Today’s Top Story
Study: Antibiotic-tolerant biofilms may be linked to high risk of failure observed with irrigation and débridement in acute PJI.
Data from a study published online in the journal Clinical Orthopaedics and Related Research suggest that antibiotic-tolerant biofilm may contribute to failure observed in acute periprosthetic joint infection (PJI). The researchers cultured methicillin-sensitive Staphylococcus aureus biofilm on total knee arthroplasty (TKA) materials and exposed the biofilm to increasing doses of cefazolin. They found that live biofilm mass was reduced by exposure to cefazolin when compared with biofilm mass in controls, but no further reduction was seen after higher doses. At the highest concentration tested (100 µg/mL), residual viable biofilm was present on all materials, with no differences in percent biofilm survival among cobalt-chromium, polymethylmethacrylate, and polyethylene. The researchers state that the tolerance appears to be a phenotypic phenomenon, as increasing cefazolin exposure was not linked to changes in minimum inhibitory concentration as compared with controls. Read the abstract…

Other News

Study questions presumed negative effects of surgical resident duty-hour limits.
A study published online in The New England Journal of Medicine suggests that less-restrictive duty-hour policies for surgical residents may not lead to inferior patient outcomes and reduced resident satisfaction. The authors conducted a national, cluster-randomized, pragmatic, noninferiority trial involving 117 general surgery residency programs in the United States. In an analysis of data from 138,691 patients, they found that flexible, less-restrictive duty-hour policies were not associated with an increased rate of patient death or serious complications, nor of any secondary postoperative outcomes examined. In addition, among 4,330 residents, those in programs assigned to flexible policies did not report significantly greater dissatisfaction with overall education quality or well-being. Overall, residents working under flexible policies were less likely than those under standard policies to perceive negative effects of duty-hour policies on multiple aspects of patient safety, continuity of care, professionalism, and resident education. However, they were more likely to perceive negative effects on personal activities. There were no significant differences between study groups in resident-reported perception of the effect of fatigue on personal or patient safety, and residents in the flexible-policy group were less likely than those in the standard-policy group to report leaving during an operation. Read more…
Read the abstract…

House falls short in vote to override president’s veto of ACA repeal bill.
In a 241-186 vote, the U.S. House of Representatives fell short of the two-thirds majority needed to override President Obama’s veto of the Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015, which sought to repeal major provisions of the Affordable Care Act (ACA). The bill, approved by the Senate in December under reconciliation, was the first ACA repeal bill to pass both houses of Congress. Read more…

Report: Communication failure linked to 30 percent of medical liability cases.
A report released by CRICO Strategies finds that communication issues may be a factor in as many as 30 percent of medical liability cases. When the researchers reviewed data on 23,658 medical liability cases from 2009 through 2013, they found that 7,149 cases included communication failures that contributed to patient harm. Overall, those cases were associated with $1.7 billion in losses, based on actual payments along with reserves on cases that remained open at the end of the study period. In addition, the researchers found that 37 percent of all cases determined to be “high severity” were associated with a communication failure. Read more…
Read the report…(registration may be required)

President to request $1.1 billion to combat opioid abuse during 2017.
The New York Times reports that President Obama plans to ask Congress to allocate an additional $1.1 billion during 2017 to combat opioid abuse. If approved, about half of the new money would be used to expand treatment facilities, with the rest going to programs intended to prevent prescription drug overdoses, crack down on illegal sales, and improve access to naloxone. According to the U.S. Centers for Disease Control and Prevention, opioids, which include prescription painkillers and heroin, were involved in 28,648 deaths in the United States during 2014. Read more…

AMA files brief in Supreme Court case that that could affect FCA suits.
The American Medical Association (AMA), the Association of American Medical Colleges, and other organizations have filed a brief in a U.S. Supreme Court case that some observers say has the potential to affect the number of False Claims Act (FCA) suits brought against healthcare providers. As reported in Modern Healthcare, the case focuses on situations in which whistleblowers allege providers have submitted false claims to government programs by failing to follow certain regulations. Those providers may be held liable under the legal theory of “implied certification,” through which a defendant can be found to have defrauded the government by committing a regulatory misstep never previously identified as disqualifying a claim for payment for services provided to a patient. The brief argues that the FCA is “too blunt an instrument to be used in this way. It is simply not an appropriate tool for enforcing regulatory compliance with requirements not explicitly linked to payment of a claim.” Read more…(registration may be required)
Read the brief (PDF)…

2016 AAOS Annual Meeting housing deadline extended to Feb. 15!
Your reservation at an official AAOS hotel counts! Booking your room at an “official” AAOS hotel helps contribute to the success of the AAOS Annual Meeting. Official hotels offer free shuttle bus service to and from the Orange County Convention Center, along with onsite housing representatives at the convention center and at your hotel, should you require assistance. Show your support for the Academy by reserving your sleeping room at an official AAOS hotel. Book your reservation…

Call for volunteers to help develop AUC for surgical management of OA of the knee.
The Appropriate Use Criteria (AUC) Section seeks AAOS fellows to participate on the voting panel of the Surgical Management of Osteoarthritis (OA) of the Knee AUC. The voting panel will participate in two rounds of voting, in which they will rate the appropriateness of various surgical treatments for patients who have OA of the knee. Voting panel members will be required to attend a 1-day, in-person meeting in Rosemont, Ill. Nominees for the voting panel are required to complete the AAOS conflict of interest enhanced disclosure form online. If you are interested in participating on the voting panel for this AUC topic, please contact Erica Linskey by Monday, Feb. 22, 2016, at: linskey@aaos.org