August 18, 2017

Today’s Top Story
Proposal would cut funding to ONC and AHRQ; increase FDA budget.
Healthcare IT News reports that a proposal released by the U.S. House of Representatives Rules Committee would, if enacted, significantly reduce the budgets for the Office of the National Coordinator (ONC) and the U.S. Agency for Healthcare Research and Quality (AHRQ) but increase the budget for the U.S. Food and Drug Administration (FDA) by $500 million. Under the proposed legislation, ONC would receive just $38 million in funding, a reduction from $60 million, while AHRQ would see its budget cut from $334 million to $300 million. The article also references an ongoing debate regarding the future of AHRQ, but notes that the funding proposal, coupled with appointment of a new director in May 2017, may signal intent to continue AHRQ as an independent agency for the foreseeable future. Read more…
Read the proposal (PDF)…

Other News

Study: Nonoperative treatment linked to increased risk of nonunion compared to open treatment for displaced midshaft clavicle fracture.
Data published in the Aug. 16 issue of The Journal of Bone & Joint Surgery suggest that nonoperative treatment may be associated with increased risk of nonunion compared to open surgery and internal fixation (ORIF) for patients with displaced midshaft clavicle fractures. The authors conducted a multicenter, randomized, controlled trial of 301 adult patients treated with either ORIF (n = 154) or nonoperative management (n = 147). At 3-month follow-up, they found no significant difference in nonunion rate across cohorts. However, at 9-month follow-up, they noted a significantly higher nonunion rate among patients in the nonoperative cohort compared to the ORIF cohort (11 percent vs. <1 percent respectively). Read the abstract…

Study: How do outcomes compare for bilateral and unilateral hip arthroscopy?
A study published online in The American Journal of Sports Medicine compares outcomes for patients who undergo bilateral or unilateral hip arthroscopy. The research team conducted a matched cohort study of 129 patients who underwent either bilateral hip arthroscopy (n = 43) or unilateral hip arthroscopy (n = 86). Compared to patients in the unilateral group, those in the bilateral group displayed less improvement from baseline in modified Harris Hip Score (mHHS) and pain scores. Overall, 76 percent (n = 65) of patients in the unilateral group achieved the minimum clinically important difference (MCID) for the mHHS compared with 49 percent (n = 21) in the bilateral group, while 74 percent (n = 64) of patients achieved the patient acceptable symptomatic state (PASS) for the mHHS, compared with 51 percent (n = 22) in the bilateral group. In addition, the research team notes that patients in the bilateral group with greater than 10 months between surgical procedures had lower postoperative Hip Outcome Score—Activities of Daily Living scores and lower improvement in pain and Hip Outcome Score—Sports Subscale scores. Read the abstract…

Study: Many patients see benefit from revision cervical spine surgery within 12 months.
Findings from a study published online in the journal Spine suggest that a majority of patients may benefit from revision cervical spine surgery. The researchers reviewed prospectively collected data on 115 patients who underwent cervical revision surgery for recurrent disease (n = 21), pseudoarthrosis (n = 45), and adjacent segment disease (n = 49). At 12-month follow-up, they found significant improvement in all patient-reported outcomes regardless of etiology. The researchers write that satisfaction was met in 75.5 to 85.7 percent of patients, depending on the etiology of the revision need, with complication rates of 4 to 9 percent. Read the abstract…

Studies look at factors associated with continued opioid use.
Two recent studies examine factors linked to continued opioid use. The first, published online in The Journal of Pain, reviewed data on 1,353,902 persons aged 14 years and older with no history of cancer or substance abuse and found that the probability of continued opioid use at 1 year was 5.3 percent. Across all pain etiologies, the authors found that chronic pain; inpatient admission; prescribed doses of ≥90 morphine milligram equivalents, initiated with tramadol or long-acting opioids; and increased days’ supply of first prescription were consistently associated with a lower likelihood of opioid discontinuation. Read more…
Read the abstract…
     In the second study, a research letter published online in the journal JAMA Surgery, researchers reviewed information on 117,118 patients who met criteria for sustained prescription opioid use. They found that only 800 individuals (0.7 percent) received their initial opioid prescription following an inpatient encounter and 458 (0.4 percent) had undergone an inpatient procedure. Read more…
Read the abstract…

Study: Improving resident support may reduce attrition at surgery training programs.
Findings from a study published online in JAMA Surgery suggest that improved support could reduce attrition rates for surgical residents. The research team surveyed 21 general surgery program directors regarding their opinions on resident education and attrition, as well as program data on total resident complement, demographic information, and annual attrition. They found that 85 of 966 residents (8.8 percent) left training during the study period: 15 (17.6 percent) after PGY1, 34 (40.0 percent) after PGY2, and 36 (42.4 percent) after PGY3 or later. Programs with lower attrition rates were more likely to use resident remediation. In addition, the research team found that program directors at high-attrition programs were more likely than their counterparts at low-attrition programs to agree with this statement: “I feel that it is my responsibility as a program director to redirect residents who should not be surgeons.” Read the complete study…

Call for volunteers: Program Committees.
Aug. 31 is the last day to submit your application for a position on a Program Committee. Members of Program Committees grade symposia in May and abstracts in June and July, and may serve as moderators for paper sessions and critical evaluators of courses at the AAOS Annual Meeting. The following openings are available:

  • Hand & Wrist (one member)
  • Practice Management/Rehabilitation (one member)
  • Shoulder & Elbow (one member)

Applicants for these positions must be active fellows or international members with a practice emphasis in the relevant area. Learn more and submit your application…(member login required)

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