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Past News Items - June 2013


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In the News

Registered Dietitians Help Critically Ill Children Get Necessary Nutrition for Recovery

Stroke Treatment Based on Traditional Chinese Medicine Increases Chances of Recovery

NuCentury Herbs Offers a Dose of Fresh Air to Colorado Black Forest Wildfire Victims

Study Results Reveal That the Bioness L300 Produces Significant Walking Improvements

Scientists Clarify Benefits And Use Of Glycemic Index, Load, And Response

Oceans Omega And Lakeview Farms Produce The World's First Omega-3 Fortified Gelatins

Integrative Therapeutics is Pleased to Name Dr. Allison Hendrix as the 2013 STAIR Residency Winner

Breakthrough Weight Loss Program Seminar

Study Expands Concerns About Anesthesia's Impact on the Brain

RidgeCrest Herbals Wins Patent for Homeopathic Encapsulation Method

Exclusive Bioavailable Quercetin Now Available

AAOS Releases Revised Clinical Practice Guideline for Osteoarthritis of the Knee




Released: 06/28/13


Registered Dietitians Help Critically Ill Children Get Necessary Nutrition for Recovery

Documented Caloric Requirements in Medical Records Lead to Higher Caloric Intake and Improved Critical Outcomes, According to Journal of the Academy of Nutrition and Dietetics Report

For the first time, researchers investigated enteral nutrition and caloric requirements (CR) among critically ill children in a new report published in the Journal of the Academy of Nutrition and Dietetics. This study also showed the value of including registered dietitians in the medical team.

Providing early nutritional support through the intestine, or enteral route, to critically ill adults has been an effective strategy to improve the healing process. Using a similar approach with critically ill children, however, may present challenges, such as an inability to accurately estimate CR or an inability to administer the CR because of fluid restrictions, procedures, and other barriers. Despite these perceived challenges and a lack of data, many experts believe that early enteral nutrition should be considered in most Pediatric Intensive Care Unit (PICU) patients.

“Our main objective was to examine the practice of early documentation of estimated caloric requirement in the medical record of critically ill children to determine if this would have any effect on their daily caloric intake and the route of nutrition being used to provide them with nutritional support,” says lead investigator Martin Wakeham, MD, FAAP, Assistant Professor of Pediatrics, Pediatric Critical Care, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee. “We hypothesized that there would be a higher total daily caloric intake and more frequent use of enteral nutrition when a CR is estimated and documented in the medical record within 48 hours of PICU admission.”

Five PICUs participated in the study. Four of these units were located in independent children’s hospitals and one was part of a large community hospital. The study team collected and analyzed data from two sources. The first was medical records detailing the nutritional intake (nutrition route, quantity, content, presence or absence of an estimated CR) of 1,349 patients admitted between January 1, 2007 and December 31, 2008, aged between 30 days and 18 years, and who remained in the PICU for 96 hours or more. The second was a multisite clinical database dedicated to data sharing and benchmarking among PICUs. Investigators also noted the type of provider when an estimated CR was present.

Careful analysis of data revealed that nearly 50 percent of the patients had a documented CR. Other findings include the following:

  • Compared to patients without a CR, these patients were younger, had a higher risk of mortality, and were less likely to be post-operative
  • Patients were more likely to receive enteral nutrition on each of the first four days of admission to the PICU
  • Patients had a higher total daily caloric intake by enteral route and parenteral route combined on each of the first four days of their stay in the PICU
  • More than 90 percent showed an estimated CR equal to or greater than the World Health Organization’s calculated resting energy expenditure (REE).
  • A registered dietitian determined the documented CR in more than 95 percent of the cases

“A CR documented in the medical record is evidence that at least a member of the health care delivery team included nutritional support and therapy in the treatment plan for that particular patient. Likewise, not having a CR present in the medical record might be evidence that the subject of nutritional therapy was never addressed in those patients,” says Dr. Wakeham.

“Another interesting finding is that almost all of the CRs present early in the medical records were entered by a registered dietitian and not by an attending physician or other medical care provider. This finding illustrates the favorable and important impact that registered dietitians can have on the nutritional outcomes of PICU patients.”

 

Released: 06/21/13


Stroke Treatment Based on Traditional Chinese Medicine Increases Chances of Recovery

NeuroAiD, a stroke treatment based on Traditional Chinese Medicine, increases the odds of achieving a better functional outcome, according to research published online in the journal Stroke.

The CHIMES study is an academic international double-blind placebo-controlled clinical trial which included 1,100 patients from several countries who had suffered an ischemic stroke of intermediate severity within 72 hours, treated and monitored for three months. Researchers found that patients who were taking NeuroAiD at acute stage had an 11 percent increase in the odds of achieving independence in function and being able to perform daily activities at the end of three months. This effect was even greater when NeuroAiD was started beyond 48 hours after stroke onset, with an increase of 39 percent.

The odds ratio was the highest among recently completed stroke trials of neuroprotective agents. The benefit observed is clinically relevant and might have reached statistical significance with a larger sample size. In addition the study confirmed the excellent safety profile of NeuroAiD. Stroke survivors who were on NeuroAiD had fewer adverse events than those in the control group. Further studies will likely look into the benefits of longer duration of treatment.

Prof. Christopher Chen, neurologist at the National University of Singapore and the principal investigator of the CHIMES study, said the results looked very promising and suggested that the effectiveness of such herbal supplements could have a great impact on stroke management. "I think one thing which is very clear is that NeuroAiD is safe in acute stroke. A previous meta-analysis suggested that NeuroAiD is efficacious and safe in the chronic stage of stroke. Now the Chimes study has provided us with much more reliable data about the safety and efficacy of NeuroAiD in acute stroke. I think the CHIMES results are not only a step forward, but also a major achievement."

Occurring every two seconds, stroke is one of the leading causes of mortality and morbidity worldwide. Each year, 20 million people suffer from the devastating disease. However, there are only a few effective, generally accepted and specific treatments available, such as thrombolytic treatment for highly selected patients. Therefore, there is an increasing need for multi-modal therapies to help more patients recover quickly and effectively from stroke. Moleac, a Singapore based bio-pharma company, developed NeuroAiD to meet this need.

The large-scale investigator-initiated study is an independent initiative conducted by the CHIMES Society, an international partnership of key opinion leaders in neurology. It is among the first large-scale endeavours to investigate the use of a product from natural substances in reducing disability after an acute stroke in a rigorous manner.

Traditional Chinese Medicine (TCM) is used extensively in Asia to facilitate recovery after stroke and has become an increasingly important player in the global health system and economy. Recent rigorous medical studies conducted on some TCMs have confirmed that they have, among other properties, antioxidant and anti-inflammatory effects, which render them attractive options to be investigated for stroke recovery.

 

Released: 06/20/13


NuCentury Herbs Offers a Dose of Fresh Air to Colorado Black Forest Wildfire Victims

As a part of their ongoing Share the Air commitment to community and education, Nu Century Herbs recently donated hundreds of packets of their herbal respiratory supplement, AirAide, to the Pikes Peak American Red Cross. Donations were sent directly from the manufacturer, as well as through a local retailer.

The Colorado Springs business owners have really stepped up to help the firefighters and victims by donating supplies. Julie Good, owner of Mountain Mama Natural Foods in Colorado Springs, CO, reports, “With the fire under control, things appear to be back to business as usual. But some have lost loved ones, homes and pets. My heart goes out to all who have been affected.” And there also health concerns. She adds, “After experiencing heavy smoke in the air from the surrounding fires, many have a feeling of burning in the throat, a persistent cough, irritated sinuses and general lethargy.” In addition to AirAide, Julie donated boxes of meal replacement bars.

If you wish to volunteer or offer a donation, please contact the The Pikes Peak Chapter of the American Red Cross: 1040 S 8th St # 200, Colorado Springs, CO 80905, (719) 632-3563.

Nu Century Herbs has been researching the connection between herbs and wellness for over two decades. As a result of this dedication and commitment to health and wellbeing they have developed safe, effective botanical products. Their synergistic formulations are quality produced in the USA with 100 percent vegetarian, all natural herbal ingredients, GMP Certified and are scientifically standardized for purity and potency.

If you wish to learn more about NuCentury Herbs visit: www.nucenturyherbs.com. For further information about this press release, please contact Elle Markey, NuCentury Herbs Colorado office (970) 668-9433.

 

Released: 06/20/13


Study Results Reveal That the Bioness L300 Produces Significant Walking Improvements

Bioness, Inc. today announced that 30-week results from the company’s study of the Bioness L300 Foot Drop System in persons with stroke have been published in the premier journal of the American Heart Association; Stroke. The results demonstrate that persons with drop foot following stroke had significant performance improvements using the Bioness L300 matching that of the standard of care, the ankle foot orthosis (AFO). Subjects who used the Bioness L300 specifically reported significantly greater satisfaction and willingness to continue use of the L300 after 30 weeks.

“For individuals who have experienced a stroke and suffer from physical deficits like foot drop, after a certain point the course of rehabilitation tends to be focused on helping them live with their limitations rather than gain functional improvement,” said Dr. Patricia Kluding, Associate Professor in the Department of Physical Therapy & Rehabilitation Science at the University of Kansas, and lead investigator on the study. “This initial data shows that there is some hope – even years after a stroke – that with the right therapy and device support, patients can potentially make significant gains with walking, opening the door to independence.”

The study, titled Foot Drop Stimulation Versus Ankle Orthosis After Stroke (30 week results from the FASTEST trial), involved 197 patients at 11 US centers. Subjects were on average 4.5 years post-stroke and were randomized to receive 30 weeks of foot drop stimulation via the Bioness L300 or AFO. Both groups received dose-matched physical therapy in the first six weeks of the trial. Performance was assessed by testing subject’s walking speed, distance walked, and balance through accepted standardized outcome measures. In addition, estimates for total steps taken per day, quality of life, and user satisfaction was also collected. Subjects were followed for a total of 42 weeks and the initial 30-week results were published in Stroke.

Participants in the L300 Group experienced an immediate increase of walking speed of 19.0 percent and continued to improve to a 33.3 percent improvement at 30 weeks. Additionally, nearly 90 percent of participants in the L300 Group were enthusiastic about continuing use of the device and rated it more useful than other walking aids, compared to only 45 percent and 56 percent, respectively, in the AFO Group.

“Rehabilitation physicians and therapists are all well aware of the challenges that their patients face with the physical limitations after stroke. Addressing these challenges with interventions and devices that provide immediate and long-term benefit while facilitating recovery, motivation, and compliance is desirable to providers and people with stroke alike,” said Keith McBride, Vice President of Global Marketing for Bioness. “The 30-week data from the FASTEST study indicates that not only can patients experience lasting benefits with the L300 even years after stroke, but that the Bioness technology can encourage and motivate patients.”

“With compliance being such a critical component of any therapy and rehabilitation program, we are encouraged by these initial 30-week results, and look forward to sharing the full 42 week results of the FASTEST study once available, added McBride. “Our ultimate goal is to expand accessibility to solutions like the L300, for providers and their patients.”

 

Released: 06/12/13


Scientists Clarify Benefits And Use Of Glycemic Index, Load, And Response

Leading Nutrition Scientists Provide Answers On Controversial Topic

An international committee of leading nutrition scientists from ten countries on three continents today released an important Scientific Consensus Statement. They concluded that carbohydrate quality (measured by the glycemic index or GI) matters, and that the carbohydrates present in different foods affect post-meal blood sugar differently, with important health implications. They also confirmed that there is convincing evidence from a large body of research that low glycemic index/glycemic load (GI/GL) diets reduce the risk of type 2 diabetes and coronary heart disease, help control blood glucose in people with diabetes, and may also help with weight management.

The Committee recommended inclusion of glycemic index and glycemic load in national dietary guidelines and food composition tables, and that packaging labels and symbols on low-GI foods should be considered. They also confirmed that low-GI measurements complement other ways of characterizing carbohydrate foods (such as fiber and whole grain content), and should be considered in the context of an overall healthy diet.

The Consensus Statement was the culmination of the International Scientific Consensus Summit on Glycemic Index, Glycemic Load, and Glycemic Response, organized June 6-7, 2013 in Stresa, Italy by two nonprofits, Oldways and the Nutrition Foundation of Italy. At the Summit, scientists reviewed the latest research on glycemic index (a measure of carbohydrate quality), glycemic load (a measure that combines carbohydrate quality and quantity in real-world portion sizes), and overall issues of glycemic response (how the body's management of blood sugar is affected by both food and lifestyle, over time).

This Consensus Statement on how different foods affect our blood sugar is especially important, given the rapid rise in obesity and diabetes. The scientists stressed the need to communicate information on GI/GL to the general public and health professionals. That's why Oldways and the Nutrition Foundation of Italy (NFI)—two nonprofits with a long history of consensus meetings—teamed up to facilitate this scientific meeting of the minds. "Top scientists and researchers presented their newest research and networked for a day and a half," said Andrea Poli, scientific director of NFI. Oldways president Sara Baer-Sinnottfurther explained, "Then they deliberated for four hours, without media or any industry attendees present, to develop a consensus statement designed to clarify current consumer understanding and guide future research in this important area."

Walter Willett, MD, PhD, Chairman of the Department of Nutrition at the Harvard School of Public Health, and one of the participating scientists, said, "Given essentially conclusive evidence that high GI/GL diets contribute to risk of type 2 diabetes and cardiovascular disease, reduction in GI and GL should be a public health priority."

David Jenkins, MD, PhD, DSc, Canada Research Chair in Nutrition and Metabolism, in the Department of Nutritional Sciences, Faculty of Medicine at the University of Toronto and widely acknowledged as the originator of the GI concept, announced that the scientists will continue to work together. "We have formed an international Carbohydrate Quality Consortium to collaborate and share research, with an overall goal of improving public health," said Dr. Jenkins.

Short interviews with the scientists are available online through the Oldways and NFI websites, and scientists' presentations will also be available soon.

Scientists taking part in the Scientific Consensus Summit included Dr. Jenkins and Dr. Thomas Wolever, who originated the concept of Glycemic Index at the University of Toronto, and Dr. Willett, who developed the Glycemic Load with colleagues at theHarvard School of Public Health. Other renowned experts, pioneers and nutrition communicators contributing to the consensus were Jennie Brand-Miller and Alan Barclay from Australia; Cyril Kendall, John Sievenpiper and Livia Augustin from Canada;Salwa Rizkalla from France; Anette Buyken from Germany; Antonia Trichopoulou from Greece; Furio Brighenti, Carlo La Vecchia, Andrea Poli, and Gabriele Riccardi from Italy; Antonio Ceriello from Spain, Inger Bjorck from Sweden; Geoffrey Liveseyfrom the UK, and Simin Liu and Sara Baer-Sinnott from the USA.

 

Released: 06/12/13


Oceans Omega And Lakeview Farms Produce The World's First Omega-3 Fortified Gelatins

Oceans Omega—a leading supplier of water-soluble omega-3 EPA and DHA ingredients for food, beverage, nutritional, and pet care products— announced today the world's first commercially produced omega-3 fortified gelatins. Oceans Omega has produced the omega-3 fortified gelatins in partnership with Lakeview Farms. Lakeview Farms is a manufacturer of gelatins, cheese spreads, desserts, snacks, dips, and other specialty products. Each cup of omega-3 enhanced gelatin delivers 32 mg of essential omega-3s (EPA/DHA), has 10 calories, and is gluten-free. The enhanced gelatins are available in four tasty flavors: Strawberry, Orange, Passion Fruit, and Pink Grapefruit.

"We are excited to be the first company in the world to produce omega-3 fortified gelatins, featuring our proprietary ingredients," said Benjamin D. Mamola, CEO of Oceans Omega. "Working collaboratively with Lakeview Farms and our supply chain partners made this substantial achievement possible."

Oceans Omega has incorporated premiere highly purified omega-3 branded oils into their gelatins including Meg-3™, life'sDHA™, and OmegaActiv®. Oceans Omega's technology provides water-soluble and stabilized omega-3 fatty acids EPA and DHA for use in standard manufacturing processes including cold-fill, hot-fill, and carbonation. Omega-3 fatty acids support cognitive function in children and seniors, which makes gelatins an ideal delivery form.

"It is extremely gratifying to have produced the world's first omega-3 fortified gelatin in partnership with Oceans Omega" said Gene Graves, CEO of Lakeview Farms. "Oceans Omega's ingredient technology is extraordinary."

 

Released: 06/10/13


Integrative Therapeutics is Pleased to Name Dr. Allison Hendrix as the 2013 STAIR Residency Winner

Integrative Therapeutics, in partnership with the American Association of Naturopathic Physicians (AANP), is pleased to announce Dr. Allison Hendrix as the winner of the 2013 STAIR Integrative Residency Program.

The STAIR Program offers a unique opportunity for both new naturopathic graduates and integrative medical practices. A qualified naturopathic graduate is matched with a successful integrative practice for a yearlong residency, fully-funded by Integrative Therapeutics.

Mandy Kraynik, Vice President of Integrative Therapeutics, explains, “This program is designed to address a serious issue: a lack of real-world opportunities for naturopathic graduates. I believe the key to cultivating successful practices is providing new healthcare professionals with the practical application opportunities and business development skills they need to make it on their own.”

After earning her doctorate in naturopathic medicine from the National College of Natural Medicine this spring, Hendrix will begin her residency at Federal Way Naturopathy, Inc. in Federal Way, Washington. She will have the opportunity to gain real-world experience as she participates in the full-spectrum of clinic life

At Federal Way Naturopathy, Dr. Hendrix will receive mentorship from Dr. Beth DiDomenico, ND, and Dr. Anja Crider, MD. The clinic’s focus is facilitating the body’s own natural mechanisms for healing using modalities such as homeopathy, cranial sacral therapy, hydrotherapy, botanical medicine, counseling, and nutrition.

“The STAIR residencies help eradicate the boundaries and barriers that too often exist between naturopathic and conventional care, and working with both an ND and MD will give Dr. Hendrix a well-rounded, unique healthcare experience,” explains Kraynik.

Recruitment for 2014 residency sites will begin in June. Visit stair.integrativeinc.com for application details or more information on the STAIR Integrative Residency Program.

 

Released: 06/10/13


Breakthrough Weight Loss Program Seminar

Join Joseph Lamb, MD and Ryan Lazarus, DC on Saturday, July 13, 2013 from 8:00 a.m. to 12:00 p.m. in Seattle, WA to discover how to transform lives with a clinically tested weight loss program. You’ll learn how this clinically successful program offers a distinct advantage for patients who have tried other weight loss plans and failed to achieve desired results. You’ll also discover the science behind the development of the program and receive guidance on how to recommend and monitor it for optimal patient outcomes. Dr. Lamb will also be accompanied by clinicians who utilize this program in their practices. Register today at metagenics.com/events.

 

Released: 06/06/13


Study Expands Concerns About Anesthesia's Impact on the Brain

As pediatric specialists become increasingly aware that surgical anesthesia may have lasting effects on the developing brains of young children, new research suggests the threat may also apply to adult brains.

Researchers from Cincinnati Children's Hospital Medical Center report June 5 the Annals of Neurology that testing in laboratory mice shows anesthesia's neurotoxic effects depend on the age of brain neurons – not the age of the animal undergoing anesthesia, as once thought.

Although more research is needed to confirm the study's relevance to humans, the study suggests possible health implications for millions of children and adults who undergo surgical anesthesia annually, according to Andreas Loepke, MD, PhD, a physician and researcher in the Department of Anesthesiology.

"We demonstrate that anesthesia-induced cell death in neurons is not limited to the immature brain, as previously believed," said Loepke. "Instead, vulnerability seems to target neurons of a certain age and maturational stage. This finding brings us a step closer to understanding the phenomenon's underlying mechanism"

New neurons are generated abundantly in most regions of the very young brain, explaining why previous research has focused on that developmental stage. In a mature brain, neuron formation slows considerably, but extends into later life in dentate gyrus and olfactory bulb.

The dentate gyrus, which helps control learning and memory, is the region Loepke and his research colleagues paid particular attention to in their study. Also collaborating were researchers from the University of Cincinnati, College of Medicine and the Children's Hospital of Fudan University, Shanghai, China.

Researchers exposed newborn, juvenile and young adult mice to a widely used anesthetic called isoflurane in doses approximating those used in surgical practice. Newborn mice exhibited widespread neuronal loss in forebrain structures – confirming previous research – with no significant impact on the dentate gyrus. However, the effect in juvenile mice was reversed, with minimal neuronal impact in the forebrain regions and significant cell death in the dentate gyrus.

The team then performed extensive studies to discover that age and maturational stage of the affected neurons were the defining characteristics for vulnerability to anesthesia-induced neuronal cell death. The researchers observed similar results in young adult mice as well.

Research over the past 10 years has made it increasingly clear that commonly used anesthetics increase brain cell death in developing animals, raising concerns from the Food and Drug Administration, clinicians, neuroscientists and the public. As well, several follow-up studies in children and adults who have undergone surgical anesthesia show a link to learning and memory impairment.

Cautioning against immediate application of the current study's findings to children and adults undergoing anesthesia, Loepke said his research team is trying to learn enough about anesthesia's impact on brain chemistry to develop protective therapeutic strategies, in case they are needed. To this end, their next step is to identify specific molecular processes triggered by anesthesia that lead to brain cell death.

"Surgery is often vital to save lives or maintain quality of life and usually cannot be performed without general anesthesia," Loepke said. "Physicians should carefully discuss with patients, parents and caretakers the risks and benefits of procedures requiring anesthetics, as well as the known risks of not treating certain conditions."

 

Released: 06/05/13


RidgeCrest Herbals Wins Patent for Homeopathic Encapsulation Method

RidgeCrest Herbals, a creator of eclectic and innovative natural remedies for specific health needs, today announced that it has been awarded a new patent for its homeopathic encapsulating method. The method allows the company to combine homeopathic ingredients (which use traces of natural substances to trigger the body's natural healing responses) with stronger and faster-working herbs without reducing the herb's effective strength and without the need for lactose and sucrose, which are traditionally used to deliver homeopathic ingredients.

When homeopathics are combined with herbs in capsule form, lactose and sucrose may take up as much as 25 percent of the room in the capsule. According to Matt Warnock, president of RidgeCrest Herbals and co-inventor of the process with Shane Hinze , this causes two problems:

  • The portion of the capsule traditionally covered with lactose and sucrose cannot be used for herbs, which can be bulky and need extra space.
  • Lactose and sucrose are not needed – or generally wanted - in herbal capsules, and can result in upset stomachs for lactose-intolerant individuals.

Herbs often require a small amount (1-2 percent of capsule weight) of a flow agent to bind to sticky or resinous ingredients and help them flow smoothly into the capsule. Micro-crystalline cellulose is more natural than many other flow agents, and chemically more similar to herbs, which already contain a lot of cellulose. With the new patented method, RidgeCrest applies the homeopathics either to a base of micro-crystalline cellulose, which can then be used as the flow agent, or to the cellulose capsule itself.

"Homeopathics are an energy medicine, and even a very small physical dose can deliver the needed energy signature," Warnock said. "Our patented method solves both of the homeopathic encapsulation problems with one elegant solution. As a result, we can provide both the homeopathic and the herbal components at maximum potency, resulting in more effective products."

The patented method, called "homeoactive" encapsulation, is already standard in RidgeCrests's seven homeopathic products:

  • Clear Lungs Extra Strength, a decongestant formula supported by a unique blend of 13 Chinese herbs.
  • Migraine Relief, which contains both a homeopathic formula for relief of headache pain, and a Chinese herbal formula to support normal vascular and nerve inflammation response.
  • DreamOn, which combines safe and natural homeopathic medicines with herbal sleep aids for gentle, natural sleep.

 

Released: 06/05/13


Exclusive Bioavailable Quercetin Now Available

New to the practitioner market, highly bioavailable Alpha-Glycosyl Isoquercitrin is now available exclusively through Integrative Therapeutics.

Quercetin is an important flavonoid that provides antioxidant protection at the cellular level. It has demonstrated several beneficial effects on the body, including inhibiting glucose absorption in the intestines, supporting cellular regulation and healthy glutathione levels, and supporting healthy control of histamine release.

Several formulations of quercetin have been used to improve its poor bioavailability. The newest and most effective of these, Alpha-Glycosyl Isoquercitrin, is now available exclusively in the healthcare professional market from Integrative Therapeutics. This quercetin glucoside complex is absorbed quickly and is nearly 18 times more bioavailable than standard quercetin.

“Our technical team is constantly researching the newest, clinically-effective ingredients available, and we are excited to bring the benefits of Alpha-Glycosyl Isoquercitrin to our customers and their patients,” explains Jeremy Appleton, ND, Director of Scientific Affairs for Integrative Therapeutics.

For more information on the new Alpha-Glycosyl Isoquercitrin, visit integrativeinc.com

 

Released: 06/05/13


AAOS Releases Revised Clinical Practice Guideline for Osteoarthritis of the Knee

The American Academy of Orthopaedic Surgeons (AAOS) recently released its revised clinical practice guideline (CPG) on the treatment of osteoarthritis of the knee, addressing two key changes. Most of the remaining recommendations provided in the 2009 CPG go unchanged. CPGs are not meant to be stand-alone documents, but rather serve as a point of reference and educational tool for both primary care physicians and orthopaedic surgeons.

The original guideline, as well as this revised version, was developed to include only treatments which are less invasive than knee replacement surgery. Osteoarthritis (OA) is a common condition that can affect any joint in the body particularly after years of use. It is also known as "wear and tear" arthritis and most commonly occurs in people who are 65 years of age or older. Some 33 million Americans are affected by osteoarthritis, and it is the leading cause of physical disability.

The two primary changes recommended in the 2013 guidelines that differ from the 2009 CPG include:

  • Acetaminophen: The recommended dosage was reduced from 4,000 mg to 3,000 mg a day. This is not a change made by AAOS specifically for OA patients, but an overall change made by the FDA since 2009 for individuals who use acetaminophen.
  • Intra-articular Hyaluronic Acid (HA): Intra-articular hyaluronic acid is no longer recommended as a method of treatment for patients with symptomatic osteoarthritis of the knee. The 2009 guidelines review was inconclusive regarding this treatment method.

"Fourteen studies assessed intra-articular hyaluronic acid injections," said David S. Jevsevar , MD, MBA, chair of the Committee on Evidence-Based Quality and Value which oversees the development of clinical practice guidelines. "Although a few individual studies found statistically significant treatment effects, when combined together in a meta-analysis the evidence did not meet the minimum clinically important improvement thresholds."

Other important recommendations that remain in the revised guideline include:

  • Patients who only display symptoms of osteoarthritis and no other problems, such as loose bodies or meniscus tears, should not be treated with arthroscopic lavage.
  • Patients with a Body Mass Index (or BMI) greater than 25 should lose a minimum of five percent of their body weight.
  • Patients should begin or increase their participation in low-impact aerobic exercise.

"One of the best ways for a patient to reduce his or her pain and realize better health is to be proactive," said Dr. Jevsevar, who also is an orthopaedic surgeon in St. George, Utah. "For instance, if a patient is overweight, losing weight is probably the best thing he or she can do to slow the progression of osteoarthritis of the knee."

The AAOS work group suggests that patients with symptomatic OA of the knee receive one of the following analgesics for pain (unless there are contraindications to this treatment):

  • Acetaminophen (not to exceed 3,000 mg per day)
  • For short-term pain relief, intra-articular corticosteroids
  • Non-steroidal anti-inflammatory drugs (NSAIDs)

The AAOS work group cannot recommend the following treatments:

  • Custom made lateral wedge insoles
  • Glucosamine and/or chondroitin sulfate or hydrochloride
  • Needle lavage (aspiration of the joint with injection of saline)

In addition, although acupuncture continues to grow in popularity, the evidence did not support its use in patients with OA of the knee.

Due to a lack of available research, the CPG is unable to recommend for or against the use of bracing, growth factor injections and/or platelet rich plasma.

"There are many treatment options for osteoarthritis of the knee," said Dr. Jevsevar. "However, not all are effective. There needs to be more and better testing, since results are still inconclusive. Therefore, if you are experiencing knee problems, the best advice is to work closely with your physician and orthopaedic surgeon to develop the best course of treatment for you."

The full guideline along with all supporting documentation and workgroup disclosures is available on the AAOS website: aaos.org/research/guidelines/GuidelineOAKnee.asp

 

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