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| Office-based Ultrasound May Improve ENT Practices
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Otolaryngologists should place a greater emphasis on office-based ultrasound in an effort to offer patients a more convenient and lower-cost diagnostic imaging service, notes a study published in the December issue of Otolaryngology — Head and Neck Surgery. Researchers report that out-of-office ultrasound increases patient travel, requires multiple appointments and delays care.
Researchers note ultrasound is easily integrated into office settings to provide real-time imaging that is more informative than X-rays. The study further reports that ultrasound machines can be purchased for less than $40,000, an amount that a practice can recoup within a year.
The study suggests otolaryngologists are well suited for in-office ultrasound because of their expertise with the anatomy of the head and neck, but Nina Shapiro, MD, professor of pediatric otolaryngology at UCLA, cautions that the variability of physician skill in interpreting the ultrasonographic findings limits the technology's effectiveness in practice.
Brent Senior, MD, chief of rhinology, allergy and sinus surgery at he University of North Carolina School of Medicine, says UNC's pediatric otolaryngologists use ultrasound to evaluate neck masses and vocal fold function in children. He says the school's physicians also employ the technology to examine thyroids and neck masses in adult patients.
"Ultrasound is relatively inexpensive and the pictures have improved quite a bit over the years," says Dr. Senior. "That being said, it still requires some training to be able to look at the images and read them appropriately."
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| Patients Prefer Unsedated Upper GI With "Skinny Scope"
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Using a "skinny scope" in the doctor's office to screen patients with chronic heartburn or pre-cancer of the esophagus is just as accurate, less expensive and less risky than traditional sedated screenings in a procedure room, according to a study published in the December issue of the American Journal of Gastroenterology. Plus, patients were found to prefer it.
Researchers at the Oregon Health and Science University in Portland screened 134 patients with histories of GERD symptoms and the use of acid-reducing medications for the prevalence of Barrett's esophagus in a randomized, crossover trial that employed both conventional and unsedated, small-caliber endoscopy.
While conventional upper endoscopy uses a 9.8mm scope and requires, according to researchers, "the resources and infrastructure of an outpatient procedure unit, two assistants, intravenous sedation and post-procedure monitoring, with a total cost in the thousands of dollars," the small-caliber scope is only 4.9mm and, because it can be used in an office without sedation, costs "in the hundreds of dollars."
A total of 98 percent of the patients successfully completed the small-caliber method in an office setting, with more than 70 percent noting that they would choose it instead of the conventional method on a subsequent endoscopy. The prevalence of Barrett's esophagus discovered by both approaches was equal and there were no undetected cases of cancer.
"This trial has established that [this technique] used in an office setting is technically feasible, well-tolerated and accurate in the screening and diagnosis of Barrett's esophagus," says principal investigator Blair A. Jobe, MD, a surgeon in the OHSU Digestive Health Center and member of the OHSU Cancer Institute. "It's a more personal approach and represents the potential to eliminate the infrastructure and costs required for intravenous sedation. It's also more immediate. As soon as you're done, you can tell the patient what you've found."
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| N.Y. Hospital Offers Bariatric Surgery for Adolescents
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Morgan Stanley Children's Hospital of New York-Presbyterian has the FDA's approval to offer teens something no other hospital in the nation can: laparoscopic adjustable gastric banding. The Manhattan hospital's newly opened Center for Adolescent Bariatric Surgery offers this procedure as an option along with several other weight-loss strategies. Approximately 50 patients are currently enrolled in the program.
"Like adults who receive treatment for obesity, adolescent patients undergo rigorous education and a lengthy program of multidisciplinary, non-surgical therapies," says Marc Bessler, MD, surgical director of the Center for Obesity Management at New York-Presbyterian. "Nevertheless, nearly 90 percent of adolescents with a BMI greater than 40 are ultimately unable to achieve or maintain adequate weight loss despite intensive medical regimens. For these patients, the new program offers LAGB, which studies have shown to be the safest and least traumatic surgical procedure."
As Jeffrey. L. Zitsman, MD, director of the Center for Adolescent Bariatric Surgery, notes, "Obesity is often a fatal disease in the long term. If we can interrupt the progression in young patients before irreversible damage is done, we will have done a very good thing."
Dr. Zitsman and Ilene Fennoy, MD, the center's medical director, say the hospital chose to perform LAGB rather than other types of bariatric surgery because it is a minimally invasive procedure, does not reroute patients' digestive anatomy and is completely reversible. However, the procedure still requires significant changes in patients' diets and lifestyles and there is as yet no conclusive evidence of its long-term effects.
At present, the center performs LAGB surgery only on children 14 years of age and older, but younger patients can enroll in its non-surgical weight-loss programs.
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| News and Notes |
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ASCS AND HOPDS WILL HAVE TO REPORT QUALITY DATA starting no sooner than 2009, thanks to a provision passed by Congress last week. CMS will be required to develop quality reporting measures using data and guidance from national consensus organizations such as the National Quality Forum. Failure on the part of ASCs and hospitals to report would result in a two percent payment penalty on the annual inflation update. CMS would also be required to publicly post reported information on its Web site. Congress's action essentially rubber-stamps CMS's plans to develop outpatient-specific quality reporting standards, which the agency announced in August upon issuing its proposed restructuring of the Outpatient Prospective Payment System.
JCAHO SEEKS YOUR FEEDBACK on a list of goals and requirements under consideration for inclusion in the organization's 2008 National Patient Safety Goals. The draft goals include measures for improved recognition and response to changes in a patient's condition, reduction in the risk of post-op sleep apnea complications and prevention of patient harm associated with staff fatigue. A complete list of the potential 2008 safety goals is available on the Joint Commission's Web site. The deadline for feedback is Thursday, Jan. 26.
AAASC AND INFORMED HEALTHCARE MEDIA HAVE JOINED FORCES TO OFFER financial and operational information for benchmarking to AAASC's members. Since the data will be compiled directly from the actual financial reports of ASCs, rather than gathered through industry surveys, the accuracy and integrity of the information will be heightened, say InforMed and AAASC. The two groups also anticipate future collaborations to develop additional research and tools for improving surgery centers' operations and financial performance. Research oversight and the creation of metrics, data, editorial content and InforMed's future ASC reports will be directed by an expanded editorial board that will include AAASC leaders and other industry observers. |
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