijzingen naar fysiotherapie en de tweede lijn

Reverse – Green Virtual Enterprises and Their Breeding Environments: Closed-Loop Networks

Part 20: Sustainable Collaborative Networks IInternational audienceGreen Virtual Enterprise Breeding Environments and their Reverse-Green Virtual Enterprises, as dynamic reverse supply networks, represent a promising paradigm to face the reverse logistics and end-of-life manufacturing challenges towards closed-loop industrial processes, closed-loop supply networks and sustainable industrial development models. This paper explores different collaborative product recovery business opportunities and strategies for capturing current missed value at the end-of-lifecycle with new activities, relationships and network configurations, put forward based on the disciplines of Industrial Ecology, Collaborative Networks and Lifecycle Management