Advertisement
Report: 20% of Orthopedic Surgeons’ Imaging Orders Are Defensive

Report: 20% of Orthopedic Surgeons’ Imaging Orders Are Defensive

About 20% of scans ordered by orthopedic surgeons appear to be “defensive imaging,” primarily ordered to avoid malpractice litigation, according to a report presented at the annual meeting of the American Academy of Orthopaedic Surgeons held in San Diego earlier this month. Furthermore, more than one-third of total diagnostic imaging expenses generated by orthopedic surgeons appear to be linked to the practice of defensive medicine. Defensive medicine is the use of diagnostic or therapeutic measures conducted more so as a safeguard against possible malpractice liability rather than ensuring the health of the patient. Researchers at Children’s Hospital of Philadelphia sent surveys to 640 members of the Pennsylvania Orthopaedic Society. Of the 2,000 imaging orders initiated by the 72 physicians who responded, 19% were ordered for defensive purposes—accounting for $113,369 (34.8%) of the total costs generated by the tests analyzed in the study. Among the orders studied, the following were done for defensive purposes: 38.7% of MRIs 11.4% of radiographs 33% of CT scans 46.4% of bone scans 52.9% of ultrasounds Defensive imaging was 58% greater among surgeons who had been named in a lawsuit in the previous 5 years. This was the first prospective study to collect data on the prevalence of defensive medicine in orthopedics, indicating that defensive imaging is both common and costly. According to the researchers, medical costs as well as the health risks posed by excessive diagnostic tests add to the urgency to ease defensive-medicine...
Cell Phones and the Brain: A Call for More Research

Cell Phones and the Brain: A Call for More Research

For years there have been concerns over the potential effects of long-term cell phone use on the brain, and studies examining brain cancer rates have been contradictory. With over 200 million Americans owning a cell phone (roughly 70% of the country’s population), the debate continues. According to a new study published in the Journal of the American Medical Association, holding a cell phone up against your ear changes the activity in your brain – however, the health implications are not clear. In the year-long study, researchers from the NIH placed cell phones receiving 50-minute muted calls near the ears of 47 men and women. They found that electromagnetic fields emitted by cell phones appear to affect the brain’s glucose metabolism, which is considered a marker for brain activity; glucose metabolism increased by 7% in the orbitofrontal cortex and temporal pole, the area of the brain near the cell phone’s antenna. The increase, however, was modest. By comparison, the metabolism of the visual cortex may spike by as much as 50% when people look at a pattern on a computer screen. Although the study raises a lot of questions, it offers few answers.  While increases in brain glucose metabolism happen during normal brain function, many question whether repeated artificial stimulation as a result of exposure to electromagnetic radiation might have a detrimental effect.  The hope is that these new data will broaden the focus of cell phone research and health.  ...

Leading the Fight Against Flu

In 2009, the H1N1 influenza virus significantly changed the way most healthcare workers in the United States think about the flu. Collectively, we learned once again that the influenza virus is an unpredictable and serious threat to our patients’ health and well-being. Every year, influenza sickens 5% to 20% of all Americans, sending about 200,000 people to the hospital. What’s worse is that thousands die from the flu each year. The best means to prevent influenza illness is vaccination. This flu season, the Department of Health and Human Services is recommending seasonal influenza vaccination for everyone 6 months of age and older. Moreover, the CDC and the Advisory Committee on Immunization Practices continue to recommend that immunization programs focus initially on providing protection for people at greater risk for influenza-related complications, including: Pregnant women. Children younger than 5, but especially children younger than 2. Adults aged 65 and older. People with chronic medical conditions (eg, asthma, diabetes, or heart disease) associated with greater risk for medical complications from influenza. People working in healthcare settings are also among those at high-risk of getting and spreading influenza, often to vulnerable populations. Lead By Example Healthcare workers can serve as role models for vaccination because they can provide vaccines and set an example by getting vaccinated themselves. Research continues to show that the flu can spread rapidly throughout healthcare settings if proper precautions aren’t taken. Vaccination of healthcare workers reduces influenza infection and absenteeism, prevents mortality in other patients, and results in financial savings to sponsoring health institutions. However, influenza vaccination coverage among healthcare workers in the U.S. remains low. Recent mid-season estimates suggest...

Is Bariatric Surgery in Diabetics Cost-Effective?

Bariatric surgery has emerged as an effective approach to reducing body weight and improving obesity-related complications, especially for patients living with diabetes. The surgery has been shown to significantly reduce weight over time. Recent research also indicates that bariatric surgery may provide benefits to people with diabetes in addition to sustained weight loss. Among severely obese patients with diabetes, bariatric surgery has been associated with aiding in reductions in A1C, allowing many patients to stop taking diabetes medications. Data suggest that bariatric surgery is a successful long-term treatment of obesity for people with diabetes, but it’s important to remember that these procedures are expensive. Studies have shown that the average cost of bariatric surgery exceeds $13,000, and that doesn’t include additional costs that may ensue in the months following surgery. Consequently, evidence on the cost-effectiveness of bariatric surgery is needed. A New Cost-Effective Analysis In the September 2010 issue of Diabetes Care, my colleagues and I conducted a study to estimate the cost-effectiveness of bariatric surgery among severely obese patients with diabetes. We wanted to assess whether bariatric surgery reduces A1C and other risk factors enough to lower diabetes complications and improve quality of life. We estimated costs, quality-adjusted life-years (QALYs), and cost-effectiveness of bariatric surgeries relative to usual diabetes care for severely obese individuals who were newly diagnosed with diabetes and for those with established diabetes. “Gastric bypass and gastric banding were cost-effective methods of reducing mortality and diabetes complications in severely obese adults with diabetes.” In all of our analyses, bariatric surgery increased QALYs and increased costs. Gastric bypass surgery had cost-effectiveness ratios of $7,000 per QALY for...

Increasing Awareness of Atrial Fibrillation

Research has shown that atrial fibrillation (AFib) is one of the most common sustained heart rhythm abnormalities, affecting an estimated 2.3 million Americans, but other investigations suggest that the condition may affect millions more. “Atrial fibrillation is a potentially serious condition,” says Nassir F. Marrouche, MD. “The irregular heartbeat associated with AFib can cause blood to pool in the atria, which can result in the formation of clots. These blood clots can travel from the heart to the brain, where they can lead to stroke.” According to current estimates, AFib increases the risk of stroke nearly five-fold. About 15% of all strokes in the United States are associated with AFib. Strokes that are associated with AFib are about twice as likely to be fatal or severely disabling as non–AFib-related strokes. In the United States, studies have predicted that as many as 5.6 million American adults will have AFib by 2050. One of the largest demographics to be affected by AFib includes elderly individuals. It has been estimated that 3% to 5% of elderly Americans have AFib, but that number may be larger because symptoms often go unrecognized by patients and physicians alike. Spotting AF Symptoms One of the aspects of AFib that makes it difficult to manage is that the condition is not always accompanied with symptoms. Published studies have shown that several symptoms may be attributable to AFib, including racing or irregular heartbeat, fluttering in the chest, heart palpitations, and shortness of breath. Other symptoms of AFib include chest pain, fatigue when exercising, sweating, and weakness, dizziness, or faintness. “It’s challenging for physicians to identify AFib because the...

Strategies to Treat Nausea & Vomiting During Pregnancy

According to published research, about 50% of women have nausea and vomiting in early pregnancy, and an additional 25% have nausea alone. The term “morning sickness” is a misnomer because it often persists throughout the day. In about 35% of women who have morning sickness, nausea and vomiting are clinically significant. As a result, family relationships may be negatively impacted or time may be lost at work. “Morning sickness symptoms may lead to dehydration and weight loss that require hospitalization in some cases,” says Jennifer R. Niebyl, MD, who described evidence-based strategies for managing nausea and vomiting in pregnant women in a review published in the October 14, 2010 New England Journal of Medicine. “Nausea and vomiting in pregnancy can severely reduce quality of life for women, but progress has been made in the means to treat it,” says Dr. Niebyl. “Pregnant women with dehydration are recommended to receive IV fluid replacement with multivitamins, especially thiamine. If the vomiting continues after 12 hours of IV therapy, hospitalization may be required.” Enteral or parenteral nutrition may also benefit patients, but should be reserved for those who continue to experience weight loss despite pharmacologic therapies. Examining the Clinical Course The cause of nausea and vomiting in pregnancy is unclear, and there are no evidence-based means to identify women who are risk for this complication. What is known, however, is that the onset of the nausea is typically within 4 weeks after the last menstrual period in most patients. The problem typically peaks at about 9 weeks gestation. “Research shows that about 60% of cases resolve by the end of the first trimester,...

Smoking Cessation in HIV/AIDS: A Call to Action

Consider the Substantial Adverse Effects There are many adverse health effects of combining smoking with an HIV/AIDS diagnosis. Since the use of antiretroviral drugs became widespread, people with HIV/AIDS have been living much longer lives, making it critical to understand how health behaviors such as smoking and physical activity influence long-term health and quality of life. People living with HIV/AIDS who are smokers are: More likely to be non-adherent to medication. At higher risk for many AIDS-defining conditions. At higher risk of premature death. Report lower quality of life than non-smoking HIV/AIDS patients. Smokers who live with HIV/AIDS also have a higher risk of opportunistic infections and other diseases than smokers without HIV/AIDS. “The time is now for clinicians, tobacco control professionals, and researchers to work together and increase the focus on finding effective cessation strategies for people with HIV/AIDS and disseminating strategies that work.” Research Lacking on Interventions In an effort to understand what works in getting HIV/AIDS patients to quit smoking, I worked with a research assistant to examine the literature on smoking and cessation for people living with HIV/AIDS. Published in the July 2010 American Journal of Public Health, I found that the vast majority of the research looked only at the relationship between smoking and HIV/AIDS, but less than 2% of the articles examined the effectiveness of interventions aimed at preventing or reducing smoking among those living with HIV/AIDS. The accumulation of nearly 2 decades of discovery research leaves little doubt that smoking is a widespread problem and a major modifiable risk factor for disease and death in people living with HIV/AIDS. Unfortunately, we do not yet...

Improving Health in Patients With Heart Failure

The American Heart Association (AHA) recently issued a scientific statement for the promotion of self-care in people with heart failure (HF). The statement, published in the September 22, 2009 issue of Circulation, highlights concepts and evidence that are important to the understanding and promotion of self-care in this patient group as well as others. “In recent years, physicians and professional associations have better recognized the critical need for and benefit from self-care among patients,” explains Barbara Riegel, DNSc, RN, FAHA, who chaired the committee that generated the scientific statement. “Tremendous advances have been made in medical therapies for HF, but clinicians often have difficulty with assisting HF patients in the integration of the daily self-care behaviors they need. These behaviors, however, are important to offsetting the burden of HF.” The AHA scientific statement aims to bring attention to the importance of self-care for HF and offers recommendations for physicians on how to promote self-care. While targeted to HF patients and the providers who manage them, the statement can also be applicable to primary care physicians. “HF is typically the final common pathway for other chronic conditions, such as hypertension and coronary artery disease,” says Dr. Riegel. “Anyone caring for a patient with diabetes, high blood pressure, elevated cholesterol, etc, can use the principles in this statement to promote self-care.” “Keeping lines of communication open between HF patients and providers is essential.” Defining Self-Care Self-care is defined in the AHA statement as a decision-making process that patients use to maintain their health through ongoing practices and healthy behaviors (Table 1). “Physicians should advise HF patients on the importance of these behaviors,” Dr....
Docs Rate 18% of Patients as “Difficult”

Docs Rate 18% of Patients as “Difficult”

Almost 18% of patients are considered difficult by physicians, according to a new study — which also found that this group is more likely to experience worse short-term outcomes than other patients. Unlike previous studies assessing difficult patient encounters, in this one the investigators also analyzed physician factors contributing to the difficult encounters. They found that older, more experienced physicians don’t appear to be as disturbed by difficult patients. Among the 750 adults with a physical symptom observed at primary care walk-in clinics, 17.8% were perceived by doctors as being difficult. Difficult patients were defined as  those who were less likely to fully trust or be satisfied with their physician and also were more likely to have worsening of symptoms at 2 weeks. Patients identified as “difficult” included those with more than 5 symptoms who also had a depressive or anxiety disorder. Typically, the lead author notes, they are not patients with complex medical conditions, but more often patients with unexplained physical symptoms, stress, pain, and discomfort. Physicians involved in these difficult encounters, however, were less experienced and had worse psychosocial orientation scores. Those with fewer than 10 years’ experience reported that almost 1 in 4 patients were difficult, while those with 20+ years experienced ranked just 2% of patients as such. The findings were published online January 26 by the Journal of General Internal...

Growing Concerns About Invasive Fungal Infections

The incidence of invasive fungal infections (IFIs) has risen sharply in the past 2 decades. A recent study has found that invasive aspergillosis results in high costs to patients and their healthcare providers. The average hospitalization for aspergillosis is 17.5 days and costs $82,425 per case. For invasive candidiasis, the cost of therapy ranges between $34,000 and $44,500 per patient. Patient populations considered at highest risk include: Individuals with profound, prolonged neutropenia. Individuals with acute leukemia, myelodysplastic syndromes. Allogeneic hematopoietic stem cell transplantation recipients. Individuals with graft-versus-host disease. Autologous graft-versus-host disease recipients with mucositis. Oncology nurses and other healthcare providers can play a major role in preventing and/or minimizing IFIs in their immunosuppressed patients by understanding how to identify high-risk patients. Recognizing the sources of IFIs and the vectors by which they are transmitted can also be of benefit. Additionally, nurses should maintain a high level of suspicion of any symptoms experienced by patients that could be caused by IFIs. Despite the rising incidence of aspergillosis, the report lists effective methods for preventing and treating IFIs. For candidiasis, fluconazole has long been the gold standard in prevention and treatment, although amphotericin and micafungin are also used. For aspergillosis,...

Identifying Cancer-Related Anorexia-Cachexia Syndrome

Nutritional status has been shown to greatly impact treatment tolerance and the long-term prognosis of patients with cancer. In 2009, approximately 20% of cancer-related deaths were caused by the effects of cancer-related anorexia-cachexia syndrome (CACS). This loss of appetite or inability to eat occurs in nearly 80% of patients with advanced cancer and significantly impacts morbidity and mortality. In a recent article, author Debra A. Walz, MS, RN, WHNP-BC, discussed the lack of awareness of CACS and the importance in identifying and addressing the condition in patients with cancer. According to Walz, nurses can play a significant role by educating patients and their families about the importance of nutrition as they are treated for their disease. She recommends that patients be informed of available interventions and treatment modalities such as nutritional counseling and pharmacologic interventions. A multimodal approach may be necessary to effectively treat patients with CACS. The article emphasized the need for oncology nurses to develop collaborative relationships with highly-skilled nutritionists, oncologists, psychotherapists, and physical therapists in order to provide patients and their families with information and help guide treatment choices. Walz added...

Conference Highlights: ISET 2011

These features highlight some of the studies that emerged from the International Symposium of Endovascular Therapy 2011 meeting, including carotid angioplasty in high- and low-risk patients, safety and efficacy of cryoballoon angioplasty, drug-eluting stents for renal artery stenosis, and the management of critical limb ischemia. » Examining CAS in High- & Low-Risk Patients » Costs in the Management of Critical Limb Ischemia » Safety & Efficacy of Cryoballoon Angioplasty » Guideline Adherence for IVC Filter Placements Examining CAS in High- & Low-Risk Patient The Particulars: Carotid angioplasty and stenting (CAS) is an alternative treatment for carotid artery stenosis. Recent studies have shown that CAS appears to have superior short-term outcomes when compared to carotid endarterectomy (CEA) in high-risk surgical patients. However, there are little data on whether low-risk surgical patients have fewer risks with CAS. Data Breakdown: Researchers analyzed results of CAS in patients at high and low surgical risks. High-risk patients included those who were older than 80 and those with postoperative restenosis, prior neck surgery or radiation, contralateral occlusion, low or high anatomic lesions, unstable or severe coronary or heart diseases, and severe comorbidities. CAS appeared to be safe overall, with favorable low event rates in high-risk and low-risk patients. Low-risk patients had a trend toward lower death and stroke rates after CAS when compared with CEA, but this risk was not statistically significant. Take Home Pearls: CAS appears to be safe for both high- and low-risk patients with carotid artery stenosis. Its use should be expanded to low-risk patients as CAS is becoming the gold standard treatment for a carotid stenosis. Costs in the Management of Critical Limb Ischemia [back to top]...
[ HIDE/SHOW ]