The updated AMSA scorecard of conflict-of-interest policies: a survey of U.S. medical schools.

BACKGROUND: Best practices for conflict-of-interest (COI) policies in medical schools have evolved rapidly over the past decade, in part motivated by the American Medical Student Association (AMSA) scorecard that has publicly graded schools since 2007. This report describes the methodological update and impact of revisions to the scorecard in 2014. METHODS: The original AMSA scorecard (used annually from 2008 to 2013) was revised by a work group to improve its methodology and to increase the stringency of its criteria for scoring COI policies. All U.S. medical schools (both allopathic and osteopathic; n = 160) were invited to submit their COI policies to AMSA for scoring with the new scorecard; web site searches were used to acquire policy information for schools that did not submit. The authors developed a codebook and analyzed 14 distinct categories of COI policies, pertaining to activities such as industry-funded gifts, meals, educational events, site access for sales reps, and conflict-of-interest disclosure requirements. The analysis yielded four possible grades for each school: A, B, C, or I (incomplete). The authors compared 2014 grades with 2013 grades, and compared the distribution of grades of schools by type (allopathic vs. osteopathic) and geographical region. RESULTS: A total of 27 (16.9 %) medical schools scored A grades, indicating that their COI policies were strong, 81 (50.6 %) scored B, 25 (15.6 %) scored C and 26 (16.3 %) policies scored I. As compared to 2013, in 2014 fewer schools qualified for A grades (17.0 % vs. 26.0 %; p = 0.05). The grade distributions of allopathic and osteopathic schools were significantly different (p < 0.0001), with osteopathic schools more likely than allopathic schools to have incomplete policies. There were no significant grade differences by geographical region. CONCLUSIONS: The revised 2014 AMSA scorecard, with its more stringent criteria for evaluating COI policies, assigned fewer As and more Bs and Cs than in years past. This was the first study to identify schools with COI policies stronger than those recommended in 2008 by the Association of American Medical Colleges. Developing more stringent COI policies should be helpful in reducing the influence of pharmaceutical and device industry marketing on both trainees and faculty in American medical schools.

Labral refixation: current techniques and indications.

BACKGROUND: Labral tears have been associated with femoroacetabular impingement, instability, sports-related activity or trauma, capsular laxity or hypermobility, dysplasia, and degeneration. Disruption of the labrum increases the rate of acetabular cartilage compression and the contact stress between the femoral and acetabular cartilage. If left untreated, these lesions will alter normal hip joint function and may eventually lead to osteoarthritis. METHODS: For the labrum with adequate tissue (>7 mm), the labrum is repaired if it is detached or torn. If the labrum is bruised, a rim reduction and repair is performed, especially in the presence of cartilage damage and the labral-chondral junction. Labri are debrided only if there is enough substance to maintain the function of the labrum. Care must be taken to fix the labrum so that it provides adequate seal with the femoral head. RESULTS: Two-year outcome on 122 patients who underwent arthroscopic treatment for femoroacetabular impingement and chondrolabral dysfunction showed that, overall, most patients showed an improvement in symptoms and function and were satisfied with the results. Independent predictors of improved outcomes were joint space >2 mm and repair of labral pathology instead of debridement. Several other studies have shown excellent results following labral refixation and repair. CONCLUSIONS: Labral tears have been associated with femoroacetabular impingement, instability, sports-related activity or trauma, capsular laxity or hypermobility, dysplasia, and degeneration. Untreated labral tears can result in premature osteoarthritis of the hip. Debridement only used to be the standard of care, but excellent results reveal arthroscopic labral repair and refixation are an option with good outcomes.