Does industry-sponsored education foster overdiagnosis and overtreatment of depression, osteoporosis and over-active bladder syndrome? An Australian cohort study

ObjectivesTo investigate patterns of industry-sponsored educational events that focus on specific health conditions for which there are concerns about overdiagnosis and overtreatment.Design and settingThis retrospective cohort study examines publicly reported industry-sponsored events in Australia from October 2011 to September 2015 for three conditions potentially subject to overdiagnosis and overtreatment: depression, osteoporosis and overactive bladder. We used a database of transparency reports to identify events with a focus on depression, osteoporosis and overactive bladder and compared these with other sponsored events. We hypothesised that companies marketing treatments for each condition would sponsor related events and that target audiences would mainly work in primary care, reflecting a broad patient population.Main outcome measuresEvent and attendee characteristics, sponsoring companies, related marketed treatments, cost-effectiveness ratings and dispensing rates.ResultsOver the study period, we identified 1567 events focusing on depression, 1375 on osteoporosis and 190 on overactive bladder (total n=3132, with 96 660 attendees). These events were attended by primary care doctors more often than sponsored events without a focus on these three conditions: relative risk (RR)=3.06 (95% CI 2.81 to 3.32) for depression, RR=1.48 (95% CI 1.41 to 1.55) for osteoporosis and RR=2.59 (95% CI 2.09 to 3.21) for overactive bladder. Servier, which markets agomelatine and AstraZeneca (quetiapine) sponsored 51.2% and 23.0% of depression events, respectively. Amgen and GlaxoSmithKline, which co-market denosumab, sponsored 49.5% of osteoporosis events and Astellas and Commonwealth Serum Laboratories (CSL) (mirabegron and solifenacin) sponsored 80.5% of overactive bladder events.ConclusionsThis 4-year overview of industry-sponsored events on three overdiagnosed and overtreated conditions found that primary care clinicians were often targeted, dinner was often provided and that a few companies sponsored most events. In most cases, sponsors’ products are not cost-effective choices for the specified condition. This pattern highlights the need for professional education to be free of commercial sponsorship.</jats:sec

Deriving modified rankin scores from medical records

&lt;p&gt;&lt;b&gt;Background and Purpose:&lt;/b&gt; Modified Rankin score (mRS) is traditionally graded using a face-to-face or telephone interview. Certain stroke assessment scales can be derived from a review of a patient’s case-record alone. We hypothesized that mRS could be successfully derived from the narrative within patient case-records.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Methods:&lt;/b&gt; Sequential patients attending our cerebrovascular outpatient clinic were included. Two independent, blinded clinicians, trained in mRS, assessed case-records to derive mRS. They scored “certainty” of their grading on a 5-point Likert scale. Agreement between derived and traditional face-to-face mRS was calculated using attribute agreement analysis.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Results:&lt;/b&gt; Fifty patients with a range of disabilities were included. Case-record appraisers were poor at deriving mRS (k=0.34 against standard). Derived mRS grades showed poor agreement between observers (k=0.33). There was no relationship between certainty of derived mRS and proportion of correct grades (P=0.727).&lt;/p&gt; &lt;p&gt;&lt;b&gt;Conclusion:&lt;/b&gt; Accurate mRS cannot be derived from standard hospital records. Direct mRS interview is still required for clinical trials.&lt;/p&gt

A Reliable Surgical Approach to Revision Total Knee Arthroplasty

BACKGROUD: The surgical exposure obtained in revision total knee arthroplasty should facilitate the utilisation of instrumentation and implants, including adjuncts such as stemmed prostheses, bone allograft, and artificial augments. We have previously identified within this cohort of revision total knee arthroplasty patients a high satisfaction rate of 93.5% at a mean 6.5 years of follow-up and a high level of postoperative function. We, therefore, seek to describe in detail the operative technique and perioperative care and report the early postoperative complications. METHODS: We report on the surgical approach, closure technique, and postoperative care used by the senior author for revision total knee arthroplasty procedures. The patient demographics, intraoperative details, and postoperative outcomes are also reported. We aim to provide a clear description of the intraoperative technique and postoperative outcome, facilitating adoption or comparison with other surgeons or techniques. Patient inclusion criteria were revision total knee arthroplasty performed by the senior author using the PFC (Depuy) prosthesis at John Flynn Private Hospital with a minimum of 2-year postoperative follow-up. A retrospective chart review was combined with a structured telephone assessment questionnaire to assess outcomes. RESULTS: A total of 202 revision total knee arthroplasties were available for follow-up in 185 patients. The mean 1-year postoperative range of motion was 110°. Key features of surgical approach include incision planning, soft-tissue plane development, parapatellar scar debridement, safe removal of implants, management of bone defects, and closure technique. The overall 90-day complication rate was 9%, including 4.4% requiring manipulation under anaesthesia and 3% superficial surgical site infections (1 patient requiring intravenous antibiotics). CONCLUSIONS: We suggest that the described technique is reproducible and reliable. It rarely requires modification and facilitates successful postoperative outcomes with a low complication rate. The adoption of this surgical technique allows surgeons to approach complex knee arthroplasty with confidence in the appropriate exposure of anatomy, facilitating subsequent steps in their arthroplasty procedures

Clinical Outcomes Following Revision Total Knee Arthroplasty: Minimum 2-Year Follow-up

BACKGROUD: The longer-term outcomes of revision total knee arthroplasty are not well described in the current literature. Managing patient expectations of revision total knee arthroplasty can be challenging for orthopedic surgeons due to a paucity of data to guide decision-making. We present outcomes of revision total knee arthroplasty performed by a single surgeon over a 12-year period from 2004 through 2015. METHODS: A retrospective review of hospital and private medical records demonstrated 202 revision total knee arthroplasties performed by the senior author in 178 patients from 2004 through 2015. Of these, 153 patients were available for assessment. Patients were contacted and invited to participate in a structured telephone interview to assess Oxford Knee Score (OKS) and patient satisfaction. All patients received the PFC (Depuy) prosthesis at a single institution and were followed up for minimum 2 years postoperatively at the time of review. Retrospective chart review was used to obtain other data for analysis including patient demographics, preoperative and postoperative range of motion (ROM), and intraoperative details. RESULTS: This cohort demonstrated a 93.5% survival rate and an 85% satisfaction rate at a mean of 6.5 years postoperatively. Mean ROM improved from 100° (range, 5°–145°) to 112° (range, 35°–135°) (p < 0.001). The mean OKS was 39.25 (range, 14–48). The factors associated with improved postoperative outcomes included male gender, fewer previous revision total knee arthroplasty procedures, increased preoperative ROM, and receiving a less constrained implant. CONCLUSIONS: This study provides a comprehensive description of outcomes following revision total knee arthroplasty in a large patient cohort with a long follow-up. Although revision total knee arthroplasty is a challenging and complex aspect of arthroplasty surgery, high patient satisfaction and good functional outcomes can be achieved for the majority of patients

A cross-sectional analysis of pharmaceutical industry-funded events for health professionals in Australia

Objectives: To analyse patterns and characteristics of pharmaceutical industry sponsorship of events for Australian health professionals and to understand the implications of recent changes in transparency provisions that no longer require reporting of payments for food and beverages. Design: Cross-sectional analysis. Participants and setting: 301 publicly available company transparency reports downloaded from the website of Medicines Australia, the pharmaceutical industry trade association, covering the period from October 2011 to September 2015. Results: Forty-two companies sponsored 116 845 events for health professionals, on average 608 per week with 30 attendees per event. Events typically included a broad range of health professionals: 82.0% included medical doctors, including specialists and primary care doctors, and 38.3% trainees. Oncology, surgery and endocrinology were the most frequent clinical areas of focus. Most events (64.2%) were held in a clinical setting. The median cost per event was $A263 (IQR$A153–1195) and over 90% included food and beverages. Conclusions: Over this 4-year period, industry-sponsored events were widespread and pharmaceutical companies maintained a high frequency of contact with health professionals. Most events were held in clinical settings, suggesting a pervasive commercial presence in everyday clinical practice. Food and beverages, known to be associated with changes to prescribing practice, were almost always provided. New Australian transparency provisions explicitly exclude meals from the reporting requirements; thus, a large proportion of potentially influential payments from pharmaceutical companies to health professionals will disappear from public view

Repair of acrylic/glass composites by liquid resin injection and press moulding

This paper presents repair methods for in-situ polymerised acrylic (Elium®)/glass composites focusing on mode-I fracture toughness recovery. Acrylic/glass composites were first subjected to double cantilever beam (DCB) tests to measure their Mode-I fracture toughness. The delaminated samples after DCB tests were repaired and rejoined. Two repair methods were performed: liquid resin injection and press moulding at two different temperatures (130°C and 160°C). The repaired samples were subjected to a second set of DCB tests. The fracture behaviours of the four specimen groups (virgin, resin-injected, pressed at 130°C, and pressed at 160°C) were evaluated in terms of strain energy release rates (GIC) during crack initiation and propagation. The results showed that specimens repaired by resin injection exhibited highest GIC values, about 30% higher than the virgin state, due to the formation of a semi-interpenetrating polymer network (semi-IPN) at the joining interface. Scanning electron microscopy images provided insight into distinctive fracture behaviours for each test group

RESOLVE (Regolith & Environmental Science Oxygen & Lunar Volatile Extraction) Project

The RESOLVE Project is a lunar prospecting mission whose primary goal is to characterize water and other volatiles in lunar regolith. The Lunar Advanced Volatiles Analysis (LAVA) subsystem is comprised of a fluid subsystem that transports flow to the gas chromatograph - mass spectrometer (GC-MS) instruments that characterize volatiles and the Water Droplet Demonstration (WDD) that will capture and display water condensation in the gas stream. The LAVA Engineering Test Unit (ETU) is undergoing risk reduction testing this summer and fall within a vacuum chamber to understand and characterize component and integrated system performance. Testing of line heaters, printed circuit heaters, pressure transducers, temperature sensors, regulators, and valves in atmospheric and vacuum environments was done. Test procedures were developed to guide experimental tests and test reports to analyze and draw conclusions from the data. In addition, knowledge and experience was gained with preparing a vacuum chamber with fluid and electrical connections. Further testing will include integrated testing of the fluid subsystem with the gas supply system, near-infrared spectrometer for the Surge Tank (NIRST), WDD, Sample Delivery System, and GC-MS in the vacuum chamber. Since LAVA is a scientific subsystem, the near infrared spectrometer and GC-MS instruments will be tested during the ETU testing phase

Brittleness index of machinable dental materials and its relation to the marginal chipping factor

OBJECTIVES: The machinability of a material can be measured with the calculation of its brittleness index (BI). It is possible that different materials with different BI could produce restorations with varied marginal integrity. The degree of marginal chipping of a milled restoration can be estimated by the calculation of the marginal chipping factor (CF). The aim of this study is to investigate any possible correlation between the BI of machinable dental materials and the CF of the final restorations. METHODS: The CERECTM system was used to mill a wide range of materials used with that system; namely the Paradigm MZ100TM (3M/ESPE), Vita Mark II (VITA), ProCAD (Ivoclar-Vivadent) and IPS e.max CAD (Ivoclar-Vivadent). A Vickers hardness Tester was used for the calculation of BI, while for the calculation of CF the percentage of marginal chipping of crowns prepared with bevelled marginal angulations was estimated. RESULTS: The results of this study showed that Paradigm MZ100 had the lowest BI and CF, while IPS e.max CAD demonstrated the highest BI and CF. Vita Mark II and ProCAD had similar BI and CF and were lying between the above materials. Statistical analysis of the results showed that there is a perfect positive correlation between BI and CF for all the materials. CONCLUSIONS: The BI and CF could be both regarded as indicators of a material’s machinability. Within the limitations of this study it was shown that as the BI increases so does the potential for marginal chipping, indicating that the BI of a material can be used as a predictor of the CF

Enhancing fracture toughness of carbon fiber/epoxy composites using polyphenylene ether as a modifier

In this study, carbon fiber/epoxy composites (CFRP) were fabricated by vacuum-assisted resin infusion molding (VARIM) with polyphenylene ether (PPE) as a toughening agent. The PPE contained hydroxyl end groups that facilitated chemical bonding with epoxy during curing. PPE was incorporated into the epoxy matrix by dissolution, and spreading in the interlaminar regions. The presence of PPE as a toughener exhibited significant improvement in the Mode-I fracture toughness of the composites. The CFRP samples, which were toughened with 5 wt.% and 10 wt.% PPE, showed about 191% to 380% enhancement, respectively, in the critical energy release rate (GIC) compared to the unmodified sample. Dynamic mechanical analysis (DMA) showed about a 6°C increase in the glass transition temperature of the toughened composites, which is an interesting aspect of this work. These results indicate the potential of using PPE as a toughening agent in CFRP composites