Geisinger rheumatologists redesign osteoporosis, rheumatoid arthritis care

DANVILLE, PA. – With the nation collectively spending about $18 billion per year on osteoporosis related bone fractures, Geisinger researchers found that streamlining the ordering process for osteoporosis bone density scans quadrupled the number of patients who received the exam.

An estimated 10 million Americans suffer from osteoporosis. Like most providers, Geisinger Health System measures the mineral content in the bones of patients who are at high-risk for osteoporosis through DXA scans.

Follow-up exams are usually needed to assess how the disease has progressed. Geisinger’s rheumatology department removed some of the steps involved, shifted the responsibility of ordering the exam from the patient’s primary care provider to the rheumatology staff and made greater use of Geisinger’s $80 million Electronic Health Record.

Before the change, 18% of patients received the test. After the test, 88% received the scan.

“A broken bone from osteoporosis can be excruciating and hard to recover from,” said Eric Newman, MD, Geisinger’s Rheumatology Director. “Testing for osteoporosis is the first step in preventing these breaks.”

Results of the study were presented at the American College of Rheumatology’s annual meeting in Boston recently. Geisinger had four presentations at the meeting, the most ever for the department.

The other work included:

Plenary Presentation - The first in-depth study of new care recommendations that were issued by the American College of Rheumatology. Geisinger examined the records of over 1,000 patients with rheumatoid arthritis to see how many patients received certain suggested care benchmarks such as joint exams and use of medication.

Among the study’s key findings was that 94% of the patients received disease modifying antirheumatic drugs, which ease pain, reduce inflammation and reduce or prevent joint damage. This was far higher than anticipated, Newman noted.

While more than 3,000 study abstracts were submitted for the meeting, this was one of just 14 studies that were accepted as plenary presentations.

The third study found that treatment decisions in patients with rheumatoid arthritis are altered if doctors have all of a patient’s data immediately in front of them in several summarizing charts, as opposed to having the information scattered throughout many pages in the Electronic Health Record and in paper files.

The fourth study examined how fellowship training for rheumatologists has improved significantly by adding a specific osteoporosis training curriculum.

“It was an outstanding year for us,” Newman said. “These studies reflect our staff’s talent and commitment to delivering the best care to our patients.”

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The studies were conducted by rheumatology fellows Leena Adhikesavan MD and Mark Diehl DO, primary care physician Nancy Gilhooley MD, staff rheumatologists Thomas Olenginski, MD and Androniki Bili, MD, MPH, fellowship director Thomas Harrington MD and Newman.

Source: http://www.eurekalert.org/pub_releases/2007-11/ghs-grr111607.php

Wheatley has broken bone in his foot

Colorado cornerback Terrence Wheatley is in danger of missing what could be the final game of his college career because of a fractured bone in his foot.

Wheatley suffered the injury two weeks ago against Missouri and missed last week's game at Iowa State, though he did travel with the team and stood on the sidelines wearing a protective boot.

"I'm feeling a lot better, I'm not wearing the boot any more," he said. "That's an upgrade I guess. I'm still in a little bit of pain when I run."

The Buffs have this week off, which should give the senior from Richardson, Texas, an opportunity to heal.

He said team physicians have told him the normal healing time for the injury is about two weeks. He said he is hoping to be feeling more like himself by the beginning of game week.

The Buffs are one win shy of bowl eligibility and facing what amounts to a playoff scenario when Nebraska comes to town Nov. 23. One last go-around with the Buffs' arch-rival combined with the fact that it will be the final home game of his career has Wheatley saying he will consider a cortisone shot prior to the contest if he is given the option.

"We'll wait and see, then at the last second, if we have to do whatever, then we'll do whatever," Wheatley said.

Full article: http://dailycamera.com/news/2007/nov/14/cu-football-wheatley-has-broken-bone-in-his-foot/

SJSU's Tafralis unfazed by broken thumb

Adam Tafralis will try to help revive the ailing San Jose State offense Saturday against New Mexico State despite a broken bone in his left thumb.

The senior quarterback hurt his non-throwing hand late in the first half of the Spartans' 42-7 loss at Boise State last weekend. Tafralis threw a touchdown pass to Kevin Jurovich, SJSU's only score in its past two games, later in that drive. Then he played the entire third quarter (completing 4 of 8 attempts for 30 yards) before being taken out with the Spartans trailing by 28 points.

"It's painful, but mostly it's annoying," said Tafralis, who completed 5 of 11 attempts for 34 yards after suffering the injury. "You don't realize how much you use your left thumb as a right-handed quarterback: catching the ball, turning it and getting it into your (right) hand to throw, and being able to grip it on the option (running plays).

"But I'll make it work."

Tafralis said he smashed his thumb on a Boise State player's helmet. The blow tore off half the thumbnail at the root and the distal phalanx, the bone above the top knuckle in the thumb. It "broke just like a carrot. It snapped right in half," Tafralis said.

After the game, the rest of the nail was removed to make sure the bone hadn't pierced Tafralis' flesh. The nail then was sewn back to protect the under-layer of skin on his thumb.

Tafralis didn't miss any time in practice this week.

"He's a tough dude," Jurovich said.

Source: http://www.mercurynews.com/collegesports/ci_7414433?nclick_check=1

Pedroia finished season with broken hand

Remember the leadoff home run Dustin Pedroia hit in Game 1 of the World Series? He hit it with a broken bone in his left hand.

According to a report by the Boston Herald, the second baseman admitted on Friday that he played the final two months of the season with a cracked hamate bone in his left hand.

He doesn't know when it occurred, but the injury was found during an MRI and bone scan on Sept. 10. He underwent surgery on Tuesday, is wearing a soft cast and can't use the hand until late November or early December.

"Some days I would wake up and it would be hard to grip a bat," Pedroia said. "I changed my grip a little bit on the bat and went from there. It was just one of those things you know you have to take care of after the season, but you have to play through. A lot of guys have done that. You definitely don't want to shut it down and have surgery during the whole thing. We just had to find a way to fight through it."

Source: http://www.southcoasttoday.com/apps/pbcs.dll/article?AID=/20071111/SPORTS/711110396

Schwarzenegger has surgery to remove plate from broken thigh bone

LOS ANGELES — Gov. Arnold Schwarzenegger underwent surgery Saturday to remove a metal plate and cables from his leg, a spokesman said.

The hardware was used to help Schwarzenegger's upper thigh bone heal after he broke it while skiing in Sun Valley, Idaho, last Dec. 23.

The orthopedic surgeon who performed the 20-minute surgery at a Los Angeles hospital said in a statement issued by the governor's office that there were no complications.

Dr. Kevin Ehrhart said removing the hardware is standard practice after the leg has fully healed. Ehrhart said the second-term Republican governor will use a crutch for several days.

Schwarzenegger spokesman Aaron McLear said the governor turned over power to Lt. Gov. John Garamendi for 90 minutes during what he described as "minor surgery." Schwarzenegger was under general anesthesia for one hour during the procedure, McLear said.

McLear would not disclose the name of the hospital, citing "privacy reasons." Schwarzenegger left the hospital Saturday afternoon to return to his Santa Monica home, McLear said.

Ehrhart, in his statement, said the governor "is in excellent health and there were no complications in this morning's successful follow-up medical procedure. The governor has fully recovered from his initial surgery last December and removing the hardware is a standard practice."

Ehrhart also performed the surgery last Dec. 26 when the plate and cable were inserted to repair Schwarzenegger's right femur, which he broke three days earlier when he fell while skiing with his family. That surgery lasted 90 minutes, Ehrhart said at the time, and used cables and screws to wire the two main fragments of the broken femur bone back together.

Schwarzenegger walked with crutches and a cane for weeks afterward, but he was able to attend his inauguration the following week.

Last year, the governor blamed an artificial hip installed about six years ago for contributing to what he described as an odd, slow-speed accident. His ski failed to release from its binding, twisting his leg until it snapped, Schwarzenegger said.

The former actor, body builder and seven-time Mr. Olympia also had a heart valve replaced in 1997. He had rotator cuff surgery in 2003. He went to a hospital complaining of a rapid heartbeat in 2005.

He also has had two recent injuries in motorcycle crashes. He had several broken ribs during a crash in 2001. A minor accident in January 2006 required 15 stitches in his lip.

Schwarzenegger met Friday morning with state, federal and local officials overseeing the cleanup of an oil spill in San Francisco Bay. He then flew to Los Angeles to deliver an afternoon speech to the Latino Coalition for a Healthy California Conference, where he argued that his health care reform plan will aid the state's economy.

He had no other public duties before entering the hospital Saturday morning for the previously scheduled surgery, McLear said. He was under anesthesia from 9:30 a.m. to 10:30 a.m.

"We don't know his schedule for next week, so I don't know when he's due back in Sacramento," McLear said. "But this will not affect his ability to govern in any way.... He's acting as governor as we speak and fully able to do whatever he needs to do to move California forward — oil spill, health care, anything else."

Schwarzenegger and legislative leaders have been negotiating over both a health care package and a multibillion dollar water bond to ease flood danger and capture more winter runoff for use during California's dry summers. They must agree quickly if they are to put the measures before voters on the February presidential primary ballot.

With winter approaching, Schwarzenegger is also anticipating a return to the ski hill now that his leg is fully healed.

"He's cleared to ski. He's able to ski and I've heard him say he hopes to get out and hit the slopes this winter," McLear said. "But I don't know if he has any concrete plans to do so."

Source: http://www.mercurynews.com/news/ci_7428368?nclick_check=1