Pain physician
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The Balanced Budget Act which became law in 1997 was designed to help stem the increasing in costs of healthcare. The Sustainable Growth Rate (SGR) formula was incorporated into that law as a method of helping balance the budget through a complex formula tying reimbursement to the growth in the economy. Soon after its inception, the flawed nature of the formula, linking the balancing of the federal budget to physician professional fees was realized. ⋯ The MACRA has been criticized for providing insufficient statutory updates, enacting a flawed quality and performance improvement program associated with MIPS and inappropriate use of utilization and payment data. Thus, the MACRA offers physicians a predictable schedule for Medicare rates - a carrot, and controls the physician behaviors with payment reforms analogous to a stick. Thus, it could be said that this legislation embodies some good, bad, and ugly aspects.
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Review Meta Analysis Comparative Study
Comparison of Percutaneous Vertebroplasty and Balloon Kyphoplasty for the Treatment of Single Level Vertebral Compression Fractures: A Meta-analysis of the Literature.
Percutaneous vertebroplasty (PVP) and percutaneous balloon kyphoplasty (PKP) can increase bone strength as well as alleviate the pain caused by vertebral compression fractures (VCFs), and both procedures rely on polymethyl methacrylate (PMMA) cement injected into the fractured vertebra for mechanical stabilization of the VCFs. However, there is debate over which of these 2 surgical procedures can give better short-term and long-term outcomes. A lot of studies and meta-analysis were designed to assess the advantages and drawbacks of PKP and PVP in the treatment of VCFs, but most of them didn't consider the effect of VCF levels on the treatment outcome, which can influence the results. ⋯ PKP and PVP are both safe and effective surgical procedures in treating OVCF. PKP has a similar long-term pain relief, function outcome (short-term ODI scores, short-and long-term SF-36 scores), and new adjacent VCFs in comparison to PVP. PKP is superior to PVP for the injected cement volume, the short-term pain relief, the improvement of short- and long-term kyphotic angle, and lower cement leakage rate. However, PKP has a longer operation time and higher material cost than PVP. To confirm this evaluation, a large multi-center randomized controlled trial (RCT) should be conducted.
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Randomized Controlled Trial
Intravenous parecoxib and continuous femoral block for postoperative analgesia after total knee arthroplasty. A randomized, double-blind, prospective trial.
Up until now, the optimal strategy for postoperative pain management after total knee arthroplasty (TKA) remains to be elucidated. ⋯ According to our findings intravenous parecoxib in combination with continuous femoral block provided superior analgesic efficacy and opioid sparing effects in patients undergoing TKA.