A proposal for an alcohol purchase license

ABSTRACT

Background: Recent advances in technology have allowed for innovative targeting of high-risk alcohol users.

Objectives: We propose the implementation of an alcohol purchase license linked to a state agency managed database, or so-called Banned Drinker Register (BDR).

Methods: Individuals who are unable to drink safely will be identified by a well-founded criterion and their ability to purchase alcohol proscribed. A state agency will be responsible for maintaining the BDR and compiling mandated reports from hospitals, courts, police and child protective agencies of alcohol-related dangerous behavior, adjudicating reports with the input of those involved in these events, and determining which individuals will not be allowed to purchase alcohol. Outlets of alcohol sales will then be required to assess customers for eligibility of alcohol purchase using an electronic card reader (as used for age verification). Individuals wanting to protect themselves from drinking may also self-request to be placed on the BDR.

Results: Overall, the convenience/access for persons who injure themselves with alcohol and others with intoxicated behavior would be reduced. Opportunities for cost savings would come from a decrease in yearly incarcerations, a reduction in preventable traffic accidents and property damage requiring state municipal intervention, a decreased cost to offending individuals by preventing increased insurance rates, loss of jobs to incarceration and loss of potential future wages, and the possibility of preventing long term medical complications of chronic alcohol use and its toll on the health care system.

Conclusions: Health benefits will include increased public safety and awareness about drinking consequences and reduced alcohol-related morbidity and mortality.     

Survival Rate and Application Number of Total Hip Arthroplasty in Patients With Femoral Neck Fracture: An Analysis of Clinical Studies and National Arthroplasty Registers

BackgroundTotal hip arthroplasty (THA) is an increasingly popular treatment option for fractured neck of femur (NOF). The primary aim of this study is to systematically review all literature on primary THA and hemiarthroplasty (HA) after fractured NOF to calculate an overall revision rate. Furthermore, we wanted to compare primary THA implantations after fractured NOF between different countries in terms of THA number per inhabitant.MethodsAll clinical studies on THA and HA for femoral neck fractures between 1999 and 2019 were reviewed and evaluated with a special interest on revision rate. Revision rate was calculated as “revision per 100 component years.” THA registers were compared between different countries with respect to the number of primary implantations per inhabitant.ResultsTHA studies showed a mean revision rate of 11.8% after 10 years, which was lower than a 24.6% 10-year revision rate for HA. We identified 8 arthroplasty registers that revealed an annual average incidence of THA for fractured NOF of 9.7 per 100,000 inhabitants.ConclusionThis study showed that patients with THA were less likely to be revised at 10 years compared to HA. We found similar annual numbers of THAs for fractured NOF per inhabitant across countries. The results of this analysis can be used to rank present and future national THA numbers within an international context.     

Risk factors for total ankle arthroplasty failure: A Dutch Arthroplasty Register study

BackgroundStudies concerning total ankle arthroplasty could be influenced by several forms of bias. Independent national arthroplasty registries represent objective data on survival and patient reported outcomes. The aim of this study was to determine survival and identify risk factors for early failure in a nationwide series of total ankle arthroplasties from the Dutch Arthroplasty Register (LROI).Patients and methodsData of 810 patients, who received 836 total ankle arthroplasties between 2014 and 2020 were obtained from the Dutch Arthroplasty Register (LROI) with a median follow-up of 38 months (range 1–84 months). Survival was expressed in Kaplan-Meier analysis and associated hazard ratios for implant failure were determined. Implant failure was defined as the need for revision surgery for any reason or (pan)arthrodesis.ResultsDuring follow-up, we recorded 39 failures (4.7%) resulting in a implant survival of 95.3% with a median follow-up of 38 months (range 1–84 months). Medial malleolus osteotomy (HR = 2.27), previous surgery (HR = 1.83), previous osteotomy (HR = 2.82) and previous ligament reconstruction (HR = 2.83) all showed potentially clinically meaningful associations with a higher incidence of implant failure, yet only previous OCD treatment (HR = 6.21), BMI (HR = 1.09) and age (HR = 0.71) were statistically significant.InterpretationExcellent short-term survival (95.3%) with a median follow-up of 38 months was reported for TAA patients from the Dutch Arthroplasty Register. Patients with a lower age, a higher BMI or who had a prior surgical OCD treatment before TAA surgery appear to have a higher risk for revision after short-term clinical follow-up. Thorough patient selection with emphasis on risk factors associated with early implant failure might be essential to improve TAA survivorship.     

An evaluation of the experiences of academics and practice educators who supported radiography students working on the temporary HCPC register during the COVID-19 pandemic

IntroductionThe COVID-19 pandemic has had a profound impact on all those residing in the United Kingdom, resulting in unprecedented changes being made to the education and training of healthcare students. Universities and practice partners had to respond quickly and work in close collaboration with Health Education England, to ensure the changes brought in by the Health and Care Professions Council (HCPC) emergency measures were implemented.The aim of this study was to explore the experiences of staff supporting final year diagnostic and therapeutic radiography students who joined the HCPC register early during phase one of the COVID-19 pandemic.MethodsThis study was informed by a phenomenological approach, in which a purposeful sample of eight participants comprising of six practice educators (PEs) and two academics. Semi-structured interviews and focus groups were conducted to collect the data via a virtual platform.ResultsThe results highlighted three themes, Competence and the transition to registration, Support mechanisms and Communication. Both academics and PEs described how they observed the new registrants gaining confidence and competence during their time on the temporary register and suggested that professional bodies could consider curriculum changes to encompass a final transitional placement similar to their experience. They suggested that having robust support mechanisms and communication in place are essential for the success of this initiative.ConclusionThe results provide insight into how PEs and academics supported new registrants to meet the necessary requirements of the HCPC register whilst working during the first phase of the COVID-19 pandemic. They highlight the importance of having robust support mechanisms and good communication in place to achieve this.Implications for practiceSome consideration could be made to changing the curriculum in the future to allow for early temporary registration and paid Band 4 final placements for students working as assistant practitioners.