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General interest items edited by Janice Flahiff

Stretching before a run does not prevent injury

Stretching before a run does not prevent injury
However, runners who typically stretch should continue, or risk injury

A coach stretches out a Pittsburgh Steeler pri...

This image was originally posted to Flickr by SteelCityHobbies at http://flickr.com/photos/94767754@N00/1394011566.

From the February 18 2011 Eureka news alert

Stretching before a run neither prevents nor causes injury, according to a study presented today at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS).

More than 70 million people worldwide run recreationally or competitively, and recently there has been controversy regarding whether runners should stretch before running, or not at all. This study included 2,729 runners who run 10 or more miles per week. Of these runners, 1,366 were randomized to a stretch group, and 1,363 were randomized to a non-stretch group before running. Runners in the stretch group stretched their quadriceps, hamstrings, and gastrocnemius/soleus muscle groups. The entire routine took 3 to 5 minutes and was performed immediately before running.

The study found that stretching before running neither prevents nor causes injury. In fact, the most significant risk factors for injury included the following:

  • history of chronic injury or injury in the past four months;
  • higher body mass index (BMI); and
  • switching pre-run stretching routines (runners who normally stretch stopping and those who did stretch starting to stretch before running).

“But, the more mileage run or the heavier and older the runner was, the more likely he or she was likely to get injured,”

“As a runner myself, I thought stretching before a run would help to prevent injury,” said Daniel Pereles, MD, study author and orthopaedic surgeon from Montgomery Orthopedics outside Washington, DC. “However, we found that the risk for injury was the same for men and women, whether or not they were high or low mileage runners, and across all age groups. But, the more mileage run or the heavier and older the runner was, the more likely he or she was likely to get injured, and previous injury within four months predisposed to even further injury,” he added.

Runners who typically stretch as part of their pre-run routine and were randomized not to stretch during the study period were far more likely to have an injury. “Although all runners switching routines were more likely to experience an injury than those who did not switch, the group that stopped stretching had more reported injuries, implying that an immediate shift in a regimen may be more important than the regimen itself,” he added.

The most common injuries sustained were groin pulls, foot/ankle injuries, and knee injuries. There was no significant difference in injury rates between the runners who stretched and the runners who didn’t for any specific injury location or diagnosis.

February 18, 2011 Posted by | Consumer Health, Consumer Safety, Medical and Health Research News | , , , , , , | Leave a comment

Health care spending: Study shows high imaging costs for defensive purposes

Health care spending: Study shows high imaging costs for defensive purposes
Costs and frequency of defensive medicine in Pennsylvania

AAOS: American Academy of Orthopaedic Surgeons® / American Association of Orthopaedic Surgeons®

From the February 16, 2011 Eureka news alert

Nearly 35 percent of all the imaging costs ordered for 2,068 orthopaedic patient encounters in Pennsylvania were ordered for defensive purposes, according to a new study presented today at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS).

For many years now, some physicians have ordered specific diagnostic procedures that are of little or no benefit to a patient, largely to protect themselves from a lawsuit. Until now, however, efforts to actually measure defensive medicine practices have been limited primarily to surveys sent to physicians. Such surveys would simply ask whether or not that individual actually practiced defensive medicine.

“This is the first study we know of that looked at the actual practice decisions of physicians regarding defensive imaging in real time — prospectively done,” says John Flynn, MD.

Flynn, who is Associate Chief of Orthopaedic Surgery at Children’s Hospital of Philadelphia, says that many lawsuits hinge on the plaintiff’s lawyer’s claim that the doctor should have ordered extra diagnostic testing. “And such a claim may be the driving force of so much of the defensive test ordering.”

According to Flynn, 72 orthopaedic surgeons, who are members of the Pennsylvania Orthopaedic Society, voluntarily participated in this study, which included some 2,068 patient encounters throughout the state of Pennsylvania. Most patients in this study were adults. The study found that 19 percent of the imaging tests ordered were for defensive purposes. Defensive imaging was responsible for $113,369 of $325,309 (34.8 percent) of total imaging charges for this patient cohort, based on Medicare dollars. The overall cost of these tests was 35 percent of all imaging ordered because the most common test was an MRI, an imaging test which costs more than a regular X-ray.

One piece of this problem to remember, Flynn says, is that the legal environment that drives physicians to order additional tests has an effect on patients too, in a way that involves more than costs. “Patients are sometimes put through tests that maybe otherwise would not be ordered.”

The finding from this research that surprised Flynn the most was that surgeons were more likely to practice defensively if they had been in practice for more than 15 years.

“This was counterintuitive,” he says. “I thought that young doctors would come out of medical school immediately after training, be less confident because they weren’t experienced, and order more defensive tests. Then, as they become more comfortable and confident after 10 or 20 years in practice, they would order many fewer tests.”

“In fact, the opposite was true. We found that — in Pennsylvania at least — a surgeon’s defensive nature gets worse over time. In this legal environment, orthopaedic surgeons order more imaging tests of a defensive nature, because over time they become more concerned that someone is going to second guess or sue them.”

Flynn says that medical liability awards typically are given because of the severity of a bad outcome, and not necessarily because of negligence. In fact, a May 2006 study published in the New England Journal of Medicine (Studdert DM) showed that 37 percent of claims did not involve medical errors, and in 3 percent of claims, no injury occurred at all.

Flynn pointed to various studies that show that defensive medicine, in general, is quite prevalent. One such study in the June 2005 Journal of the American Medical Association (Studdert DM) reported that almost 93 percent of 824 physicians in Pennsylvania responding to a survey practiced defensive medicine.

“Ideally, as a next step, we would hope to try to get a broader national picture using this prospective practice audit methodology, so we could get a better sense of the true costs of defensive imaging in orthopaedics,” says Flynn.

“Ultimately, if you had doctors from multiple specialties — from OB/Gyn to Neurosurgery to Emergency Medicine — do this type of practice audit, you could accurately quantify how much of our nation’s healthcare resources are wasted on defensive medicine.”

 

 

 

 

February 16, 2011 Posted by | Medical and Health Research News | , , , , , | Leave a comment

Biological joints could replace artificial joints soon

Biological joints could replace artificial joints soon

University of Missouri researchers are part of team that has successfully regenerated complete shoulder joint surfaces using the patient’s own cells

From a January 5, 2011 Eureka news alert

Artificial joint replacements can drastically change a patient’s quality of life. Painful, arthritic knees, shoulders and hips can be replaced with state-of-the-art metal or ceramic implants, eliminating pain and giving a person a new lease on life. But, what if, instead of metal and plastic, doctors were able to take a patient’s cells and grow an entirely new joint, replacing the old one with a fully functional biological joint? A team of University of Missouri and Columbia University researchers have found a way to create these biological joints in animals, and they believe biological joint replacements for humans aren’t far away.

In a study published this fall in The Lancet***, James Cook, a researcher in the MU College of Veterinary Medicine and Dept of Orthopaedic Surgery participated on a research team that created new cartilage in animals using a biological “scaffold” in the animals’ joints. Cook assisted with the implant design and performed the surgeries to implant the biologic joint replacements. The study was led by Jeremy Mao of Columbia University….

 

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January 7, 2011 Posted by | Medical and Health Research News | , , | Leave a comment

   

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