Survey, Healthcare Finance, Reform Top Issues Confronting Hospitals in 2014
Financial challenges again ranked No. 1 on the list of hospital CEOs' top concerns in 2014, according to the American College of Healthcare Executives' annual survey of top issues confronting hospitals. Healthcare reform implementation and governmental mandates ranked next in a tie for second, closely followed by patient safety and quality.
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Robotic-assisted surgeries started in 2000 after the FDA approved the da Vinci surgical system made by Intuitive Surgical Inc. of Sunnyvale, Calif. Intuitive it has installed more than 4,100 systems world-wide and more than four million procedures have been performed using it.
Elizabeth Raskin, a colon and rectal surgeon at Loma Linda University in Loma Linda, Calif., says the study doesn't effectively highlight the cases in which the robotic system has its most pronounced advantages, such as when patients are obese, have a narrow pelvis or have had multiple prior operations. (She is paid by Intuitive to teach the system to other surgeons.) "The equipment actually allows surgeons to do things that are exceptionally more difficult with laparoscopy," says Dr. Raskin, who says she performs most resection surgeries using the robot system. While there are surgeons who are very good at laparoscopy for such surgeries, the majority aren't, she says.
Aseem Shukla, director of minimally invasive surgery at the Children's Hospital of Philadelphia, says robotic-assisted surgery is of great value for more difficult surgeries that require a lot of suturing, because it provides increased range of motion.
Martin Makary, a professor of surgery at Johns Hopkins Hospital, acknowledged that there are surgeries for which the robotic system is superior, such as for posterior throat tumors and more complicated hysterectomy cases. Also, robotic-assisted prostate surgeries are easier on the surgeon's back, because it's hard to access the pelvis since the patient's chest is in the way of the best surgical positioning. Link.
"Robot-Assisted Surgery Costs More But May Not Be Better." Sumathi Reddy. The Wall Street Journal. Oct. 30, 2017.
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Hospitals tout robot-assisted surgeries, but two studies find they're longer and pricier than laparoscopy. Two studies published online last week in JAMA compared robotic-assisted surgeries to laparoscopic surgeries. Both are minimally invasive procedures done through small incisions, designed to avoid the large incisions made in open surgeries. David Jayne, a consulting surgeon at Leeds Teaching Hospital in England and lead author of one of the JAMA studies, "The [robotic] operation is exactly the same as the laparoscopic operation. So there's always been a big question mark about whether it's going to result in any different outcomes."
The RJ reported that the UNLV's business school has received pledges of $3 million from Dennis Troesh and $1 million from the Charles Koch Foundation for its Center for Entrepreneurship. The Dean of the Lee School of Business, Brent Hathaway, said that the school has seen increased demand from students across all majors for entrepreneurship training. The money will be dispersed over a 5 year period.
The question was asked to The New York Times "Ask Well" column. Microvascular heart disease affects about four times as many women as men and "is serious, actually," said Dr. Stacey Rosen, a cardiologist, since it can lead to heart attacks, heart failure, and death and is a form of ischemic heart disease. While traditional coronary heart disease involves the buildup of plaque and resulting blockages in the large arteries that feed the heart muscle, microvascular heart disease affects the tiny branches or tributaries of these large vessels. Abnormalities in the endothelium, or inner lining, of these smaller vessels, can cause spasms, resulting in pain and diminished blood flow to the heart. Treatment typically involves the use of medications that keep cholesterol and blood pressure in check, aspirin to prevent blood clots, and nitroglycerin to relax the blood vessels and assuage chest pain.Shortness of breath, fatigue or pain in the jaw, left arm, back or neck may be warning signs of microvascular dysfunction or an imminent heart attack. Breaking out in a cold sweat, or feeling nausea or lightheadedness, may also be warning signs of a heart attack.
"Is Microvascular Heart Disease a Serious Condition? Roni Caryn Rabin. Ask Well. The New York Times. Sept. 29, 2017.
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