Rheumatoid Joint Disease

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Academic Journal
Main Category: Arthritis / Rheumatology
Article Date: 26 Dec 2011 – 0:00 PST

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A small study published online in the Annals of Rheumatic Diseases reveals that “Mindfulness” exercises, irrespective of how difficult they are, that focus on experiencing the present moment can help to limit the stress and fatigue linked to painful rheumatoid joint disease.

Researchers assessed 73 patients aged between 20 and 70 years with painful joint disease due to rheumatoid arthritis, ankylosing spondylitis, or psoriatic arthritis for a minimum of 12 months. Half of the patients were randomly allocated to receive 10 group sessions of “mindfulness” exercises over a course of 15 weeks, plus a booster session about 6 months following the completion of the course, whilst the other half received standard care plus a CD with similar exercises home use, as and when they wanted.

The exercise sessions, which were part of VTP’s Vitality Training Program, were held by healthcare professionals who were trained in mindfulness techniques. During each session they addressed particular topics, including the recognition of each individual’s limitations as well as dealing with strong emotions like anger, joy and sorrow.

Participants were encouraged to practice awareness and deliberately focus on their feelings, thoughts and bodily experiences without judging or trying to avoid them. This also applied to pain. Other sessions consisted of creative exercises like guided imagery, music and drawing and subsequently sharing experiences with other group members.

After all 10 sessions were finished the researchers evaluated the participants’ coping abilities, stress levels and symptom control, including pain and fatigue by using validated scores. The assessment was repeated 12 months later.

From a total of 67 participants who completed all assessments, the researchers observed no differences in pain levels, disease activity or the ability to talk about feelings, however they did observe substantial differences in stress levels and fatigue.

From 13 participants who scored a high stress score of over 23 in the GHQ-20 questionnaire 11 participants stress level was lower, with only two maintaining their high stress score after just 12 months after the sessions had finished, whilst in the control group 10 participants started out with a high stress score of over 23 with eight reporting lower levels of stress.

The researchers did however note a significant reduction in measured levels of fatigue amongst the intervention group whereas the control group reported no such change.

According to the researchers, earlier attempts of using psychological and educational tactics to help arthritis sufferers cope better with the distressing aspects of their disease tended to be short term.

They say the lasting improvements observed in the VTP course: “indicate that the participants may have incorporated some mindfulness strategies into their daily lives and that these strategies have strengthened their ability to respond to their stressful experience in a more flexible way,” emphasizing that although rheumatoid arthritis therapies have greatly improved, they tend to be less effective in individuals in whom the disease is more established. They continue saying that ultimately the disease can only be controlled in part and that it forces many patients to undertake extremely demanding changes in their style of life.

They conclude saying:

“There is therefore a need for complementary interventions that enhance individuals’ health-promoting resources and help them adjust to their disease.”

Written by Petra Rattue

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High-Risk Pregnancies

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Main Category: Medicare / Medicaid / SCHIP
Article Date: 26 Dec 2011 – 0:00 PST

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A new legislative proposal by The American Telemedicine Association (ATA) aims to expand the use of telemedicine for Medicaid enrollees with high-risk pregnancies and neonatal care needs. If the plan should be adopted, it would mean an improvement in providing care for people who are at-risk, whilst creating substantial long-term savings for the government as well as taxpayers.

Avalere Health has been commissioned by ATA to appraise the proposal using Congressional Budget Office style cost estimating. They established that adopting the plan could save up to $186 million over the next decade.

Jonathan Linkous, CEO of the American Telemedicine Association declared:

“This is a win-win for both patients and Federal taxpayers. We urge Congressional leaders to quickly adopt this proposal and realize these savings.”

Under the proposal, Medicaid would receive telemedicine coverage for mother and unborn care as well as neonatal care through the comprehensive care “birthing network”.

These networks could allow telemedicine technologies to treat serious health conditions related to high-risk pregnancies more effectively, including pre-term labor, mild preeclampsia, gestational hypertension ad gestational diabetes mellitus. The Department of Health and Human Services would ensure the quality of care these networks provide by issuing performance reports.

The idea is based on findings from the Institute of Medicine and builds upon the successful implementation of the University of Arkansas ANGELS Program, which has managed a birthing network cost effectively for almost a decade.

The proposal is based on a shared savings approach to encourage providers to adopt the scheme and a 90% contribution in the first two years from the Federal government to support adoption.

For the complete Avalere memorandum on ATA’s proposal, please visit http://www.americantelemed.org/MedicaidProposal.

Written by Petra Rattue

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health care reform a great idea

posted by AbrahamCanfield on 26 Dec 2011 at 3:33 am

I think that health care reform is a great idea. I have type 1 diabetes and for me to get insurance, it was a nightmare until I found “Penny Medical” search for them online and you can get affordable health insurance instantly.

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Discovery May Lead To Safer Treatments For Asthma, Allergies And Arthritis

Main Category: Arthritis / Rheumatology
Also Included In: Allergy
Article Date: 22 Dec 2011 – 1:00 PST

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Scientists have discovered a missing link between the body’s biological clock and sugar metabolism system, a finding that may help avoid the serious side effects of drugs used for treating asthma, allergies and arthritis.

In a paper published last week in Nature, scientists at the Salk Institute for Biological Studies report finding that proteins that control the body’s biological rhythms, known as cryptochromes, also interact with metabolic switches that are targeted by certain anti-inflammatory drugs.

The finding suggests that side effects of current drugs might be avoided by considering patients’ biological rhythms when administering drugs, or by developing new drugs that target the cryptochromes.

“We knew that our sleep and wake cycle are tied to when our bodies process nutrients, but how this happened at the genetic and molecular level was a complete mystery,” says Ronald M. Evans, a professor in Salk’s Gene Expression Laboratory, who led the research team. “Now we’ve found the link between these two important systems, which could serve as a model for how other cellular processes are linked and could hold promise for better therapies.”

Glucocorticoids are steroid hormones that occur naturally in the body and help control the amount of sugar in a person’s blood, so that nutrient levels rise in the morning to fuel daily activities and fall again at night. They function in cells by interacting with glucocorticoid receptors, molecular switches on the outside of the nucleus, which Evans first discovered in 1985.

Glucocorticoids also play a role in regulating inflammation and are used as anti-inflammatory drugs for diseases caused by an overactive immune system, such as allergies, asthma and rheumatoid arthritis. They are also used to treat inflammation in cancer patients.

However, because of their role in sugar metabolism, the steroids can disrupt a person’s normal metabolism, resulting in dangerous side effects, including excessively high blood sugar levels, insulin resistance and diabetic complications.

The Salk researchers may have found a way around these side effects by discovering a new function for cryptochromes 1 and 2, proteins that were previously known for their function in the biological clock.

The cryptochromes serve as breaks to slow the clock’s activity, signaling our biological systems to wind down each evening. In the morning, they stop inhibiting the clock’s activity, helping our physiology ramp up for the coming day.

In their new study on mouse cells, Evans and his colleagues made the surprising discovery that cryptochromes also interact with glucocorticoid receptors, helping to regulate how the body stores and uses sugar.

“We found that not only are the crytopchromes essential to the functioning of the circadian clock, they regulate glucocorticoid action, and thus are central to how the clock interacts with our daily metabolism of nutrients,” says Katja A. Lamia, an assistant professor at The Scripps Research Institute and former post-doctoral researcher in Evan’s laboratory at Salk.

Mouse cells function much like human cells, so the findings could have important implications for treatment of autoimmune diseases and cancer. By taking into account the daily rise and fall of cryptochrome levels, the scientists say, doctors might be able to better time administration of glucocorticoid drugs to avoid certain side effects related to sugar metabolism.

The discovery also raises the possibility of developing new anti-inflammatory drugs that avoid some side effects by targeting cryptochromes instead of directly targeting the glucocorticoid switches.

More broadly, Evans says, the study may help explain the connection between sleep and nutrient metabolism in our bodies, including why people with jobs that require night work or erratic hours are at higher risk for obesity and diabetes.

“Disrupting the normal day-night cycle of activity may prevent a person’s biological clock from synchronizing correctly with their daily patterns of nutrient metabolism,” Evans says. “As a result, the body might not store and process sugar normally, leading to metabolic disease.”

The study was funded by the National Institutes of Health, the Glenn Foundation for Medical Research, the Leona M. and Harry B. Helmsley Charitable Trust and the Life Sciences Research Foundation.

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Medicare And Private Insurance Spending Similar Throughout Texas

Main Category: Health Insurance / Medical Insurance
Also Included In: Medicare / Medicaid / SCHIP
Article Date: 22 Dec 2011 – 1:00 PST

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Variations in health care spending by Medicare and Blue Cross Blue Shield of Texas (BCBSTX) are similar throughout the state despite previous research, which found significant spending differences between the private and commercial sector in McAllen, Texas. The latest research results from The University of Texas Health Science Center at Houston (UTHealth), the Commonwealth Fund, and the Brookings Institution are published in The American Journal of Managed Care’s December web exclusive issue.

Researchers compared variations in spending and inpatient admissions in 32 Texas regions between Medicare and Blue Cross Blue Shield of Texas, the state’s largest health insurer, and did not find significant differences.

“This research was based on aggregate data and leaves many questions unanswered about the causes of the variation in Medicare and private insurance spending” said Luisa Franzini, Ph.D., professor and director of the Division of Management, Policy and Community Health at The University of Texas School of Public Health, a part of UTHealth.

Recently, BCBSTX provided a gift to UTHealth to form The University of Texas School of Public Health/Blue Cross and Blue Shield of Texas Research Program in Payment Systems and Policy, a research program to foster research about cost and utilization of health care services in Texas.

“The funds and data provided by BCBSTX will allow us to investigate sources of variations in medical spending so that we can develop specific policies to control variations and lower healthcare expenditures,” said Franzini. “We are in the process of conducting research in order to provide more definitive explanations and recommendations for the public and commercial sectors.”

Previous research by Franzini and collaborators had compared Medicare and Blue Cross Blue Shield of Texas spending levels in McAllen and El Paso and found significant differences. “The results for the entire state of Texas indicate that high Medicare spending rates in the McAllen are an outlier,” said Franzini.

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The Academy Of Nutrition And Dietetics Advocates For Expanded Nutritional Coverage Under Medicare

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Nutrition / Diet
Article Date: 21 Dec 2011 – 0:00 PST

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The Academy of Nutrition and Dietetics has prepared a request to submit to the Centers for Medicare and Medicaid Services (CMS) to expand coverage of medical nutrition therapy (MNT) for specific diseases, including hypertension, obesity, and cancer, as part of the CMS National Coverage Determination (NCD) Process. Most chronic health conditions can be controlled or treated with medical nutrition therapy, yet Medicare will only reimburse nutrition therapy services provided by a registered dietitian for individuals with diabetes and renal disease. “That’s just not enough if we want to improve the health of the nation and rein in escalating healthcare costs,” says Marsha Schofield, MS, RD, LD, the Academy’s Director of Nutrition Services Coverage.

Under the NCD Process, the Secretary of the Department of Health and Human Services can expand Medicare coverage for services that are reasonable and necessary for the prevention of an illness. Ms. Schofield explains, “There are an escalating number of baby boomers turning 65 and entering the Medicare system. The majority of Medicare spending is on individuals with chronic conditions, and almost 70% of Medicare beneficiaries suffer from cardiovascular disease. Chronic conditions can be controlled or treated with medical nutrition therapy, so it just makes sense to try to expand the Medicare beneficiary’s access to these important services.”

The Academy’s NCD request is published in the January 2012 issue of the Journal of the Academy of Nutrition and Dietetics and it presents evidence from over 20 scientific studies that demonstrate the health benefits and cost effectiveness of medical nutrition therapy, provided by registered dietitians, in older adults with several diseases and conditions. The evidence is grouped into three sections: cardiovascular disease, including the treatment of high cholesterol, hypertension, and heart failure; disease progression, including obesity and metabolic syndrome, and pre-diabetes; and diseases related to reduced nutrient intake or unintentional weight loss, for example related to cancer, celiac disease, chronic obstructive pulmonary disease, and HIV/AIDS.

In a podcast about the Academy’s NCD request, Ms. Schofield notes, “What was very significant about the document is that whether you’re talking about cardiovascular disease, pre-diabetes, hypertension, cancer, or unintended weight loss, the evidence shows that medical nutrition therapy services result in positive dietary change, improved clinical status, and an improved quality of life. Also, they are cost effective and have been proven to save money.” For example, four previously published studies demonstrate that MNT provided by registered dietitians (RDs) promotes changes in dietary intake of fat and saturated fat, and leads to improvements in serum lipid levels in adults with high LDL cholesterol. Four studies demonstrate that MNT provided by an RD significantly reduces dietary sodium and lowers blood pressure in older adults with hypertension. Seven studies demonstrate that MNT provided by an RD results in significantly improved outcomes in adults with cancer.

Medical nutrition therapy is provided by RDs, trained professionals who offer food and nutrition services while assisting patients in making healthy lifestyle changes. The evidence compiled by the Academy in its NCD request shows that involvement by RDs in beneficiary care has a substantial effect on both the health of the beneficiary, and is almost always more cost effective than other treatments. “The research demonstrates the value of the RD and our unique contributions on the healthcare team are critical. We’re the trusted source of credible and useful nutritional information,” says Jeanne Blankenship, MS, RD, CLE, Vice President, Policy Initiatives and Advocacy for the Academy.

According to the authors, MNT in each of the conditions discussed clearly meets the requirements of an NCD. Moreover, RDs are the most qualified professionals to deliver the necessary nutrition education and MNT services for prevention, wellness, and disease management. By expanding services under MNT, CMS has the opportunity to play a major role in improving the quality of care provided to elderly and disabled persons who fall into the Medicare population.

In an accompanying podcast Ms. Schofield, Ms. Blankenship, and Ms. Gradwell discuss the NCD process undertaken by the Academy and share insights about its potential impact on healthcare and the role of the registered dietitian. The podcast is available at http://andjrnl.org/content/podcast.

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The article is “The Academy of Nutrition and Dietetics National Coverage Determination Formal Request,” by Prashanthi Rao Raman, Esq, MPH, and Erica Gradwell, MS, RD, in the Journal of the Academy of Nutrition and Dietetics, Volume 112, Issue 1 (January 2012) published by Elsevier.

Elsevier Health Sciences

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Knee Pain Common In Older Women

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Academic Journal
Main Category: Arthritis / Rheumatology
Also Included In: Women’s Health / Gynecology;  Seniors / Aging
Article Date: 20 Dec 2011 – 6:00 PST

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It appears that knee pain of some kind is a common complaint in middle-aged and mature women, with varying possible causes leading to varying types of pain. A new study on knee-pain patterns assessed periodically over 12 years in a representative UK population finds that nearly two-thirds (63%) of women
aged 50 and over experience knee pain at least once, persistently, or intermittently over such a period.

The authors found these patterns were more likely in women with higher BMI, with a previous knee injury, or whose scans
showed they had osteoarthritis (OA). They write about their findings in the 19 December online issue of the journal Arthritis
Rheumatism
.

Senior author Dr Nigel Arden, a Professor of Rheumatology at the University of Oxford in the UK, told the media that this was
the first study involving community-based participants that investigates patterns of knee pain using “multiple assessment
points” over a period of 12 years:

“Understanding the prevalence and predictors of knee pain is the first step in developing comprehensive pain assessment plans
that could lead to more targeted treatment options for those burdened by OA.”

For their analysis, Arden and colleagues used data gathered in the Chingford Study, a prospective population-based study of OA
and osteoporosis established in 1989. This started with more than 1,000 women aged from 44 to 57 (median 52) years.

The cohort is described as representative of women in the UK in general in terms of height, weight, and smoking status. At four
times over the 12 years of the study, the participants completed questionnaires about their knee pain.

From their responses the researchers classed the 489 participants who were still in the study at the end into one of four groups,
depending on their pain characteristics: asymptomatic, persistent, incident, and intermittent.

The results showed that:

  • 44% of women reported experiencing “any days of pain”.
  • 23% reported experiencing “pain on most days of the previous month”.
  • Of those experiencing “any pain”, 9% had persistent pain, 24% had incident pain, and 29% had intermittent pain.
  • Of those experiencing “pain on most days”, these figures were 2%, 16% and 18% respectively.
  • A higher BMI predicted persistent and incident patterns of pain, while radiographic OA predicted persistent pain.
  • Those who reported a previous knee injury were more likely to have persistent or intermittent patterns of pain.

The researchers conclude the results show a “significant variability” in patterns of knee pain over time in this representative
population, with few participants “consistently reporting knee pain at each time point”.

They also suggest that a strength of the study is that it describes a natural history of knee pain over a long period of time, taking
data from several points along that timescale.

Finding that separate factors appear to predict pain patterns differently (eg BMI predicted persistent and incident patterns while
OA predicted only persistent pain patterns) may be why studies that measure pain at one time point seem to show inconsistent
relationships between pain predictors and pain patterns, they add.

Arden said:

“Validation of our findings through reproduction in other patient groups is needed to advance knowledge of knee pain predictors
that will ultimately enhance prevention and treatment strategies for those with OA.”

OA is a leading cause of disability throughout the world. In the US, the American College of Rheumatology estimates that over
27 million Americans over the age of 25 are living with the disease, with pain being the most problematic symptom.

The damage to the economy that can be linked to OA is substantial. In the UK, reports suggest it accounts for £3.2 billion a year
loss in productivity. The US Centers for Disease Control and Prevention (CDC) puts the cost of job-related OA at between $3.4
and $13.2 billion a year.

Previous studies indicate that OA of the knee in particular is linked to reduced physical function and is a substantial burden to
society. According to figures from the CDC, nearly half a million total knee replacements were carried out in the the US in 2004,
with around $14 billion spent on the hospital costs of such an operation.

Written by Catharine Paddock PhD

Copyright: Medical News Today

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Salk Discovery May Lead To Safer Treatments For Asthma, Allergies And Arthritis

Main Category: Respiratory / Asthma
Also Included In: Allergy;  Arthritis / Rheumatology
Article Date: 20 Dec 2011 – 1:00 PST

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Scientists have discovered a missing link between the body’s biological clock and sugar metabolism system, a finding that may help avoid the serious side effects of drugs used for treating asthma, allergies and arthritis.

In a paper published last week in Nature, scientists at the Salk Institute for Biological Studies report finding that proteins that control the body’s biological rhythms, known as cryptochromes, also interact with metabolic switches that are targeted by certain anti-inflammatory drugs.

The finding suggests that side effects of current drugs might be avoided by considering patients’ biological rhythms when administering drugs, or by developing new drugs that target the cryptochromes.

“We knew that our sleep and wake cycle are tied to when our bodies process nutrients, but how this happened at the genetic and molecular level was a complete mystery,” says Ronald M. Evans, a professor in Salk’s Gene Expression Laboratory, who led the research team. “Now we’ve found the link between these two important systems, which could serve as a model for how other cellular processes are linked and could hold promise for better therapies.”

Glucocorticoids are steroid hormones that occur naturally in the body and help control the amount of sugar in a person’s blood, so that nutrient levels rise in the morning to fuel daily activities and fall again at night. They function in cells by interacting with glucocorticoid receptors, molecular switches on the outside of the nucleus, which Evans first discovered in 1985.

Glucocorticoids also play a role in regulating inflammation and are used as anti-inflammatory drugs for diseases caused by an overactive immune system, such as allergies, asthma and rheumatoid arthritis. They are also used to treat inflammation in cancer patients.

However, because of their role in sugar metabolism, the steroids can disrupt a person’s normal metabolism, resulting in dangerous side effects, including excessively high blood sugar levels, insulin resistance and diabetic complications.

The Salk researchers may have found a way around these side effects by discovering a new function for cryptochromes 1 and 2, proteins that were previously known for their function in the biological clock.

The cryptochromes serve as breaks to slow the clock’s activity, signaling our biological systems to wind down each evening. In the morning, they stop inhibiting the clock’s activity, helping our physiology ramp up for the coming day.

In their new study on mouse cells, Evans and his colleagues made the surprising discovery that cryptochromes also interact with glucocorticoid receptors, helping to regulate how the body stores and uses sugar.

“We found that not only are the crytopchromes essential to the functioning of the circadian clock, they regulate glucocorticoid action, and thus are central to how the clock interacts with our daily metabolism of nutrients,” says Katja A. Lamia, an assistant professor at The Scripps Research Institute and former post-doctoral researcher in Evan’s laboratory at Salk.

Mouse cells function much like human cells, so the findings could have important implications for treatment of autoimmune diseases and cancer. By taking into account the daily rise and fall of cryptochrome levels, the scientists say, doctors might be able to better time administration of glucocorticoid drugs to avoid certain side effects related to sugar metabolism.

The discovery also raises the possibility of developing new anti-inflammatory drugs that avoid some side effects by targeting cryptochromes instead of directly targeting the glucocorticoid switches.

More broadly, Evans says, the study may help explain the connection between sleep and nutrient metabolism in our bodies, including why people with jobs that require night work or erratic hours are at higher risk for obesity and diabetes.

“Disrupting the normal day-night cycle of activity may prevent a person’s biological clock from synchronizing correctly with their daily patterns of nutrient metabolism,” Evans says. “As a result, the body might not store and process sugar normally, leading to metabolic disease.”

The study was funded by the National Institutes of Health, the Glenn Foundation for Medical Research, the Leona M. and Harry B. Helmsley Charitable Trust and the Life Sciences Research Foundation.

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Physical Function Following Hip Replacement Surgery Improved By Walking Skills Program

Main Category: Arthritis / Rheumatology
Also Included In: Bones / Orthopedics;  Rehabilitation / Physical Therapy
Article Date: 18 Dec 2011 – 0:00 PST

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Researchers in Norway report that patients who receive walking skills training following total hip arthroplasty for osteoarthritis show improved physical function. The physical therapy program displayed a positive effect on walking distance and stair climbing which continued 12 months following hip replacement surgery. Results of the study appear in Arthritis Care Research, a journal published by Wiley-Blackwell on behalf of the American College of Rheumatology (ACR).

Osteoarthritis (OA) is a joint disease where loss of cartilage in affected joints such as the knees, hips, fingers or spine causes pain and stiffness that can be disabling. In some cases, the only treatment option for OA is total replacement of the joint, known as arthroplasty. The World Health Organization (WHO) estimates that 10% of men and 18% of women 60 years of age and older suffer from OA. In the U.S., the National Hospital Discharge Survey reported that 230,000 Americans had hip replacement surgery in 2007.

Previous research reported pain relief, a return to daily functioning, and maintaining an active lifestyle to be high priorities for hip replacement patients. Yet despite improvements in pain and mobility following surgery, several studies have shown patients with hip replacements had more walking impairment compared to healthy peers, and displayed poorer hip flexibility and muscle strength in their affected hip. “Physical therapy, particularly exercises that increase strength and improve walking, is a major component of patient rehabilitation following hip arthroplasty,” said Kristi Elisabeth Heiberg, a Ph.D. candidate at the University of Oslo in Norway and lead author of the current study.

To investigate the effects of a walking skills training program on walking, stair-climbing, balance, physical function, and pain, the research team recruited participants undergoing total hip arthroplasty at two hospitals in the Oslo area. Patients were enrolled consecutively from October 2008 through March 2010, with 68 patients randomized to either a training group (35) or in the control group (33). Participants had a mean age of 66 years, with 35 women and 33 men taking part in the study.

Participants in the training group engaged in 12 sessions that were led by a physical therapist twice a week. Each 70 minute session was solely performed in weight-bearing positions and included physical activities such as sitting to standing, walking over obstacles, walking with turns, and climbing stairs. The aim of the training program was to improve patients’ flexibility, strength, coordination, balance, and walking endurance following surgery.

Results show those who took part in the walking program displayed significant improvement in physical performance measures and self-reported physical functioning at five months following surgery compared to the control group. Compared to baseline measures (3 months post surgery), 66% of subjects in the training group and 15% in the control group improved their walking distance to 164 feet (50 meters) or more by the fifth month following hip replacement surgery. At 12 months post surgery the training group showed greater improvement in walking distance and stair climbing abilities than the control. “The training program was well tolerated by patients and no complications were reports,” concludes Ms. Heiberg. “Our findings suggest physical rehabilitation helps improve mobility and function in patients who received hip replacements.”

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Introducing A New Knee Replacement Model Increases The Likelihood Of Early Revision Surgery

Main Category: Bones / Orthopedics
Also Included In: Arthritis / Rheumatology
Article Date: 18 Dec 2011 – 0:00 PST

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Orthopaedic surgeons face a steep learning curve to get used to new prostheses, and the instruments and methods that go with them, before new total knee replacement procedures are as safe and effective as conventional methods. Patients who undergo the first 15 operations using a new device in a hospital are 48 percent more likely to need early revision surgery, than patients undergoing an operation to fit a prosthesis previously used in the hospital. The work by Mikko Peltola from the National Institute for Health and Welfare in Finland, and colleagues, is published online in Springer’s journal, Clinical Orthopaedics and Related Research.

Total knee arthroplasty, or replacement, is an established treatment for patients with severe osteoarthritis of the knee. There are numerous brands and models of endoprostheses (a prosthesis used internally) available and new models continue to emerge as a result of a combination of new technology, marketing efforts and the increasing number of patients requiring the surgery.

Hospital staff makes important decisions when choosing the implants and instruments they use, and these decisions carry consequences for patients’ health. According to the research team, however, new equipment and techniques are often used in clinical practice, occasionally without evidence of effectiveness and safety.

Peltola and team looked at the risk of early revision surgery following the introduction of a new endoprosthesis model for total knee arthroplasty. They studied data from the Finnish Arthroplasty Register to identify centers that had performed total knee replacement operations for primary osteoarthritis between 1998 and 2004. Of the 23,707 total number of patients who underwent the surgical procedure, 22,551 were followed up for five years.

The researchers found that the introduction of an endoprosthesis model in a hospital put the first patients at greater risk of revision surgery. The effect was substantial for the first 15 patients operated on with the new model, who were at 48 percent greater risk than patients having undergone an operation to implant a conventional endoprosthesis. Overall, the likelihood of needing revision surgery was greatest during the first two years after the surgery. The learning curve smoothed quickly, however, with no increased risk after the first 15 operations with the new model.

The authors conclude: “Patients should be informed if there is a plan to introduce a new model and offered the option to choose a conventional endoprosthesis instead. Although introducing potentially better endoprosthesis models is important, there is a need for managed uptake of new technology.”

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Overall Hospital Admission Rates In US Linked With High Rates Of Readmission

Main Category: Public Health
Also Included In: Medicare / Medicaid / SCHIP;  Heart Disease
Article Date: 16 Dec 2011 – 0:00 PST

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High hospital readmission rates in different regions of the U.S. may have more to do with the overall high use of hospital services in those regions than with the severity of patients’ particular conditions or problems in the quality of care during and after hospital discharges, according to a new study from researchers at Harvard School of Public Health (HSPH).

The study appears in the December 15, 2011 issue of the New England Journal of Medicine.

“This is a very important observation that has been largely unrecognized in the literature or by policy makers,” said study lead author Arnold Epstein, John H. Foster Professor of Health Policy and Management and chair of the Department of Health Policy and Management at HSPH. “Hospitals may have limited ability to reduce readmissions. The responsibility for readmissions lies with the entire delivery system. Meaningful progress may require incentives directed at that level and a change in culture.”

Rehospitalizing patients after discharge is a costly problem, and hospitals and policymakers have made significant efforts to reduce readmission rates. Most efforts to reduce readmission rates have focused on improving transitional care – what happens to patients at discharge and shortly after they’re released from the hospital. This study implies that the problem is much broader than that.

Hospital readmission rates are high – nearly one in four Medicare patients discharged with congestive heart failure is rehospitalized within 30 days, according to the study. Unplanned readmissions are costly and are often associated with poor patient health outcomes. But previous studies have shown that efforts to improve hospital discharge planning have not significantly decreased readmission rates.

Epstein and coauthors Ashish Jha, associate professor at HSPH, and E. John Orav, associate professor at Brigham and Women’s Hospital, used national Medicare data from the first six months of 2008 to calculate, for different U.S. regions, the 30-day, 60-day, and 90-day readmission rates among patients discharged with congestive heart failure or pneumonia. They examined overall hospitalization rates as well as differences in patients’ coexisting conditions, the quality of discharge planning, and the number of physicians and hospital beds in each region, looking at how each factor affected readmissions.

The results showed that readmission rates among regions ranged from 11% to 32% among patients with congestive heart failure and from 8% to 27% among those with pneumonia. Greater severity of coexisting conditions was associated with higher regional readmission rates. But of all the potential causes for regional differences in readmission rates, overall hospital admission rates were found to play the biggest role; they accounted for 16% to 24% of the variation in cases of congestive heart failure, and 11% to 20% for pneumonia cases. No other factor accounted for more than 6% of the variation.

To effectively reduce readmission rates, the authors recommend that payers use programs that include shared savings with health care providers, such as accountable care organizations, that are able to reduce readmission rates and bring down the overall cost of care.

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