Another interesting list of commonly used low-value practices that should be questioned.
Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain: The SPACE Randomized Clinical Trial – JAMA (link to abstract – $ for full-text)
Commentaries: Opioids Don’t Beat Other Medications For Chronic Pain – NPR (free) AND More Data Opioids No Better for Chronic Back, Arthritis Pain – Medscape (free registration required) AND Opioids no better than NSAIDs for chronic back or arthritis pain – Reuters (free)
Related Guideline: Guideline for opioid therapy and chronic noncancer pain – Canadian Medical Association Journal (free)
This campaign encourages thoughtful conversation between clinicians and patients to reduce harms associated with opioid prescribing, with recommendations relevant to different specialties.
Comparative cardiovascular safety of non-steroidal anti-inflammatory drugs in patients with hypertension: a population-based cohort study – British Journal of Clinical Pharmacology (link to abstract – $ for full-text)
Randomized double-blind controlled study of bedtime low dose amitriptyline in chronic neck pain – European Journal of Pain (link to abstract – $ for full-text)
Commentary: Low-dose amitriptyline reduces idiopathic chronic neck pain – Univadis (free registration required)
Related: Infographic: ATLS Trauma Update 2018
Aspirin or Rivaroxaban for VTE Prophylaxis after Hip or Knee Arthroplasty – New England Journal of Medicine (link to abstract – $ for full-text)
Quick Take Video Summary: Preventing VTE after Hip or Knee Arthroplasty (free)
“Among patients who received 5 days of rivaroxaban prophylaxis after total hip or total knee arthroplasty, extended prophylaxis with aspirin was not significantly different from rivaroxaban in the prevention of symptomatic venous thromboembolism”.
New Choosing Wisely Lists in Pediatrics: Four Things Physicians and Patients Should Question in Pediatric Infectious Diseases and Medical Microbiology – Choosing Wisely Canada (free) AND Five Things Physicians and Patients Should Question in Pediatric Orthopedics – Choosing Wisely U.S. (free)
“Neither labral repair nor biceps tenodesis had any significant clinical benefit over sham surgery for patients with SLAP II lesions in the population studied”.
Original article: Effect of Locking Plate Fixation vs Intramedullary Nail Fixation on 6-Month Disability Among Adults With Displaced Fracture of the Distal Tibia: The UK FixDT Randomized Clinical Trial – JAMA (link to abstract – $ for full-text)
Original article: Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial – The Lancet (free) AND Editorial: No benefit of arthroscopy in subacromial shoulder pain (free)
“The odds of postoperative mortality were 27 percent higher for patients admitted to the hospital on Saturday or Sunday, compared to those hospitalized on a weekday” (from NewsWise).
Author interview: USPSTF Recommendation: Screening for Adolescent Idiopathic Scoliosis (free)
Commentaries: Not Enough Evidence on Benefits, Harms of Routine Scoliosis Screening for Children and Adolescents – The JAMA Network (free) AND U.S. doctors not certain all kids need scoliosis screening – Reuters (free)
Screening in the community to reduce fractures in older women (SCOOP): a randomised controlled trial – The Lancet (link to abstract – $ for full-text)
Commentaries: Screening could catch a quarter of hip fractures before they happen – University of Manchester (free) AND FRAX Screening Reduces Hip Fractures in Healthy Older Women – Medscape (free registration required)
Bisphosphonates in Multiple Myeloma – Cochrane Library (free summary)
Original article: Bisphosphonates in multiple myeloma: an updated network meta-analysis – Cochrane Library (free)
Commentaries: Do Vitamin D, Calcium Supplements Cut Fracture Risk in Older Patients? – MPR (free) AND Vitamin D and Calcium Don’t Prevent Bone Fractures – The New York Times (10 articles per month are free) AND Calcium And Vitamin D Supplements Still Do Not Prevent Fractures – American Council on Science and Health (free)
Commentaries: Small increases in complications when knee replacement done as outpatient procedure – Wolters Kluwer Health, Via EurekAlert (free) AND More Data on Outpatient vs Inpatient Joint Replacement – OrthoBuzz (free) AND Outpatient Knee Replacement Complications: How Important Are They? – OrthoBuzz (free)
See Apropriate Use Criteria: Management of Osteoarthritis of the Hip (free)
Related AAOS Guideline: Management of Osteoarthritis of the Hip (free PDF)
Commentary: AAOS: Non-Surgical Tx Best for Hip OA – MedPage Today (free registration required)
Original article: Effectiveness of Exercise Programs in Ankylosing Spondylitis: A Meta-Analysis of Randomized Controlled Trials – Archives of Physical Medicine and Rehabilitation (link to abstract – $ for full-text)
Oral Sex and Condom Use in a U.S. National Sample of Adolescents and Young Adults – Journal of Adolescent Health (link to abstract – $ for full-text)
Editorial: Overlapping Surgery—Perspectives From the Other Side of the Table (free)
Commentaries: Study: Overlapping surgeries boost complication risks – Becker’s Hospital Review (free) AND Does Overlapping Surgery Increase Complication Risk After Hip Surgery? – The JAMA Network (free)
Association Between Wait Time and 30-Day Mortality in Adults Undergoing Hip Fracture Surgery – JAMA (link to abstract – $ for full-text)
Commentaries: Delaying Surgery for Hip Fracture for More Than One Day Associated with Small Increased Risk of Death – The JAMA Network (free) AND Delaying Hip Fracture Surgery for 1 Day Tied to Higher Mortality Risk – Physician’s First Watch (free) AND Emergency Hip Surgery Best Done Within 24 Hours – Medscape (free registration required)
Editorial: No benefit of arthroscopy in subacromial shoulder pain (free)
Commentaries: Common shoulder surgery may offer little pain relief – OnMedica (free) AND Is a common shoulder surgery useless? – MedicalXpress (free) AND Popular Surgery To Ease Chronic Shoulder Pain Called Into Question – NPR (free)
Commentaries: Motorcycle crashes cause 5 times as many deaths as car accidents, 6 times the health costs – CMAJ, via EurekAlert (free) AND Motorcycle crashes are alarmingly common — and incredibly costly – STAT (free)
Diabetic foot – The BMJ (free for 2 weeks)
Infographic: A visual overview of the primary care assessment and monitoring of a diabetic foot (free PDF)
“…there is no evidence that any of the newer hip implant combinations, such as ceramic or uncemented, are better than the widely used small head metal-on-plastic cemented hip combination, which has been commonly used since the 1960s”.
Exercise for the Prevention of Low Back Pain: Systematic Review and Meta-Analysis of Controlled Trials – American Journal of Epidemiology (link to abstract – $ for full-text)
Commentary: Exercise may help prevent low back pain or make it less severe – Reuters (free)
Related meta-analysis: Prevention of Low Back Pain: A Systematic Review and Meta-analysis – JAMA Internal Medicine (free)
European guidelines on perioperative venous thromboembolism prophylaxis (free PDF articles):
Commentaries: No Significant Difference in Pain Relief for Opioids vs Non-Opioid Analgesics for Treating Arm or Leg Pain – The JAMA Network (free) AND Acetaminophen plus Ibuprofen Noninferior to Low-Dose Oral Opioids for Acute Extremity Pain – Journal Watch (free)
Commentary: New USPSTF Draft Recommendations for Osteoporosis Screening – Medscape (free registration required)
Commentaries: Ibuprofen Better Than Morphine After Minor Surgery in Kids – Medscape (free registration required) AND Ibuprofen better choice over oral morphine for pain relief in children after minor surgery – MedicalXpress (free)
Stair-related injuries treated in United States emergency departments – The American Journal of Emergency Medicine (link to abstract – $ for full-text)
Commentary: Injuries on stairs occur in all age groups and abilities – Reuters (free)
Original article: Peripheral nerve blocks for hip fractures – Cochrane Library (link to abstract – $ for full-text)
Original article: Comprehensive Geriatric Assessment for Prevention of Delirium After Hip Fracture: A Systematic Review of Randomized Controlled Trials – Journal of The American Geriatrics society (link to abstract – $ for full-text)
Commentaries: Acupuncture, Electrotherapy after Knee Replacement Associated with Reduced and Delayed Opioid Use – The JAMA Network (free) AND Electrotherapy, Acupuncture Tied to Less Opioid Use After Knee Arthroscopy – Medscape (free registration required) AND Meta-Analysis: Electrotherapy, Acupuncture May Help Reduce Opioid Use After Knee Arthroplasty – Physician’s First Watch (free)
Osteoarthritis of the Knee Clical Care Standard – Australian Commission on Safety and Quality in Health Care (PDF Guideline and other resources)
Source: Research Review Australia (free resource to find articles of interest)
Low molecular weight heparin for prevention of venous thromboembolism in patients with lower-limb immobilization – Cochrane Library (link to abstract – $ for full-text)
“Moderate-quality evidence showed that the use of LMWH in outpatients reduced DVT when immobilization of the lower limb was required, when compared with no prophylaxis or placebo”.
Source: ACP Journal Wise ($)
“Epidural injections of corticosteroid plus lidocaine offered no benefits from 6 weeks to 12 months beyond that of injections of lidocaine alone”
Is Weight Loss Associated with Less Progression of Changes in Knee Articular Cartilage among Obese and Overweight Patients as Assessed with MR Imaging over 48 Months? Data from the Osteoarthritis Initiative – Radiology (free)
Commentaries: Weight Loss Can Slow Down Knee Joint Degeneration – RSNA Press Release (free) AND Osteoarthritis: Knee joint degeneration slowed with weight loss, study confirms – Medical News Today (free)
Commentaries: Benefits and harms of osteoporosis medications unclear for patients with CKD – Medical News Today (free) AND Benefits and harms of osteoporosis medications unclear for patients with CKD – 2 Minute Medicine (free)
Source: ACP Journal Club ($)
Related article: Use of placebo controls in the evaluation of surgery: systematic review – The BMJ (free)
“With evidence mounting that many minor operations owe their success to the placebo effect, is it time to call a halt to some routine procedures?”
When Sports Injuries Lead to Arthritis in Joints – The New York Times (10 articles per month are free)
Related guideline: The Role of Athletic Trainers in Preventing and Managing Posttraumatic Osteoarthritis in Physically Active Populations: a Consensus Statement of the Athletic Trainers’ Osteoarthritis Consortium (free)
Commentaries: Gabapentinoids Seem to Offer Little Benefit, Substantial Risks in Low Back Pain – Physician’s First Watch (free) AND Evidence does not support the use of gabapentinoids for chronic low back pain – PLOS, via Science Daily (free) AND Gabapentinoids for Chronic Low Back Pain? Not So Fast – Practical Pain Management (free)
Pregabalin and gabapentin have significant risk of adverse effects without any demonstrated benefit in chronic low back pain.
Ibuprofen versus placebo effect on acute kidney injury in ultramarathons: a randomised controlled trial – Emergency Medicine Journal (link to abstract – $ for full-text)
State of the Art Review: Advances in the diagnosis and management of neck pain – The BMJ (free)
Related guideline: Neck Pain: Revision 2017 – Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health from the Orthopaedic Section of the American Physical Therapy Association (free)
Antibiotic prophylaxis is not indicated prior to dental procedures for prevention of periprosthetic joint infections: A systematic review and new guidelines from the Dutch Orthopaedic and Dental Societies (free)
Source: EvidenceAlerts (free resource to find articles of interest)
Functional Gain and Pain Relief After Total Joint Replacement According to Obesity Status – The Journal of Bone & Joint Surgery (link to abstract – $ for full-text)
Commentaries: Joint Replacement Weight Loss Requirements Challenged – Medscape (free registration required) AND Pain relief, functional outcomes after joint replacement similar in obese and normal-weight patients – News Medical (free)
The best running stride? The one that comes naturally – The New York Times (10 articles per month are free)
“Mainstream medicine has failed people with chronic back pain”
Commentaries: Long-Term Bisphosphonate Use Degrades Cortical Bone – Medscape (free registration required) AND How Do Bisphosphonates Cause Atypical Femoral Fractures? – MedPage Today (free registration required) AND Study highlights underlying mechanisms of fractures associated with osteoporosis drug – Cornell University, via EurekAlert (free)
Subgroup analyses of the effectiveness of oral glucosamine for knee and hip osteoarthritis: a systematic review and individual patient data meta-analysis from the OA trail bank – Annals of Rheumatic Diseases (link to abstract – $ for full-text) (RT @PhysioMeScience see Tweet)
“Currently, there is no good evidence to support the use of glucosamine for hip or knee OA”
New National Guideline Clearinghouse (NGC) Summaries in Low back, Cervical and Thoracic Spine Disorders with focus on occupational health.
Systematic Review: Treatment Outcomes for Patients with Failed Back Surgery – Pain Physician (free PDF)
Original article: Effectiveness of an Internet-Delivered Exercise and Pain-Coping Skills Training Intervention for Persons With Chronic Knee Pain: A Randomized Trial – Annals of Internal Medicine (free) AND Commentaries: Online Intervention Reduces Knee Pain, Improves Mobility – Medscape (free registration required) AND The Internet may be an effective tool for treating chronic knee pain – 2 Minute Medicine (free) AND Chronic knee pain eased with the help of Skype – CNN (free text and video)
Diclofenac 150 mg/day is the most effective NSAID available at present (are the cardiac and renal risks worth it?) and Paracetamol does not seem to work for this condition.
Related guideline: Low back pain and sciatica in over 16s: assessment and management – NICE (free)
“…cyclobenzaprine is a long-acting sedative, not a muscle relaxant, and questioning whether any potential benefits are worth the side effects”. (from TI Newsletter). “If prescribed, a dose of 5 mg at bedtime should be tried first. Evidence suggests titration based on response and tolerability to a maximum dose of 15 mg/day, for no longer than one week”.
Commentary: 3 steps to restore patient trust in overlapping surgeries – FierceHealthcare (free)
This interesting viewpoint discusses the practice of scheduling overlapping surgeries, in which a qualified practitioner finishes noncritical parts of the first operation while the primary surgeon moves to the next surgery.
Implant Survival After Minimally Invasive Anterior or Anterolateral Vs. Conventional Posterior or Direct Lateral Approach: An Analysis of 21,860 Total Hip Arthroplasties from the Norwegian Arthroplasty Register (2008 to 2013) – The Journal of Bone and Joint Surgery (link to abstract – $ for full-text)
Source: EvidenceAlerts (free resource to find articles of interest in all specialties)
“There were no significant differences among the surgical approaches with regard to the 2 and 5-year survival rates or RR of revision due to any cause”
Venous Thromboembolism Prophylaxis in Major Orthopedic Surgery: Systematic Review Update. Comparative Effectiveness Review – Agency for Healthcare Research and Quality (free report and summary)
See also: Executive summary (free PDF)
Source: ACP Journal Wise ($ resource to find articles of interest)
Comprehensive review on the evidence regarding thromboembolism prophylaxis in major orthopedic surgery.
Association of delay of urgent or emergency surgery with mortality and use of health care resources: a propensity score–matched observational cohort study – Canadian Medical Association Journal (free)
Source: STAT News Newsletter
“Delayed operating room access for emergency surgery was associated with increased risk of inhospital mortality, longer length of stay and higher costs”.
What I Wish I’d Known About My Knees – The New York Times (10 articles per month are free)
Source: PracticalReviews ($)
See related article on the effect of multicomponent nonpharmacologic interventions to prevent delirium in abdominal surgery in our May 25th issue (see #5)
Delirium-friendly preprinted postoperative orders executed by regular nursing staff resulted in a significant reduction in postoperative delirium.
Source: EvidenceAlerts (free resource to find articles of interest)
“Antiplatelet therapy at the time of noncardiac surgery confers minimal bleeding risk with no difference in thrombotic complications. In many cases, it is safe to continue antiplatelet therapy in patients with important indications for their use”
Yoga, Physical Therapy, or Education for Chronic Low Back Pain: A Randomized Noninferiority Trial – Annals of Internal Medicine (link to abstract – $ for full-text)
Commentaries: Yoga Vs. Physical Therapy For Chronic Low Back Pain: Which Is More Effective? – Forbes (free) AND Yoga Noninferior to Physical Therapy for Low Back Pain – Physician’s First Watch (free) AND Yoga as Good for Low Back Pain as Physical Therapy – Medscape (free registration required)
2017 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty (free)
Press release: New Guideline Aims to Reduce Infections in Total Hip & Knee Replacement Patients (free)
Commentaries: New medication guidelines for rheumatic disease patients having joint replacement – Hospital for Special Surgery, via EurekAlert (free) AND New Guidelines Issued on Antirheumatic Drugs for Patients Undergoing Knee or Hip Replacement – Physician’s First Watch (free)
Draft Recommendation Statement: Adolescent Idiopathic Scoliosis: Screening – U.S. Preventive Services Task Force (free)
Author interview video: Comparison of Intra-articular Triamcinolone vs Saline for Knee Osteoarthritis (free)
JAMA report video: Comparison of Intra-articular Triamcinolone vs Saline for Knee Osteoarthritis (free)
Commentaries: This orthopedic surgery is the world’s most common. But patients rarely benefit, a panel says – STAT News (free) AND Guideline Recommends Against Arthroscopy for Most Cases of Degenerative Knee Disease – Journal Watch (free) AND Arthroscopic Surgery Doesn’t Help With Arthritis Knee Pain – NPR Health News (free)
Commentaries: ACP Updates Guidelines on Treating Low Bone Density, Osteoporosis – Physician’s First Watch (free) AND New ACP Guidelines on the Treatment of Osteoporosis – Medscape (free registration required)
Related guideline: UK clinical guideline for the prevention and treatment of osteoporosis – Archives of Osteoporosis (free)
Invited commentary: Surgical Site Infection Prevention – What We Know and What We Do Not Know – JAMA Surgery (free)
Commentary: ‘Long-Awaited’ CDC Guidelines on SSI Prevention Released – Medscape (free registration required)
After Knee or Hip Replacement, No Place Like Home – The New York Times (10 articles per month are free)
Original article abstract ($ for full-text): Effect of Inpatient Rehabilitation vs a Monitored Home-Based Program on Mobility in Patients With Total Knee Arthroplasty: The HIHO Randomized Clinical Trial – JAMA (free)
The NYT commentary talks about the futility of some interventions currently used to postpone surgery and about the benefits of outpatient rehabilitation.
Mortality Trends After a Voluntary Checklist-based Surgical Safety Collaborative – Annals of Surgery (link to abstract – free PDF available)
Sources: Global Health NOW Newsletter (free) AND South Carolina Hospitals Saw Surgery Deaths Drop After Implementing WHO Checklist – AJMC News (free) AND A simple checklist prevents deaths after surgery, a large new study suggests – The Washington Post (a few articles per month are free)
See also: WHO Surgical Safety Checklist – World Health Organization (free) AND A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population – New England Journal of Medicine (free)
Selection of resources for primary care providers to improve their ability to prevent and treat injuries from sports and physical activity.
Browse Appropriateness Criteria Topics (free)
This comprehensive guide from American College of Radiology (ACR) covers 230 topics with more than 1,100 clinical indications and has just been updated. It is a very useful resource for doctors in all specialties to guide which exam is most appropriate in each clinical situation.
Total knee replacement for patients with osteoarthritis had minimal effects on quality of life in this study. Severely affected patients seem to benefit the most from the procedure.
Going Under the Knife, With Eyes and Ears Wide Open – New York Times (free access to 10 articles per month)
“More and more surgeries are being performed with the patient awake and looking on, for financial and medical reasons”.
Trial of Pregabalin for Acute and Chronic Sciatica – New England Journal of Medicine (link to abstract – $ required for full-text)
Pregabalin did not reduce pain and was associated with higher incidence of adverse events.
Comprehensive review with practical algorithm.