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March 2014 Briefing - Surgery

Here are what the editors at HealthDay consider to be the most important developments in Surgery for March 2014. 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.

Long-Acting Clotting Agent Approved for Form of Hemophilia

MONDAY, March 31, 2014 (HealthDay News) -- The drug Alprolix has been approved by the U.S. Food and Drug Administration as the first long-acting hemophilia B clotting agent, the FDA said in a news release.

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CDC: Invasive Cancer Diagnoses Down Slightly in 2010

FRIDAY, March 28, 2014 (HealthDay News) -- Cancer incidence declined from 2009 to 2010, according to a report published in the March 28 issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

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Pre-Op Pregabalin Best for Pain in Spinal Surgery

FRIDAY, March 28, 2014 (HealthDay News) -- Preoperative pregabalin is superior to either gabapentin or placebo for the relief of pain in patients undergoing lumbar discectomy, according to a study published in the March 15 issue of Spine.

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NCHS Estimates Health Insurance Coverage for 2013

THURSDAY, March 27, 2014 (HealthDay News) -- In the first nine months of 2013, 6.7 percent of children and 20.5 percent of adults were uninsured, according to a study published online March 27 by the National Center for Health Statistics (NCHS).

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White House Extends Affordable Care Act Enrollment Deadline

WEDNESDAY, March 26, 2014 (HealthDay News) -- Americans who've started applying for health insurance under the Affordable Care Act but can't complete the process by the March 31 enrollment deadline will be given an extension.

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1 in 25 Inpatients Has Health Care-Associated Infection Daily

WEDNESDAY, March 26, 2014 (HealthDay News) -- There were an estimated 648,000 patients with 721,800 health care-associated infections in U.S. acute care hospitals in 2011, according to research published in the March 27 issue of the New England Journal of Medicine.

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Guidance Updated for Sentinel Node Biopsy in Breast Cancer

WEDNESDAY, March 26, 2014 (HealthDay News) -- The American Society of Clinical Oncology has updated its clinical practice guideline on the use of sentinel node biopsy (SNB) in early breast cancer. The updated guideline was published online March 24 in the Journal of Clinical Oncology.

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AMA Introduces Medical Education Initiative

WEDNESDAY, March 26, 2014 (HealthDay News) -- The American Medical Association's (AMA) Accelerating Change in Education initiative is being introduced in 11 medical schools in an effort to shift the focus of education toward real-world practice and competency assessment, according to an AMA report.

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Americans Seem Unprepared for Health Insurance Exchanges

WEDNESDAY, March 26, 2014 (HealthDay News) -- Individuals in the United States seem not to be sufficiently informed about the health insurance exchanges established by the Affordable Care Act (ACA), according to a study published online March 24 in the Proceedings of the National Academy of Sciences.

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Radiofrequency Ablation Cuts Barrett's Esophagus Progression

TUESDAY, March 25, 2014 (HealthDay News) -- Radiofrequency ablation reduces the risk for neoplastic progression in patients with Barrett's esophagus with low-grade dysplasia, according to a study published in the March 26 issue of the Journal of the American Medical Association.

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Surgical Site Infection Rate Down With Lower Target Glucose

TUESDAY, March 25, 2014 (HealthDay News) -- For patients undergoing hepato-biliary-pancreatic surgery, having a lower blood glucose target (4.4 to 6.1 mmol/L) is associated with reduced incidence of surgical site infection (SSI), according to a study published online March 12 in Diabetes Care.

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Patient Request Impacts Doc Prescribing Behavior

MONDAY, March 24, 2014 (HealthDay News) -- Patients requesting specific medications are more likely to be prescribed those medications, according to research published in the April issue of Medical Care.

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Review: Recently Diagnosed Diabetes Linked to Pancreatic CA

MONDAY, March 24, 2014 (HealthDay News) -- There is a strong association between pancreatic ductal adenocarcinoma (PDAC) and recently diagnosed diabetes mellitus (DM), according to a systematic review and meta-analysis published in the March issue of the Annals of Surgical Oncology.

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Hemicraniectomy Also Beneficial for Older Patients

FRIDAY, March 21, 2014 (HealthDay News) -- For older patients with middle-cerebral-artery infarction, early decompressive hemicraniectomy increases survival without severe disability, according to a study published in the March 20 issue of the New England Journal of Medicine.

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Practices Can Take Steps to Improve Care Transitions

FRIDAY, March 21, 2014 (HealthDay News) -- Implementation of a rigorous process can improve transitions of care, according to an article published March 10 in Medical Economics.

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Blood Transfusions for Spinal Fusion Holding Steady

FRIDAY, March 21, 2014 (HealthDay News) -- Among U.S. patients undergoing spinal fusion, the rates of allogeneic blood transfusion (ALBT) increased from 2000 to 2009, while predonated autologous blood transfusion (PR-ABT) rates decreased, according to a study published in the Feb. 15 issue of Spine.

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Electrolarynx Allows Speech in Orally Intubated Patients

THURSDAY, March 20, 2014 (HealthDay News) -- An electrolarynx can be used successfully in orally intubated patients receiving mechanical ventilation, according to a letter to the editor published in the March 20 issue of the New England Journal of Medicine.

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Post-Mastectomy Radiation Beneficial With 1 to 3 Nodes

THURSDAY, March 20, 2014 (HealthDay News) -- For women with breast cancer and one to three positive lymph nodes, radiotherapy is beneficial after mastectomy and axillary dissection, according to a study published online March 19 in The Lancet.

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Living Liver Donor Consent Form Needs Standardization

THURSDAY, March 20, 2014 (HealthDay News) -- Standardization of living liver donor evaluation consent forms is needed, according to a study published online Feb. 25 in Liver Transplantation.

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Insurers Must Offer Same-Sex Couples Spousal Benefits

MONDAY, March 17, 2014 (HealthDay News) -- Health plans that offer benefits for heterosexual couples must do the same for same-sex married couples, the Obama administration says.

Other Health Highlights: March 17, 2014

Rx Expenditures Expected to Rise in 2014

MONDAY, March 17, 2014 (HealthDay News) -- Drug costs are projected to rise 3 to 5 percent across all care settings in 2014, according to a study published in the March 15 issue of the American Journal of Health-System Pharmacy.

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Better Ruptured Abdominal Aortic Aneurysm Outcomes in U.S.

MONDAY, March 17, 2014 (HealthDay News) -- Outcomes for patients with ruptured abdominal aortic aneurysm (rAAA) are better in the United States than in England, with common factors suggesting strategies for outcome improvement, according to a study published in the March 15 issue of The Lancet.

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Improving EHR Interoperability Is a National Priority: HHS

FRIDAY, March 14, 2014 (HealthDay News) -- Interoperability of electronic health record (EHR) systems is a national priority of the Office of the National Coordinator for Health Information Technology, according to an article published March 4 in Medical Economics.

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Chronic Hyperglycemia Tied to Worse Surgical Outcomes

FRIDAY, March 14, 2014 (HealthDay News) -- Chronic hyperglycemia (A1C >8 percent) is associated with poor surgical outcomes, as measured by an increased hospital length of stay (LOS), according to a study published in the March issue of Diabetes Care.

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Adoption of Surgical Safety Checklists Doesn't Cut Mortality

WEDNESDAY, March 12, 2014 (HealthDay News) -- Adoption of surgical safety checklists is not associated with significant reductions in mortality or surgical complications, according to a study published in the March 13 issue of the New England Journal of Medicine.

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AMA: CMS Wants Physician Input on Practice Transformation

WEDNESDAY, March 12, 2014 (HealthDay News) -- Physicians are being given the opportunity to describe what resources they need in order to transition to value-based models of care, according to a report published by the American Medical Association (AMA).

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Prehospital Stroke Alerts Speed Door-to-CT Times

WEDNESDAY, March 12, 2014 (HealthDay News) -- Emergency medical services (EMS) prenotification regarding the arrival of patients who have had a stroke allows patients to bypass the emergency department and undergo computed tomography (CT) in a timely manner, according to a study published in the March issue of Neurosurgery.

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Fewer Failures With Vaginal Mesh Repair in Prolapse With Avulsion

WEDNESDAY, March 12, 2014 (HealthDay News) -- For women with vaginal prolapse after hysterectomy and levator ani avulsion, Prolift Total is associated with a lower anatomical failure rate than unilateral vaginal sacrospinous colpopexy with native tissue vaginal repair (sacrospinous fixation [SSF]), according to a study published online March 11 in Ultrasound in Obstetrics & Gynecology.

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More Lumbar Sx Complications at Teaching Hospitals

WEDNESDAY, March 12, 2014 (HealthDay News) -- Patients undergoing lumbar spine surgery at teaching hospitals incur longer hospitalizations and have more postoperative complications compared to those treated at nonteaching hospitals, according to a study published in the March 1 issue of Spine.

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Medicare Drug Plan Changes Withdrawn by White House

TUESDAY, March 11, 2014 (HealthDay News) -- Proposed changes to the Medicare prescription drug program have been withdrawn by the Obama administration after strong opposition from patient groups.

Other Health Highlights: March 11, 2014

Discrepancies ID'd in Studies on ClinicalTrials.gov, Journals

TUESDAY, March 11, 2014 (HealthDay News) -- Nearly all clinical trials reported on ClinicalTrials.gov and published in high-impact journals report at least one discrepancy in cohort, intervention, or results, according to a research letter published in the March 12 issue of the Journal of the American Medical Association.

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Study Compares Transvaginal Approaches for Vaginal Prolapse

TUESDAY, March 11, 2014 (HealthDay News) -- For women undergoing surgery for vaginal prolapse and stress urinary incontinence, outcomes for two common transvaginal approaches are comparable, and perioperative behavioral therapy with pelvic floor muscle training (BPMT) does not improve surgical outcomes, according to a study published in the March 12 issue of the Journal of the American Medical Association.

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White House: More Than Four Million Have Signed Up for ACA

TUESDAY, March 11, 2014 (HealthDay News) -- More than four million Americans have signed up for health coverage through state and federal insurance marketplaces established by the Affordable Care Act, the Obama administration announced Tuesday.

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Patients Prefer Specific Info From Docs for Prostate Cancer

TUESDAY, March 11, 2014 (HealthDay News) -- Although patients with prostate cancer endorse multiple sources of information, they report greatest satisfaction with information from the treating physician about patient outcomes, according to research to be published in the May issue of The Journal of Urology.

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Pediatric Kidney Transplant Outcomes Have Improved

TUESDAY, March 11, 2014 (HealthDay News) -- Over the last 25 years, pediatric kidney transplantation outcomes have improved in the United States, according to a study published online March 10 in Pediatrics.

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Keeping Salaries Secret Harms Worker Performance

MONDAY, March 10, 2014 (HealthDay News) -- Keeping salaries secret hurts worker performance and increases turnover of top talent, according to a study published online Jan. 13 in the Academy of Management Journal.

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Diagnosis of Pseudarthrosis After Fusion Remains Difficult

MONDAY, March 10, 2014 (HealthDay News) -- There is no definitive method besides surgical exploration to make the diagnosis of pseudarthrosis following spinal fusion surgery, according to a review published in the March 1 issue of The Spine Journal.

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Gender Gap Exists in Domestic Duties of Working Physicians

FRIDAY, March 7, 2014 (HealthDay News) -- Gender differences exist in domestic activities among career-oriented academic physicians with children, according to a study published online March 3 in the Annals of Internal Medicine.

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AMA Grants Curriculum Efforts to Address Health Disparities

FRIDAY, March 7, 2014 (HealthDay News) -- Medical schools are beginning to change their curriculum to address ways to eliminate health disparities, according to the American Medical Association (AMA).

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Web-Based Mental Health Screening Feasible, Acceptable

THURSDAY, March 6, 2014 (HealthDay News) -- For patients in general hospital settings, a routine web-based mental health screening is feasible and acceptable, according to a study published in General Hospital Psychiatry.

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Drop in Compensation Gap for Primary Care Docs, Specialists

THURSDAY, March 6, 2014 (HealthDay News) -- From 2012 to 2013, there was a 5.7 percent increase in the median total cash compensation for primary care physicians, with a smaller gap seen for medical and surgical specialists, according to the results of a recent survey from SullivanCotter.

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Relative Value Units Useful In Evaluating Practice Finances

THURSDAY, March 6, 2014 (HealthDay News) -- The Relative Value Unit (RVU) is a useful tool for managing practice finances, according to an article published Feb. 25 in Medical Economics.

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Fewer Positive Margins With Robot-Assisted Prostatectomy

THURSDAY, March 6, 2014 (HealthDay News) -- Robot-assisted radical prostatectomy (RARP) is associated with improved surgical margin status compared with open radical prostatectomy (ORP) for intermediate- and high-risk disease and with less use of additional cancer therapy, according to a study published online March 4 in European Urology.

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Pre-Op Pain Patterns Affect Stenosis Surgery Outcomes

THURSDAY, March 6, 2014 (HealthDay News) -- For patients with spinal stenosis without degenerative spondylolisthesis, predominance of back pain (BP) versus leg pain (LP) is associated with worse surgical outcomes, according to a study published in the Feb. 1 issue of Spine.

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Prostatectomy Cuts Mortality in Early Prostate Cancer

THURSDAY, March 6, 2014 (HealthDay News) -- Surgical treatment reduces long-term mortality among men with localized prostate cancer compared with those who undergo watchful waiting, according to research published in the March 6 issue of the New England Journal of Medicine.

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Value-Based Insurance Plans Can Up Rx Adherence

WEDNESDAY, March 5, 2014 (HealthDay News) -- Value-based insurance design (VBID) plans with certain features aside from solely lowering cost sharing can increase medication adherence, according to a study published in the March issue of Health Affairs.

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WHO Program Improves U.S. Medical Facility Hand Hygiene

WEDNESDAY, March 5, 2014 (HealthDay News) -- For U.S. health care facilities, participation in the World Health Organization (WHO) global campaign to improve hand hygiene practices is associated with improved hand hygiene, according to a study published in the March issue of the American Journal of Infection Control.

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Gap in Regulatory Coverage Affects 5 to 16 Percent of Trials

WEDNESDAY, March 5, 2014 (HealthDay News) -- Human subjects protections (HSP) policies do not provide regulatory coverage for all clinical trials, while up to about a quarter of trials are considered overlap trials, according to a research letter published in the March 5 issue of the Journal of the American Medical Association.

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Polydeoxyribonucleotide Aids Healing of Diabetic Foot Ulcers

TUESDAY, March 4, 2014 (HealthDay News) -- The adenosine A2A receptor agonist polydeoxyribonucleotide (PDRN) facilitates healing of diabetic foot ulcers in patients with diabetes, according to a study published online Jan. 31 in the Journal of Clinical Endocrinology & Metabolism.

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Nurses Can Perform Colonoscopies As Well As Docs

TUESDAY, March 4, 2014 (HealthDay News) -- Colonoscopy quality and safety are comparable for nurse and physician endoscopy trainees, according to a study published in the March issue of Clinical Gastroenterology and Hepatology.

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Women-Specific Research Is Still Inadequate

MONDAY, March 3, 2014 (HealthDay News) -- Women are still underrepresented in medical science and research, and sex differences are often ignored, according to a report published March 3 by the Brigham and Women's Hospital.

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Persistent Post-Cardiac Surgery Pain Seen at 24 Months

MONDAY, March 3, 2014 (HealthDay News) -- For patients undergoing cardiac surgery, persistent postoperative pain decreases over time and is 9.5 percent at 24 months after surgery, according to a study published online Feb. 24 in CMAJ, the journal of the Canadian Medical Association.

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CMS: No More Delays to ICD-10 Implementation Deadline

MONDAY, March 3, 2014 (HealthDay News) -- There will be no more delays to the Oct. 1, 2014, deadline for implementation of the International Classification of Diseases, 10th Revision (ICD-10), according to an article published Feb. 27 in Medical Economics.

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Dental Extraction Pre-Cardiac Surgery Can Be Risky

MONDAY, March 3, 2014 (HealthDay News) -- For patients with planned dental extraction before cardiac surgery, the risk of a major adverse outcome is 8 percent, including a 3 percent risk of death before surgery, according to a study published in the March issue of the Annals of Thoracic Surgery.

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