Public Health’s Role in Health Care Reform—Lessons from Massachusetts

Posted on June 17, 2013

Experience Can Help Public Health Personnel to Prepare for Affordable Care Act, Says Special Article in Journal of Public Health Management and Practice

Philadelphia, Pa. (June 12, 2013) – How will full implementation of the Affordable Care Act (ACA) affect the work and goals of state and local public health departments—and how can public health personnel contribute to the success of health care reform?  The experience in Massachusetts has some important lessons, according to an article published online by the Journal of Public Health Management and Practice.  The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Just as Massachusetts was implementing its ground-breaking health care reform legislation, John Auerbach was appointed state Commissioner of Public Health.  In a special ‘Management Moment’ article, he addresses some lessons learned—”our victories as well as our mistakes”—regarding the public health’s role in the era of health care reform.

‘Five Important Lessons’ from the Massachusetts Experience

With the ongoing nationwide rollout of the ACA, public health activists and employees at the local, state, and national levels are asking what health care reform will mean for the work they do.  In his article, Auerbach—now Distinguished Professor of Practice and Director of the Institute on Urban Health Research and Practice at Northeastern University, Boston—summarizes five important lessons learned from the Massachusetts experience.

Getting a Seat at the Table—Auerbach “learned the hard way” that public health personnel had to fight for a decision-making role in implementing health care reform.  They needed a crash course in the basics of insurance, while building an appreciation for the “values, priorities, and incentives” of insurers.  They also came to understand the need for hard data to demonstrate some of the “core assumptions” of public health—for example, that smoking cessation programs would produce short-term reductions in health costs.

Taking a Critical Look at Public Health Work—Rather than a “circle the wagons” mentality, Auerbach and colleagues learned they needed to make a “balanced, analytical assessment” of how health care reform would affect public health initiatives.  Instead of reacting to program cuts, Auerbach now thinks his department would have been better off performing a comprehensive review of the likely impacts on various programs.  “[C]hange was inevitable,” he writes.  “We were either going to be guiding change or reacting to it.”

Defending Traditional Public Health, When Appropriate—In some cases, public health officials needed to make a stand in defense of traditional public health services.  Auerbach cites the key example of childhood vaccination programs—planned cuts in state funding would have dealt a major setback to statewide success.  It took months of negotiations with the legislature and insurers to come up with a “creative alternative” to across-the-board cuts.

Watching for Chances to Contribute—By “trial and error,” Auerbach and colleagues identified a few important opportunities for public health to contribute to the success of health care reform.  These included efforts to help reduce health care costs while documenting improved health outcomes.  In hindsight, Auerbach believes this should have been a higher priority—perhaps coordinated by national public health organizations.

Envisioning a Better Model—Over time, the emphasis of health care reform in Massachusetts shifted from expanding access to controlling costs and improving the quality of health care.  As they gained familiarity with the insurance industry, the public health community became “better prepared to conceptualize new models for linking population health with reimbursable clinical care.”  Auerbach outlines some programs included in the state’s updated global payment model, developed with public health input.

While there’s still a “very steep learning curve,” Auerbach writes, “Health care reform is working in our state [with] continual involvement of public health officials and practitioners in the process.”  He hopes the lessons learned in Massachusetts will be of value as the ACA becomes implemented nationwide—particularly in ensuring that the essential public health mission continues to survive and thrive in a changing health care environment.

About Journal of Public Health Management and Practice

Journal of Public Health Management and Practice publishes articles which focus on evidence based public health practice and research.  The journal is a bi-monthly peer-reviewed publication guided by a multidisciplinary editorial board of administrators, practitioners and scientists. Journal of Public Health Management and Practice publishes in a wide range of population health topics including research to practice; emergency preparedness; bioterrorism; infectious disease surveillance; environmental health; community health assessment, chronic disease prevention and health promotion, and academic-practice linkages.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes.

LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2012 annual revenues of €3.6 billion ($4.6 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Posted in All Medicine, Public Health, Publications | Leave a comment

Differences in Outcomes of Cervical Spine Surgery at Teaching versus Non-Teaching Hospitals

Posted on June 17, 2013

Teaching Hospitals Have Higher Mortality and Complication Rates—But Also Do Higher-Risk Procedures, Reports Study in Spine

Philadelphia, Pa. (June 12, 2013) – For patients undergoing surgery on the cervical (upper) spine, overall rates of complications and death are higher at teaching hospitals than at non-teaching hospitals, reports a study in the June 1 issue of Spine.  The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

But the differences are small and are likely explained by the more-complex surgeries performed and higher-risk patients treated at teaching hospitals, according to the report by Dr Kern Singh of Rush University Medical Center, Chicago, colleagues.

Small Increase in Risks with Cervical Spine Surgery at Teaching Hospitals…

Using a national database (the Nationwide Inpatient Sample), the researchers identified more than 212,000 cervical spine surgeries performed at U.S. hospitals between 2002 and 2009.  The study focused on cervical fusion procedures, performed to join together one or more vertebrae in the upper spine; and various decompression procedures, done to relieve pressure on spinal nerves.

Dr Singh and colleagues compared complication and mortality rates for patients treated at teaching hospitals, which have residency training programs, versus non-teaching hospitals.  The characteristics of the patients treated and procedures performed were compared as well.  About 55 percent of the procedures were done at teaching hospitals, even though teaching hospitals accounted for just 30 percent of hospitals in the database.

Risks of both death and complications were higher at teaching hospitals.  The mortality rate was twice as high:  1.2 per 1,000 patients at teaching hospitals, compared to 0.6 per 1,000 at non-teaching hospitals.  The complication rate was also somewhat higher at teaching hospitals:  24.7 versus 17.4 per 1,000 patients.

…But Mainly Related to Higher-Risk Patients and Procedures

However, there were also some significant differences in the types of surgeries performed and the characteristics of patients treated.  Teaching hospitals performed more complex procedures, entailing higher surgical risks.  For example, they performed more multilevel fusion procedures, in which three or more vertebrae are fused.  Teaching hospitals also treated more patients with pre-existing medical conditions that could increase the risk of poor outcomes.

After adjustment for these and other factors, undergoing surgery at a teaching hospital was no longer associated with a higher mortality risk. In contrast, older age and certain medical conditions remained significant risk factors.

There’s a long history of debate over the quality of care provided at teaching and nonteaching hospitals.  Studies have found that teaching hospitals achieve better outcomes for patients with some common medical conditions, and for certain types of complex surgery.  But patients are sometimes concerned about risks related to having a resident (trainee) surgeon perform their procedure.

The new study shows some “subtle yet significant” differences in outcomes of cervical spine surgery among U.S. teaching versus non-teaching hospitals.  Mortality and complication rates appear higher at teaching hospitals.  However, teaching hospitals also perform more complex surgeries in a higher-risk patient population, which likely explains the difference in outcomes.

Dr Singh and colleagues note some important limitations of their database analysis—for example, it provided no information on whether patients were operated on by a resident or not.

“This study should provide reassurance to patients that the presence of a teaching hospital will have little, if any, effect on their surgical outcomes,” according to an editorial by Dr Timothy S. Carey of University of North Carolina. Further studies are needed to assess longer-term benefits or risks from cervical spine surgery, after patients are discharged from the hospital.

Read the Full Article in Spine.

About Spine

Recognized internationally as the leading journal in its field, Spine (www.spinejournal.com) is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine.  According to the latest ISI Science Citation Impact Factor, Spine is the most frequently cited spinal deformity journal among general orthopaedic journals and subspecialty titles.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes.

LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2012 annual revenues of €3.6 billion ($4.6 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Posted in All Medicine, Orthopedics, Publications | Leave a comment

Not Really ‘Bath Salts’—Paper Provides Update on ‘Designer Stimulants’

Posted on June 5, 2013

Journal of Addiction Medicine Reviews Emerging Data on New and Hazardous Drugs of Abuse

Philadelphia, Pa. (June 4, 2013) –The last few years have seen the emergence of a new drug problem in so-called “bath salts”—actually “designer stimulants,” packaged and sold in ways that skirt drug laws.  A review and update on these designer drugs is presented in the June Journal of Addiction Medicine, the official journal of the American Society of Addiction Medicine.  The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Recent high-profile incidents have drawn attention to “bath salts” as a new and potentially hazardous type of recreational drug.  Addiction medicine specialist Dr Erik W. Gunderson of University of Virginia, Charlottesville, and colleagues, review available data on the use and effects of these designer drugs in this issue of JAM. The paper provides a timely update including implications for medical management and drug policy.

Rapid Rise in Abuse of ‘Designer Stimulants’

Over the last few years, products containing “substituted cathinone stimulants” have become widely available for sale on the Internet and elsewhere.  To evade legal controls, the stimulants are sold as bath salts, stain removers, or other household products.  Although packages are conspicuously labeled “not for human consumption,” they are clearly intended for “use as psychoactive substances,” according to Dr Gunderson and coauthors.

Initially more prominent in Europe, designer stimulants have become a problem in the United States over the last few years.  The number of calls to U.S. poison control centers regarding substituted cathinone stimulants increased from zero in 2009, to about 300 calls in 2010, to more than 6,000 in 2011.  The chemical components of these products vary widely, and the mechanisms of their effects in humans are still unclear.  As of yet, standardized testing to detect their use is not easily accessible.

The effects are generally similar to those of cocaine, amphetamine, and other stimulants but vary with compound, dose, and route of administration.  Users may sniff or swallow the drugs, or even inject them. Reported symptoms in patients treated for acute toxicity include agitation, fast heart rate, and combative or violent behavior, potentially accompanied by delusions or hallucinations.  The picture is often complicated by use of other drugs and underlying mental illness.

Serious acute (short-term) toxic effects of substituted cathinone stimulants have been reported—including deaths resulting from medical complications and suicide.  Chronic (long-term) toxicity has also been observed, with evidence of tolerance, withdrawal, and dependence.

More Study Needed to Guide Drug Treatment and Regulation

To illustrate the dangers, Dr Gunderson and colleagues present a case report of a patient who developed hallucinations, delusions, and potentially violent behavior after a three-week “bath salt binge.”  The findings suggest a possible interaction with the antihistamine diphenhydramine (Benadryl)—which users commonly take to manage insomnia caused by the drugs’ stimulant effect.

Substituted cathinone products are still new, so there are no formal guidelines for medical treatment of acute toxicity.  Experience suggests that physical symptoms resolve after a few days, with supportive care.  However, psychotic effects such as hallucinations may persist for a longer time.  Intoxicated patients need close psychiatric observation and monitoring to keep them from harming themselves or others.

Treatment following acute care, according to Dr Gunderson and coauthors, should follow guidelines for treatment of other stimulant use disorders.  In theory, substituted cathinone stimulants are controlled substances under current U.S. law.  However, because of Internet distribution and the “forensic challenges” in identifying these substances, they have been difficult to police and regulate. 

Dr Gunderson and coauthors highlight the need for further research on the “epidemiology, behavioral pharmacology, clinical effects and management” of substituted cathinone products.  They write, “It is hoped that such research and coordinated public health efforts will help prevent and mitigate the rising harm associated with designer stimulant use.”

About Journal of Addiction Medicine

The mission of Journal of Addiction Medicine, the official journal of the American Society of Addiction Medicine, is to promote excellence in the practice of addiction medicine and in clinical research as well as to support Addiction Medicine as a mainstream medical specialty.  Published quarterly, the Journal is designed for all physicians and other mental health professionals who need to keep up-to-date with the treatment of addiction disorders. Under the guidance of an esteemed Editorial Board, peer-reviewed articles published in the Journal focus on developments in addiction medicine as well as on treatment innovations and ethical, economic, forensic, and social topics.

About the American Society of Addiction Medicine

The American Society for Addiction Medicine is a professional society representing over 3,000 physicians dedicated to increasing access and improving quality of addiction treatment, educating physicians and the public, supporting research and prevention, and promoting the appropriate role of physicians in the care of patients with addictions.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes.

LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2012 annual revenues of €3.6 billion ($4.6 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Posted in All Medicine, Psychiatry, Psychology and Addiction Medicine, Publications | Leave a comment

‘Preferred Retinal Location’ May Aid Rehabilitation in Patients with Central Vision Loss

Posted on May 31, 2013

Dr. Susana T.L. Chung Receives Glenn A. Fry Lecture Award for Research on ‘Visual Plasticity’ in Older Adults

Philadelphia, Pa. (May 29, 2013) – Perceptual learning techniques may provide a useful new approach to rehabilitation in patients with central vision loss—taking advantage of visual plasticity that persists even in old age, according to a special article, “The Glenn A. Fry Award Lecture 2012: Plasticity of the Visual System Following Central Vision Loss”, appearing in the June issue of Optometry and Vision Science, official journal of the American Academy of Optometry.  The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The paper by Susana T.L. Chung, OD, PhD, FAAO, 2012 recipient of the prestigious Glenn A. Fry Lecture Award, presents new research findings on plasticity of the visual system in older adults with central vision loss.  Anthony Adams, OD, PhD, Editor-in-Chief of Optometry and Vision Science, comments: “This award-winning author explored whether the new ‘preferred retinal location’ (PRL) in these typically older patients adopted important properties of the original fovea and hence provide evidence that even the older brain’s visual cortex shows plasticity.”

Evidence of ‘Visual Plasticity’ in Central Vision Loss…

Patients with loss of vision in the central part of the visual field face major challenges for daily living.  The most common cause is age-related macular degeneration (AMD), which is also the leading cause of blindness in older adults.  Central vision loss results from destruction of the fovea— the central pit of the retina, where visual acuity is sharpest.

Patients with central vision loss have problems with tasks requiring detailed vision, such as reading and recognizing faces.  Although magnification can help, “Alternative rehabilitation strategies need to be developed to improve the functional vision of people with central vision loss, which hopefully will lead to an improved quality of life,” Dr Chung writes.

One potentially useful approach is “perceptual learning”—improving various aspects of sensory function through repeated practice.  Perceptual learning can improve vision in younger patients with amblyopia (“lazy eye”).  It was previously thought that older patients, like those with AMD, no longer had enough visual plasticity to benefit from this approach.

Dr Chung’s research takes advantage of the fact that people with central vision loss often adopt another location in the macula—the so-called preferred retinal location—to perform visual tasks.  She reports a series of experiments “demonstrate[ing] the presence of plasticity in the visual system after bilateral central vision loss, especially at and around the PRL.” 

…May Lead to New Rehab Strategies in Central Vision Loss

These results show that “The visual system for these individuals is still plastic and can be modified through experiences,” Dr Chung writes.  She tested this hypothesis in a preliminary study of six older adults with central vision loss.  In these patients, perceptual learning techniques targeting the PRL led to an average 50 percent increase in reading speed.

However, perceptual learning can’t improve visual acuity—patients still needed large-print books or magnification to see print.  In addition, they would likely need continued practice in order to retain the improvement in reading speed.  Dr Chung concludes, “The presence of this experience-dependent plasticity offers us an exciting opportunity to adopt perceptual learning as an alternative rehabilitative strategy for improving visual functions for people with central vision loss.”

Dr. Chung received the 2012 Glenn A. Fry Lecture Award in recognition of her research contributions.  This prestigious award was established by American Optometric Foundation to honor Dr. Glenn A. Fry, who contributed so much to the profession of optometry through his writings, teachings, and administrative duties at the Ohio State University.

To read the article, “The Glenn A. Fry Award Lecture 2012: Plasticity of the Visual System Following Central Vision Loss”, please visit http://journals.lww.com/optvissci/Fulltext/2013/06000/The_Glenn_A__Fry_Award_Lecture_2012___Plasticity.3.aspx

About Optometry and Vision Science

Optometry and Vision Science, official journal of the American Academy of Optometry, is the most authoritative source for current developments in optometry, physiological optics, and vision science. This frequently cited monthly scientific journal has served primary eye care practitioners for more than 75 years, promoting vital interdisciplinary exchange among optometrists and vision scientists worldwide.

About the American Academy of Optometry

Founded in 1922, the American Academy of Optometry is committed to promoting the art and science of vision care through lifelong learning.  All members of the Academy are dedicated to the highest standards of optometric practice through clinical care, education or research.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes.LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2012 annual revenues of €3.6 billion ($4.6 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Posted in All Medicine, Ophthalmology, Optometry, Publications | Leave a comment

New York City Successfully Locates HIV-Positive Patients ‘Lost to Follow-Up’

Posted on May 31, 2013

Intensive Effort Leads Most Patients to Restart Treatment, Reports Study in AIDS Journal

Philadelphia, Pa. (May 30, 2013) – Public health officials in New York City have launched a successful program to locate HIV-positive patients who have been “lost to follow-up” and reconnect them with treatment services, reports a study published in AIDS, official journal of the International AIDS Society. AIDS is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Efforts to restart antiretroviral therapy are especially important with the current emphasis on “treatment-as-prevention” for HIV, according to the study by Chi-Chi N. Udeagu, MPH, and colleagues of the New York City Department of Health and Mental Hygiene.  The article is available on the AIDS journal homepage and in the June 12 print edition.

Effort to Locate HIV Patients Lost to Follow-Up …

The program used the NYC HIV surveillance registry to identify patients who had previously tested positive for HIV but did not have current information on routine laboratory test results.  Public health case workers made intensive efforts—including phone calls, mail, home visits, and Internet searches— to contact this group of “lost to follow-up” patients.

Once located, patients were offered help in re-engaging with treatment services and restarting HIV care.  They were also targeted for efforts to identify sexual partners who might be at risk of HIV.

Case workers were able to locate 689 out of 797 patients presumed lost to follow-up.  After being contacted, 33 percent of patients were found to be up-to-date with HIV treatment — their most recent lab results were not yet reported in the database, or they were seen by HIV medical providers  not required to report lab results to the health department, such as Veterans hospitals and HIV clinical trial units.  Five percent of located patients had moved or were incarcerated, while two percent had died.

This left 409 patients who were successfully located and verified as not being up-to-date with HIV care.  Once located, 77 percent of these patients accepted an appointment at an HIV clinic and 57 percent returned to treatment. 

…Leads Most to Re-Engage with Treatment Services

Overall, the program was successful in identifying about half of the initial list of patients as being lost to follow-up, and in re-rengaging most of them with treatment services. About half of patients lost to follow-up agreed to be interviewed for partner services.  These efforts led to identification and a new diagnosis of HIV infection in three patients.

When patients were asked why they stopped attending HIV care, about 40 percent said they felt well and didn’t think they needed treatment.  Other reasons included day-to-day responsibilities, not trusting health care workers, side effects of HIV medicines, feeling depressed, being uninsured, and not wanting to think about being HIV-positive.

Recent years have seen a growing emphasis on “treatment-as-prevention” of HIV — giving antiretroviral medications to lower the viral load, which significantly reduces the risk of transmitting the infection.  Most studies of this approach have focused on patients newly diagnosed with HIV.  But it’s just as important to focus efforts on patients with previously diagnosed HIV who are “un-engaged or under-engaged” in HIV medical care.

The public health effort reported in the study would not have been possible without the NYC HIV surveillance registry, which was used to identify patients “”lost to follow-up”, and monitor their outcomes following re-engagement efforts.  The fact that one-third of located patients actually were current with care probably reflects lag times in reporting lab test results to the registry.

Based on their results, Udeagu and coauthors conclude, “HIV surveillance data can and should be used by health departments to identify and locate people living with HIV who are lost to follow-up, and public health case-workers should investigate such cases with the goal of re-engaging such [patients] in medical care for HIV.”  They add, “Although challenges abound, such efforts are essential to any comprehensive effort to control the HIV epidemic.”

About AIDS

AIDS publishes the very latest ground-breaking research on HIV and AIDS. Read by all the top clinicians and researchers, AIDS has the highest impact of all AIDS-related journals.  With 18 issues per year, AIDS guarantees the authoritative presentation of even more significant advances. The Editors, themselves noted international experts who know the demands of HIV/AIDS research, are committed to making AIDS the most distinguished and innovative journal in the field.   Visit the journal website at www.aidsonline.com.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes.

LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2012 annual revenues of €3.6 billion ($4.6 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Posted in All Medicine, Infectious Disease, Public Health, Publications | Leave a comment

Virginia’s ‘Hybrid’ Surveillance Strategy Aided Response to Contaminated Steroid Outbreak

Posted on May 31, 2013

Innovative Approach Relied on Coordination between Public Health and Clinical Partners, Says Report in Journal of Public Health Management and Practice

Philadelphia, Pa. (May 30, 2013) – An innovative “hybrid” surveillance strategy—highlighted by close cooperation between public health officials and clinical partners—helped Virginia mount an efficient and effective response to the ongoing outbreak of fungal meningitis and other infections, according to a report in the July/August issue of Journal of Public Health Management and Practice.  The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The Virginia Department of Health (VDH) “worked closely with clinical partners, combining assessment, referral to care and public health surveillance methodologies in a hybrid surveillance model,” according to the article by Dr. Laurie Forlano and colleagues. They believe their strategy—involving “intensive collaboration” between public health officials and hospitals and doctors serving the affected communities—is a promising model for responding to future public health threats.

‘Hybrid’ Surveillance Response to Contaminated Steroid Crisis

The VDH implemented the hybrid strategy in response to the 2012 outbreak of meningitis and other fungal infections, which was traced to contaminated steroid products supplied by a Massachusetts compounding pharmacy.  Virginia was one of the hardest-hit states, with 53 affected patients—including two deaths—over a six-month period. Two Virginia healthcare facilities—both free standing pain/interventional radiology clinics in the southwest region of the state—received the contaminated products. 

Because of the subtle symptoms, potentially long incubation period, and the risk of serious illness and death, Virginia public health officials decided that intensive, active surveillance was needed to contact and track nearly 700 exposed residents.  The VDH rapidly developed a “hybrid” active surveillance strategy, reflecting a combination of traditional active surveillance performed by public health personnel, and additional surveillance and clinical follow-up performed by health care providers and hospitals.

In the hybrid surveillance model, public health personnel took the lead in contacting potentially exposed patients who may have received spinal injections with the contaminated steroids.  Telephone follow-up included weekly calls to assess for new signs and symptoms of possible infection, and to refer patients to clinical care if indicated.

‘Excellent Partnership’ between Public Health and Clinical Partners

Once patients had received testing and care from clinical partners, responsibility for further tracking and follow-up was passed on to the treating physicians.  If the patient was diagnosed with a fungal infection, the doctor reported the suspected case back to the VDH.  The VDH maintained close contact with partner hospitals to keep up with evolving clinical information.

“It was a division of labor of sorts, as the volume of patients requiring close follow up was just so large,” Dr. Forlano explains.  “In most cases, if a patient with symptoms sought medical attention—whether from an emergency room, primary care doctor, infectious disease specialist, or elsewhere—that exposed person became the responsibility of the clinical team.

“Both the clinical teams and the public health team provided weekly follow up on the people for whom they were responsible,” Dr. Forlano adds.  “It was an excellent partnership—the clinicians were willing to do follow up even on patients who didn’t meet the VDH definition of ‘cases’ so we could focus on the exposed persons who hadn’t yet developed symptoms.”

From the start of October through the end of November, 2012, the VDH documented nearly 3,100 patient contacts.  The initial surveillance program was stopped after eight weeks, based on evidence suggesting that any infections caused by the contaminated steroids would have developed within that time.

One-on-one contact was essential to the success of the hybrid surveillance approach, according to Dr. Forlano and her colleagues at the VDH.  They believe their experience highlights the need to address key areas of communication with exposed patients and between public health and clinical personnel.

Dr. Forlano and coauthors also believe their hybrid model could be usefully applied to future large-scale health threats, whether natural or man-made.  They conclude, “It should be used as a basis for planning the response to events requiring time-sensitive, active follow-up of a large number of exposed individuals that could be required after an intentional or unintentional community wide exposure to a biologic, radiologic or chemical agent.”

About Journal of Public Health Management and Practice

Journal of Public Health Management and Practice publishes articles which focus on evidence based public health practice and research.  The journal is a bi-monthly peer-reviewed publication guided by a multidisciplinary editorial board of administrators, practitioners and scientists. Journal of Public Health Management and Practice publishes in a wide range of population health topics including research to practice; emergency preparedness; bioterrorism; infectious disease surveillance; environmental health; community health assessment, chronic disease prevention and health promotion, and academic-practice linkages.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes.

LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2012 annual revenues of €3.6 billion ($4.6 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Posted in All Medicine, Public Health, Publications | Leave a comment

Gene Therapies for Regenerative Surgery Are Getting Closer, Says Review in Plastic and Reconstructive Surgery

Posted on May 30, 2013

Genetic Techniques Show Promise in Promoting Growth of Skin, Bone and Other Tissues

Philadelphia, Pa. (May 29, 2013) – Experimental genetic techniques may one day provide plastic and reconstructive surgeons with an invaluable tool—the ability to promote growth of the patient’s own tissues for reconstructive surgery.  A review of recent progress toward developing effective gene therapies for use in “regenerative surgery” appears in the June issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Over the past ten years, researchers have developed several promising gene therapy techniques to grow skin, bone and other tissues for reconstructive surgery.  But they still face many challenges in developing gene-based approaches that can make the leap from the research lab to the operating room, according to the review by Dr. Giorgio Giatsidis and colleagues of Padua University Hospital, Italy.

Gene Therapy Approaches Studied for ‘Almost Every Tissue’…

Dr. Giatsidis and coauthors reviewed the state of the art in research on gene therapy techniques for treatment of local disorders and injuries—the first such review in more than a decade.  They found studies using gene therapy to promote the growth of “almost every different tissue” for use in regenerative surgery.  “Gene therapy may represent a leading strategy to develop more efficient regenerative surgical treatments for numerous clinical needs,” they write.

Gene therapy has the potential to provide reconstructive surgeons with a new approach to solving one of their most difficult problems: the lack of adequate tissues to correct deformities of a specific area or structure.  For example, in patients with relatively small burns, plastic and reconstructive surgeons have designed a wide range of skin flaps for use in transferring healthy tissue to the burned area.

But for patients with burns involving larger areas, the lack of suitable tissues for coverage may severely limit the reconstructive options.  Using gene techniques to promote growth of specific types of tissues would be a major step forward in the ability to perform truly regenerative surgery.

…But Translation from Lab to OR Poses Many Challenges

Several research groups are pursuing gene therapy approaches to regenerate skin, such as using genes to control expression of growth factors involved in skin healing.  One small study reported promising results with tissue-engineered products to promote healing of diabetic skin ulcers.

Researchers are also targeting growth factors involved in new bone formation, with promising results in techniques using transplantation of genetically modified donor bone.  One study reported clinical benefits using gene therapy to regenerate joint cartilage in patients with rheumatoid arthritis.  Techniques to promote healing of tendons, regeneration of injured nerves, and growth of skin flaps for reconstructive surgery are all being explored.

But despite progress in all of these areas, translating experimental gene therapy methods into regenerative surgery techniques for use in the operating room will remain a difficult challenge.  Even after the technical problems are addressed, more work will be needed to develop regenerative surgery techniques that are productive and cost-effective.

“After two decades, regenerative surgery is an adolescent looking forward to growing up,” Dr. Giatsidis and coauthors write.  “Despite extensive preclinical approaches, translation of gene therapy strategies into clinical trials is still a difficult and expensive process.”

So far, the studies of diabetic ulcers and rheumatoid arthritis mentioned above are the only methods to show evidence of clinical effectiveness in human patients.  “Even so,” the authors add, “cutting-edge gene therapy-based strategies in reconstructive procedures [are close] to setting valuable milestones for development of efficient treatments in a growing number of local diseases and injuries.”

Plastic and Reconstructive Surgery® is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.

About Plastic and Reconstructive Surgery

For more than 60 years, Plastic and Reconstructive Surgery® (http://journals.lww.com/plasreconsurg/) has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. The official journal of the American Society of Plastic Surgeons, Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair, and cosmetic surgery, as well as news on medico-legal issues.

About ASPS

The American Society of Plastic Surgeons (ASPS) is the world’s largest organization of board-certified plastic surgeons. Representing more than 7,000 Member Surgeons, the Society is recognized as a leading authority and information source on aesthetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. ASPS advances quality care to plastic surgery patients by encouraging high standards of training, ethics, physician practice and research in plastic surgery. You can learn more and visit the American Society of Plastic Surgeons at www.plasticsurgery.org or www.facebook.com/PlasticSurgeryASPS and www.twitter.com/ASPS_news.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes.

LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2012 annual revenues of €3.6 billion ($4.6 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Posted in All Medicine, Publications, Surgery - Plastic and Reconstructive | Leave a comment

Study Looks at Sports-Related Facial Fractures in Kids, Reports Plastic and Reconstructive Surgery

Posted on May 30, 2013

Data on Fracture Causes and Patterns May Help to Inform Preventive Measures

Philadelphia, Pa. (May 29, 2013) – Facial fractures are relatively common, and potentially serious, sports-related injuries among children participating in a wide range of sports, according to a study in the June issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

The five-year study provides insights into the characteristics of sports-related facial fractures in young athletes—including the causes and patterns of fractures in specific sports.  “These data may allow targeted or sport-specific craniofacial fracture injury prevention strategies,” write Dr. Lorelei Grunwaldt and colleagues of Children’s Hospital of Pittsburgh.

Sports-Related Facial Fractures in Kids:  Patient and Injury Characteristics

The researchers analyzed 167 children and adolescents with sports-related fractures seen at their hospital’s emergency department from 2000 to 2005.  Of all facial fractures in children treated during that time, 10.6 percent were sports-related.

About 80 percent of the injured patients were boys; nearly two-thirds were between 12- and 15-years-old.  Nasal fractures accounted for about 40 percent of the injuries, 34 percent were fractures around the eye, and skull fractures accounted for 31 percent.

Although the injuries were not critical, many were quite serious.  Approximately 45 percent of the patients were hospitalized, including 15 percent admitted to the intensive care unit.  About 10 percent lost consciousness.  Four percent of the children had more severe “level I” trauma—unstable airway or vital signs, or spinal cord injury.

Approximately 45 percent of fractures occurred when the child was hit by a ball—most often when attempting to catch it.  Collisions with another player were the second most common cause at 24.5 percent, followed by falls, about 19 percent.

Sport-Specific Fractures Have Lessons for Prevention

Forty-four percent of the facial fractures were sustained from baseball or softball activities. Basketball and football were less common, only accounting for 10 percent of the cases.  Analysis of various sports found some important differences in causes and fracture patterns:

  • Baseball/softball—Most injuries occurred in fielders trying to catch the ball, most often a line drive.
  • Basketball, football and soccer—All fractures in basketball and football, and most in soccer, were caused by colliding with another player.
  • Golf—Most injuries occurred at home, all in patients struck by another player’s club.
  • Skiing/snowboarding and skateboarding—All facial fractures in skiing/snowboarding, and most in skateboarding, occurred in youth who were not wearing helmets.
  • Horseback riding—Fractures were caused by being kicked by a horse.

Although fractures related to horseback riding and skateboarding were less common, the injuries tended to be more severe.  Rates of level I trauma were 29 percent in horseback riding and 14 percent in skateboarding.

The study is one of the few to focus on sports-related facial fractures in children. The findings have important implications for plastic surgeons, emergency department personnel and others who evaluate and treat young athletes with facial fractures.

The data on causes and patterns of fractures may also aid in efforts to prevent facial fractures in young patients, the researchers believe. They emphasize that proper supervision and efforts to promote following the rules and “fair play” may reduce the overall risk of injuries in young athletes.

In skateboarding and skiing/snowboarding, wearing helmets has proven effective in reducing fracture risk.  Nasal protectors may help prevent some fractures in basketball and soccer.  The use of softer, low-impact balls has been recommended in youth baseball and softball.  Given the high rate of fractures occurring in fielders trying to catch a ball in these sports, Dr. Grunwaldt and coauthors conclude, “[O]ur strongest recommendation for injury prevention may be further consideration of face protective equipment [face guards] for players fielding in baseball and softball.”

Plastic and Reconstructive Surgery® is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.

About Plastic and Reconstructive Surgery

For more than 60 years, Plastic and Reconstructive Surgery® (http://journals.lww.com/plasreconsurg/) has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. The official journal of the American Society of Plastic Surgeons, Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair, and cosmetic surgery, as well as news on medico-legal issues.

About ASPS

The American Society of Plastic Surgeons (ASPS) is the world’s largest organization of board-certified plastic surgeons. Representing more than 7,000 Member Surgeons, the Society is recognized as a leading authority and information source on aesthetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. ASPS advances quality care to plastic surgery patients by encouraging high standards of training, ethics, physician practice and research in plastic surgery. You can learn more and visit the American Society of Plastic Surgeons at www.plasticsurgery.org or www.facebook.com/PlasticSurgeryASPS and www.twitter.com/ASPS_news.

About Lippincott Williams & Wilkins
Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes.

LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2012 annual revenues of €3.6 billion ($4.6 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Posted in All Medicine, Publications, Surgery - Plastic and Reconstructive | Leave a comment

Weight of Tissue Flaps Affects Complication Risk after Breast Reconstruction

Posted on May 30, 2013

Information on Risk Factors May Help Plastic and Reconstructive Surgeons Optimize Flap Design and Patient Outcomes, Suggests Study in PRS Global Open

Philadelphia, Pa. (May 29, 2013) – For women undergoing breast reconstruction after mastectomy, the weight of the tissue flap used affects the risk of an important complication called fat necrosis, reports a study in Plastic and Reconstructive Surgery—Global Open®, the official open-access medical journal of the American Society of Plastic Surgeons (ASPS).

Information on flap weight—and the number of blood vessels supplying the flap—can help plastic and reconstructive surgeons optimize outcomes for women undergoing breast reconstruction after mastectomy for breast cancer, according to the study by ASPS Member Surgeon Dr. Justin M. Sacks and colleagues from the Department of Plastic and Reconstructive Surgery at the Johns Hopkins School of Medicine, Baltimore.

Flap Weight and Blood Supply Predict Fat Necrosis Risk

The researchers analyzed risk factors for fat necrosis in 123 women undergoing breast reconstruction after mastectomy for breast cancer. Fat necrosis refers to the death of fat cells in the reconstructed breast; it is caused by problems with blood supply to the transplanted flap.

The reconstructions were performed using the women’s own tissues—specifically, using flaps of tissue transferred from the abdominal area. In performing autologous reconstructions, plastic and reconstructive surgeons create custom-designed flaps of muscle, fat and skin from the abdominal area, along with their supplying blood vessels.

Dr. Sacks and coauthors evaluated surgical and patient-related factors affecting the risk of fat necrosis after reconstruction—including the total weight of the abdominal tissue flap before it was transferred to the chest. The analysis included a total of 179 flaps (including 56 women undergoing reconstruction of both breasts).

Fat necrosis occurred in 7.5 percent of flaps overall. The risk was significantly higher for women with heavier tissue flaps: for each 100-gram increase in flap weight, the risk of fat necrosis increased by 50 percent. (The average flap weight was approximately 650 grams.)

Risk of fat necrosis was also affected by the number of supplying blood vessels, or “perforators”—especially in heavier flaps. Among flaps larger than 1,000 grams, the rate of fat necrosis was about 43 percent in those with a single perforator, compared to 14 percent for those with two or more perforators.

Attention to Risk Factors May Improve Breast Reconstruction Outcomes

African American women were also at higher risk of fat necrosis after breast reconstruction, with a risk nearly 12 times higher than in Caucasian women. Risk was not significantly affected by patient age, body weight, and various medical and surgical factors.

Fat necrosis is an important complication after breast reconstruction. “Development of fat necrosis requiring reoperation can result in significant aesthetic deformity as well as emotional and financial costs,” Dr. Sacks and coauthors note.

Plastic and reconstructive surgeons are constantly working to refine the technical aspects of breast reconstruction, including flap design, in order to provide the best possible surgical and aesthetic results. Although other studies have looked at risk factors for fat necrosis, the new study is the first to focus on the flap weight and its interaction with blood supply.

The results show that larger, heavier flaps are at higher risk of fat necrosis, particularly in flaps with just one perforating blood vessel. Dr. Sacks and colleague suggest that plastic and reconstructive surgeons should consider “balancing perforator number and increasing flap weight” in designing abdominal flaps for autologous breast reconstruction. They suggest to ensure adequate blood supply to flaps in African American women, who appear to be at higher risk of fat necrosis after breast reconstruction.

Plastic and Reconstructive Surgery—Global Open® is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.

About PRS Global Open

Plastic and Reconstructive Surgery—Global Open (PRS GO) (www.prsgo.com) is  a companion journal to the American Society of Plastic Surgeons’ flagship publication, Plastic and Reconstructive Surgery. PRS GO is an open access, rigorously peer-reviewed, international journal focusing on global plastic and reconstructive surgery. PRS GO educates and supports plastic surgeons globally to provide the highest quality patient care and maintain professional and ethical standards through education, research, and advocacy.

About ASPS

The American Society of Plastic Surgeons (ASPS) is the world’s largest organization of board-certified plastic surgeons. Representing more than 7,000 Member Surgeons, the Society is recognized as a leading authority and information source on aesthetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. ASPS advances quality care to plastic surgery patients by encouraging high standards of training, ethics, physician practice and research in plastic surgery. You can learn more and visit the American Society of Plastic Surgeons at www.plasticsurgery.org or www.facebook.com/PlasticSurgeryASPS and www.twitter.com/ASPS_news.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes.

LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2012 annual revenues of €3.6 billion ($4.6 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Posted in All Medicine, Publications, Surgery - Plastic and Reconstructive | Leave a comment

Plastic and Reconstructive Surgery–Global Open Journal Launched

Posted on May 28, 2013

Introduces First Fully Open Access Journal Published by Wolters Kluwer Health – Lippincott Williams & Wilkins

New York, NY (May 28, 2013)—Plastic and Reconstructive Surgery–Global Open (PRS GO) is a new open access journal launched as a companion title to the leading Plastic & Reconstructive Surgery, the official journal of the American Society of Plastic Surgeons. PRS GO represents the first fully open access journal published by Wolters Kluwer Health – Lippincott Williams & Wilkins (LWW).

PRS GO is intended to globalize plastic surgery research, collaboration, and best practice sharing to improve the field. Its mission is to disseminate high-quality, peer-reviewed research in plastic and reconstructive surgery to the widest possible global audience, through an open access platform. As a complementary journal to Plastic and Reconstructive Surgery, PRS GO provides an open access venue for the publication of those research studies sponsored by private and public funding agencies that require open access publication of study results.

“We’re delighted to provide our society partners with options to publish quality, peer-reviewed content such as fully open- and hybrid open access journals along with traditional publishing models,” said Jayne Marks, Vice President, Publishing for Wolters Kluwer Health, Medical Research. “Plastic and Reconstructive Surgery has been a true innovative partner with Wolters Kluwer Health, and we’re excited to help them deliver PRS GO in realizing their mission to bring important specialty research to a global audience.”

“This is an exciting step in our evolution to support research and education for the international plastic surgery community, including surgeons, care providers, and patients alike,” said Dr. Rod Rohrich, MD, Editor-in-Chief of Plastic and Reconstructive Surgery and PRS GO journals. “A further reflection of the journal’s global scope and perspective is the composition of our editorial board, representing respected plastic surgeons and researchers from 26 countries.”

PRS GO provides rapid review and publication of accepted papers; all articles and content are published under the Creative Commons License Attribution Non-Commercial No Derivative 3.0 License (CCBY-NC-ND). For more details about the journal, please see http://journals.lww.com/prsgo/pages/aboutthejournal.aspx.

About PRS Global Open
Plastic and Reconstructive Surgery Global Open (PRS GO) is an open access, peer-reviewed, international journal focusing on global plastic and reconstructive surgery. PRS GO publishes on all areas of plastic and reconstructive surgery, including basic science/experimental studies pertinent to the field and also clinical articles on such topics as: breast reconstruction, head and neck surgery, pediatric and craniofacial surgery, hand and microsurgery, wound healing, and cosmetic and aesthetic surgery. Clinical studies, experimental articles, ideas and innovations, and techniques and case reports are all welcome article types.

About ASPS
The American Society of Plastic Surgeons (ASPS) is the world’s largest organization of board-certified plastic surgeons. Representing more than 7,000 Member Surgeons, the Society is recognized as a leading authority and information source on aesthetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. ASPS advances quality care to plastic surgery patients by encouraging high standards of training, ethics, physician practice and research in plastic surgery. You can learn more and visit the American Society of Plastic Surgeons at www.plasticsurgery.org or www.facebook.com/PlasticSurgeryASPS and www.twitter.com/ASPS_news.

About Wolters Kluwer Health

Wolters Kluwer Health (Philadelphia, PA) is a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Serving more than 150 countries and territories worldwide, Wolters Kluwer Health’s customers include professionals, institutions and students in medicine, nursing, allied health and pharmacy. Major brands include Lippincott Williams & Wilkins, Ovid®, Medknow, UpToDate®, Medi-Span®, Facts & Comparisons®, Pharmacy OneSource®, Health Language®, Lexicomp® and ProVation® Medical.

Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company. Wolters Kluwer had 2012 annual revenues of €3.6 billion ($4.6 billion), employs approximately 19,000 people worldwide, and maintains operations in over 40 countries across Europe, North America, Asia Pacific, and Latin America.

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Posted in All Medicine, Publications, Surgery - Plastic and Reconstructive, Uncategorized | Leave a comment