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Since most German immigrants to the US from to the 's came from the Grandduchy of Hessen this book is exactly what genealogists will need. Libraries will want a reference and a circulating copy of this book. Thomas Jay Kemp; GenealogyBank. I probably would have found it without the Map Guide, but who knows how many years it would have taken.
I can't wait for Hessen-Nassau book to come out. It is heavily used by the library patrons and they will be excited to know that further volumes will be printed. Super high amount of views. Great seller with very good positive feedback and over 50 ratings. Like us on Facebook. This paper focuses on reporting a secondary use of care pathways : to commission and monitor performance of primary dental care services. Findings of a project involving three dental practices implementing a system based on rating patients according to their risk of disease and need for care are outlined.
Data from surgery-based clinical databases and interviews from commissioners and providers are reported. The use of both process and outcome key performance indicators in this context is discussed, as well as issues which arise such as attributability of outcome measures and strategic approaches to improving quality of care.
How socioeconomic inequalities impact pathways of care for coronary artery disease among elderly patients: study protocol for a qualitative longitudinal study. Several studies have identified that socioeconomic inequalities in coronary artery disease CAD morbidity and mortality lead to a disadvantage in patients with low socioeconomic status SES. International studies have shown that socioeconomic inequalities also exist in terms of access, utilisation and quality of cardiac care.
The aim of this qualitative study is to provide information on the impact of socioeconomic inequalities on the pathway of care for CAD, and to establish which factors lead to socioeconomic inequality of care to form and expand existing scientific theories. Patients are interviewed two times face-to-face using semistructured interviews.
Data are transcribed and analysed based on grounded theory. Only participants who have been informed and who have signed a declaration of consent have been included in the study. The study complies rigorously with data protection legislation. The results of the study will be presented at several congresses, and will be published in high-quality peer-reviewed international journals. Care pathways for dementia: current perspectives. With an uncertain illness trajectory and unpredictable levels of deterioration and stability in symptoms, people with a diagnosis of dementia may live with uncertainty and anxiety and find it hard to make plans or decisions for their future.
People with memory problems and caregivers seeking a diagnosis of dementia may also potentially find themselves navigating a labyrinth-like maze of services, practitioners, assessments, and memory tests, with limited understanding of test scores and little information about what support is available.
Examples of these approaches are presented from UK dementia services with illustrations of existing care pathways and associated time points, specifically focusing on: 1 early symptom identification and first service encounters, 2 assessment process, 3 diagnostic disclosure, 4 postdiagnostic support, and 5 appropriate interventions. We review the evidence around these themes, as well as discuss service pathways and referral routes used by some services in England and internationally.
Evaluating the effect of clinical care pathways on quality of cancer care : analysis of breast, colon and rectal cancer pathways. Substantial gaps exist between clinical practice and evidence-based cancer care , potentially leading to adverse clinical outcomes and decreased quality of life for cancer patients.
This study aimed to evaluate the usefulness of clinical pathways as a tool for improving quality of cancer care , using breast, colon, and rectal cancer pathways as demonstrations. Newly diagnosed patients with invasive breast, colon, and rectal cancer were enrolled as pre- pathway groups, while patients with the same diagnoses treated according to clinical pathways were recruited for post- pathway groups. Compliance with preoperative core biopsy or fine-needle aspiration, utilization of sentinel lymph node biopsy, and proportion of patients whose tumor hormone receptor status was stated in pathology report were significantly increased after implementation of clinical pathway for breast cancer.
For colon cancer, compliance with two care processes was significantly improved: surgical resection with anastomosis and resection of at least 12 lymph nodes.
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Regarding rectal cancer, there was a significant increase in compliance with preoperative evaluation of depth of tumor invasion, total mesorectal excision treatment of middle- or low-position rectal cancer, and proportion of patients who had undergone rectal cancer surgery whose pathology report included margin status.
Moreover, total length of hospital stay was decreased remarkably for all three cancer types, and postoperative complications remained unchanged following implementation of the clinical pathways. Clinical pathways can improve compliance with standard care by implementing evidence-based quality indicators in daily practice, which could serve as a useful tool for narrowing the gap between clinical practice and evidence-based care.
Understanding sharps injuries in home healthcare: The Safe Home Care qualitative methods study to identify pathways for injury prevention. Home healthcare is one of the fastest growing sectors in the United States. Percutaneous injuries from sharp medical devices sharps are a source of bloodborne pathogen infections among home healthcare workers and community members.
Sharps use and disposal practices in the home are highly variable and there is no comprehensive analysis of the system of sharps procurement, use and disposal in home healthcare. This gap is a barrier to effective public health interventions. The objectives of this study were to i identify the full range of pathways by which sharps enter and exit the home, stakeholders involved, and barriers for using sharps with injury prevention features; and ii assess the leverage points for preventive interventions.
This study employed qualitative research methods to develop two systems maps of the use of sharps and prevention of sharps injuries in home healthcare. Twenty-six in-depth interview sessions were conducted including home healthcare agency clinicians, public health practitioners, sharps device manufacturers, injury prevention advocates, pharmacists and others.
Interview transcripts were audio-recorded and analyzed thematically using NVIVO qualitative research analysis software. Analysis of supporting archival material also was conducted. All findings guided development of the two maps. Sharps enter the home via multiple complex pathways involving home healthcare providers and home users. The providers reported using sharps with injury prevention features. However, home users' sharps seldom had injury prevention features and sharps were commonly re-used for convenience and cost-savings. Improperly discarded sharps present hazards to caregivers, waste handlers, and community members.
The most effective intervention potential exists at the beginning of the sharps systems maps where interventions can eliminate or minimize sharps injuries, in particular with needleless treatment methods and sharps with injury prevention features. Pathways to psychiatric care in European prison systems. The aims of this study were to describe and analyse the concepts of provision of mental health services for prison inmates in 24 countries in the European Union and the EFTA.
Data were gathered by means of a structured questionnaire that was completed by national experts in the participating countries. This article stresses the different organizational models of mental health care for inmates, different legal standards for screening their mental health status and different pathways to psychiatric care and aftercare. The study revealed serious shortcomings. Even the most rudimentary health reporting standards for mental health care in prison are lacking almost everywhere in Europe. Psychiatric screening and assessment procedures at prison entry and during imprisonment differ substantially and do not fulfil recognized quality standards.
In many countries, the appointment of inadequately trained staff to perform such screenings increases considerably the risk that mental disorders or psychiatric needs of the inmates will remain undetected. Furthermore, the pathways to care in the case of an acute psychotic episode differ significantly, since referral to prison hospitals, medical prison wards, forensic hospitals, or general psychiatric hospital are used in various combinations depending on different national legal regulations and on the availability of services or other regional circumstances.
Therefore, the collaborating experts place the quality of European prison mental health care into serious question. Bousquet, J. Cepeda; Cesario, A. Fink; Fletcher, M. Lodrup; Louis, R. Radier; Redon, J. To screen and to follow-up the patients with high cardiovascular risk in general practice may amplify the decrease of the cardiovascular morbi-mortality observed since a few years.
The objective of this study is to identify the patients with high cardiovascular risk and to describe the management of these patients by general practitioners in Aquitaine. Transversal study of a sample of patients from 18 to 70 years old with high cardiovascular risk combining at least 3 factors , included by voluntary general practitioners GP. Forty-seven GP included patients, presenting on average 3. The analysis of care pathways identified the cardiologist as the privileged interlocutor.
The doctors thought that seven patients out of 10 could change their risk behaviors. For the patients, the scale of declared importance to change was 6. The confidence in their capacity to change was 3. Although doctors' sample is not representative, these results give an original overview of the management of patients with high cardiovascular risk and their care pathways.
Medical treatments were globally in accordance with guidelines. The difficulty to change risk behaviors illustrates the necessity of patient therapeutic education. Various care pathways for COPD exist across Europe leading to different responses to similar problems. Determining these differences and the similarities may improve health and the functioning of health services. Methods: HCPs were interviewed in two stages using a qualitative, semistructured email interview and a face-to-face semistructured interview.
Results: Lack of communication among different health care providers managing COPD and comorbidities was a common feature of the. Purpose To test the fit of a theoretically driven conceptual model of pathways to STI risk among foster youth transitioning to adulthood. The model included: 1 historical abuse and foster care experiences, 2 mental health and attachment style in late adolescence, and 3 STI risk in young adulthood.
Methods We used path analysis to analyze data from a longitudinal study of youth transitioning out of foster care. Covariates included gender, race and an inverse probability weight. Results Thirty percent reported they or a partner had been diagnosed with an STI. There was also a borderline association with having greater than 5 partners. Having a very close relationship with a caregiver and remaining in foster care beyond age 18 decreased STI risk.
Integrated care pathways ICPs define a chronological sequence of steps, most commonly diagnostic or treatment, to be followed in providing care for patients. Care pathways help to ensure quality standards are met and to reduce variation in practice. Although research on the computerisation of ICP progresses, there is still little knowledge on what are the requirements for designing user-friendly and usable electronic care pathways , or how users normally health care professionals interact with interfaces that support design, analysis and visualisation of ICPs.
In order to address the aim of this study , an evaluation methodology was designed based on heuristic evaluations and a mixed method usability test. The results showed that modular visualisation and direct manipulation of information related to the design and analysis of ICPs is useful for engaging and stimulating users. However, designers should pay attention to issues related to the visibility of the system status and the match between the system and the real world, especially in relation to the display of statistical information about care pathways and the editing of clinical information within a care pathway.
The paper concludes with recommendations for interface design. Shared care and implementation of a pediatric clinical pathway. Study 2 An increased overall proportion of children with well-controlled asthma. Study 3 Favorable changes in the use of asthma medication. Study 4 Self-reported higher quality of life among children with asthma Material and methods At baseline the involved health care professionals participated in an introduction to the clinical pathway and treatment guide.
Furthermore the clinical pathway and treatment guide We sincerely thank Lars G. Care pathways for organ donation after brain death: guidance from available literature? A discussion of the literature concerning the impact of care pathways in the complex and by definition multidisciplinary process of organ donation following brain death.
Enhancing the quality and safety of organs for transplantation has become a central concern for governmental and professional organizations. At the local hospital level, a donor coordinator can use a range of interventions to improve the donation and procurement process. Care pathways have been proven to represent an effective intervention in several settings for optimizing processes and outcomes. A discussion paper. Each paper was reviewed to investigate the effects of existing care pathways for donation after brain death. An additional search for unpublished information was conducted.
Although literature supports care pathways as an effective intervention in several settings, few studies have explored its use and effectiveness for complex care processes such as donation after brain death.
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Nurses should be aware of their role in the donation process. Care pathways have the potential to support them, but their effectiveness has been insufficiently explored. Further research should focus on the development and standardization of the clinical content of a care pathway for donation after brain death and the identification of quality indicators. These should be used in a prospective effectiveness assessment of the proposed pathway. Methods: The study recruited active service personnel who were attending mental health services, employed a qualitative design, used semi-structured interview schedules to collect data, and explored these data using interpretative phenomenological analysis IPA.
Results: Five themes emerged about how participants were able to access help; having to reach a crisis point before accepting the need for help, overcoming feelings of shame, the importance of having an internal locus of control, finding a psychological explanation for their symptoms and having strong social support.
Conclusions: This study reported that for military personnel who accessed mental health services, there were a number of factors that supported them to do so. In particular, factors that combated internal stigma, such as being supported to develop an internal locus of control, appeared to be critical in supporting military personnel to engage in help-seeking behaviour.
Service user perspectives on the experience of illness and pathway to care in first-episode psychosis: a qualitative study within the TOP project. Delays in initiating treatment are associated with poor clinical and functional outcomes, yet there remains unclarity as to what facilitates and what acts as barriers to accessing appropriate support for first-episode psychosis. To explore this we examined service users' views of their illness trajectory and help-seeking behavior.
To describe service-users' experiences with and understanding of their illness and pathway to care , including their need for treatment, the role of their relatives and experience with the treatment service. In-depth interviews were conducted with eleven randomly selected service users median age 20, range , 6 males, 5 females diagnosed with a first-episode psychosis and currently enrolled in treatment for this disorder.
Fear of stigma, lack of knowledge about mental illness and normalisation of symptoms were barriers to accessing appropriate treatment, while support from significant others and information accessed by internet were reported as important elements in seeking appropriate treatment. The findings regarding barriers to treatment are in accordance with themes found in earlier studies and serve to validate these.
Our study highlights the need to include psychological factors such as normalisation of symptoms and fear of stigma when attempting to reduce DUP in early psychosis, in addition to initiatives to reduce service delays. Also, a greater use of the potentials inherent in Internet and social media platforms seems important in this regard. Impact of care pathways for in-hospital management of COPD exacerbation: a systematic review.
In-hospital management of COPD exacerbation is suboptimal, and outcomes are poor. Care pathways are a possible strategy for optimizing care processes and outcomes. The aim of the literature review was to explore characteristics of existing care pathways for in-hospital management of COPD exacerbations and to address their impact on performance of care processes, clinical outcomes, and team functioning.
Main inclusion criteria were I patients hospitalized for a COPD exacerbation; II implementation and evaluation of a care pathway ; III report of original research, including experimental and quasi experimental designs, variance analysis, and interviews of professionals and patients about their perception on pathway effectiveness. Four studies with a quasi experimental design were included. Three studies used a pre-post test design; the fourth study was a non randomized controlled trial comparing an experimental group where patients were treated according to a care pathway with a control group where usual care was provided.
The four studied care pathways were multidisciplinary structured care plans, outlining time-specific clinical interventions and responsibilities by discipline. Statistic analyses were rarely performed, and the trials used very divergent indicators to evaluate the impact of the care pathways. The studies described positive effects on blood sampling, daily weight measurement, arterial blood gas measurement, referral to rehabilitation, feelings of anxiety, length of stay, readmission, and in-hospital mortality.
Research on COPD care pathways is very limited. The studies described few positive effects of the care pathways on diagnostic processes and on clinical outcomes. Though due to limited statistical analysis and weak design of the studies , the internal validity of results is limited. Who cares? Pathways to psychiatric care for young people experiencing a first episode of psychosis. The authors reviewed the literature to better understand pathways to psychiatric care among young persons experiencing a first episode of psychosis.
Because no discrete body of literature exists about how young people with psychotic illness gain access to psychiatric services, the authors examined three related areas: illness recognition, help-seeking, and referral pathways. Automated and manual searches of primarily medical and psychological sources from to were conducted. The review found evidence of delay in obtaining early treatment among young people with an emerging psychosis, although comparisons between studies are difficult.
Early psychiatric intervention is believed to significantly aid recovery and is an increasingly important clinical issue. Recognizing psychiatric illness is problematic for professionals and nonprofessionals. Understanding of help seeking by patients experiencing a first psychotic episode and of their referral pathways is limited. Taken together, studies suggest factors affecting access to treatment but provide neither sufficient empirical information nor an adequate conceptual framework to better target secondary prevention strategies.
Formulation of a pathways-to-care model appears to offer a useful way of understanding mental health care use. Exploration of consumer experiences would enrich the model. Strategies to reduce treatment delay could then be developed and evaluated. Increased consumer involvement might help ensure that services are better tailored to patients' needs. Complex care pathways can result in detrimental treatment delay particularly in tuberculosis patients. The purpose of this retrospective study was to assess the care pathways followed by tuberculosis patients prior to diagnosis and to assess impact on the delay for initiation of treatment in Conakry, Guinea.
A total of patients were interviewed at the time of first admission for pulmonary tuberculosis with positive bacilloscopy. Based on interview data, pathways were classified as conventional use of health care facilities only and mixed use of health care facilities, self-medication, and traditional medicine. The correlation between patient characteristics and type of pathway was assessed by univariate and multivariate analysis and the two groups, i.
The care pathway was classified as mixed in two out of three patients. The mean delay for treatment was similar, i. The findings of this study indicate that tuberculosis patients follow a variety of care pathways that can lead to delayed treatment. An information campaign is needed to increase awareness among the population and care providers.
A maturity model for care pathways. Over the last recent decades, increasing the quality of healthcare services while reducing costs has been among the top concerns in the healthcare landscape. Several healthcare institutions have initiated improvement programs and invested considerably in process orientation and management.
This chapter describes career pathways that evolved through a Trade Adjustment Assistance Community College and Career Training consortium grant designed to help students complete programs of study and enter health care careers. The purpose of this study was to develop an integrated care pathway for doctors of chiropractic, primary care providers, and mental health professionals who manage veterans with low back pain, with or without mental health comorbidity, within Department of Veterans Affairs health care facilities.
The research method used was a consensus process. A multidisciplinary investigative team reviewed clinical guidelines and Veterans Affairs pain and mental health initiatives to develop seed statements and care algorithms to guide chiropractic management and collaborative care of veterans with low back pain. A 5-member advisory committee approved initial recommendations. The modified Delphi process was conducted in July to December The final care pathway addressed the topics of informed consent, clinical evaluation including history and examination, screening for red flags, documentation, diagnostic imaging, patient-reported outcomes, adverse event reporting, chiropractic treatment frequency and duration standards, tailored approaches to chiropractic care in veteran populations, and clinical presentation of common mental health conditions.
Care algorithms outlined chiropractic case management and interprofessional collaboration and referrals between doctors of chiropractic and primary care and mental health providers. This study offers an integrative care pathway that includes chiropractic care for veterans with low back pain. Promoting men's participation in unpaid care work is part of the Programme of Action for the International Conference on Population and Development.
However, men's involvement in care work does not mirror the advances women have made in paid work outside the home. This mixed method study explores which men are more involved in caregiving, and what childhood and adulthood factors influence their level of involvement. Quantitative research presents findings from men across six countries with children aged , and a qualitative study presents findings from in-depth interviews with 83 men engaged in atypical caregiving practices.
Survey research finds that being taught to care for children, witnessing one's father take care of one's siblings, respondents' present attitudes about gender equality and having outside help or none, in some cases were all also associated with men's higher level of involvement. Qualitative research reveals that men's experiences of violence, the normalisation of domestic work as children and life circumstances rather than greater-than-average beliefs in gender equality all propelled them into care work. Findings suggest that engaging more men into care work implies changes to policies and structural realities in the workplace coupled with changing gender attitudes.
These insights inform policy and practice aimed at promoting greater involvement in care work by men. Clinical- and cost-effectiveness of the STAR care pathway compared to usual care for patients with chronic pain after total knee replacement: study protocol for a UK randomised controlled trial. There is little evidence for effective interventions for the management of this pain, and current healthcare provision is patchy and inconsistent. Given the complexity of this condition, multimodal and individualised interventions matched to pain characteristics are needed.
We have undertaken a comprehensive programme of work to develop a care pathway for patients with chronic pain after total knee replacement. This protocol describes the design of a randomised controlled trial to evaluate the clinical- and cost-effectiveness of a complex intervention care pathway compared with usual care. This is a pragmatic two-armed, open, multi-centred randomised controlled trial conducted within secondary care in the UK. Patients will be screened at 2 months after total knee replacement and patients with chronic pain at 3 months postoperatively will be recruited.
Recruitment processes will be optimised through qualitative research during a 6-month internal pilot phase. Patients are randomised using a intervention:control allocation ratio. All participants receive usual care as provided by their hospital. The intervention comprises an assessment clinic appointment at 3 months postoperatively with an Extended Scope Practitioner and up to six telephone follow-up calls over 12 months.
In the assessment clinic, a standardised protocol is followed to identify potential underlying causes for the chronic pain and enable appropriate onward referrals to existing services for targeted and individualised treatment. Outcomes are assessed by questionnaires at 6 and 12 months after randomisation. The co-primary outcomes are pain severity and pain interference assessed using the Brief Pain Inventory at 12 months after randomisation. Secondary outcomes relate to resource use, function, neuropathic pain, mental well-being, use of pain medications, satisfaction with pain relief, pain frequency, capability.
Social capital, pathway to care and duration of untreated psychosis Socio-environmental factors are associated with an increased incidence of psychosis and may affect the pathway to care in first-episode psychosis FEP. To determine the relationship between individual- and neighbourhood-level socio-environmental factors household income and rated measures User interface design for mobile-based sexual health interventions for young people: design recommendations from a qualitative study on an online Chlamydia clinical care pathway.
The increasing pervasiveness of mobile technologies has given potential to transform healthcare by facilitating clinical management using software applications. These technologies may provide valuable tools in sexual health care and potentially overcome existing practical and cultural barriers to routine testing for sexually transmitted infections.
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In order to inform the design of a mobile health application for STIs that supports self-testing and self-management by linking diagnosis with online care pathways , we aimed to identify the dimensions and range of preferences for user interface design features among young people. Discussions explored young people's views with regard to: the software interface; the presentation of information; and the ordering of interaction steps.
Discussions were audio recorded and transcribed verbatim. Interview transcripts were analysed using thematic analysis. Four over-arching themes emerged: privacy and security; credibility; user journey support; and the task-technology-context fit. From these themes, 20 user interface design recommendations for mobile health applications are proposed.
For participants, although privacy was a major concern, security was not perceived as a major potential barrier as participants were generally unaware of potential security threats and inherently trusted new technology. Customisation also emerged as a key design preference to increase attractiveness and acceptability.
Considerable effort should be focused on designing healthcare applications from the patient's perspective to maximise acceptability. The design recommendations proposed in this paper provide a valuable point of reference for the health design community to inform development of mobile-based health interventions for the diagnosis.
Process evaluation of the implementation of scorecard-based antenatal risk assessment, care pathways and interdisciplinary consultation: the Healthy Pregnancy 4 All study. To evaluate the implementation of a complex intervention in the antenatal healthcare field in 14 Dutch municipalities. The intervention consisted of the implementation of a systematic scorecard-based risk assessment in pregnancy, subsequent patient-tailored care pathways , and consultations of professionals from different medical and social disciplines.
Saunders's seven-step method was used for the development of a programme implementation monitoring plan, with specific attention to the setting and context of the programme. Data were triangulated from multiple sources, and prespecified criteria were applied to examine the evidence for implementation. A process evaluation of implementation of a complex intervention is possible. The results can be used to improve understanding of the associations between specific programme elements and programme outcomes on effectiveness of the intervention.
Additionally, the results are important for formative purposes to assess how future implementation of antenatal risk assessment can be improved in comparable contexts. Published by Elsevier Ltd. Optimizing a magnetic resonance care pathway : A strategy for radiography managers. Purpose: This study reports the optimization of a local MR care pathway.
A search of the literature did not result in any studies regarding the optimization of MRI care pathways through a formal research process. Discussions with international MR radiographers indicated that such development is often carried out using informal methods that are highly dependent on local conditions, that are rarely reported in the public domain and the validities of which are therefore not open to scrutiny; in addition, care pathways need to be specific to local healthcare needs and culture.
In this study , the authors propose a formal documented methodology for developing a local MRI care pathway based on the well-established nominal group technique. Methods and materials: A nominal group technique was conducted amongst a multi-professional panel. Results: 14 participants accepted the invitation to participate: an executive from the principal public general hospital, a manager from the national Ministry for Health, a service development manager from the allied healthcare professional sector, 2 senior physiotherapists, 3 nursing officers, 3 MRI radiographers, 2 medical physicists, 1 radiologist.
Ten optimization related issues were identified and ranked in order of decreasing importance. Highest ranking scores were assigned to patient safety, education of referrers and use of quality criteria. The NGT method also brought forward novel themes in particular the need for a radiographer's technical report and the need for referrers to indicate pain levels of patients. Conclusion: The design of an MR care pathway was successfully optimized using a collaborative multi-stakeholder approach.
Study of the care pathways is an important topic for care planning, as well as to observe guidelines application. This study aimed to describe care pathways and the period of time between treatments of women with breast cancer BC , at a population level. Women with in situ, local and regional BC who were hospitalized and newly treated in were included and followed for 1 year. Care pathways were described, focusing on surgery partial mastectomy [PM], total mastectomy [TM] , chemotherapy, and radiotherapy. The periods of time between treatments were measured and compared with the guidelines.
The study involved 52, women. The most common care pathways among the women with in situ BC were PM-radiotherapy Among the 41, women with local BC, they were: PM-radiotherapy The French medicoadministrative databases allow the study , at a national population level, of the care pathways and periods of time between treatments of women with BC according to the stage of the disease. They were close to the guidelines, although an improvement is highly necessary. Cost-effectiveness analysis of a postoperative clinical care pathway in head and neck surgery with microvascular reconstruction.
Background The objective of this study is to evaluate the cost-effectiveness of a postoperative clinical care pathway for patients undergoing major head and neck oncologic surgery with microvascular reconstruction. Methods This is a comparative trial of a prospective treatment group managed on a postoperative clinical care pathway and a historical group managed prior to pathway implementation.
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