The parents of children scheduled for ear, nose and throat surgery remember little more than half of the risks that their physicians discuss with them during pre-op meetings, according to a study of surgical risk counseling conducted by the Walter Reed Army Medical Center.

"Despite our best efforts in this study, patients and parents clearly do not retain and/or understand the full extent of the surgical risks that were discussed during the informed consent process even though this is the number one goal of the informed consent discussion," write the study's authors, who published their findings in the March issue of the Archives of Otolaryngology-Head & Neck Surgery.

When surveyed immediately after the pre-op meetings, parents remembered an average of 58% of the 9 risks discussed. Researchers also found that mothers retained more information than fathers, and that parents with less education remembered more than more-educated parents.

The authors recommend using a checklist and handouts during pre-operative discussions. Parents who received documentation remembered 67% of the risks associated with their children's surgeries, as compared to only 49% for those who didn't receive handouts, write the authors.

Kent Steinriede

Virtual biopsy probes and retrograde-viewing devices improve polyp detection rates during colonoscopy, according to several studies released this month.

Mayo Clinic researchers anticipate that virtual biopsy probes might soon be able to determine if a polyp is cancerous, eliminating the need to remove it for biopsy. In the March issue of the journal Gastroenterology, they note that confocal laser endomicroscopy probes were 91% accurate in detecting precancerous polyps, which topped the 77% accuracy rate of virtual chromoendoscopy probes.

"We are getting closer to where we want to be, which is 100% accurate," says the study's senior author, Michael Wallace, MD, MPH, professor of medicine at the clinic's College of Medicine in Jacksonville, Fla. "Someday soon we will be able to use these probes to virtually biopsy a polyp, removing only those that could become cancerous."

Meanwhile, 2 studies appearing in the March issue of Gastrointestinal Endoscopy tout the efficacy of a retrograde viewing device that fits into a standard colonoscope to provide continuous backward views of the colon as the scope is withdrawn. The first study reports 13.2% more polyps were detected, including 11% more precancerous polyps, when the device was used.

The second study notes the device increased overall polyp detection rates by 14.8% and helped detect 16% more adenomas than a standard colonoscope did. "Compared with routine colonoscopy, a retrograde-viewing device can increase detection rates for clinically significant adenomas without detriment to procedure time or procedure complications," this study's authors conclude.

Daniel Cook

Ophthalmic patients at surgery centers and hospitals whose treatment is reimbursed by Medicare are about 550 percent more likely to undergo cataract surgery than those receiving care through Veterans Affairs facilities, say researchers.

"The results of our study raise important questions about the possible existence of a two-tier, federally funded health-care system that may not be equivalent in terms of quality of care," says co-author Dustin French, PhD, a health economist and assistant professor of medicine at Indiana University School of Medicine.

The study, published in the March issue of the American Journal of Medical Quality, questions whether financial incentives may be driving civilian facilities' and surgeons' cataract surgery volumes. The researchers note that many older veterans are covered by both government-funded health insurance plans, but VA hospitals and surgeons don't share Medicare-participating facilities' financial incentives to perform cataracts.

"We don't know yet what exactly accounts for the five and a half fold difference in surgery rates between the two systems," says Dr. French. "It may be related to how the two systems are funded by the government, it could be a difference between physician-driven decisions or it may be related to a lack of ophthalmologists within the VA system."

David Bernard

Does your facility track and review physician-specific costs per case? Tell us in this week's poll question. We'll report the results in this space next week.

Last week's poll asked about the average age of your nursing staff. Out of 237 respondents, more than half (54%) said the average nurse at their facility is older than 45. Another 38% said most of their nurses are between 36 and 45. Five percent said most nurses are between 26 and 35 and 3% said most nurses are between 18 to 25.

Dan O'Connor