Should I Ask Doctor Google? Reliability of Israeli Web-based Information Regarding General Orthopedic Injuries and Symptoms.

BACKGROUND: Websites serve as a source of medical information for a large part of the public, some claim to be a substitute for a physician's consultation. Many patients meet a physician after conducting internet research. Medical staff are concerned that internet sources of information are unreliable and may lead to erroneous decisions by patients. OBJECTIVES: To examine the reliability of web-based sources of information (through the Google™ search engine) regarding five common orthopedic complaints and injuries. METHODS: We performed a search of five common orthopedic complaints and injuries using the Google search engine. The reliability of web-based information was measured by the DISCERN tool, which is a valid and verified tool for examining the reliability of medical information sources to the public. The reliability of 47 websites was examined by two orthopedic surgeons and two senior residents. RESULTS: The overall average score given to the sites was 2.8, on a scale of 1 to 5. We found that the higher the site appeared in the search results, the higher the quality of its information. Commercial sites scored higher than general internet information sources. CONCLUSIONS: The internet network is a very broad source of information. For those who lack scientific education and training it is not easy to distinguish between reliable and unreliable or biased sources. The trend of searching for medical information and self-healing is increasing. We must strengthen the network with reliable sources by creating official scientific position papers by medical teams and promoting them online.

[ANTERIOR HIP ARTHROPLASTY: EVOLUTION, REVOLUTION, OR AN ELAPSING TREND?]

INTRODUCTION: Over the years total hip arthroplasty had turned from a procedure indicated for elderly, low functioning patients, into a procedure indicated also for younger patients who are interested in a well-functioning hip joint to maintain their active lifestyle. Previously, posterior approach was most commonly utilized, however in recent years, due to the accumulating evidence regarding the advantages of the anterior approach, an increase in the prevalence of the anterior approach is noted. In contrast to other surgical approaches, the anterior approach "respects" inter-muscular and inter-nervous planes and therefore is perceived as associates with less pain, faster rehabilitation, and a good stability relative to other approaches. Thus, the anterior approach received the attention of both the orthopedic community and the patients who are interested in maintaining their active life routine. In contrast to the advantages associated with the anterior approach, there are some disadvantages that are unique to this approach such as technical difficulties, a challenging learning curve, and a relatively common impairment of the sensation of the lateral aspect of the operated thigh. Due to the increasing rates of total hip arthroplasty procedures that are performed via the anterior approach, there is a need for reviewing the different aspects of this approach. The aim of this review is to discuss the principles of the anterior approach, the outcomes and complications.

[THE RELATIONSHIP BETWEEN INJURIES, SHOES AND STYLE IN THE RUNNER'S POPULATION].

INTRODUCTION: We are now standing four decades after the 'running revolution' which occurred during the 70's of the previous century. Despite the developments that have occurred in medicine and the large budgets invested in the development of the sport's equipment, the runner's morbidity has not changed. In this article, we would like to review the changes in running that occurred throughout the years, as well as the common risk factors for running injuries. Furthermore, we would like to examine the scientific point of view regarding running shoes and running technique as risk factors for running injuries. A new trend, the "minimalist running", characterized by a unique technique and rigid shod might be the "game changer" in diminishing the injury rates in runners. Note, that minimalist running is not yet a common technique and thus, we might encounter a new set of injuries which we still have to evaluate.

A 14-Year Experience in the Management of Patients with Acquired Immune Thrombotic Thrombocytopenic Purpura in Northern Israel.

Acquired idiopathic thrombotic thrombocytopenic purpura (I-TTP) is a life-threatening microangiopathic disorder usually treated with therapeutic plasma exchange (TPE). The current study assessed the role of rituximab in the treatment of complicated I-TTP. The sequence of TTP events was compared in a group of I-TTP patients treated with TPE and a cohort of refractory or relapsed patients who also received rituximab. This retrospective evaluation included 45 I-TTP patients, treated between January 2000 and October 2013, who underwent at least 3 TPE procedures and were followed up until December 2013 or death. Thirty-one patients with an uncomplicated course received TPE only. Fourteen patients had a complicated course due to either a primary refractory/exacerbated disease (n = 5) or relapse (n = 9) and received rituximab together with TPE. The median number of TPE procedures performed in the first TTP episode in the uncomplicated cohort and groups with primary refractory or relapsed TTP was 11, 27 and 45, respectively. The relapse rates per follow-up year in the uncomplicated I-TTP, primary refractory and relapsed I-TTP groups were 0.18, 0.2 and 0.6 episodes, respectively. After rituximab therapy this rate dropped to 0.2 per year in the relapsed subgroup. In conclusion, about a quarter of patients with I-TTP had a complicated course and experienced a major benefit from rituximab in terms of effectiveness and safety.