Prehabilitation may benefit hip and knee replacement patients
All hip and knee replacement patients have physical therapy after their surgery. However, a new study is suggesting that prehabilitation may be highly beneficial to some patients. Researchers found prehabilitation could significantly diminish the need for postoperative care. In some cases, postoperative care was cut by nearly 30 percent, resulting in a significant cost savings.
The study included more than 4,700 patients and it found that 54 percent of the preoperative physical therapy group required postoperative care services. However, 79 percent of the patients who did not have preoperative therapy required postoperative care services. The study suggested there could a cost reduction of $1,215 per patient with prehabilitation. The researchers said preoperative physical therapy cost an average of $100 per patient, and was generally limited to one or two sessions.
Approximately 50 million U.S. adults have physician-diagnosed arthritis. As the condition progresses, arthritis patients often require hip or knee replacements. The number of hip replacement patients is expected to grow by 174 percent between 2005 and 2030, and the number of knee replacement patients is expected to grow by 673 percent during that same period. In recent years, the length of hospital stay following surgeries has decreased from an average of 9.1 days in 1990 to 3.7 days in 2008. Today, it is sometimes only two days. However, the cost of post-acute care has skyrocketed. The findings have been published in the Journal of Bone & Joint Surgery.
Good news for veterans with PTSD
California researchers are now reporting that a simple anesthetic procedure can significantly help veterans and possibly others with PTSD (post-traumatic stress disorder). The investigators conducted a small study with 12 patients with PTSD. All the patients underwent a simple anesthetic procedure called a stellate ganglion block (SGB). This common procedure involves injecting a small amount of local anesthesia into the base of the neck. SGB is traditionally used to treat a variety of conditions, from pain syndromes to sleep disorders.
"While it doesn't cure the problem, we found that SGB appears to be a fast-acting and effective long-term treatment for chronic, extreme PTSD in veterans," said Dr. Michael Alkire, who is with the Long Beach VA Healthcare System in California. "These improvements far outlasted what we would expect from SGB, which is usually used as a temporary nerve block and typically lasts 3 to 5 hours."
In the study, the patients each were given one SGB and followed closely with structured interviews and other psychological tests for six months. The positive effects of the SGB were evident often within minutes and were demonstrated at three months. However, the benefits began fading and were generally gone by six months. Overall, 75 percent of the participants reported significant improvement of their PTSD symptoms after the SGB.
Researchers said SGB also may be an effective initial treatment for depression and anxiety disorders.
"Further work is needed to identify which patients might respond best to this treatment as well as understand the mechanisms involved," said Dr. Alkire.
Eating Granny Smith apples may be extra beneficial
Compounds in Granny Smith apples may help prevent disorders associated with obesity, according to scientists at Washington State University (WSU). It has always been known that apples are a good source of nondigestible compounds but there are differences in varieties. Now, researchers have found the tart green Granny Smith apples benefit the growth of friendly bacteria in the colon due to their high content of non-digestible compounds, including dietary fiber and polyphenols, and low content of available carbohydrates.
The researchers conducted animal studies and found that despite being subjected to chewing, these compounds remain intact when they reach the colon. Once there, they are fermented by bacteria in the colon, which benefits the growth of friendly bacteria in the gut.
The study showed that Granny Smith apples surpass Braeburn, Fuji, Gala, Golden Delicious, McIntosh and Red Delicious in the amount of nondigestible compounds they contain.
"Results from this study will help consumers to discriminate between apple varieties that can aid in the fight against obesity," said lead researcher Giuliana Noratto, who is a food scientist at WSU.
The discovery could help prevent some of the disorders associated with obesity such as low-grade, chronic inflammation that can lead to diabetes. The balance of bacterial communities in the colon of obese people is disturbed. Noratto said re-establishing a healthy balance of bacteria in the colon stabilizes metabolic processes that influence inflammation and the sensation of feeling full.
John Schieszer is an award-winning national journalist and radio broadcaster of The Medical Minute. He can be reached at medicalminutes@gmail.com.
John Schieszer is an award-winning national journalist and radio and podcast broadcaster of The Medical Minute.
