Arthroscopic knee surgery may have no greater effect on easing patients' osteoarthritis pains than drugs and physical therapy alone do, while knee pain that often leads to surgery may not come from the expected source, say two studies published in the Sept. 11 issue of the New England Journal of Medicine.

In the surgery study, researchers at the University of Western Ontario and St. Joseph's Health Care in London, Ontario, compared the cases of 86 middle-aged patients who'd undergone arthroscopic debridement surgery for arthritic knee pain and 86 who'd been treated non-surgically with therapy and medications. At the two-year followup, both groups reported similar levels of physical function, pain and quality of life.

These findings echoed a 2002 U.S. Department of Veterans Affairs study which compared the results of real surgery and sham surgery on patients suffering arthritic knee pain. Then, too, the patients undergoing the actual surgery fared no better than the control group.

In the pain study, researchers at the Boston University School of Medicine determined that, while orthopedic specialists have been trained to focus on meniscal tears as the primary source of knee pain, the pain may be originating from an entirely different source.

In a review of 991 patients, the researchers found that 63 percent of those suffering from arthritic knee pain also showed damage to the meniscus, but that 60 percent with no knee pain complaints also showed such tissue damage.

David Bernard

Researchers at the University of Arkansas are hoping to use the three-dimensional online world of "Second Life" to revolutionize healthcare delivery and logistics.

The researchers have constructed a virtual hospital outfitted with everything from surgical suites and waiting areas to stockrooms and equipment. The corridors are populated with avatars - virtual doctors, nurses, staffers and patients - who interact with each other and the virtual environment around them.

It may sound like fun and games, but these researchers are using the virtual world to model real world healthcare logistics such as inventory management, supply-chain networks and patient information systems as well as to determine how new technologies can help to improve those processes.

According to the University of Arkansas College of Engineering's Web site on the project, the researchers are specifically investigating "ubiquitous computing, location aware systems, RFID, massive use of sensors, smart devices, using natural language to talk to devices, workflows, ways of merging reality and virtual reality, and other technology ideas" related to healthcare delivery.

"If the real world is moving toward identity-management technologies like RFID to keep track of things, we can get there first in a virtual world, analyze business situations, and then optimize to make them safer and less expensive," says computer science and computer engineering professor Craig Thompson in a press release. "The ultimate goal is to move beyond modeling, so that these systems may actually be used as tools in real hospitals, real pharmacies and clinics and other care facilities."

Irene Tsikitas

Antibiotic cycling, a method by which medications are rotated at regular intervals, seems to significantly lower the likelihood that MRSA bacteria develops resistance and lingers in a surgical intensive care unit, according to a study published in the Sept. 3 issue of the journal Surgical Infections.

In their study, researchers at the University of Virginia Health System found that switching between two antibiotics, linezolid and vancomycin, every three months in the surgical ICU decreased the MRSA infection rate from 1.9 to 1.4 patients per 100 admissions.

The UVA study is the first to assess the impact of antibiotic cycling on a group of bacteria known as gram-positive cocci. The study's key focus was methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus, pathogens that tend to develop resistance to antibiotics in sterile and contained environments.

Dan O'Connor

Even though it seems to go against perioperative standards, nurses in most ORs are allowed to wear Crocs, the backless plastic clogs with holes on top, according to the results of last week's online poll. Nearly 78 percent of our 102 respondents let their staff wear Crocs.

"Shoes must be enclosed and fluid-resistant," says Lisa Reed, CST, RN, MS, CNOR, who co-authored a recent Outpatient Surgery Magazine column on surgical attire. "You should not be wearing sandals, canvas-type shoes or Crocs."

While the manufacturer has produced a shoe without holes ("I actually won a pair at AORN last year," says Ms. Reed) they're still backless. "To fully protect the healthcare worker, clogs should have a back to them," she says.

Check out this week's poll question - Obama or McCain? - on the lower right hand side of our front page.

Dan O'Connor