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| 2/2/2012 |
Survey: U.S., Older Physicians More Skeptical of HIT |
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By Jane Anderson
Physicians in eight countries agree that health information technology has the potential to improve clinical data and care coordination while reducing medical errors, according to a new survey. However, physicians in the United States and doctors older than 50 voiced considerably more skepticism than did their younger and international colleagues about the technology’s ability to improve care.
The survey, conducted by global consulting firm Accenture, exposed generational and geographic divides among physicians when it comes to their views on the benefits of health information technology (HIT). Physicians who haven’t used the technology are most skeptical, but once they start to use HIT, they begin to see those benefits, said Frances Dare, a senior executive with Accenture Health.
“The value indicators from those [physicians] who have used the technology are very strong,” meaning they think the technology can improve care and reduce costs, Ms. Dare said in an interview. “It’s not that physicians try it and don’t like it and stop. We really do need to focus on physicians who haven’t used these technologies; it’s really getting across that first adoption hurdle.”
Accenture surveyed 500 doctors per country in Australia, Canada, England, France, Germany, Spain, and the United States, along with 200 doctors in Singapore, in August and September 2011. The researchers measured physicians’ attitudes toward HIT, including whether they thought it would bring access to better-quality data, improved coordination, reductions in medical errors, and improved diagnostic decisions.
The survey found that nearly 71 percent of physicians in the eight countries surveyed think that HIT will improve data for clinical research, and 69 percent think it will improve coordination of care. About two-thirds think it will lead to a reduction in medical errors, and about 65 percent think it will lead to better health care decisions.
However, fewer than 50 percent of physicians think it will lead to less litigation, and fewer than 50 percent think it will lead to fewer unnecessary procedures or increased speed of access to health services for patients. Because HIT is frequently touted with promises of improved access and better coordination of care, this finding shows that physicians haven’t fully bought into those promises, according to Accenture.
Finally, fewer than 40 percent of physicians in the eight countries are not certain that HIT will lead to improved patient outcomes.
Ms. Dare said that policy makers and companies involved in the HIT field have tended to focus on how the technology can reduce costs and unnecessary care, whereas this survey shows that physicians care more about how HIT can improve access to care and care coordination for patients. However, using HIT to improve care – which physicians want – ultimately will address cost issues as well, she said.
“If we say to physicians, ‘This technology will allow you to better coordinate care’ – if we speak to the benefits physicians care about – then we will get the benefits policy makers and industry care about, which are utilization and cost,” Ms. Dare said.
Physicians who use HIT most frequently have the highest opinions of it, according to the survey.
For example, more than 72 percent of physicians younger than age 50 say that electronic medical records and health information exchanges will improve care coordination, the survey found, whereas 73 percent think those technologies will offer better access to quality data for clinical research. Among older physicians, only 65 percent think research data will improve, and 68 percent think care coordination will improve, according to the survey.
Meanwhile, negative opinions about HIT are most pronounced among physicians in the United States, according to Accenture. Fewer than half of all U.S. physicians surveyed said they believed that HIT would improve health care overall, compared with 59 percent of physicians in all eight countries.
In addition, only 45 percent of U.S. physicians believe that HIT will improve diagnostic decisions, compared with 61 percent of all physicians surveyed, and just 47 percent of U.S. physicians say that technology already has improved the quality of treatment decisions, compared with an average of 61 percent of physicians in all eight countries. Only 45 percent of U.S. physicians believe that HIT leads to improved outcomes, compared with 59 percent of all physicians.
The United States “is behind,” Ms. Dare said. “We’re…a decade late [in having] a national agenda to drive adoption and having a unified approach to drive adoption” of HIT. Still, Ms. Dare said she believes the United States can catch up quickly if more physicians begin to use HIT and see the benefits from it. |
| 2/1/2012 |
30-Day Postop Mortality Higher in Low-BMI Patients |
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By Mary Ann Moon
Low body mass index is a significant predictor of mortality within 30 days of surgery, according to a large analysis based on the the American College of Surgeons’ National Surgical Quality Improvement Program data set.
Low BMI raises postoperative mortality risk even after allowances are made for the type of surgery and for the individual patient’s preoperative expected risk of death, said Florence E. Turrentine, Ph.D., R.N., of the department of surgery, University of Virginia, Charlottesville, and her associates in a report published online in Archives of Surgery. In particular, the one-fifth of patients with the lowest BMI (less than 23.1 kg/m2) “demonstrated a significant increased risk of death, with 40 percent higher odds than the risk of death among patients in the middle range for BMI,” they noted.
The study subjects were 189,533 patients who underwent a major general or vascular surgical procedure in 2005 and 2006 at 183 participating medical centers. All patients were examined preoperatively and were given a 30-day mortality probable risk score based on more than 30 demographic characteristics, comorbidities, and laboratory values.
“The analysis of such a large number of patients allowed us to [examine] individual procedures done by general surgeons to a level of specificity not previously available,” Dr. Turrentine and her colleagues noted (Arch. Surg. 2011 Nov. 21 [doi:10.1001/archsurg.2011.310]).
A total of 3,245 patients (1.7 percent) died within 30 days of their surgery.
Interestingly, compared with normal weight, obesity was associated with lower rather than higher postoperative surgical risk, but not to a statistically significant degree. Somewhat unexpectedly, it was low BMI that raised mortality risk. Patients were divided into quintiles based on their BMI. After the data were adjusted to account for predicted mortality risk and type of surgery, the percentage of deaths among patients in the lowest BMI quintile (2.8 percent) was more than double that among patients in the highest BMI quintile (1.0 percent), which included patients with a BMI of 35.3 or greater.Thirty-day mortality also was significantly higher among patients in the lowest quintile of BMI than among patients in the middle quintiles (1.8 percent, 1.5 percent, and 1.4 percent).
In this analysis, overweight and obese patients in the upper two quintiles had lower 30-day mortality than did normal-weight patients in the middle quintiles, but those differences did not attain statistical significance.
The investigators further analyzed the data by type of surgery, discriminating among 45 different procedures. Laparoscopy, which was selected as the reference procedure, had an overall mortality of 2.0 percent. In comparison with laparoscopy, exploratory laparotomy carried the highest 30-day mortality (13.9 percent).
The effect of BMI on 30-day mortality was found to be quite different for certain operations. High BMI raised 30-day mortality risk for colostomy formation, wound debridement, colorectal resection, hernia repair, and mastectomy. |
| 1/2/2012 |
Walking Speed a Good Marker for Surgical Recovery |
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By Christina Frangou
San Francisco—An elderly person’s walking speed can predict how well he or she will fare after an operation, according to a report at the 2011 Annual Clinical Congress of the American College of Surgeons (ACS).Researchers from the University of Colorado, Denver, reported that a simple walking test performed before surgery is a powerful tool for determining the extent to which seniors will recover after cardiac or colorectal procedures.
“Our study showed that this timed up-and-go test is a very sharp predictor of complications and mortality,” said Daniel Wu, MD, study co-author and chief surgical resident, Denver Veteran’s Affairs Medical Center, in Colorado, in a press release from the ACS. “It’s a cheap and simple test that may eventually lead to a change in preoperative care. You really only need a stop watch to perform this test, and the implications are huge.”
The findings stem from a study of 195 patients aged 65 and older who were scheduled for heart or colorectal surgery. Before surgery, the researchers gave the patients a short, timed walking test. Patients were asked to stand up from a chair, walk 10 feet, turn around, return to the chair and sit down. After completing the test, the patients were classified as fast (≤ 10 seconds), intermediate (11-14 seconds) or slow (≥ 15 seconds).
Results showed that slower walking speed was associated with increased risk for complications, longer length of stay and higher rates of discharge after both cardiac and colorectal procedures. Among the 65 colorectal patients, the patients classified as slow spent more than twice as many days in the hospital as fast patients (14.4±12.4 vs. 6.3±4.1 days; P=0.009), and they were 10 times more likely to be discharged to an institution rather than home (59% vs. 5%; P=0.007). These patients also had significantly higher rates of complications (56% vs. 20%; P=0.0424). Similar differences were shown in patients undergoing cardiac procedures.
Walking speed is a good marker of physical frailty, said investigators. A walking speed test may distinguish physiologically weak patients in a way that preoperative assessments of heart, lung or kidney function might not.The simple walking test is a useful tool that surgeons now can add to their preoperative evaluations of geriatric patients, said Emily Finlayson, MD, assistant professor of surgery, University of California, San Francisco. “It’s something that can be done fairly easily in the clinic. It just takes a minute, and this one simple measure really has a powerful ability to tell us whether patients are going to have complications, whether they are going to have prolonged hospital stays and where they are going to be going after surgery,” she said. Many of the other tests for frailty are cumbersome, she said. This one is not, and the results, although early, are compelling.
“With this, we can have really informed discussions with our patients about what the expected outcomes are after their operations and also help with planning afterward. For instance, if you are somebody who is going to require acute rehabilitation after surgery, you can start organizing that even before surgery.”
Study co-author Thomas Robinson, MD, associate professor of surgery, University of Colorado, Boulder, said he hopes this approach could lead to a more individualized way of deciding who should undergo surgery.“We are designing tests to get away from chronological age, and instead are now focusing on physiologic age,” Dr. Robinson said. “Ultimately, what we are trying to do is establish very simple tools that the average surgeon can use to determine who is going to fare poorly after an operation.”
The research is a proof-of-concept study, and more work is needed to develop an accurate tool for assessing geriatric patients, he added. The investigators are currently organizing a multi-institution trial to confirm the results. |
| 12/15/2011 |
Best Hospitals 2011-12: the Honor Roll |
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By U.S. News Staff
A place on the Best HospitalsHonor Roll is reserved for medical centers that demonstrate unusually high expertise across multiple specialties, scoring at or near the top in at least six of 16 specialties. Just 17 of the nearly 5,000 hospitals evaluated for the 2011-12 rankings qualified. Hospitals with the highest scores in a given specialty received 2 Honor Roll points; those with slightly lower scores received 1 point.* Honor Roll standing was determined by the total number of Honor Roll points across all 16 specialties.
1. Johns Hopkins Hospital, Baltimore, MD
2. Massachusetts General Hospital, Boston, MA
3. Mayor Clinic, Rochester, NY
4. Cleveland Clinic, Cleveland, OH
5. Ronald Reagan UCLA Medical Center, Los Angeles
6. New York-Presbyterian University Hospital of Columbia and Cornell, NY
7. UCSF Medical Center, San Francisco, CA
8. Brigham and Women’s Hospital, Boston, MA
9. Duke University Medical Center, Durham, NC
10. Hospital of the University of Pennsylvania, Philadelphia, PA
11. Barnes/Jewish Hospital/Washington University, St.Louis, MO
12. UPMC-University of Pittsburg Medical Center, Pittsburg, PA
13. University of Washington Medical Center, Seattle, WA
14. University of Michigan Hospital and Health Center, Ann Arbor, MI
15. Vanderbilt University Medical Center, Nashville, TN
16. Mount Sinai Medical Center, New York, NY
17. Stanford Hospital and Clinic, Stanford, CA
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| 12/1/2011 |
Innovations in Heart Valve Surgery: Hybrid Procedures for Aortic Stenosis |
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by Columbia Surgery
Severe aortic stenosis usually requires replacement of the aortic valve. In some cases, patients who have had valve replacements will also need to have additional procedures to correct blocked arteries. Until recently, these procedures were traditionally both done through open surgery.
But open surgery may be too risky for certain patients, and may be particularly problematic for patients who have coronary artery disease, or who had prior heart surgery and need re-operation. In the past, if patients were unable to withstand open bypass surgery, they simply had to endure their worsening symptoms as their hearts grew weaker. Now, the advent of hybrid surgeries – which combine catheter-based procedures with minimally invasive surgical techniques – are providing a broader and better range of treatment options.
Hybrid surgery is gaining traction throughout the nation, but at this time remains available only in select institutions because of the need for specialized operating rooms and multidisciplinary expertise. Hybrid procedures require close collaboration between interventionalists and surgeons, a type of cooperation not usually found in institutions with traditional departmental divisions. |
| 11/16/2011 |
No Survival Benefit For Mastectomy Over Lumpectomy |
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By Karen Blum
Women aged 40 years and younger who are treated for breast cancer have similar recurrence and survival rates regardless of whether they opt for breast-conservation therapy (BCT) or mastectomy, according to two new studies. The results, presented at the 2011 Breast Cancer Symposium in San Francisco. In the first study, Julliette Buckley, MD, a breast surgery fellow at Massachusetts General Hospital, in Boston, and colleagues reviewed medical records of 628 women aged 40 and younger who were diagnosed with up to stage III breast cancer between 1996 and 2008. They collected data on the women’s cancer stage, treatment, recurrence and overall survival (OS) during an average follow-up period of 72 months.
Analyzing the data according to the type of surgery the women received, researchers found no statistically significant difference in risk for local cancer recurrence. Of the 421 women who underwent BCT, 30 (7.1%) developed a local recurrence during the study period, whereas of the 161 women who had a mastectomy, 12 (7.5%) developed a local recurrence.The overall rates of local recurrence, including both groups, were 5.6% five years after diagnosis and 13% 10 years after diagnosis. Overall rates of distant recurrence were 12% five years after diagnosis and 19% 10 years after diagnosis. The average time to a recurrence was 35 months.
Of the women, 93% were alive five years after diagnosis and 87% were alive 10 years after diagnosis. Nearly 83% were alive with no evidence of breast cancer five years after diagnosis, and at 10 years after diagnosis that number was nearly 69%.
The study suggests that younger women diagnosed with breast cancer have a good prognosis with a low risk for recurrence, and that lumpectomy is a safe option for women, Dr. Buckley said.
“We believe that awareness of the genetic risks for breast cancer, advances in screening for breast cancer and improvements in systemic and radiation therapy have contributed to longer overall survival for young women with breast cancer,” she said. |
| 11/16/2011 |
Surgical Tools, Inc. at MEDICA This Week! |
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| Surgical Tools, Inc. will be attending the MEDICA World Forum for Medicine International Trade Fair with Congress in Dusseldorf, Germany on November 16-19, 2011. Please come visit us. We'd love to see you! |
| 11/1/2011 |
Post-Op Fluids Key to Sodium Levels in Children |
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By John Gever, Senior Editor, MedPage Today
Abnormally low sodium levels were much more common in children recovering from surgery when they were given hypotonic maintenance fluids, rather than isotonic fluids, according to the results of a randomized, controlled trial.
The relative risk for hyponatremia associated with hypotonic fluids in the 258-patient trial was 1.82 (95% CI 1.21 to 2.74) compared with isotonic fluids, reported Karen Choong, MB, of McMaster Children's Hospital in Hamilton, Ontario, and colleagues online in Pediatrics.
Some 41% of children in the study developed hyponatremia when given the hypotonic fluids -- the current standard of care for children postoperatively -- versus 23% of those receiving isotonic fluids. That worked out to a number-needed-to-treat of six for isotonic fluids to prevent one case of hyponatremia, the researchers indicated.
"The results of this trial indicate that the current standard for postoperative fluid and electrolyte management for pediatric patients should change," Choong and colleagues concluded.
In an accompanying editorial, two pediatric nephrologists agreed.
"There can no longer be any justification for the routine administration of hypotonic fluids in hospitalized children," wrote Michael L. Moritz, MD, of the University of Pittsburgh, and Juan Carlos Ayus, MD, of Renal Consultants of Houston. They added, "the FDA should review the existing literature on hypotonic fluids and issue a warning about the dangers associated with its use."
As the trial results indicated, hyponatremia is a common occurrence in hospitalized children and especially in those who have undergone surgery.
Hypotonic maintenance fluids have gained currency under a theory that isotonic fluids pose too much risk for excessive sodium and its consequences, such as interstitial fluid overload and hyperchloremic metabolic acidosis.
In the trial, euvolemic patients from 6 months to 16 years old undergoing elective surgery were randomized to fluids with 0.45% saline (hypotonic) or 0.9% saline (isotonic) on a double-blind basis. About 40% of enrolled patients were undergoing orthopedic surgery. Other types of procedures included urologic, plastic, otolaryngologic, and general. Fluids were started as soon as possible after surgery and given for a maximum of 48 hours. Plasma sodium and anti-diuretic hormone (ADH) were monitored. |
| 10/16/2011 |
Hospitals Mislead Patients about Benefits of Robotic Surgery |
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By Neev M. Arnell
(NaturalNews) A majority of the estimated four in 10 hospital websites in the United States that publicize the use of robotic surgery, tout the superiority of robotic surgery over conventional surgery, despite a lack of scientific evidence to support that claim, a new Johns Hopkins study finds. The promotional materials on the hospital websites overestimate the benefits of surgical robots, largely ignore the risks and are strongly influenced by the product's manufacturer, according to the report in Journal for Healthcare Quality. "The public regards a hospital's official website as an authoritative source of medical information in the voice of a physician," said Marty Makary, associate professor of surgery at the Johns Hopkins University School of Medicine and lead researcher of the study. "But in this case, hospitals have outsourced patient education content to the device manufacturer, allowing industry to make claims that are unsubstantiated by the literature. It's dishonest and it's misleading."More hospitals are buying the expensive new equipment and many use aggressive advertising to lure patients who want to be treated with what they think is the latest and greatest in medical technology, Makary said. In the last four years, he added, the use of robotics to perform minimally invasive surgeries and other types of common procedures has grown 400 percent.
Proponents say robot-assisted operations use smaller incisions, are more precise and result in less pain and shorter hospital stays. But there are no randomized, controlled studies showing patient benefit in robotic surgery, Makary said. In fact, robotic surgeries take more time, keep patients under anesthesia longer and are more costly.
Manufacturer-provided materials were used on 73 percent of websites, while 33 percent directly linked to a manufacturer website. "This is a really scary trend," Makary says. "We're allowing industry to speak on behalf of hospitals and make unsubstantiated claims."
When describing robotic surgery, the researchers found that 89 percent made a statement of clinical superiority over more conventional surgeries, the most common being less pain, shorter recovery, less scarring and less blood loss. Thirty-two percent made a statement of improved cancer outcome. None mentioned any risks. Makary says the use of manufacturer-provided images and text also raises serious conflict- of-interest questions. He says hospitals should police themselves in order not to misinform patients. Johns Hopkins Medicine, for example, forbids the use of industry-provided content on its websites.
"Hospitals need to be more conscientious of their role as trusted medical advisers and ensure that information provided on their websites represents the best available evidence," he says. "Otherwise, it's a violation of the public trust."
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| 10/3/2011 |
Donald Trump Casino Offers Plastic Surgery Jackpot |
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A New Jersey casino owned by Donald Trump is offering gamblers in New Jersey the chance to win a lump sum to spend on plastic surgery. The winner of the Nip, Tuck and Lift Sweepstakes at the Trump Taj Mahal in Atlantic City will receive $25,000 towards various cosmetic procedures, according to the casino.
Players will earn the chance to win the makeover throughout October 2011, with the final draw to choose a winner being held on October 29 at the casino.
"We wanted to change the face of a typical casino promotion and with this one we are literally doing it," Trump Entertainment Resorts senior vice president of marketing Kathleen McSweeney said. "Many people have something they want to change; a nip and tuck here, a lift there, but the cost of these procedures can be quite costly."
The casino said the winner would receive the cash to spend on anything from breast augmentation and eyelid tucks to Botox injections and liposuction. |
| 9/17/2011 |
Duodenal Switch Surgery Riskier Than Gastric Bypass |
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The first randomized comparison of gastric bypass and duodenal switch surgery, published in the Annals of Internal Medicine, shows greater weight loss and improvements in cardiovascular risk factors with duodenal switch, but at the expense of more adverse events.
Two years after gastric bypass or duodenal switch was performed on some 60 patients with superobesity (BMI, 50 to 60), most cardiovascular risk factors improved in both groups. Duodenal switch patients had greater weight loss than bypass patients (mean loss, 74 vs. 51 kg), as well as greater reductions in total and LDL cholesterol. However, they also had more adverse events (62% vs. 32%); in particular, malnutrition-related events such as night blindness, severe iron deficiency, and protein calorie deficiency occurred only after duodenal switch.
An editorialist notes that few patients had adverse cardiovascular profiles to begin with and concludes: "We should seriously question whether there is any role for the duodenal switch operation ... its complications are very real and very severe." |
| 9/10/2011 |
Visit Us at MEDICA 2011 |
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Surgical Tools, Inc. will be attending the MEDICA World Forum for Medicine International Trade Fair with Congress in Dusseldorf, Germany on November 16-19, 2011. Please come visit us. We'd love to see you!
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| 9/2/2011 |
FDA Planning Tougher Regulations For Surgical Mesh |
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By Jennifer Corbett Dooren and Anjali Athavaley
(Dow Jones)--The Food and Drug Administration is proposing tougher regulations for surgical mesh products when used inserted through the vagina to treat a condition called pelvic organ prolapse in women.
In a document posted to FDA's website Thursday the agency said, the "rate and severity of mesh-specific adverse events following vaginal POP repair with mesh calls into question the safety of these devices." Many side effects were caused by the mesh protruding out of the vaginal tissue, which in turn caused pain, infection and bleeding.
The agency said is proposing new mesh products undergo a premarket review process, which requires companies to conduct studies looking at a product's safety and effectiveness prior to approval. The mesh products are currently reviewed under the less stringent review known as the 510(k) process. The agency is also proposing that studies involving current products be conducted but said it would consider a grace period for companies to submit a premarket approval applications.
An FDA advisory panel is being called on to discuss the mesh products next week. The meeting is expected to mostly focus on mesh when used to treat organ prolapse, but the panel will be asked to discuss the use in treating a condition known as stress urinary incontinence. The consumer group Public Citizen petitioned the FDA last week to recall existing mesh products and require new products to undergo a premarket review process.
The mesh products are made by at least nine companies.
"For women suffering from pelvic organ prolapse or stress urinary incontinence, surgical intervention and the use of mesh is an important treatment option," says Wanda Moebius, spokeswoman for AdvaMed, a Washington trade group representing medical device makers. "The use of surgical mesh has an established track record and the 510(k) process has enabled great learning and medical advances in this field." Both Boston Scientific and Johnson & Johnson's Ethicon unit, which makes the mesh, also said they would continue to work with FDA on the matter.
In July the FDA issued a safety communication warning health care providers and patients that surgical placement of mesh through the vagina to repair pelvic organ prolapse could expose patients to greater risk than other surgical options to fix sagging organs. The condition occurs when the internal structures that support the pelvic organs such as the bladder, uterus and bowel, become so weak or stretched that the organs drop from their normal position and bulge or prolapse into the vagina.
FDA said surgery to repair POP can be performed through the abdomen or transvaginally, through the vagina, using stitches, or with the addition of surgical mesh to reinforce the repair and correct the anatomy. The agency said there were about 75,000 transvaginal procedures that used surgical mesh. From 2008 to 2010, the FDA received 1503 adverse event reports associated with mesh used for POP repair, which was five times as many as the agency received from 2005 to 2007. |
| 8/15/2011 |
Risks: Better Odds for Surviving Complex Surgery |
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By Roni Caryn Rabin
The odds that a Medicare patient will die after undergoing one of eight high-risk operations have fallen sharply, an analysis of medical records has found. Fewer hospitals are performing these procedures, and the hospitals that do them are high-volume facilities that tend to have more experience caring for high-risk patients, the researchers found. But that trend does not fully account for the decline in deaths.
Patients who had surgery to repair abdominal aortic aneurysms experienced the steepest decline in mortality in the analysis. Their death rate fell to 2.8 percent in 2007-8 from 4.4 percent in 1999-2000 — a 36 percent drop, due mostly to new medical technology, the researchers said.
Death rates also fell among patients after operations to treat cancers of the esophagus, pancreas, lung and bladder, and among those who had had coronary artery bypass grafting, aortic valve replacement and carotid endarterectomy, according to the study, published this month in The New England Journal of Medicine.
The declines in mortality translate into about 2,000 fewer deaths each year, said Dr. John D. Birkmeyer, director of the Center for Healthcare Outcomes and Policy at University of Michigan and the paper’s senior author. Much of the improvement stems from a new emphasis on patient safety, Dr. Birkmeyer added.
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| 8/2/2011 |
Studies Reveal Importance of Pre-op Testing for Lynch Syndrome |
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by Christina Frangou
Vancouver, British Columbia—Mayo Clinic researchers are calling for all young patients with colorectal cancer (CRC) to undergo preoperative testing for Lynch syndrome as the results can significantly alter surgical management.
“The benefit of this testing to the patient and their family is huge,” said Rajesh Pendlimari, MBBS, a research fellow at Mayo Clinic in Rochester, Minn., and a study investigator.
“If they have Lynch syndrome and will, therefore, be more prone to getting cancer, they can get screened more regularly. The knowledge gleaned can change the course of surgical treatment.”
At the 2011 annual meeting of the American Society of Colon and Rectal Surgeons, the Mayo team presented two studies examining the benefit of pre- and postoperative microsatellite instability (MSI) testing for Lynch syndrome.
In the first study, 210 of 258 newly diagnosed patients younger than age 50 years who underwent colorectal surgery at Mayo Clinic had MSI testing between 2003 and 2008. Of these, 82 underwent testing postoperatively, according to the hospital’s protocol requiring pathologists to complete MSI testing on operative specimens for all young patients who did not have the tests done prior to surgery. Overall, 13% of patients were found to have high levels of MSI and 33% of these would have been missed without the testing protocol.
The second, complementary paper retrospectively compared the surgical management of 210 patients who were tested pre- and postoperatively for MSI (n=103, n=107, respectively).
Results showed that the MSI test results significantly influenced surgical recommendations for total colectomy. Of patients with positive preoperative MSI tests (MSI-H), 94% underwent total colectomy, compared with 8% of patients whose status was not known until after surgery (P<0.0001). Moreover, there appears to be an increased rate of hysterectomy among women with MSI-H. Eight of 10 MSI-H women had a hysterectomy. There was only one female patient who was tested postoperatively and she did not have a hysterectomy.
“Probably the most significant result of this research is that it has stimulated our multidisciplinary team of geneticists, pathologists, gastroenterologists and surgeons to develop new clinical pathways that will direct patients at risk to providers experienced with management of Lynch syndrome,” said Eric Dozois, MD, professor of surgery at Mayo Clinic and lead researcher on the project.
Other gastroenterologists and surgeons applauded the paper, saying that preoperative testing for Lynch syndrome is easy to do and can dramatically affect surgical treatment. |
| 7/1/2011 |
SCIP Improves Adherance, But Not Infection Rates |
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By Christina Frangou
“SCIP adherence was neither associated with a lower surgical site infection rate at the patient level, nor with lower hospital surgical site infection rates,” said lead author Mary Hawn, MD, MPH, associate professor of surgery at the University of Alabama and a staff surgeon at the VA in Birmingham, Ala. An analysis of 112 Veterans Affairs hospitals showed that risk-adjusted surgical site infection (SSI) rates remained stable between 2005 and 2009, even though hospital adherence to SCIP infection control measures improved over the same period.
The study findings raise questions about releasing SCIP adherence information to the public, said researchers.
Currently, this information is given to third-party payers, administrators and patients, who often use it as a gauge for a hospital’s quality. Adherence figures are available online at Hospital Compare (http://www.hospitalcompare.hhs.gov).
SCIP was implemented in 2006 with the goal of reducing surgical complications by 2010. Since then, the Centers for Medicare & Medicaid Services made it mandatory for hospitals to publicly report surgical processes of care, including infection prevention measures, rather than clinical outcomes. The agency requires two sets of SCIP measures for infection and venous thromboembolism be reported publicly. Hospitals must submit data quarterly, which are then posted online.
“The policy of continued SCIP measurement for public reporting and payment should be re-evaluated,” said Dr. Hawn.
Dr. Hawn’s study is the fourth study in the past year to show no association between SSI rates and adherence to SCIP measures (JAMA 2010;303:2479-2485; JACS 2010;211:705-714; Arch Surg 2010 Oct;145:999-1004). Dr. Hawn’s is the only study to use patient-level data to study multiple SCIP measures and SSI assessed by a quality-tracking system.
Donald Fry, MD, executive vice president at the think tank Michael Pine and Associates and an adjunct professor of surgery at Northwestern University, both in Chicago, said the studies show that “it’s almost impossible to identify any improvement” in SSIs as a result of the SCIP measures.
Dr. Fry, who was instrumental in organizing the original surgical infection project, believes that the SCIP measures are scientifically valid but are not enough. Infection control involves far more variables than those monitored by SCIP. |
| 6/15/2011 |
ABSITE Study Tool Now Available for Smartphones |
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by Christina Frangou
Washington—For residents who are dreading next year’s American Board of Surgery In-Training Examination (ABSITE), there’s a new free study tool that’s much lighter to carry around than a textbook.
Apple Inc., recently approved the Pass the ABSITE application, an iPhone 4 app written by a group of general-surgery residents in Ohio and designed for general-surgery residents studying for their in-training exams.
An independent group of surgical residents then tested the app, giving it a 90% approval for ease of use, and 75% and 85%, respectively, for functionality and overall graphic design.
The work, which was presented last fall at the Clinical Congress of the American College of Surgeons, was recognized as one of the top poster presentations of the meeting. The app was made available over iTunes in February after Apple approved the application. It is the first free application specifically geared toward the ABSITE.
Reviews from residents who have tried the application, however, are mixed. Some have said it’s easy to use and provides another source of ABSITE questions, but others have criticized the design and functionality, the limited number of questions and lack of a scorekeeping feature.
“An app for the ABSITE is a great idea but it needs to address the basic issues above,” said Gavin Falk, MD, a general surgery resident at Cleveland Clinic, in Ohio.
Dr. Sparks and colleagues are working on an updated version of the app, which will be available on earlier-generation iPhones and other smartphones. |
| 6/1/2011 |
WHO Group Says Cell Phones 'Possibly' Carcinogenic |
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Electromagnetic radiation generated by cell phones is "possibly carcinogenic" to humans, the WHO's International Agency for Research on Cancer concludes.
According to a WHO press release, an international working group of 31 scientists analyzed hundreds of studies and found — on the basis of "limited" evidence — a positive association between wireless telephone use and glioma. The group cited one study that showed a 40% increased risk for glioma among the heaviest users (people who reported using their cell phones 30 minutes daily over 10 years). However, chance, bias, or confounding could not yet be ruled out, so electromagnetic radiation was given the "2B" classification as being possibly carcinogenic.
IARC director Christopher Wild said that further research needs to be done on heavy, long-term use of cell phones. Until those results are published, he added, "it is important to take pragmatic measures to reduce exposure such as hands-free devices or texting." |
| 5/16/2011 |
Surgeon–Industry Relationships: Where To Draw the Lines? |
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by Gabriel Miller
National Harbor, Md.—When versions of the Sunshine Act were originally passed in states like Massachusetts and Vermont in 2008 and 2009, there were running jokes in the exhibition halls of surgical society meetings around the country. The fact that surgeons from these states were barred from drinking the free cans of Diet Coke that device companies might hand out at their booth seemed ludicrous.
One surgeon at a meeting recently joked that “it’s been a long, lonely week avoiding all the pharmaceutical and device company dinners ... I could live this way for five or six days, but I don’t think I could live this way forever.”
The jokes, however, stand to become more than a laughing matter. In 2009, Congress introduced a bill that would require physicians to disclose any gift worth more than $100, that later was rolled into the health care reform law enacted in March 2010. The Physician Payment Sunshine Act provisions included in the Patient Protection and Affordable Care Act lowered the gift threshold to $10 and provided for the creation of a national, publicly accessible database that would list physicians’ names, addresses and the nature and value of all gifts received from industry.
The database may be the most visible measure that affects physicians, but for surgeons in particular, it’s probably not the most far-reaching. Conflict of interest among medical professionals has become a national debate in medical colleges, in Congress and across the front pages of national newspapers. Many surgeons agree that bias is present, but they argue that medical devices are vastly different from pharmaceutical products.
At the 12th World Congress of Endoscopic Surgery last year, experts voiced concerns rippling through the surgical community that losing or denying industry support might hurt graduate and continuing medical education (CME), the leadership of specialty surgical societies and the development of minimally invasive surgery as a whole. |
| 5/3/2011 |
Most Patients with Perioperative MIs Don't Have Symptoms |
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Two thirds of patients who experience a myocardial infarction during or shortly after noncardiac surgery do not have ischemic symptoms, according to an Annals of Internal Medicine study.
Researchers followed a cohort of some 8350 patients who had, or were at risk for, atherosclerosis and were undergoing noncardiac surgery. ECGs were performed several times until day 30 after surgery, and troponin levels were measured daily through day 3.
Five percent of patients had a perioperative MI (usually within 2 days after surgery). Of these, only one third had ischemic symptoms, while nearly all (94%) had elevated troponin levels. Patients who had MIs, even without symptoms, were at increased risk for another cardiac event or death within 30 days.
The authors conclude that because most patients with perioperative MIs will not have symptoms, "physicians should ... require perioperative troponin monitoring to avoid missing these prognostically important MIs."
Annals of Internal Medicine article (Free abstract) |
| 3/31/2011 |
EPA Monitoring Continues to Confirm That No Radiation Levels of Concern Have Reached the U.S. |
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Contact Information: EPA Press Office press@epa.gov
WASHINGTON – During detailed filter analyses from 12 RadNet air monitor locations across the nation, the U.S. Environmental Protection Agency (EPA) identified trace amounts of radioactive isotopes consistent with the Japanese nuclear incident. Some of the filter results show levels slightly higher than those found by EPA monitors last week and a Department of Energy monitor the week before. These types of findings are to be expected in the coming days and are still far below levels of public health concern.
EPA’s samples were captured by monitors in Alaska, Alabama, California, Guam, Hawaii, Idaho, Nevada, Saipan, Northern Mariana Islands and Washington state over the past week and sent to EPA scientists for detailed laboratory analysis.
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| 3/15/2011 |
Preoperative Alcohol Use Tied to Arthroplasty Complications |
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The investigators found that 32 patients had an AUDIT-C score suggesting alcohol misuse before their surgery. Post-surgery, six of these patients developed one complication, four developed two complications, and two patients had three complications. The AUDIT-C screening scores were significantly related to the number of complications; every point increase in the AUDIT-C score above one had a 29 percent increase in the expected number of complications.
"Preoperative screening for alcohol misuse and counseling patients about the risks of their alcohol consumption may be indicated for patients undergoing total joint arthroplasty," the authors write. |
| 3/7/2011 |
Robotic Nurse 'Gesture Recognition' |
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Article Date: 07 Feb 2011 - 0:00 PST
Surgeons of the future might use a system that recognizes hand gestures as commands to control a robotic scrub nurse or tell a computer to display medical images of the patient during an operation.
Both the hand-gesture recognition and robotic nurse innovations might help to reduce the length of surgeries and the potential for infection, said Juan Pablo Wachs, an assistant professor of industrial engineering at Purdue University.
The "vision-based hand gesture recognition" technology could have other applications, including the coordination of emergency response activities during disasters.
"It's a concept Tom Cruise demonstrated vividly in the film 'Minority Report,'" Wachs said.
Surgeons routinely need to review medical images and records during surgery, but stepping away from the operating table and touching a keyboard and mouse can delay the surgery and increase the risk of spreading infection-causing bacteria.
The new approach is a system that uses a camera and specialized algorithms to recognize hand gestures as commands to instruct a computer or robot.
At the same time, a robotic scrub nurse represents a potential new tool that might improve operating-room efficiency, Wachs said.
Findings from the research will be detailed in a paper appearing in the February issue of Communications of the ACM, the flagship publication of the Association for Computing Machinery. The paper, featured on the journal's cover, was written by researchers at Purdue, the Naval Postgraduate School in Monterey, Calif., and Ben-Gurion University of the Negev, Israel.
Research into hand-gesture recognition began several years ago in work led by the Washington Hospital Center and Ben-Gurion University, where Wachs was a research fellow and doctoral student, respectively.
He is now working to extend the system's capabilities in research with Purdue's School of Veterinary Medicine and the Department of Speech, Language, and Hearing Sciences.
"One challenge will be to develop the proper shapes of hand poses and the proper hand trajectory movements to reflect and express certain medical functions," Wachs said. "You want to use intuitive and natural gestures for the surgeon, to express medical image navigation activities, but you also need to consider cultural and physical differences between surgeons. They may have different preferences regarding what gestures they may want to use."
Other challenges include providing computers with the ability to understand the context in which gestures are made and to discriminate between intended gestures versus unintended gestures.
"Say the surgeon starts talking to another person in the operating room and makes conversational gestures," Wachs said. "You don't want the robot handing the surgeon a hemostat."
A scrub nurse assists the surgeon and hands the proper surgical instruments to the doctor when needed.
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| 9/23/2009 |
Full Moon Does Not Affect Surgery Outcomes |
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Jeanna Bryner
Senior Writer
livescience.com – Wed Sep 23, 12:13 am ET
While a full moon can tug on ocean tides and make for a romantic setting, scientists have found no reliable evidence that it triggers suicides or hospital admissions, or facilitates conception, the transformation of werewolves or any of a host of other phenomena often blamed on it.
Evidence is mounting, however, for things on which the moon has no impact.
A new study, which will be published in the October issue of the journal Anesthesiology, shows the moon's phase has no effect on the outcome of a heart-related surgery. The statistical sigh of relief is the result of an investigation into surgical outcomes of more than 18,000 patients who underwent so-called elective coronary artery bypass graft surgery, in which blood flow is rerouted through a new artery or vein. The operations were performed at the Cleveland Clinic between 1993 and 2006.
Allen Bashour and Daniel Sessler, of the Cleveland Clinic, and their colleagues specifically looked at risk of death, heart attacks immediately following surgery, and infections, among other factors.
"The moon phase has been somewhat of an urban legend," Bashour told LiveScience. "There's no science that I know of to justify it. So really we didn't expect that would be an influence." But in science, one has to look, not assume, and so they did.
Timing of surgery
The researchers also found that the time of day, day of the week and month of the year had no bearing on whether patients would have a positive result.
Essentially, Bashour and his colleagues wanted to find out if a patient who came in for surgery on a Friday afternoon in July would be at a disadvantage compared with someone going under the knife on a Tuesday morning, say, in early March.
Unlike the lunar link, timing could be a legitimate factor in surgical outcomes, Bashour said. For instance, doctors and other hospital personnel may be more tired at the end of a work week or later in the day. And in early July and August, new residents enter teaching hospitals, so it might not be a good time to schedule a surgery, as the doctors-in-training (who provide care after surgeries) are just that, he said.
"Our study found that the surgeries can be scheduled throughout the workday, any day of the work week or in any month of the year without compromising outcomes," Bashour said.
Moon myths
The study adds another scientific strike against the idea that the moon has mystical powers of sorts. There is some truth to the suspicions, it turns out, but not likely for the reasons many people believe.
For instance, doctors, nurses and others in emergency services have claimed full-moon nights are busier than other nights. And a study of nearly 12,000 emergency room visits for pets revealed the risk of such emergencies, ranging from cardiac arrest to trauma, was more than 20 percent greater for cats and dogs on days surrounding full moons compared with other days.
One idea is that flooded emergency rooms could be the result of more people and pets out and about during the full moon since the night is bright.
Scientists have also found beach pollution is worse during the full moon, a phenomenon linked to real variations in tides related to the lunar cycle.
As for why many scientifically unproven myths still draw a crowd, perhaps people just want to believe. Meanwhile, you can believe this: Feel free to schedule your next surgery for Sunday, Oct. 4, the next full moon.
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| 7/10/2009 |
Surgical Tools instruments on upcoming TV drama, "Three Rivers" |
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"Three Rivers", an upcoming 2009 drama about organ transplants that stars Alex O'Loughlin, is having their set supplied with surgical instruments from Surgical Tools, Inc. / surgicaltools.com. The series will air on CBS, Sundays at 9 PM Eastern Standard Time.
Tune in and see if you can catch a glimpse of our instruments on the show! |
| 6/15/2009 |
Office Grand Opening |
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Surgical Tools, Inc. is pleased to announce the opening of its new office in Bedford, VA. The new office and warehouse spaces consist of over 30,000 square feet of a completely renovated dress factory, dating back to the 1940's. The office officially opened with the annual sales meeting, and also saw a large increase in the Surgical Tools / surgicaltools.com sales and support staff. With custom designed office and warehouse space and our ever-growing team of professional sales and customer service staff, Surgical Tools and surgicaltools.com continue their dedication to having the highest quality customer service and support in the medical industry. |
| 1/15/2009 |
Study: Basic checklist cut surgical deaths in half |
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ATLANTA – Scrawl on the patient with a permanent marker to show where the surgeon should cut. Ask the person's name to make sure you have the right patient. Count sponges to make sure you didn't leave any inside the body. Doctors worldwide who followed a checklist of steps like these cut the death rate from surgery almost in half and complications by more than a third in a large international study of how to avoid blatant operating room mistakes.
The results — most dramatic in developing countries — startled the researchers.
"I was blown away," said Dr. Atul Gawande, a Harvard surgeon and medical journalist who led the study, published in Thursday's New England Journal of Medicine.
U.S. hospitals have been required since 2004 to take some of these precautions. But the 19-item checklist used in the study was far more detailed than what is required or what many institutions do.
The researchers estimated that implementing the longer checklist in all U.S. operating rooms would save at least $15 billion a year.
"Most of these things happen most of the time for most patients, but we need to make it so that all these things happen all the time for all patients, because each slip represents an opportunity for harm," said Dr. Alex Haynes of the Harvard School of Public Health, one of the study's authors.
The checklist was developed by the World Health Organization and includes measures such as these:
• Before the patient is given anesthesia, make sure the part of the body to be operated on is marked, and make sure everyone on the surgical team knows if the patient has an allergy.
• Before the surgeons cut, make sure everyone in the operating room knows one another and what their roles will be during the operation, and confirm that all the needed X-rays and scan images are in the room.
• After surgery, check that all the needles, sponges and instruments are accounted for.
That checklist was tested in 2007-08 in eight cities around the world: Seattle; Toronto; London; New Delhi; Auckland, New Zealand; Amman, Jordan; Manila, Philippines; and Ifakara, Tanzania. (Heart and pediatric cases were excluded.)
Before the checklist was introduced, 1.5 percent of patients in a comparison group died within 30 days of surgery at the eight hospitals. Afterward, the rate dropped to 0.8 percent — a 47 percent decrease.
The biggest decreases were in developing countries, with the combined death rate for Jordan, India, Tanzania and the Philippines falling 52 percent. There was no significant difference in deaths in the wealthiest countries.
Overall, major complications dropped from 11 percent to 7 percent. Again, the biggest decreases were in the lower-income countries.
"What we're seeing is the benefits of good team work and coordinated care," Haynes said.
The results were so dramatic that Dr. Peter Pronovost, a Johns Hopkins University doctor who proved in a highly influential study a few years ago that checklists could cut infection rates from intravenous tubes, said he was skeptical of the findings.
One possible flaw, he said, is that "you had people who bought into the system collecting their own data."
The researchers acknowledged it is possible that the results were partly because people perform better when they know they're being watched.
However, the 19-point checklist is already being adopted. Ireland, Jordan, the Philippines and Britain have recently established nationwide programs to have the checklist used in all operating rooms.
In the U.S., the Joint Commission, which accredits most hospitals and sets standards for them, said it is considering adopting more of the steps. The agency already requires three of them, including marking the incision site and pausing before surgery to make sure everything is in place.
At least one patient in the study at the University of Washington Medical Center in Seattle welcomed the checklist.
Darrell McDonald, 63, had a hernia operation in March. A longtime bush pilot in Alaska, he followed a checklist before every takeoff, including checking the controls and walking around the propeller-driven plane "to make sure nothing is getting ready to fall off."
So McDonald was fine with his doctor writing on his body where the incision would be. He had no problems with repeated inquiries about who he was and why he was there. He applauded measures such as a poster-size checklist hanging from an IV pole in the operating room.
"It eliminates the little bit that could possibly go wrong," he said. |
| 6/5/2008 |
Surgical Tools staff receives hands-on training at Medicon World Meeting |
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Surgical Tools staff recently traveled to Bavaria for the 2008 Medicon World Meeting. The conference showcased new Medicon products including an updated Cranio-Maxillo-Facial line, Orthopedics, and the new Servotronic Micro-Motor System.
Workshops provided hands on training for a variety of Medicon products, including a mock lumbar microdiscectomy surgery hosted by Dr. Luca Papavero using the new Piccolino spreading system.
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| 2/1/2008 |
Finnish patient gets new jaw from own stem cells |
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HELSINKI (Reuters) - Scientists in Finland said they had replaced a 65-year-old patient's upper jaw with a bone transplant cultivated from stem cells isolated from his own fatty tissue and grown inside his abdomen.
Researchers said on Friday the breakthrough opened up new ways to treat severe tissue damage and made the prospect of custom-made living spares parts for humans a step closer to reality.
"There have been a couple of similar-sounding procedures before, but these didn't use the patient's own stem cells that were first cultured and expanded in laboratory and differentiated into bone tissue," said Riitta Suuronen of the Regea Institute of Regenerative Medicine, part of the University of Tampere.
She told a news conference the patient was recovering more quickly than he would have if he had received a bone graft from his leg.
"From the outside nobody would be able to tell he has been through such a procedure," she said.
She added, the team used no materials from animals -- preventing the risk of transmitting viruses than can be hidden in an animal's DNA, and followed European Union guidelines.
Stem cells are the body's master cells and they can be found throughout the blood and tissues. Researchers have recently found that fat contains stem cells which can be directed to form a variety of different tissues.
Using a patient's own stem cells provides a tailor-made transplant that the body should not reject.
Suuronen and her colleagues -- the project was run jointly with the Helsinki University Central Hospital -- isolated stem cells from the patient's fat and grew them for two weeks in a specially formulated nutritious soup that included the patient's own blood serum.
In this case they identified and pulled out cells called mesenchymal stem cells -- immature cells than can give rise to bone, muscle or blood vessels.
When they had enough cells to work with, they attached them to a scaffold made out of a calcium phosphate biomaterial and then put it inside the patient's abdomen to grow for nine months. The cells turned into a variety of tissues and even produced blood vessels, the researchers said.
The block was later transplanted into the patient's head and connected to the skull bone using screws and microsurgery to connect arteries and veins to the vessels of the neck.
The patient's upper jaw had previously been removed due to a benign tumor and he was unable to eat or speak without the use of a removable prosthesis.
Suuronen said her team had submitted a report on the procedure to a medical journal to be reviewed.
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| 2/1/2008 |
Roanoke hopes to reap research rewards |
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A joint project between Virginia Tech and Carilion Clinic is expected to have quite an economic impact.
A proposed medical research institute near downtown Roanoke could create 350 jobs over the next six years and annually pump tens of millions of dollars into the local economy, according to new details of a joint project between Virginia Tech and Carilion Clinic.
Tech officials say about 150 of the new workers will fill core research positions and earn salaries of $90,000, nearly triple the average yearly wage in Roanoke.
The project will occupy about two-thirds of a $59 million building it will share with the medical school at the Riverside Center for Research and Technology on South Jefferson Street.
"The research institute is probably a bigger part of the plan than the medical school itself," said Roderick Hall, an associate vice president for research at Tech. "But the medical school is critical to undertake research work."
Besides the 150 new research jobs, the university plans to fill the remaining 200 positions with support staff with salaries of about $40,000 a year, Hall said.
To pay for those salaries, Tech is looking to bring in $30 million a year in grant-funded research projects by 2014 and attract the kinds of scientists now going to the "UVas, Dukes and Wake Forests of the world," Hall said.
If the projections are close, the combination of the two is destined to become a catalyst for new-business formation and could help jump-start Roanoke's fledging medical research industry, according to analysts and economic development officials.
Research will focus on real-world applications
Virginia Tech and Carilion are seeking state funding to pay for the new building, and the governor's office included $59 million for the project in a taxpayer-supported bond proposal winding its way through the General Assembly.
If lawmakers approve the current bond package, voters could approve it in November. However, one lawmaker has introduced a bill to fast-track delivery of the money by bypassing the need for voter support.
Tech and Carilion estimate the startup costs for the research institute at about $50 million. Another $20 million will go toward establishing the medical school. Those figures are separate from the costs of the building.
The startup costs will come from a combination of private gifts and investments from Carilion, Hall said.
Tech Provost Mark McNamee said the institute will help link the two institutions by focusing on translational medical research -- academic work that has real-world applications in patient care at Carilion.
"You're taking research discoveries and trying, almost from the beginning, to find ways to apply them to the clinical practice," McNamee added.
The university already has various pockets of federally funded medical research taking place in biomedical engineering and through its collaboration with an osteopathic medical school in Blacksburg.
But its expansion in Roanoke is part of a broader strategy to beef up the university's human health programs so it can better compete for federal funding from the National Institutes of Health, Hall said. NIH is the nation's largest funder of medical research.
The planned medical campus is also a piece of Carilion's long-standing vision to transform the 27-acre business park, which it owns, into a hub for cutting-edge health care research and education.
Virginia Tech already has located an obesity research laboratory at the center. It joined with Carilion last year to open the lab, which is supported through federal grants, in the center's only office building.
It now employs seven, including a primary researcher.
Once the medical campus is established, Virginia Tech plans to take full ownership of the new institute, while the medical school will become an independent nonprofit organization with its own board of directors, Hall said.
In the meantime, Virginia Tech and Carilion continue to move forward with plans to begin construction as early as this summer.
Hall said Tech expects to name a director for the institute within the next month and plans to have more than half of the institute's 43 research teams in place by the time the medical college enrolls its first class in 2010.
By the fourth year, the university expects the researchers to draw funding for their teams entirely through federal grant money, Hall said.
Officials: Institute will drive regional economy
Economic development leaders in Roanoke say they can't remember another new employer announcing jobs with such high wages.
"Generally, we're in the $30,000 to $35,000 range," said Phil Sparks, executive director of the Roanoke Valley Economic Development Partnership.
In fact, only 5 percent of Roanoke residents earned salaries above $75,000 in 2006, according to the U.S. Census Bureau.
And while few hundred more jobs are not going to increase the region's total job numbers dramatically, the salaries will likely raise the economic base in the city, said Bill Mezger, chief economist for the Virginia Employment Commission.
The total job count for the Roanoke metropolitan region is about 166,000, he said.
For one, high-paying jobs can have a significant impact on housing, said Brian Brown, Roanoke's economic development administrator.
"Many of those people will want to live in the city itself and higher salaries lead to higher housing prices," he said.
The types of jobs also dovetail with the city's goal of attracting more young professionals to the area, Brown said.
If all the 150 research positions are filled, the institute will triple the number of scientific research workers in the city, said Christine Chmura, a Richmond-based economist and founder of Chmura Economics & Analytics.
Right now, only 51 people working in Roanoke are described as providing scientific research and development, Chmura said. The average salary for this work in the area is $56,800 while the state average is closer to $89,000, she said.
"Any time you bring in a firm that pays wages higher than the average for the region, it is good news. It tends to lift the living standards in the area. It tends to provide demand for services," Chmura said.
A costly endeavor that few undertake
The still-unnamed institute may also draw other companies, such as suppliers, to the city, Chmura said.
"So that could add to a positive ripple effect to this expansion," she said.
So far, neither Carilion nor Virginia Tech has released projections for the medical school's employee totals.
Provost McNamee said he anticipates the core faculty for the medical college will remain in the dozens and that most of the teaching staff will come from existing employees at Carilion and Virginia Tech.
But according to studies by Pittsburgh research company Tripp Umbach, a new medical school can have an economic impact of anywhere from $150 million to $200 million annually after its fourth year of operation. Plus, the research institute's ability to secure federal grant money will add to money flowing into the local economy from outside sources.
"Those are fresh dollars coming from out of state," said Paul Umbach, president and founder of Tripp Umbach, which studies the economic impact of new medical schools.
The money will likely trickle down to other sectors of the economy, such as housing, retail and restaurants, and come in through events, conferences and people visiting the medical campus, he said.
At the same time, developing a research center alongside a new medical college is a costly endeavor that few other academic institutions nationwide are willing to take on.
Most universities establish the medical school first and later focus on building the pricier laboratory space required for research programs.
"You're looking at spending twice as much for a research building," Umbach said, noting that for many new medical schools that cost is prohibitive.
Yet, he added: "If you have it to spend, it's not a bad investment."
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| 2/1/2008 |
Best U.S. Hospitals, 2007 |
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Follow the link below to see U.S. News & World Report listings of America's best hospitals for 2007.
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| 1/31/2008 |
Top-Rated Hospitals Continue to Deliver Better Care |
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(HealthDay News) - Patients admitted to the top-rated hospitals in the United States have an average 27 percent lower risk of dying than patients admitted to other hospitals in the country, a new study shows.
Released Thursday by HealthGrades, an independent health-care ratings organization, the analysis of 27 procedures and diagnoses also found that patients who have surgery at the top-rated hospitals have an average 5 percent lower risk of complications during their hospital stay.
For this study, researchers analyzed nearly 41 million hospitalizations in 2004, 2005 and 2006 at all 4,971 of the nation's non-federal hospitals. If all hospitals had the quality of care of the top 5 percent of those hospitals, 171,424 lives may have been saved, and 9,671 major complications may have been avoided during the three years studied.
The study also found that the top 5 percent of hospitals lowered their in-hospital risk-adjusted death rates over those three years by an average of 15 percent.
The procedures and diagnoses included in the analysis included: cardiac surgery; angioplasty and stenting; heart attack; heart failure; atrial fibrillation; chronic obstructive pulmonary disease; community-acquired pneumonia; stroke; abdominal aortic aneurysm repair; bowel obstruction; gastrointestinal bleeding; pancreatitis; diabetic acidosis and coma; pulmonary embolism; and sepsis.
Dr. Samantha Collier, HealthGrades chief medical officer, said, "The data in this year's study clearly indicates that the gap between top-performing hospitals and others persists. This disparity in the quality of care at U.S. hospitals is disappointing."
The top-rated hospitals "have proven that consistently delivering top-notch medical care is possible, and it is time for the rest to follow suit," Collier said in a prepared statement.
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| 1/14/2008 |
Study: Cholesterol Drug Zetia Doesn't Cut Heart Attack Risk |
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(HealthDay News) - The long-awaited results of a trial of Zetia, a cholesterol-lowering drug prescribed to about a million Americans, shows the drug confers no medical benefit to users.
In fact, the pace at which artery-clogging plaques formed within vessels almost doubled in patients taking Zetia (ezetimibe) along with another cholesterol-lowering drug, Zocor (simvastatin), compared to those taking Zocor alone, the study found.
The two medications -- ezetimibe plus simvastatin -- are also marketed in one prescription pill, called Vytorin. About 60 percent of U.S. patients who are taking Zetia now receive the drug as part of Vytorin.
But the new two-year trial of 720 patients sheds doubt on whether it makes any sense for people battling cholesterol to take Vytorin versus Zocor alone, experts said. The study was funded by the two companies that make Zetia, Merck and Schering-Plough.
"This wraps it up," said Dr. Steven E. Nissen, chairman of cardiology at the Cleveland Clinic. "That's all there is. There just isn't any evidence that adding ezetimibe to simvastatin produces any advantage."
No one is disputing that Zetia can lower levels of LDL "bad" cholesterol by 15 percent to 20 percent -- that had been shown in previous trials. However, whether that reduction led to any greater lowering of heart attack or stroke risk had remained unclear.
The new ENHANCE trial -- which involved patients with a genetic condition that causes abnormally high levels of blood cholesterol -- found no such added benefit. According to a statement released by the two drug companies Monday, researchers found no statistically significant difference in heart attacks or stroke among trial participants who took Zetia plus Zocor, a widely used cholesterol-lower drug, versus those who got Zocor alone.
The study also noted that the speed at which arteries thickened with plaque almost doubled among those on the two-drug regimen compared to those taking Zocor alone.
Safety profiles were similar for Zetia/Zocor versus Zocor alone, the team added.
"These results are very important considerations on how we treat patients with elevated cholesterol and will very likely impact the way we choose drugs to lower cholesterol and eliminate plaque," said Dr. Howard Weintraub, clinical director of the Center for the Prevention of Cardio-Vascular Disease at New York University Medical Center, New York City, and clinical associate professor at the NYU School of Medicine.
"ENHANCE found that plaque got slightly worse when the drug combination was used," Weintraub noted in a statement. "But, the real take-home message here is that getting LDL down is important, and that's not something that should be lost as a consequence of this study."
The ENHANCE study was completed in April 2006, but the results were only released Monday by Merck and Schering-Plough after continual prodding by medical professionals. According to The New York Times, the companies had initially planned to release the findings by March 2007, but then missed several self-imposed deadlines, blaming the delay on the complexities of necessary data analysis.
Now that the results have arrived, Zetia and Vytorin should be viewed as "drugs of last resort," for patients not helped by standard statin therapy, Nissen said. Only if you can't tolerate full doses of simvastatin should you take ezetimibe, he said.
"This is one of the most widely advertised and widely used drugs out there, so it's obviously good to get these study results," Nissen added.
Another group questioned why patients should be prescribed more expensive cholesterol-lowering drugs, such as Vytorin, versus cheaper, generic statins such as Zocor.
"We already know that millions of people who take these brand drugs probably don't need to; they could be taking a less expensive generic instead. This study lends support to that cost-saving strategy for the health system and for consumers," said Steven Findlay, managing editor of Consumer Reports Best Buy Drugs, a public information and education project of Consumers Union, publisher of Consumer Reports.
"If there is no apparent clinical benefit, why take a drug that cost three or four times more?" Findlay said in a statement. "Most people do not need that magnitude of cholesterol reduction anyway."
Sales of Zetia and Vytorin totaled $3.7 billion in the nine months ending Sept. 30, up 33 percent from a year ago. Analysts estimate that about 70 percent of Schering-Plough's earnings depend on the drugs, the Times noted.
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| 9/1/2007 |
Surgical Tools on hit TV show, "Crossing Jordan" |
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NBC studios has recently purchased Surgical Tools Medicon branded instruments for use on the popular television series, "Crossing Jordan". The hit drama heads into its fifth season by exploring disturbing topical crimes and offenses with a cadre of coroners eager to offer their forensic skills to the police in order to bring murderers to justice and closure to the families of victims. Jill Hennessy (NBC's "Law&Order") stars as Dr. Jordan Cavanaugh, a sexy, smart and fearless Boston medical examiner with a checkered career past who works under the guidance of Dr. Garret Macy (Miguel Ferrer, "Traffic").
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| 7/30/2005 |
surgicaltools.com offers net 30, 2% 10 day terms to qualified customers |
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surgicaltools.com is pleased to offer 30 day payment terms to qualified customers. Hospital, Medical Center, and Pre-approved customers may now elect online at the time of purchase to pay by credit card, wire transfer of funds, or to be invoiced for their order. Invoice terms are net 30 days, with an attractive 2% prompt payment discount applied if payment is remitted within 10 days.
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