Surgery News - January 2009 - (Page 1) VOL. 5 • NO. 1 • JANUARY 2009 BONNIE JOHNSTON/JAMES GRAHAM BROWN CANCER CENTER IOM Recommends Some Changes in Work Hours Maximum 80-hour week retained. BY DAMIAN MCNAMARA INSIDE Intent to 20/20N Prevent O VISI Former Surgeon General Richard Carmona pitches prevention as a health care strategy. • 6 THE Else vier Global Medical Ne ws Older women given hormonal therapy after breast-conserving surgery have an excellent prognosis, said Dr. Anees B. Chagpar. Elderly May Safely Skip Radiation for Breast Ca BY JANE SALODOF MACNEIL Else vier Global Medical Ne ws S A N T A F E , N . M . — Elderly breast cancer patients who are given hormonal therapy may not need radiation therapy after breast-conserving surgery, according to a retrospective study of a randomized controlled trial. Investigators who compared outcomes for patients 70 years of age and older in the North American Fareston [toremifene] Versus Tamoxifen Adjuvant (NAFTA) trial said that they saw no difference at a median follow-up of 56 months in localregional recurrences, diseasefree survival, or overall survival among 344 women who had ra- diation therapy and 113 women who did not. There were just two recurrences in the radiation cohort and one in the group that did not receive radiotherapy. The 5-year actuarial local-regional recurrence rates were calculated at 1.2% and 1.1%, respectively (odds ratio 1.0), Dr. Anees B. Chagpar reported at the annual meeting of the Western Surgical Association. “Older women treated with hormonal therapy after breastconserving surgery have an excellent prognosis,” said Dr. Chagpar, an ACS Fellow. “In this population, adjuvant radiation therapy does not sigSee Radiation • page 4 W E S T PA L M B E A C H , F L A . — Changes in the maximum shift length for residents, increases in mandatory time off, and inclusion of all moonlighting in total work hours are among the recommendations put forth by the Institute of Medicine in early December. The institute did not recommend changing the average weekly maximum of 80 hours, and it favored retention of the policy allowing a maximum of 88 hours for programs demonstrating a sound educational rationale, while continuing to restrict emergency department residents to a 60-hour work week that includes maximum 12-hour shifts followed by at least 12 hours off. Release of the 323-page report, “Resident Duty Hours: Enhancing Sleep, Supervision, and Safety,” coincided with the annual meeting of the Southern Surgical Association, where surgeons reacted with a call for a unified response. “It is vital that all of us be informed about this. It’s important to the future of surgery quality in this country,” said Dr. James O’Neill Jr., an ACS Fellow and professor of surgery at Vanderbilt University, Nashville, Tenn. In response to the report in a media release, the American College of Surgeons agreed that the 80-hour average maximum should be retained: “The ACS firmly believes that these work hours are important to provide surgical residents with the depth and variety of educational experiences that are essential for physicians to become competent surgeons.” The ACS is concerned, however, about some of the details, See Work Hours • page 4 News From the College The Year Ahead Dr. Thomas R. Russell highlights key ACS initiatives intended to influence future health care reform efforts. • 8 Thoracic Tracheal Triumph The first human tissueengineered tracheal transplant has functioned for more than 4 months without the need for immunosuppression. • 1 0 Practice Trends Making the Grade The United States earned only a C– on a recently issued emergency care report card. • 15 ‘Never Events’ on CMS Chopping Block B Y A L I C I A A U LT Else vier Global Medical Ne ws VITAL SIGNS Direct Patient Care Hours Varied Among Surgical Settings in 2007 Mean clinical hours per week for and Medicaid Services is The CentersrefuseMedicare proposing to all payments related to so-called never-event surgical errors. The agency is proposing a national coverage decision of nonpayment if an invasive procedure is performed on the wrong body part, if an incorrect invasive procedure is performed, or if a procedure is performed on the wrong patient. The proposal would affect payments not just to hospitals but also to physicians, other health care providers, and suppliers involved in the never events. “These types of surgical errors can cause serious injury or Cardiovascular (n = 157) Pediatric (n = 40) Vascular (n = 99) Trauma (n = 49) General (n = 651) Colon and rectal (n = 29) 46.3 44.2 42.4 ELSEVIER GLOBAL MEDICAL NEWS death to beneficiaries and result in increased costs to Medicare due to the need to treat the consequences of the errors,” Kerry Weems, CMS Acting Administrator, said in a statement. The CMS proposal is not a surprise, but it came earlier than expected. During an August 2008 press briefing, Mr. Weems had said the CMS expected to issue three national coverage decisions on surgical never events in February 2009. The agency invited comments in midsummer, when it first considered the national coverage decision. At that time, the American Medical Association said that it objected to using the process, partly because there would appear to be no room for a provider to See Never Events • page 3 40.0 39.8 35.4 Note: Clinical hours do not include time spent on administrative tasks. Source: 2007 survey data, Medical Group Management Association
Table of Contents Feed for the Digital Edition of Surgery News - January 2009 Surgery News - January 2009 Contents The 20/20 Vision Intent to Prevent News From the College: The Year Ahead Thoracic: Tracheal Triumph Practice Trends: Making the Grade Surgery News - January 2009 Surgery News - January 2009 - Contents (Page 1) Surgery News - January 2009 - Contents (Page 2) Surgery News - January 2009 - Contents (Page 3) Surgery News - January 2009 - Contents (Page 4) Surgery News - January 2009 - Contents (Page 5) Surgery News - January 2009 - The 20/20 Vision Intent to Prevent (Page 6) Surgery News - January 2009 - The 20/20 Vision Intent to Prevent (Page 7) Surgery News - January 2009 - News From the College: The Year Ahead (Page 8) Surgery News - January 2009 - News From the College: The Year Ahead (Page 9) Surgery News - January 2009 - Thoracic: Tracheal Triumph (Page 10) Surgery News - January 2009 - Thoracic: Tracheal Triumph (Page 11) Surgery News - January 2009 - Thoracic: Tracheal Triumph (Page 12) Surgery News - January 2009 - Thoracic: Tracheal Triumph (Page 13) Surgery News - January 2009 - Thoracic: Tracheal Triumph (Page 14) Surgery News - January 2009 - Practice Trends: Making the Grade (Page 15) Surgery News - January 2009 - Practice Trends: Making the Grade (Page 16)
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