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We’ve Got a New Look on Facebook

We’ve Got a New Look on Facebook

Today marks the day Facebook is changing over all business or “Fan” pages to its new “Timeline” format. If your hospital or medical practice owns a Facebook page that no one has checked on lately, you have a little surprise in store when you next log in to the site. The new format has been available as an option for all Facebook personal profiles as well as business pages for months, but today was the deadline for business pages to convert their content to fit into the new format.   Features new with Facebook Timeline include: A wider page format with a landscape format “cover photo” that spans the width of the page The ability for page fans and page owners to message one another privately. A chronological layout that organizes posts into boxes and makes them more accessible. Older posts can be pinned to the top of the page so important announcements don’t get lost in the timeline. Facebook tabs are now Facebook “apps,” organized in an area directly under the profile image. Enhanced analytics tools in Facebook Insights, providing a more in-depth look into page activity. The private messaging option in particular presents an excellent opportunity for individual physicians and other medical professionals to engage with patients in a business forum on Facebook while limiting access to their personal profile pages to friends, family and colleagues. The landscape image gives greater flexibility in branding your practice and the new “apps” area provides visitors easy access to business location information, products and services, newsletter subscriptions, videos, events and more. We invite you to visit our Physician’s Weekly Facebook...
Can New Blood Test Predict Heart Attacks?

Can New Blood Test Predict Heart Attacks?

A new blood test may predict patients at risk of an imminent heart attack. Researchers have discovered mutated circulating endothelial cells (CECs) that are released into the bloodstream days before the formation of a clot. A blood test may be used to identify this particular cell type up to 2 weeks before the heart attack is likely to occur. During initial stages of a heart attack, endothelial cells that line the blood vessels are damaged when vessel walls weaken, become eroded, and attract inflammatory cells. Severe inflammation causes the CECs to mutate; they clump together, break off, and enter the bloodstream. A team of researchers at Scripps Translational Science Institute published a study in the journal Science Translational Medicine involving 94 patients, 50 of whom had experienced a heart attack while the others were healthy controls. CEC blood levels among those heart attack victims were more than four times higher than in the control group. Additionally, in those who experienced a heart attack, the CECs themselves were mutated; they had become larger, misshapen, and/or many had multiple nuclei. While doctors have long been able to identify risk factors that increase patients’ risk for heart disease (eg, smoking, obesity and high cholesterol), heart attacks are highly unpredictable. CEC counts may serve as a promising clinical measure for the prediction of heart attacks in the future. Physician’s Weekly wants to know… If heart attacks can be predicted, what would be the clinical and medicolegal impact of having this...

An Emerging Surgical Strategy for Acute Appendicitis

Appendectomy is one of the more common surgical procedures that is performed throughout the United States each year despite decreasing in annual incidence. Open and laparoscopic appendectomy procedures are current standard treatments for non-complicated appendicitis, but advances in surgical techniques are continuing to emerge to further reduce postoperative pain and recovery time. One such procedure is natural orifice transluminal endoscopic surgery (NOTES) for performing transgastric appendectomy. Transvaginal surgery is one component of NOTES that is gaining momentum for use in appendectomy and cholecystectomy. Transvaginal appendectomy (TVA) is a procedure performed via a single port that is inserted through the posterior vaginal fornix. The surgery is a type of NOTES that allows for appendectomy without visible scars. “NOTES has been at the forefront of minimally invasive surgery since it first emerged in 2004,” says Kurt E. Roberts, MD. “Some studies have described laparoscopic assisted TVAs for acute appendicitis in the surgical literature. However, pure TVAs have been limited to only one single-case report in Germany.” Data on the Safety & Efficacy of TVA Exploring the safety and efficacy of pure TVAs and comparing them with traditional laparoscopic appendectomy are important, according to Dr. Roberts. In the February 2012 Annals of Surgery, he and his colleagues published a study that compared a series of patients who underwent TVA with those who received conventional three-port laparoscopic appendectomy. TVA was offered to 42 women, 18 of whom agreed to undergo the surgery while two others declined it. The remaining 22 women were considered the control group, receiving three-port laparoscopic appendectomy. Patients in the TVA arm required significantly less pain medication and returned to...

Incivility in Surgery

Hospitals and medical centers are increasingly beginning to appreciate that disruptive behavior in the operating room (OR) is a problem deserving of serious attention. The costs associated with incivility in the OR can be substantial, oftentimes leading to increased staff sick days and decreased nursing retention, both of which are associated with medication errors. Exposure to incivility among surgeons often begins in their formative years. Frequently, perpetrators of belittlement or harassment are residents, fellows, and clinical professors, the same people who serve as role models for the next generation of physicians. The Perils of Incivility in Surgery Incivility can lead to social isolation or exclusion, the devaluation of someone else’s work, verbal threats, and even physical confrontations. Furthermore, research shows that rude behavior is bad for both mental and physical health. Conversely, other studies have demonstrated that civil behavior within the workplace can lead to a “helper’s high,” in which others in the OR feel empowered and contribute to improving outcomes in the patients they treat. The challenge for those entrusted with teaching the next generation of surgeons is to nurture the important surgical traits of ego strength, confidence, focus, work ethic, and dedication without forgetting the need to be committed to being civil to each other. Surgeons are people in the position of power who are typically hired on the basis of their knowledge, training, and technical accomplishments. ORs, however, are social environments where everyone must work together for the patients’ benefit. Fostering Civility in Surgery To establish a positive OR culture, increased emphasis should be placed on non-technical skills, such as leadership, communication, teamwork, and situational awareness....

A New Look at Leaving Without Being Seen in EDs

A decrease in access to EDs throughout the United States has strained the healthcare system significantly. When patients leave the ED without being seen, the emergency care delivery system has failed to provide care to individuals who are in greatest need. Studies have shown that left without being seen (LWBS) visits are a marker of ED crowding and have been associated with longer waits. “The number of LWBS visits has increased dramatically in the past 15 years,” says Renee Y. Hsia, MD, MSc. “This is a reflection of mounting strains on the U.S. emergency care system.” Regardless of the cause—be it longer wait times, increased visits, or decreased supply—patients who leave the ED without being seen signal that access-to-care issues are prevalent. “Previous studies examining LWBS have provided data on patient- level and operational determinants at single hospitals,” explains Dr. Hsia. “There is a need, however, to broaden the scope of what is known about LWBS from a larger perspective rather than in a single-hospital setting.” Little is known about variation in the amount of LWBS or about hospital-level determinants. Contemporary attempts to study LWBS have been limited by the scarcity of data reporting it. Due to a lack of information, the ability of policymakers to understand the effect of crowding on vulnerable communities and to design system-level interventions to improve access to emergency care has been hindered. New Leaving Without Being Seen Data A study published in the July 2011 Annals of Emergency Medicine performed a cross-sectional analysis of 262 acute-care hospitals involving more than 9 million ED visits to hospitals in California that operated an ED in...

Bariatric Surgeries: Assessing Safety Profiles

A systematic review and meta-analysis has found that laparoscopic bariatric surgery appears to be safer than open bariatric surgery for those requiring the operation. Wound infection and incisional hernia risks were lower for patients who received the laparoscopic technique than for those receiving open surgery. Risks of reoperation, anastomotic leak, and all-cause mortality, however, were similar for both the laparoscopic and open methods. Abstract: Archives of Surgery, November...

The Effect of Pregnancy on Common Surgeries

Postoperative maternal morbidity after appendectomy and cholecystectomy does not appear to be increased with pregnancy, according to a review of data from the National Surgical Quality Improvement Program. The analysis found that composite 30-day major morbidity rates were 3.9% and 3.1% for pregnant and non-pregnant women, respectively, following appendectomy. Following cholecystectomy, the morbidity rate was 1.8% for both pregnant and non-pregnant women. Abstract: Obstetrics & Gynecology, December...

Heart Failure Complicates Infective Endocarditis

An international study suggests that in patients with infective endocarditis complicated by heart failure (HF), the severity of HF appears to be strongly associated with surgical therapy and subsequent mortality. The research team added that valvular surgery appeared to be associated with lower in-hospital and 1-year mortality. The in-hospital mortality rate for those undergoing valvular surgery was 20.6%, compared with 44.8% for those undergoing medical therapy alone. Abstract: Journal of the American Medical Association, November 23,...

Drug-Eluting Stent System Gains FDA Approval

A next-generation drug-eluting stent system (PROMUS Element Plus Platinum Chromium Stent System, Boston Scientific) has received FDA approval for use in patients with coronary artery disease. The device has been shown to improve cardiac performance and features an innovative platinum chromium platform. Source: Boston...

Aortic Valve Replacement Without Open-Heart Surgery

The FDA has approved an artificial heart valve (Sapien Transcatheter Heart Valve, Edwards Lifesciences) for use when replacing an aortic heart valve damaged by senile aortic valve stenosis. The FDA reports that the device is the first to be approved that does not require open-heart surgery. Full Approval from...

Bisphosphonate Use in Lower Limb Arthroplasty

European research suggests that bisphosphonate use appears to be associated with a nearly two-fold increase in implant survival time for patients undergoing lower limb arthroplasty. Time to revision after hip or knee arthroplasty, however, was also increased in bisphosphonate users when compared with non-users. Abstract: British Medical Journal, December 6,...

Carotid Artery Stenting Beneficial for Acute Stroke

Carotid artery stenting (CAS) appears to be feasible, safe, and useful in patients with acute atherosclerotic extracranial internal carotid artery occlusions with severe stroke symptoms when used within the first 6 hours of symptom onset. In a small study, 95% of patients achieved successful revascularization with acute CAS. At 90 days, the mortality rate was 13.6%. Abstract: Journal of the American College of Cardiology, November 29,...

Energy-Based Vessel Sealing in Vaginal Hysterectomy

A large literature review suggests that operating time, blood loss, and hospital stay for women undergoing vaginal hysterectomy can be reduced with energy-based vessel sealing devices when compared with suturing. Investigators observed no differences in complication rates between the treatment strategies. Abstract: Obstetrics & Gynecology, November...
Docs in Hot Water for Online Behavior

Docs in Hot Water for Online Behavior

The majority of state medical boards across the country have received and acted on complaints about physicians’ online behavior, according to a recent poll published in JAMA.  Investigators surveyed the 68 executive directors of all medical and osteopathic boards in the United States and its territories about violations of online professionalism reported to them and subsequent actions taken. All but four medical boards indicated that they received reports of “online professionalism violations” at some point. The most common violations included prescribing drugs over the internet without seeing the patient or misrepresenting credentials. The less common but still reported complaints included the following online behaviors: Violation of patient confidentiality Failure to reveal conflicts of interest Derogatory comments about patients Depictions of intoxication Discriminatory language or practice More than 70% of respondents said they had pursued some type of disciplinary procedure including formal hearing, consent order, or informal warning. Suspension, restriction, or revocation of licenses had occurred at 56% of boards. Other sanctions included letters of reprimand, fines, and mandatory education or community service. While online misbehavior by physicians is probably still uncommon overall, administrators worry this is likely to change as the use of social media grows. Physician’s Weekly wants to know… Do you feel hospitals need to implement strong ethical rules for physicians’ online behavior? Should official guidelines should be created by professional organizations for social media use among physicians?...
Revising the MCAT for 2015

Revising the MCAT for 2015

The Medical College Admission Test (MCAT), a test that hasn’t been revised in over 20 years, will be getting an overhaul come 2015. Two new sections will be added that will place focus on critical thinking and the sociocultural and behavioral determinants of health—increasing the length of the test from about 5.5 hours to 6.5 hours. The writing section, however, will be eliminated. “Being a good doctor is about more than scientific knowledge,” says Darrell Kirch, MD, president and chief executive officer of the Association of American Medical Colleges in a news release. “It also requires an understanding of people.” As of 2015, the MCAT will continue to test a student’s knowledge of the natural sciences, such as physics, chemistry, biology, and biochemistry, but there will be a new emphasis on the basic principles of psychology, behavior, and sociology. The revised test will also evaluate a student’s understanding of basic research methods, statistics, and ability to comprehend, evaluate, and apply information. The committee examining the current MCAT chose to eliminate the writing section in the 2015 MCAT because they found the section offered medical school admissions departments little information about an applicant’s qualifications for medical school. The evolving demography of the U.S. population calls for physicians to not only have a better understanding of human health, but also to be able to interpret and apply new research to their patients.   Physician’s Weekly wants to know…as an experienced physician, do you feel the changes to the MCAT will better reflect the skills necessary to be good doctor? What other changes to the test would you...

Delirium Worsens Outcomes in Stroke Patients

Stroke patients with delirium appear to have unfavorable outcomes when compared with those who do not have delirium, according to a Canadian study. When compared with stroke patients without delirium, those with it had: Higher inpatient and 12-month mortality rates. Longer hospitalizations (mean difference, 9.39 days). A greater degree of post-discharge dependence. The analysis noted that those with delirium were more likely to be discharged to a nursing home or other institution. Source: Stroke, March...

Analyzing the Delivery of Preventive Services

A combination of factors appears to play a role in whether preventive services are recommended or delivered to patients aged 50 to 80. An American investigation found that the likelihood of preventive service delivery tended to increase with increasing BMI, patient–physician gender concordance, and each additional minute between the scheduled appointment time and when the physician presented. It decreased with patient age, physician use of electronic medical records, a visit within the past year, and the number of patient-raised concerns.   Source: American Journal of Preventive Medicine, February...
Obesity & BMI Levels Remain Steady

Obesity & BMI Levels Remain Steady

A study from researchers at the CDC has found that the prevalence of obesity did not appear to change significantly in 2009-2010 when compared with data from 2003-2008. The rates of obesity in adult men and women were 35.5% and 35.8%, respectively, in 2009-2010, and the age-adjusted BMI was 28.7 kg/m2 for both genders in the same time period. The analysis revealed, however, that there were statistically significant increases in obesity among African-American and Mexican-American women between 1999 and 2010.   Abstract: JAMA, February 1,...

Agent Approved for Highly Toxic Chemotherapy Levels

The FDA has approved glucarpidase (Voraxaze, BTG International) for treating patients with toxic levels of methotrexate—a type of chemotherapy—in the blood due to kidney failure. The drug breaks down methotrexate to a form that the body is able to eliminate. Source: FDA...
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