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Link Between Obstructive Sleep Apnea And Diabetic Retinopathy
The eyes may be the window into the soul, but they may also contain important medical information. According to new research presented at the American Thoracic Society"s 105th International Conference in San Diego on May 19, patients with diabetes who have retinopathy should also be screened for obstructive sleep apnea (OSA).
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Planned Parenthood Of Alaska, Teacher File Suit To Block Parental Notification Initiative
Planned Parenthood of Alaska and an Anchorage high school teacher filed a lawsuit in Anchorage Superior Court on Friday to block a voter initiative that would make it illegal for minors younger than age 18 to obtain abortion services without parental notification, the Anchorage Daily News reports. Supporters of the initiative, which was certified on July 2, must gather nearly 33,000 signatures in order for it to be put on the ballot in August 2010.The lawsuit claims that the initiative should not have been certified because of what the newspaper termed "legal technicalities" and because the ballot description of its impact is misleading. According to legal documents filed by Planned Parenthood and teacher Susan Wingrove, the language of the initiative indicates that minor changes would be made to an existing law "rather than making clear that the initiative is abolishing rights currently afforded to the citizens of Alaska who are minors." They also claim that the initiative does not make it clear that violations of the law would be a felony and that it would be the responsibility of the physician to inform parents.Previous attempts to enact parental notification and consent laws have failed in Alaska. The Alaska Parental Consent Act, which was approved in 1997, said that parental notification or approval from a judge was necessary before a minor could obtain an abortion. Legal challenges prevented the act from going into effect, and the Alaska Supreme Court in 2007 ruled that the law was unconstitutional. In addition, a bill that would have required girls younger than age 17 to notify a parent failed to make it through the state Legislature this year.Former Lt. Gov. Loren Leman (R), a supporter of the new initiative, called Planned Parenthood of Alaska and the teacher "desperate," adding that they "would deny the people of Alaska the opportunity to participate in the initiative process" (Holland, Anchorage Daily News, 7/31).
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Reminder Program Dramatically Increases Mammography Rates, Kaiser Permanente Study Finds
A reminder program aimed at screening for breast cancer when it is most treatable boosted mammography rates by more than 17 percentage points, according to a new study by Kaiser Permanente"s Center for Health Research in the August issue of the American Journal of Preventive Medicine. The program used electronic health records to identify women who would soon be due for a mammogram and reached out to them via postcards, automated voice messages and personal phone calls.
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Impact Of Surgeon And Hospital Volume On Outcomes Of Radical Prostatectomy

UroToday.com - In the online edition of Urologic Oncology, Dr. Michael Cookson and his colleagues at Vanderbilt University reviewed the impact of surgeon and hospital volume on outcomes of radical prostatectomy (RP). They concluded that better outcomes are associated with higher volume surgeons and centers. The report is a literature review. Regarding hospital volume, there were no randomized trials identified, but 13 papers addressed the topic. Eight of the 13 addressed length of hospital stay, and all found that high-volume hospitals had a shorter mean length of stay. One meta-analysis reported a length of stay decrease of 0.9 days in high-volume centers. Another large multi-institution database found a 3.8 day LOS and 18.6% ICU admission rate in low-volume centers compared to 2.1 day LOS and 1.3% ICU admission rate in high-volume centers. Hospital readmission rates were also higher in the lowest volume quartile hospitals compared to the highest quartile. Five of 6 studies that evaluated complication rates found decreased peri-operative complication rates in high-volume hospitals, one study reporting 27% in these institutions compared with 32% in low-volume institutions. The difference in one multi-institutional cohort was 10%. The meta-analysis found a 1.21% decrease in complications for every additional 10 cases performed per year. Death was also lower in high volume hospitals; 0.04% in the highest volume quartile compared with 0.3% in the lowest volume decile. After adjusting for clinical variables, the oncologic efficacy of RP in higher volume hospitals was superior, with longer time to recurrence and lower incidence of secondary cancer treatments. Eight studies reported on the impact of surgeon volume on RP outcomes. Higher surgeon volume is associated with lower complication rates (26% vs. 32%), shorter LOS, lower incontinence rates (by 4%). Surgical margin rates in a single institutional study were lower with increasing surgical experience. However, individual surgeon was also an independent predictor of margins status, suggesting that volume alone is not the sole factor involved. The likelihood of biochemical recurrence was 17.9% for a surgeon who had performed only 10 prior cases and 10.7% for surgeons who had performed 250 prior cases. This suggested that 250 may represent a volume threshold, as no significant decrease in BCR was noted after this number of cases. Regarding annual volume, one study showed that a surgeon performing at least 20 cases in the 2 years before surgery had a higher progression-free survival rate than men treated by surgeons who had 10-19 cases or 0-9 cases in the 2 years before surgery. All these data may drive changes in care of radical prostatectomy patients at the individual surgeon and hospital level or via regionalization of certain procedures at high-volume centers. Barocas DA, Mitchell R, Chang SS, Cookson MS Urol Oncol. 2009 Apr 21. (Epub ahead of print) 10.1016/j.urolonc.2009.03.001 Written by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice. To access the latest urology news releases from UroToday, go to: www.urotoday.com Copyright © 2009 - UroToday


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