 Contributed by Robert A. Fink, MD, FACS, Berkeley, Calif. Dr. Fink reported no conflicts for disclosure. (click to enlarge) |
In the Loupe The patient presented with a mass on his head (top left). The scalp was reflected, showing an encapsulated mass containing cloudy fluid (top right). Underneath the mass was an area of skull which had been eroded, and in one place the dura had actually been breached by the capsule of the mass (bottom left). After excision of the mass, a cranial defect of approximately 4.5 centimeters was exposed, and an acrylic cranioplasty was performed (bottom right). The wound healed well with both a good anatomical and cosmetic result.The lesion was found to be an epidermoid. |
Latest SPORT Results: Significant Improvement With Surgery
Spinal stenosis patients improve more with surgery than with nonsurgical treatment
according to the latest results from Spine Patient Outcomes Research Trial,
but patients who choose not to have surgery are likely to improve over time.
The paper by Weinstein and colleagues, published in the Feb. 21 issue of the
New England Journal of Medicine, is the third in a series reporting SPORT study
results. The study was launched in 2000 to look at the three most common back
conditions leading to surgery: herniated disk with sciatica, spinal stenosis,
and spondylolisthesis. In this most recent study, surgical patients saw improvement
more rapidly and reported better physical function and less pain than did the
nonsurgical patients, who reported only moderate improvement two years after
their diagnosis.
“What we now know and can share with our patients is that they have a choice,” Dr. Weinstein stated. “If they choose surgery, they will improve greatly. However, if their preference is not to have surgery, their condition is not likely to worsen and they will see some improvement over time.”
Enrolled in the study were 289 patients in a randomized group and 365 in an observational group. As with the other SPORT studies, some patients randomized or who had chosen surgery crossed over to the nonsurgical group and vice versa. At two years, 67 percent of patients randomly assigned to surgery had had surgery, whereas 43 percent of those randomly assigned to nonsurgical care ultimately had surgery. Overall, 400 patients had surgery and 254 received nonsurgical treatment.
In the first study, for herniated disk with sciatica, surgical patients did
slightly better than nonsurgical patients but both groups showed significant
improvement at one and two years after entering the trial. Studies from the
SPORT trial that focus on cost-effectiveness and other measures will be released
in coming months.
https://www.nejm.org
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Successful Medical Groups Have This in Common
Better-performing practices are more likely to have formal policies and processes
for patient safety, to make investments in the practice, and to have implemented
electronic medical records or electronic health records, according to Performances
and Practices of Successful Medical Groups: 2007 Report Based on 2006 Data,
produced by the MGMA. More than 72 percent of better performers reported that
they had formal patient safety policies, compared with 63.2 percent of other
groups. More than 14 percent of better performers said that they acquired new
laboratory equipment compared with just 6.2 percent of others, and 20 percent
said they had built new facilities or acquired or expanded facilities, as opposed
to 13.5 percent of others. Significantly more of the better performers said
they had added ancillary services. By the end of the 2006, nearly 29 percent
of better performers said they had fully implemented EMR/EHR for all physicians
and practice locations, and 25 percent had fully implemented the technology
in a portion of the practice compared with 13.7 percent of other practices.
Better performing practices were defined as those that excelled in profitability
and cost management; productivity, capacity and staffing; accounts receivable
and collections; and patient satisfaction. https://www.mgma.org
More Spine Spending Doesn’t Equal Better Health
Although expenses related to back and neck problems have increased substantially
in the last decade, outcomes such as functional disability and work limitations
do not appear to be improving, according to a study in the Feb. 13 issue of
the Journal of the American Medical Association. Martin and colleagues analyzed
1997–2005 data from the nationally representative Medical Expenditure
Panel Survey. A total of 23,045 respondents were sampled in 1997, including
3,139 who reported spine problems. In 2005, the sample included 22,258 respondents,
including 3,187 who reported spine problems. The researchers found that expenditures
were higher in each year for those with spine problems than for those without.
From 1997 to 2005 there was an estimated 65 percent inflation-adjusted increase
in the total national expenditure for adults with spine problems—including
expenses for inpatient, outpatient, emergency department and pharmacy—an
increase more rapid than for overall health expenditures. The estimated proportion
of people with back or neck problems who self-reported physical functioning
limitations increased from 20.7 percent to 24.7 percent from 1997 to 2005.
Further, adjusted self-reported measures of mental health, physical functioning,
work or school limitations, and social limitations among adults with spine
problems were worse in 2005 than in 1997. https://jama.ama-assn.org
Safety Questions?
Surgical Patients Would Rather Ask Nurses
Patients prefer to challenge nurses rather than doctors about safety issues
related to their care, and women are far more prepared to speak up than men,
according to a study in Quality and Safety in Health Care. Davis and colleagues
based their findings on a validated survey that assessed the factors influencing
patients’ willingness to ask healthcare professionals questions related
to safety. The 80 survey respondents all had undergone surgery at one London
teaching hospital. The results showed that patients were far more likely to
ask factual questions of all healthcare professionals, such as the length of
their hospital stay, than they were to pose questions that might be perceived
as challenging clinical abilities, such as whether the healthcare professional
had washed his or her hands. Patients were more willing to ask factual questions
of doctors than of nurses, and they were more willing to ask challenging questions
of nurses than of doctors. But when doctors encouraged patients to ask challenging
questions, patients were more willing to quiz both sets of professionals on
safety and quality issues.
https://qshc.bmj.com