Arthroscopy for Knee Osteoarthritis Has Not Decreased After a Clinical Trial.

BACKGROUND: Multiple clinical trials have shown that arthroscopy for knee osteoarthritis is not efficacious. It is unclear how these studies have affected orthopaedic practice in the USA. QUESTIONS/PURPOSES: We questioned whether, in the Veterans Health Administration system, rates of knee arthroscopy in patients with osteoarthritis have changed after publication of the initial clinical trial by Moseley et al. in 2002, and whether rates of arthroplasty within 2 years of arthroscopy have changed during the same period. METHODS: Patients 50 years and older with knee osteoarthritis who underwent arthroscopy between 1998 and 2010 were retrospectively identified and an annual arthroscopy rate was calculated from 1998 through 2002 and from 2006 through 2010. Patients who underwent knee arthroplasty within 2 years of arthroscopy during each period were identified, and a 2-year conversion to arthroplasty rate was calculated. RESULTS: Between 1998 and 2002, the annual arthroscopy rate decreased from 4% to 3%. Of these arthroscopies, 4% were converted to arthroplasty within 2 years. Between 2006 and 2010, the annual arthroscopy rate increased from 3% to 4%. Of these arthroscopies, 5% were converted to arthroplasty within 2 years. CONCLUSIONS: Rates of arthroscopy in patients with knee osteoarthritis and conversion to arthroplasty within 2 years have not decreased with time. It may be that evidence alone is not sufficient to alter practice patterns or that arthroscopy rates for arthritis for patients in the Veterans Health Administration system were already so low that the results of the initial clinical trial had no substantial effect. LEVEL OF EVIDENCE: Level III, Retrospective cohort study.

Prevalence of substance use and substance-related disorders among US Veterans Health Administration patients.

BACKGROUND: Substance use and related disorders are common among US Veterans, but the population burden of has never been directly assessed among Veterans Health Administration (VA) patients. We surveyed VA patients to measure substance use and related disorders in the largest US integrated healthcare system. METHODS: We surveyed N = 6000 outpatients from 30 geographically-representative VA healthcare systems. We assessed substance use (lifetime, past 12-month, daily in past 3 months) and past 12-month disorders following DSM-5 criteria and estimated the association with Veteran characteristics (age, gender, race/ethnicity, socioeconomic status, VA utilization). RESULTS: Alcohol was the most commonly-reported substance (24% used past 12 months, 11% daily in past 3 months, 10% met criteria for alcohol use disorder), followed by cannabis (42% lifetime use, 12% use in past 12 months, 5% daily use in past 3 months, 3% met criteria for cannabis use disorder). Overall, 5% met criteria for non-alcohol drug use disorder (13% for substance use disorder (SUD)). SUD prevalence was highest for young Veterans and those who were unemployed or otherwise not employed for wages. Past 12-month cannabis use was common, even among older adults (65-74 years: 10%; 75 and older: 2%). CONCLUSIONS: Prevalence data are important inputs into decisions around population health monitoring, treatment capacity, and quality measurement strategies. Substance use and SUD are more prevalent than previously reported, and VA may need to screen for non-alcohol drugs to identify patients who need care. More tailored assessment may be needed for cannabis use, high-prevalence subgroups, and older adults.

The asthma trigger inventory: validation of a questionnaire for perceived triggers of asthma.

BACKGROUND: Asthma patients' perceptions of triggers have been explored in a largely unstructured fashion in the past. We therefore developed and validated a questionnaire of commonly perceived asthma triggers. METHODS: Two hundred forty-seven primary care patients with asthma filled in an asthma trigger survey together with questionnaires on demographics, asthma-relevant information, perceived control of asthma, and general health status. Factor structure of the item pool and psychometric properties of trigger subscales were evaluated. We also investigated the relationship between allergen or psychological trigger reports and allergy skin test response or respiratory impedance during emotional film viewing, respectively. RESULTS: Principal component analysis yielded six factors that were thematically associated with psychology, animal allergens, pollen allergens, physical activity, infection, and air pollution/irritants. Subscales showed good internal consistencies and low to moderately positive intercorrelations. Psychological triggers were consistently associated with less favorable health status, a reduced perception of asthma control, and greater medical treatment utilization. Animal allergen scores correlated positively with skin test responses to animal allergens. Respiratory impedance increases during emotional film clips were positively correlated with the psychological trigger subscale. CONCLUSION: The questionnaire is a reliable measure of commonly perceived asthma triggers. Aspects of patients' trigger reports reflect actual reactivity to specific trigger factors.