Western Maryland Health Systems, the major hospital serving this poor and isolated region, is carrying out an experiment that could leave a more profound imprint on the delivery of health care than President Obama’s reforms. The goal, seemingly so simple, has so far proved elusive elsewhere: as much as possible, keep people out of hospitals, where the cost of health care is highest. Here, the experiment seems to be working.
Intraoperative cholangiography failed to reduce the risk of common-duct injury during cholecystectomy, an instrumental variable analysis of 92,000 cases showed. Use of intraoperative imaging was associated with an injury rate of 0.21 percent compared with 0.36 percent for cholecystectomy procedures performed without cholangiography.
In order for a patient to make an informed decision on whether surgery is appropriate, doctors and patients must be on equal ground regarding the specific risk factors involved. The ACS Surgical Risk Calculator is a free-to-use tool, compiled from statistical data collected from just under 1.5 million patients, that allows surgeons to adjust risk factors for a more personalized risk estimate.
Long-term follow-up in children undergoing hemispherectomy for refractory epilepsy showed that most were seizure-free and able to walk independently, but deficits in many areas of daily function were common, researchers said. Among 115 children with a mean of 6.05 years of follow-up, 70 were seizure-free and 96 were able to walk without assistance, according to Ajay Gupta, MD, of the Cleveland Clinic in Ohio, and colleagues.
A 3-month-old Indian baby is the center of a medical mystery as doctors are trying to determine if the infant suffered from spontaneous human combustion, according to the New York Times. The infant is being treated at the Kilpauk Medical College Hospital in Chennai, India, after his parents claimed he caught on fire four separate times.
Older breast cancer patients had significantly higher odds of undergoing mastectomy if their evaluation included MRI, use of which increased exponentially during the study period, investigators reported. Breast MRI was associated with an increase of more than 20 percent in the likelihood of mastectomy versus breast-conserving surgery in women 65 and older.
The University of Kentucky has settled its case with the state over the release of safety data for its embattled pediatric heart surgery program, which was closed last year following patient deaths. The dispute stems from a request last year by a local radio reporter for information about the program.
Patients with the most severe blunt trauma to the kidney may be managed without surgery, researchers reported. In a 12-year retroactive analysis of people with grade IV or V blunt renal injury who were hemodynamically stable, nonoperative management was successful in more than 90 percent of patients treated without surgery.
Every year, more than half a million Americans undergo procedures to have a narrowed coronary artery propped open with a small metal mesh tube, or stent. In an emergency, when someone is having a heart attack, the operation can be lifesaving. But far too often, studies show, stents continue to be implanted in patients who stand to gain little if any benefit.
The family of Anthony Stokes, the 15-year-old boy who was denied a place on the heart transplant waiting list because of "non-compliance," now say doctors at a George hospital have changed their minds. Anthony has an enlarged heart and has been given six months to live, but Anthony's family said doctors told them that they wouldn't put him on the transplant list because of his history of "non-compliance."
Hospitals across the nation are being swept up in the biggest wave of mergers since the 1990s, a development that is creating giant hospital systems that could one day dominate American healthcare and drive up costs. The consolidations are being driven by a confluence of powerful forces, not least of which is President Obama’s signature healthcare law, the Affordable Care Act.
The University of Florida's health system is reviewing the application of a heart surgeon from Kentucky who came under scrutiny after a CNN investigation into the deaths of babies in his care. Dr. Mark Plunkett was the chief heart surgeon at Kentucky Children's Hospital before he resigned to take a position with University of Florida Health.
Better communication is the key to improving patient outcomes after cardiac surgery, according to a new scientific statement from the American Heart Association. "Preventable errors are often not related to failure of technical skill, training, or knowledge," investigators wrote, "but represent cognitive, system, or teamwork failures."
Barbara Mancini, the Philadelphia nurse who is being charged with assisting in the suicide of her 93-year-old father, is pinning her hopes on Pennsylvania's attorney general to drop felony charges that could send her to jail. Mancini, 57, is alleged to have given her ailing father, Joseph Yourshaw, a lethal dose of morphine to hasten his death.
Patients who underwent carotid artery stenting followed a few weeks later by open heart surgery (a "staged" procedure) had a lower risk of the composite primary endpoint of all-cause death, stroke, or myocardial infarction (MI) than those who underwent staged carotid endarterectomy followed by open heart surgery (CEA-OHS) or those who had CEA-OHS performed on the same day (a "combined" procedure).