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The differential diagnosis of unexplained hip pain after trauma in patients with normal radiographs includes both soft tissue and bony abnormalities. We have presented a case of an isolated fracture of the greater trochanter in an adult with normal radiographs where the diagnosis was made by MRI.

Background: Hypertension (HTN) control may be highly dependent on patient behaviors, including filling of antihypertensive medication prescriptions (AHM Rxs). We examined electronic health records (EHR) for patients of Geisinger Clinic who had prescription benefits through Geisinger Health Plan. Methods: Prescriptions in the EHR were defined as filled if a claim was paid within 90 days. We used logistic regression to test if a patient’s filling rate (FR) was associated with gender, age, economic status (measured as median household income by ZIP code) and number of vascular comorbidities (angina, MI, PVD, stroke). We then tested whether a higher categorical FR (0, 1–33, 33–67, 67–99 or 100%) resulted in a greater percent of office visits with blood pressure (BP) controlled to JNC7 standards (%BPc). Results: All results are reported as Adjusted Odds Ratios (AOR) [95% CI]. Among 20,161 patients who met JNC7 criteria for HTN and had >3 AHM Rxs during plan enrollment from 2002 to 2006, 99% were Caucasian and 53% were female with a mean age of 58.5 years (SD 15.8). Of 191,120 AHM Rxs (mean per patient 9.5, SD 6.5), 49%, 59% and 62% were filled within 30, 60 and 90 days. Based on a 90-day FR, 14.7% of patients filled no Rxs and 36.2% filled all. Factors negatively associated with FR were female gender (AOR 0.89 [CI 0.870.90]), increasing age (nonlinear, 0.30 [0.290.30] for age 60–80 years vs. age 40–60 years), and number of vascular comorbidities (nonlinear, 0.79 [0.770.81] for 1 vs. 0 comorbidities, 0.66 [0.610.71] for 2 vs. 0 comorbidities). Higher economic status was positively associated with FR (1.05 [1.031.07] per $10k estimated annual income). In 19,500 patients who had >3 office visits, the mean number of BP readings per patient was 19.6 (SD 10.6), and 60% of readings were under control. After adjusting for the factors above and baseline blood pressures, there was a positive nonlinear association between FR and %BPc (1.08 [1.06–1.13] for 33–67% vs. 0% FR, 1.09 [1.08–1.16] for 67–99% vs. 0% FR, and 1.34 [1.07–1.46] for 100% vs. 0% FR). Results were similar if we excluded patients with 0% FR who may have used alternate insurance for Rxs. Conclusions: These findings suggest that prescription filling differs by gender, age and comorbidity status and that higher Rx filling rates are associated with better BP control.

Foreword.- Preface.- SECTION I: ETIOPATHOGENIC BASES AND THERAPEUTIC IMPLICATIONS.- Background. Patellofemoral malaligment vs Tissue homeostasis. Myths and truths about patellofemoral disease.- Pathogenesis of anterior knee pain and patellar instability. What have we learned from realignment surgery?.- Biological causes of anterior knee pain.- In search of the etiology of anterior knee pain.- Biomechanics of the patellofemoral joint. Implications in the genesis of pain and instability.- Anatomy of patellar dislocation.- Evaluation of the patient with anterior knee pain and patellar instability.- Influence of psycological factors on pain and dissability in patellofemoral pain syndrome.- Uncommon causes of anterior knee pain.- Risk factors and prevention of anterior knee pain.- Conservative treatment of athletes with anterior knee pain: science, classical and new ideas.- Conservative management of anterior knee pain: the McConnell program.- Squeletal malalignment and anterior knee pain. Rationale, diagnosis and management.- Patellar tendinopathy: Where does the pain come from?.- Pathophysiology of patellofemoral arthritis.- Prevention of anterior knee pain after anterior cruciate ligament reconstruction.- Donor-site morbidity after anterior cruciate ligament reconstruction using autografts.- SECTION II: EMERGING TECHNOLOGIES FOR INVESTIGATING PATELLOFEMORAL JOINT.- Computational modeling for investigating patellofemoral joint. Clinical relevance.- Kinetic and kinematic analysis in evaluating patellofemoral disorders.- SECTION III: CLINICAL CASES COMMENTED.- Complicated cases studies.- Failure of patellofemoral surgery. Analysis of clinical cases.- Neuromatous knee pain: Evaluation and management.- Posterior knee pain referred from the patellofemoral joint.- SECTION IV: SURGICAL TECHNIQUES.- Reconstruction of the medial patellofemoral ligament.- Reconstruction of the medial patellofemoral ligament.- Reconstruction of the lateral patellofemoral ligament.- Reconstruction of the lateral patellofemoral ligament.- Rotational osteotomy.- Trochleoplasty.- Osteotomies in patella baja / patella alta.- Arthroscopic patellar release for the treatment of patellar tendinopathy.- Anteromedial tibial tubercle osteotomy (Fulkerson osteotomy).- Autologous chondrocyte implantation.-Patellofemoral arthroplasty: Pearls and pitfalls.- EPILOGUE.

Background: Treatment of AIA typically involves prolonged hospitalization and substantial use of intensive care (ICU) resources. This study compared consumption of hospital resources by AIA pts receiving initial treatment with either VOR or CAB. Methods: Data were collected prospectively as part of a clinical trial comparing VOR to CAB in AIA of immunocompromised pts, where VOR showed a significant improvement in success and a relative survival benefit (Herbrecht R et al, NEJM2002; 347: 408–15). Pts in the modified-intent-to-treat population with completed resource utilization data were included. Total days of hospitalization, days of ICU, and hospitalization-free survival days during 12 weeks following initiation of therapy were compared. The impact of survival on resource consumption was explored. Results: There were 143 and 131 pts in the VOR and CAB arms, respectively, with resource utilization data. Resource utilization data are presented in the Table. Resource Utilization by Treatment Arm VOR Mean (SD) CAB Mean (SD) Difference (95% CI) Total Hospital Days 27.8 (22.7) 27.7 (20.8) 0.1 (−5.1, 5.3) Total Hospital Days (survivors) 30.2 (24.2) 33.3 (22.2) −3.1 (−10.3, 4.0) ICU Days 5.6 (10.7) 8.1 (14.4) −2.5 (−5.5, 0.5) ICU Days (survivors) 4.0 (10.9) 8.1 (14.6) −4.1 (−7.9, −0.2) Hospitalization-free survival (days) 40.3 (29.8) 28.4 (28.5) 11.9 (4.9, 18.8) Conclusion: VOR pts had significantly longer hospitalization-free survival and had a trend toward fewer ICU days than CAB pts. Improved survival with less hospital resource utilization and lower total drug acquisition costs (Lewis JS et al, ICAAC 2003, A1359) support the economic benefit of using VOR for primary therapy for AIA.

In situ rod contouring is proposed as a means of three-dimensionally controlling the three columns of the spine. Our goal was to determine the biomechanical effectiveness of the technique for both clinical application and future research. Six cadaver specimens were tested with pedicle screw instrumentation from T12 to L2 in an L1 corpectomy model with all longitudinal ligaments retained across the defect. Contouring moment, anterior longitudinal ligament (ALL) forces, and distraction and lordosis across L1 were monitored. Rods were contoured to 26 degrees, and axial distraction averaged 6.9 mm. Bone/screw-interface failure began during contouring in every case < 10 degrees with no resulting increase in lordosis across L1. High tensile forces generated in the ALL resisted the moment applied by the rod benders and instead caused failure of the weaker bone/screw interface.

Summary Objectives The goal of this study was to provide a comprehensive analysis of the potential health impact of universal vaccination of infants with the 7-valent pneumococcal conjugate vaccine (PCV7) in China. Methods A decision-analytic model designed for pneumococcal disease and outcomes of pneumococcal infection was populated with local age-specific incidence and mortality data to estimate the expected health benefits of vaccinating birth cohorts of approximately 16 million infants per year over a 10-year time horizon in China. The model incorporates both the direct impact on vaccinated children and the indirect effect of herd protection on unvaccinated children and adults. Results The model predicts that more than 16.2 million cases of pneumococcal disease and 709 411 deaths could be prevented in China over the initial 10-year period following the introduction of the PCV7 vaccine. The majority of these health benefits are due to the indirect effectiveness of the vaccine on the unvaccinated population, resulting in approximately 10.8 million cases prevented and 636 371 lives saved over 10 years. Conclusions The results suggest that a policy of universal PCV7 vaccination among infants in China would have a substantial positive public health impact on the population of China.

Summary Objectives To describe the incidence, mortality, cost, and length of stay (LOS) of hospitalized community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP) in three Southeast Asian countries: Malaysia, Indonesia, and the Philippines. Methods Using Casemix system data from contributing hospitals, patients with International Classification of Diseases 10 th revision (ICD-10) codes identifying pneumonia were categorized into CAP or HAP using a logical algorithm. The incidence among hospitalized patients, case fatality rates (CFR), mean LOS, and cost of admission were calculated. The population incidence was calculated based on Malaysian data. Results For every 100000 discharges, CAP and HAP incidences were 14245 and 5615 cases, respectively, in the Philippines, 4205 and 2187, respectively, in Malaysia, and 988 and 538, respectively, in Indonesia. The impact was greatest in the young and the elderly. The CFR varied from 1.4% to 4.2% for CAP and from 9.1% and 25.5% for HAP. The mean LOS was 6.1–8.6 days for CAP and 6.9–10.2 days for HAP. The cost of hospitalization was between USD 254 and USD 1208 for CAP and between USD 275 and USD 1482 for HAP. Conclusions The burden of CAP and HAP is high. Results varied between the three countries, likely due to differences in socio-economic conditions, health system differences, and ICD-coding practices.

Background Prior studies have found that patients taking single-pill amlodipine/atorvastatin (SPAA) have greater likelihood of adherence at 6 months than those taking 2-pill calcium-channel blocker and statin combinations (CCB/statin). This study examines whether this adherence benefit results in fewer cardiovascular (CV) events. Methods A retrospective cohort study was conducted using administrative claims data from the IMS LifeLink: US Health Plan Claims database, identifying adults already taking CCB or statin (but not both) who had an index event of either initiating treatment with SPAA or adding CCB to statin (or vice versa) between April 1, 2004 to August 31, 2005. Inclusion criteria included age 18+ years, continuously enrolled for minimum of 6 months prior and 18 months following treatment initiation, >1 diagnosis of hypertension, and no prescription claims for SPAA or added CCB or statin for 6 months prior. Exclusion criteria included >1 claim with missing or invalid days supplied, age 65+ years and not enrolled in Medicare Advantage, or history of prior CV events, cancer diagnosis, or chronic renal failure. The primary outcome measure was the rate of CV events (myocardial infarction, heart failure, angina, other ischemic heart disease, stroke, peripheral vascular disease, or revascularization procedure) from 6 to 18 months following index date, analyzed at three levels: 1) all adherent vs. non-adherent patients, 2) SPAA vs. dual-pill patients (regardless of adherence level), and 3) adherent SPAA, adherent dual-pill, and non-adherent SPAA patients vs. non-adherent dual-pill patients. Results Of 1,537 SPAA patients, 56.5% were adherent at 6 months, compared with 21.4% of the 17,910 CCB/statin patients (p < 0.001). Logistic regression found SPAA patients more likely to be adherent (OR = 4.7, p < 0.001) than CCB/statin patients. In Cox proportional hazards models, being adherent to either regimen was associated with significantly lower risk of CV event (HR = 0.77, p = 0.003). A similar effect was seen for SPAA vs. CCB/statin patients (HR = 0.68, p = 0.02). In a combined model, the risk of CV events was significantly lower for adherent CCB/statin patients (HR = 0.79, p = 0.01) and adherent SPAA patients (HR = 0.61, p = 0.03) compared to non-adherent CCB/statin patients. Conclusions Patients receiving SPAA rather than a 2-pill CCB/statin regimen are more likely to be adherent. In turn, adherence to CCB and statin medications is associated with lower risk of CV events in primary prevention patients.

Background A life-threatening attack of asthma that leads to intensive care unit (ICU) admission, intubation, or both identifies patients at high risk of subsequent morbidity and mortality and represents a major cost burden. Objective To assess the rates, characteristics, and costs of ICU admissions and intubations among asthma-related hospitalizations. Methods This analysis was performed using a database of 215 hospitals representing more than 3 million annual inpatient visits. Asthma-related hospital admissions were identified by a primary diagnosis code for asthma during 2000. Logistic regression was used to estimate the odds ratios (ORs) for predictors of ICU admission, intubation, and in-hospital mortality. Ordinary least squares regression was used to estimate adjusted mean costs and length of stay. Results Of 29,430 admissions with a primary diagnosis of asthma, 10.1% were admitted to the ICU and 2.1% were intubated. The risk of in-hospital death was significantly greater in patients who were intubated but not admitted to the ICU (OR, 96.20; 95% confidence interval [CI], 50.24–184.20), those who were admitted to the ICU and intubated (OR, 62.69; 95% CI, 38.17–102.96), and patients with more severe comorbidities (OR, 1.53; 95% CI, 1.38–1.70). On average, intubated patients stayed in the hospital 4.5 days longer and incurred more than $11,000 in additional costs; patients admitted to the ICU stayed 1 day longer and accounted for $3,000 in additional costs vs standard admissions. Conclusions The inpatient mortality, morbidity, and cost burden of life-threatening asthma in the United States is considerable. This study characterizes patients with asthma at risk of ICU admissions and intubations. Appropriate recognition and treatment are needed to prevent these severe and potentially life-threatening events.