Despite differences in the structure of health care delivery systems, health care spending continues to outpace gross domestic product (GDP) and average wage globally. This highlights the stark... Show moreDespite differences in the structure of health care delivery systems, health care spending continues to outpace gross domestic product (GDP) and average wage globally. This highlights the stark reality that health systems today are – in many cases – financially unsustainable. Further, most health care services today are paid for via a fee-for-service or payment for each service provided mechanism, which does not ensure a focus on optimal health outcomes for patients; this includes clinical outcomes most important to them, such as function, pain, andquality of life. As such, bold reforms are needed to better align incentives to “bend” the cost curve and to ensure high-quality health care and the best possible patient outcomes. This dissertation includes scientific studies that highlight how the core principles of value-based health care, which focuses on maximizing the outcomes achieved per dollar spent, may be able to begin to address some of the issues plaguing our strained health care delivery systems globally, including within orthopaedic surgery. Show less
In dit proefschrift werd onderzoek gedaan naar het verbeteren van feedback voor orthopedisch chirurgen met betrekking tot totale heup- en knieprothesen. Hierbij werd gebruikt gemaakt van het... Show moreIn dit proefschrift werd onderzoek gedaan naar het verbeteren van feedback voor orthopedisch chirurgen met betrekking tot totale heup- en knieprothesen. Hierbij werd gebruikt gemaakt van het dataregister van de Landelijke Registratie Orthopedische Interventies (LROI). Er werd gevonden dat voor vrijwel alle ziekenhuizen die ‘’slechter’’ presteerde voor revisies binnen een jaar een onderliggende reden kon worden gevonden wat kan leiden tot gerichte kwaliteitverbeterinitiatieven. Daarnaast werd een nieuwe statistische methode getoetst waardoor ‘’beter’’ en ‘’slechter’’ presterende ziekenhuizen sneller kunnen worden geïdentificeerd. Ook werd een geordende samengestelde uitkomst ontwikkeld waardoor de geleverde kwaliteit van zorg in een uitkomst kan worden gevat. Om de effectiviteit van feedback verder te verbeteren werd onderzocht in welke uitkomsten orthopedisch chirurgen geïnteresseerd zijn en op welke manier en met welke frequentie zij de feedback toegestuurd willen krijgen. Deze bevindingen werden gecombineerd met hedendaagse theorieën over effectieve feedback om een kwaliteitverbeterinterventie te ontwikkelen en de effectiviteit te testen in een cluster gerandomiseerde en gecontroleerde trial. Ziekenhuizen die de interventie ontvingen, verbeterden met 4,3% in vergelijking met de controlegroep. Deze bevindingen ondersteunen dat frequente feedback aan chirurgische teams moet worden aangevuld met interactieve educatie en toolbox met daarin kwaliteitverbeterinitiatieven die zijn afgestemd op specifieke uitkomsten om de kwaliteit van zorg met betrekking tot THP en TKP effectief te verbeteren. Show less
Aims: Arthroplasty surgery of the knee and hip is performed in two to three million patients an-nually. Periprosthetic joint infections occur in 4% of these patients. Debridement, antibiot-ics, and... Show moreAims: Arthroplasty surgery of the knee and hip is performed in two to three million patients an-nually. Periprosthetic joint infections occur in 4% of these patients. Debridement, antibiot-ics, and implant retention (DAIR) surgery aimed at cleaning the infected prosthesis often fails, subsequently requiring invasive revision of the complete prosthetic reconstruction. Infection-specific imaging may help to guide DAIR. In this study, we evaluated a bacteria -specific hybrid tracer (99mTc-UBI29-41-Cy5) and its ability to visualize the bacterial load on fem-oral implants using clinical -grade image guidance methods. Methods: 99mTc-UBI29-41- Cy5 specificity for Stapylococcus aureus was assessed in vitro using fluorescence confocal imaging. Topical administration was used to highlight the location of S. aureus cul-tured on femoral prostheses using fluorescence imaging and freehand single photon emis-sion CT (fhSPECT) scans. Gamma counting and fhSPECT were used to quantify the bacterial load and monitor cleaning with chlorhexidine. Microbiological culturing helped to relate the imaging findings with the number of (remaining) bacteria. Results: Bacteria could be effectively stained in vitro and on prostheses, irrespective of the presence of biofilm. Infected prostheses revealed bacterial presence on the transition zone between the head and neck, and in the screw hole. Qualitative 2D fluorescence images could be com-plemented with quantitative 3D fhSPECT scans. Despite thorough chlorhexidine treatments, 28% to 44% of the signal remained present in the locations of the infection that were iden-tified using imaging, which included 500 to 2,000 viable bacteria.Conclusion: The hybrid tracer99mTc-UBI29-41-Cy5 allowed effective bacterial staining. Qualitative real -time fluorescence guidance could be effectively combined with nuclear imaging that enables quantitative monitoring of the effectiveness of cleaning strategies. Show less
Aims Arthroplasty surgery of the knee and hip is performed in two to three million patients an-nually. Periprosthetic joint infections occur in 4% of these patients. Debridement, antibiot-ics, and... Show moreAims Arthroplasty surgery of the knee and hip is performed in two to three million patients an-nually. Periprosthetic joint infections occur in 4% of these patients. Debridement, antibiot-ics, and implant retention (DAIR) surgery aimed at cleaning the infected prosthesis often fails, subsequently requiring invasive revision of the complete prosthetic reconstruction. Infection-specific imaging may help to guide DAIR. In this study, we evaluated a bacteria -specific hybrid tracer (99mTc-UBI29-41-Cy5) and its ability to visualize the bacterial load on fem-oral implants using clinical -grade image guidance methods.Methods 99mTc-UBI29-41- Cy5 specificity for Stapylococcus aureus was assessed in vitro using fluorescence confocal imaging. Topical administration was used to highlight the location of S. aureus cul-tured on femoral prostheses using fluorescence imaging and freehand single photon emis-sion CT (fhSPECT) scans. Gamma counting and fhSPECT were used to quantify the bacterial load and monitor cleaning with chlorhexidine. Microbiological culturing helped to relate the imaging findings with the number of (remaining) bacteria.Results Bacteria could be effectively stained in vitro and on prostheses, irrespective of the presence of biofilm. Infected prostheses revealed bacterial presence on the transition zone between the head and neck, and in the screw hole. Qualitative 2D fluorescence images could be com-plemented with quantitative 3D fhSPECT scans. Despite thorough chlorhexidine treatments, 28% to 44% of the signal remained present in the locations of the infection that were iden-tified using imaging, which included 500 to 2,000 viable bacteria.Conclusion The hybrid tracer99mTc-UBI29-41-Cy5 allowed effective bacterial staining. Qualitative real -time fluorescence guidance could be effectively combined with nuclear imaging that enables quantitative monitoring of the effectiveness of cleaning strategies. Show less
