AccessSurgery Blog http://books.mcgraw-hill.com/medical/accesssurgery/blog The official blog for McGraw-Hill's Access Surgery online reference. Sun, 15 Nov 2009 23:33:48 +0000 http://wordpress.org/?v=2.7 en hourly 1 October was the New Pink! http://books.mcgraw-hill.com/medical/accesssurgery/blog/?p=366 http://books.mcgraw-hill.com/medical/accesssurgery/blog/?p=366#comments Sun, 15 Nov 2009 23:33:48 +0000 blogmaster http://books.mcgraw-hill.com/medical/accesssurgery/blog/?p=366 With the end of October, the breast cancer campaign has proven to be one of the best-run and most successful health campaigns of all time. Soft drinks, clothing, walks, runs, almost every commodity and activity bought and sold over the course of the month was pink ( even lemonade!) - drawing attention to the important killer that is breast cancer. I wonder aloud if similar campaigns would ….perhaps should be launched for lung cancer. It quietly remains the number one cause of cancer deaths in the United States. It might benefit from a colored ribbon and some attention too.

]]> http://books.mcgraw-hill.com/medical/accesssurgery/blog/?feed=rss2&p=366 Dirty, pretty things http://books.mcgraw-hill.com/medical/accesssurgery/blog/?p=338 http://books.mcgraw-hill.com/medical/accesssurgery/blog/?p=338#comments Sun, 06 Sep 2009 11:44:20 +0000 blogmaster http://books.mcgraw-hill.com/medical/accesssurgery/blog/?p=338 The shock over the recent discovery of kidneys for sale in the US is just another example of how we may often choose to remain oblivious to those things, those actions that threaten or challenge the ethical constructs of how we view the life and the world at large. The WHO estimates that at least 10 % of all kidney transplants are from paid donors often obtained by illegal transaction performed in less than optimal surroundings and circumstances……but now we know that these are also occurring in prestigious institutions in the United States and the public is outraged. But is it, really? In a free market society, isn’t everything and anyone for sale? Most will say, absolutely not. American law does not permit the exchange of organs for material or pecuniary gain but yet, it is still happening - seemingly without redress. So where do we go from here? Without legal intervention and regulation, these practices are likely to continue. But there is a fear that the forces of economics may result in an exploitation of the disadvantaged and bring us back to the historical controversy of whether one life is more valuable than another…and though that makes for an easy answer, with the consideration of America’s past, it  poses  an extremely awkward  question.

]]> http://books.mcgraw-hill.com/medical/accesssurgery/blog/?feed=rss2&p=338 Who Needs Insurance anyway?! http://books.mcgraw-hill.com/medical/accesssurgery/blog/?p=327 http://books.mcgraw-hill.com/medical/accesssurgery/blog/?p=327#comments Wed, 26 Aug 2009 04:01:14 +0000 blogmaster http://books.mcgraw-hill.com/medical/accesssurgery/blog/?p=327 The healthcare debate has become manifestly vociferous over the past weeks as Americans decidedly flex their democratic muscle in a debate that is increasingly dividing the lines. The Obama administration have given us scant details about what to really expect and the angst is growing as contrived and misinformed ideas from both sides replace the missing factual richness of the explanations we deserve and have been expecting. As far as I, as a surgeon, am concerned, HR 3200 will (finally) address the Sustainable Growth Rate issue. The resultant plan will not require physician participation and there will be a greater focus on Physician Quality Reporting Initiative. An alternative plan will come into existence. Private insurance companies are up in arms. Private insurees are up in arms too - concerned that they will be unable to access their doctors and be subjected to the “substandard care” akin to that provided in other wealthy countries in Europe and Asia.

The only silence seems to be from the uninsured. Strangely, not one of the 37 million of them seems to object. Might they know something we don’t?

]]> http://books.mcgraw-hill.com/medical/accesssurgery/blog/?feed=rss2&p=327 Being Anal about Raising Awareness http://books.mcgraw-hill.com/medical/accesssurgery/blog/?p=318 http://books.mcgraw-hill.com/medical/accesssurgery/blog/?p=318#comments Fri, 24 Jul 2009 00:21:03 +0000 blogmaster http://books.mcgraw-hill.com/medical/accesssurgery/blog/?p=318 Michael Jackson’s death dominated the world press and also seemingly eclipsed Farah Fawcett’s untimely demise too. The lack of information, the right information about why she may have died offered an opportunity for a public health focus on anal cancer - how it is prevented and how it is treated. Many still do not know much about this condition and what causes it. The Livestrong phenomenon that raised awareness for testicular cancer might have found a similar audience with anal cancer. We almost had this opportunity with Farah Fawcett but alas, still - we refuse to talk about it.

]]> http://books.mcgraw-hill.com/medical/accesssurgery/blog/?feed=rss2&p=318 SAGES Abstracts http://books.mcgraw-hill.com/medical/accesssurgery/blog/?p=317 http://books.mcgraw-hill.com/medical/accesssurgery/blog/?p=317#comments Fri, 24 Jul 2009 00:07:53 +0000 blogmaster http://books.mcgraw-hill.com/medical/accesssurgery/blog/?p=317 SAGES has invited you all to submit paper and video abstracts to the Scientific Session Congress, to be held during the 12th World of Endoscopic Surgery, jointly hosted by SAGES & CAGS. The meeting will be held April 14-17, 2010 in National Harbor, MD at the Gaylord National Resort and Convention Center.

]]> http://books.mcgraw-hill.com/medical/accesssurgery/blog/?feed=rss2&p=317 Call for ASC Abstracts http://books.mcgraw-hill.com/medical/accesssurgery/blog/?p=315 http://books.mcgraw-hill.com/medical/accesssurgery/blog/?p=315#comments Fri, 03 Jul 2009 01:06:04 +0000 blogmaster http://books.mcgraw-hill.com/medical/accesssurgery/blog/?p=315 The 5th Annual Academic Surgical Congress will be held on February 3-5, 2010 at
San Antonio Marriott River Center, San Antonio, Texas

DEADLINE August 24, 2009

]]> http://books.mcgraw-hill.com/medical/accesssurgery/blog/?feed=rss2&p=315 Segregation may be a very effective obstruction to access http://books.mcgraw-hill.com/medical/accesssurgery/blog/?p=297 http://books.mcgraw-hill.com/medical/accesssurgery/blog/?p=297#comments Sat, 20 Jun 2009 18:10:48 +0000 blogmaster http://books.mcgraw-hill.com/medical/accesssurgery/blog/?p=297 I suspect that access is a more complex notion than we give it credit for. There are very intricate reasons why some Americans are denied access - some of which were predictably engineered in the 1940s by established custodians of American social and urban planning. Now we have some races who live in complete isolation, living only among themselves in over 500 of the total 3200 plus counties in the country. I examined access as a function of opportunity and utilization and found that geography DOES matter. We  reported this in two articles this month in The Journal of the American College of Surgeons and Archives of Surgery.

Racial clustering and access to colorectal surgeons, gastroenterologists, and radiation oncologists by African Americans and Asian Americans in the United States: a county-level data analysis. Hayanga AJ, Waljee AK, Kaiser HE, Chang DC, Morris AM. Arch Surg. 2009 Jun;144(6):532-5

Residential segregation and access to surgical care by minority populations in US counties.  Hayanga AJ, Kaiser HE, Sinha R, Berenholtz SM, Makary M, Chang D. J Am Coll Surg. 2009 Jun;208(6):1017-22

If you are distrustful of the health system and you have no exposure to the system except through distant strangers, you will be less likely to wish to use those services until too late. This has important preventive health implications. These populations do not get screened, get diagnosed late and die earlier.  This has received a certain amount of attention.

http://www.thedoctorschannel.com/video/2071.html

http://www.healthfinder.gov/news/newsstory.aspx?docid=628090
http://www.redorbit.com/news/health/1704005/research_finds_segregation_reduces_access_to_surgical_care

http://cancer.med.upenn.edu/resources/article.cfm?c=3&s=8&ss=23&Year=2009&Month=06&id=16305

http://www.eurekalert.org/pub_releases/2009-06/jaaj-ucw061109.php

http://www.physorg.com/news164302548.html

http://esciencenews.com/articles/2009/06/11/study.finds.segregation.decreases.access.surgical.care.minorities

http://www.sciencecentric.com/news/article.php?q=09061606-us-counties-with-more-african-american-patients-may-have-fewer-colorectal-cancer-specialists

http://www.modernmedicine.com/modernmedicine/Modern+Medicine+Now/Racial-Clustering-Linked-With-Access-to-Colon-Canc/ArticleNewsFeed/Article/detail/604058?contextCategoryId=46736

America has significant health challenges but without addressing the effect of racial clustering and geography, there is little to believe that health disparities in access in  the US will be resolved before 2010 like the federal government promised many years ago.

]]> http://books.mcgraw-hill.com/medical/accesssurgery/blog/?feed=rss2&p=297 Two Upcoming meetings…. http://books.mcgraw-hill.com/medical/accesssurgery/blog/?p=287 http://books.mcgraw-hill.com/medical/accesssurgery/blog/?p=287#comments Sat, 09 May 2009 02:39:11 +0000 blogmaster http://books.mcgraw-hill.com/medical/accesssurgery/blog/?p=287 The 50th Annual Meeting at Digestive Disease Week, May 30 to June 3, 2009, Chicago, Illinois.

AND

The 5th Annual ASC/AAS/SUS from February 3- 5, 2010 at the Marriott River Center in San Antonio, Texas.

]]> http://books.mcgraw-hill.com/medical/accesssurgery/blog/?feed=rss2&p=287 The Audacity of Ration http://books.mcgraw-hill.com/medical/accesssurgery/blog/?p=274 http://books.mcgraw-hill.com/medical/accesssurgery/blog/?p=274#comments Wed, 15 Apr 2009 01:27:15 +0000 blogmaster http://books.mcgraw-hill.com/medical/accesssurgery/blog/?p=274 In order to expand coverage to the estimated 40 million Americans
without healthcare, the Obama healthcare plan is likely to require the
assistance of all Americans. The mere availability of an increased
budget beyond the current 640 billion dollars will likely be
insufficient and instead require a more judicious approach in how care
is rendered without merely relying on increasing capacity in monetary
terms. One can envisage a triage system that would use algorithimic
modelling to identify patients with multiple organ dysfunction,
increased age, lethal comorbidities and poor predictive survival and,
from the outset, make the recommendation for a less aggressive
approach. This is likely to constitute a revolution in medical
decision making in healthcare in the US, affecting both patient and
provide alike. Might we actually have to lower our expectations about just how aggressive care can be in futile situations? Unseeming though it may sound, the judicious use of healthcare resources has been a trademark of all other OECD countries that have offered universal healthcare and if the US is finally ready to join Asian and European counterparts of similar economic stature, she may be best advised to rethink how the resources we have available are used.

]]> http://books.mcgraw-hill.com/medical/accesssurgery/blog/?feed=rss2&p=274 Playing NICE http://books.mcgraw-hill.com/medical/accesssurgery/blog/?p=268 http://books.mcgraw-hill.com/medical/accesssurgery/blog/?p=268#comments Sun, 29 Mar 2009 22:16:52 +0000 blogmaster http://books.mcgraw-hill.com/medical/accesssurgery/blog/?p=268 After what seems a lifetime of tight glycemic control and a seeming fixation of the adequacy of a glucose of 110 mg/dl, new evidence has emerged that tight glycemic control may increase mortality. The results, published by the NICE-SUGAR Study Investigators from a large international randomized trial was published in this week’s New England Journal of Medicine and may change the way we view glycemic control for a long time to come.

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