oday’s Top Story
What’s next for the ACA?
The election of Donald Trump to president of the United States combined with Republican control of both houses of the U.S. Congress places the future of the Affordable Care Act (ACA) in jeopardy. Speculation continues regarding the form and timing of ACA repeal or replacement, but some information has emerged.
A brief statement posted to the presidential transition website says that the “Trump Administration will work with Congress to repeal the ACA and replace it with a solution that includes Health Savings Accounts (HSAs), and returns the historic role in regulating health insurance to the States.”
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Healthcare IT News reports that, in separate press conferences, both Senate Majority Leader Mitch McConnell (R-Ky.) and House Speaker Paul Ryan (R-Wisc.) recently vowed to seek ACA repeal.
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An article in Kaiser Health News discusses which ACA features may be retained if replacement legislation is enacted.
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An article in The New York Times looks at the approach taken by previous House and Senate repeal efforts, and the response of insurers.
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U.S. News & World Report notes that more than 100,000 people purchased insurance via the HeathCare.gov website the day after the election; the strongest single day of enrollment so far this year.
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Other News
Study: Wear rates appear similar for patients who undergo THA with either 36-mm or 28-mm metal-on-XLPE articulation.
A study published in the Nov. 2 issue of The Journal of Bone & Joint Surgery examines wear rates for larger highly cross-linked polyethylene (XLPE) articulations in primary total hip arthroplasty (THA). The research team conducted a randomized, controlled trial (RCT) of 56 THA patients aged 65 to 74 years who received either a 36-mm or 28-mm metal-on-XLPE articulation. They found that the mean annual proximal wear rates between 1 and 3 years were 0.00 mm/year for the 36-mm cohort and 0.01 mm/year for the 28-mm cohort. The authors write that no patient had a proximal wear rate of >0.1 mm/year, with mean wear very low in all directions. The wear rate of 36-mm articulations was not significantly greater than that of 28-mm articulations on the basis of proximal, medial 2-dimensional, and 3-dimensional wear. However, the research team argues that “before a 36-mm metal-on-XLPE articulation is widely recommended, particularly in young active patients, long-term wear rates and association between wear and periprosthetic osteolysis should be determined.”
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Study questions findings of 33 published RCTs.
A study published online in the journal Neurology calls into question the validity of a number of RCTs published by a certain group of researchers. The authors used statistical techniques to analyze 33 human RCTs undertaken by a group of researchers, about which concerns had previously been raised. They found that the treatment groups were improbably similar, with a distribution of p values for differences in baseline characteristics differing markedly from the expected uniform distribution. In addition, the distribution of standardized sample means for baseline continuous variables and the differences between participant numbers in randomized groups also differed markedly from expected distributions. Overall, the authors found outcomes to be “remarkably positive, with very low mortality and study withdrawals despite substantial comorbidity.” The trials reported large reductions in hip fracture incidence, regardless of intervention, greatly exceeding those reported in meta-analyses of other trials. Further, the authors noted multiple examples of inconsistencies between and within trials, errors in reported data, misleading text, duplicated data and text, and uncertainties about ethical oversight.
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Study: What are the risks of return to play following spinal cord concussion?
Findings from a study published online in The Spine Journal suggest limited evidence regarding current practice standards for return to play following spinal cord concussion (SCC). The researchers conducted a systematic review of 16 studies and found that, although some patients played after surgery without problems, several patients experienced recurrent SCC due to herniation at levels adjacent to the surgical sites. With respect to important predictors, the researchers noted a greater frequency of patients who experienced recurrence of symptoms or spinal cord injury following return to play had a “long” duration of symptoms (>24 hours) compared to those who were problem-free. However, the researchers state that most of the data reviewed were drawn from small sample sizes, and argue that future prospective multicenter studies should be conducted to determine predictive factors of poor outcomes following return to play following SCC.
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FDA holds hearing to discuss communications regarding off-label use of drugs and devices.
Medpage Today reports on a U.S. Food and Drug Administration (FDA) hearing held to discuss issues related to communications regarding off-label use of FDA-regulated drugs and medical devices for humans by manufacturers, packers, and distributors. The writer notes that previously, FDA had strict regulations prohibiting nearly all promotion of unapproved indications for approved drugs and devices, but federal courts later ruled that “truthful and non-misleading speech” by manufacturers about their products is protected under the First Amendment. Physicians and consumer advocates argued that the agency should not loosen its restrictions on companies marketing off-label medical products. However, others argued that the limiting communications regarding off-label use may confuse healthcare professionals, and called for uniformity and clarity in the regulatory process to enable appropriate sharing of information.
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Learn more about the meeting, with links to further information…
AJRR releases annual report on hip and knee arthroplasty.
The American Joint Replacement Registry (AJRR) has released its 2016 Annual Report on hip and knee arthroplasty data. The organization notes that the number of procedures on which it has collected data has more than doubled since the 2015 report, with more than half a million procedures in the registry, and 427,181 procedures collected from 2012 to 2015. The new report includes data from 3,710 surgeons at 416 hospitals. In addition, the organization has released a separate California Joint Replacement Registry (CJRR) Annual Report. AJRR and CJRR merged in 2015, and the CJRR report features patient-reported outcome completion rates, length of stay, comorbidities and adverse events, and other patient factors influencing the results of hip and knee replacement surgeries in California.
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Read the AJRR report (PDF)…
Read the CJRR report (PDF)…
Call for volunteers: AAOS Emergency Medical Services Program Product Line series editor.
Dec. 16 is the last day to submit your application for the position of series editor designee for AAOS’s Emergency Medical Services product line. Applicants for this position must be active or emeritus fellows with extensive knowledge or current experience as an emergency medical technician, paramedic, or emergency medical services director.
Learn more and submit your application…(member login required)
