Despite the benefits of immediate post-mastectomy breast reconstruction, only a small minority of women, regardless of age, choose this option, a new study indicates. Research has shown that compared with a delayed procedure, immediate post-mastectomy reconstruction improves psychological well-being and quality of life. The new study, headed by Dawn Hershman, M.D., associate professor of medicine and epidemiology at Columbia University Medical Center, indicates that only about one-third of women opt for the procedure, according to the American Association for Cancer Research.
Immediate breast reconstruction does lead to better results in patients with early stage breast cancer. That is a pretty much well known fact. This statistic of less than a third of women seeking this type of reconstruction in this light seems kinda sad, but keep reading: Read more »
*This blog post was originally published at Truth in Cosmetic Surgery*
Turns out there is an unintended consequence of many of the current efforts to standardize the way doctor’s practice medicine. It is called de-skilling. De-skilling can occur when physicians and other providers try to adapt to standardized, new ways of doing things. Examples of such standardization include clinical based care guidelines, electronic medical records (EMRs), Pay for Performance (P4P), Patient Centered Medical Home (PCMH) requirements and so on.
Examples of physician de-skilling were revealed in a recent study which consisted of in-depth interviews with 78 primary care physicians regarding EMR use. EMRs are all about standardization – what data is captured and recorded, how data is reported, how data is used, and so on.
Over the course of the interviews, physicians in the study described significant examples of de-skilling behavior. Most indicated that Read more »
*This blog post was originally published at Mind The Gap*
Ten days ago a post here mentioned the 14th ICSI / IHI Colloquium. I said the Society for Participatory Medicine was well represented, including:
- Jessie Gruman, four time cancer patient and founding co-editor of our journal, gave an important breakout session, about which I’ll be writing soon. (Jessie is founder and president of the excellent Center For Advancing Health.)
Jessie’s talk was so good it had me going nuts on Twitter – I couldn’t keep up with all the “tweet-worthy” things that came out of her mouth.
Well, I’ve just re-read her text, and it brought back why I went nuts. I was going to write about it, but I’m just going to post the full text.
For those who don’t know, last fall Jessie underwent surgery for her fourth cancer; she has some experience. Read more »
*This blog post was originally published at e-Patients.net*
Before reading any further, I would like to issue a warning. If your ideas about healthcare delivery are of an older ilk; if you cling white-knuckled to past dogma, please stop reading now. What follows may cause your atria to fibrillate.
Last month I wrote that the best tool for treating atrial fibrillation (AF) was to give patients information—to teach them about their AF, its complications, role of lifestyle factors and the many treatment options. I didn’t say this was easy. In fact, thoroughly explaining AF takes nearly the same time it takes me to isolate the pulmonary veins–a lot longer than the 10 minutes allotted for a typical office visit. (Remember: of a 30 minute office visit, I have to review your chart, listen attentively to your story, examine you, and complete the e-record. That doesn’t leave much time for teaching.)
I was serious about the role of education in AF therapy, but I didn’t have any hard data to support such a bold claim. All I could offer was 15 years of experience on the front lines of treating AF—cardiology’s most expensive and prevalent disease.
But now I have found some real-world data to support the thesis that good teaching translates to better AF outcomes. Read more »
*This blog post was originally published at Dr John M*
Physicians and surgeons all agree on the link between smoking and postoperative complications. We don’t agree (or know) how much time is required between cessation of smoking and surgery for optimal risk reduction.
Dr.Thomas Fiala wrote a nice blog post, Smoking Cessation and surgical complications, recently discussing the 3rd reference article below.
Smokers that quit smoking before surgery had 41% fewer complications. The researchers found that each week of cessation increases the effect by 19%.
Trials of at least 4 weeks’ smoking cessation had a significantly larger treatment effect than shorter trials (P = .04).
Smokers that quit had lower rates of total complications, fewer wound healing complications, and fewer pulmonary complications.
Read more »
*This blog post was originally published at Suture for a Living*