August 21, 2017

Today’s Top Story
Study finds sustained opioid use is not tied to hospital events, associated procedures.
According to a study published online in JAMA Surgery, “most of the events that led to sustained prescription opioid use were not hospital events and associated procedures, but diagnoses that were either nonspecific or associated with spinal or other conditions for which opioid administration is not considered standard of care.” The study identified 117,118 patients, insured through TRICARE, who met the criteria for sustained prescription opioid use and were considered opioid naïve. Overall, only 800 patients (0.7 percent) received their initial opioid prescription following an inpatient encounter, with 0.4 percent having undergone an inpatient procedure. Among all the patients, the most common diagnosis associated with the initial opioid prescription was other ill-defined conditions (30.6 percent). Spinal conditions were among the most frequent diagnoses in both civilian and military settings, while spine and orthopaedic disorders were the most prominent among specific categories of conditions associated with the initial opioid prescription. To reduce the risk of sustained opioid use, the authors suggest better leveraging of best practices in prescribing combined with improved documentation of the rationale for opioid prescriptions.
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Read the abstract…

Other News

CMS to reduce audit burden on physicians.
A new policy issued by The Centers for Medicare & Medicaid Services (CMS) will reduce the likelihood that physicians who follow appropriate billing practices will be audited, an article in Medscape reports. The new approach, called Targeted Probe and Educate (TPE), includes identifying providers who have made billing errors and then educating them. According to CMS, Medicare administrative contractors (MACs) “who perform audits select claims for services or items that pose the greatest financial risk to the Medicare trust fund and/or those that have a higher national error rate.” Via data analyses, the MACs will identify providers and suppliers who have the highest claim error rates or use billing practices that greatly differ than those of their peers. Once providers are identified, they are subjected to a review of 20 to 40 claims per service, which, according to the CMS, is a smaller amount compared to previous medical reviews. “If this first-round review shows that the provider is noncompliant with Medicare billing requirements, the provider receives individualized education. After a period of at least 45 days, the MAC may review a second batch of 20 to 40 claims. If, after more education, the provider is still noncompliant, a third round of reviews is conducted,” the article states. Per a CMS update posted on Aug. 14, 2017, the CMS may require additional action from providers and suppliers with continued high error rates.
Read more…(registration may be required)
Read the CMS update…

Study results shed new light on cartilage breakdown.
Researchers from Queen Mary University of London have found that collagen changes its crystallinity in response to physical forces, suggesting that the ordered arrangement in collagen molecules of knee cartilage switches from one structural state to another as people walk, Medical News Today reports. The study’s results, which shed new light on how cartilage is able to withstand the demanding mechanical environment of the joint, may help to explain why cartilage breaks down with aging or with arthritis.
“The response of collagen to physical forces is critical to the function of cartilage in our joints, and therefore understanding this behavior may help us develop new strategies to prevent cartilage degradation,” said the study’s coauthor Prof. Martin Knight.
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Read the abstract…

FDA announces voluntary recalls of drug products due to lack of sterility assurance.
The U.S. Food and Drug Administration (FDA) has announced two voluntary manufacturer recalls of drug products due to a lack of sterility assurance. Vital Rx, Inc., dba Atlantic Pharmacy and Compounding, is recalling all lots of compounded injectable prescription medications to the consumer level. Vital RX is notifying its patients of the recall via U.S. mail and is requesting that all unexpired lots of compounded injectable prescription medications be destroyed immediately upon receipt of the notification.
Bella Pharmaceuticals is voluntarily recalling all lots of unexpired sterile drug products distributed between April 17, 2017, and Aug. 10, 2017. The medications are packaged in syringes, vials, or eyedroppers. Anyone with a recalled product should discontinue its use and contact the company. Bella Pharmaceuticals is notifying its customers of the recall by email and phone as well as arranging for the return of all recalled products.
Read the Vital Rx recall notice…
Read the Bella Pharmaceuticals recall notice…

Study: FAI features linked to radiographic findings consistent with early OA in young athletes.
A study published online in The American Journal of Sports Medicine examines physiological changes over a 5-year period for athletes aged 12 to 18 years with asymptomatic limited range of motion (LROM) of the hip. The research team conducted a cohort study of 26 athletes, 13 of whom (21 of 26 hips) had at least one hip having internal rotation <10° with the hip flexed to 90°, and 13 matched controls. At the time of study enrollment, 16 of 26 hips (62 percent) in the LROM group had abnormal magnetic resonance imaging findings within the acetabular labrum or cartilage, compared with 8 of 26 hips (31 percent) in the control group, and 13 of 26 hips (50 percent) in the LROM group had a positive anterior impingement sign, compared to 0 of 26 hips (0 percent) in controls. At 5-year follow-up, the research team found that young athletes with LROM of the hip displayed increased progressive degenerative changes on MRI and radiographs compared with matched controls. “Although the majority of these participants remained asymptomatic,” the research team writes, “those with features of femoroacetabular impingement [FAI] had radiographic findings consistent with early osteoarthritis [OA].”
Read the abstract…

Study: Zero profile ACDF may be effective treatment for multilevel cervical spondylotic myelopathy.
A study conducted in China and published online in the journal Spine compares zero-profile (ZP) anterior cervical discectomy and fusion (ACDF) construct to traditional ACDF with anterior plate (ACP) for treatment of multilevel cervical spondylotic myelopathy. The authors conducted a prospective, randomized trial of 104 patients with multi-level cervical spondylotic myelopathy who underwent ZP ACDF (n = 52) or ACDF with ACP (n = 52). At 2-year follow-up, they found that complications occurred in 4 percent of ZP patients and 17 percent of ACP patients. In addition, zero patients in the ZP cohort and four patients in the ACP cohort reported hoarseness or dysphagia.
Read the abstract…

Call for volunteers: Resident Bowl Question Workgroup.
Sept. 15, 2017, is the last day to submit your application for a position on the Resident Bowl Question Workgroup (15 member openings). The AAOS Resident Bowl is an opportunity for residents to compete against one another in a quiz-bowl setting during the AAOS Annual Meeting. Applicants for this position must be active members, emeritus fellows, or candidate members with an interest in residents and resident issues, and a facility for writing interesting and varied questions.
Learn more and submit your application…(member login required)


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