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| MIT Researchers Study Liquid as Tool to Stop Bleeding
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MIT and Hong Kong University researchers have shown that some simple biodegradable liquids can stop bleeding in wounded rodents within seconds, a development they say could revolutionize bleeding control and reduce the time to perform an operation by up to 50 percent.
When the liquid, composed of protein fragments called peptides, is applied to open wounds, the peptides self-assemble into a nanoscale protective barrier gel that seals the wound and halts bleeding. Once the injury heals, the nontoxic gel is broken down into molecules that cells can use as building blocks for tissue repair.
"We have found a way to stop bleeding, in less than 15 seconds," says Rutledge Ellis-Behnke, PhD, research scientist in the MIT Department of Brain and Cognitive Sciences.
This study, which appears in the online edition of the journal Nanomedicine, marks the first time that nanotechnology has been used to achieve complete hemostasis, the process of halting bleeding from a damaged blood vessel.
Doctors currently have few effective methods to stop bleeding without causing other damage. More than 57 million Americans undergo nonelective surgery each year, and as much as 50 percent of surgical time is spent working to control bleeding.
In their experiments on hamsters and rats, the MIT and HKU researchers applied the clear liquid containing short peptides to open wounds in several different types of tissue -- brain, liver, skin, spinal cord and intestine.
"In almost every one of the cases, we were able to immediately stop the bleeding," says Dr. Ellis-Behnke, the lead author of the study.
He foresees that the material could be of great use during surgery, especially surgery that is done in a messy environment such as a battlefield. A fast and reliable way to stop bleeding during surgery would allow surgeons better access and better visibility during the operation.
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| ASC Leaders Voice Displeasure With 2007 Changes in Medicare Payment
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Before CMS overhauls the ASC payment policy in 2008 with wholesale changes in the way it reimburses freestanding surgical centers, ASC owners and operators still have the intermediate changes CMS has proposed for next year to worry about.
Last week was the deadline for ASC industry groups to tell CMS what they thought of the changes in Medicare payment for 2007, the last year in which ASCs will be paid under the existing groupers. The near-unanimous message to CMS officials: It's not enough. We want more procedures. And higher reimbursement rates.
Both FASA and AAASC say that the 14 additions to the ASC list are clinically appropriate, but both groups expressed concern that the payment group assignments for certain procedures "will result in reimbursement at a level insufficient to cover the cost of performing the procedure." As an example, AAASC cites the payment group assignment for CPT code 21356, which describes the open treatment of a depressed zygomatic arch fracture. The proposed payment group assignment is Group 3 ($510). Based on a survey of ASCs, the average cost of performing this procedure in an ASC is $1,365.
Both groups also chide CMS for unnecessarily excluding from the ASC List many procedures that are appropriately performed in ASCs. FASA also implored CMS to identify specific reasons for the exclusion of certain procedures, noting that, "it is essential that CMS identify the specific criterion that is not met in CMS's view so that knowledgeable commenters are able to address the agency's particular concerns."
Meanwhile, representatives from the American Society of Cataract and Refractive Surgery and the Outpatient Ophthalmic Surgery Society want to ensure CMS promotes patients' access to new technology, and call for payment adjustments greater than the $50 facilities currently receive for implantation of new technology IOLs.
"We're suggesting CMS be amenable to pay more than $50 as long as manufacturers can make the case for the higher amount by showing the lens has superlative benefits to the patient," says Michael Romansky, Washington counsel for OOSS.
A second set of comments regarding the new ASC payment system is due to CMS by Nov. 6, 2006. These comments will address changes to be implemented in 2008 that will eliminate grouper payments and adopt the APC relative weights used in the hospital outpatient prospective payment system.
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| Plastic Surgery a Natural Mood Enhancer?
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It has been proven that plastic surgery can improve self-esteem, but can it also act as a natural mood enhancer? A significant number of patients stopped taking antidepressant medication after undergoing plastic surgery, according to a study presented at last week's American Society of Plastic Surgeons conference in San Francisco.
"Plastic surgery patients are taking a proactive approach in making themselves happier by improving something that has truly bothered them," says Bruce Freedman, MD, ASPS Member Surgeon and study author. "While we are not saying that cosmetic plastic surgery alone is responsible for the drop in patients needing antidepressants, it surely is an important factor."
In the study, 362 patients had cosmetic plastic surgery -- 17 percent or 61 patients were taking antidepressants. Six months after surgery, however, that number decreased 31 percent, down to 42 patients. In addition, 98 percent of patients said cosmetic plastic surgery had markedly improved their self-esteem.
All of the patients, who were primarily middle-aged women, had an invasive cosmetic plastic surgery procedure such as breast augmentation, tummy tuck or facelift. The authors did not identify any other major life changes that may have affected patients' use of antidepressants.
"We have just begun to uncover the various physical and psychological benefits of plastic surgery," says Dr. Freedman. "By helping our patients take control over something they were unhappy about, we helped remove a self-imposed barrier and ultimately improved their self-esteem."
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| News and Notes
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OUTPATIENT SURGERY CENTERS NOW OUTNUMBER GENERAL HOSPITALS IN PENNSYLVANIA, and the centers perform one of every four surgical and diagnostic procedures in the state, according to a new report. The same rapid growth is happening nationally as surgery centers are poised to outnumber the roughly 4,800 general hospitals in the country, if they don't already. In Pennsylvania, a report being released today by the Pennsylvania Health Care Cost Containment Council said 25 outpatient centers opened in the 12 months ending in May, bringing the total to 202 and surpassing in number the approximately 180 general hospitals in the state. Pennsylvania's surgery centers accounted for one-fourth of the 2.2 million surgical and diagnostic procedures performed in the state last year, up from one-fifth in 2004. The $515.1 million in revenue reported by 172 of the surgery centers was about 5 percent of the general hospitals' outpatient revenue last year.
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