Today’s Top Story
Uncertainty regarding immigration order could affect hospitals’ approach to Match Day.
An article in The Wall Street Journal looks at the effect a recently issued executive order may have on the upcoming Match Day. The order restricts entry to the United States for citizens of certain countries, and according to the Association of American Medical Colleges (AAMC), about 1,000 of the 56,530 physicians who applied for U.S. residency slots this year are from the seven countries included in the ban. Although an appellate court recently upheld an injunction against the executive order, observers say uncertainty regarding the issue could force hospitals to choose between forgoing strong candidates from countries included in the ban or risk vacancies if the injunction is successfully appealed.
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Other News
Study: Regardless of treatment, patients may see greater mechanical loading of the knee following Achilles rupture.
A study published online in The American Journal of Sports Medicine suggests that patients may be susceptible to greater mechanical loading of the knee during sporting tasks in the wake of an Achilles tendon rupture, regardless of treatment approach. The research team conducted a controlled laboratory study of 34 patients, 17 of whom were treated surgically and 17 of whom were treated nonsurgically for Achilles tendon rupture. At mean 6.1-year follow-up, they found no significant differences in outcomes across cohorts. Patients in both groups displayed large side-to-side deficits in plantarflexion angle at toeoff while walking, jogging, and hopping on the involved limb. The research team also noted side-to-side deficits in angular velocity, but only during jogging and hopping.
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Study: Insurer status linked to complication risk for shoulder arthroplasty patients.
Findings from a study published online in the Journal of Shoulder and Elbow Surgery suggest that insurance payer status may be associated with perioperative complication risk for patients who undergo shoulder arthroplasty. The authors reviewed data on 103,290 shoulder arthroplasty patients (68,578 Medicare, 27,159 private insurance, 3,544 Medicaid/uninsured, 4,009 other) from the Nationwide Inpatient Sample database. They found that the overall complication rate was 17.2 percent (n = 17,810) and the mortality rate was 0.20 percent (n?=?208). Overall, Medicare and Medicaid/uninsured patients had a significantly increased risk of medical, surgical, and overall complications compared with private insurance using controlled match data. Multivariate regression analysis suggested that private insurance was associated with fewer overall medical complications.
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Studies examine effects of various approaches to ACO implementation.
Two studies published online in the journal JAMA Internal Medicine look at various approaches to accountable care organization (ACO) models. In the first, researchers who reviewed fee-for-service Medicare claims found that, for ACOs that entered in 2012, participation in the Medicare Shared Savings Program (MSSP) was associated with a 9 percent differential reduction in postacute spending by 2014. The shift appeared to be driven by reductions in discharges to facilities, length of facility stays, and acute inpatient care. The researchers noted that MSSP participation was not associated with significant changes in 30-day readmissions, use of highly-rated skilled nursing facilities, or mortality.
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The second study compares Medicaid ACO models in Oregon and Colorado. The researchers note that the Oregon model was characterized by a large federal investment and movement to global budgets, while the Colorado model was more limited in scope and implemented without substantial federal investment. They also found that standardized expenditures for selected services declined in both states over a 4-year period, but the decreases were not significantly different between the two states. However, the researchers note that the Oregon model was associated with reductions in emergency department and primary care visits, as well as improvements in acute preventable hospital admissions, three of four measures of access, and one of four measures of appropriateness of care.
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Study: Do enough clinicians fully understand benefits and harms of interventions?
A study published online in JAMA Internal Medicine suggests that some medical professionals may carry inaccurate expectations of benefits and harms of treatments, tests, and screening tests. The research team conducted a systematic review of 48 studies covering 13,011 clinicians. Overall, 20 studies focused on treatment, 20 on medical imaging, and 8 on screening. The research team found that most participants correctly estimated 13 percent of 69 harm expectation outcomes and 11 percent of 28 benefit expectations. A majority of participants overestimated benefit for 32 percent of outcomes but underestimated benefit for 9 percent of outcomes. In addition, they underestimated harm for 34 percent of outcomes, but overestimated harm for 5 percent of outcomes. The research team argues that inaccurate perceptions regarding benefits and harms of interventions may result in suboptimal clinical management choices.
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Study: Concussion may disrupt autonomic cardiovascular control.
Findings from a study published online in the American Journal of Physiology suggest that concussion may disrupt autonomic cardiovascular control, and that autonomic reflex tests may be a practical approach to evaluate that dysfunction. The authors compared data on 23 recreational athletes, 12 of whom had experienced concussion and 11 of whom had not. Participants performed forced breathing, standing and Valsalva autonomic tests at four time points: within 48 hours of injury, 24 hours later, 1 week after injury and 2 weeks after injury. The authors found that, within 48 hours of injury, participants in the concussed group had significantly greater resting heart rate and blood pressure responses to standing and 90 percent systolic blood pressure normalization times after the Valsalva, but the group differences had subsided 24 hours later.
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Call for volunteers: Adult Reconstruction Hip Program Committee.
March 31 is the last day to submit your application for a position on the Adult Reconstruction Hip Program Committee (five member openings). Members of program committees grade symposia in May and abstracts in June and July, and may serve as moderators for paper presentations at the AAOS Annual Meeting. Applicants for this position must be active or international members with a practice emphasis in hip.
Learn more and submit your application…(member login required)
