Today’s Top Story
Study: Overall use of fracture-associated drugs may change little following fragility fracture.
A study published in the October issue of the journal JAMA Internal Medicine looks at prescription drug use patterns before and after fragility fracture. The research team conducted a retrospective cohort study of 168,133 community-dwelling Medicare beneficiaries who were enrolled in fee-for-service Medicare with drug coverage and who survived a fracture of the hip, shoulder, or wrist. Overall, 77.1 percent of hip, 74.1 percent of wrist, and 75.9 percent of shoulder fracture patients were exposed to at least one non-opiate drug associated with increased fracture risk in the 4 months before fracture. The research team found that about 7 percent of those patients discontinued the drug exposure following fracture, but this was offset by new users after fracture, leaving no significant change in the proportion of the cohort exposed following fracture and no change in the average number of fracture-associated drugs used.
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Other News
Study: Use of PSH model linked to improved patient satisfaction and fewer tests following joint arthroplasty.
According to findings presented at the annual meeting of the American Society of Anesthesiologists (ASA), use of a perioperative surgical home (PSH) following joint arthroplasty may improve pain management and patient communication with physicians, while decreasing the number of tests and length of stay. The researchers reviewed medical records for 1,356 patients who underwent total knee, hip, or shoulder arthroplasty procedures, 50 percent of whom received care under the PSH model and 50 percent of whom did not. They found that use of a PSH was associated with a 9 percent decrease in imaging tests, a 22 percent reduction in number of laboratory tests prior to surgery, an 87 percent decrease in blood transfusion requirements, and an average decrease of slightly more than half a day in length of hospital stay. In addition, the researchers noted improvements in patient satisfaction, with better reported pain management and more effective physician communication.
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Study: Do patients need more encouragement following THA?
Data from a study published online in the journal Clinical Rehabilitation suggest little difference in physical activity levels before and up to 1 year following unilateral primary total hip arthroplasty (THA). The authors examined data from 17 studies, nine of which were analyzed in a meta-analysis and eight of which were analyzed qualitatively. Pre- to post-THA, they found no statistically significant difference in physical activity based on movement-related activity, percentage of 24-hours spent walking, 6-minute walk test, or the cardiopulmonary exercise test. The authors note that the quality of evidence ranged from low to moderate. Nonetheless, they suggest that the findings indicate a need for improvement in encouragement for patients to be more physically active following THA.
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Study: Long-term outcomes acceptable for patients treated with cemented primary THA for DDH.
Findings published in the November issue of the journal Clinical Orthopaedics and Related Research suggest “satisfying” long-term outcomes for patients with previous developmental dysplasia of the hip (DDH) who have been treated with cemented primary THA with the use of impaction bone grafting. The research team conducted a retrospective analysis of 28 hips treated with acetabular impaction bone grafting procedures for secondary osteoarthritis believed to be caused by DDH. At mean 20-year follow-up (range 16–29 years), they found that three revision surgeries had been performed: Two cup revisions were for aseptic loosening at 12 and 26 years, and one cup revision was related to sciatic nerve problems at 2 years. Overall, stable radiographic appearance of the graft was seen in 19 of 25 unrevised hips, and none of the unrevised cups showed migration or radiographic failure. Four hips showed acetabular radiolucent lines, and two showed acetabular osteolysis. Harris Hip Score improved from 37 (range, 9–72) preoperatively to 83 (range, 42–99) at latest follow-up.
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Is it time to adopt a National Trauma Action Plan?
A perspective piece published in the Oct. 19 issue of The New England Journal of Medicine argues for the establishment of a National Trauma Action Plan designed to build on advances achieved by the military health system through experience in Iraq and Afghanistan and, “by doing so, to drive the number of preventable deaths after injury down to zero.” The writers note that in 2004, the U.S. armed forces created the Joint Trauma System (JTS), an enterprise modeled on high-performing civilian trauma systems, which included the creation of a trauma registry to compile treatment and outcomes data, including information on the timing and causes of death and disability, the establishment of procedures to improve performance and the quality of care, and the formation and dissemination of clinical practice guidelines. Data from that registry illuminated challenges and identified aspects of care that were either suboptimal or associated with poor outcomes. In addition, the JTS used continuous performance-improvement processes and “focused empiricism” to inform practice and evolve standards of care.
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Should medical students speak up when they perceive patient safety concerns?
An article HealthLeaders Media suggests that some medical students may be uncomfortable questioning their superiors regarding patient safety issues, even when they see something they find to be concerning. The writer notes that a survey of medical students published online in the American Journal of Medical Quality finds that 62 percent of respondents perceived problems in safety and 44 percent saw what they believed to be lack of evidence-based care. However, only 51 percent of students said they were comfortable reporting incidents to their superiors and just 20 percent noted a change in response after bringing up their concerns. One study author argued that whether the quality issues were real or not, they need to be addressed. “Either [the students] are missing the opportunity to learn about quality and safety, or they are missing the opportunity to learn about clinical medicine,” he said.
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Last call: AAOS Emergency Medical Services Program Product Line series editor.
Oct. 28 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)
