Know about some basic facts of Mentoplasty Surgery

The popularity and huge success of plastic surgery is due to the fact that there is in fact no part of the body or face that cannot be treated with the help of plastic surgery. It is due to this reason that despite being quite an expensive affair the popularity of plastic surgeries has not decreased a bit. Among these is one such surgery that has not come much into lime light but has been part of the plastic surgery sector for a long time. This surgery is called Mentoplasty which is also called in a colloquial term as chin job. This is again like any other surgery which is a choice by an individual as a disproportionate chin size does not pose any problem to the body or to the face muscle or bones.

What is Mentoplasty?

This is a chin surgery where the either through the reduction of the chin size or enhancement of the chin size a proportionate shape is been delivered to the chin area. This is a proper surgical method which requires incisions and hence this surgery should not be taken lightly at all.

Some Basic facts About Mentoplasty

• Many times it is been found that surgeons refer to go for chin surgery despite the fact that actually have a problem of disproportionate nose. The newly positioning of the chin may either magnify or minimize the effects of the nose and can actually provide a proper proportionate look of the face.
• Chin surgery is usually best recommended to those who have passed the age of 20 or are fully adults. This is because the facial muscles and bones are in a constant growth process though that process is quite slow. Hence it is better to wait till the bone development in the chin area has completely taken place.
• The surgical process is quite delicate and hence it can several hours for the surgeon to finish.
• A huge incision is usually made at the time of the surgery. Hence most surgeons are of the opinion that when the incision is done within the mouth which is naturally a concealing position. Sometimes in case of an external incision it is done just below the chin in the area where the neck begins. The scarring cannot be avoided and hence such concealing areas are being sought.
• Following the surgery it is often found that after the surgery one can experience an uncomfortable feeling while chewing and can even feel that the other skin on the chin is tight. For pan immediately after the surgery, pain killers are often prescribed.
• Infections are possible in case the implant in chin enhancement move out of its location.

Hi I am Carl Bowman a soccer player by profession. Few years back my chin had been reduced a little after a small accident. It was then I was looking for a mentoplasty surgeon who was affordable and board certified. After much searching I did get a fantastic surgeon and can say that for facial surgeon in New York is best for Facial and cosmetic procedures.

UK Healthcare says it must get even bigger, and expand its market area, to provide needed services to Kentucky

By Molly Burchett and Al Cross
Kentucky Health News

The University of Kentucky's health-care system has grown by leaps and bounds in the last decade, becoming one of the state's largest businesses, but its boss says it must expand its geographical reach to maintain its newly raised national status and to ensure access to quality care for Kentuckians.

Over the last decade, UK HealthCare’s caseload has increased 85 percent, and its annual hospital budget has increased from $300 million to $922 million, Dr. Michael Karpf, executive vice president for health affairs, said in an interview.

This explosive growth, in addition to the growth of the UK medical school, has jacked up the enterprise's national ranking. It has grown from about the 85th largest academic hospital in the U.S. to approaching the 35th largest in terms of total discharges, the benchmark it uses. That means it has jumped from the bottom third to the top third in less than a decade. (For a more precise measurement over time, based on a Council of Teaching Hospitals standard, see chart.)

The push for growth and development began in 2003, after UK's caseload hit a plateau even though the 1998 General Assembly had mandated it to become a top 20 public research institution. Karpf came aboard and combined the Chandler Medical Center, clinics, faculty practice plans and the College of Medicine into a single integrated system of care -- branded as UK HealthCare -- which he commands. Good Samaritan Hospital in Lexington was added in 2007.

"Ten years ago people viewed this a safety-net hospital," Karpf said of the Chandler facility. "We've had to redo the brand." Now more people are choosing the hospital, as suggested by who's paying the bills. Medicare now covers a plurality of the patients; a decade ago, it trailed Medicaid, the program for the poor and disabled. In that time, the total caseload grew 7.2 percent; Medicare cases rose 10.9 percent.

But despite the huge growth in the last decade, the enterprise is still not big enough, Karpf said.

"We want the hospital to be the first choice when it comes to complex care,” he said. “We must advance to better serve the health-care needs of Kentucky.” To do this, he said, UK HealthCare is rejuvenating its brand as "Kentucky's Best Hospital," with a broad range of advanced specialties to keep Kentuckians from leaving the state for care, and is moving to expand its geographic reach to Western Kentucky and out-of-state markets.

Karpf said UK must expand because its traditional market, approximately the eastern half of the state, is not large enough to provide the number of cases that UK will need to receive certification as a federal “Center of Excellence” for complex services like brain surgery and heart, liver, kidney and lung transplantation. He said such a designation will be necessary to get enough referrals from doctors and smaller hospitals to maintain these services and to guarantee that Kentuckians can get the care they need inside the state. "What we make money on is the complex stuff," he said.

Unless UK secures half the available business from out-of-state competitive areas over the next 10 years, Karpf said, "It becomes an issue of access for Kentuckians."

He said the out-of-state institutions that are large and advanced enough to effectively compete with UK as a major referral center include Vanderbilt University, Washington University in St. Louis, Indiana University, Ohio State University, Cleveland Clinic, the University of Pittsburgh Medical Center and the University of Virginia. Vanderbilt is the nation's 10th largest academic medical center and gets many patients from Western and Southern Kentucky. 

UK HealthCare map shows out-of-state markets and institutions it targets for its expansion.

What about Louisville, Cincinnati, Knoxville and other cities? Karpf said the University of Louisville, the University of Tennessee, the University of Cincinnati and West Virginia University are too small and too far behind to be Centers of Excellence. U of L's hospital ranks 88th in total discharges among academic medical centers.

All hospitals are facing challenges from federal health-care reform, but Karpf said at UK it has prompted a culture change centered on quality of care, which the reform law is designed to reward. As UK tries to expand its market, he said, it is critical to stay focused on, safety, service and patient satisfaction. One issue Karpf is dealing with now is the hospital's cardiothoracic surgery program for children, which has been suspended pending an internal review.

As UK seeks more referrals, Karpf said, it is building better relationships with smaller hospitals. "in the past, academic medical centers have been seen as predatory," he said. "We concluded that we need to be seen as in another line of business. . . . We have very strong relationships with community hospitals in Western Kentucky."

For example, UK is  training a cardiologist who is dedicated to practicing in Paducah once his training is complete, and kidney specialists from the area are in its transplant network. The specialists evaluate patients, send them to Lexington for transplants, and provide follow-up care upon their return. Such coordination helps community hospitals keep patients and recruit professional staff, and helps UK capture the cases it might lose to Vanderbilt and other out-of-state hospitals.

Baptist Hospitals Inc. has a large facility in Paducah and recently bought the Trover Health System hospital in Madisonville, making Baptist the largest hospital system in Kentucky, but Karpf said UK has a strong relationships with Baptist and the Norton Healthcare hospitals in Louisville. "They do not compete with us for complex care," he said. "We don't go after the bread-and-butter cases."

Complex care, for which insurance companies pay well, accounts for 5 to 7 percent of UK's cases but almost all its profits. Karpf said UK loses money on another 5 to 7 percent and breaks about even on the rest. He said the profits are invested in buildings, technological equipment and attracting nationally recognized specialists.

The most visible evidence of that is the hospital's new bed tower, part of $1.4 billion UK Healthcare has spent revitalizing itself, mostly with its own profits. But the larger impact is probably in expansion of good-paying jobs.

Dr. Michael Karpf

"We've been the most important growth engine in this region," said Karpf. UK HealthCare went from paying $350 million in salaries and benefits in 2004 to more than $700 million last year. The College of Medicine went from 1,810 employees in 2004 to 2,337 in 2012. The hospital grew from 2,562 full time employees in 2004 to 5,544 in 2012, a 116 percent increase.

The medical school's full-time faculty has expanded from 443 a decade ago to 625 now. "We know the stronger you are clinically, the better your research profile," Karpf said. UK Healthcare hopes to achieve National Cancer Institute designation for the Markey Cancer Center, and it must continue to evolve in its clinical, education and research missions, Karpf said.

If UK HealthCare can do that, it will continue to be a major economic driver for Kentucky while ensuring that all Kentuckians have access to quality care.

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Say Goodbye To Cellulite Forever

You are familiar with the adage “you don’t get out of this life alive”, but for most woman they might add “and cellulite-free.” Incessant complaints about unruly humps and bumps around thigh area are constant predicament even among teens to women nearing in their golden years. According to American Society for Aesthetic Plastic Surgery, almost 90% of all women regardless of race are prone to cellulite.

The intensity of the demand to fight or least curb cellulite overwhelmed mall shelves with anti-cellulite products from temporary relief such as caffeine infused creams to more effective no surgery fat processes like laser, massage and suction. Introducing Cellulaze, an anti-cellulite laser treatment approved by Food and Drug Administration. Unlike other fat treatments that target the outer layer of our skin, Cellulaze goes underneath to fix the unsightly humps and bumps of the skin. Let’s us discuss the basics of the on the dreaded skin condition.

Cottage Cheese Explained

Cellulite is undiscriminating skin condition. Being slim does not exempt you being cellulite-free. So whether you are fat or thin, jiggly or muscled, you are a perfect target of cellulite. The fight for cellulite is synonymously battling with genetics, hormonal factors, diet, lifestyle and age. Sad to say women are more prone to those pesky undulations and indentations due to female skin architecture says NYC dermatologist, Dr.Schweiger. Men’s connective tissue is diagonal and criss-crossed, laid smoothly and continuous. While women’s connective tissue lies vertical to the skin and during the start of puberty, wherethe estrogen levels increases and skin elasticity weakens and the fat chambers (septae) starts to develop due to the connective tissue structure causing the fat to be pushed upwards while at the same time the fibrous bands pull the skin downwards.

Introducing the New Technique

Before, having cellulites means that you have to deal with them forever, but not anymore and this is what the buzz about Cellulaze. A surgeon will administer a local anesthesia and threads a laser fiber with the help of a cannula that is as thin as the pencil lead and trims the fat chambers (septae) melts them and heats the skin from the inside out and this encourages the growth of collagen and elastin.

The laser fiber turned into 90 degrees is effective enough to break and vaporize  stubborn septae. The laser fiber will then be turned toward skin surface wherein the heat will thicken the skin. The moment those septae were severed, there is no chance for them to grown back making you totally cellulite-free. The laser heat is said to promote collagen and elastin growth will make your skin 29% more elastic.

The key to get rid of cellulite successfully is to treat the problem at the root just like what Cellulaze does. With minimal downtime, patients’ needs not to avail leave from work since they can go back to work the next day as observed with patients who undergone Celulaze. But patient are required to wear compression garments, thinksupertight bike shorts for at least a week. Expect bruising and soreness during the first two weeks before it disappears. Patients can see a change as fast as two weeks. Maximum results can be achieved within four to six months at most as that is the time where the increase of collagen and elastin are maximized. And the good news to all is that patients who undergone Cellulaze three years ago experience zero-cellulite reoccurrence.

Breast Reduction Can Solve Problems

A reduction mammoplasty, more commonly referred to as a breast reduction surgery is usually performed for a number of reasons that prove to be a medical necessity. There are cases in which the size of a woman's breasts is excessive and this leads to a several afflictions, such as back and neck pain, breathing problems and even severe spine deformation.

Breast Reduction Eliminates Many Physical Shortcomings

When breasts are excessively large, physical limitations and health-related problems are only several natural consequences. Not only the weight, but also the size and bulk of the breasts are causes for physical and also psychological problems, as physical shortcomings reflect upon a woman's psyche.

A reduction mammoplasty is a surgical procedure that alleviates all of these issues and the women who undergo such a procedure are more than pleased with the results. Even before the wounds are completely healed, the patient's first observation is, generally speaking, the complete relief of back and neck pain.

In the long run, all physical problems that were caused by overly sized breasts are solved. The spine can sustain a correct posture, without any painful effort, breathing problems are completely eliminated, troubles with sleep fade away and the patient starts to feel better about herself.

What Goes On During A Breast Reduction Procedure?

Each woman's body is different, thus the surgical procedure she is about to undergo must be adapted to her case. First of all, the plastic surgeon must explain to the patient which breast proportion is ideal for her body. During the surgical procedure itself, glandular tissue, along with excess fat and cutaneous tissue are removed.

The remaining tissues are then rebuilt and reshaped in order to achieve the desired result. In most cases, the reduced breasts are firmer and evenly shaped. In addition to that, liposuction in the armpit area and around the breasts might also be necessary for the best results. Furthermore, the areolas, commonly known as the nipples, have to be re-positioned and, in some cases their size is also reduced.

Cautions To Consider Before Such A Reduction Mammoplasty

The only caution that must be taken into consideration before taking the decision to undergo a breast reduction procedure is the ability to lactate, which is limited after the milk ducts are severed when glandular tissue is removed. If the patient wants to have a baby in the near future, she will be advised to postpone the reduction mammoplasty until she does not need to breastfeed her infant anymore.

Nonetheless, if that is not the case, then breast reduction surgery does not have to be reconsidered at all, as it does not cause any further limitations - as a matter of fact, it solves them.

The patient must provide the plastic surgeon with all her medical records. This is absolutely necessary, so that the surgeon can assess her state of health and inform her about the results she should expect - as each procedure of this type is highly individualized and in accordance with the patient's physical conformation and health.

In conclusion, breast reduction is advised for women who suffer from the burden of excessively large breasts. The rate of success for such a procedure is very high (over 98%) and there are virtually no so-called side effects. Physical problems, such as back pain, difficult breathing and the risks of skeletal deformations are entirely solved or eliminated. This article contributed by Mark who works as a plastic surgeon specialising in breast reduction.

How can you find the Best Orthopedic Surgeons?

If you are planning to go for total knee replacement, it is important that you get in touch with a renowned surgeon for undergoing this surgery. Total knee replacement is an extremely crucial surgery and for this reason, you need to choose a surgeon who understands your problems and provides you with options to overcome them. In this article, we will highlight some tips that will help you to find best orthopedic surgeons. Read on.

The Surgeon should be Skilled

It is important to select a surgeon who is skilled in hip surgeries. More specifically, he should be well-acquainted with total knee and hip replacement, joint replacement surgery as well as shoulder replacement surgery. It is also a great idea to choose a surgeon who specializes in trauma reconstruction, skeletal tumor, and knee arthroscopy.

Regarding post surgery medications, the surgeon should have suggestions for required antibiotics. Usually antibiotics are given both during and after the surgery. This is done to ensure that infection does not develop in the new joint. However, not all medicines suit all patients. Hence, you should always opt for a surgeon who has relevant experience and has successfully treated numerous orthopedic cases both pre and post surgery.

He should be experienced

Experience is a great teacher and therefore, we suggest that you to select a surgeon who has been associated with reputed hospitals or medical centers. Ideally, you should select a surgeon who has been in this field for at least 5-10 years.

Is He Well-Known and Respected?

Apart from being skilled and experienced, a doctor should evaluate things from point of view of his patients, and be sympathetic towards them. To ascertain whether your chosen surgeon possesses these qualities or not, it is important that you check his reputation.

Ideally, you should trust a doctor who has been named at least once in the database of Best Orthopedic Doctors in America. You can also check with organizations of your area that bestow well-known doctors with awards and special recognition. If you reside in Florida, you can check Consumer's Research Council of America to obtain information
about your selected surgeon. Apart from specific organizations, you can also get in touch with previous patients of the doctor to get in-depth information about him.

He Should Enjoy his Work

Finally, you should go for a surgeon who enjoys his work, because this means that he has a genuine interest in solving the problems of his patients. If your chosen surgeon loves educating people about hip and knee surgeries, lectures regularly and contributes to health magazines, you can be sure that he loves his job.

Consider these tips for selecting best orthopedic surgeons. To get in touch with best surgeons in your area, consider reaching them online as there you get fair idea about the quality of experience they possess and treatment options they offer. Also, the online customer reviews will help you decide for the best surgical option in your region.

The information provided in this article is for informational purposes only. It is not to be construed as medical care or medical advice and is not a replacement for medical care given by your physicians or trained medical personnel.

Dangers of Weight Loss Surgery

Weight loss surgery is now very popular. You have probably heard of many amazing testimonials wherein people have lost 30, 50 to hundreds of pounds because of surgery. This is the reason why weight loss surgeries have tripled since early 2000s.

The major problem is that most people overlook the risks involved with the surgery. They think that Bariatric surgery is a quick fix that will miraculously help them achieve the perfect body. The truth is that surgery is only for the very obese and complications are very common. One in two hundred patients dies from gastric bypass surgery which is the most popular weight loss surgery today.

Although patients are counselled regarding the risks involved, most people disregard the warning and think that complications are not likely. A recent study found that 40% of patients experience problems, from diarrhea to intestinal leaks. Patients also usually develop nutritional deficiencies because of the limited absorption due to the shorter digestive tract.

The best way to lose weight is still naturally with a clean diet and regular exercise. Natural supplements for weight loss are also available which can help improve fat burning and help suppress appetite. Weight loss surgery should only be the last option and it should only be for the very obese or those suffering from serious weight-related health problems.

UK has its pediatric heart program under review; chief is on leave, and patients are being referred to other hospitals

Kentucky Children's Hospital at the University of Kentucky is reviewing its cardio-thoracic surgery program and referring surgical patients to other hospitals, "but the reasons why are unclear," Brenna Angel reported Dec. 21 for WUKY-FM, the university-owned station.

Angel did identify "the surgeon at the center of the review," Dr. Mark Plunkett, left, who is on a leave of absence but "remains on staff at UK with a $700,000 annual salary," as chief of cardio-thoracic surgery. "UK denied an open-records request for the date of his most recent surgery and his patient mortality rate," citing privacy rules in the federal Health Insurance Portability and Accountability Act. It was unclear how release of such statistics, without any personally identifying information, would compromise privacy. Plunkett and officials of the medical center refused to be interviewed.

"It's been pretty hush-hush," Tabitha Rainey of Lexington, the mother of a Plunkett patient, told Angel, who reported: "Plunkett and his assistant Dr. Deborah Kozik operated on Waylon seven days after he was born. Tabitha was later told that Dr. Plunkett was taking a leave of absence." Rainey told Angel, "Months went past and they lost another patient, who was a dear friend of mine, and it was pretty heavy in the unit at the time. Then soon after I guess they decided to stop doing the surgeries and review the entire program."

Angle was able to get some records from UK and reported they showed that "The number of children Dr. Plunkett operated on this year is down around 43 percent from two years ago." UK Trustee Dr. Charles Sachatello, a surgeon who sits on the Board of Trustees' health-care committee, told Angel, "I was not aware of that, and that was never announced at the Board of Trustees meeting." Sachatello told Angel that UK should merge its pediatric heart program with the one at the University of Louisville because of the high operational costs of such programs. (Read more)

Health care decisions by and for Medicare patients differ widely by place; Lexington big in back surgery, low in mastectomy

All medicine involves decisions and, according to a new series of nine reports published by the Dartmouth Atlas Project, those decisions differ drastically by location for Medicare patients. In the East South Central region -- Kentucky, Tennessee, Alabama and Mississippi), the variation between how things are diagnosed and treated can change when one crosses county lines.

An example, with numbers but without explanation: The total knee replacement rate in Harlan is 3.3 per 1,000 Medicare beneficaries; in Bardstown, it's 13.8. As the report goes on to note: "If you have heart disease and live in Huntsville, Ala., you are half as likely to undergo balloon angioplasty than if you live in Hattiesburg, Miss., and twice as likely to undergo back surgery if you live in Lexington, Ky." The greatest variation in the region was seen in mastectomy, ranging from a low of 0.3 percent per 1,000 female Medicare beneficiaries in Lexington to 2.1 per 1,000 in Tupelo, Miss.

The point, researchers say, is that providers and patients need to work together to determine care. The report looked at rates for early-stage breast cancer, stable angina, low back pain, arthritis of the knee or hip, carotid artery disease, gallstones, enlarged prostate, and early-stage prostate cancer. Read the report here.

UK music therapy helps manage surgical anxiety, pain, recovery

A University of Kentucky study has found that music therapy can reduce pain before, during and after a surgical procedure, and shorten recovery time. The study report, published in the Southern Medical Journal, showed music was also useful in managing surgical anxiety. According to Lori Gooding, UK director of music therapy and lead author of the report, the music should be selected by trained personnel with a mind toward specific guidelines for music selection in order to maximize its positive effect on patients, though the patient's musical tastes should still be considered. Gooding suggests patients be offered several playlists from which to choose so they can have something to suit their tastes as well as the medical protocol. (UK video)



Gooding writes that the tempo, rhythm and volume of the music should be carefully controlled to maximize its effect. Calm, slow, gentle music was shown to produce the most positive results and facilitate relaxation and pain reduction in patients. UK began providing music therapy for patients in Kentucky Children’s Hospital, UK Chandler Hospital and UK Good Samaritan Behavioral Health in October 2010. The UK Music Therapy program was established as part of the Lucille Caudill Little Performing Arts in HealthCare Program, a unique partnership between the UK School of Music and UK HealthCare. (Read more)

First heart-lung transplant in Ky. in 15 years performed at UK

University of Kentucky surgeons performed Kentucky's first combined heart-lung transplant in 15 years this summer, UK announced today.

Dawn Nelson, 29, of Louisville, received two lungs and a heart from the same donor in one procedure at the Albert B. Chandler Medical Center on July 7. She and her parents discussed it with Courier-Journal reporter Laura Ungar in this video by The C-J's Kylene White:


For Ungar's story, click here. Combined heart-lung transplants are rare; only 27 were performed nationwide in 2011. They are generally performed on younger patients who have a fatal disease and cannot be treated with medication or other interventions.

Nelson was diagnosed with systemic lupus erythematosus at 17 and rheumatoid arthritis at 22. Four years ago, she developed pulmonary hypertension, fatal without timely treatment. The disease destroyed her lungs, and her heart began to fail when it could no longer push blood into them.

Dr. Wesley McConnell, a transplant pulmonologist with Kentuckiana Pulmonary Associates in Louisville, began caring for Dawn two and a half years ago at KPA's Pulmonary Hypertension Center. After she didn't respond to drug therapies, McConnell referred Dawn to UK May 11 for a transplant evaluation. "Dawn was extremely ill and it became clear that her only chance for survival would be a heart-lung transplant," he said. "I knew that UK was her best option because they had the most experienced team in the state."

Dr. Charles Hoopes, director of the UK Transplant Center, performed the surgery, only the seventh such procedure to be performed at UK since it began transplantation in 1964. The last time UK performed this surgery was 1996. "Although the surgery itself is relatively simple, combined heart-lung transplants are rare because they require three donor organs and are reserved for patients who are extremely ill with heart and lung failure," said Dr. Jay Zwischenberger, chair of the UK Department of Surgery. "They also require a great deal of infrastructure and support to perform successfully. At UK, we have that team in place, and moving forward we expect to perform one or two of these combined transplants per year."

More than four months after her surgery, Nelson continues to improve and grow stronger. Dr. Enrique Diaz, medical director for lung transplantation, and Dr. Navin Rajagopalan, medical director of cardiac transplantation, both provide followup care for her at UK, and she continues to see McConnell in Louisville. "Dawn is doing quite well. At the time of transplant, she was so sick she only weighed about 80 pounds," Rajagopalan said. "Now, she feels well, is gaining weight, and is able to do things that she had not been able to do for years.”

Nelson's collaborative treatment is a prime example of the partnership UK is trying to cultivate among Louisville and Lexington doctors, said Dr. Michael Karpf, UK executive vice president for health affairs: “Our goal is to continue to provide highly advanced subspecialty care such as Ms. Nelson’s complex transplant to patients like her who otherwise would either have to leave the commonwealth or, worse, not receive the treatment needed.”

In November 2010, UK in collaboration with Norton HealthCare opened up an outreach Transplant and Specialty Clinic at Norton Audubon Hospital to provide comprehensive pre- and post-transplant care for patients. The partnership ensures that patients like Nelson will not have to leave the state to receive complex acute care or followup treatment, a UK press release said.

"We can take care of you better if you understand your disease" - Cleveland Clinic's project for visual learners

In this White Board Series, Cleveland Clinic cardiothoracic surgeon Eric Roselli, MD, takes us on a tour of the heart that simply illustrates complex problems so everyone can understand. He says, "We can take care of you better if you understand your disease", and I could not agree more. The videos are below:

State's hospitals see impressive growth spurt from nearly $1 billion in capital investment

Kentucky’s major hospital systems are going big, making high-profile, technology-forward capital investments across the commonwealth. Josh Shepherd of The Lane Report writes that every sector of the state is part of the hospital boom. The state's cumulative total of investment since 2010 is roughly a billion dollars, notes Shepherd, and has meant hundreds of construction and, soon, medical and other hospital-related jobs. Here's the list of the most notable construction projects now under way:

Owensboro Medical Health System,  $385 million, a new complex (pictured, above) that will allow expansion for the next 50 years, completion date: summer 2013.

Norton Healthcare System, Louisville, converting Suburban Hospital into Norton Women's Hospital and Kosair Children's Hospital, $120 million, completion date: 2013.

Pikeville Medical Center, new office building and parking facility, $130 million, completion soon.

Baptist Health, Lexington, expansion of Central Baptist Hospital medical services complex with parking structure, $200 million.

University of Kentucky Healthcare, Chandler Medical Center, $750 million, includes new plans for Shriners Hospital for Children.

Frankfort Regional Hospital,  $8 million expansion, emergency department.

Trigg County Hospital, $7 million, surgery and rehabilitation unit.

Lifepoint Hospitals-owned Clark Regional Medical Center, $60 million, 79-bed hospital. (Read more)

18 Kentucky hospitals cited as 'top performers' on accreditation board's annual list

Eighteen Kentucky hospitals have been included on the annual list of hospitals that have excelled at adhering to basic procedures for surgery and other treatment of common illnesses such as heart attacks, heart failure and pneumonia. The Joint Commission, the nation’s major hospital accreditation board, has released this year's list of 620 hospitals considered to be “top performers” for following recommended protocols at least 95 percent of the time. The top 18 percent of accredited hospitals make the list.

Among the Kentucky hospitals that qualified on all four measurements were Greenview Hospital in Bowling Green, Ephraim McDowell Regional Medical Center in Danville, St. Elizabeth Medical Center in both Florence and Fort Thomas, Central Baptist Hospital in Lexington.

Those qualifying in three categories were the Robley Rex Veterans Affairs Medical Center in Louisville (not in surgery) and the Appalachian Regional Hospitals in Harlan and Middlesboro (not in heart attack).

Qualifying in two categories were Twin Lakes Regional Medical Center in Leitchfield, Frankfort Regional Medical Center, the Hospital of Louisa and Jackson Hospital Corp., all for pneumonia and surgical care.

Recognized for pneumonia care were Parkway Regional Hospital in Fulton, Paul B. Hall Regional Medical Center in Paintsville, Logan Memorial Hospital in Russellville and the KentuckyOne Health Hospital in Martin.

Among behavioral-health hospitals, ranked on their in-patient psychiatric care, the Kentucky facilities on the list were the Universal Health Services facility in Bowling Green, the new Cumberland Hall Hospital in Hopkinsville.

According to Kaiser Health News, the Leapfrog Group, a nonprofit organization devoted to patient safety, aided in the rankings process, as did Consumer Reports. The Commission has its own metrics. It's worth noting that next month, Medicare will start using hospital quality rankings on its Hospital Compare website to set reimbursements. (Read more)

After two days with doctors at work, Herald-Leader columnist wonders about patients and future of health-care system

Tom Eblen

Tom Eblen, the Lexington Herald-Leader's local columnist and former editor, spent two days shadowing doctors last week and lived to tell about it. Part of the Lexington Medical Society's Mini-Internship Program, Eblen was given a close-up look at the working lives of physicians and the world in which they, well, operate. He found himself alongside an orthopedic surgeon replacing shoulders, doing fascinating retinal work with an caring opthalmologist, in an emergency room on a slow day and with a busy internal medicine specialist. He learned more than confirming he had probably made the correct career choice, he writes.

In the emergency room: "A middle-aged man with a history of heart trouble came in with chest pains. An elderly man came in suffering from dizziness. A young man came in with an infection from a mouth full of rotten teeth. Like more than one-quarter of all Kentuckians, the young man and several other people Wooster saw that day had no health insurance. What people forget when they debate the cost of universal coverage is that society already pays for treating uninsured people, often at high-cost emergency rooms. . . .

"As I shadowed these physicians, I kept thinking how much of their patients' pain and suffering could have been avoided if they had taken better care of themselves — if they had eaten better, gotten more exercise, and avoided cigarettes and substance abuse. I wondered how we will continue to manage not only our health care system, but our rising expectations. As people live longer and get sicker, we may need to focus more on quality of life rather than simply extending it at all costs." (Read more)

Surgeon Folds and Throws Paper Airplane Using da Vinci Robot (video)

From Swedish hospital YouTube channel: Dr. James Porter, medical director of robotic surgery at Swedish folds a small paper airplane with the da Vinci robot to demonstrate how this device gives surgeons greater surgical precision and dexterity over existing approaches.



With over 600,000 views, this video undoubtedly brings good publicity to the hospital.

However, the robot costs on average $1.3 million, in addition to several hundred thousand dollars of annual maintenance fees. Surgical procedures performed with the robot take longer than traditional ones. Critics say that hospitals have a hard time recovering the cost and that most clinical data does not support the claim of improved patient outcomes.

The manufacturer Intuitive Surgical has sold more than 1,000 units worldwide.

References:

Prepping Robots to Perform Surgery, The New York Times, 4 May 2008.
Wikipedia

Comments from Twitter:

Meenakshi Budhraja @gastromom: Cool !!

Westby Fisher, MD @doctorwes:  Surgeon Folds and Throws Paper Airplane Using da Vinci Robot (video) bit.ly/KG2EG6 - Manual faster, no?

PDara MD, FACP @JediPD:  da Vinci good for that

Skeptical Scalpel @Skepticscalpel:  Finally a use. Maybe the airplanes could have the hospital's logo on them. Folding a paper airplane. Amazing feat by a surgical robot? I think not. My blog. is.gd/6tBcZp -- Folding a paper airplane. Amazing feat by the surgical robot?  http://goo.gl/cz7lC

Ravi Pamnani @ravrav0: Surgical robots: Folding tiny paper airplanes - CHECK. Actually improving clinical outcomes - TBD. bit.ly/LEp3jg  #medtech

Jenaro Fdez-Valencia @JenaroFV_MD: after all ... it doesn't fly! If he did a boat instead, it would work. Can he try?

Tonsillectomies not necessary much of the time; among $158 billion spent each year on unnecessary health care

Photo by Matthew Staver, Bloomberg

Tonsillectomies are the most common procedure for children requiring anesthesia. "The only problem is there's no evidence they work for most" kids, reports Sarah Cliff of The Washington Post.

"The procedure does show some benefits for those with really serious symptoms — very sore throats, fevers and other symptoms at least seven times in the past year — but no improvement for those whose indications are milder," Cliff reports.

Yet, more and more of the procedures are being performed. Between 1996 and 2006, the number of tonsillectomies increased by 74 percent.

"It's a silent epidemic of unnecessary care," said David Goodman of the Dartmouth Atlas of Health Care. "In most instances, it's done for patients with much less recurrent symptoms than should be indicated. I think a lot of this is unbeknownst to providers."

Unnecessary health care costs about $158 billion every year, Cliff reports, and the sum is partly to blame on demanding patients, to whom doctors acquiesce. Because doctors are paid based on volume, there is also an incentive to provide more care, even if it's not necessary.

Goodman said the medical education system is one main culprit. "Medical schools and graduate schools are failing us deeply," he said. "We need to move some of these ideas about the evidence being uncertain into the beginning of education. There's been such little work on that." (Read more)

Battling depression with "battery-powered brains" - CNN report on deep brain stimulation (DBS)

CNN reports on treating severe depression with electrodes inside the brain:



The procedure -- called deep brain stimulation, or DBS -- targets a small brain structure known as Area 25, the "ringleader" for the brain circuits that control our moods.

Area 25 is relatively overactive in depressed patients. One hypothesis is that in patients who do not improve with treatments for depression, Area 25 is somehow stuck in overdrive.

DBS had been used since 1997 as a treatment for movement disorders, including essential tremor, Parkinson's disease and dystonia.

References:

Treating depression with electrodes inside the brain. CNN, 2012.

What Does It Mean to Be Transgender?

When you think of yourself as male or female, it's called gender identity. Everyone has a gender identity the inborn sense of ourselves as being male or female.

Most people's gender identity matches their anatomy. But people who are transgender feel different from their physical appearances.

What society expects of us as men, women, boys, and girls also affects what we feel about ourselves. Every culture has "rules" about what is expected for men and what is expected for women. These expectations can include things like hairstyles, clothing, and jobs and how people should act or behave.

Society doesn't have to state these "rules." Everyone knows them because we see them all over. So most of us grow up believing men should act a certain way and women should act a certain way without thinking about it much. Transgender people, though, have a very different sense of themselves.

Some transgender people know they feel "different" from the time they're young kids. Others start sensing it around puberty or even later. When people who are transgender become aware that they feel mismatched with their bodies, they may feel confused and emotionally conflicted.

Some people decide to physically change their bodies through surgery or taking hormones to match the gender they feel they really are. Physically becoming the opposite gender can be a long, complicated, and expensive process.

Not everyone decides to get surgery or hormones, though. Some transgender people are most comfortable keeping their physical anatomy but dressing as the opposite gender. Some aren't completely sure what they want yet, but may start by asking to be called a new name and use the pronouns that go with that name (such as "Amanda" instead of "Anthony" and "she" instead of "he").

Once transgender people start living their lives as the opposite gender, many issues may come up like how to fill out forms that require checking "female" or "male," and even which public bathrooms to use.

As with any group, not all transgender people want or think the same things. It all depends on what that particular person needs to feel most comfortable in both body and mind.

By: Linda A. Hawkins, EdD, and Nadia Dowshen, MD

iPad App for Education of Heart Patients After Surgery - Mayo Clinic Video

From Mayo Clinic YouTube channel: "Being in the hospital after major surgery is no fun. On top of dealing with pain, patients have uncertainty. They also have to worry about getting all the information they need to support their recovery. That's not always easy in the hospital; things happen quickly and doctors and hospital staff are often really busy. Doctors at Mayo Clinic may have a solution to this issue. They're giving iPads to heart surgery patients to see if a new iPad app can make hospital stays easier and more satisfying."



Our research presented during the 2011 ACAAI meeting showed that 95% patients thought the iPad was helpful for coming to understanding of their condition:

PATIENT PERCEPTION OF A POINT-OF-CARE TABLET COMPUTER (IPAD™) BEING USED FOR PATIENT EDUCATION - P318

A. Nickels*, V. Dimov, V. Press, R.Wolf, Chicago, IL.

Background:

During the fall of 2010, the Internal Medicine/Pediatrics program at University of Chicago introduced Point-of-Care Tablet Computers (iPad™) for clinical use. iPads™ are intended to improve access to EMR, work flow, resident and patient education, and access to electronic clinical tools. The graphic display and ease of interface makes the iPad™ a potentially powerful tool to achieve these goals. This pilot study is designed to gauge the initial patient perception of the iPad™ when used for patient education.

Methods:

8 questions, physician administered, patient survey of Allergy Immunology patients or their parents. Preloaded iPads™ with education materials (“mind map” diagrams, clinical pictures) into the photo software were used to clinically education the patients. Simple percentages and Fisher’s exact non-parametric test were used for statistical analysis. Results: 20 patients surveyed (11 resident/9 attending). For those survey items without 100% agreement, there was no statistically significant difference in responses based on level of training (p≥0.45). 100% [0.861, 1] of participants liked the iPad™ being used to help explain their children’s condition, 95% [0.783, 0.997] of participants did not find it distracting. 100% [0.8601, 1] found it helpful. 100% [0.861, 1] would like it to be used again to help explain medical information. 95% [0.784, 0.9974386] thought the iPad™ was helpful for coming to understanding of their condition. Limitations of this study include a convenient sample, physician-administered survey, and observer bias.

Conclusion:

Patient perception was very positive toward the use of a Point-of-Care Tablet Computer (iPad™) in a clinical setting. While limited to only two operators, level of training did not have an effect on patient perception. Confirmation of the results may be required before wider implementation.

Source:  Patient Perception of a Point-of-Care Tablet Computer (iPad) Being Used for Patient Education. A. Nickels, V. Dimov, V. Press, R. Wolf. American College of Allergy, Asthma & Immunology (ACAAI) 2011 Annual Meeting.

http://www.annallergy.org/supplements

Blood Management Summit and App - Transfuse 2012

Announcement: Blood Management Summit - Transfuse 2012 will be held on April 19-20, 2012 at the JW Marriott in Scottsdale, Arizona.

This conference has been developed with collaboration between Mayo Clinic and Hartford Hospital, building upon the success of three previous national conferences. "Transfuse 2012" is a unique multi-disciplinary conference focused on exploring the current state-of-the-art techniques and programs to reduce allogeneic blood utilization in hospitals. This international conference will feature national and international blood management experts from China, New Zealand and Australia along with a unique iPad app launch and one-of-a-kind hands-on animal lab.

Mayo Clinic's Mark H. Ereth, M.D. introduces the conference and the iPad app in this 3-minute video:



This conference is designed for all physicians, including surgeons and anesthesiologists, perfusionists, nurses and leaders in quality and patient safety. The conference is a CME accredited activity for physicians, nurses and perfusionists.

The Conference Website is: http://www.mayo.edu/cme/anesthesiology-2012r780

One of the course directors is Dr. Ajay Kumar, Chief of Division of Hospital Medicine at Hartford Hospital, and a good friend of mine. Another friend from the time I worked at Cleveland Clinic is also on faculty, Dr. Moises Auron.

It should be a great conference. Go check it out.