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Wednesday, March 7, 2012

Knee Replacement Outcome Data Fall Short

Long-term data on total knee replacement surgery is largely limited to revision, leaving clinicians and patients in the dark about outcomes such as residual pain and disability, researchers said.

Currently the best data come from national procedure registries, but the traditional outcome measure is subsequent revision surgery, which "can underestimate problems [because] patients can remain with pain or poor function without necessarily undergoing revision," according to Andrew J. Carr, FMedSci, of the University of Oxford in England, and colleagues.

More than 600,000 knee replacement procedures are performed in the U.S. annually, according to the Agency for Healthcare Research and Quality.

Writing online in The Lancet (PDF), Carr and colleagues outlined four directions for the future of knee replacement surgery:

  • More consistent patient selection for knee replacement

  • Long-term monitoring with patient-oriented outcomes, as well as revision, as endpoints

  • Approval of new designs only after large randomized trials that demonstrate cost-effectiveness as well as clinical efficacy

  • Better management of young people with early arthritis to avoid need for replacement surgery MedPage Today
  • Merck Manual app is a useful mobile resource despite one or two interface issues

    The Merck Manual is well known as one of the key reference texts for internal medicine physicians.

    Unbound Medicine, developers of other well known reference apps including Johns Hopkins POC-IT series, Harriet Lane Handbook, have recently released the latest edition (19th) of the popular Merck Manual of Diagnosis and Therapy.

    This app review will not focus on the core content of the Merck Manual but rather examine the app itself. iMedicalApps

    Exercise changes your DNA

    You might think that the DNA you inherited is one thing that you absolutely can't do anything about, but in one sense you'd be wrong. Researchers reporting in the March issue of Cell Metabolism, a Cell Press publication, have found that when healthy but inactive men and women exercise for a matter of minutes, it produces a rather immediate change to their DNA. Perhaps even more tantalizing, the study suggests that the caffeine in your morning coffee might also influence muscle in essentially the same way. MedicalXpress

    Some new Clinical Guidelines for Ortho via MD Consult

    American College of Chest Physicians (ACCP)

    American College of Chest Physicians (ACCP)

    Antibiotics I-Pocketcards app assists healthcare providers with antimicrobial choices

    Faced with innumerable micro-organisms, evolving susceptibility patterns, and patient antibiotic allergies, clinicians –especially those in training like myself—often struggle with antimicrobial regimen choices in the management of infectious diseases, in both the inpatient as well as outpatient settings.

    What antibiotics should I order (or not order) for a penicillin-allergic postpartum patient with a fever, a hypotensive nursing home resident with a sacral ulcer, an otherwise healthy middle-aged man with dysuria, a diabetic with foot cellulitis, or a cystic fibrosis patient with an infiltrate on chest x-ray?

    Borm Bruckmeier Publishing LLC, founded in 1992 by two German physicians, has brought us the expansive I-Pocketcards series of apps for the iPhone/iPad, including the most recently reviewed Smoking Cessation I-Pocketcards. To assist in clinical decision making, Borm Bruckmeier Publishing LLC has developed an I-Pocketcards App for Antibiotics. iMedicalApps

    Surgery less than 24 hours after traumatic cervical spinal cord injury leads to improved outcomes

    Researchers at the Rothman Institute at Jefferson have shown that patients who receive surgery less than 24 hours after a traumatic cervical spine injury suffer less neural tissue destruction and improved clinical outcomes. The results of their study, the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS) are available in PLoS One.

    "This practice-changing study is the first to show that the timing of surgery after traumatic spinal cord injury (SCI) matters," says Alexander Vaccaro, MD, PhD, professor of Orthopaedics and Neurosurgery at Jefferson Medical College of Thomas Jefferson University and attending surgeon at Thomas Jefferson University Hospital, the largest spinal cord injury center in the country. Eurekalert!

    Vitamin D intake may be associated with lower stress fracture risk in girls

    Vitamin D may be associated with a lower risk of developing stress fractures in preadolescent and adolescent girls, especially among those very active in high-impact activities, according to a report published Online First by Archives of Pediatrics & Adolescent Medicine. MedicalXpress

    Test Would Speed Treatment of Joint Replacement Infections

    Infection poses one of the most serious risks to patients getting a hip or knee replaced, and a major U.S. drugmaker is developing a test to quickly identify the pathogens responsible so doctors can treat problems sooner.

    Abbott Diagnostics Group, a unit of Abbott Laboratories, is working with privately held Genetics Laboratory Inc., whose expertise is in orthopedics, to develop the test.

    It will be based on Abbott's PLEX-ID system for identifying microbes, and is expected to help doctors detect infections that become rooted in the body's joints long before they become apparent through physical symptoms. NewsMax Health

    Ekso Bionics Sells Its First Commercial Exoskeleton

    Ekso Bionics (Berkeley, CA) has recently delivered the ready-to-wear, battery-powered Ekso exoskeleton to its first customer, the Craig Hospital in Denver, an institution dedicated to spinal cord injury and traumatic brain injury rehabilitation. The Ekso system is strapped on to the user over clothing, enabling paraplegics to stand and walk.  The company will deliver more units over the next few months. MedGadget

    Study reveals how anesthetic isoflurane induces Alzheimer's-like changes in mammalian brains

    The association of the inhaled anesthetic isoflurane with Alzheimer's-disease-like changes in mammalian brains may by caused by the drug's effects on mitochondria, the structures in which most cellular energy is produced. In a study that will appear in Annals of Neurology and has received early online release, Massachusetts General Hospital (MGH) researchers report that administration of isoflurane impaired the performance of mice on a standard test of learning and memory – a result not seen when another anesthetic, desflurane, was administered. They also found evidence that the two drugs have significantly different effects on mitochondrial function. Eurekalert!

    Sunday, March 4, 2012

    AAOS Now and Ortho Supersite are two apps that provide orthopedic and musculoskeletal news and information

    Many apps are small versions of their respective web site. Others carry out one distinct function that works well in the portable world. Still others augment the main web site’s functionality.

    AAOS NOW and OrthoSupersite, known as reliable sources of orthopedic print and web information, have ventured out with their own respective apps. iMedicalApps

    Study shows brain flexibility, gives hope for natural-feeling neuroprosthetics

    Opening the door to the development of thought-controlled prosthetic devices to help people with spinal cord injuries, amputations and other impairments, neuroscientists at the University of California, Berkeley, and the Champalimaud Center for the Unknown in Portugal have demonstrated that the brain is more flexible and trainable than previously thought.

    Their new study, to be published Sunday, March 4, in the advanced online publication of the journal Nature, shows that through a process called plasticity, parts of the brain can be trained to do something it normally does not do. The same brain circuits employed in the learning of motor skills, such as riding a bike or driving a car, can be used to master purely mental tasks, even arbitrary ones. Eurekalert!