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Surgeons balk at withdrawing life support after medical errors
Nearly two-thirds of surgeons are unwilling to honor a patient’s request to end life support after operating on that patient, and they are less willing to do so when a surgical error occurs, said a study in Annals of Surgery in July. Researchers surveyed 912 neurosurgeons, cardio-thoracic surgeons and vascular surgeons who performed an average of 10 high-risk procedures a month about how they would respond to a scenario specific to their specialty. The vignette in the survey concerns a high-risk surgery for a 75-year-old woman with emphysema and stable coronary artery disease who has an intra-operative stroke and weakness in her arm and leg upon awakening after surgery. She struggles post-surgery and is re-intubated twice, and after seven days has developed pneumonia and needs ventilator care. The patient and family request withdrawal of life support, saying her future quality of life is unacceptable. Faced with that scenario, 63% of surgeons said they would be “not at all” [Read more]
Heart condition that puts young women at greater risk sometimes overlooked
Chest pain should not be dismissed in young, fit patients because it could be a symptom of spontaneous coronary artery dissection, which often affects otherwise healthy individuals, a new study says. Women appear to have a greater risk of developing the condition than do men, said Rajiv Gulati, MD, PhD, lead author of the study published online July 16 in Circulation. More research is needed to determine the cause of spontaneous coronary artery dissection, he said. But potential factors associated with the condition include fibromuscular dysplasia, extreme physical activity and hormones (the condition was most common in women during the three months after giving birth). An estimated 800 new cases of spontaneous coronary artery dissection occur in the U.S. each year, the study said. But many other cases go undiagnosed, in part, due to the difficulty of identifying the problem on an angiogram, Dr. Gulati said. “SCAD is not related to plaque buildup that more commonly causes [Read more]
Employers to emulate Medicare by buying quality care
Employers and labor organizations will follow Medicare’s lead in paying physicians and hospitals based on the value of their care, agreeing to purchase health plans for workers that reward health professionals for care quality and efficiency. A coalition of 18 large employers and unions has agreed to align with Medicare’s value-based purchasing programs, such as an initiative to share savings from lowered health spending, through a collaborative called Buying Value. The project offers employers guidance for how to purchase the best health plans that reward quality. The private purchasers will have an active voice in health coverage instead of just paying the bills, said Gerald Shea, assistant to the president of AFL-CIO, one of the participating groups. Although many insurers already have their own quality initiatives, the participants and the Medicare program will establish common measures for purchasing value. “When we started talking about it, everyone thought we shou [Read more]
FDA approves in-home HIV test that gives results within an hour
It takes between 20 and 40 minutes for the OraQuick In-Home HIV Test to deliver results on whether a person is HIV positive, but it took seven years for the test to win Food and Drug Administration approval for over-the-counter sales to patients. FDA officials required the product’s manufacturer, OraSure Technologies, to conduct studies to prove that patients could reliably follow written instructions to use the test, interpret the results and access follow-up care. In July, OraSure won FDA approval. The OraQuick In-Home HIV test, which can detect HIV antibodies, is administered by swabbing the gums and inserting the vial into a solution. Test results will need to be confirmed through laboratory testing. One in every 12 OraQuick tests yields a false negative. Also, the test does not reliably detect HIV until at least three months after the infection. “Knowing your status is an important factor in the effort to prevent the spread of HIV,” said Karen Midthun, MD, director [Read more]
2 major health organizations give nod to noncaloric sweeteners
Physicians should consider encouraging overweight patients to swap their sugary beverages and foods for products that contain non-nutritive sweeteners such as aspartame and saccharin, a report said. Doing so could help people reach and maintain a healthy weight by reducing their calorie consumption, said a scientific statement by the American Heart Assn. and American Diabetes Assn. However, data show that this approach is effective only if people continue to regulate the amount of sugars and calories they consume throughout the day, according to the statement published online July 9 in the journals Circulation and Diabetes Care. “If you choose a beverage sweetened with non-nutritive sweeteners instead of a 150-calorie soft drink but then reward yourself with a 300-calorie slice of cake or cookies later in the day, non-nutritive sweeteners are not going to help you control your weight because you added more calories to your day than you subtracted,” said Christopher Gardner, P [Read more]
White House exceeded authority with Medicare Advantage project, GAO says
The agency administering the Medicare program lacks the statutory authority to boost payments to certain Medicare Advantage plans under a nationwide demonstration project that rewards insurers for average performance, federal auditors said. A July 11 letter from the Government Accountability Office stated the Centers for Medicare & Medicaid Services has failed to provide evidence that its Medicare Advantage demo complies with federal statute. The demonstration does not need to result in increased efficiency or economy, but it must follow the principles established in enabling legislation, the 2010 health system reform law. These provisions authorized incentives to improve quality and cost-effectiveness. CMS chose to run a program that differs from the one outlined in the reform law by testing whether a tiered bonus structure would produce better results. The $8 billion Medicare Advantage program began rewarding the private plans under the three-year demonstration starting this ye [Read more]
Lou Gehrig home-run ball helps put dent in doctor’s student debt
With a swing of his bat, baseball legend Lou Gehrig helped reduce the student debt of Michael Gott, MD. A home-run ball smashed by Gehrig in game 2 of the 1928 World Series sold at auction for $62,617 on July 10 — nearly 84 years later. The ball was expected to sell for between $100,000 and $200,000, money the Gott family planned to use to erase Dr. Gott’s $200,000 in medical school debt. The Gotts didn’t get the windfall they wanted, but they’re still satisfied. “It’s very difficult to be disappointed at any money at all,” said Dr. Gott, a fifth-year orthopedic resident at North Shore-Long Island Jewish Hospital in New York. “Sixty thousand dollars is great and, hopefully, that will make a big dent in my high-interest loans.” On Oct. 5, 1928, the New York Yankees were playing the St. Louis Cardinals in the second game of the Series. Grover Cleveland Alexander was pitching in the first inning when Gehrig stepped to the plate. With runners Babe Ruth on firs [Read more]
High Medicaid population state reports record low access
It’s becoming more difficult for Texas Medicaid patients to find a doctor. A survey released July 9 by the Texas Medical Assn. reported that regulatory burdens and other administrative hassles are forcing physicians to reduce the number of patients on government health care programs whom they will accept. “This is not about physicians wanting to abandon Medicaid patients,” TMA President Michael E. Speer, MD, said. He said Medicare and Medicaid “have more and more paperwork and more and more rules,” which results in less time to see patients. Medicaid patient access is the hardest hit, the survey found. The portion of Texas physicians available to treat new Medicaid patients has dropped from 42% in 2010 to 31% this year, “an all-time low,” according to the survey. The Medicaid program in Texas covers 3.4 million people. Cuts to Medicaid payment rates of 2% in 2010 and 2011 have made it difficult for physicians to practice, as payments now cover less than half of [Read more]
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