Orthopedics
22 Jul No Association Between Kidney Stones and Osteoporosis or Fractures in Women
MedicalResearch.com Interview with:
Monique Bethel, MD
Subspecialty Service, Department of Veterans Affairs Medical Center,
Department of Medicine, Section of Rheumatology
Georgia Regents University
Augusta, GA
MedicalResearch: What is the background for this study?
Dr. Bethel: Osteoporosis and kidney stones share several risk factors, including elevated calcium in the urine (hypercalciuria), low potassium intake, and possibly, diets high in sodium. Accordingly, several studies have shown a significant relationship between kidney stones and osteoporosis in men. However, it is unclear if this relationship is also true for women. Previous studies examining this association have been small and inconclusive. With the Women’s Health Initiative, we had data available from approximately 150,000 postmenopausal women in the US. Using this database, we were able to study the relationship between kidney stones and changes in bone mineral density and fractures.
MedicalResearch: What are the main findings?
Dr. Bethel: We found no association between the presence of kidney stones and changes in bone mineral density over time at the hip, lumbar spine, or the whole body. Also, there was no association between the presence of kidney stones and fractures. We also found that 14% of women who had a history of kidney stones upon entering the studies had another one occur during the course of the study (approximately 8 years).
20 Jul Non-Psychotropic Cannabis Extract May Promote Bone Healing
MedicalResearch.com Interview with:
Yankel Gabet, DMD, PhD
Department of Anatomy and Anthropology
Sackler Faculty of Medicine, Tel Aviv University
Tel Aviv Israel
Medical Research: What is the background for this study? What are the main findings?
Dr. Gabet: Cannabis affects the body via specific components that are able to binding to receptors in the brain and other tissues. The components include the well-known ?9-tetrahydrocannabinol (THC) and cannabidiol (CBD), the major constituents of cannabis. The cannabinoid receptors in our body are activated by several molecules (‘endocannabinoids’) synthesized by different sorts of cells under specific conditions. These receptors can be activated by synthetic compounds (cannabinoid ligands) as well as by natural cannabis. The effect of endocannabinoids in bone metabolism has been studied before but this study is the first report on the actions of natural THC and CDB in bone fracture healing. This is particularly important in light of the high incidence of both cannabis use and bone fractures; it is likely that many patients suffering from bone fractures consume cannabis that may have beneficial or adverse effects on the healing process. Another important point is that the non-psychogenic CDB is enough to promote bone healing, so there is no need to be exposed to the euphoric effects of cannabis/THC to get the beneficial functions of CBD on bone. (You can buy cbd oil online to help with other conditions as well such as fibromyalgia and diabetes.) If you are interested in learning more about CBD/THC and its products there are places online where you can find information, for example, from an online cbd store, a CBD Blog and other resources.
13 Jul Athletes With Shoulder Instability Better Able To Return To Sport After Arthroscopic Repair
MedicalResearch.com Interview with:
Brett D. Owens, MD
Professor of Orthopaedic Surgery
Brown University Alpert Medical School
Providence, RI
Medical Research: What is the background for this study? What are the main findings?
Response: Last year at this meeting we presented the results of a prospective multicenter study of collegiate contact athletes who experienced in-season shoulder instability events. While most were able to return to sport within a week, only roughly one quarter were able to successfully return without recurrent instability. We continued to follow this cohort and 39 athletes with additional eligibility the subsequent season. We found that 90% of the 29 who underwent arthroscopic stabilization successfully returned the next season compared with 40% of the 10 underwent nonoperative treatment
26 Jun Menopausal SSRIs Increases Risk of Bone Fractures
MedicalResearch.com Interview with: Dr Matthew Miller Department of Health Science Northeastern University Department of Health Policy and Management, Harvard T.H. Chan School of Public Health Harvard University Boston, Massachusetts and Yi-Han Sheu Department of Epidemiology Harvard T.H. Chan School of Public Health Harvard University Boston, Massachusetts Medical Research: What is the background for this study? Response: Selective serotonin reuptake inhibitors (SSRIs) were recently approved by the FDA to treat vasomotor symptoms associated with menopause. No prior study has directly examined whether fracture risk is increased among perimenopausal women who initiate SSRIs or among a population of women without mental disorders more generally.. Medical Research: What are the main findings? Response: We found that SSRIs treatment for non-psychiatric conditions at doses customarily used to treat depression is, all else equal, associated with higher rates of fractures -- an effect that first became evident several months after beginning treatment and, importantly, persisted over the five year study period.12 Jun More Screen Time Linked To Lower Bone Mass In Boys
MedicalResearch.com Interview with:
Anne Winther Msc
Department of Health and Care Sciences, UiT The Arctic University of Norway
Division of Rehabilitation Services, University Hospital of North Norway, Tromsø, Norway
Medical Research: What is the background for this study? What are the main findings?
Response: Norway has one of the highest reported incidences of osteoporotic fractures in the world. Research on fracture risk has primarily focused on bone mass in the elderly. However, there is a growing awareness of the importance of bone mass during growth as a compensation for the inevitable bone loss and prevention of fractures in the elderly . A recent study on Norwegian adolescents´ lifestyle and bone health concluded that peak bone mass seem to be modifiable by lifestyle factors as higher physical activity levels were strongly associated with bone mass. The other way around; low levels of physical activity may have considerable negative effects on bone health, and increasing sedentary behavior in place of sports and play during growth is worrying. In this study we explored the associations between self-reported hours spent in front of television/computers during weekends along with self reported hours spent on leisure time physical activities and bone mass density (BMD) levels at the hip. This population based study, Fit Futures 1 consisting of 388 girls and 359 boys 15-17 years old was conducted in 2010/2011, and repeated two years later including 66% of the original cohort (Fit Futures 2; 312 girls and 231 boys).
Boys spent more time in front of computers and television than girls; approximately 5 and 4 hours, compared with 4 and 3 hours daily in weekends and weekdays, respectively.
Physical activity levels were adversely related to leisure time computer use at weekends. However, 20 % of the girls and 25 % of the boys balanced 2-4 hours in front of the screen daily with more than 4 hours of sports and hard training per week.
Screen time at weekends was negatively associated with bone mass density levels in boys and positively in girls, after adjustments of several confounders known to affect bone, including age, puberty, physical activity levels and weekday screen time.
Moreover; these contrasting patterns persisted two years later.
02 Jun US Surgery Patients Report More Pain, Receive More Opioids
MedicalResearch.com Interview with: Winfried Meissner, M.D. Dep. of Anesthesiology and Intensive Care Jena University Hospital University Hospital Jena, Germany Medical Research: What is the background for this study? Dr. Meissner: Post-operative pain is managed inadequately worldwide. There are probably many reasons for this, one of which may be lack of evidence about outcomes of treatment in the clinical routine. PAIN OUT was established as a multi-national research network and quality improvement project offering healthcare providers validated tools to collect data about pain-related patient reported outcomes and management after surgery. Patients fill in a questionnaire asking for pain intensity, pain interference and side effects of pain management. The questionnaire has now been translated into 20 languages. Data are collected electronically and clinicians are provided with feedback about management of their own patients, compared to similar patients in other hospitals. Furthermore, the findings are used for outcomes and comparative effectiveness research. PAIN OUT is unique in that outcomes of postoperative pain management can be examined internationally. PAIN OUT was created in 2009 with funds from the European Commission, within the FP7 framework and has now been implemented in hospitals in Europe, USA, Africa and SE Asia. The findings allow us to gain insights as to how pain in managed in different settings and countries. For this particular study, we compared management of pain in the US to other countries. We assessed a large group of patients who underwent different types of orthopedic surgery and compared their patient reported outcomes and management regimens. We included 1011 patients from 4 hospitals in the USA and 28,510 patients from 45 hospitals in 14 countries (“INTERNATIONAL”). Medical Research: What are the main findings? Dr. Meissner: Postoperative pain intensity of US patients was higher than in INTERNATIONAL patients; they felt more often negatively affected by pain-associated anxiety and helplessness, and more US patients stated they wished to have received more pain treatment. However, other patient-reported outcomes like time in severe pain or the level of pain relief did not differ. We found that treatment regiments of American patients differed compared to INTERNATIONAL patients. More US patients received opioids, and their opioid doses were higher compared to INTERNATIONAL patients. In contrast, INTERNATIONAL countries use more nonopioid medications intraoperatively and postoperatively. Thus, under-supply with opioids cannot explain our findings. Mean BMI of US patients was 30.3 while for INTERNATIONAL it was 27.4. However, insufficient evidence exists that this finding might account for differences in pain intensity. Routine pain assessment was performed in almost all US patients, in contrast to about 75% in the INTERNATIONAL group. Obviously, routine pain assessment, as practiced in the United States, fails to result in lower postoperative pain. Perhaps it has the opposite effect by directing patients’ attention to the pain.08 May Orthopedic Patients and Their Families At Risk For Opioid Abuse
MedicalResearch.com Interview with:
Hassan R. Mir, MD, MBA
Associate professor of Orthopaedics and Rehabilitation
Vanderbilt Orthopaedic Institute and
and
Dr. Brent J. Morris, M.D.
Shoulder and Elbow Surgery Fellowship
Texas Orthopaedic Hospital University of Texas Houston Health Science Center,
Houston, Texas
Medical Research: What is the background for this study? What are the main findings?
Dr. Mir: The past few decades have seen an alarming rise in opioid use in the United States, and the negative consequences are dramatically increasing. The US represents less than 5% of the world's population, yet consumes 80% of the global opioid supply. Management of pain is an important part of patient care, however, the increased usage of opioids for the treatment of pain has led to several unanticipated aftereffects for individual patients and for society at large.
Orthopaedic surgeons are the third highest prescribers of opioid prescriptions among physicians in the United States. Orthopaedic patients can experience a tremendous amount of pain with acute injuries and chronic conditions, and the treatment plan may involve opioid prescriptions for relief of discomfort. A significant number of orthopaedic patients and their families are at risk for repercussions from opioid use. We must work together to decrease the use of opioids for musculoskeletal pain.
Clinicians should aim to control pain and improve patient satisfaction while avoiding overprescribing opioids. A comprehensive strategy of risk assessment is needed to identify patients who may be at risk for opioid abuse. Objective measures including patient history, recognition of aberrant behavior, urine drug testing, state prescription drug–monitoring programs, and opioid risk-assessment screening tools may be necessary in select cases.
06 Apr Pitch Count May Not Be Best Predictor Of Injury In MLB Players
MedicalResearch.com Interview with:
Thomas Karakolis
Department of Kinesiology
University of Waterloo
Waterloo, Ontario, Canada
Medical Research: What is the background for this study? What are the main findings?
Response: Major League Baseball (MLB) pitchers have an injury rate approaching 1 in 4, depending on the study you look at. As an occupational injury rate, this number is extremely high. In fact, I think you would be hard pressed to find another industry where the injury rate is that high.
One way that coaches and managers in MLB are trying to lower the
injury rate is to restrict the total 'workload' on pitchers per
season. Particularly in young pitchers, many MLB organizations
restrict the number of innings a pitcher can pitch based upon the
number of innings they pitched the previous year. Essentially, they
are using innings pitched as a surrogate for workload.
If this is an effective strategy, you would expect a correlation
between the increase in number of innings pitched between successive
seasons and future injury. Our study found that no such correlation
exists. Innings pitched does not appear to be a sensitive enough
measure to asses the true workload a pitcher experiences throughout
the season.
06 Apr Readmissions After Hip or Knee Replacement Are Costly
Posted at 22:27h
in Author Interviews, Cost of Health Care, Hospital Readmissions, NYU/NYMC, Orthopedics, Surgical Research
MedicalResearch.com Interview with: Dr. Joseph Bosco MD III Orthopedic Surgery The New York University Langone Medical Center Medical Research: What is the background for this study? Dr. Bosco: NYU Langone’s Hospital for Joint Diseases was one of the first institutions selected to participate in a Bundled Payment Care Initiative for total joint patients. For this...
11 Mar Nonsurgical Treatments May Equal Surgery For Many Broken Shoulders
MedicalResearch.com Interview with:
Prof. Amar Rangan
Clinical Professor, Trauma & Orthopaedic Surgery
School of Medicine & Health, Durham University & Consultant Orthopaedic Surgeon
The James Cook University Hospital Middlesbrough
Medical Research: What is the background for this study? What are the main findings?
Prof. Rangan: The majority of fractures of the proximal humerus (broken shoulders) occur in people older than 65 years. Although surgical treatment is being increasingly used for the more serious (displaced) fractures, it has been unclear whether surgical intervention (fracture fixation or humeral head replacement) produces consistently better outcomes than non-surgical treatment (arm-sling); both followed by physiotherapy.
Our multicentre randomized controlled trial (ProFHER), funded by the UK National Institute for Health Research’s Health Technology Assessment Programme, recruited 250 patients aged 16 years or older (mean age, 66 years) who presented at the orthopedic departments of 32 acute UK National Health Service hospitals between September 2008 and April 2011 after sustaining the most common types of acute displaced fracture of the proximal humerus.
Data for 231 patients (92.4% of 250) included in the primary analysis showed that there was no significant difference between the two treatment groups over two years or at 6, 12 and 24 months follow-up in self-reported pain and function scores. Nor were there significant differences on measures of health-related quality of life, complications related to surgery or shoulder fracture, later surgery or treatment for these complications, and death.
25 Feb Shorter Hospital Stay For Hip Fracture Linked To Higher Mortality After Discharge
MedicalResearch.com Interview with: Prof. Peter Nordström Department of Community Medicine and Rehabilitation Geriatrics, Umeå University Umeå, Sweden MedicalResearch: What is the background for this study? What are the main findings? Prof. Nordström: The number of elderly people is increasing, while the number of hospital beds is decreasing in Europe, which may be related to economic constraints...
06 Feb Hip Fractures: Comprehensive Geriatric Care Improved Outcomes and Reduced Costs
MedicalResearch.com Interview with:
Ingvild Saltvedt PhD
Department of Neuroscience, Norwegian University of Science and Technology,
Medical Faculty Trondheim, Norway
Medical Research: What is the background for this study? What are the main findings?
Dr. Saltvedt: Hip fracture patients are often old, frail and have many comorbidities. When treated with a traditional orthopaedic approach the outcomes are often poor, and many patients get functionally impaired with reduced ability to walk independently and impairment in daily life activities and with high costs for the society. In many ways these patients are geriatric patients with hip-fractures. It has previously been shown that acutely sick geriatric patients benefit from treatment in geriatric wards and different kind of orthogeriatric treatment models where orthopaedic surgeons and geriatricians collaborate have been studied and have shown beneficial results on short term outcomes. In the present study patients home-dwelling hip-fracture patients were randomised to orthogeriatric treatment or traditional orthopaedic treatment from admission to the hospital and during the entire stay except for the surgery that was performed similar in both groups. The study focused on long-term outcomes and also on use of health care services and cost-effectiveness. Patients in the orthogeriatric group got comprehensive geriatric assessment and treatment performed by an interdisciplinary team that emphasised early mobilisation and rehabilitation and started discharge planning early. In the orthopaedic group traditional treatment according to national and international guidelines was offered.
The primary endpoint was mobility at four months, that was better in the orthogeriatric group than in the orthopaedic group, the same difference was also shown at 12 months. In addition there were differences in instrumental activities of daily living and personal activities of daily living, quality of life and fear of falling, all differences were statistically and clinically significant and in favour of the orthoegeriatric group. The length of hospital stay was 1,7 days longer in the geriatric group, while there was no differences in days spent in hospital during one year of follow-up. One of four orthogeriatric patients were discharged directly home as compared to one of ten in the orthopaedic group. The orthopaedic group spent more days in nursing homes and rehabilitation institutions during one year of follow-up. The treatment was cost-effective in favour of the orthogeriatric group.
04 Dec Meniscal Knee Surgery May Accelerate Arthritis and Cartilage Loss
MedicalResearch.com Interview with:
Frank W. Roemer, MD
Associate Professor of Radiology
Co-Director, Quantitative Imaging Center (QIC), Department of Radiology Boston University School of Medicine
and Associate Professor of Radiology, University of Erlangen-Nuremberg, Germany
Medical Research: What is the background for this study? What are the main findings?
Dr. Roemer: Meniscal surgery is one of the most common orthopedic procedures performed in order to alleviate pain and improve joint function. However, increasing evidence is emerging that suggests that meniscal resection is detrimental for knee joint preservation including accelerated rates of OA and joint deterioration defined as cartilage loss. Our study focuses on disease onset and shows that structural damage due to surgery might also be observed in these early stages of disease. In light of this the indications for performing meniscal surgery might need to be defined more stringently as is the case today in order to preserve joint structure in the long term.
03 Dec Are Bisphosphonates Underutilized In Men on Androgen Deprivation Therapy?
MedicalResearch.com Interview with: Shabbir M. H. Alibhai, MD, MSc and Husayn Gulamhusein, BHSc Department of Medicine, University Health Network Toronto, Ontario, Canada Medical Research: What is the background for this study? What are the main findings? MedicalResearch: In 2009, we published a research letter in JAMA which examined the rate of bone mineral density (BMD) testing in men starting androgen deprivation therapy (ADT) in the province of Ontario, Canada, between 1995 and 2008. Despite being recommended as a tool to better characterize fracture risk and optimize bone health, use of bone mineral density testing was low throughout the study period. This current study focuses on another aspect of bone health, which is the use of bisphosphonates among men undergoing androgen deprivation therapy for prostate cancer. Bisphosphonates are generally safe and effective medications that can reduce fracture risk particularly in those at higher risk of future fracture. Throughout the 17-year study period, we found that rates of new prescriptions for bisphosphonates remained low. Even when focusing on those men who should be receiving bisphosphonates as per Canadian guidelines due to their high risk for future fracture, i.e. those with a prior fragility fracture or prior diagnosis of osteoporosis, prescription rates remained low. Moreover, in all three groups, new bisphosphonate prescriptions dipped between the 2007-09 and 2010-12 time periods. This may be partly due to recent negative media attention regarding the association of bisphosphonates with rare but serious side effects (i.e. osteonecrosis of the jaw and atypical femoral fracture).27 Nov Minimally Invasive Surgery May Not Be Best For Disc Removal
MedicalResearch.com Interview with: Nat
han Evaniew MD
Division of Orthopaedics
McMaster University
Medical Research: What is the background for this study?
Dr. Evaniew: Symptomatic cervical and lumbar spinal disc diseases affect at least 5% of the population and they cause a great deal of pain, disability, social burden, and economic impact. For carefully selected patients that fail to improve with nonsurgical management, conventional open discectomy surgery often provides good or excellent results.
Minimally invasive techniques for discectomy surgery were introduced as alternatives that are potentially less destructive, but they require specialized equipment and expertise, and they may involve increased risks for technical complications.
06 Nov Low Birth Weight Linked To Increased Adult Hip Replacement Risk
MedicalResearch.com Interview with:
Professor Flavia Cicuttin
School of Public Health and Preventive Medicine
Monash University and Alfred Hospital
Melbourne, Australia
Medical Research: What is the background for this study? What are the main findings?
Prof. Cicuttin: Previous research found that low birth weight and preterm birth have been linked to hypertension, cardiovascular disease, insulin resistance and reduced bone mass in adulthood. Given these adverse outcomes related to birth weight and preterm birth we set out to investigate if low birth weight and preterm birth also played a role in increase risk of joint replacement surgery as adults.
We found that low birth weight and preterm birth were associated with a 2-fold increased risk of hip but not knee replacement surgery.
29 Oct Does Milk Increase Bone Fractures?
MedicalResearch.com Interview with:
Professor Karl Michaëlsson
Professor in Medical Epidemiology, Senior Consultant in Orthopaedic Surgery
Uppsala Clinical Research Institute
Medical Research: What are the main findings of the study?
Prof. Michaëlsson: A high milk intake is recommended for the prevention of osteoporotic fractures but milk is also the major dietary source of galactose intake. The addition of galactose by injection or in the diet is an established animal model of aging by induction of oxidative stress and inflammation. Previous research results regarding the importance of milk intake for the prevention of fractures and the influence on mortality rates are conflicting. High milk intake was in our study associated with higher mortality in one cohort of women and in another cohort of men, and with higher fracture incidence in women. In subsamples of two additional cohorts, one in males and one in females, a positive association was seen between milk intake and both urine 8-iso-PGF2α (a biomarker of oxidative stress) and serum interleukin 6 (a main inflammatory biomarker).
02 Oct ACL Injury Risk Factors Different For Men than Women
MedicalResearch.com Interview with:
Dr. Bruce Beynnon
McClure Professor of Musculoskeletal Research
Dept Orthopedics and Rehabilitation
University of Vermont College of Medicine
Burlington, VT 05405-0084
Medical Research: What are the main findings of the study?
Dr. Beynnon: The anterior cruciate ligament (ACL) is an important stabilizer of the joint, and the study investigated how geometry of this ligament and surrounding bone is related to non-contact injury of this ligament. Specifically, the study focused on MRI-based measurements of the size of the ACL, measured as its volume, and the size of the femoral intercondylar notch, or the small space located in the center of the femur in which the ACL resides. Our study revealed that a decrease in the volume of the ACL and a decrease in the size of the intercondylar notch were associated with an increased risk of suffering a non-contact ACL injury in athletes.
This finding may be explained by the fact that a smaller ligament is associated with a decrease in its biomechanical properties, such as a smaller ultimate failure load. An alternative explanation is that a decreased femoral intercondylar notch size could result in a greater tendency for the ACL to impinge against the walls of the femoral notch during high demand activities, and increase the risk of injury.
The investigation was a longitudinal study with a nested case-control analysis of young, healthy high school and college athletes. The investigation was rigorously designed to control for age, sex, and participation on the same sports team. This enabled us to determine which combination of geometric parameters of the ACL and adjacent bony structures influence risk of suffering a first time non-contact ACL injury.
01 Oct Randomized Trial Shows Acupuncture Not Helpful For Chronic Knee Pain
MedicalResearch.com Interview with: Ben Metcalf BsC (co-author) on behalf or A/Prof Rana Hinman PhD Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia Medical Research: What are the main findings of the study? Dr. Metcalf: This study investigated whether acupuncture is an effective treatment for people aged more than 50 years with chronic knee pain. Participants in our study were randomly assigned to one of four groups; needle acupuncture, laser acupuncture, sham laser acupuncture or no treatment. The people in the treatment groups received acupuncture treatment from a family physician for 12 weeks. Participants were assessed after treatment and again after one year. There were no significant differences in knee pain or physical function between active and sham laser acupuncture at 12 weeks or at one year. Both needle and laser acupuncture resulted in modest improvements in pain compared with no treatment at 12 weeks that were not maintained at one year. Needle acupuncture improved physical function at 12 weeks compared with no treatment but was not different from sham acupuncture and was not maintained at one year.17 Sep New Joint Implants Fail To Demonstrate Benefit Over Older Models
MedicalResearch.com Interview with:
Marc Nieuwenhuijse MD
Research fellow ICOR and FDA
Weill Cornell Medical College New York City
Medical Research: Why did you decide to study this topic?
Dr. Nieuwenhuijse : The introduction of new orthopaedic implants and related technologies has been the focus of major scientific and policy discussions since the failures of articular surface replacement and large head size metal-on-metal articulations in total hip replacement were brought to light. However, scientists and policy makers seem to “run out of steam,” and the momentum for change generated by these recent high profile failures is waning. The consequences of uncontrolled device introduction worldwide may not be fully recognised by the scientific community and there is a high likelihood that current practice regarding device innovations will not change much. As such, there is a need to investigate whether the problems associated with the articular surface replacement and large head size metal-on-metal articulation are isolated events or if there is a systemic problem affecting the introduction of a much wider range of implantable devices.
In this study, we systematically evaluate the evidence concerning the introduction of five substantial, innovative, relatively recent, and already widely implemented device technologies used in major total joint replacement to determine the evidence of effectiveness and safety for introduction of five recent and ostensibly high value implantable devices in major joint replacement to illustrate the need for change and inform guidance on evidence based introduction of new implants into healthcare.
09 Sep Osteoporosis Medications Differ in Joint Fracture Reduction, Adverse Effects
MedicalResearch.com Interview with:
Carolyn J. Crandall, MD, MS
Professor of Medicine
David Geffen School of Medicine at University of California,
Los Angeles
Medical Research: What are the main findings of the study?
Dr. Crandall:
1. We found high-strength evidence that several medications decrease fracture risk when used by persons with bone density in the osteoporotic range and/or with pre-existing hip or vertebral fracture. While many of the medications (alendronate, risedronate, zoledronic acid, ibandronate, denosumab, teriparatide, and raloxifene) reduce vertebral fractures, a reduction in the risk of hip fracture is not demonstrated for all of the medications. In particular, hip fracture reduction is only demonstrated for alendronate, risedronate, zoledronic acid, and denosumab. Unfortunately, due to a lack of head-to-head trials, the comparative effectiveness of the medications is unclear.
2. The adverse effects of the medications vary. For example, raloxifene is associated with an increased risk of thromboembolic events, whereas denosumab and the bisphosphonate medications have been associated with increased risk of osteonecrosis of the jaw and atypical subtrochanteric femoral fractures.
05 Aug Bundled Payment Orthopedic Pilot Program A Bust In California
MedicalResearch.com: Interview with:
M. Susan Ridgely, JD
Senior Policy Analyst
RAND Corporation
Santa Monica, California
Medical Research: What are the main findings of the study?
Answer: We evaluated a three-year effort, coordinated by the Integrated Healthcare Association, to determine whether bundled payment could be an effective payment model for California. The pilot focused on bundled payment for orthopedic procedures for commercially insured adults under age 65. Bundled payment is a much-touted strategy that pays doctors and hospitals one fee for performing a procedure or caring for an illness. The strategy is seen as one of the most-promising ways to curb health care spending. Unfortunately, the project failed to meet its goals, succumbing to recruitment challenges, regulatory uncertainty, administrative burden and concerns about financial risk.
At the outset of the project, participants included six of the state’s largest health plans, eight hospitals and an independent practice association. Eventually, two insurers dropped out because they believed the bundled payment model in this project would not lead to a redesign of care or lower costs. Another decided that bundled payment was incompatible with its primary type of business (health maintenance organization). Just two hospitals eventually signed contracts with the three remaining health plans to use bundled payments. Hospitals that dropped out cited concerns about the time and effort involved.
The project was hurt by a lack of consensus about what types of cases to include and which services belonged in the bundle. In the end, most stakeholders agreed that the bundle definitions were probably too narrow to capture enough procedures to make bundled payment viable.
12 Jul Best Way To Avoid Repeat ACL Injury Is To Avoid Cutting Activities
Posted at 23:26h
in Orthopedics
MedicalResearch.com Interview with:
Christoher C. Kaeding M.D.
Judson Wilson Professor, Department of Orthopaedics
Executive Director, Sports Medicine Center
Head Team Physician, Department of Athletics
The Ohio State University
MedicalResearch: What are the main findings of the study?
Dr. Kaeding:
- Younger age and high activity level were predictors off another ACL injury after an ACL Reconstruction.
- Allograft use in younger more active patients Had an increased risk of re-injury.
23 Apr Bone Mineral Density: What is Impact of Change in Physician Reimbursement?
MedicalResearch.com Interview with: Susan Jaglal, PhD Senior Scientist Toronto Rehabilitation Institute University of Toronto, Toronto, Ontario MedicalResearch.com: What are the main findings of the study? Dr. Jaglal: Bone Mineral Density (BMD) tests are used to both diagnose osteoporosis and assess and individual’s risk of fracture. While the tests play an important role in bone health, they are sometimes ordered inappropriately. For example, while women age 40-44 are typically not at risk of fragility fracture or in need of Bone Mineral Density testing, these individuals received almost half the Bone Mineral Density tests performed in Ontario in 2007/2008. Policy changes have been made in recent years in an effort to curb unnecessary testing of low risk individuals in both the United States and Canada. Policy efforts in Ontario included a 2008 fee schedule change that limited repeated testing among low-risk patients and included a new fee code for a “baseline” tests. Patients were limited to 1 baseline test in their lifetime. The goal of the present study was to determine the impact of this fee schedule change on Bone Mineral Density testing rates. The study was based on an analysis of provincial administrative data including physician billings, hospital discharges, and emergency department visits. Results demonstrated that while fee schedule changes were associated with a decrease in BMD testing rates, the decreases affected both low and high-risk patients. Most decreases were seen in testing rates of low-risk women. However, the associated decrease in testing among high-risk patients (e.g., those over 65 or with a recent fracture) is concerning, as high-risk patients benefit from screening and monitoring of Bone Mineral Density.19 Apr Overuse Sports Injuries More Common In Children From High Income Families
MedicalResearch.com Interview with:
Neeru Jayanthi, MD
Associate Professor
Medical Director, Primary Care Sports Medicine
Loyola University Medical Center study
MedicalResearch.com: What are the main findings of the study?
Dr. Jayanthi: We surveyed a cohort of 1,190 athletes ages 7 to 18, including 1,121 for whom insurance status could be determined. Our main findings were:
1. The rate of serious overuse injuries in athletes who come from families that can afford private insurance is 68 percent higher than the rate in lower-income athletes who are on public insurance (Medicaid).
2. Privately insured young athletes are twice as likely as publicly insured athletes to be highly specialized in one sport.
08 Apr Higher Social Class Linked To Lower Risk of Bone Fractures
MedicalResearch.com Interview with:
Dr. Carolyn Crandall, M.D.
Division of General Internal Medicine,
David Geffen School of Medicine at University of California,
Los Angeles, CA, 90024, USA
MedicalResearch.com: What are the main findings of the study?
Dr. Crandall: We found that higher social class was linked with a lower risk of fractures among non-Caucasian women. Compared with non-Caucasian women who had no more than a high school education, those with at least some postgraduate education had nearly 90% lower rates of non-traumatic fracture. These results were present even after we accounted for income.
16 Mar Osteoarthritis: Total Hip, Knee Replacements Reduce Cardiovascular Risk
MedicalResearch.com Interview with:
Bheeshma Ravi, MD
Orthopedic Surgery
University of Toronto Medical Center
MedicalResearch.com: What are the main findings of the study?
Dr. Ravi: This study suggests that in persons with moderate-severe osteoarthritis of the hip or knee, total joint replacement is associated with a significant reduction in the risks for serious cardiovascular events.
11 Mar Orthopedic Trauma Patients: ‘Doctor Shopping’ and Increased Narcotics Use
MedicalResearch.com Interview with:
Brent J. Morris, M.D.
Shoulder and Elbow Surgery Fellowship
Texas Orthopaedic Hospital in affiliation with the University of Texas Houston Health Science Center, Houston, Texas
MedicalResearch.com: What are the main findings of the study?
Dr. Morris: There are concerns that an increasing percentage of patients are receiving narcotics by “doctor shopping” or seeking narcotics from multiple providers. One in five of our postoperative orthopedic trauma patients received narcotics from one or more additional providers other than the treating surgeon.
Patients that doctor-shopped postoperatively had a significant increase in narcotic prescriptions, duration of narcotics, and morphine equivalent dose per day.