The Inpatient Only Rule,Alternative Payment Models,and the Relative Value Update Committee Reimbursement and Coding Changes: What Do They Mean?

BackgroundThe unsustainable rising costs of healthcare, a greater portion of which is being borne by the federal government, has resulted in the government’s development of programs aimed to control costs without adversely affecting outcomes.Methods/ResultsAlternative Payment Models, the shift from inpatient to outpatient and ambulatory surgery centers’ surgical venues, and Relative Value Update Committee coding and reimbursement strategies are all designed to achieve the aforementioned goal. These programs will continue to influence our practice patterns.ConclusionIt is clear that we must continue to advocate for access to high quality care reimbursed at a fair price. It is also clear that the successful adult reconstructive surgeon will understand these programs and adjust his/her practice to take full advantage of the opportunities that these programs present.     

The MRCS examination – an update on the latest facts and figures

The Intercollegiate Committee for Basic Surgical Examinations (ICBSE) is responsible for the standard, quality assurance, and continued development of both the MRCS and the Diploma in Otolaryngology and Head and Neck Surgery (DOHNS). It is accountable to the 4 Royal Colleges of Surgeons in the UK and Ireland, and the General Medical Council (GMC). This article gives information and an update (including pass rates) for candidates and trainers on the 2013 MRCS format, and summarises the most recent changes to the examination made by the ICBSE with the approval of the GMC.     

Update on classification,diagnosis, and management of immunoglobulin G4-related disease

Immunoglobulin G4-related disease (IgG4-RD) is a newly recognized chronic fibro-inflammatory autoimmune disease, and its recognition has been constantly increasing worldwide over the last few years. A correct and timely recognition, as well as appropriate intervention, is crucial for the treatment of IgG4-RD. For certain subtypes of IgG4-RD, organ-specific criteria are formulated to make the diagnosis more accurate. New biomarkers have emerged in the recent years to aid the disease diagnosis, it...     

Validating and updating a prediction rule for serious bacterial infection in patients with fever without source

AIM: To externally validate and update a previously developed rule for predicting the presence of serious bacterial infections in children with fever without apparent source. METHODS: Patients, 1-36 mo, presenting with fever without source, were prospectively enrolled. Serious bacterial infection included bacterial meningitis, sepsis, bacteraemia, pneumonia, urinary tract infection, bacterial gastroenteritis, osteomyelitis/ethmoiditis. The generalizability of the original rule was determined. Subsequently, the prediction rule was updated using all available data of the patients with fever without source (1996-1998 and 2000-2001, n = 381) using multivariable logistic regression. RESULTS: the generalizability of the rule appeared insufficient in the new patients (n = 150). In the updated rule, independent predictors from history and examination were duration of fever, vomiting, ill clinical appearance, chest-wall retractions and poor peripheral circulation (ROC area (95%CI): 0.69 (0.63-0.75)). Additional independent predictors from laboratory were serum white blood cell count and C-reactive protein, and in urinalysis > or = 70 white bloods (ROC area (95%CI): 0.83 (0.78-0.88). CONCLUSIONS: A previously developed prediction rule for predicting the presence of serious bacterial infection in children with fever without apparent source was updated. Its clinical score can be used as a first screening tool. Additional laboratory testing may specify the individual risk estimate (range: 4-54%) further.     

Update on hypertrophic scar treatment

Scar formation is a consequence of the wound healing process that occurs when body tissues are damaged by a physical injury. Hypertrophic scars and keloids are pathological scars resulting from abnormal responses to trauma and can be itchy and painful, causing serious functional and cosmetic disability. The current review will focus on the definition of hypertrophic scars, distinguishing them from keloids and on the various methods for treating hypertrophic scarring that have been described in the literature, including treatments with clearly proven efficiency and therapies with doubtful benefits. Numerous methods have been described for the treatment of abnormal scars, but to date, the optimal treatment method has not been established. This review will explore the differences between different types of nonsurgical management of hypertrophic scars, focusing on the indications, uses, mechanisms of action, associations and efficacies of the following therapies: silicone, pressure garments, onion extract, intralesional corticoid injections and bleomycin.     

An Update of Current Practice in Hypospadias Surgery

Today, a multiple number of surgical techniques, modifications, and combinations of techniques are used to improve cosmetic and functional outcomes and to minimise the procedure burden for the patient. Nevertheless, controversy exists regarding the ideal management of hypospadias. This update is based on current literature following a systematic review using MEDLINE.     

骨质疏松症的研究进展

骨质疏松症是当今人口老龄化社会常见的代谢性骨病，患病率逐年上升。老年人尤其是绝经后女性极易受累。骨质疏松症导致的骨折及其他．并发症严重影响老年人的寿命和生活质量,并增加相关的医疗费用。骨质疏松症的防治原则为掌握危险因素及易感人群,适时评估骨量，多学科综合性治疗。作者对骨质疏松症的流行病学、病理生理、危险因素、评估方法和治疗措施等方面的研究进展作如下综述。