Today’s Top Story
Trump budget to call for large cuts in Medicaid.
President Trump will propose $800 billion in cuts to Medicaid in the budget his administration will unveil tomorrow, The Washington Post reports. The move to slash the state-federal program for low-income individuals mirrors a bill passed by the House earlier in the month. That bill specifies that states receiving federal funds for having expanded Medicaid coverage under the Affordable Care Act would no longer receive the enhanced funding as of 2020, while those that did not expand coverage would not be able to do so, effective immediately. The bill would also reduce funding for Medicaid overall, by an estimated 25 percent, with the expected effect that the states would reduce eligibility and/or cut coverage and provider payments. The Congressional Budget Office estimates that the effect of the proposed cuts would sever Medicaid benefits for some 10 million people over the next 10 years. Read the Washington Post article…
Read more from Bloomberg…
Physicians urged to think twice before using PRP or stem cells to treat injuries in young athletes.
A study published online in the American College of Sports Medicine’s Current Sports Medicine Reports suggests that physicians, parents, and coaches should exercise caution when considering the use of platelet-rich-plasma (PRP) or stem cells to treat injuries in young athletes. According to the study’s authors, little is known about the safety or effectiveness of regenerative treatments for musculoskeletal injuries in children and adolescents. The collaborative study, which involved sport medicine clinicians, researchers, and a bioethicist, included the following seven-point call to action:
- Exercise caution in treating youth with cell-based therapies as research continues.
- Improve regulatory oversight of these emerging therapies.
- Expand governmental and private research funding.
- Create a system of patient registries to gather treatment and outcomes data.
- Develop a multiyear policy and outreach agenda to increase public awareness.
- Build a multidisciplinary consortium to gather data and promote systematic regulation.
- Develop and pursue a clear collective impact agenda to address the “hype” surrounding regenerative medicine.
Study: Treatment of sepsis in ED associated with lower in-hospital mortality rates.
Results from a study published in The New England Journal of Medicine indicate that early administration of antibiotics, but not intravenous fluids, in the emergency department (ED) was associated with lower in-hospital death rates among patients with suspected sepsis in New York state, MedPage Today reports. The results support New York state regulations, which were implemented in 2013 following the death of 12-year-old boy with undiagnosed sepsis in the ED, that require hospitals to follow protocols for the early identification and treatment of sepsis. Approximately 50,000 patients with sepsis and septic shock who were reported to the New York State Department of Health between April 1, 2014, and June 30, 2016, were included in the study. Patients had a sepsis protocol initiated within 6 hours after arrival in the ED and all items in a 3-hour bundle of sepsis care (blood cultures, broad-spectrum antibiotic agents, and lactate measurement) were completed within 12 hours. The researchers found that more rapid completion of a 3-hour bundle of sepsis care and rapid administration of antibiotics, but not rapid completion of an initial bolus of intravenous fluids, were associated with lower risk-adjusted in-hospital mortality. Read more…
Read the study…
Study: No significant correlation between postdischarge opioid quantity and pain scores.
A study on the effect of opioid prescribing by quantity on the pain management scores for patients following discharge from surgery found no significant difference between scores in patients stratified in the first quintile for opioid prescribing and those in the fifth quintile. The study, reported as a Research Letter in JAMA, tabulated the mean quantity of opioids (by oral morphine equivalents [OMEs]) prescribed for 31,481 patients in 47 Michigan hospitals who underwent orthopaedic, general, gynecologic, cancer, cardiac, and vascular surgery. The authors concluded that the results show that in these patients, postoperative opioid prescribing was not correlated with pain measures within the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), a scoring survey used to determine hospital payments. The authors note that concern has been raised that HCAHPS could incentivize overprescribing of opioids and that the Centers for Medicare & Medicaid Services plans to remove pain management from payment criteria, “even though little is known regarding the possible correlation between HCAHPS scores and postdischarge prescribing.” Read more…
Study: BMI may not significantly affect clinical outcomes after arthroscopy with capsular plication for FAI.
A study published online in The American Journal of Sports Medicine (AJSM) finds no link between body mass index (BMI) and clinical outcomes after hip arthroscopic surgery with capsular plication for femoroacetabular impingement (FAI). The authors reviewed data on 381 patients (409 hips) who underwent primary hip arthroscopic surgery for FAI, seven of whom were underweight (<185 kg/m>2), 197 normal (18.5–24.9 kg/m2), 130 overweight (25.0–29.9 kg/m2), 31 obese (30.0–34.9 kg/m2), and 16 morbidly obese (=35.0 kg/m2). At 2-year follow-up, they found significant differences in Hip Outcome Score (HOS)—Activities of Daily Living (ADL), HOS—Sports, and modified Harris Hip Score among normal-BMI patients. The authors note that increasing BMI was associated with a higher infection risk, but multivariate analysis found no significant difference in patient clinical outcomes across BMI categories. However, the authors write that the study may have been underpowered to detect certain trends due to small cohort sizes at the extremes of the BMI categories. Read the abstract…
Study: Two-tunnel transtibial repair of radial meniscus tears may be as effective as inside-out repair of vertical meniscus tears.
Findings from a study published online in AJSM suggest that two-tunnel transtibial repair of radial meniscus tears may offer comparable results to inside-out repair of vertical meniscus tears. The research team conducted a cohort study of 27 patients who underwent two-tunnel transtibial pullout repair for radial meniscus tears and 33 patients who underwent inside-out repair for vertical meniscus tears. At 2-year follow-up, they found no significant differences across cohorts for any postoperative outcome scores (Lysholm score, Western Ontario and McMaster Universities Osteoarthritis Index, Short Form–12 physical component summary, Tegner activity scale, and patient satisfaction). Read the abstract…
Call for volunteers: AAAHC Orthopaedic Certification Standards Technical Panel.
AAOS seeks to nominate two members to the Accreditation Association for Ambulatory Health Care (AAAHC) Orthopaedic Certification Standards Technical Panel. The association is launching a Centers of Excellence program, with the introduction of Orthopedic/Joint Replacement certification. The program will focus on transitions of care from pre-assessment to intra-operative, discharge, and rehabilitation specific to the ambulatory surgical center. Applicants for this position must be active fellows, candidate members, candidate members osteopathic, candidate member applicants for fellowship, or candidate member applicants for fellowship osteopathic. In addition, all applicants must provide the following: an online AAOS CAP application and a current curriculum vitae. All supporting materials must be submitted by May 30, 2017, at 11:59 p.m. CT, to Kyle Shah at: firstname.lastname@example.org.
Learn more and submit your application…(member login required)