If surgery is a team sport, should surgeons bear sole responsibility for errors?
A Kentucky appeals court ruled that a surgeon was not responsible for a burn caused by an instrument that had been removed from an autoclave and placed on an anesthetized patient’s abdomen.
According to an article in Outpatient Surgery, the surgeon was not in the room when the injury occurred and only discovered it when he was about to begin the procedure.
An insufflator valve had been sterilized and was apparently still hot when an unknown hospital staff member put it down on the patient’s exposed skin. (An insufflator is a machine that is used to pump CO2 through tubing into the abdomen for laparoscopic surge...
Source: Kevin, M.D. - Medical Weblog - December 26, 2015 Category: Journals (General) Authors: Skeptical Scalpel, MD Tags: Physician Malpractice Surgery Source Type: blogs
Is robotic assisted prostatectomy worth the added expense?
Since the introduction of the robotically assisted laparoscopic radical prostatectomy (RALP) in 2000, the long-term prostate cancer control has been uncertain. We now have the first long-term cancer control study that compared the results of the earliest RALP with historical open radical retropubic prostatectomy (ORP) outcomes. Diaz and associates from a recognized RALP center of excellence concluded that RALP has similar long term cancer control compared to open surgery. Not better, not worse but about the same.
More rapid recovery, enhanced quality of life, improved continence and erectile function are central themes of...
Source: Kevin, M.D. - Medical Weblog - November 17, 2015 Category: Journals (General) Authors: Leonard G. Gomella, MD Tags: Conditions Surgery Source Type: blogs
Phooled Again - More Settlements Suggesting Bad Behavior by Big Pharma/ Biotech
Once again, here is a roundup of cases showing big multi-national pharmaceutical and biotechnology companies are up to their usual tricks.Presented in alphabetical order...Bristol-Myers Squibb Settles Charges of Bribery of Chinese Hospitals.The best version of this I could find was in USA Today, in early October, 2015,Pharmaceutical manufacturer Bristol-Myers Squibb has agreed to pay more than $14 million in fines to settle charges that its joint venture in China paid cash and other benefits to state-owned hospitals in exchange for prescription sales, the Securities and Exchange Commission announced Monday.After its invest...
Source: Health Care Renewal - October 15, 2015 Category: Health Management Tags: adulterated devices bribery Bristol-Myers-Squibb crime deception deferred prosecution agreement Genzyme intimidation legal settlements Pfizer Sanofi-Aventis Source Type: blogs
Why doctors and digital experts should work together to improve patient health
As a family doctor, I have seen a dramatic shift in the range of people I work alongside every day — all for the better. When I was in training, most family doctors worked only with other family doctors and registered nurses. Today my health care team is rich with a variety of critical skills, including social workers, psychologists, and dieticians. There are even examples of primary care teams engaging lawyers and accountants to help with health-related issues, such as housing and income.
But what’s missing — and should be an essential part of any health care team — is the digital expert. Here’s why....
Source: Kevin, M.D. - Medical Weblog - September 20, 2015 Category: Journals (General) Authors: Joshua Tepper, MD Tags: Tech Mobile health Source Type: blogs
Genzyme Corp. Pays $32.5 Million To Resolve Criminal Charges Related to Med Device Promotion
Last week, Genzyme Corporation, a wholly-owned subsidiary of the French company Sanofi, agreed to pay $32.5 million to resolve criminal charges that it violated the federal Food, Drug and Cosmetic Act (FDCA) with regard to the unlawful distribution of Seprafilm, a surgical device it markets and promotes. The DOJ targeted two aspects Seprafilm promotion in particular--that the company (1) encouraged surgeons to use its Seprafilm surgical product in unapproved ways, and (2) suggested without enough proof that it was safe for certain cancer surgeries.This follows a separate $22.28 million civil agreement the gover...
Source: Policy and Medicine - September 9, 2015 Category: American Health Authors: Thomas Sullivan Source Type: blogs
The public diagnosis of cancer and how President Carter did it right
President Jimmy Carter has been diagnosed with metastatic melanoma. Recently, he gave a press conference where he discussed the history of his illness, his plans for treatment, and answered questions from the media. It was superb.
Carter, now 90 years old, demonstrated an impressive understanding of his medical circumstance. As someone who thinks and writes on patient empowerment, here are my favorite moments:
1:52 — Carter explains that his liver abnormality was found via MRI, quickly correcting the word “cancer” to “growth, a tumor,” demonstrating his knowledge of the limitations of that modality. In the n...
Source: Kevin, M.D. - Medical Weblog - September 4, 2015 Category: Journals (General) Authors: Victor R. Laurion Tags: Conditions Cancer Dermatology Source Type: blogs
Antibiotics for appendicitis: 3 unintended consequences
A Finnish group randomized patients with acute appendicitis to surgery and antibiotics and found that antibiotics were successful in 73 percent of patients. Depending on how this is framed, you can celebrate a 70 percent success or lament a 30 percent failure. Much of the debate in health care is a battle of framing. The study has limitations. Finland is not just a land of the midnight sun but a land of fewer laparoscopic surgeries than the USA. This is important because if done properly laparoscopic surgery has a lower morbidity than open surgery, as Skeptical Scalpel explains.
Should we be excited that antibiotics ...
Source: Kevin, M.D. - Medical Weblog - September 3, 2015 Category: Journals (General) Authors: Dr. Saurabh Jha Tags: Conditions Medications Surgery Source Type: blogs
Antibiotics for Appendicitis: Penny wise but pound foolish
By SAURABH JHA
A Finnish group randomized patients with acute appendicitis to surgery and antibiotics and found that antibiotics were successful in 73 % of patients. Depending on how this is framed, you can celebrate a 70 % success or lament a 30 % failure. Much of the debate in healthcare is a battle of framing.The study has limitations. Finland is not just a land of the midnight sun but a land of fewer laparascopic surgeries than the USA. This is important because if done properly laparoscopic surgery has a lower morbidity than open surgery, as Skeptical Scalpel explains.
Should we be excited that antibiotics can be us...
Source: The Health Care Blog - August 20, 2015 Category: Consumer Health News Authors: suchandan roy Tags: THCB Saurabh Jha Source Type: blogs
Antibiotics for appendicitis? Not for this surgeon. Here’s why.
The long-awaited Finnish randomized controlled trial of antibiotics vs. surgery for appendicitis was just published in JAMA. Depending on your perspective, 73 percent of patients were successfully treated with antibiotics or 27 percent of patients failed antibiotics and needed surgery.
The good news is that it was a large multicenter study involving 273 patients randomized to surgery and 257 to antibiotics. Patients included in the study had uncomplicated appendicitis as diagnosed by CT scan.
The bad news is that the paper has many limitations.
Of the patients who underwent appendectomy as the primary treatment, only 15 (5...
Source: Kevin, M.D. - Medical Weblog - July 20, 2015 Category: Journals (General) Authors: Skeptical Scalpel, MD Tags: Conditions Surgery Source Type: blogs
Maryland’s Maverick Health Care Overhaul: A Physician Perspective
Beginning last year, the state of Maryland embarked on an extraordinary new experiment — one that could be a model for the nation. In partnership with the Centers for Medicare and Medicaid Services (CMS), Governor Martin O’Malley’s statewide hospital commission announced in January 2014 that it would address escalating health care costs by tackling the arms race of medical care. The Commission unveiled the framework for a new plan that will pay hospitals for quality over quantity, enabling them to profit from providing more appropriate—rather than simply more—care.
The proposed change of incentives ha...
Source: Health Affairs Blog - July 20, 2015 Category: Health Management Authors: Martin Makary and Seth Goldstein Tags: Costs and Spending Featured Health Professionals Hospitals Organization and Delivery Population Health Public Health Quality AHRQ fee-for-service Martin Makary Martin O'Malley Maryland Patient Safety Prevention RVU targets Source Type: blogs
FFL: Complicated
Ten years ago, I got on a plane and went to Florida to hang out with a bunch of diabetes people. I was getting to know (IRL) the people that had previously lived only in my computer.(aka the Children With Diabetes Chatrooms) There was no Adults With Diabetes support. I volunteered to be a chaperone at the Teen Dance,which amounted to me standing outside the door and making sure no parents snuck in.(That was how I met Joe S.)2015. My ninth FFL. I am kind like the shy little sister that hangs around and that everyone kinda knows of,but not really knows,because I am a shy introvert and public speaking doesn't happen much...
Source: The D-Log Cabin - July 15, 2015 Category: Endocrinology Authors: HVS Source Type: blogs
Surgical Complication Rates and the New Data Perspective
By JORDAN SHLAIN, MD + (UPDATED)
In an age where the importance of data, statistics and predictive modeling win big games for baseball teams and make fat money for high-frequency traders, we are at the dawn of a new age of transparency in healthcare It behooves every actor, in every sector, to use this new perspective to constructively illuminate best practices and design an infrastructure for true operational, clinical and logistic efficiencies at large scale and the local level – all in the spirit of getting the patient the best outcome.
Every modern industry uses ‘big data’ to understand ...
Source: The Health Care Blog - July 15, 2015 Category: Consumer Health News Authors: John Irvine Tags: THCB Source Type: blogs
Surgical Complication Rates just got Simple: MedicineBall Is the New MoneyBall
By JORDAN SHLAIN, MD
In an age where the importance of data, statistics and predictive modeling can win games for baseball teams and make money for high-frequency traders, the last bastion of opacity is in the midst of getting a whopping dose of sunshine.
Every modern industry uses detailed information, mostly via the Internet, to lie out their foundational strategies for gaining market share and building their brands. Fortress medicine has received a shot over the bow regarding the power of data and how they will need to craft a strategy that includes the bright light of outcomes into their institutions. Propublica, i...
Source: The Health Care Blog - July 15, 2015 Category: Consumer Health News Authors: John Irvine Tags: THCB Source Type: blogs
MKSAP: 48-year-old woman with gradual weight gain
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 48-year-old woman is evaluated during a routine examination. She is concerned about her gradual weight gain over the years and requests counseling on how she can most effectively lose weight.
Over 8 years, she has gained approximately 18 kg (40 lb). With several commercial diets, she has lost weight but always gains it back. She has a sedentary job, and often skips breakfast or eats dinner on the run. She states she cannot fit exercise into her busy day. She takes no medications and has no allergies.
On physic...
Source: Kevin, M.D. - Medical Weblog - April 25, 2015 Category: Journals (General) Authors: mksap Tags: Conditions Obesity Source Type: blogs
10 secrets to success as an academic surgeon
1. Be yourself and learn to be flexible. Don’t ever change who you are as a person. It’s OK to have a personality of your own. If you secretly listen to Taylor Swift’s Shake it Off on the way to work, it’s OK. As a junior member of the team it’s very unlikely your iPhone playlist will make the cut for the operating room (OR) entertainment anyway, so go ahead and keep it on your most played list. On the flip side, being successful means being flexible, learning new things, being wrong sometimes, and even changing the way you do things. It can be mind-blowing to learn that there is more than one way to accomplis...
Source: Kevin, M.D. - Medical Weblog - March 30, 2015 Category: Journals (General) Authors: Sarah Bryczkowski, MD Tags: Physician Surgery Source Type: blogs
