Today’s Top Story
Studies look at trends in mortality, distribution of services among U.S. trauma networks.
Two recently released studies examine the network of trauma services in the United States. The first, published online in the journal Annals of Surgery, reviews data on 839,809 severely injured patients across 287 centers, and finds that each 1 percent increase in volume was associated with a 73 percent increased likelihood of improved standardized mortality ratio (SMR) over time, while each 1 percent decrease in volume was linked to a 2-fold increase in odds of worsening SMR over time. In addition, the authors note that level I and II centers saw significant improvement in SMR after 3 or more preceding years of increasing volume. Read more…
Read the abstract…
     The second study, published online in the Journal of the American College of Surgeons, suggests that trauma services in the United States may be unevenly distributed. The researchers reviewed data on trauma admissions, providers, demographics, and mortality for 1,345,024 trauma admissions during 2013. They found considerable variation between the top 5 and bottom 5 states in terms of Level I/Level II trauma centers and surgical critical care (SCC) surgeon availability, despite less variation in trauma admission density. Overall, they note that distribution of trauma admissions was positively associated with SCC provider density and age-adjusted trauma mortality, and inversely associated with per-capita income. They also note that each additional SCC provider per 1 million population was linked to a decrease of 618 deaths per year. Read more…
Read the abstract…

Other News

Study: Fixation with IM nails may be helpful in reducing pain and maintaining mobility in patients with metastatic sarcomas.
Findings from a study published in Clinical Orthopaedics and Related Research (CORR) suggest that patients with an impending or pathologic fracture from multifocal metastatic sarcoma to a long bone may gain short-term benefit from surgical fixation with intramedullary (IM) nails. The researchers reviewed data on 34 patients with metastatic sarcoma who had impending (n = 26) or pathologic (n = 14) fractures from bone metastases. All 40 fractures had been treated with IM nails between 1997 and 2014 at a single institution. Eleven patients had received either preoperative or postoperative radiation therapy; 29 patients had received some form of chemotherapy. At 13-month follow-up, 30 patients (88 percent) had died; 29 (85 percent) had retained their original IM nail. “Although we have no group for comparison, such as treating with radiotherapy alone or resection and an endoprosthesis, our findings suggest that use of intramedullary nails is helpful for providing fixation that, in most instances, lasts for the lifetime of patients with multifocal bone metastases from sarcomas,” the authors write. Read the abstract…
Read the study…

Study: T2 Mapping may be suitable alternative to dGEMRIC for hip cartilage assessment.
T2 mapping may be a viable alternative to dGEMRIC in assessing hip cartilage at the chondrolabral junction, a study in CORR reported. The study involved 31 patients with hip-related symptoms resulting from femoroacetabular impingement who underwent a preoperative 3-T MRI of their hip that included dGEMRIC and T2 mapping, with 10 asymptomatic patients as a control. Acetabular and femoral head cartilages were graded. In the midsagittal plane, single-observer analyses of precontrast T1 values (volunteers), the dGEMRIC index (T1Gd, patients), and T2 mapping values (everyone) were compared in acetabular and corresponding femoral head cartilage at the chondrolabral junction of each hip. In the symptomatic group, T1 and T2 values were lower in the acetabular cartilage compared with the corresponding femoral head cartilage, while the asymptomatic group demonstrated no difference in T1 and T2 values. The authors note that the findings may be of interest in light of case reports of gadolinium-related toxicities and “increasing theoretical concerns about the use of gadolinium for MR imaging,” and resultant interest in techniques such as T2 mapping that do not require contrast media application. Read more…

Medical schools address primary care physician shortages.
An article in Modern Healthcare notes that although many medical schools are creating programs that encourage students to pursue a career in primary care or family medicine, their efforts may be hampered by factors outside of their control. In some cases, large amounts of student debt and future income expectations are steering many new doctors toward higher-paid specialties. Yet, according to a survey conducted by the Association of American Medical Colleges, a student’s eventual specialty choice is influenced more by individual personality and role models. Since 1999, the Health Resources and Services Administration has provided more than $9.4 billion in grants to medical schools and other organizations that seek to increase the ranks of primary care providers and other healthcare professionals in underserved communities. The schools hope the programs will help alleviate an expected shortage of roughly 12,000 to 31,000 primary care physicians by 2025. Read more…

Copper shows mettle in fighting hospital infections.
Experience at two hospitals indicates that the use of copper in surface materials subject to touch as well as in linens and garments may provide natural protection against infectious microbes, Modern Healthcare reports. Copper, long viewed as having sterilizing properties, has been shown in studies to destroy or deactivate pathogens such as MRSA and norovirus. At Grinnell Regional Medical Center in Iowa, after “high touch” surfaces such as bed rails, toilet levers, light switches, and IV poles were fitted in copper alloy in half of 18 patient rooms, 88 percent of rooms with copper fixtures had bacterial samples below recommended concentration levels, while 55 percent of the non-copperized rooms exceeded the threshold. Sentara Leigh Hospital in Virginia saw a 78 percent reduction in C. difficile–related infections in a new wing in which copper-impregnated composite was used for hard surfaces and patients received copper-laced linens and gowns. At Grinnell, the average cost of outfitting a room in copper was $5,500. Read more…
Read the Sentara Leigh study…

ACGME proposes increase to PGY-1 duty hour limits.
The Accreditation Council for Graduate Medical Education (ACGME) has proposed revisions to its rules for residency and fellowship programs that, among other things, include the removal of a requirement limiting PGY-1 residents to 16-hour shifts. Currently, residents above PGY-1 are limited to 24 hours consecutive time on-task, plus 4 hours to manage transitions in care, and promote professionalism, empathy, and commitment. Under the proposal, PGY-1 duty limits would be increased to match those of other residents. In addition, the proposal includes:

  • An expanded section on patient safety and quality improvement
  • A new section on physician well-being
  • Strengthened expectations around team-based care

ACGME will accept comments on the proposal for 45 days. Read more…
Read the statement (PDF)…

Call For Volunteers: SMOAK workgroup.
AAOS is currently accepting applications for a workgroup that will develop a set of performance measures for surgical management of osteoarthritis of the knee (SMOAK). The Performance Measures Committee seeks an interdisciplinary work group of approximately 18 individuals with the following perspectives and areas of expertise:

  • Subject matter expertise
  • Consumer/patient/family perspective
  • Healthcare disparities
  • Performance measurement
  • Quality improvement
  • Purchaser perspective
  • Health Informatics

Applicants must have no relevant financial conflicts of interest and be willing to sign an attestation form declaring that they will maintain an absence of relevant conflicts for the duration of the measure development process and 2 full years following. Applications must be submitted by Nov. 30, 2016. For more information regarding the application process, contact Meghan Hough at 847-384-4323 or via email, at: hough@aaos.org
Access the workgroup application…