Surgery News - August 2008 - (Page 1) VOL. 4 • NO. 8 • AUGUST 2008 Gastric Bypass Changes β Cells In Diabetes ©CHARLES GIORNO PHOTOGRAPHY INSIDE Making 20/20NAmends O VISI The AMA has apologized for racial disparities and promises to do better. • 6 THE Study links surgery with remission. B Y J E F F E VA N S Else vier Global Medical Ne ws The 18-month reprieve allows time to develop a long-term solution to the problem, said ACS Executive Director Thomas R. Russell. Modest Raise Replaces Medicare Pay Cut B Y M A RY E L L E N SCHNEIDER Else vier Global Medical Ne ws summertime wrangling Washington’s paid off for physicians as Congress successfully overrode President Bush’s veto of legislation to stop a 10.6% cut to Medicare physician payments. The legislation (H.R. 6331), which passed the House and Senate by veto-proof margins in early July, extends the 0.5% Medicare pay increase in place for the first half of 2008 through the end of the year and gives physicians a 1.1% raise for next year. The bill relies on controversial cuts to the Medicare Advantage program to fund the pay update, authorizes increased bonus payments under the Physician Quality Reporting Initiative (PQRI), and delays implementation of the Competitive Acquisition Program for durable medical equipment. H.R. 6331 (the Medicare Improvements for Patients and Providers Act) passed the House by an overwhelming margin in late June but failed to get enough votes in the Senate for cloture, which would have closed debate and allowed for an up-or-down vote. Following the July 4th recess and a week of intense lobbying by physician and patient groups, the Senate reconsidered the bill on July 9. At that time, a number of ReSee Pay Cut • page 2 NAT I O NA L H A R B O R , M D. — A low degree of β-cell sensitivity per degree of insulin sensitivity may be the defining quality of type 2 diabetes, according to a retrospective study of severely obese patients who experienced remission of type 2 diabetes after undergoing gastric bypass surgery. The classic explanation for the transition from obesity to type 2 diabetes holds that obesity leads to insulin resistance, followed by a compensatory increase in βcell sensitivity, which allows for normal glycemic control until eventually irreversible β-cell exhaustion and poor glycemic control result. But a study of 219 consecutive gastric bypass patients with and without type 2 diabetes showed that diabetic patients have a reversible downregulation of insulin secretion rather than β-cell exhaustion. Dr. Richard A. Perugini, an ACS Fellow, and his coinvestigators at the University of Massachusetts, Worcester, measured fasting glucose and insulin levels in patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB). They estimated insulin resistance and β-cell sensitivity before and at intervals up to 1 year after surgery. Each procedure formed a 30- to 45-mL gastric pouch and a Roux limb of about 100 cm. Both groups had a mean body mass index greater than 40 kg/m2. β-Cell sensitivity was defined as the ability of the β cells to produce insulin in response to glucose, whereas insulin sensitivity is the ability of peripheral tissues to store glucose or fat in response to insulin. Insulin resistance is the inverse of insulin sensitivity. The investigators estimated insulin resistance, insulin sensitivity, and β-cell sensitivity with the homeostatic model assessments See Diabetes • page 2 News From the College Dedicated Effort The new Nora Institute for Surgical Patient Safety signals the College’s commitment to improving practice. • 8 Opinion NOTESworthy? Experts assess the viability of natural orifice transluminal endoscopic surgery. • 1 2 Pediatric Surgery Burn Remedy Children treated with Biobrane dressing had short hospital stays, few complications. • 13 Surgeons Team Up to Improve Outcomes BY BRUCE JANCIN Else vier Global Medical Ne ws VITAL SIGNS Projected Aggregate Physician and Clinical Service Expenditures in the U.S. (in billions of dollars) $819.9 $447.0 ELSEVIER GLOBAL MEDICAL NEWS 2006 2008 2010 2012 2014 2016 Notes: Based on the 2005 version of the National Health Expenditures data. Includes outpatient and laboratory services. Source: Centers for Medicare and Medicaid Services N E W YO R K — An innovative, surgeon-led, quality improvement collaborative has achieved markedly reduced rates of negative appendectomy at participating hospitals in Washington state. Experience gained through the state’s Surgical Care and Outcomes Assessment Program (SCOAP) suggests that negative appendectomy (that is, appendectomy performed in patients who turn out not to have appendicitis) appears to be a modifiable adverse outcome, and its major driver is the quality of preoperative imaging interpretation by radiologists, Dr. David R. Flum said at the annual meeting of the American Surgical Association. “The key thing is that accuracy of diagnostic testing is a worthy quality of care metric that brings our radiology colleagues in on the care of surgical patients. We think this is an opportunity to reduce unnecessary procedures and save health care dollars,” said Dr. Flum, an ACS Fellow and surgeon at the University of Washington, Seattle. Indeed, 15% of all appendectomies nationwide are estimatSURGERY NEWS ed to be negative appendectomies. In reproductive-age women, the rate is one in four. An estimated $750 million per year is spent on patients who have a negative appendectomy, he said. SCOAP, which is currently used at 26 urban and rural hospitals across Washington state, takes an evidence-based apSee Outcomes • page 3 Presorted Standard U.S. Postage PAID Permit No. 384 Lebanon Jct. KY 60 Columbia Rd., Bldg. B Morristown, NJ 07960 CHANGE SERVICE REQUESTED
Table of Contents Feed for the Digital Edition of Surgery News - August 2008 Surgery News - August 2008 Contents The 20/20 Vision: Making Amends News From the College: Dedicated Effort Opinion: NOTESworthy? Pediatric Surgery: Burn Remedy Surgery News - August 2008 Surgery News - August 2008 - Contents (Page 1) Surgery News - August 2008 - Contents (Page 2) Surgery News - August 2008 - Contents (Page 3) Surgery News - August 2008 - Contents (Page 4) Surgery News - August 2008 - Contents (Page 5) Surgery News - August 2008 - The 20/20 Vision: Making Amends (Page 6) Surgery News - August 2008 - The 20/20 Vision: Making Amends (Page 7) Surgery News - August 2008 - News From the College: Dedicated Effort (Page 8) Surgery News - August 2008 - News From the College: Dedicated Effort (Page 9) Surgery News - August 2008 - News From the College: Dedicated Effort (Page 10) Surgery News - August 2008 - News From the College: Dedicated Effort (Page 11) Surgery News - August 2008 - Opinion: NOTESworthy? (Page 12) Surgery News - August 2008 - Pediatric Surgery: Burn Remedy (Page 13) Surgery News - August 2008 - Pediatric Surgery: Burn Remedy (Page 14) Surgery News - August 2008 - Pediatric Surgery: Burn Remedy (Page 15) Surgery News - August 2008 - Pediatric Surgery: Burn Remedy (Page 16)
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