To provide patients and physicians with realistic estimates on risk for death from major elective surgeries, researchers examined Medicare data for 14 cardiovascular and cancer-related procedures. Reviewing 1.2 million surgeries in patients aged 65 to 99, they found that mortality risk is considerably higher than typically reported in case series and trials; varies widely according to the type of surgery; and increases with age (“Operative Mortality with Elective Surgery in Older Adults,” p. 172).
Goodbye to Diet Rules for Fecal Occult Blood Test?
Cantaloupe, broccoli and cauliflower can come off the “foods to avoid” list for patients about to take a fecal occult blood test (FOBT), according to a new analysis. Researchers found little difference in the proportion of positive results for patients randomly assigned to follow dietary guidelines when taking unrehydrated FOBTs compared with patients assigned to follow their usual diets. While finding no evidence that current diet guidelines reduced test completion rates, the researchers warn more severe dietary restrictions may. (“Meta-Analysis of Dietary Restriction during Fecal Occult Blood Testing,” p. 150). An editorial says it’s time to simplify diet restrictions for this important, yet underused, test (“Diet for Fecal Occult Blood Test Screening: Help or Harm?” p. 180).
Dramatic Regional Differences in Numbers of Neonatologists in U.S.
The number of neonatologists per 10,000 live births ranged from 1.2 to 25.6 among 256 hospital regions of the United States, with high numbers in such cities as Washington, D.C., and Newark, N.J.; and low numbers in Great Falls, Mt., and St. Louis, Mo. The researchers said neonatologists’ numbers have grown rapidly despite stable birth rates (“The Uneven Landscape of Newborn Intensive Care Services: Variation in the Neonatology Workforce,” page 143). An editorial asks, Is the increasing supply of neonatologists beneficial or harmful to the long-term outcomes of newborns? (“Neonatal Workforce: How Much is Enough?” p. 178).
Effective Clinical Practice, the journal for quality improvement in health care delivery systems, seeks to answer how much, how often, and how best to deliver clinical care. ECP is published by ACP-ASIM, the nation’s largest medical specialty society, and the Alliance of Community Health Plans, which is dedicated to helping participating plans improve the health of their members and their communities. These highlights do not substitute for articles as sources of information. Please request articles by calling 215-351-2655, or by sending an E-mail to lteer@mail.acponline.org.