September 2013 Briefing - Surgery

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

Lower National Health Spending Due to Slow Economy

MONDAY, Sept. 30 (HealthDay News) -- National health care expenditures remain sluggish but are expected to grow at a rate of approximately 6.2 percent per year after 2014, with federal, state, and local governments accounting for half, according to research published online Sept. 18 in Health Affairs.

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Only One-Third of Voters Think Congress Should Delay ACA

MONDAY, Sept. 30 (HealthDay News) -- With a government shutdown impending, only one-third of voters think that Congress should delay, defund, or repeal the health care laws set to take effect imminently, according to a report from The Morning Consult.

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Medicare, Medicaid Will Still Run If Government Shuts Down

MONDAY, Sept. 30 (HealthDay News) -- According to U.S. officials, veterans and Medicare and Medicaid recipients will continue to receive health care benefits even if the federal government shuts down on Tuesday.

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DOL Clarifies Employer Health Insurance Notification Duty

MONDAY, Sept. 30 (HealthDay News) -- The U.S. Department of Labor has provided clarification in the form of a frequently-asked-questions (FAQ) document, relating to employer obligations to provide employees with written notice about the Affordable Care Act's health insurance marketplaces by Oct. 1, 2013.

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Modifiable Factors ID'd for Reducing Surgical Site Infections

MONDAY, Sept. 30 (HealthDay News) -- Specific modifiable preoperative, intraoperative, and postoperative factors can be optimized to reduce the risk of surgical site infections (SSIs) for patients undergoing elective orthopedic surgery, according to research published in the September issue of The Spine Journal.

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Post-Hip Replacement Mortality Drops in England and Wales

FRIDAY, Sept. 27 (HealthDay News) -- Postoperative mortality following total hip replacement has decreased in England and Wales, according to research published in the Sept. 28 issue of The Lancet, a theme issue on surgery.

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Practical Tips Offered for Medical Employee Satisfaction

FRIDAY, Sept. 27 (HealthDay News) -- Managing staff is a learned skill, and one for which physicians are often ill-equipped. An article published Sept. 25 in Medical Economics lays out some practical tips and advice for motivating staff to excel.

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Health Worker Roles Impacted When 'Undervalued' by Patients

FRIDAY, Sept. 27 (HealthDay News) -- Job satisfaction among nurse practitioners and other professionals can suffer when clientele lack a clear understanding of what they do, according to research published in the Aug. 1 issue of the Academy of Management Journal.

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HEALTH REFORM: ACA Impact on Medicare Recipients Unclear

FRIDAY, Sept. 27 (HealthDay News) -- The Affordable Care Act (ACA) will help millions of uninsured Americans access affordable health care coverage, but it's unclear what effect the law will have on people covered by Medicare.

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Use of Stem Cells May Improve Viability of Fat Grafts

FRIDAY, Sept. 27 (HealthDay News) -- Using stem cells may improve the survival of autologous fat grafts used in reconstructive surgery, according to research published in the Sept. 28 issue of The Lancet, a theme issue on surgery.

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Sutures Not Superior to Staples for Closure in GI Surgery

FRIDAY, Sept. 27 (HealthDay News) -- Compared with standard procedure using staples, skin closure with subcuticular sutures does not reduce the incidence of wound complications after open gastrointestinal (GI) surgery, according to research published in the Sept. 28 issue of The Lancet, a theme issue on surgery.

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Surgery, Physical Therapy Similar for Cervical Radiculopathy

FRIDAY, Sept. 27 (HealthDay News) -- Surgery with physical therapy results in a more rapid improvement during the first postoperative year for patients with cervical radiculopathy, compared to physical therapy alone, but similar outcomes are seen at two years, according to a study published in the Sept. 15 issue of Spine.

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Bariatric Surgery in T1DM Teens Doesn't Aid Glycemic Control

THURSDAY, Sept. 26 (HealthDay News) -- Despite significant weight loss, improvements in cardiovascular risk factors, and quality of life, bariatric surgery does not necessarily lead to improved glycemic control in adolescents with type 1 diabetes mellitus (T1DM), according to a case report published online Sept. 23 in Pediatrics.

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HEALTH REFORM: Medicaid Expansion Will Up Coverage

THURSDAY, Sept. 26 (HealthDay News) -- Two aspects of the Affordable Care Act (ACA) have the potential to extend health insurance coverage to those who do not qualify for government-sponsored health care but cannot afford to purchase private plans.

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CDC: Flu Shot Coverage of Health Care Personnel Increasing

THURSDAY, Sept. 26 (HealthDay News) -- Influenza vaccination coverage has increased among health care personnel but varies by occupation type and occupational setting, according to a report published in the Sept. 27 issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

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Antibodies Predict Graft Injury, Loss in Kidney Transplants

WEDNESDAY, Sept. 25 (HealthDay News) -- Patients who have complement-binding donor-specific antibodies to human leukocyte antigens (HLAs) after kidney transplantation have a nearly five-fold higher risk of graft loss, according to a study published in the Sept. 26 issue of the New England Journal of Medicine.

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More Options, Lower Premiums With Insurance Exchanges

WEDNESDAY, Sept. 25 (HealthDay News) -- Consumers are likely to find insurance options more plentiful and more affordable than expected in the new Health Insurance Marketplace that goes into effect Oct. 1, according to a report released Sept. 25 by the U.S. Department of Health and Human Services.

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HEALTH REFORM: Exchanges Offer Options for the Uninsured

WEDNESDAY, Sept. 25 (HealthDay News) -- Millions of part-time, seasonal, self-employed workers and other individuals currently without health insurance may find a solution to their vulnerable status when the new health care exchanges go into effect on Oct. 1.

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Long-Term Metabolic Effects Seen With Bariatric Surgery

WEDNESDAY, Sept. 25 (HealthDay News) -- In obese patients, bariatric surgery can aid in achieving sustainable remission and improvement of type 2 diabetes mellitus (T2DM), according to a study published in the October issue of the Annals of Surgery.

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ACP Provides Overview of Health Insurance Marketplaces

WEDNESDAY, Sept. 25 (HealthDay News) -- The opportunities and challenges presented by health care reform are discussed in an article published online Sept. 24 in the Annals of Internal Medicine.

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HEALTH REFORM: Health Care Reform a Mixed Bag for Workers

TUESDAY, Sept. 24 (HealthDay News) -- Much discussion of the Affordable Care Act revolves around the dramatic changes in store for America's uninsured, but the health care reform law will also have an impact on individuals with employer-based coverage.

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FDA Gives Final Guidance on Mobile Medical App Oversight

TUESDAY, Sept. 24 (HealthDay News) -- The U.S. Food and Drug Administration issued final guidance for mobile application (app) developers, and is focusing its oversight on medical apps that will be used as accessories to regulated medical devices, or that transform a mobile device into a regulated medical device.

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Medicare Expenditure Per Patient Up for Acute MI

TUESDAY, Sept. 24 (HealthDay News) -- For patients with acute myocardial infarction (AMI), Medicare expenditures per patient increased significantly from 1998-1999 to 2008, according to research published online Sept. 23 in JAMA Internal Medicine.

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Marriage Shown to Provide Cancer Survival Benefit

TUESDAY, Sept. 24 (HealthDay News) -- Unmarried patients are at significantly higher risk of presentation with metastatic cancer, undertreatment, and cancer-related death, according to a study published online Sept. 23 in the Journal of Clinical Oncology.

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Infectious Endocarditis Risk ID'd in Congenital Heart Disease

MONDAY, Sept. 23 (HealthDay News) -- For children with congenital heart disease (CHD), the risk of infectious endocarditis (IE) is 6.1 per 1,000 children, and predictors include cyanotic CHD, endocardial cushion defects, and left-sided lesions, according to a study published in the Sept. 24 issue of Circulation.

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FDA Issues Final Rule for Device Identification System

MONDAY, Sept. 23 (HealthDay News) -- The U.S. Food and Drug Administration has released a final rule for the unique device identification system (UDI) that, when implemented, will improve patient safety by providing a consistent way to identify approved medical devices.

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HEALTH REFORM: Young People Likely to Be Key to Success

MONDAY, Sept. 23 (HealthDay News) -- Young, healthy adults are considered key to the success of health insurance reform, but many are not even aware of state insurance exchanges.

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HEALTH REFORM: Health Care Exchanges Going Into Effect

MONDAY, Sept. 23 (HealthDay News) -- As of Oct. 1, consumers looking for health insurance will be able to turn to state-based health care exchanges, a centerpiece of the Affordable Care Act intended to help the uninsured and small businesses find affordable coverage.

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Majority of U.S. Consumers Want Full Access to EMR

MONDAY, Sept. 23 (HealthDay News) -- Most U.S. consumers want to have full access to their electronic medical records (EMR), and 41 percent would be willing to switch doctors to gain access, according to a survey published by Accenture.

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Post-Op Delirium Common in Elderly Spinal Surgery Patients

MONDAY, Sept. 23 (HealthDay News) -- There is an overall incidence of delirium events of 8.4 per 1,000 in patients undergoing lumbar spine surgical procedures, according to a study published in the Sept. 15 issue of Spine.

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Physical Exams Commonly Lacking in Low Back Pain Care

FRIDAY, Sept. 20 (HealthDay News) -- Among adults with low back pain (LBP) visiting a physician, 43 percent report no inspection and 20 percent report no palpation at physician encounters, according to a study published in the Sept. 15 issue of Spine.

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New Model Better Predicts Risk of Post-PCI Bleeding

FRIDAY, Sept. 20 (HealthDay News) -- A new definition of post-percutaneous coronary intervention (PCI) bleeding and a new predictive risk model can better identify patients at risk for bleeding complications, according to a study published in the September issue of the Journal of the American College of Cardiology: Cardiovascular Interventions.

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Hypofractionated Radiation Effective for Early Breast Cancer

THURSDAY, Sept. 19 (HealthDay News) -- Long-term follow-up of the START (Standardization of Breast Radiotherapy) trials confirms that appropriately-dosed hypofractionated radiotherapy is safe and effective for the treatment of invasive early breast cancer, according to research published online Sept. 19 in The Lancet Oncology.

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Major Complications Predicted by Age, Back Surgery Type

THURSDAY, Sept. 19 (HealthDay News) -- American Society of Anesthesiologists (ASA) class, age, and type of back surgery are independent risk factors for major medical complications, according to research published in the Sept. 1 issue of Spine.

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New Medicaid Enrollees Under ACA May Be Healthier

THURSDAY, Sept. 19 (HealthDay News) -- Adults potentially eligible for Medicaid under the Patient Protection and Affordable Care Act (ACA) are expected to have equal or better health status than current beneficiaries, according to research published in the September/October issue of the Annals of Family Medicine.

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Pros and Cons of Shortening Medical School Discussed

THURSDAY, Sept. 19 (HealthDay News) -- The pros and cons of shortening medical school to three years are discussed in two perspective pieces published in the Sept. 19 issue of the New England Journal of Medicine.

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Millions Are Harmed by Unsafe Medical Care Each Year

THURSDAY, Sept. 19 (HealthDay News) -- Adverse events caused by inferior medical care are a major source of morbidity and mortality globally, according to research published in the October issue of BMJ Quality & Safety.

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High-Volume Hospitals Have Fewer Surgical Readmissions

WEDNESDAY, Sept. 18 (HealthDay News) -- Hospitals with a high volume of surgeries and low surgical mortality rates have lower rates of surgical readmission than other hospitals, according to research published in the Sept. 19 issue of the New England Journal of Medicine.

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Surgery Better Than Physical Therapy for Incontinence

WEDNESDAY, Sept. 18 (HealthDay News) -- Midurethral-sling surgery is more effective than physical therapy based on subjective reports of improvement from women with stress urinary incontinence, according to a study published in the Sept. 19 issue of the New England Journal of Medicine.

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Expansion of VA Mammography Services Impacts Care

WEDNESDAY, Sept. 18 (HealthDay News) -- Rapid expansion of mammography screening at a Veterans Affairs (VA) facility has translated to increased clinical volumes and increased time to definitive treatment, according to research published online Sept. 18 in JAMA Surgery.

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Enhanced Care Program Set Up at Six Mayo Clinic Hospitals

WEDNESDAY, Sept. 18 (HealthDay News) -- A new program has been developed and implemented at six Mayo Clinic Health System hospitals to improve care and shorten hospital stays using remote monitoring, according to a press release issued by the Mayo Clinic.

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~11 Percent of Combat Wounded Have Spinal Injuries

WEDNESDAY, Sept. 18 (HealthDay News) -- Spine injuries account for more than 11 percent of all casualties among U.S. combat-wounded military in Iraq and Afghanistan, according to a study published in the Sept. 15 issue of Spine.

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EHR Systems Meeting Meaningful Use Criteria Beneficial

WEDNESDAY, Sept. 18 (HealthDay News) -- Most electronic health record (EHR) systems meet meaningful use criteria, and these systems are associated with time-saving and other benefits, according to a September data brief published by the U.S. Centers for Disease Control and Prevention's National Center for Health Statistics.

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Payment for Routine Office Visits Varies Substantially

WEDNESDAY, Sept. 18 (HealthDay News) -- There is substantial variation in private insurance payment to physicians for routine office visits, according to research published in the September issue of Health Affairs.

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Dual Epidural Analgesia Most Effective for Scoliosis Surgery

WEDNESDAY, Sept. 18 (HealthDay News) -- Dual continuous epidural analgesia (CEA) is the most effective pain control method following surgery for adolescent idiopathic scoliosis, according to a study published in the Sept. 1 issue of Spine.

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Unfounded Fears Prompt Prophylactic Mastectomy Choice

TUESDAY, Sept. 17 (HealthDay News) -- Among young women who undergo a bilateral mastectomy for cancer in one breast, contralateral prophylactic mastectomy (CPM) is often chosen to reduce risk of future cancer and improve survival, according to research published in the Sept. 17 issue of the Annals of Internal Medicine.

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Correlates of Post-Op Thigh/Groin Pain ID'd in LLIF

TUESDAY, Sept. 17 (HealthDay News) -- For patients undergoing stand-alone lateral lumbar interbody fusion (LLIF) procedures, there is a significant association between the amount of coronal curve correction and increase in lumbar lordosis and the development of postoperative anterior thigh/groin pain, according to research published in the Sept. 1 issue of Spine.

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More Than 1.6 Million Americans Expected to Get Cancer in 2013

TUESDAY, Sept. 17 (HealthDay News) -- Although significant progress has been made in treating cancer, more than 1.6 million Americans are projected to receive a cancer diagnosis in 2013, according to the third American Association for Cancer Research's Cancer Progress Report 2013.

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Robotic Hysterectomy Usage Up for Benign Disease

FRIDAY, Sept. 13 (HealthDay News) -- The use of robotic hysterectomy procedures has significantly increased, according to a study published online Sept. 11 in Obstetrics & Gynecology.

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Score Predicts Diabetes Remission After Gastric Bypass

FRIDAY, Sept. 13 (HealthDay News) -- A novel score based on four preoperative variables can predict the likelihood of type 2 diabetes remission following Roux-en-Y gastric bypass (RYGB) surgery, according to a study published online Sept. 13 in The Lancet Diabetes & Endocrinology.

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Residual Sleep Apnea Common After Adenotonsillectomy

FRIDAY, Sept. 13 (HealthDay News) -- For children younger than 3 years with obstructive sleep apnea (OSA), residual OSA is relatively common after adenotonsillectomy (T&A), according to a study published online Sept. 12 in JAMA Otolaryngology-Head & Neck Surgery.

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Mindfulness Training Beneficial for Clinicians, Patients

THURSDAY, Sept. 12 (HealthDay News) -- Mindfulness training is associated with improvements in physician burnout; and, clinicians who rate themselves as more mindful engage in more patient-centered communication, according to two studies published in the September/October issue of the Annals of Family Medicine.

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Mesh Doesn't Up Cure Rate for Vaginal Prolapse Repair

THURSDAY, Sept. 12 (HealthDay News) -- There are no differences in cure rates after three years of follow-up between women receiving mesh or no mesh for vaginal prolapse repair, according to a study published online Sept. 6 in Obstetrics & Gynecology.

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ER Visits After Surgery Fairly Common in Medicare Patients

THURSDAY, Sept. 12 (HealthDay News) -- About 20 percent of Medicare patients discharged following six common inpatient surgeries visit the emergency department within 30 days, according to research published in the September issue of Health Affairs.

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Virtual Surgical Planning Aids Complex Facial Reconstruction

THURSDAY, Sept. 12 (HealthDay News) -- Virtual surgical planning aids in the performance of successful complex maxillofacial reconstruction, according to a study published in the September issue of Plastic and Reconstructive Surgery.

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Poorer Outcomes After Non-Cardiac Surgery in DM

WEDNESDAY, Sept. 11 (HealthDay News) -- For patients undergoing non-cardiac surgery, diabetes is associated with adverse perioperative complications and mortality, according to a study published online Aug. 29 in Diabetes Care.

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Unplanned Readmission Common After Spine Fusion

TUESDAY, Sept. 10 (HealthDay News) -- For patients undergoing spine fusion for adult spinal deformity, unplanned hospital readmissions are relatively common and are often related to surgical site infections, according to a study published in the Sept. 1 issue of Spine.

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About Half of Health Care Providers Are 'Digital Omnivores'

TUESDAY, Sept. 10 (HealthDay News) -- About half of health care providers are "digital omnivores," meaning they use a tablet, smartphone, and laptop/desktop computer routinely in a professional capacity, according to a report published by Epocrates.

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Treatment in Critical Care Often Perceived As Futile

TUESDAY, Sept. 10 (HealthDay News) -- Intensive care unit (ICU) treatment is frequently perceived as futile by critical care specialists, and entails considerable costs, according to a study published online Sept. 9 in JAMA Internal Medicine.

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'Meaningful Use' Achievement Not Uniform Across Hospitals

MONDAY, Sept. 9 (HealthDay News) -- In regard to the adoption of electronic health records (EHRs), achievement of "meaningful use" criteria is not uniform across all hospitals, according to a study published in the August issue of Health Affairs.

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Anxiety, Fear of Pain Predict Chronic, Post-Surgery Pain

MONDAY, Sept. 9 (HealthDay News) -- State anxiety, psychological measures of amplification of pain, and acute postoperative pain independently predict post-surgical pain at three months, according to a study published in the August issue of The Journal of Pain.

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Program Helps Patients Quit Smoking Before Surgery

MONDAY, Sept. 9 (HealthDay News) -- A smoking cessation intervention offered in a preadmission clinic is associated with decreased rates of smoking on the day of surgery and 30 days postoperatively, according to research published in the September issue of Anesthesia & Analgesia.

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Young Women With Fatal Breast Cancer Are Mostly Unscreened

MONDAY, Sept. 9 (HealthDay News) -- Most breast cancer deaths occur in unscreened women, according to a study published online Sept. 9 in Cancer.

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Most Physicians Report Being Satisfied With Career Choice

MONDAY, Sept. 9 (HealthDay News) -- Most physicians report being satisfied with their career choice, although 40 percent would rethink their path given the chance to choose again, according to the 2013 Great American Physician Survey published in Physicians Practice.

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Steroids Effective Short Term for Carpal Tunnel Syndrome

THURSDAY, Sept. 5 (HealthDay News) -- Methylprednisolone injections relieve symptoms of carpal tunnel syndrome in the short term, but most patients still have surgery at one year, according to a study published in the Sept. 3 issue of the Annals of Internal Medicine.

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Major Health Care-Linked Infections Cost $9.8 Billion

WEDNESDAY, Sept. 4 (HealthDay News) -- The total annual cost associated with the five major health care-associated infections (HAIs) is $9.8 billion, according to a meta-analysis published online Sept. 2 in JAMA Internal Medicine.

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Low Rates of Gastrointestinal Bleeding Post-Lumbar Fusion

WEDNESDAY, Sept. 4 (HealthDay News) -- The rates of gastrointestinal (GI) hemorrhage complications are very low following lumbar fusion surgery, but are associated with greater costs and mortality, according to a study published in the Aug. 15 issue of Spine.

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Male-Female Physician Earnings Gap Has Persisted for 20 Years

TUESDAY, Sept. 3 (HealthDay News) -- For physicians, the male-female earnings gap has not changed significantly since 1987, according to a research letter published online Sept. 2 in JAMA Internal Medicine.

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Docs' Confidence in Diagnosis Unrelated to Diagnostic Accuracy

TUESDAY, Sept. 3 (HealthDay News) -- Physicians' confidence in their diagnostic accuracy is not associated with actual diagnostic accuracy or with case difficulty, according to a study published online Aug. 26 in JAMA Internal Medicine.

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Workaholics Have Poorer Physical and Mental Health

MONDAY, Sept. 2 (HealthDay News) -- Workaholics, defined as those who work more than 50 hours per week, have reduced physical and mental well-being, according to researchers from Kansas State University.

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Employer-Based Health Insurance Premiums Rose Modestly in 2013

MONDAY, Sept. 2 (HealthDay News) -- Employer-sponsored health insurance premiums rose only modestly in 2013, according to research published in the August issue of Health Affairs.

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