Marquis Rehabilitation and Nursing Center » medicine

Need a New Hip? Check the Joint Registry First

admin — Thu, 08 Jul 2010 16:29:52 +0000

806,000 hip and knee implants were performed in the US in 2007 – that’s double the amount done a decade earlier. However, a 2007 study demonstrates that 7% of Medicare patients who underwent a hip replacement required another replacement hip within seven and a half years. That number, small as it sounds, translates into thousands of patients who eventually need a “do over”. A joint surgery involves risk, pain, convalescence, rehab and medical expenses; no one wants to go through that more than once if necessary.

A National Joint Replacement Registry helps reduce the rate of failed procedures by keeping a database of information that keys in surgeons to problematic implants, and provides insight as to how to avoid mess ups. According to Dr. Daniel Berry, chief of orthopedic surgery at the Mayo Clinic in Rochester, Minn, “Every country that has developed a registry has been able to reduce failure rates significantly.” Sweden is one case in point.

The newly formed American Joint Replacement Registry is still in its nascent stage and has started collecting data. Its goal is to improve the quality, outcomes, and cost-effectiveness of total joint replacement (TJR) surgeries through the achievement of four objectives:

1. Establish an infrastructure and a uniform system for the collecting device information and monitoring outcomes of TJR throughout the U.S.;

2. Identify patients who may need follow-up evaluation thereby increasing patient safety;

3. Create real-time survivorship curve in order to detect poorly performing implants;

4. Establish a uniform system that can be used to define the epidemiology of TJR for outcomes research to improve the quality and outcomes of patient care.

Until we have access to solid facts from the U.S. Registry, there are some proactive steps you can take if you are in the market for a new joint.

– Go with a highly experienced surgeon in a busy hospital; don’t look for the best deal. Ask for recommendations. A 2004 study published in The Journal of Bone and Joint Surgery found that patients receiving knee replacements from doctors who performed more than 50 of the procedures a year had fewer complications than patients whose surgeons did 12 procedures or fewer a year.

A similar trend was documented with hospital volume. Patients at hospitals that performed more than 200 knee replacements a year fared better than patients at hospitals that performed 25 or fewer.

– A joint replacement is not for everyone. Some arthritic problems are better served with medication, and surgery may be too risky for those who have uncontrolled high blood pressure or another serious chronic condition.

– Research the joint implant that your surgeon recommends. Find out how well it has performed in others and if there are known complications. Some implants are somewhat controversial and may cause tissue and bone damage; newer doesn’t necessarily mean better. If the hospital has its own registry, ask to review the data.

– Educate yourself as to what the surgery entails. The American Academy of Orthopaedic Surgeon’s patient information Web site, orthoinfo.org is very helpful.

– Prepare your recovery in advance. Arrange for the necessary support upon your return home, and make sure you have all the help you need. It is crucial not to overexert yourself during your initial healing period.

Senior Self Neglect Increases Risk of One-Year Mortality

admin — Mon, 21 Sep 2009 04:30:41 +0000

It starts with neglecting one’s hygiene, nutrition and medications, and can lead to death within the year. According to data compiled by the Chicago Health and Aging Project (CHAP), an older person’s risk of dying within the year increases six-fold when he or she starts to ignore his or her physical and medical needs.

The CHAP study took place from 1993-2005 in three Chicago neighborhoods and the 9,318 participants were ages 65 or older. Among that population there were 1,544 reported cases of self-neglect (mean age of 73.2 years old) and in the average follow-up within almost a year, there were 927 deaths (47.8%) in that group.

Elder abuse of any kind also generated a greater mortality rate, with a 61.6% death rate within an average of 2.7 years.

By the self neglect cases, the increased mortality rate wasn’t affected by whether or not the senior’s cognitive or physical functions were impaired. However by confirmed abuse cases there was a significant difference – increased mortality was not associated with elder abuse of high functioning seniors, demonstrating that this group was more likely to recognize abuse and seek help.

Stiff Joints Keeping You Up at Night? Try Some Cognitive Therapy

admin — Fri, 18 Sep 2009 02:54:27 +0000

As the Baby Boomer generation ages, there is a swelling populaton of people suffering from osteoarthritis. Arthritis pain seems to go hand in hand with insomnia, with joint pain keeping awake 60% of those with osteoarthritis

A new study, reported in the Aug. 15 issue of Journal of Clinical Sleep Medicine, finds that cognitive therapy has a beneficial effect on osteoarthritis patients and insomniacs – assisting them in their quest for a good night’s sleep.

Cognitive behavior therapy for insomnia or CBT-I,was given by an experienced clinical psychologist who taught participants cognitive restructuring techniques that helped change unrealistic beliefs and irrational fears regarding sleep or lack of it.

Handwritten sleep logs kept by participants documented their sleep patterns, and pain level was graded by the Short-Form McGill Pain Questionnaire (MPQ) and the Body Pain Subscale (SF-PAIN) question from the Medical Outcomes Study Short Form-36 Pain.

Results showed that after CBT-I treatement, patients were falling asleep faster than before, and remained sleeping approximately 37 minutes longer. CBT-I seems to be an effective tool for treatment of osteoarthritis in conjunction with other pain management techniques, and may also work well with other chronic pain conditions.

Hormones That Shouldn’t Be Replaced

admin — Thu, 18 Dec 2008 18:28:55 +0000

By Edna Milay

A recent study demonstrates a proven way to lower breast cancer risk and occurrence by half.

Sounds too good to be true? It’s not, because a huge proportion of breast cancer cases can be traced to something women voluntarily do: take replacement hormones.

Women who took estrogen and progestin post-menopause to replace hormones doubled their risk for breast cancer. Even more dramatic, when they stopped taking hormones, their risk subsided within two years.

This is not to say that everyone taking hormones should drop them immediately. The risk increases with time, so short-term use is not likely to result in cancer.

Pathogen Alert

admin — Tue, 02 Dec 2008 16:44:17 +0000

by Staff

Clostridium difficile.

The name might be unfamiliar, but the pathogen is on the rise. There has been a sharp increase in the prevalence of C. diff in hospitals around the country, according to a survey taken in 648 hospitals in 47 states.

As many as 13 out of every 1,000 patients tested positive for Clostridium difficile, with 94% showing symptoms of the accompanying disease: diarrhea, fever, appetite loss, nausea, and stomach pain. About 4% of patients will die from the disease.

How does this compare to C. diff levels in the past? Between 2000 and 2005, the number has more than doubled.

This may be partially due to prescription techniques. C. diff isn’t affected by most antibiotics, so broad spectrum antibiotics, which kill all other bacteria, give C. diff room to grow and thrive. Whenever possible, physicians should prescribe narrowly targeted antibiotics, to prevent C. diff from expanding unchecked.

Based on an article by Jacob Goldstein in the WSJ

Lifestyle Tips to Prevent Cancer

admin — Thu, 13 Nov 2008 15:28:20 +0000

by Edna Milay

Sometimes it seems like everything causes cancer. Then it seems like everything prevents it. What advice should you follow and what can you regard skeptically until further research actually proves something? Here are a few lifestyle tips for cancer prevention. All are well proven to correlate with reduced cancer risks.
1. A little alcohol affects men and women differently. Men actually benefit from a small daily intake of spirits, while women should not exceed a single drink a day, if even that much.
2. Avoid processed meats at all cost, and limit your consumption of all red meat. Fish and fowl are rich in all the proteins you need without the unhealthy fats that come along with.
3. Along the same lines, try to avoid overdosing on sodium and salt, which most people do. The average salt intake is already well above the necessary limit, so any reduction on your part can only be good.
4. Whole, unprocessed foods are your best bet. Fruits, veggies, and things that grow from the ground are healthy. Foods with ingredients you can’t pronounce or that don’t resemble any naturally occurring edible should be shunned. And while you’re at it, aim for a variety of veggies and fruits. Different foods have different vitamins and minerals, so take in as much as possible.
5. Exercise. About 30 minutes of activity per day, enough to get your heart rate up, should do the trick.
6. Avoid fat, especially saturated and hydrogenated. Hydrogenated fats, found in margarine and most junk foods, are directly linked to cancer risks. Processed sugar is also a known evil. Reduce your calorie intake as much as possible, a strategy linked to longer life overall.

Orthopedic Surgeons & Their Patients Clamor for the Establishment of a National Joint Registry

admin — Mon, 04 Aug 2008 14:45:41 +0000

By Ruth Folger Weiss

A few months after undergoing routine hip replacements, a number of patients of a well known LA orthopedic surgeon started suffering from excruciating pains. The surgeon, Dr. Lawrence Dorr, was stymied until he discovered one factor they all had in common; the same replacement joint, manufactured by Zimmer Holdings, was implanted in all of them. Several needed to have their replacement replaced in another bout of surgery. When Zimmer was first contacted about this problem, they just brushed it off. It took a year of more complaints and pressure from doctors until they pulled this device off the market. In the interim many more patients unknowingly had their joints replaced with a faulty Zimmer “Durom Cup” with crippling results.

This upsetting scenario could have been avoided, and many patients could have been spared the agony, if the U.S. would have a Joint Registry in place. A Joint Registry is a national database that tracks the well being of patients with artificial hips and knees. Countries such as Australia, Britain, Norway and Sweden have such a system in place and the benefits are numerous. Tracking the success rates of the different joints available results in the faulty ones being pulled from the market much quicker. The registry data puts pressure on manufacturers to explain why their products perform poorly and the registry alerts surgeon to stop using flawed joints.

Monitoring devices like artificial joints supposedly falls under the domain of the The Food and Drug Administration but they are often overwhelmed by the vast number of products it monitors and because doctors often do not report problems.

Nearly one million hips and knees were replaced in the U.S. alone last year, about half of the world’s total. As the world’s leader in joint replacement, the U.S. should take the initiative and be the leader in follow-up too. So far all efforts to establish a database here have failed due to the many hurdles, financial and practical, of our fragmented and decentralized health care system, as well as a lack of support from Medicare.

Optimistic Advances in Search for an Alzheimer’s Miracle Drug

admin — Mon, 04 Aug 2008 14:44:40 +0000

By Neil Bekker

At the recent International Conference on Alzheimer’s Disease in Chicago, some interesting discoveries in Alzheimer’s research were presented.

Claude Wischik, Ph.D., of the University of Aberdeen in Scotland and founder and chairman of TauRx Therapeutics presented the findings of his 84 week study, whereas 321 seniors were given a daily capsule of Rember, which stopped their cognitive decline by an astonishing rate of 81%. Rember is a a new formulation of methylene blue (Urolene Blue), a drug used to combat urinary-tract infections in the past, and was developed to target the protein “tangles” in the brain, stopping new tangles from forming and loosening those that already exist. This theory counters the accepted amyloid hypothesis, which contends that the buildup of amyloid plaque (the sticky brain-clogging masses) in the brain is the main mechanism of Alzheimer’s disease.

Others believe that both amyloid and tangles, also called tau, are important factors in Alzheimer’s and that the ideal treatment would be a combination of medication that targeted both.

Another interesting presentation was given by researchers from Mt. Sinai School of Medicine on an interesting link between alzheimer’s and insulin. Alzheimer’s patients with diabetes who took insulin plus another anti-diabetes medication to control blood sugar, had 80% fewer amyloid plaques than those who were not diabetic. The drugs seem to regulate the brain’s communication network of insulin receptors, which goes awry in the Alzheimer’s brain, while at the same time clearing away the damaging plaques.

New screening tests to identify Alzheimer’s patients in the earlier stages before their brain deteriorates too much – was another innovation presented. By identifying patients by the specific type of brain buildup — plaques versus tangles — that they are suffering from, doctors can utilize the more effective therapies for each individual.

Exercising from the Couch

admin — Mon, 04 Aug 2008 14:43:49 +0000

by Bill Diblasio

Wouldn’t it be nice if you could get the benefits of exercise without expending more energy then swallowing a pill? AICAR, an old drug that has long been recognized for its ability to stimulate the creation of mitochondria, might be the pill for you.
Mitochondria are the powerhouses of the cell, producing the energy that powers our body. Recently, AICAR was administered to mice who were kept sedentary. After a few weeks, the AICAR mice raced regular sedentary mice, and ran 44% farther and 23% longer.
AICAR seems to mimic the effects of aerobic exercise, increasing stamina, but not building strength. It is being investigated as an aid in fighting diabetes and aging, and for uses in heart bypass surgery. Athletes need not apply.
Of course, the fact that AICAR works in mice doesn’t mean it’ll work in humans. Furthermore, it might have unpleasant side effects. And, as many researchers have hastened to point out, it doesn’t mimic all the myriad of benefits a person gets from real movement and exercise, which includes many chemical reactions besides mitochondria.

Getting to the Heart of Dementia

admin — Mon, 04 Aug 2008 14:43:06 +0000

~ by Damion Drilla

Dementia isn’t all about aging, studies show. Health in mid-life can have a marked effect on cognitive ability later on.

A British study of 10,308 people, mostly men, followed the subjects from roughly the ages of 35-55 (the study started in 1985) to about 60-75 years (the study ended in 2004).

Coronary heart disease in midlife was found to be linked to lower cognition in later years. In men, heart disease was linked to lower reason, vocabulary, and MMSE scores. In women, it corresponded additionally to lower phonemic and semantic fluency.

The longer the heart disease – meaning, the earlier it was contracted – the greater the drop in cognitive ability over the years. This suggests that heart disease creates an ongoing condition that continuously deteriorates mental function until dementia kicks in.