Abstract:

What is economic credentialing? The California Medical Association defines economic credentialing as follows: "The use of economic criteria that do not apply to quality for granting or renewing medical staff pr ivileges?" The American Medical Association defines economic credentialing as " ... the use of economic criteria unrelated to quality of care or professional competency in determining an individual's qualification for initial or continuing hospital medical staff membership or pr-ivileges?" The Florida Medical Association defines economic credentialing as "... any practice that denies access to hospitals based on economic criteria unrelated to the clinical qualifications or professional responsibilities of the physician." It also defines economic credentialing as " ... fiscal responsibility in practicing quality healthcare," and specifically notes that the governing body of a hospital has the right to discipline physicians (and presumably, exclude them) on the basis of resource utilization.

Authors:

Mohan C. Airan, M.D., F.A.C.S., F.A.C.M.Q., Good Samaritan Hospital, Downers Grove, IL, Mount Sinai Hospital, Chicago, IL, Finch University, The Chicago Medical School, Chicago, IL; Frank Madda, M.D., Good Samaritan Hospital, Downers Grove, IL; Raj B. Lal, M.D., F.A.C.S., Good Samaritan Hospital Downers Grove, IL

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Abstract:

Infection remains a significant source of morbidity and expense in the treatment of surgical patients therefore, antibiotics continue to be an important part of the general surgeon's armamentarium. Unfortunately, physicians, and surgeons in particular, continue to order too many antibiotics too often, and for too long. Optimal use of antibiotics, as for any therapeutic modality, requires consideration of the risks and benefits associated with available agents and regimens. Although the desired benefit is always successful eradication or avoidance of offending pathogens, the best way to acheive that goal may not be obvious. Decisions regarding choice of antimicrobial agent, duration of therapy, and route of administration are primarily based upon anticipation of clinical efficacy.

Authors:

David Safran, M.D., University of South Alabama Medical Center, University of South Alabama College of Medicine, Mobile AL; J. Raymond Fletcher, M.D., University of South Alabama Medical Center, Mobile, AL

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Abstract:

Imaging in surgery is used for diagnosis, planning, intraoperative navigation and post-operative evaluation. Digital medical imaging modalities include computed tomography (CT), magnetic resonance imaging (MRI), MR therapy (MRT), fluoroscopy and ultrasound. These modalities are applied singly or jointly (multimodality). Surgical requirements differ according to the nature of intervention, and real-time guidance is sometimes needed such that a sequence of images is generated and displayed as acquired. Soft copy display on CRT screens is satisfactory for intraoperative use, while hardcopy film images or physical replica modeling may be needed in other cases. Computed tomography/ developed more than 20 years ago, remains important in craniofacial and orthopedic surgery. Newer imaging systems, especially ultrasound, magnetic resonance imaging, and digital fluoroscopy are used for neurosurgery, oncology, cardiothoracic and abdominal surgery. Each modality offers specific qualities that subserve specific needs in diagnosis, planning, intraoperative navigation and evaluation.

Authors:

Michael W. Vannier, M.D., F.A.C.R., Jeffrey L. Marsh, M.D., F.A.C.S., Ge Wang, Ph.D., Gary E. Christensen, D.Sc., Alex A. Kane, M.D., Washington University School of Medicine, St. Louis, MO

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Abstract:

In the last few years there has been increasing interest in the development of 3-D display in medical imaging techniques. 3-D imaging is capable of enhancing the anatomic information of the images. This technique facilitates the localization of normal and pathologic structures and the understanding of spatial relationships. Computer reconstructed 3-D views of computed tomography (CT) and magnetic resonance imaging (MRI) have improved image interpretation by clinicians especially in reconstructive and orthopaedic surgery. Although the advantageous features of 3-D display are well recognized for radiologic imaging methods, 3-D data acquisition in ultrasonography has not yet found broad clinical acceptance. This has been mainly due to the lack of hardware appropriate for clinical use and the time required for data processing of high resolution 3-D images. However, recently some experimental solutions for sonographic data acquisition as well as more rapid computer systems have been developed.

Authors:

Dr. med. Michael Hünerbein, Peter Hohenberger, M.D., Ph.D., Peter M. Schlag, M.D., Ph.D., Virchow Hospital, Humboldt University, Robert Rössle Hospital and Tumor Institute, Berlin Germany

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Abstract:

Recently, there has been increasing interest among anesthesiologists in the responses to surgical stress because surgical procedures have become more and more invasive. While the responses are natural and protective in themselves, they may have adverse consequences for the patients. There have been many investigations suggesting that anesthetic techniques such as spinal and epidural analgesia may alter the endocrine response. Some measures which block inflammatory reaction are reported to allow modulation of the response. In the present study preemptive analgesia for postoperative pain using spinal and extradural blockade, and pre-treatment of cyclo-oxygenase inhibitor indomethacin were applied to patients responses were assessed.

Authors:

Ryo Ogawa, M.D., Ph.D., Akire Ogura, M.D., Chol Kim, M.D., Mahito Yamaguchi, M.D., Nippon Medical School, Tokyo, Japan Technology Assessment James S. Brevis, M.D., Kaiser Permanente Medical Group, San Francisco, CA

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Abstract:

The proliferation of medical technology, including prescription drugs, devices, and procedures, is often perceived in the current managed healthcare environment as a threat to the ability of managed care organizations to control healthcare costs. However, the ongoing need for new technologies and innovations in medical care demands that we look beyond the cost of developing and acquiring such technologies to the outcomes being achieved with the resources invested. We need to document not only costs and/or clinical outcomes related to such technologies and interventions, but also measures such as cost effectiveness, patient quality of life, and patient satisfaction. Outcomes research is the term given to the assessment of such measures.

Authors:

Kimberly Kunz, M.P.P., Peter Mazonson, M.D., M.B.A., Technology Assessment Group, San Francisco, CA

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Abstract:

Mortality after surgery in patients with severe and progressive anemia is an entity: risks related to blood loss and insufficient oxygen delivery to tissues are still a major concern in surgery. Risks of blood transfusion parallel those of blood loss: blood-borne infectious diseases and immunological side effects' may frustrate therapeutic efforts of surgery. Thus, blood transfusion in surgery must be kept to a level in which both risks are reduced to a minimum (or theoretically even absent). This review will deal with two relevant questions: (a) how to define the lowest amount of blood tranifusion needed for sur8ery and (b) how to reduce or abolish post-tranifusion risks of this amount.

Authors:

Vincenzo De Angelis, M.D., Luigi De Marco, M.D.,IRCCS Centro di Riferimento Oncologico, Aviano, Italy

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Abstract:

The number of individuals infected by the human immunodeficiency virus type-l (HIV) continues to increase on a worldwide basis. A significant percentage, ifnot all, of these individuals will eventually develop the acquired immunodeficiency syndrome (AIDS). While horizontal transmission in the homosexual population may be contained or decreasing, heterosexual transmission and infection through contaminated blood supplies continues to increase: Additionally, vertical transmission from infected females to their fetuses is also on the rise with a resultant increase in the number of children with AIDS. New strategies, therefore, must be devised in order to limit more effectively the spread of this virus.

Authors:

William D. Lyman, Ph.D., Irwin R. Merkatz, M.D., Steven G. Kaali, M.D., F.A.C.O.G., Albert Einstein College of Medicine, New York, NY

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Abstract:

The main direction in modern imaging is increasing the spatial resolution and selectivity for pathology pattern recognition at the microscale. Dynamic optical imaging (DOl) has enormous potential in the selectivity of description of living tissue state at cellular and subcellular levels. However, multiple light scattering creates considerable difficulties in revealing the tissue microstructure in its depth. On the other hand, along with changes in the microstructure, pathology should also manifest itself in the integral macroscopic pattern of the tissue. Actually, living tissue, as a distributed active media with well-developed reception and self-regulation, is characterized by a high spatial synergy. In such a media, even morphologically small pathology could disturb tissue functioning in a rather extended area. As a result, after some definite time, a diffuse "field" of the pathological phenomena appears even in the morphological image. Since optical contrast is determined by tissue components (such as blood), which actively participate in physiological functioning, the distributed functional pattern of the tissue is reflected in optical images in the form of spatiotemporal modulation of the optical density. This observation opens up the possibility of investigating the diffuse pattern of the pathology at the functional stage of its development, even before the actual appearance of noticeable morphological changes.

Authors:

Edward Godik, Ph.D., Dynamics Imaging, Inc., Washington Township, NJ; Tamas Gergely, Applied Logic Laboratory, Budapest, Hungary; Vladimir Liger, Ph.D., Vladimir Zlatov, M.S., Dynamics Imaging, Inc., Washington Township, NJ; Alex Taratorin, Ph.D., Technion-Israel Institute of Technology, Haifa, Israel

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Abstract:

Surgical repair of inguinal hernia is among the oldest and most common operations performed by general surgeons. Currently, 700,000 procedures are performed annually in the United States. Regardless of the large volume of hernia surgery which is performed, the results arc less than ideal. It is estimated that the recurrence rate of primary hernia repair remains at 10% to 15% with a higher rate following repair of recurrent hernia. Equally important, there is frequently a long period of disability and discomfort. Many surgeons still advise their patients to refrain from work, exercise, and heavy lifting for periods of 3 to 8 weeks. While it is common in the United States for hernia surgery to be performed on an ambulatory basis, it is still not unusual that patients are hospitalized for several days to a week in other parts of the world. It is readily apparent that unnecessary days spent in hospital add a great burden to every country's healthcare expenditures.

Authors:

Alan W. Robbins, M.D., F.A.C.S., Ira M. Rutkow, M.D., The Hernia Center, Freehold, NJ

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