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July 2013 Briefing - Surgery

Here are what the editors at HealthDay consider to be the most important developments in Surgery for July 2013. This roundup includes the latest research news from journal articles, as well as the FDA approvals and regulatory changes that are the most likely to affect clinical practice.

After Hip Replacement, Aspirin Cost-Effective for VTE Prophylaxis

WEDNESDAY, July 31 (HealthDay News) -- Aspirin is a cost-effective choice for prophylaxis of venous thromboembolism (VTE) following total hip arthroplasty, but the choice of aspirin versus low-molecular-weight heparin (LMWH) for patients younger than 80 years undergoing total knee arthroplasty is unclear, according to research published in the July 17 issue of The Journal of Bone & Joint Surgery.

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Lung-Protective Ventilation Ups Outcomes Post-Abdominal Op

WEDNESDAY, July 31 (HealthDay News) -- For patients at intermediate to high risk of pulmonary complications after major abdominal surgery, lung-protective ventilation with the use of low tidal volumes and positive end-expiratory pressure is associated with improved clinical outcomes, according to a study published in the Aug. 1 issue of the New England Journal of Medicine.

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Health 'Mutual Accountability' Pilot Program Launching

WEDNESDAY, July 31 (HealthDay News) -- The State of Oklahoma Office of Management and Enterprise Services has chosen MedEncentive to conduct a three-year heath improvement program pilot among HealthChoice beneficiaries.

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OK to Continue Aspirin Therapy Up to Pancreatic Surgery

WEDNESDAY, July 31 (HealthDay News) -- Patients on aspirin therapy do not have higher rates of perioperative bleeding, transfusion, or major procedure-related complications following elective pancreatic surgery, according to research published online July 26 in Surgery.

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Surgery Not Needed With All Abnormal Breast Lesions

WEDNESDAY, July 31 (HealthDay News) -- Women with atypical lobular hyperplasia (ALH) or lobular carcinoma in situ (LCIS) biopsy findings can be safely observed when careful radiologic-pathologic correlation for concordance is established, according to research published online July 30 in Radiology.

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Risk Factors for Lumbar Spine Fx ID'd in U.S. Military Cohort

TUESDAY, July 30 (HealthDay News) -- The overall incidence rate of lumbar fractures was 0.38 per 1,000 person-years from 2001 to 2010 among a U.S. military cohort, according to a study published in the June issue of the Journal of Spinal Disorders & Techniques.

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Reversal of Medical Practices Common Over Past Decade

TUESDAY, July 30 (HealthDay News) -- Over 100 contemporary medical practices have subsequently been reversed over the last 10 years, according to a review published online July 22 in Mayo Clinical Proceedings.

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Spondylolisthesis Sx Improves Pediatric Health Related-QOL

TUESDAY, July 30 (HealthDay News) -- In pediatric patients with high-grade spondylolisthesis, health-related quality of life (HRQOL) improves significantly after surgery, especially in patients with low baseline HRQOL scores, according to a study published in the July issue of The Spine Journal.

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Aids Help Decision Making for Prostate Cancer Screening

TUESDAY, July 30 (HealthDay News) -- A print and web-based decision aid helps men with their decision making about prostate cancer screening, but does not affect screening rates, according to a study published online July 29 in JAMA Internal Medicine.

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Back Pain Management Relying on Guideline Discordant Care

TUESDAY, July 30 (HealthDay News) -- Management of back pain is increasingly relying on guideline discordant care, including narcotic use, advanced imaging, and referrals to physicians, according to research published online July 29 in JAMA Internal Medicine.

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After Cervical Disc Surgery Pro Athletes Can Return to Sports

MONDAY, July 29 (HealthDay News) -- Professional athletes may return to full contact sports following a single-level anterior cervical discectomy and fusion (ACDF), according to research published in the July issue of Neurosurgery.

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Equipment, Technology Contribute to Errors in the OR

FRIDAY, July 26 (HealthDay News) -- Equipment-related failures account for a substantial proportion of errors occurring in the operating room (OR), and checklists may reduce these errors, according to a review published online July 25 in BMJ Quality & Safety.

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Duodenum May Be Used for Biliary Reconstruction

FRIDAY, July 26 (HealthDay News) -- Duodenal anastomosis is a safe and effective method for biliary reconstruction, according to research published online July 24 in JAMA Surgery.

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Review Defines New Fracture Risk Factors Post-Vertebroplasty

THURSDAY, July 25 (HealthDay News) -- Patients with low bone mineral density (BMD), low body mass index (BMI), and intradiscal cement leakage are at risk for new osteoporotic vertebral compression fractures (VCFs) after vertebroplasty, according to a review published in the June issue of the Journal of Spinal Disorders & Techniques.

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IOM Confirms Geographic Variation in Health Spending

THURSDAY, July 25 (HealthDay News) -- Considerable geographic variation exists in health care spending and utilization, but a geographically-based value index is unlikely to promote value improvement, according to a report published July 24 by the Institute of Medicine.

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Docs Need to Follow Patients' Lead, Embrace Social Media

WEDNESDAY, July 24 (HealthDay News) -- As more patients discuss and manage their health care online, doctors need to keep up and use social media, according to a report published by the American Medical Association (AMA).

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Rabies, Fatal Encephalitis Caused by Donated Kidney

WEDNESDAY, July 24 (HealthDay News) -- Eighteen months after receiving a kidney transplant, a recipient died from acute progressive encephalitis caused by rabies infection that had been undiagnosed in the donor, according to research published in the July 24/31 issue of the Journal of the American Medical Association.

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U.S. Physicians Not Supportive of Changes in Payment Models

TUESDAY, July 23 (HealthDay News) -- U.S. physicians accept some responsibility for reducing health care costs in their practice, but most do not want to change payment models, according to research published in the July 24/31 issue of the Journal of the American Medical Association.

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Pros and Cons of Electronic Cigarette Regulation Discussed

TUESDAY, July 23 (HealthDay News) -- The pros and cons of electronic cigarette (EC) regulation are discussed in to two editorials published online July 23 in The Lancet Respiratory Medicine.

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Incidence of Cardiac Events in Lumbar Spine Surgery ID'd

MONDAY, July 22 (HealthDay News) -- The overall incidence of cardiac complications is 6.7 per 1,000 lumbar spine surgical procedures, and complications are more frequent with lumbar fusion versus decompression, according to a study published in the July 15 issue of Spine.

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Premiums Expected to Be About 20 Percent Lower in 2014

MONDAY, July 22 (HealthDay News) -- Premiums in the Health Insurance Marketplace are likely to be about 20 percent lower than anticipated in 2014, according to a report published by the U.S. Department of Health and Human Services (HHS).

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Full-Moon Cycle Favorable in Aortic Dissection Repair

MONDAY, July 22 (HealthDay News) -- For patients undergoing ascending aortic dissection repair, season has no significant effect on mortality, while the full-moon cycle seems to be associated with reduced odds of death and a shorter length of stay (LOS), according to a study published online July 9 in Interactive Cardiovascular and Thoracic Surgery.

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Tablets Help Physicians Keep Up With Medical Research

MONDAY, July 22 (HealthDay News) -- Most physicians find keeping up with the latest research to be challenging, but the use of tablets and smartphones may help, according to a report published by Wolters Kluwer Health.

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Chemoprophylaxis Found to Be Safe After Spine Trauma Surgery

FRIDAY, July 19 (HealthDay News) -- Thromboembolic chemoprophylaxis seems to be safe and efficacious in at-risk trauma patients having spinal stabilization surgery, according to a retrospective review published in the July 15 issue of Spine.

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Missed Diagnoses, Med Errors Most Common Malpractice Claims

FRIDAY, July 19 (HealthDay News) -- The most common medical misadventures resulting in malpractice claims in primary care are missed or delayed diagnoses and medication errors, according to a review published online July 18 in BMJ Open.

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Pre-Op Anemia Tied to Adverse Outcomes in Elective Spine Sx

FRIDAY, July 19 (HealthDay News) -- Preoperative anemia is significantly associated with adverse perioperative and postoperative outcomes following elective spine surgery, according to a study published in the July 1 issue of Spine.

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Top Challenges for Docs Include Financial Management

FRIDAY, July 19 (HealthDay News) -- The top issues and challenges facing physicians include managing changing reimbursement models with payors and financial management, according to a report published by Wolters Kluwer Health.

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Decision Aid Reduces Conflict in Breast Cancer Treatment

FRIDAY, July 19 (HealthDay News) -- Chinese women considering surgery for breast cancer have less decisional conflict and subsequent regret if they receive an educational take-home booklet to involve them in decision making, according to a study published online July 8 in the Journal of Clinical Oncology.

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Intelligent Knife IDs Tumor Biochemistry During Resection

THURSDAY, July 18 (HealthDay News) -- For patients undergoing tumor resection, the coupling of rapid evaporative ionization mass spectrometry (REIMS) with electrosurgery, an approach known as the intelligent knife (iKnife), has been validated as an intraoperative approach to accurately identify tissue, according to a study published in the July 17 issue of Science Translational Medicine.

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Medicaid Insurance Linked to Post-Spine Sx Complications

THURSDAY, July 18 (HealthDay News) -- Spine surgery patients who are covered by Medicaid have a significantly increased likelihood of complications compared with privately insured patients, according to a study published in the July 15 issue of Spine.

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Gastric Surgery in Diabetes Changes Stimulus Response

WEDNESDAY, July 17 (HealthDay News) -- In obese patients with type 2 diabetes, gastric bypass surgery changes the postprandial response, improving glucose tolerance, β-cell function, and insulin sensitivity while worsening endogenous glucose production in response to a stimulus, according to a study published online July 8 in Diabetes.

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Epidural During/Post Spine Surgery Gives Better Outcomes

WEDNESDAY, July 17 (HealthDay News) -- In patients undergoing reconstructive spine surgery, combined epidural and general anesthesia results in better pain control and other outcomes compared with general anesthesia plus narcotics, according to a study published in the July 1 issue of Spine.

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Financial Incentives Can Drive Health IT Adoption

WEDNESDAY, July 17 (HealthDay News) -- Financial incentives can drive providers' adoption of health information technology, including e-prescribing, according to a study published in the July issue of Health Affairs.

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Redesign of Medical Education Needed for Chronic Disease Era

TUESDAY, July 16 (HealthDay News) -- Medical education programs should be redesigned to address the current complex chronic disease era, with emphasis on appropriate basic sciences and clinical skills, according to a special communication published online July 15 in JAMA Internal Medicine.

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Early Surgery No Benefit in Prosthetic Valve Endocarditis

TUESDAY, July 16(HealthDay News) -- For patients with prosthetic valve endocarditis (PVE), early valve replacement is not associated with lower mortality versus medical therapy, after adjustment for clinical characteristics and survival bias, according to a study published online July 15 in JAMA Internal Medicine.

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CMS Medicare Physician Fee Schedule Could Benefit Docs

TUESDAY, July 16 (HealthDay News) -- The Centers for Medicare and Medicaid Services has released the 2014 proposed Medicare physician fee schedule, which could help create a more equitable payment system by adjusting misvalued codes and proposing new complex management codes, according to a report published by American Academy of Family Physicians.

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Improvements Made to CMS Online Directory of Physicians

TUESDAY, July 16 (HealthDay News) -- The Centers for Medicare and Medicaid Services (CMS) has reworked and redesigned their online directory of physicians (Physicians Compare) after errors were discovered throughout the site.

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Uterine Massage Doesn't Cut Post-Delivery Blood Loss

TUESDAY, July 16 (HealthDay News) -- For women who deliver vaginally, the addition of transabdominal uterine massage to oxytocin following the delivery of the placenta does not reduce blood loss compared with oxytocin alone, according to a study published online July 8 in Obstetrics & Gynecology.

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EHRs May Slow Growth in Ambulatory Health Care Costs

MONDAY, July 15 (HealthDay News) -- Adoption of electronic health records (EHRs) modestly slows growth in ambulatory health care costs, according to research published in the July 16 issue of the Annals of Internal Medicine.

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More Job Opportunities Available for Physicians

MONDAY, July 15 (HealthDay News) -- More than half of physicians are receiving up to three employment solicitations per week, according to a report published by American Medical Association (AMA).

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AMI Up With Stress-Induced Hyperglycemia After Hip Fx

MONDAY, July 15 (HealthDay News) -- For patients after hip fracture, stress-induced hyperglycemia is associated with an increased risk of acute myocardial infarction (AMI), according to a study published online July 11 in Diabetes Care.

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CMS Proposes New Rule for Outpatient Payment Policies

MONDAY, July 15 (HealthDay News) -- A new rule proposes updating Medicare payment policies and rates for the hospital outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) services, according to a report issued by the Centers for Medicare and Medicaid Services.

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Lower Extremity Amputations Fall in Medicare Patients

FRIDAY, July 12 (HealthDay News) -- During the past decade, the use of lower extremity amputations (LEAs), particularly proximal amputations, in Medicare patients has declined markedly, and the use of orthopedic treatments for diabetic foot ulcer (DFU) has increased sharply, according to research published in the July issue of Foot & Ankle International.

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Physicians Frustrated by Third-Party Interference

FRIDAY, July 12 (HealthDay News) -- Third-party interference is the most commonly cited key frustration for physicians, according to the results of a survey published in Physicians Practice.

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AMA Offers Guidance for Improving EHR Effectiveness

FRIDAY, July 12 (HealthDay News) -- The American Medical Association (AMA) House of Delegates has voted for policies to help physicians navigate patient interaction while using electronic devices and to improve the interoperability of electronic health records (EHRs).

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Phone Call OK Instead of Visit for Routine Post-Op Follow-Up

FRIDAY, July 12 (HealthDay News) -- A telephone visit can be safely substituted for the standard clinic visit as postoperative follow-up for certain types of ambulatory surgery, and most patients report a high degree of satisfaction, according to research published online on July 10 in JAMA Surgery.

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Smoker Status Not Linked to Poor Outcome in Spine Surgery

FRIDAY, July 12 (HealthDay News) -- Smoking, by itself, is not associated with adverse outcomes in elective spinal surgery, but current smokers with more than 60 pack-years are more likely to die within 30 days of surgery than never smokers, according to research published in the July 1 issue of Spine.

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Health Searches May Be Leaked to Third Parties

THURSDAY, July 11 (HealthDay News) -- Free health-related websites often have third-party tracking elements and leak search terms to third-party tracking entities, unlike U.S. government or physician-oriented websites, according to a research letter published online July 8 in JAMA Internal Medicine.

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Grants of $150 Million for Community Health Centers

THURSDAY, July 11 (HealthDay News) -- Grants totaling $150 million are to be shared by 1,100 community health centers to help enroll patients in insurance programs, according to the U.S. Department of Health and Human Services (HHS).

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U.S. Adults Value Health Care Provider Skill Evaluation

THURSDAY, July 11 (HealthDay News) -- Most adults feel that health care providers who treat them should adhere to a recertification program, including passing examinations, attending educational programs, and undergoing certification, regardless of time in practice, according to a report published by the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) and the Citizen Advocacy Center.

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Full, Limited Range of Motion Extension Exercise Benefit LBP

THURSDAY, July 11 (HealthDay News) -- A 12-week training program with isolated lumbar extension resistance training with either full range of motion (FullROM) or limited ROM (LimROM) increases full ROM lumbar extension strength and improves perceived pain and disability in patients with chronic low back pain, according to a study published in the July 1 issue of Spine.

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Docs Don't Often Talk to Patients About Dietary Supplements

THURSDAY, July 11 (HealthDay News) -- Although primary care physicians are discussing dietary supplements with patients during outpatient visits, these exchanges happen infrequently, according to research published in the June issue of Patient Education and Counseling.

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One in Five U.S. Adults Will Have Trouble Paying Medical Bills

THURSDAY, July 11 (HealthDay News) -- About one in five U.S. adults will have problems paying health care bills in 2013, including about 10 million adults with year-round insurance coverage, according to a report published by the American Medical Association (AMA).

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Quality Metrics Play Small Role in Physician Compensation

THURSDAY, July 11 (HealthDay News) -- Quality measures play a small but emerging role in physician compensation, according to a report published by the Medical Group Management Association (MGMA).

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In 2010, Blood Transfusion Most Frequent Hospital Procedure

THURSDAY, July 11 (HealthDay News) -- The most frequent procedure performed during hospitalization in 2010 was blood transfusion, which was common among all age groups except for infants, according to the Agency for Healthcare Research and Quality (AHRQ).

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Red Cross Issues Emergency Call for Blood Donors

THURSDAY, July 11 (HealthDay News) -- The American Red Cross has issued an emergency request for blood and platelet donors of all blood types, according to report posted July 9.

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Operating Room Wait Time Increases Infection Risk

WEDNESDAY, July 10 (HealthDay News) -- The risk of surgical site infections (SSIs) is significantly elevated with lengthier waits in the operating room prior to surgical incision, according to a study published in the July 1 issue of Spine.

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Autologous Fat Grafting Common in Breast Surgery

WEDNESDAY, July 10 (HealthDay News) -- Fat grafting is commonly used in reconstructive surgeries of the breast, according to research published in the July issue of Plastic and Reconstructive Surgery.

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Patients Overestimate Spine Surgeons' Compensation

WEDNESDAY, July 10 (HealthDay News) -- Patients overestimate both what they think spinal surgeons should be reimbursed and the actual amount that Medicare reimburses, according to a study published in the July 1 issue of Spine.

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Improvement Needed in Drug Post-Marketing Studies

WEDNESDAY, July 10 (HealthDay News) -- Since the requirement in 2007 that drug makers conduct post-marketing studies, the number of studies not yet started has declined while the number of studies fulfilling obligations has nearly doubled, according to a report published in the July 10 issue of the Journal of the American Medical Association. However, more than 40 percent of studies had not yet been started in 2011, and the number of studies with delays doubled as of 2011.

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Improvements Noted in U.S. Health From 1990 to 2010

WEDNESDAY, July 10 (HealthDay News) -- From 1990 to 2010, considerable progress has been made in improving health in the United States, according to a report published online July 10 in the Journal of the American Medical Association.

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Tablets More Useful Than Smartphones for Docs Using EHRs

WEDNESDAY, July 10 (HealthDay News) -- Although tablets are less often used by physicians than smartphones, they are more frequently used for accessing electronic health records (EHRs), and time spent on tablets is much higher, according to two reports published by AmericanEHR Partners.

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Health Insurance Marketplaces Not Required to Verify Claims

WEDNESDAY, July 10 (HealthDay News) -- Health insurance marketplaces will not be required to verify consumers' income and health insurance status and can rely on self-reported information, the Obama administration announced Friday.

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Digital Divide Plagues Underserved Areas

TUESDAY, July 9 (HealthDay News) -- Electronic health record (EHR) adoption is uneven, with traditionally underserved areas having lower adoption rates across the United States, according to a study published online June 26 in Health Services Research.

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Geographic Variation in Use of Cardiovascular Procedures

TUESDAY, July 9 (HealthDay News) -- There is considerable geographic variation in the use of cardiovascular procedures among Medicare Advantage beneficiaries and Medicare fee-for-service (FFS) beneficiaries, according to a study published in the July 10 issue of the Journal of the American Medical Association.

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Adoption of Electronic Health Records Is Progressing

TUESDAY, July 9 (HealthDay News) -- In 2012, 44 percent of hospitals reported having at least a basic electronic health record (EHR), according to an annual report published by the Robert Wood Johnson Foundation.

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Rural Program Affects Choice of Surgical Practice

TUESDAY, July 9 (HealthDay News) -- Surgical residents who complete a rural surgery rotation are much more likely to enter general surgery practice and practice in a rural area, even if they had initially planned to specialize, according to research published online July 3 in JAMA Surgery.

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Remote Training Feasible, Effective for Surgical Skills

MONDAY, July 8 (HealthDay News) -- Remote teaching of surgical skills is feasible and effective in low-resource areas, according to a study published in the July issue of Obstetrics & Gynecology.

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Practices Are Not Ready for Implementation of ICD-10

MONDAY, July 8 (HealthDay News) -- Most practices are not ready for implementation of the International Classification of Diseases, Tenth Revision (ICD-10), according to a report published by the Medical Group Management Association (MGMA).

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Challenges Noted in Identifying Poor Surgeon Performance

MONDAY, July 8 (HealthDay News) -- For some surgical specialties, the number of procedures that a surgeon performs each year is low, and consequently the chance of identifying poor performance is also low, according to research published online July 5 in The Lancet.

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Adding 'Organ Donor' to Facebook Ups Registration

FRIDAY, July 5 (HealthDay News) -- Initiation of the Facebook organ donor initiative has dramatically increased organ donor registration, according to a study published online June 18 in the American Journal of Transplantation.

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Three-Gene mRNA Signature IDs Acute Cellular Rejection

WEDNESDAY, July 3 (HealthDay News) -- A signature composed of messenger RNA (mRNA) from three genes in urinary cells can identify kidney biopsy samples showing acute cellular rejection, according to a study published in the July 4 issue of the New England Journal of Medicine.

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Melanoma Recurrence a Decade Later Not Rare

WEDNESDAY, July 3 (HealthDay News) -- Melanoma that recurs over a decade after initial treatment is not uncommon, occurring in about 7 percent of patients, and is associated with improved survival compared with that seen in patients whose tumors recur earlier, according to a study published in the July issue of the Journal of the American College of Surgeons.

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More Than 40 Percent of Docs Report Work Dissatisfaction

WEDNESDAY, July 3 (HealthDay News) -- Many physicians are dissatisfied and are unlikely to recommend the medical profession to young people, according to a report published by Jackson Healthcare.

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Obama Administration: ACA's Employer Mandate Delayed

WEDNESDAY, July 3 (HealthDay News) -- The Obama Administration is postponing a major Affordable Care Act (ACA) provision, the employer mandate, according to an announcement made Tuesday via the U.S. Department of the Treasury website.

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Home-Based Walking Intervention Beneficial in PAD

TUESDAY, July 2 (HealthDay News) -- In patients with peripheral artery disease, a home-based, group-mediated cognitive behavioral walking intervention significantly improves walking endurance and physical activity, according to a study published in the July 3 issue of the Journal of the American Medical Association.

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Docs Impact Comparative Effectiveness Research Opinion

TUESDAY, July 2 (HealthDay News) -- Doctors' support of comparative effectiveness research (CER) influences public opinion and has a greater impact on public opinion than cues from political players, according to research to be published this fall in the Journal of Health Politics, Policy and Law.

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Patients, Spinal Surgeons Differ in Expectations of Sx Outcomes

TUESDAY, July 2 (HealthDay News) -- For patients and spinal surgeons, there are frequently wide discrepancies in the expectations of the outcomes of surgery, according to a study published in the May 20 issue of Spine.

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Post-CABG Risk of Death Increased for Blacks With PAD

MONDAY, July 1 (HealthDay News) -- For patients undergoing coronary artery bypass grafting (CABG), the risk of death is higher for those with peripheral artery disease (PAD), particularly for black versus white patients, according to a study published online June 3 in the Annals of Thoracic Surgery.

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Post-Gynecologic Operation Gum Chewing Improves Bowel Motility

MONDAY, July 1 (HealthDay News) -- For patients who undergo gynecologic laparoscopic surgery, postoperative gum chewing has positive effects on bowel motility, according to a study published in the July issue of Obstetrics & Gynecology.

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