Author Interviews, Cost of Health Care, JAMA, Medicare, Orthopedics, University of Pennsylvania / 06.01.2017

MedicalResearch.com Interview with: [caption id="attachment_30994" align="alignleft" width="180"]MedicalResearch.com Interview with: Amol Navathe, MD PhD University of Pennsylvania Staff Physician, CHERP, Philadelphia VA Medical Center Assistant Professor of Medicine and Health Policy, Perelman School of Medicine Senior Fellow, Leonard Davis Institute of Health Economics, The Wharton School Co-Editor-in-Chief, HealthCare: the Journal of Delivery Science and Innovatio Dr. Amol Navathe[/caption] Amol Navathe, MD PhD University of Pennsylvania Staff Physician, CHERP, Philadelphia VA Medical Center Assistant Professor of Medicine and Health Policy, Perelman School of Medicine Senior Fellow, Leonard Davis Institute of Health Economics, The Wharton School Co-Editor-in-Chief, HealthCare: the Journal of Delivery Science and Innovation MedicalResearch.com: What is the background for this study? Response: Bundled payments pay a fixed price for an episode of services that starts at hospital admission (in this case for joint replacement surgery) and extends 30-90 days post discharge (30 days in this study). This includes physician fees, other provider services (e.g. physical therapy), and additional acute hospital care (hospital admissions) in that 30 day window.
Author Interviews, Dermatology, Orthopedics / 02.01.2017

MedicalResearch.com Interview with: [caption id="attachment_18200" align="alignleft" width="266"]Psoriasis Psoriasis[/caption] Hsien-Yi Chiu, MD/ Tsen-Fang Tsai, MD Department of Dermatology, National Taiwan University Hospital Taipei, Taiwan MedicalResearch.com: What is the background for this study? What are the main findings? Response: Psoriasis is a chronic, immune-mediated disorder, characterized by red, itchy and scaly skin patches. Over the past several years, accumulating research had shown the effects of psoriasis go far deeper than the skin and psoriasis is associated with multiple comorbidities. Psoriasis shares the inflammatory pathways and several contributing factors with avascular necrosis (AVN), a bone disease presented with death of trabecular bone and collapse of the bony structure. However, previous studies mostly focus on evaluation the increased risk of cardiovascular diseases in patients with psoriasis. No large scale studies have previously explored a potential association between psoriasis and AVN. Our nationwide population-based cohort study investigated this risk in 28268 patients with psoriasis registered in the Taiwan National Health Insurance Research Database. The patients were matched, by age and sex, with 113072 controls without psoriasis. Both the patients and controls were followed to identify those who subsequently diagnosed with an AVN. The results showed that psoriasis was associated with a disease severity–dependent increase in avascular necrosis risk. Moreover, AVN risk was positively associated with male sex, age younger than 30 years, corticosteroid use, severe psoriasis, and concomitant psoriatic arthritis. People with severe psoriasis were 3 times more likely to develop AVN compared with the control group.
Author Interviews, Heart Disease, Occupational Health, Orthopedics / 31.12.2016

MedicalResearch.com Interview with: [caption id="attachment_30872" align="alignleft" width="142"]Kurt T. Hegmann, M.D., M.P.H. Director, Division of Occupational and Environmental Health Chief, Division of Occupational and Environmental Health The University of Utah Health Care Dr. Kurt Hegmann[/caption] Kurt T. Hegmann, M.D., M.P.H. Director, Rocky Mtn. Center for Occupational and Environmental Health Chief, Division of Occupational and Environmental Health The University of Utah Health Care MedicalResearch.com: What is the background for this study? Response: This line of work for us began approximately 20 years ago. Normal tendons never rupture, as the weak point when loading the muscle-tendon unit is either the muscle-tendon junction (i.e., a true muscle strain) or bone-tendon junction. Researchers in the 1960s reported there is poor blood supply in the area of rotator cuff tendon tears, providing one of the two main etiological theories of rotator cuff tears. The other main theory is “impingement syndrome” or a biomechanical impingement in the shoulder joint. Though who experience this might find that they need something similar to this shoulder dislocation surgery. Naturally, both theories could co-exist. Next, we noted rotator cuff tendinitis and shoulder risks from tobacco in other studies. We also reported prior research of increased risks with obesity. These led us to the theory that these rotator cuff tears are likely vascular in etiology. The next problem was to show this.
Author Interviews, BMJ, Orthopedics / 28.12.2016

MedicalResearch.com Interview with: Daniel Bonanno Lecturer & 3rd Year Podiatry Co-ordinator Discipline of Podiatry, College of Science, Health, and Engineering La Trobe University Victoria Australia MedicalResearch.com: What is the background for this study? What are the main findings? Response: Foot orthoses and shock-absorbing insoles are commonly used for the prevention of many musculoskeletal disorders of the lower extremity, so this review summarized the findings of existing clinical trials that evaluated their effectiveness for preventing such injuries. The main findings of our review were that foot orthoses were found to be effective for preventing overall injuries and stress fractures, but not soft-tissue injuries. Regarding shock-absorbing insoles, there is no evidence to date to support their use for the prevention of injury.
Author Interviews, NEJM, Orthopedics, Surgical Research, Thromboembolism / 06.12.2016

MedicalResearch.com Interview with: [caption id="attachment_30279" align="alignleft" width="187"]Suzanne C. Cannegieter, M.D., Ph.D. Einthoven Laboratory Leiden University Medical Center The Netherlands Dr. Suzanne Cannegieter,[/caption] Suzanne C. Cannegieter, M.D., Ph.D. Einthoven Laboratory Leiden University Medical Center The Netherlands MedicalResearch.com: What is the background for this study? What are the main findings? Response: Patients who undergo arthroscopic knee surgery and patients who are treated with casting of the lower leg are at increased risk for venous thromboembolism (VTE). It is uncertain whether thromboprophylaxis is effective in these situations to prevent VTE. For both indications, several trials have been performed to evaluate the effectiveness of anticoagulant prophylaxis. However, an overall risk–benefit balance could not be established because of methodologic shortcomings; hence, there has been reluctance to establish international guidelines regarding the use of anticoagulant therapy for either of these indications.
Author Interviews, Blood Pressure - Hypertension, Bone Density, JAMA, Kaiser Permanente, Osteoporosis, Pharmacology / 22.11.2016

MedicalResearch.com Interview with: [caption id="attachment_29895" align="alignleft" width="200"]Joshua I. Barzilay, MD Kaiser Permanente of Georgia Duluth, GA 30096 Dr. Joshua I. Barzilay[/caption] Joshua I. Barzilay, MD Kaiser Permanente of Georgia Duluth, GA 30096 MedicalResearch.com: What is the background for this study? Response: Hypertension (HTN) and osteoporosis (OP) are age-related disorders. Both increase rapidly in prevalence after age 65 years. Prior retrospective, post hoc studies have suggested that thiazide diuretics may decrease the risk of osteoporosis. These studies, by their nature, are open to bias. Moreover, these studies have not examined the effects of other anti HTN medications on osteoporosis. Here we used a prospective blood pressure study of ~5 years duration to examine the effects of a thiazide diuretic, a calcium channel blocker and an ACE inhibitor on hip and pelvic fractures. We chose these fractures since they are almost always associated with hospitalization and thus their occurrence can be verified. After the conclusion of the study we added another several years of follow up by querying medicare data sets for hip and pelvic fractures in those participants with medicare coverage after the study conclusion.
Author Interviews, Endocrinology, Hormone Therapy, JCEM, Menopause, Osteoporosis / 20.11.2016

MedicalResearch.com Interview with: [caption id="attachment_29927" align="alignleft" width="131"]Dr Georgios Papadakis FMH, Médecin InternenMédecin assistant Service d'endocrinologie, diabétologie et métabolisme Lausanne Dr Georgios Papadakis[/caption] Dr Georgios Papadakis FMH, Médecin InternenMédecin assistant Service d'endocrinologie, diabétologie et métabolisme Lausanne MedicalResearch.com: What is the background for this study? Response: This study was mainly motivated by the absence of available data on the effect of menopausal hormone therapy (MHT) on bone microarchitecture, as well as contradictory results of previous trials regarding the persistence of a residual effect after MHT withdrawal. We performed a cross-sectional analysis of 1279 postmenopausal women aged 50-80 years participating in OsteoLaus cohort of Lausanne University Hospital. Participants had bone mineral density (BMD) measurement by dual X-ray absorptiometry (DXA) at lumbar spine, femoral neck and total hip, as well as assessment of trabecular bone score (TBS), a textural index that evaluates pixel grey-level variations in the lumbar spine DXA image, providing an indirect index of trabecular microarchitecture.
Author Interviews, Orthopedics, Pain Research, Smoking, Surgical Research / 31.10.2016

MedicalResearch.com Interview with: [caption id="attachment_29280" align="alignleft" width="140"]Dr. David Kusin MD University of Nebraska Medical Center Omaha Dr. David Kusin[/caption] Dr. David Kusin MD University of Nebraska Medical Center Omaha MedicalResearch.com: What is the background for this study? What are the main findings? Response: There is a wealth of research showing that cigarette smoking impairs healing through various mechanisms, including microvascular injury. Some evidence also suggests that tobacco use results in direct neurological injury to the peripheral and central nervous systems. Many studies have also shown that smoking reduces fusion rates and time to fusion in orthopedic surgery, including cervical surgery. Prior to our work, only a few high quality studies had been conducted to investigate prognostic factors in patients undergoing surgery for cervical myelopathy, and these identified smoking as a risk factor for a poorer outcome. The purpose of our study was to investigate this relationship further. We conducted a retrospective cohort study of 87 nonsmokers and 47 smokers and correlated postoperative change in Nurick score (a measure of severity of cervical myelopathy from 0-5 with 5 being the worst) with smoking status. After controlling for age, sex, diabetes, duration of preoperative symptoms, severity of preoperative symptoms, signal change on MRI, surgical approach, number of spinal levels operated on, and alcohol use, we found that smokers had a significantly decreased improvement in Nurick score. Nonsmokers improved by 1.5 points whereas smokers only improved by 0.6 points. We also found that this was a dose response relationship, such that those with a history of greater tobacco use by pack years or packs per day had a greater decrease in improvement postoperatively. Interestingly, we found no correlation between tobacco use and preoperative severity of symptoms.
Author Interviews, Hip Fractures, Orthopedics, Surgical Research / 27.10.2016

MedicalResearch.com Interview with: Tom Withers Research Student, School of Health Sciences University East Anglia Norwich, UK MedicalResearch.com: What is the background for this study? What are the main findings? Response: There is a lot of subjective evidence to suggest that physical activity does not improve following hip replacement we wanted to therefore synthesise the current evidence to come to a more objective conclusion. The main finding from this study is that physical activity does not significantly change pre-operatively compared to up to one year post-operatively.
Author Interviews, Endocrinology, Menopause, Osteoporosis / 27.10.2016

MedicalResearch.com Interview with: [caption id="attachment_29173" align="alignleft" width="165"]Pauline Camacho, MD, FACE Professor, Endocrinology Director, Loyola University Osteoporosis and Metabolic Bone Disease Center, Fellowship Program Director, Endocrinology, Medical Director, Osteoporosis Center Dr. Pauline Camacho[/caption] Pauline Camacho, MD, FACE Professor, Endocrinology Director, Loyola University Osteoporosis and Metabolic Bone Disease Center, Fellowship Program Director, Endocrinology, Medical Director, Osteoporosis Center MedicalResearch.com: What is the background for this report? What is the prevalence and significance of osteoporosis in US women? Response: Osteoporosis is widely prevalent and is increasing in prevalence not only in the US but also around the world. 10.2 million Americans have osteoporosis and that an additional 43.4 million have low bone mass. More than 2 million osteoporosis-related fractures occur annually in the US, more than 70% of these occur in women ( from National Osteoporosis Foundation (NOF) estimates).
Author Interviews, Cost of Health Care, Orthopedics / 26.10.2016

MedicalResearch.com Interview with: [caption id="attachment_29160" align="alignleft" width="125"]Kelechi Okoroha, M.D. Orthopaedic Surgery House Officer Henry Ford Health System Dr. Kelechi Okoroha[/caption] Kelechi Okoroha, M.D. Orthopaedic Surgery House Officer Henry Ford Health System MedicalResearch.com: What is the background for this study? What are the main findings? Response: Historically, patient perceptions of surgeon reimbursement have been exaggerated compared with actual reimbursement. Currently there has been an increased focus or reducing health care cost, increasing access to health care and a shift to tie Medicare and insurance reimbursement to quality outcomes. Among these changes was the reduction in reimbursement payments for orthopedic surgeons. When we polled over 200 of our clinic patients, we found that most patients don’t think an orthopedic surgeon is overpaid but they greatly exaggerate how much a surgeon is reimbursed by Medicare for performing knee surgery. When told of the reimbursement payments, patients found them too be low and said they would be willing to pay more out-of-pocket costs. Patients also believe a surgeon should be compensated more for having fellowship training. • Nearly 90 percent of patients say physicians are not overpaid and their salaries should not be cut. • 61 percent of patients say a surgeon’s salary should not be tied to outcomes. • 79 percent of patients say reimbursement to drug and device companies should be reduced.
Author Interviews, BMJ, Orthopedics, Technology / 26.10.2016

MedicalResearch.com Interview with: [caption id="attachment_29117" align="alignleft" width="150"]Jason Busse PhD Associate Professor, Department of Anesthesia McMaster University Hamilton, ON Jason Busse[/caption] Jason Busse PhD Associate Professor, Department of Anesthesia McMaster University Hamilton, ON MedicalResearch.com: What is the background for this study? What are the main findings? Response: Our group previously reviewed the evidence regarding the effectiveness of low-intensity pulsed ultrasound (LIPUS) for fracture healing. We found moderate to very low quality evidence for LIPUS in accelerating functional recovery among patients with fracture, and that most trials only explored effects on surrogate outcomes (e.g. radiographic healing); only five of 13 trials directly assessed functional end points - of these, one was positive. We concluded that large trials of high methodological quality, focusing on patient important outcomes such as quality of life and return to function, were needed to establish the role of LIPUS in fracture healing. We have now completed such a study. Our large, international trial of LIPUS for surgically managed tibial fractures found the addition of LIPUS does not improve functional recovery or accelerate radiographic healing.
Author Interviews, Lancet, Orthopedics, Stem Cells / 21.10.2016

MedicalResearch.com Interview with: [caption id="attachment_29027" align="alignleft" width="100"]Professor Ivan Martin, PhD Department of Surgery and Department of Biomedicine University Hospital Basel University of Basel, Basel, Switzerland Prof. Ivan Martin[/caption] Professor Ivan Martin, PhD Department of Surgery and Department of Biomedicine University Hospital Basel University of Basel Basel, Switzerland MedicalResearch.com: What is the background for this study and new use of autologous nasal chondrocytes? Response: We previously demonstrated that nasal chondrocytes, harvested from the nasal septum, have a larger and more reproducible capacity to form new cartilage than articular chondrocytes, harvested from the knee joint. We further established that the cartilage tissue generated by nasal chondrocytes can respond to physical forces (mechanical loads) similar to articular cartilage and has the ‘plasticity’ to adapt to a joint environment, since it efficiently integrated with surrounding articular cartilage when implanted in goat joints. This was the rationale for using nasal chondrocytes for articular cartilage repair.
Author Interviews, Columbia, NEJM, Orthopedics, Osteoporosis / 21.09.2016

MedicalResearch.com Interview with: [caption id="attachment_28216" align="alignleft" width="118"]MedicalResearch.com Interview with: Felicia Cosman, M.D. Dr. Felicia Cosman[/caption] Felicia Cosman, M.D. Medical Director of the Clinical Research Center Helen Hayes Hospital Professor of Medicine Columbia University College of Physician and Surgeons New York Editor-in-Chief, Osteoporosis International MedicalResearch.com: What is the background for this study? What are the main findings? Response: Amgen and UCB presented detailed data from the Phase 3 FRAME study in an oral session at ASBMR 2016, and the data were also published in the New England Journal of Medicine. Additionally, the FRAME abstract has been awarded the 2016 ASBMR Most Outstanding Clinical Abstract Award. The FRAME data show significant reductions in both new vertebral and clinical fractures in postmenopausal women with osteoporosis. Patients receiving a monthly subcutaneous 210 mg dose of romosozumab experienced a statistically significant 73 percent reduction in the relative risk of a vertebral (spine) fracture through 12 months, the co-primary endpoint, compared to those receiving placebo (fracture incidence 0.5 percent vs. 1.8 percent, respectively [p<0.001]). By six months, new vertebral fractures occurred in 14 romosozumab and 26 placebo patients; between six to 12 months, fractures occurred in two versus 33 additional patients in each group, respectively. Patients receiving romosozumab experienced a statistically significant 36 percent reduction in the relative risk of a clinical fracture, a secondary endpoint, through 12 months compared to those receiving placebo (fracture incidence 1.6 percent vs. 2.5 percent, respectively [p=0.008]). In patients who received romosozumab in year one, fracture risk reduction continued through month 24 after both groups transitioned to denosumab treatment through the second year of the study: there was a statistically significant 75 percent reduction in the risk of vertebral fracture at month 24 (the other co-primary endpoint) in patients who received romosozumab followed by denosumab vs. placebo followed by denosumab (fracture incidence 0.6 percent vs. 2.5 percent, respectively [p<0.001]). Clinical fractures encompass all symptomatic fractures (both non-vertebral and painful vertebral fractures; all clinical fractures assessed in the FRAME study were symptomatic fragility fractures. A 33 percent reduction in relative risk of clinical fracture was observed through 24 months after patients transitioned from romosozumab to denosumab compared to patients transitioning from placebo to denosumab (nominal p=0.002, adjusted p=0.096).
Author Interviews, MRI, Orthopedics, Radiology / 15.09.2016

MedicalResearch.com Interview with: [caption id="attachment_27918" align="alignleft" width="155"]Dr-Muyibat-Adelani.jpg Dr. Muyibat Adelani[/caption] Muyibat Adelani, MD Assistant Professor of Orthopaedic Surgery Washington University St. Louis MedicalResearch.com: What is the background for this study? What are the main findings? Response: In our practice, we noticed that more patients are coming in already having had MRIs. We wanted to know how many people actually had weight-bearing knee x-rays before the MRI. We found that only a quarter of patients had weight-bearing x-rays before the MRI. We found that half of the MRIs obtained prior to referral to an orthopaedic surgeon did not contribute to the patient's treatment.
Author Interviews, JAMA, Orthopedics / 12.09.2016

MedicalResearch.com Interview with: [caption id="attachment_27845" align="alignleft" width="200"]R. Grant Steen, PhD Medical Affairs, Bioventus LLC Durham, North Carolina Dr. R. Grant Steen[/caption] R. Grant Steen, PhD Medical Affairs, Bioventus LLC Durham, North Carolina MedicalResearch.com: What is the background for this study? What are the main findings? Response: When we started this research, it was really only guesswork as to how big a problem fracture nonunion really is. What we've done is to work with an enormous database of patient health claims, with two goals. First, we wanted to characterize how common fracture nonunion is among patients across a wide age range. Second, we wanted to identify risk factors that make a patient more likely to have problems healing. We've now succeeded in both aims. We know that roughly 5% of fracture patients will go to nonunion, and we know a whole host of risk factors that predispose them to do so. Most of the risk factors that we've identified—with a few exceptions—would not be a surprise to physicians who treat fracture patients. However, what we've done is to put all of these risk factors in a broader context, so that we know which risk factors are most important and which are less so. For example, it has been known for a long time that smoking is a risk factor for nonunion. What we've shown is that, in the scheme of things, it's not all that important. Let me be more precise here, because this is an important point. If all you know about a patient is that they smoke, we've shown that smoking is associated with a 62% increase in risk of nonunion. That's a lot. But, as you learn more about that patient and can factor that new knowledge into a risk prediction, it turns out that smoking, all by itself, increases the risk of nonunion by only about 20%. However, smoking is a surrogate marker for a range of other risk factors that also increase risk, including male gender, cardiovascular disease, obesity, vitamin D deficiency, alcoholism, and so on. Once you factor these separate risk factors into your new nonunion prediction, you have a much more nuanced—and probably much more accurate—prediction of nonunion risk.
Author Interviews, Columbia, Depression, Nature, Orthopedics, Pharmacology / 09.09.2016

MedicalResearch.com Interview with: [caption id="attachment_27772" align="alignleft" width="157"]Patricia Ducy, PhD Associate Professor Department of Pathology & Cell Biology Columbia University New York, NY 10032 Dr. Patricia Ducy[/caption] Patricia Ducy, PhD Associate Professor Department of Pathology & Cell Biology Columbia University New York, NY 10032 MedicalResearch.com: What is the background for this study? Response: In the past few years, several large clinical studies have reported an association between the use of selective serotonin reuptake inhibitors (SSRIs) and an increased risk of bone fractures. Yet, a few studies conducted on small cohorts using these drugs for a short time showed a decrease in bone resorption parameters and thus minor bone gain. To understand this paradox and to define how the deleterious effect of SSRIs could be prevented we conducted a series of studies in mice treated with fluoxetine, the active molecule of the widely prescribed SSRI Prozac.
Author Interviews, Orthopedics / 26.08.2016

MedicalResearch.com Interview with: [caption id="attachment_27341" align="alignleft" width="125"]Brandon J. Erickson, MD Midwest Orthopaedics Rush, Rush University Medical Center Chicago, IL Dr. Brandon Erickson[/caption] Brandon J. Erickson, MD Midwest Orthopaedics Rush, Rush University Medical Center Chicago, IL MedicalResearch.com: What is the background for this study? What are the main findings? Response: Ulnar collateral ligament reconstruction (UCLR), also known as Tommy John surgery has become a common procedure amongst major league baseball (MLB) pitchers. It is unclear if a limit on innings pitched following Tommy John surgery should be instituted to prevent revision Tommy John surgery. The purpose of this study was to determine if innings pitched following Tommy John surgery is associated with an increased risk of revision Tommy John surgery amongst MLB pitchers. To answer this question we located all MLB pitchers between 1974-2015 who pitched at least one full season following their Tommy John surgery and included them in our analysis. Pitch counts and innings pitched for the first full season following Tommy John surgery as well as total pitch count and total innings pitched over the course of the player’s career were recorded. Pitch counts and innings pitched were compared amongst players who required revision Tommy John surgery and those who did not. We were able to include 154 pitchers. Of these, 135 pitchers did not require revision Tommy John surgery while 19 underwent revision Tommy John surgery.  No significant difference existed between pitchers who underwent revision Tommy John surgery and those who did not when comparing number of innings pitched in the season following Tommy John surgery,  number of pitches thrown in the season following Tommy John surgery,  number of innings pitched in the pitcher’s career following Tommy John surgery and number of pitches thrown in the pitcher’s career following Tommy John surgery.  Furthermore, no difference existed in revision rate between pitchers who pitched more or less than 180 innings in the first full season following Tommy John surgery.
Author Interviews, Frailty, Hip Fractures, JAMA, Pharmacology / 22.08.2016

MedicalResearch.com Interview with: [caption id="attachment_27214" align="alignleft" width="160"]Jeffrey Munson, MD, MSCE Assistant Professor The Dartmouth Institute for Health Policy & Clinical Practice Assistant Professor, Department of Medicine Geisel School of Medicine at Dartmouth Dr. Jeffrey Munson[/caption] Jeffrey Munson, MD, MSCE Assistant Professor The Dartmouth Institute for Health Policy & Clinical Practice Assistant Professor, Department of Medicine Geisel School of Medicine at Dartmouth MedicalResearch.com: What is the background for this study?  Response: Fragility fractures due to osteoporosis are a common and costly event among older Americans. Patients who experience one fragility fracture are at increased risk to have a second fracture. Our group is interested in exploring ways in which the risk of a second fracture could be reduced. In this paper, we studied prescription drug use both before and after fracture. We know many prescription drugs have been shown to increase the risk of fracture, but we don’t know whether doctors try to reduce the use of these drugs after a fracture has occurred. Our study was designed to answer this question.
Author Interviews, Diabetes, Orthopedics / 08.08.2016

MedicalResearch.com Interview with: [caption id="attachment_26825" align="alignleft" width="133"]Patrick Griffin, PhD Professor Department of Molecular Therapeutics The Scripps Research Institute Florida Campus Dr. Patrick Griffin[/caption] Patrick Griffin, PhD Professor Department of Molecular Therapeutics The Scripps Research Institute Florida Campus MedicalResearch.com: What is the background for this study? Response: Over the past decade, our laboratory and that of TSRI Associate Professor Theodore Kamenecka, have focused on molecules that increase sensitivity to insulin. Using newly discovered information, we have made significant advances in developing a family of drug candidates that target a receptor known as peroxisome proliferator-activated receptors gamma (PPARγ), a key regulator of stem cells controlling bone formation and bone resorption and a master regulator of fat.
Author Interviews, Orthopedics, Science, Technology / 21.07.2016

MedicalResearch.com Interview with: [caption id="attachment_26353" align="alignleft" width="191"]Emilia Morosan PhD, Professor Rice University Physics and Astronomy Houston TX 77005 Dr. Emilia Morosan[/caption] Emilia Morosan PhD,  Professor Rice University Physics and Astronomy Houston TX 77005 MedicalResearch.com: What is the background for this study? What are the main findings?  Dr. Morosan: My group works mainly on searching for compounds with magnetic properties. The first step in the characterization of such compounds is powder X-ray diffraction, which requires grinding the samples to fine powder. When we discovered such a compound based on (titanium) Ti and (gold) Au, we were unable to grind it because of its apparent hardness. This prompted the hardness measurement on the magnetic compound (with equal amounts of Ti and Au) and also on other mixtures of the two metals. The main result of this study was that the particular compound beta-Ti3Au was the hardest among all Ti-Au mixture in our study and compared to previous hardness measurements on these binary alloys. Most remarkable was the four-fold increase in hardens in beta-Ti3Au over Ti, or most other biocompatible engineering alloys. Furthermore, beta-Ti3Au also has higher wear resistance, meaning its durability extends beyond that of other alloys.
Author Interviews, Exercise - Fitness, Orthopedics / 13.07.2016

MedicalResearch.com Interview with: Dr. Marcos Muñoz Jimenez University of Jaén MedicalResearch.com: What is the background for this study? What are the main findings? Response: Barefoot running has become very popular in recent years and remains a hotly debated topic among runners. The debate about the pros and cons of barefoot running is current. Many coaches consider barefoot training to have an effect on muscle strength and to be important for performance and for preventing injuries. The main objective of this study is to determine what changes in foot strike, inversion-eversion and foot rotation are produced after a 12-week programme of barefoot running with progressive volume at the end of the athletes daily training session. Our data support that a 12-week programme of barefoot running training, applied by progressively increasing the volume of barefoot running, causes significant changes to foot strike patterns with a tendency towards midfoot strike, regardless of running speed.
Author Interviews, Orthopedics / 11.07.2016

MedicalResearch.com Interview with: Dr. Duong Nguyen, Medicine Professional Corporation MD,MSc(c),FRCSC,DipABOS,DipSportsMed(ABOS),FAAOS,CIME [caption id="attachment_26002" align="alignleft" width="147"]Dr. Duong Nguyen Medicine Professional Corporation MD,MSc(c),FRCSC,DipABOS,DipSportsMed(ABOS),FAAOS,CIME,DipSportMed(CASEM) Diplomate of the American Board of Orthopaedic Surgery Subspecialty Board Certification in Sports Medicine (ABOS) Fellow of the American Academy of Orthopaedic Surgeons (FRCSC/AAOS) Certified Independent Medical Examiner (ABIME) Diplomate Sport & Exercise Medicine (CASEM) Arthroscopic & Reconstructive Shoulder,Elbow & Knee Surgery Medical Director / Urgent Sports Injury & Fracture Clinic MSc Candidate/ Clinical Epidemiology & Health Research Methodology Adjunct Clinical Professor - McMaster University Toronto, ON. Dr. Duong Nguyen[/caption] Diplomate of the American Board of Orthopaedic Surgery Subspecialty Board Certification in Sports Medicine Fellow of the American Academy of Orthopaedic Surgeons Certified Independent Medical Examiner (ABIME) Diplomate Sport & Exercise Medicine (CASEM) Arthroscopic & Reconstructive Shoulder,Elbow & Knee Surgery Medical Director / Urgent Sports Injury & Fracture Clinic MSc Candidate/ Clinical Epidemiology & Health Research Methodology Adjunct Clinical Professor - McMaster University Toronto, ON. MedicalResearch.com: What is the background for this study? What are the main findings? Response: ACL re-tear after surgery is a serious complication in the sports medicine world with many implications for the athlete such as lost game time, the morbidity of a second surgery and extended rehabilitation, lost scholarship, decreased self esteem and social isolation,as well as decreased academic performance. We found in our study that athletes who are less than 25, are female, and have a graft size less than 8 mm are at increased risk for ACL re-tear after surgery.
Author Interviews, Exercise - Fitness, Orthopedics / 19.05.2016

MedicalResearch.com Interview with: [caption id="attachment_24498" align="alignleft" width="171"]Robert Keller, M.D., Chief resident Department of Orthopedic Surgery Henry Ford Hospital Detroit Dr. Robert Keller[/caption] Robert Keller, M.D., Chief resident Department of Orthopedic Surgery Henry Ford Hospital Detroit MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Keller:  Injuries to the medial ulnar collateral ligament (the ligament torn in pitchers requiring tommy john surgery) are common in overhead-throwing athletes. Recent data supports that the number of MLB pitchers requiring tommy john surgery continues to increase, with estimates near 25% of all MLB pitchers undergoing tommy john surgery.   Recent investigations have attempted to analyze factors that contribute to UCL injuries with the aim to decrease the rate of injury. Studies have suggested that possible risk factors include pitching mechanics, pitch type (curve ball, fastball, etc), g, pitching fatigue, chronic overuse, and pitch velocity, among other factors. Specifically, increased pitch velocity has been implicated as a risk factor for UCL injury.  However, no study has exclusively attempted to assess whether MLB pitchers who required Tommy John surgery pitch at a higher velocity than those that do not. Pitch type (fastball, curveball, slider, etc) is another significant factor that has been investigated as a contributor to UCL injuries. Various biomechanical studies have attempted to correlate pitch types with torque across the throwing elbow, with contrasting results: some suggest fastballs create more torque, whereas others found off-speed pitches produce increased stresses. Beyond not evaluating MLB pitchers, these previous studies also failed to evaluate the volume or amount of a specific pitch type thrown by these pitchers that may contribute to UCL injuries.
Author Interviews, Orthopedics, Osteoporosis / 20.04.2016

MedicalResearch.com Interview with: [caption id="attachment_23574" align="alignleft" width="142"]Professor Nicholas C W Harvey, MA MB BChir PhD FRCP Professor of Rheumatology and Clinical Epidemiology Honorary Consultant Rheumatologist MRC Lifecourse Epidemiology Unit University of Southampton Southampton General Hospital Southampton UK Prof. Harvey[/caption] Professor Nicholas C W Harvey, MA MB BChir PhD FRCP Professor of Rheumatology and Clinical Epidemiology Honorary Consultant Rheumatologist MRC Lifecourse Epidemiology Unit University of Southampton Southampton General Hospital Southampton UK MedicalResearch.com: What is the background for this study? What are the main findings? Prof. Harvey:  It is well established that fracture risk is substantially increased by having had a previous fracture. A previous study suggested that fracture risk soon after a spine fracture might be greater than the risk later on, and if the risk varies with time, it would be sensible to identify the time at greatest risk, so intervention can be given. The risk of a second osteoporotic fracture was greatest immediately after the first fracture and thereafter decreased with time though remained higher than the population risk throughout follow up. For example, 1 year after the first fracture the risk of a second fracture was three times higher than the population risk. After 10 years it was two times higher.
Author Interviews, Bone Density, Endocrinology, Hip Fractures, Pharmacology / 08.04.2016

MedicalResearch.com Interview with: [caption id="attachment_23284" align="alignleft" width="151"]Bente Langdahl Professor, Consultant, PhD, DMSc Department of Endocrinology and Internal Medicine THG Aarhus University Hospital Aarhus Denmark Dr. Bente Langdahl[/caption] Bente Langdahl Professor, Consultant, PhD, DMSc Department of Endocrinology and Internal Medicine THG Aarhus University Hospital Aarhus Denmark MedicalResearch.com: What is the background for this study? What are the main findings? Response: Romosozumab is a humanised antibody against sclerostin currently in development for the treatment of osteoporosis. Romosozumab has a dual effect on bone; it stimulates bone formation and inhibits bone resorption. If this new treatment obtains regulatory approval and becomes available for the treatment of osteoporosis, some of the patients who will be candidates for this new treatment will already have been treated with other available treatments, for example, bisphosphonates. This study compared the effects of romosozumab and teriparatide, a currently available bone forming treatment, on bone mass, bone structure and bone strength. The results showed that the percent change from baseline in BMD at the total hip through month 12 (the primary endpoint) was significantly greater with romosozumab compared with teriparatide: 2.6 percent versus –0.6 percent, respectively (p<0.0001). For the secondary endpoints; lumbar spine BMD by DXA, total hip and femoral neck BMD by DXA and QCT and bone strength estimated by finite element analysis patients treated with romosozumab had significantly larger increases from baseline compared with those taking teriparatide, with mean differences ranging from 3.1 percent to 4.6 percent (all p-values <0.0001).
Author Interviews, Medical Imaging, NYU/NYMC, Orthopedics, Radiology / 18.03.2016

MedicalResearch.com Interview with: [caption id="attachment_22716" align="alignleft" width="133"]Sanjit Konda, MD Assistant professor of orthopaedic surgery NYU Langone Medical Center Dr. Sanjit Konda[/caption] Sanjit Konda, MD Assistant professor of Orthopaedic surgery NYU Langone Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Konda: We serendipitously found that we could identify periarticular fractures associated with deep knee wounds with the use of a CT-scan. We published a study in the Journal of Orthopaedic Trauma showing that a CT scan could identify a traumatic arthrotomy of a joint better than a saline load test, which at the time was considered the diagnostic gold standard. When we presented that work, we received criticism that we were subjecting patients to a high dose of radiation for a diagnostic test; however, our rationale at the time was that the saline load test was a painful, invasive procedure using a needle, and that we would trade a bit of radiation for lack of invasive procedure. This got us thinking of ways we could decrease the amount of radiation in the CT yet maintain the same diagnostic accuracy of identifying penetrating joint injuries. Collaborating with Dr. Soterios Gyftopoulos, an assistant professor in the Department of Radiology at NYU Langone, we were able to successfully reduce the amount of radiation in these CT scans and still get good bony images. We then thought, if we can get a CT scan that shows us good bony detail and is safer, then why shouldn’t we be doing it on every joint fracture, not just these arthrotomy cases? We then applied this to our current research protocol, REDUCTION(Reduced Effective Dose Using Computed Tomography In Orthopaedic Injury) in which we reduced the average amount of radiation from 0.43 msV to 0.03 msV, or down to the average dose given in a routine chest X-ray. After running a comparison study with our ultra-low dose radiation protocol compared to conventional CT scans, we found we were able to obtain nearly the exact same types of images for various joint fractures and locations without sacrificing any diagnostic accuracy in most cases. We gave sets of these CT scans to orthopaedic surgeons to analyze, and found we achieved 98 percent sensitivity and 89 percent specificity with the ultra-low dose CT scans when occult fractures, or those that could not be seen on an X-ray, were removed from our analysis.
Author Interviews, Hospital Readmissions, JAMA, Orthopedics, Surgical Research / 11.03.2016

MedicalResearch.com Interview with: [caption id="attachment_22572" align="alignleft" width="120"]Chairman and Surgeon-in-Chief Department of Surgery Saint Barnabas Medical Center Professor of Surgery New Jersey Medical School Rutgers University Dr. Ronald Chamberlain[/caption] Ronald S. Chamberlain, MD, MPA, FACS Chairman and Surgeon-in-Chief Department of Surgery Saint Barnabas Medical Center Professor of Surgery New Jersey Medical School Rutgers University MedicalResearch.com: What is the background for this study? Dr. Chamberlain:  With the rapidly growing arthritic, aging, and obese population, total hip replacement (THR) has become the most commonly performed orthopedic procedure in the United States (US).  The Affordable Care Act signed by President Barack Obama imposed financial penalties for excess readmissions following certain procedures and diagnoses. While the initial program aimed to reduce readmissions for heart failure, pneumonia, and acute myocardial infarction (AMI), the program expanded to include THR in 2015. With current research estimating a 10%, 30-day readmission rate following a total or partial hip replacement, this study sought to identify factors associated with readmission and to create a scale which could reliably stratify preoperative readmission risk.
Author Interviews, BMJ, Exercise - Fitness, Orthopedics / 10.03.2016

MedicalResearch.com Interview with: David Morrissey MB PhD FRCS (Tr&Orth) Orthopaedic Specialist Registrar  MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Morrissey: Injury rates in rugby union have increased substantially over the past twenty years, both in the professional and amateur game. The pattern of injury has also changed, reflecting higher grades of trauma. Our institution is a tertiary referral centre for pelvic and acetabular trauma serving a population of 4.5 million. The majority of our cases occur as a result of high velocity trauma such as road traffic accidents. We have not previously seen hip dislocations/acetabular fractures occurring secondary to sporting participation. In the past number of years, however, we have identified four such injuries in three juvenile patients, that occurred during rugby union participation. These injury patterns may have sub-optimal outcomes in up to 30% of patients and can severely affect a young person’s life. The demographic change may be due to changes in the physical development of players as well as an increased emphasis on the tackle/ruck area. In the juvenile game, differing rates of maturation magnify size differences between players, potentially increasing the risk of injury.
Author Interviews, Cost of Health Care, Medicare, NYU/NYMC, Orthopedics / 04.03.2016

MedicalResearch.com Interview with: [caption id="attachment_22312" align="alignleft" width="200"]Richard Iorio, MD Dr. William and Susan Jaffe Professor of Orthopaedic Surgery Chief of the Division of Adult Reconstructive Surgery NYU Langone Medical Center Dr. Richard Iorio[/caption] Richard Iorio, MD Dr. William and Susan Jaffe Professor of Orthopaedic Surgery Chief of the Division of Adult Reconstructive Surgery NYU Langone Medical Center  MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Iorio: NYU Langone Medical Center’s Department of Orthopaedic Surgery realized early that alternate payment strategies based on value rather than volume were going to be increasing in prevalence and represent the future of compensation strategies  As leaders in orthopaedics, we knew that we must embrace this change and develop strategies and effective protocols to successfully navigate this alternative payment universe. In 2011, NYU Langone’s Hospital for Joint Diseases was chosen as a pilot site for CMS’s Bundled Payment Care Initiative, focusing on Medicare patients undergoing a total joint replacement. Beginning in 2013, we implemented protocols developed at our hospital focusing on preoperatiive patient selection criteria in an effort to ensure better outcomes for Medicare patients who underwent total joint replacements. Under a bundled payment program, hospitals assume financial responsibility for any complications over the entire episode of care 90 days after surgery, including postsurgical infections and hospital readmissions. We compared year over year outcomes from year 1 to year 3 of this program, and found:
  • Average hospital length of stay decreased from 3.58 days to 2.96 days;
  • Discharges to inpatient rehabilitation or care facilities decreased from 44 percent to 28 percent;
  • Average number of readmissions at 30 days decreased from 7 percent to 5 percent; from 11 percent to 6.1 percent at 60 days; and from 13 percent to 7.7 percent at 90 days;
  • The average cost to CMS of the episode of care decreased from $34,249 to $27,541 from year one to year three of the program.