Free Workouts for Furloughed Government Employees during Government Shutdown
Stress can have negative effects on your health, resulting in headaches, chest pain, high blood pressure, upset stomach, and sleep problems. Boston, New York, Washington, and Philadelphia Sports Clubs are doing their part during the government shutdown by opening their doors to any government employee currently out of work. By showing their government ID, furloughed employees can work out and attend group classes for free for the duration of the shutdown.
Studies show that forty-three percent of all adults suffer from stress-related health issues and up to 90% of all doctor’s visits are for stress-related ailments. Stress is a serious issue for government employees facing the prospect of weeks without pay while Congress debates the new spending bill. In addition to sleepless nights, stress can leave its victims feeling physically ill and incapable of completing tasks.
Despite too much stress often being stated as the number one reason why people don’t exercise, exercise has been shown to significantly decrease stress. This is both for physical reasons—exercise releases endorphins into your brain and gives you a natural high—and for mental reasons—exercise gets you out of the house and distracts you from your troubles.
Government employees in Boston, New York, Washington, and Philadelphia can take a break from their current stressors at their local Sports Clubs. Any government employee 18 and older can work out for free from now until the shutdown ends. This includes attending popular classes such as yoga and zumba. The membership is available all hours except for Monday through Friday, 4:30-7:30pm.
Endurance Of Total Knee Replacements In Younger Patients With Juvenile Arthritis
When you think of knee replacement surgery, you generally envision an older adult with painful arthritis. But the procedure is also used for younger patients with juvenile idiopathic arthritis (JIA) whose joints have been severely damaged by the disease. Because the surgery in younger patients is relatively rare, little data exist on the longevity of knee replacements in JIA patients.
An international, multi-center study led by researchers at Hospital for Special Surgery (HSS) has found that total knee replacements in younger patients with juvenile arthritis last at least 10 years in 92 percent of cases. More than 75 percent of the implants lasted 20 years or more.
"The surgery in this patient population, although performed by only a small number of highly specialized orthopedic surgeons nationwide, is life-changing for JIA patients," said Dr. Mark P. Figgie, senior author of the study and chief of the Surgical Arthritis Service at HSS. "Joint replacement can free patients - many of them adolescents - from a life of unrelenting pain. It can enable those in a wheel chair to walk again, giving many a new lease on life."
Revised Clinical Practice Guideline On The Treatment Of Osteoarthritis Of The Knee
The American Academy of Orthopaedic Surgeons (AAOS) recently released its revised clinical practice guideline (CPG) on the treatment of osteoarthritis of the knee, addressing two key changes. Most of the remaining recommendations provided in the 2009 CPG go unchanged. CPGs are not meant to be stand-alone documents, but rather serve as a point of reference and educational tool for both primary care physicians and orthopaedic surgeons.
The original guideline, as well as this revised version, was developed to include only treatments which are less invasive than knee replacement surgery. Osteoarthritis (OA) is a common condition that can affect any joint in the body particularly after years of use. It is also known as “wear and tear” arthritis and most commonly occurs in people who are 65 years of age or older. Some 33 million Americans are affected by osteoarthritis, and it is the leading cause of physical disability.
The two primary changes recommended in the 2013 guidelines that differ from the 2009 CPG include:
- Acetaminophen: The recommended dosage was reduced from 4,000 mg to 3,000 mg a day. This is not a change made by AAOS specifically for OA patients, but an overall change made by the FDA since 2009 for individuals who use acetaminophen.
- Intra-articular Hyaluronic Acid (HA): Intra-articular hyaluronic acid is no longer recommended as a method of treatment for patients with symptomatic osteoarthritis of the knee. The 2009 guidelines review was inconclusive regarding this treatment method.
"Fourteen studies assessed intra-articular hyaluronic acid injections," said David S. Jevsevar, MD, MBA, chair of the AAOS Evidence Based Practice Committee which oversees the development of clinical practice guidelines. "Although a few individual studies found statistically significant treatment effects, when combined together in a meta-analysis the evidence did not meet the minimum clinically important improvement thresholds."
Other important recommendations that remain in the revised guideline include:
- Patients who only display symptoms of osteoarthritis and no other problems, such as loose bodies or meniscus tears, should not be treated with arthroscopic lavage.
- Patients with a Body Mass Index (or BMI) greater than 25 should lose a minimum of five percent of their body weight.
- Patients should begin or increase their participation in low-impact aerobic exercise.
"One of the best ways for a patient to reduce his or her pain and realize better health is to be proactive," said Dr. Jevsevar, who also is an orthopaedic surgeon in St. George, Utah. "For instance, if a patient is overweight, losing weight is probably the best thing he or she can do to slow the progression of osteoarthritis of the knee."
Photo: Stewart Black
Moderate Physical Activity Does Not Increase Risk of Knee Osteoarthritis
Adults age 45 and older who engaged in moderate physical activity up to two and a half hours a week did not increase their risk of developing knee osteoarthritis over a 6-year follow-up period, a new study finds. Study participants who engaged in the highest levels of physical activity – up to 5 hours a week – did have a slightly higher risk of knee osteoarthritis, but the difference was not statistically significant.
Those findings taken together are good news, said Joanne Jordan, MD, MPH, senior study author and director of the Thurston Arthritis Research Center in the University of North Carolina School of Medicine. “This study shows that engaging in physical activity at these levels is not going to put you at a greater risk of knee osteoarthritis,” she said. “Furthermore, we found this held true no matter what a person’s race, sex or body weight is. There was absolutely no association between these factors and a person’s risk.”
Photo: Nick Page
Lateral Wedge Insoles Not Associated with Improvement of Knee Pain in Osteoarthritis
Although a pooling of data from 12 studies showed a statistically significant association between use of lateral wedge insoles and lower pain in medial knee osteoarthritis, among trials comparing wedge insoles with neutral insoles, there was no significant or clinically important association between use of wedge insoles and reduction in knee pain, according to a study in the August 21 issue of JAMA.
Matthew J. Parkes, B.Sc., of the University of Manchester, England, and colleagues conducted a meta-analysis to assess the efficacy of lateral wedge treatments (shoes and insoles designed to reduce medial knee compartment loading) in reducing knee pain in patients with medial knee osteoarthritis. The authors conducted a search of the medical literature to identify randomized trials that compared shoe-based treatments (lateral heel wedge insoles or shoes with variable stiffness soles) aimed at reducing medial knee load, with a neutral or no wedge control condition. The wedge needed to be of 5° to 15° of angulation, which is a level shown in previous studies to reduce external knee adduction moment (torque). Studies must have included patient-reported pain as an outcome. Twelve trials met inclusion criteria with a total of 885 participants of whom 502 received lateral wedge treatment.
The researchers found, when considering all 12 trials, the overall effect estimate was a standard mean difference in pain between interventions that showed a moderately significant effect of a lateral wedge on pain reduction. However, the findings were highly heterogeneous across studies. Larger trials with a lower risk of bias suggested a null association.
Photo: Robert S. Donovan
Lower Rates Of Complications In Hip And Knee Replacement Using Regional Anesthesia Technique
A highly underutilized anesthesia technique called neuraxial anesthesia, also known as spinal or epidural anesthesia, improves outcomes in patients undergoing hip or knee replacement, according to a new study by researchers at Hospital for Special Surgery. The study, which appears in the May issue of the journal Anesthesiology, found that neuraxial anesthesia, a type of regional anesthesia, reduced morbidity, mortality, length of hospital stay and costs when compared with general anesthesia.
"The influence that the type of anesthetic can have on perioperative outcomes has been vastly underestimated. Indeed, our study suggests that the type of anesthesia chosen may have important impacts on all kind of medical and economic outcomes in orthopedic surgical patients," said Stavros Memtsoudis, M.D., Ph.D., director of Critical Care Services at Hospital for Special Surgery, New York City. "It is not something to be taken lightly." The findings of this comparative effectiveness research could be applied to over one million patients undergoing joint arthroplasty in the United States each year.
Scars from Childhood Cancer Can Affect Adult Quality Of Life
Scars left behind by childhood cancer treatments are more than skin-deep. The increased risk of disfigurement caused by childhood cancer and treatment is associated with emotional distress and reduced quality of life in adulthood, according to a new study led by a Northwestern Medicine advanced practice nurse, Karen Kinahan, and based on data from the Childhood Cancer Survivor Study (CCSS).
The largest study of its kind, published in the Journal of Clinical Oncology, compared adult survivors, who were scarred or disfigured by childhood cancer, to their siblings, who were not childhood cancer survivors. The study found that survivors with a head, neck, arm, or leg disfigurement had increased risk of depression.
"The results of this study help illustrate the complex chain of events childhood cancer can have on quality of life as an adult," said senior author Kevin Krull, Ph.D., an associate member in the St. Jude Children’s Research Hospital departments of epidemiology and cancer control and psychology. "We have long been aware that radiation therapy is associated with increased risk for emotional distress and social problems, though we did not fully understand the process this involves. The current study begins to map this process."
Photo: Steven Depalo
The Societal Benefits of Knee Replacement Surgery Highlighted by New Health Economics Study
The full impact of knee replacement surgery on both patients’ lives and on society includes significant overall cost savings, according to a new study published in theJournal of Bone and Joint Surgery (JBJS).Researchers found that for the average patient undergoing knee replacement surgery, the expense of surgery is offset by indirect savings of nearly $40,000. This translates to an average lifetime societal benefit of $10,000-$30,000. Most of the societal savings come from the patient’s ability to maintain employment and increase earnings over a longer time in the workforce. The study also found benefits from fewer missed worked days and lower disability payments.
As an aging population stays in the workforce longer and obesity rates continue to climb, demand for total knee replacement surgery is expected to exceed 3 million by the year 2030 - up from 600,000 in 2009. Now with a new way of comparing direct and indirect costs between surgical and non-surgical treatments, patients suffering from end-stage osteoarthritis of the knee are able to get a quantitative look at the overall cost benefits of knee replacement surgery relative to the societal and economic savings.
"We know that when a knee replacement is done on patients at the appropriate time, it adds tremendous value to their lives. It gets them back to work and back to their families. It improves their quality of life and allows them to be productive and active again," said John R. Tongue, MD, American Academy of Orthopaedic Surgeons (AAOS) past-president. "But until now, that value has been hard to quantify. This study allows patients to see the big picture of the effect on their daily lives and in the long term."
Photo: epSos Photography