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February 2013 Briefing - Orthopedics

February 2013 Briefing - Orthopedics

Here are what the editors at HealthDay consider to be the most important developments in Orthopedics for February 2013. This roundup includes the latest research news from journal articles, as well as the FDA approvals and regulatory changes that are the most likely to affect clinical practice.

Glycemic Control Not Linked to Adverse Outcomes After TKA

THURSDAY, Feb. 28 (HealthDay News) -- For patients undergoing total knee arthroplasty, diabetes (with or without poor glycemic control) is not associated with adverse surgical outcomes, according to research published online Feb. 27 in The Journal of Bone & Joint Surgery.

Abstract (http://jbjs.org/article.aspx?articleid=1566977 )Full Text (subscription or payment may be required) (http://jbjs.org/article.aspx?articleid=1566977 )Editorial (http://jbjs.org/article.aspx?articleid=1566981 )

CMS Issues Final Rule on Physician Sunshine Act

THURSDAY, Feb. 28 (HealthDay News) -- The Centers for Medicare and Medicaid Services (CMS) have issued a final rule requiring drug and device manufacturers and group purchasing organizations (GPOs) to report payment or gifts of more than $10 to physicians, hospitals, and other providers, and necessitating manufacturers and GPOs to report ownership or investment interests held by physicians or their family members.

More Information (http://www.gpo.gov/fdsys/pkg/FR-2013-02-08/pdf/2013-02572.pdf )

Preparation Underway for Implementation of ACA in 2014

TUESDAY, Feb. 26 (HealthDay News) -- As the implementation of the Affordable Care Act (ACA) nears, states are preparing for some of its provisions, including expanded access to Medicaid and the Children's Health Insurance Program (CHIP) and the use of information technology, according to a report issued by the Kaiser Family Foundation.

More Information (http://www.kff.org/medicaid/2013medicaid50statesurvey.cfm )

USPSTF: Vitamin D, Calcium Supplements Don't Prevent Fx

MONDAY, Feb. 25 (HealthDay News) -- For non-institutionalized postmenopausal women, the U.S. Preventive Services Task Force (USPSTF) recommends against daily supplementation with ≤400 IU of vitamin D3 and ≤1,000 mg of calcium for primary prevention of fractures, and a lack of evidence impairs the provision of recommendations for other populations, according to a statement published online Feb. 26 in the Annals of Internal Medicine.

Abstract (http://annals.org/article.aspx?articleid=1655858#Abstract )Full Text (http://annals.org/article.aspx?articleid=1655858 )Editorial (http://annals.org/article.aspx?articleid=1655860 )

Spine Surgery Readmission Rates May Be Overestimated

MONDAY, Feb. 25 (HealthDay News) -- For patients admitted for spine surgery, the readmission rate may be overestimated when calculated based on administrative data sets, according to a study published in the February issue of the Journal of Neurosurgery: Spine.

Abstract (http://thejns.org/doi/full/10.3171/2012.10.SPINE12559#abstract )Full Text (http://thejns.org/doi/full/10.3171/2012.10.SPINE12559 )Editorial (http://thejns.org/doi/full/10.3171/2012.9.SPINE12856 )

Mental Health and Substance Use Disorder Benefits Expanded

FRIDAY, Feb. 22 (HealthDay News) -- In a final rule, which will make purchasing health coverage easier for consumers, mental health and substance use benefits will be expanded to 62 million Americans, according to a report published Feb. 20 by the U.S. Department of Health and Human Services.

More Information (http://www.hhs.gov/news/press/2013pres/02/20130220a.html )

CMS Proposes Payment and Policy Updates for 2014

THURSDAY, Feb. 21 (HealthDay News) -- Payment and policy updates have been proposed for 2014, according to the Centers for Medicare and Medicaid Services (CMS) Advanced Notice and draft Call Letter published Feb. 15.

More Information (http://www.cms.gov/apps/media/press/release.asp?Counter=4540&intNumPerPage=10&checkDa%20te=&checkKey=&srchType=1&numDays=3500&sr )

Higher Risk of Hip Implant Failure for Women Than Men

THURSDAY, Feb. 21 (HealthDay News) -- After adjustment, implant failure is more likely for women than men who undergo total hip arthroplasty (THA), according to a study published online Feb. 18 in JAMA Internal Medicine.

Abstract (http://archinte.jamanetwork.com/article.aspx?articleid=1653996#Abstract )Full Text (subscription or payment may be required) (http://archinte.jamanetwork.com/article.aspx?articleid=1653996 )Editorial (subscription or payment may be required) (http://archinte.jamanetwork.com/article.aspx?articleid=1653990 )

Report Discusses Impact of ACGME 2011 Requirements

THURSDAY, Feb. 21 (HealthDay News) -- Although many residency program directors approve of individual components within the Accreditation Council for Graduate Medical Education (ACGME) Common Program Requirements introduced in 2011, less than half express overall approval, according to a perspective piece published in the Feb. 21 issue of the New England Journal of Medicine.

Full Text (http://www.nejm.org/doi/full/10.1056/NEJMp1214483 )

Extended Dabigatran Effective for Venous Thromboembolism

THURSDAY, Feb. 21 (HealthDay News) -- For patients with venous thromboembolism, extended treatment with dabigatran is noninferior to warfarin, according to a study published in the Feb. 21 issue of the New England Journal of Medicine.

Full Text (subscription or payment may be required) (http://www.nejm.org/doi/full/10.1056/NEJMoa1113697?query=featured_home )Editorial (subscription or payment may be required) (http://www.nejm.org/doi/full/10.1056/NEJMe1215678?query=featured_home )

Faster Adoption of Electronic Health Records Needed

WEDNESDAY, Feb. 20 (HealthDay News) -- The adoption of electronic health records (EHRs) by health providers for Medicare is increasing, but not quickly enough to avoid penalties in 2015, according to a letter published in the Feb. 21 issue of the New England Journal of Medicine.

Full Text (subscription or payment may be required) (http://www.nejm.org/doi/full/10.1056/NEJMc1213481 )

Two Endocrine Disruptors Linked to Osteoarthritis

WEDNESDAY, Feb. 20 (HealthDay News) -- Higher serum concentrations of two endocrine disrupting chemicals, perfluorooctanoate (PFOA) and perfluorooctane sulfonate (PFOS), are associated with nearly twice the risk of osteoarthritis in women, but not men, according to research published online Feb. 14 in Environmental Health Perspectives.

Abstract (http://ehp.niehs.nih.gov/2013/02/1205673/ )Full Text (http://ehp.niehs.nih.gov/pdf-files/2013/Feb/ehp.1205673.pdf )

CMS: Unnecessary Medicare Regulations to Be Reformed

TUESDAY, Feb. 19 (HealthDay News) -- Medicare regulations which are unnecessary, obsolete, or excessively burdensome on hospital or health care providers will be reformed, according to a rule proposed by the Centers for Medicare & Medicaid Services (CMS) in response to the President's instructions in Executive Order 13563.

Proposed Rule (http://www.gpo.gov/fdsys/pkg/FR-2013-02-07/html/2013-02421.htm )Press Release (http://www.hhs.gov/news/press/2013pres/02/20130204d.html )

Multimodality Approach Needed to Reengineer Health Care

TUESDAY, Feb. 19 (HealthDay News) -- A multimodality approach focusing on reengineering the U.S. health care system may provide a way to improve quality and reduce costs, according to a viewpoint published in the Feb. 20 issue of the Journal of the American Medical Association.

Full Text (subscription or payment may be required) (http://jama.jamanetwork.com/article.aspx?articleid=1653532 )

Program Cuts Unnecessary Referrals for Scoliosis in Teens

TUESDAY, Feb. 19 (HealthDay News) -- Implementation of a quality improvement program correlates with a sustained reduction in unnecessary referrals for adolescent idiopathic scoliosis (AIS), according to a study published online Feb. 18 in Pediatrics.

Abstract (http://pediatrics.aappublications.org/content/early/2013/02/13/peds.2012-2359.abstract )Full Text (subscription or payment may be required) (http://pediatrics.aappublications.org/content/early/2013/02/13/peds.2012-2359.full.pdf+html )

Artificial Intelligence Can Improve Patient Care

TUESDAY, Feb. 19 (HealthDay News) -- Use of an artificial intelligence (AI) framework can improve patient outcomes at one-third of the costs of the current standard of care, according to a study published online Jan. 2 in Artificial Intelligence in Medicine.

Abstract (http://www.aiimjournal.com/article/S0933-3657(12)00151-0/abstract )Full Text (subscription or payment may be required) (http://www.aiimjournal.com/article/S0933-3657(12)00151-0/fulltext )

Race Affects Physical Activity Levels in Knee Osteoarthritis

MONDAY, Feb. 18 (HealthDay News) -- In persons with or at risk for radiographic knee osteoarthritis (RKOA), African-Americans are 72 to 76 percent less likely than whites to meet the 2008 United States Department of Health and Human Services (DHHS) Physical Activity Guidelines aerobic component, according to a study published in the February issue of Arthritis Care & Research.

Abstract (http://onlinelibrary.wiley.com/doi/10.1002/acr.21803/abstract )Full Text (subscription or payment may be required) (http://onlinelibrary.wiley.com/doi/10.1002/acr.21803/full )

Health Care-Associated Infections Decreased in 2011

FRIDAY, Feb. 15 (HealthDay News) -- In 2011, decreases were noted for some health care-associated infections (HAIs), according to a report prepared by the U.S. Centers for Disease Control and Prevention.

More Information (http://www.cdc.gov/hai/pdfs/SIR/SIR-Report_02_07_2013.pdf )

Self-Rated Health Measure Can Predict Outcomes in Knee OA

FRIDAY, Feb. 15 (HealthDay News) -- For patients with symptomatic knee osteoarthritis (OA), a single-item measure of self-rated health can be used to predict mental and social health outcomes, according to a study published in the February issue of Arthritis Care & Research.

Abstract (http://onlinelibrary.wiley.com/doi/10.1002/acr.21661/abstract )Full Text (subscription or payment may be required) (http://onlinelibrary.wiley.com/doi/10.1002/acr.21661/full )

General Anesthesia Ups Knee Replacement Complications

FRIDAY, Feb. 15 (HealthDay News) -- For patients undergoing total knee arthroplasty, use of general anesthesia is associated with a significant increase in complications compared with spinal anesthesia, according to a study published in the Feb. 6 issue of The Journal of Bone & Joint Surgery.

Abstract (http://jbjs.org/article.aspx?articleid=1485661 )Full Text (subscription or payment may be required) (http://jbjs.org/article.aspx?articleid=1485661 )

Anterior Cruciate Ligament Surgery Not Needed for All Skiers

THURSDAY, Feb. 14 (HealthDay News) -- For recreational alpine skiers who have an anterior cruciate ligament (ACL) injury, evaluation at six to 12 weeks post-injury can identify patients who can be treated successfully without surgery, according to research published in Knee Surgery, Sports Traumatology, Arthroscopy.

Abstract (http://link.springer.com/article/10.1007%2Fs00167-012-2324-8 )Full Text (subscription or payment may be required) (http://link.springer.com/article/10.1007%2Fs00167-012-2324-8 )

Psychological, Sexual Impact of Female Breadwinners Explored

THURSDAY, Feb. 14 (HealthDay News) -- For couples in which the wife earns more than the husband, there may be psychological and sexual implications, according to a study published in the March issue of the Personality and Social Psychology Bulletin.

Abstract (http://psp.sagepub.com/content/39/3/359.abstract )Full Text (subscription or payment may be required) (http://psp.sagepub.com/content/39/3/359.full )

IOM Urges International Action to Eradicate Fake Drugs

THURSDAY, Feb. 14 (HealthDay News) -- Falsified and substandard medications pose public health problems around the world, and international action should be taken to combat the phenomenon, according to a report published Feb. 13 by the Institute of Medicine (IOM).

More Information (http://www.iom.edu/Reports/2013/Countering-the-Problem-of-Falsified-and-Substandard-Drugs.aspx )

Oregon Experiment Will Provide Insight Into ACO-Based Reform

WEDNESDAY, Feb. 13 (HealthDay News) -- The outcome of the Oregon experiment, an ambitious program centered on a model of an accountable care organization (ACO), will offer important lessons for the wider implementation of ACOs as cost-saving mechanisms, according to a perspective piece published online Feb. 13 in the New England Journal of Medicine.

Full Text (http://www.nejm.org/doi/full/10.1056/NEJMp1214141?query=featured_home )

Health Insurance Exchanges Are Top Priority on U.S. Agenda

WEDNESDAY, Feb. 13 (HealthDay News) -- The public's health care agenda places creation of a health insurance exchange or marketplace as a top priority, according to a report published by the Kaiser Family Foundation/Robert Wood Johnson Foundation/Harvard School of Public Health.

More Information (http://www.kff.org/kaiserpolls/8405.cfm )

Obtaining Price Estimate for Hip Arthroplasty Found Difficult

TUESDAY, Feb. 12 (HealthDay News) -- Obtaining a price estimate for a total hip arthroplasty (THA) procedure from U.S. hospitals is difficult, and there is considerable variation in the prices, according to a study published online Feb. 11 in JAMA Internal Medicine.

Abstract (http://archinte.jamanetwork.com/article.aspx?articleid=1569848#Abstract )Full Text (http://archinte.jamanetwork.com/article.aspx?articleid=1569848 )Editorial (http://archinte.jamanetwork.com/article.aspx?articleid=1569849 )

Increasing Patient Activation Tied to Lower Health Care Costs

MONDAY, Feb. 11 (HealthDay News) -- Patient activation is associated with improved outcomes and lower health care costs, according to a review published in the February issue of Health Affairs.

Abstract (http://content.healthaffairs.org/content/32/2/207.abstract )Full Text (subscription or payment may be required) (http://content.healthaffairs.org/content/32/2/207.full )

Final HIPAA Omnibus Rule Goes Into Effect March 26

FRIDAY, Feb. 8 (HealthDay News) -- The final omnibus rule, which makes changes to the Health Insurance Portability and Accountability Act (HIPAA) of 1996, goes into effect March 26, and physicians must be in compliance by Sept. 23.

More Information (https://west.exch021.serverdata.net/owa/redir.aspx?C=2BpJN5QLtEmB-5Woq0l-bNrw6TmX2c8I7hgPmbx20P3Mfgjo9nB4RSWE9wgEPgrSDXzoR0FnkQ4.&URL=http%3a%2f%2fwww.gpo.gov%2ffdsys%2fpkg%2fFR-2013-01-25%2fpdf%2f2013-01073.pdf )

Less Benefit for Obese With Lumbar Disc Herniation Tx

THURSDAY, Feb. 7 (HealthDay News) -- Obese patients derive less benefit from both operative and non-operative lumbar disc herniation treatment, according to a study published in the Jan. 2 issue of The Journal of Bone & Joint Surgery.

Abstract (http://jbjs.org/article.aspx?articleid=1391018 )Full Text (subscription or payment may be required) ( http://jbjs.org/article.aspx?articleid=1391018 )Editorial (http://jbjs.org/article.aspx?articleid=1391021 )

Risk Factors ID'd for Cervical Spinal Surgery Complications

THURSDAY, Feb. 7 (HealthDay News) -- Risk factors have been identified for medical complications following cervical spine surgery, with cardiac and pulmonary complications correlating with death within two years, according to research published in the Feb. 1 issue of Spine.

Abstract (http://journals.lww.com/spinejournal/Abstract/2013/02010/Risk_Factors_for_Medical_Complication_After.6.aspx )Full Text (subscription or payment may be required) (http://journals.lww.com/spinejournal/Abstract/2013/02010/Risk_Factors_for_Medical_Complication_After.6.aspx )

Minimally Invasive, Open Hemilaminectomy Equivalent

WEDNESDAY, Feb. 6 (HealthDay News) -- Minimally invasive (MIS) and open multilevel hemilaminectomy are similar with respect to cost and improved quality of life measures for the treatment of degenerative lumbar spinal stenosis, according to a study published in the February issue of the Journal of Spinal Disorders & Techniques.

Abstract (http://journals.lww.com/jspinaldisorders/Abstract/2013/02000/Cost_utility_Analysis_of_Minimally_Invasive_Versus.7.aspx )Full Text (subscription or payment may be required) (http://journals.lww.com/jspinaldisorders/Abstract/2013/02000/Cost_utility_Analysis_of_Minimally_Invasive_Versus.7.aspx )

Review Finds Limited Value for Spinal Manipulation in Acute LBP

WEDNESDAY, Feb. 6 (HealthDay News) -- Spinal manipulative therapy (SMT) is no more effective a treatment for acute low back pain than inert interventions, sham SMT, or as adjunct therapy, according to the results of an updated systematic literature review published in the Feb. 1 issue of Spine.

Abstract (http://journals.lww.com/spinejournal/Abstract/2013/02010/Spinal_Manipulative_Therapy_for_Acute_Low_Back.20.aspx )Full Text (subscription or payment may be required) (http://journals.lww.com/spinejournal/Abstract/2013/02010/Spinal_Manipulative_Therapy_for_Acute_Low_Back.20.aspx )

Physicians' Pay for Existing Patients Dropped in 2012

TUESDAY, Feb. 5 (HealthDay News) -- Physicians' pay for existing patients dropped considerably in 2012, according to the results of the Fee Schedule Survey published Jan. 31 in Physicians Practice.

More Information (http://www.physicianspractice.com/fee-schedule-survey/2012-fee-schedule-survey-data )

Corticosteroids Worsen Long-Term Epicondylalgia Outcomes

TUESDAY, Feb. 5 (HealthDay News) -- Patients with unilateral lateral epicondylalgia have worse long-term outcomes after injection with a corticosteroid compared with placebo, according to a study published in the Feb. 6 issue of the Journal of the American Medical Association.

Abstract (http://jama.jamanetwork.com/article.aspx?articleid=1568252#Abstract )Full Text (subscription or payment may be required) (http://jama.jamanetwork.com/article.aspx?articleid=1568252 )

Pre-Op Physiatry Consultation Reduces Spinal Surgery Rates

TUESDAY, Feb. 5 (HealthDay News) -- Requiring patients interested in spinal surgery to first see a rehabilitation physician reduces the number of spinal surgeries, reduces costs, and leaves patients largely satisfied, according to a study published in the Feb. 1 issue of Spine.

Abstract (http://journals.lww.com/spinejournal/Abstract/2013/02010/The_Effect_of_Required_Physiatrist_Consultation_on.21.aspx )Full Text (subscription or payment may be required) (http://journals.lww.com/spinejournal/Abstract/2013/02010/The_Effect_of_Required_Physiatrist_Consultation_on.21.aspx )

Single-Question Low Back Pain Severity Assessment Accurate

MONDAY, Feb. 4 (HealthDay News) -- Patient-reported chronic low-back pain (CLBP) severity, based on answering a single question, provides an accurate indicator of patient-reported health status, according to a study published in the February issue of the Journal of Spinal Disorders & Techniques.

Abstract (http://journals.lww.com/jspinaldisorders/Abstract/2013/02000/Relationship_Between_Self_reported_Low_back_Pain.2.aspx )Full Text (subscription or payment may be required) (http://journals.lww.com/jspinaldisorders/Abstract/2013/02000/Relationship_Between_Self_reported_Low_back_Pain.2.aspx )

Self-Rated Low Physical Capacity Tied to Low Back Pain

MONDAY, Feb. 4 (HealthDay News) -- Women health care workers who rate their physical capacity as low are significantly more likely to develop non-chronic and persistent low back pain (LBP) compared with those who assess their physical capacity as high, according to research published in the Feb. 1 issue of Spine.

Abstract (http://journals.lww.com/spinejournal/Abstract/2013/02010/Does_Self_Assessed_Physical_Capacity_Predict.13.aspx )Full Text (subscription or payment may be required) (http://journals.lww.com/spinejournal/Abstract/2013/02010/Does_Self_Assessed_Physical_Capacity_Predict.13.aspx )

FSMB: Approaches Explored for Expediting Multi-State Licenses

MONDAY, Feb. 4 (HealthDay News) -- New approaches are being explored for streamlining physician multi-state licensure to accommodate the use of telemedicine in the delivery of health care, according to a report from a meeting held from Jan. 16 to 17 by the Federation of State Medical Boards (FSMB).

More Information (http://www.fsmb.org/pdf/nr-licensure-meeting.pdf )

More Complications for Inpatient Lumbar Discectomy

MONDAY, Feb. 4 (HealthDay News) -- Patients undergoing inpatient lumbar discectomy have significantly higher overall complication rates than those treated as outpatients, according to a study published in the Feb. 1 issue of Spine.

Abstract (http://journals.lww.com/spinejournal/Abstract/2013/02010/Outpatient_Surgery_Reduces_Short_Term.12.aspx )Full Text (subscription or payment may be required) (http://journals.lww.com/spinejournal/Abstract/2013/02010/Outpatient_Surgery_Reduces_Short_Term.12.aspx )

Tourniquet Use Beneficial in Total Knee Arthroplasty

FRIDAY, Feb. 1 (HealthDay News) -- Although associated with slightly more postoperative pain, the use of a tourniquet during a total knee arthroplasty procedure reduces blood loss, postoperative inflammation, and muscle damage without affecting postoperative recovery, according to research published in the Dec. 19 issue of The Journal of Bone & Joint Surgery.

Abstract (http://jbjs.org/article.aspx?articleid=1473741 )Full Text (subscription or payment may be required) (http://jbjs.org/article.aspx?articleid=1473741 )

July Residency Influx Doesn't Impact Spinal Surgery Outcomes

FRIDAY, Feb. 1 (HealthDay News) -- The July influx of new residents has a minimal effect on peri-procedural outcomes for patients undergoing spinal surgery, according to a study published online Jan. 29 in the Journal of Neurosurgery: Spine.

Abstract (http://thejns.org/doi/full/10.3171/2012.12.SPINE12300#abstract )Full Text (http://thejns.org/doi/full/10.3171/2012.12.SPINE12300 )

Knowing Cost of Imaging Tests Doesn't Cut Utilization

FRIDAY, Feb. 1 (HealthDay News) -- Physicians do not order fewer imaging tests if they are aware of the costs, according to a study published online Jan. 2 in the Journal of the American College of Radiology.

Abstract (http://www.jacr.org/article/S1546-1440(12)00347-X/abstract )Full Text (subscription or payment may be required) (http://www.jacr.org/article/S1546-1440(12)00347-X/fulltext )