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Most plants use the C3 pathway for carbon fixation. However, some plants, such as sugar cane, corn, and cacti that grow in hot conditions, use alternative pathways to fix carbon and conserve energy loss due to photorespiration. Photorespiration is the process that occurs when the oxygen concentration is high. Under such conditions, the rubisco enzyme in the Calvin cycle binds O2 instead of CO2, which halts photosynthesis and consumes energy.
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Synovial joints are the most common type of joint in the body. A key structural characteristic for a synovial joint is the presence of a joint cavity. This fluid-filled space is where the articulating surfaces of the bones contact each other. Also, unlike fibrous or cartilaginous joints, the articulating bone surfaces at a synovial joint are not directly connected to each other with fibrous connective tissue or cartilage. This gives the bones of a synovial joint the ability to move smoothly...
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Fibrous joints are a type of joint where the bones are connected by fibrous connective tissue. These joints provide stability and minimal to no movement between the articulating bones. There are three types of fibrous joints.
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The adult human body usually has 206 bones, and except for the hyoid bone in the neck, each bone is connected to at least one other bone. Joints are the location where bones come together. Many joints allow for movement between the bones. At these joints, the articulating surfaces of the adjacent bones can move smoothly against each other. However, the bones of other joints may be joined by connective tissue or cartilage. These joints are designed for stability and provide little or no...
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Clinical pathway efficiency for elective joint replacement surgeries: a case study.

Maude Laberge1, André Côté1, Angel Ruiz1

  • 1Department of Operations and Decision Systems, Universite Laval Faculte des sciences de l'administration , Quebec, Canada.

Journal of Health Organization and Management
|May 25, 2019
PubMed
Summary
This summary is machine-generated.

Delays between total joint replacement (TJR) surgery steps significantly impact wait times, with the initial phase being critical. Addressing these operational inefficiencies at health system or organizational levels can reduce patient wait times for TJR surgery.

Keywords:
EfficiencyElective surgeryLeanWaiting lists

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Area of Science:

  • Health Services Research
  • Process Engineering
  • Orthopaedic Surgery Management

Background:

  • Total joint replacement (TJR) surgery pathways involve multiple steps with potential for delays.
  • Understanding and optimizing these pathways is crucial for improving patient access to care.
  • Variability in operational processes can lead to extended wait times for elective procedures.

Purpose of the Study:

  • To define the clinical pathway for total joint replacement (TJR) surgery.
  • To estimate the impact of delays between pathway steps on surgical wait times.
  • To identify factors promoting operational efficiency and implementation challenges within TJR pathways.

Main Methods:

  • A mixed-methods case study approach was employed, combining qualitative interviews with hospital staff and quantitative analysis of patient records.
  • Process mapping of the TJR care pathway was conducted through on-site observations and analysis of 60 patient records, including time-stamp data.
  • Regression analysis was performed on the duration of the entire patient trajectory to identify significant predictors of wait time.

Main Results:

  • Significant variations in delays were observed across the seven identified steps of the TJR pathway.
  • The delay between Step 1 and Step 2 emerged as the sole significant predictor of total wait time for surgery.
  • A notable misalignment existed between qualitative findings on efficiency strategies and quantitative data on inter-step delays.

Conclusions:

  • The study successfully mapped the TJR clinical pathway up to the surgical procedure, highlighting critical delay points.
  • Wait times for TJR surgery can be mitigated through strategic interventions at both health system and organizational levels.
  • While processes can be defined, influencing organizational culture and established practices presents a significant challenge to efficiency gains.