Medicine and Science from The BMJ Is robotic joint surgery worth the cost & the prevalence of prescribing cascades
In this episode of podcast we explore two clinical dilemmas - unrecognised drug side effects, and the outcomes from hip and knee replacements.
When an unrecognised adverse drug effect is mistaken for a new symptom, the resulting prescribing cascade can end in polypharmacy and potentially preventable patient harm. New research on nearly 2.3 million adults in Ontario, has found 24 high-priority, potentially inappropriate prescribing cascades—including laxatives after iron, pain relievers following statins, and sedatives after cholinesterase inhibitors. Paula Rochon, Jerry Gurwitz, and Antonio Cherubini, three of the study's authors join us to discuss.
Over 100,000 hip and, 100,000 knee replacements are performed annually in the NHS, and health systems are investing hundreds of millions to rapidly scale robot-assisted surgery, but is this expensive new tech delivering better patient outcomes? Two target trial emulation papers, using the UK's National Joint registry aim to find out if robots are better at join replacement. Hassan Mohammad, one of the papers' authors shares their findings, and Teppo Järvinen joins the conversation to discuss challenging orthopaedic surgery standard practice.
Guest List Prescribing Cascades Discussion-
Paula Rochon, Geriatrician, senior scientist, and professor at Sinai Health and the University of Toronto.
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Jerry Gurwitz, Geriatrician, researcher, and professor of Medicine at UMass Chan Medical School.
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Antonio Cherubini, Geriatrician and clinical eesearcher at Università Politecnica delle Marche and INRCA (Istituto Nazionale di Riposo e Cura per Anziani)
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Hassan Mohammad, academic clinical lecturer in orthopaedics at Barts and The London School of Medicine and Dentistry
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Teppo Järvinen, orthopaedic surgeon and professor at the University of Helsinki, and Head of the Finnish Centre for Evidence-Based Orthopaedics (FICEBO) in Finland.