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Standards for Child Surgical Care

Standards for Child Surgical Care

Studies indicate that newborns and children who undergo surgery in environments with pediatric expert resources have better outcomes, fewer complications, and shorter hospital stays when compared with those cared for at non-specialized centers. “Millions of children undergo surgery in the United States each year, but some of these patients receive surgical care in environments that are not matched to their needs,” says Keith T. Oldham, MD, FACS. “This can affect how children fare after operations.” In 2014, the Task Force for Children’s Surgical Care published an article that defined the resources U.S. surgical facilities need to perform surgery effectively and safely in infants and children. The document, published in the Journal of the American College of Surgeons, was approved by the American College of Surgeons (ACS), the American Pediatric Surgical Association, and the Society of Pediatric Anesthesia. “The intent of these standards is to ensure that all infants and children receive care in a surgical environment that matches their individual medical, emotional, and social needs,” says Dr. Oldham, who chaired the task force that developed the document. Important Definitions The proper surgical environment for children was defined as one that offers all of the facilities, equipment, and—most importantly—access to providers who have the appropriate background and training to optimize care. “To accomplish this mission, clinicians must balance the issues of access, available manpower, and the need to improve value,” Dr. Oldham says. Levels of resources are designated similarly to how ACS has done for trauma centers, with the goal of prospectively defining optimal training and experience. To achieve Level I status, hospitals must have adequate resources to provide comprehensive...
The Impact of Obesity on Total Knee Arthroplasty

The Impact of Obesity on Total Knee Arthroplasty

According to recent data, more than one-third of American adults were obese in 2010, and studies continue to show that obesity prevalence is rising throughout the United States. Research has shown that obesity negatively impacts the risks and outcomes of various diseases, including knee osteoarthritis, and leads to higher healthcare expenditures. Total knee arthroplasty (TKA) is increasingly being performed in obese patients. In fact, studies suggest that obese patients represent at least half of all patients undergoing TKA. “Obesity does not seem to interfere with the effectiveness of TKA, but evidence is lacking as to whether overweight or obese patients undergoing these procedures assume higher costs than their normal-weight counterparts,” says Hilal Maradit Kremers, MD, MSc. She notes that obesity may be associated with higher costs in TKA because of the increased prevalence of obesity-related comorbidities. It may also be due to the higher risk of short-term TKA complications, such as infections or thrombovascular events. Previous analyses have had mixed results in establishing patterns in the relationship between obesity and TKA costs in terms of complication and readmission rates. Discrepancies in these studies may be the result of methodological differences or from variations in the way researchers have adjusted for comorbidities. Costs from comorbidities and complications can theoretically be considered attributable to obesity too. “It’s important to examine the effect of obesity on costs in patients undergoing TKA and the impact of the higher prevalence of comorbidities and complications among obese individuals,” says Dr. Maradit Kremers. Analyzing New Data To explore the issue further, Dr. Maradit Kremers and colleagues had a study published in the Journal of Bone &...
Who Broke The American Healthcare System?

Who Broke The American Healthcare System?

Healthcare is a hot topic in the media these days. Yet, few people are satisfied with the way it is working. Many claim that the American healthcare system is broken. Patients are increasingly frustrated with finding a doctor, getting tests and medications they need, and paying for out-of-pocket expenses. Numerous doctors are disenchanted with their career choice, and burnout is a common complaint. Frequently, doctors are now looking to retire early or for alternate career paths. Treating patients has become unfulfilling for many due to administrative burdens, increasing government regulations, and overbearing insurance over-sight. Doctors fight daily to get procedures and medications covered that their patients need. Most often, the battle is with someone who is not even a doctor or has any clue about the patient. These daily battles become wearing. Additionally, doctors now have to fight on a more abundant basis to get paid for services they provided. Their incomes are stagnant or shrinking while overhead costs are soaring. Increasingly, doctors are selling out their practices and joining large groups and hospitals. “When I go in the exam room and close the door, I face my patient and am again reminded of why I became a doctor: to alleviate suffering.”   Many people look to put blame on doctors for the broken healthcare system. Yet, it has been years since doctors truly had any control over it. More often these days, doctors are treated like pawns and servants, our independence and integrity being worn away and questioned. But, who really is to blame for the broken healthcare system? 1. Commercial insurance companies who have no oversight and...
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