Today’s Top Story
Hospitals brace for Irma, evacuate patients.
Hospitals and medical facilities in southern Florida and beyond are mobilizing as one of the strongest hurricanes on record bears down on the region. Hospitals in the Florida Keys evacuated patients and moved some to locations as far away as Alabama and North Carolina, as well as to other Florida facilities better prepared to withstand catastrophic weather and aftermath. By Wednesday, many south Florida hospitals were discharging patients who could be sent home safely or moving those needing continued care to safer and secure locations. Mercy Hospital in Miami was evacuating approximately 200 patients to other locations and had closed its emergency department to new patients while continuing to treat those already admitted. Some patients in the region were sent to nearby facilities that are hardened and equipped to withstand and function in extreme conditions, including Baptist Hospital in Miami, which CNN reported as being able to “survive on its own” for 2 weeks. Mount Sinai Medical Center in Miami Beach said Thursday it would not evacuate patients or essential staff and would keep emergency centers open, while noting that it was not equipped to serve as a public shelter and planned during the active storm period to accept “only persons with medical emergencies, third-trimester maternity patients, and individuals with special needs previously assigned to Mount Sinai.” Many orthopaedic practices in the region had posted plans to close beginning today. Read more…
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Other News

Study: Use of factor Xa-inhibitors may increase risk of bleeding/wound complication after joint arthroplasty.
Data from a study published online in The Journal of Arthroplasty suggest that the use of factor Xa-inhibitors for prevention of venous thromboembolism (VTE) after joint arthroplasty procedures may be associated with an increased likelihood of bleeding and complication. The authors retrospectively reviewed information on 59 consecutive patients (31 knees, 28 hips) at a single center, who had no previous history of VTE, bilateral procedures, or medical conditions already requiring VTE chemoprophylaxis. Overall, 27 patients (46 percent) were given aspirin for VTE prophylaxis and 32 patients (54 percent) received a factor-Xa inhibitor. There were no new VTE complications in either cohort. However, 6 patients (18.7 percent) in the Xa-inhibitor group had a postoperative bleeding/wound complication (4 delayed healing/blistering, 1 hematoma/excessive ecchymosis, 1 readmission for cellulitis), compared to zero bleeding/wound complications in the aspirin group. Read the abstract…

Petition: Take high-dose opioids off the market.
Five groups involved in efforts to blunt the opioid misuse epidemic have called for the U.S. Food and Drug Administration to remove ultra-high dosage unit (UHDU) oral and transmucosal analgesic drugs from the market. Signing onto a petition calling for an immediate end to the selling of UHDU formulations of oxycodone, morphine, hydropmorphone, methadone, and transmucosal fentanyl were the National Safety Council, Physicians for Responsible Opioid Prescribing, the Association of State and Territorial Health Officials, the American College of Medical Toxicity, and the Fed Up! Coalition to End the Opioid Epidemic. Their statement cited findings from the Centers for Disease Control & Prevention that patients taking doses 50 to 100 morphine milligram equivalent (MME) per day had a risk of addiction 1.9 to 4.6 times greater than those using less than 20 MME. “The harms of UHDU orally administered opioid analgesics outweigh the modest benefit of allowing patients to swallow fewer tablets or capsules,” the petition asserted. The president of the Society of Palliative Care Pharmacists told Pharmacy Times that physicians should have the option of prescribing high-dose opioids to meet the analgesic needs of some cancer patients or others who may benefit from the formulations. Read more…
Read the petition (PDF)…

Study: Many surgeons have positive views of device sales representatives in the OR.
A study published in the September issue of the Journal of Orthopaedic Trauma examines surgeon attitudes regarding the presence of device sales representatives in the operating room (OR) during surgery. The researchers surveyed 127 members of the Orthopaedic Trauma Association regarding conflict of interest (COI) and sales representatives. They found that overall, respondents held favorable views of sales representatives, without any perception of COI. However, in comparing generational demographics of those surveyed, the researchers noted that respondents classified as Generation X were more likely to say that device sales representatives should be present in the OR for all cases, whereas Baby Boomers were more likely to say they should not. Read the abstract…

Medical educators respond to President Trump’s “Dreamers” remarks.
Earlier this week, President Donald Trump ordered an end to the Deferred Action for Childhood Arrivals (DACA) program, a President Barack Obama-era initiative that shields young, undocumented immigrants from deportation. Then yesterday, acting on a prompt by House Minority Leader Nancy Pelosi, President Trump, having called on Congress to act on retaining the program within 6 months, tweeted, “For all of those (DACA) that are concerned about your status during the 6-month period, you have nothing to worry about!” Many in the medical community reacted with dismay to the initial announcement. FierceHealthcare reported that “advocates from the Association of American Medical Colleges (AAMC) said they were ‘extremely dismayed’ by the decision, Stanford University described it as ‘shameful,’ and a representative from Loyola University’s Stritch School of Medicine said it was a ‘sad day’ for the country, the healthcare workforce, and patients.” Hospitals and universities have voiced concern that ending the program could impact medical students with DACA status who may not have permits and could prevent them from pursuing residency programs. Read more…
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Survey: Work-life balance a major concern of residents.
A survey of medical residents conducted by Medscape finds that 33 percent of respondents consider work-life balance to be the greatest challenge they face, and 66 percent list “manageable work schedule/call hours” as a key to avoiding burnout. Additional findings include:

  • 85 percent say they still look forward to working as a doctor
  • 76 percent list clinical knowledge and experience as the most rewarding part of their job
  • 38 percent cite work schedule/call hours as a key factor they’ll look for in their first job
  • 10 percent report that making a serious mistake is a concern of theirs always or most of the time
  • 32 percent of men and 29 percent of women turn to exercise to cope with stress and burnout

The researchers surveyed 1,546 medical residents across more than 25 specialty residency programs. Read more…
View the survey findings…(registration may be required)

Call for volunteers: Biomedical Engineering Committee.
Oct. 11, 2017, is the last day to submit your application for a position on the Biomedical Engineering Committee (two member openings). This committee monitors and reviews scientific and regulatory developments in the field of biomedical engineering as they relate to orthopaedic surgery. Applicants for this position must be active fellows, candidate members, or candidate member applicants for fellowship with a practice emphasis on either adult reconstruction or spine. Learn more and submit your application…(member login required)