Background
We evaluated an extended role for the physiotherapist in primary care in referring patients to plain X-ray.
Methods
This prospective cohort study was set in a single region in Sweden. It included 20 physiotherapists who were educated in a one-day training in performing referral to X-ray, along with 107 patients with musculoskeletal disorders who were referred to X-ray. We evaluated that referral quality, patient and physiotherapist satisfaction, and calculated health care and patient costs.
Results
All referrals fulfilled the basic requirements of quality, and 78% were classified as good, fulfilling all criteria. Both patients and physiotherapists were satisfied with the extended role for the physiotherapist that decreased waiting time to diagnosis and to adequate treatment. Costs were reduced for patients (by €53/patient) and health care (by €6286.2/107 patients). The cost to visit a physician was twice that of a physiotherapist visit.
Conclusions
An extended role for physiotherapists in primary care in referring patients to X-ray was effective and safe for patients and reduced costs for patients and for health care. Physiotherapists in primary care were able to refer patients to X-ray after one day of training, and the extended role freed up 45 minutes of physician time for each patient with a musculoskeletal disorder in need of an X-ray.
This paper focuses on the technological characteristics of Keilmesser with a lateral tranchet blow modification on the cutting edge. It examines the underlying technological production of these bifacial objects: this implies the evaluation of their working stage succession, as well as produced forms necessary for the execution of tranchet blow performance. Furthermore, it offers a techno-morphological description of these enigmatic tools. The Keilmesser with tranchet blow and corresponding blanks of tranchet blows from Grotte de la Verpillière I in Germolles (Saône-et-Loire, France) are used as case study. The collection of Keilmesser with tranchet blow and corresponding blanks of tranchet blow has been massively expanded with new fieldwork and the review of ancient assemblages. The majority of the pieces were made on blanks from local raw material. The evaluation of the underlying production concept shows that a Keilmesser with tranchet blow, regardless of the wide range of morphologies and matrix size, always consists of specific parts that are necessary for the production sequence and the assumed function. The production of these pieces follows highly specific working stages, some of which can be interchanged in sequence. However, it is always the goal to obtain a low-angled cutting edge. The performance of a tranchet blow is not only an integral part of production, but it is rather the aim of the entire production.
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