Today’s Top Story
Report: Millions of people with undiagnosed osteoporosis at risk for fractures.
According to a report by the International Osteoporosis Foundation (IOF), millions of people with osteoporosis are going undiagnosed and untreated, leaving them at risk for fracture. The IOF asserts that, although safe and cost-effective therapies for treating osteoporosis are widely available, approximately 80 percent of patients who have already sustained a broken bone due to osteoporosis remain unprotected against future fractures. The IOF lists 10 major care gaps clustered into four major themes: case finding and management, public awareness, government and health system issues, and lack of data. Citing the “impending catastrophic burden that will be placed on the world’s population and economy by fragility fractures,” the organization encourages national health authorities worldwide to implement possible solutions outlined in the report.
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Read the report…(PDF)

Other News

CDC investigates increased incidence of polio-like disease.
Acute flaccid myelitis (AFM) is a rare illness that affects the nervous system—specifically, the spinal cord. The Centers for Disease Control and Prevention (CDC) received an increased number of reports of patients with AFM beginning in August 2014 for which no cause could be found. Between Jan. 1 and Aug. 31, 2016, a total of 50 people in 24 states across the country were confirmed to have AFM. Symptoms have been most similar to those caused by certain viruses, including poliovirus, non-polio enteroviruses, adenoviruses, and West Nile virus. Although there have been fewer cases of AFM in 2016 compared to 2014, CDC is concerned about the increase in cases in recent months and is intensifying its efforts to identify the cause and risk factors of AFM.
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Hurry up and slow down: Initiative seeks to reduce diagnostic errors.
Three healthcare institutions in Colorado are collaborating to confront the issue of diagnostic errors, with an emphasis not only on improving communication and care handoffs but with a focus on the role of cognitive bias, reports an article in HealthLeaders magazine. Part of the effort will be to encourage clinicians to “think slower” so as to “avoid ‘anchoring’ and other cognitive biases that can lead to diagnostic errors and delays,” said Daniel Hyman, MD, of Children’s Hospital Colorado. Dr. Hyman will work with faculty at Children’s, University of Colorado Hospital, and University of Colorado School of Medicine to foster skills to avoid bias and expand the diagnostic assessment—for example, beyond the confines of the symptomatic anatomic site. The Colorado initiative will seek to mirror global efforts at other institutions to “close the referral loop” to ensure that test results and other diagnostic information are communicated promptly to all parties who should receive it—including patients.
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Study: Little evidence to support use of antibiotics for open surgical wound management.
A new Cochrane review finds little evidence that the use of antibiotics or antiseptics helps open surgical wounds heal by slowing the growth of dangerous microorganisms, Reuters reports. The researchers reviewed data from 11 randomized trials that evaluated the effects of topical or systemic antibiotic or antiseptic use on secondary intention surgical wound healing. The studies were conducted in the United States, Europe, Africa, and Asia between 1998 and 2013 and involved more than 800 patients. Among the 11 trials, four compared antiseptic treatment to other treatment with no antimicrobials, four studied alternative antimicrobial options, and three compared management with and without antimicrobial agents. The reviewers found low-quality evidence that antibiotic or antiseptic wound management of open surgical wounds would decrease time to healing, increase the number of wounds healed, or decrease adverse events or infection. The reviewers note, however, that because the studies were small and often poorly reported, the interventions they examined may not accurately reflect current clinical practice.
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Read a summary of the Cochrane review:(login required)

Study: Multisensory education program could help improve patient comprehension.
Data from a study published in the Oct. 5 issue of The Journal of Bone & Joint Surgery suggest that use of a multisensory patient education program could improve patient comprehension and informed consent. The authors conducted a randomized trial of 67 patients considered medically appropriate for a knee corticosteroid injection. Each patient listened to a 10-minute scripted lecture based on content from the AAOS OrthoInfo website, along with either video, model, or no additional components, followed by a validated comprehension test. The authors found that mean comprehension scores were 71 percent for the verbal only group, 74 percent for the verbal plus video group, and 84 percent for the verbal plus model group.
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Study: Early anti-inflammatory treatment may affect biomarkers of chondral degeneration.
According to a study published online in The American Journal of Sports Medicine, early intervention with an anti-inflammatory may affect biomarkers of chondral degeneration, suggesting possible treatment paradigms for patients with anterior cruciate ligament (ACL) injury. The research team conducted a randomized study of 49 patients with acute ACL injury who received either corticosteroid at 4 days after ACL injury and placebo saline injection at 2 weeks, placebo at 4 days and corticosteroid at 2 weeks, corticosteroid at both time intervals, or placebo at both time intervals. With the exception of matrix metalloproteinase 1 and tumor necrosis factor–inducible gene 6, they found that chondrodegenerative markers worsened and patient-reported outcomes improved over the first 5 weeks for all treatment groups. However, increases in C-telopeptide of type II collagen, which is associated with collagen type II breakdown, were significantly greater in the placebo group than in either of the two groups that received corticosteroid injection on day 4. The research team notes that evidence increasingly suggests that the progression from injury to posttraumatic osteoarthritis may be multifactorial, involving interplay between biomechanical disturbances and biochemical homeostasis of articular cartilage.
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Call for volunteers: FDA Network of Experts Program.
AAOS seeks to nominate candidates to participate in the U.S. Food and Drug Administration (FDA) Network of Experts program who have experience with devices intended for assessment of global coagulation. The agency is seeking information regarding the clinical application, performance and validation of such devices from various providers. Applicants for this position must be active fellows, candidate members, candidate member applicants for fellowship, candidate member applicants for fellowship osteopathic, or candidate members osteopathic. In addition, all applicants must provide the following: an online AAOS CAP application, a current curriculum vitae, and a completed conflict of interest form (available from the email below). All supporting materials must be submitted by Oct. 16, 2016, by 11:00 p.m. CT, to Kyle Shah at .