Bisphosphonates improve joint replacements - retrospective GPRD cohort

A retrospective cohort study on joint replacements using the UK's General Practice Research Database (GPRD) is published in the BMJ.[1]

Researchers from Oxford looked at the records of almost 42,000 patients who had a knee or hip replacement and found that 1912 of them had bisphosphonates. They concluded,

"In patients undergoing lower limb arthroplasty, bisphosphonate use was associated with an almost twofold increase in implant survival time. These findings require replication and testing in experimental studies for confirmation."

It is important to remember that this is a non-randomised study and is observational in nature. Controversy exists on how this type of data should be used and, as the researchers suggest, it requires experimental study.

With the recent news of the potential release of routine NHS data these types of observations will become more frequent. Should we act on them in the interests of improving quality or consider them hypotheses that require testing?

1. Prieto-Alhambra D, Javaid MK, Judge A, Murray D, Carr A, Cooper C, Arden NK. Association between bisphosphonate use and implant survival after primary total arthroplasty of the knee or hip: population based retrospective cohort study. BMJ 2011 Dec;343(dec06 1):d7222-d7222. Available from: http://www.bmj.com/content/343/bmj.d7222

MedEdMOOC organisers' meeting 11th Dec 2011

Had a good Google+ hangout and parallel Twitter chat about #MedEdMOOC today and looks like there's a creative group that has come together. Documentation has been updated and a new organisers-only area started so that some key decisions can be made. Still looking at an April / May 2012 course of about 5 - 6 weeks.


Date Sunday 11th December 21:00 GMT (worldtime here) - poll was here
On G+ and Twitter using the hashtag #MedEdMOOC
Agenda (and minutes)

• governance structure
• decided organiser group with asynchronous loose consensus
• organiser Google doc (request an invite)
• work on it until second week of January have another meeting
• topic list
• to work on in the organiser doc
• research agenda
• not discussed
• dates
• April looks good
• requirements (platforms, technologies, speakers etc.)
• Multimedia archiving platform such as Blackboard Collaborate

Time	From User	Tweet
Sun, 11 Dec 2011 23:09:04 +0000	phcsig	RT @bronwynah: #CochraneColloquium in NZ 2012 http://t.co/fnMw9y2f #EBP #mededmooc
Sun, 11 Dec 2011 23:03:27 +0000	dean_jenkins	@claireOT can you DM me your Google login email so that I can add you to the organisers' document for #MedEdMOOC?
Sun, 11 Dec 2011 22:37:10 +0000	bronwynah	@BrianSMcGowan great idea, many speech path / disability links & resources that can be pulled in, also networks #mededmooc #slpeeps etc
Sun, 11 Dec 2011 22:35:53 +0000	dean_jenkins	#MedEdMOOC organisers' Google Doc. http://t.co/GdzAjqYc #mededmooc
Sun, 11 Dec 2011 22:35:18 +0000	dean_jenkins	Have set up an organisers' Google Doc but need to have email addresses to invite you in. #mededmooc
Sun, 11 Dec 2011 22:18:51 +0000	croakeyblog	RT @bronwynah: #CochraneColloquium in NZ 2012 http://t.co/fnMw9y2f #EBP #mededmooc
Sun, 11 Dec 2011 22:16:27 +0000	BrianSMcGowan	Great lessons in planning out the "24 hours of #mededMOOC" - do you find 24 spkrs? seek out 24 topics? leverage different regions?
Sun, 11 Dec 2011 22:11:00 +0000	dean_jenkins	@helen_otuk suggests maybe 3 regional organising groups for the 24 hour session. #mededmooc
Sun, 11 Dec 2011 22:10:03 +0000	dean_jenkins	24 hour global MedEdMOOC tour will reflect the 5 or 6 topic weeks that would follow. ... possibly #mededmooc
Sun, 11 Dec 2011 22:08:47 +0000	dean_jenkins	Move the topic discussion into the organisers' Google doc to tie it down from the big list. #mededmooc
Sun, 11 Dec 2011 22:07:11 +0000	dean_jenkins	@lewismal cheers! #mededmooc
Sun, 11 Dec 2011 22:06:23 +0000	lewismal	I need to go now and attend to my kids. I check back. #Mededmooc
Sun, 11 Dec 2011 22:03:51 +0000	claireOT	RT @dean_jenkins: Talking about a world #MedEdMOOC day with different sessions covering all timezones! Ambitious. Like World OT day. #mededmooc
Sun, 11 Dec 2011 22:02:38 +0000	lewismal	@lewismal See http://t.co/PqDQPZE1 #Mededmooc
Sun, 11 Dec 2011 22:01:16 +0000	lewismal	A wiki is good home for a event #Mededmooc
Sun, 11 Dec 2011 22:00:26 +0000	lewismal	Virtual international day of the midwife also a model. The original I think from @sarahstewart #Mededmooc
Sun, 11 Dec 2011 21:59:22 +0000	dean_jenkins	Brian will research a 'home' like Moodle. #mededmooc
Sun, 11 Dec 2011 21:58:47 +0000	lewismal	By the way this tends to be a good time for online meeting for me #Mededmooc
Sun, 11 Dec 2011 21:56:08 +0000	lewismal	RT @dean_jenkins: Elluminate (now Blackboard Collaborate) would be good. Archiving a good feature. #Mededmooc
Sun, 11 Dec 2011 21:55:24 +0000	BrianSMcGowan	like 'battle to the death' session? RT @lewismal: We could have series of eliminate sessions ... #Mededmooc
Sun, 11 Dec 2011 21:55:03 +0000	dean_jenkins	Elluminate (now Blackboard Collaborate) would be good. Archiving a good feature. #mededmooc
Sun, 11 Dec 2011 21:52:34 +0000	dean_jenkins	24hour event would be a good way of including a lot of points of view. Platform will be key. Twitter back channel as well. #mededmooc
Sun, 11 Dec 2011 21:52:30 +0000	lewismal	We could have series of eliminate sessions gaps filled by tweet chats, other online events over 24 hrs #Mededmooc
Sun, 11 Dec 2011 21:48:56 +0000	Helen_otuk	like it... RT @lewismal: A 24 hour event would be good team building & gr8 marketing #Mededmooc
Sun, 11 Dec 2011 21:48:14 +0000	dean_jenkins	RT @lewismal: A 24 hour event would be good team building & gr8 marketing #mededmooc
Sun, 11 Dec 2011 21:48:12 +0000	BrianSMcGowan	+1 RT @lewismal: A 24 hour event would be good team building & gr8 marketing #Mededmooc
Sun, 11 Dec 2011 21:47:13 +0000	kirstyes	RT @dean_jenkins: Talking about a world #MedEdMOOC day with different sessions covering all timezones! Ambitious. Like World OT day. #mededmooc
Sun, 11 Dec 2011 21:47:02 +0000	lewismal	A 24 hour event would be good team building & gr8 marketing #Mededmooc
Sun, 11 Dec 2011 21:45:37 +0000	lewismal	Stages formation, concept, plan, promote, run, evaluate, sustain #Mededmooc
Sun, 11 Dec 2011 21:44:40 +0000	dean_jenkins	There'll be a social media resource booth at Alliance meeting. #mededmooc
Sun, 11 Dec 2011 21:43:42 +0000	dean_jenkins	@helen_otuk talking about a social media 'surgery' #mededmooc
Sun, 11 Dec 2011 21:41:15 +0000	dean_jenkins	6 weeks to get a group together. 6 months to get the MOOC up. (Brian's suggested rule of thumb from what we've done so far) #mededmooc
Sun, 11 Dec 2011 21:41:05 +0000	amcunningham	RT @dean_jenkins: Talking about a world #MedEdMOOC day with different sessions covering all timezones! Ambitious. Like World OT day. #mededmooc
Sun, 11 Dec 2011 21:40:03 +0000	lewismal	RT @dean_jenkins: @amcunningham w00t! #Mededmooc
Sun, 11 Dec 2011 21:39:55 +0000	amcunningham	RT @dean_jenkins: Can't see how to easily record a Google Hangout. My sound recorder (on Linux) just records my Mic. #mededmooc
Sun, 11 Dec 2011 21:39:48 +0000	dean_jenkins	Learnt a lot in the last 6 weeks. Would be good to document it and present it within various disciplines. #mededmooc
Sun, 11 Dec 2011 21:39:21 +0000	dean_jenkins	Jumping around a bit. Requirements - link to other groups like Physios and Cochrane. #mededmooc
Sun, 11 Dec 2011 21:37:54 +0000	Helen_otuk	#mededmooc health aspects makes mededmooc different from other MOOCs
Sun, 11 Dec 2011 21:35:43 +0000	dean_jenkins	Talking about a world #MedEdMOOC day with different sessions covering all timezones! Ambitious. Like World OT day. #mededmooc
Sun, 11 Dec 2011 21:34:52 +0000	dean_jenkins	@amcunningham w00t! #mededmooc
Sun, 11 Dec 2011 21:34:46 +0000	BrianSMcGowan	Can we launch #mededmooc with a 24 hours of learning...keeping a G+ hangout going for 24 hours + twitter backchannel...w/ 24 speakers...
Sun, 11 Dec 2011 21:34:29 +0000	dean_jenkins	@lewismal agreed - we're talking about using a GDoc to coordinate and record the decision making. #mededmooc
Sun, 11 Dec 2011 21:34:20 +0000	amcunningham	@dean_jenkins go with flow! #mededmooc
Sun, 11 Dec 2011 21:32:27 +0000	BrianSMcGowan	Governance: First mover with broadly communicated dates. Learning: Keep track of plans that were deprioritized (and why). #mededMOOC
Sun, 11 Dec 2011 21:32:26 +0000	dean_jenkins	Healthcare ethics need to be considered. #mededmooc
Sun, 11 Dec 2011 21:29:57 +0000	lewismal	Seems with timezones, we need to make use of asynchonist decision making. Move a motion, get agreement in doc #Mededmooc
Sun, 11 Dec 2011 21:28:41 +0000	dean_jenkins	"Can't do everything in a pilot." Bronwyn #mededmooc
Sun, 11 Dec 2011 21:28:26 +0000	dean_jenkins	Governance - record those ideas that aren't prioritised so that we can return to them. Limited resources dictates. #mededmooc
Sun, 11 Dec 2011 21:26:19 +0000	dean_jenkins	Set dates in the open document, flag decisions, those available can meet and coordinate. Avoid excluding. #mededmooc
Sun, 11 Dec 2011 21:23:24 +0000	lewismal	We need to build agreement, shared purpose and a critical mass in a team #Mededmooc
Sun, 11 Dec 2011 21:21:43 +0000	lewismal	@dean_jenkins Agree with tweet #Mededmooc
Sun, 11 Dec 2011 21:19:13 +0000	dean_jenkins	Working on governance. Probably first mover advantage plus consensus where possible. #mededmooc
Sun, 11 Dec 2011 21:17:59 +0000	lewismal	http://t.co/5y4XiE3u #Mededmooc
Sun, 11 Dec 2011 21:17:17 +0000	dean_jenkins	Just getting started. #mededmooc
Sun, 11 Dec 2011 21:14:23 +0000	lewismal	Audacity software I think is used by @downes. It is free and moderatly easy to use. #Mededmooc
Sun, 11 Dec 2011 21:13:26 +0000	dean_jenkins	Can't see how to easily record a Google Hangout. My sound recorder (on Linux) just records my Mic. #mededmooc
Sun, 11 Dec 2011 21:10:02 +0000	dean_jenkins	@lewismal any suggestions as to how to do that? #mededmooc
Sun, 11 Dec 2011 21:09:08 +0000	dean_jenkins	Waiting for a few more participants. #mededmooc
Sun, 11 Dec 2011 21:08:51 +0000	Helen_otuk	Have fun. RT @dean_jenkins @amcunningham you in the pub then after your game? #mededmooc
Sun, 11 Dec 2011 21:07:50 +0000	dean_jenkins	@bronwynah are you Uni Queensland? I think I've added you into the G+ circle. #mededmooc
Sun, 11 Dec 2011 21:06:56 +0000	lewismal	Can we set up audio recording archive, it may help make decisions #Mededmooc
Sun, 11 Dec 2011 21:06:36 +0000	dean_jenkins	@amcunningham you in the pub then after your game? #mededmooc
Sun, 11 Dec 2011 21:05:16 +0000	dean_jenkins	@lewismal OK will try and retweet things for you! #mededmooc
Sun, 11 Dec 2011 21:04:15 +0000	lewismal	I'm here but have low bandwidth also can,t join G hangout from iPad I discover. Carry on I will follow on twitter #Mededmooc
Sun, 11 Dec 2011 21:03:22 +0000	dean_jenkins	@helen_otuk and @dean_jenkins on http://t.co/rHMeRiLE for chat on #mededmooc
Sun, 11 Dec 2011 21:02:44 +0000	dean_jenkins	@amcunningham boo ... any points or you happy to go with the flow? #mededmooc
Sun, 11 Dec 2011 21:01:57 +0000	amcunningham	#mededmooc sorry not going to make the meeting!
Sun, 11 Dec 2011 21:00:45 +0000	dean_jenkins	Who's here then? #mededmooc
Sun, 11 Dec 2011 21:00:21 +0000	dean_jenkins	G+ on http://t.co/rHMeRiLE if you're not in my MedEdMOOC circle then let me know. #mededmooc
Sun, 11 Dec 2011 20:56:49 +0000	dean_jenkins	Setting up a G+ hangout for http://t.co/is6rCtnm #mededmooc
Sun, 11 Dec 2011 20:02:05 +0000	dean_jenkins	#MedEdMOOC chat in 1 hour. Start on Twitter then on to G+ probably. @amcunningham might be late :-)
Sun, 11 Dec 2011 14:01:47 +0000	Helen_otuk	RT @dean_jenkins: Audioboo: #MedEdMOOC chat today 11th December at 21:00 hrs GMT http://t.co/hVJB1yy7 #mededmooc
Sun, 11 Dec 2011 12:58:43 +0000	dean_jenkins	Audioboo: #MedEdMOOC chat today 11th December at 21:00 hrs GMT http://t.co/hVJB1yy7 #mededmooc

Patients do better if they know their results.

A meta-analysis of anticoagulation studies by researchers from Oxford say that self-management is safe and can improve the quality of care.

"Patients who monitor their own treatment with warfarin or other blood-thinning drugs reduce their risk of developing blood clots by half, an Oxford University study has found. ...Taking charge of their own treatment can empower patients, improve the quality of treatment and be more convenient. The researchers say their findings confirm that self-monitoring of warfarin is safe for suitable patients of all ages." http://www.ox.ac.uk/media/news_stories/2011/110112.html

"Our [meta] analysis showed that self-monitoring and self-management of oral coagulation is a safe option for suitable patients of all ages. Patients should also be offered the option to self-manage their disease with suitable health-care support as back-up." http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61294-4/abstract

I note the recent JAMA editorial advising caution about a proposed rule to allow access to investigations by patients,

"The current policy of allowing state laws to limit patient access to test results could deter patient engagement, thereby contradicting the intention of transparency in health care reform. However, offering patients direct and potentially immediate access to laboratory results has potential consequences that must be addressed. Without involvement of physicians, delivery of abnormal test results will be a major concern. For example, patients having access to abnormal test results before physicians have had the opportunity to interpret and counsel patients may create unnecessary anxiety." http://jama.ama-assn.org/content/early/2011/11/22/jama.2011.1797.full

OK so anticoagulation monitoring is not the same as diagnostic interventions but it makes sense to assume that the person most likely to act quickly and efficiently on their results is the patient - the one with the most to gain. Access to results may generate 'extra' work for staff when patients prompt them into action (or reassurance) but isn't that work which would be done anyhow? It might change the scheduling of work and might just stimulate a more efficient system.