Total thyroidectomy may be more reasonable as initial surgery in unilateral multifocal papillary thyroid microcarcinoma: a single-center experience

The ethics statement of our study by the Ethics Committee of Jilin University affiliated First Hospital. (DOC 58 kb

San Diego: Major Providers Pursue Countywide Networks and New Patient Care Models

San Diego has long been a geographically well-defined health care market with high managed care penetration and a consolidated provider sector. In recent years, hospital systems have faced increasing cost pressures as commercial health plans have responded to employer demands for more affordable premiums. Safety-net providers expanded capacity to deal with the large Medi-Cal expansion that began in 2014, but continue to grapple with how to provide adequate care for a new enrollee population that is far sicker, with more complex medical and social service needs, than the providers' previous patient base.Key developments include:While the hospital market remained largely stable in recent years, most of the smaller hospitals have been losing volume and struggling financially.Major systems are pursuing population health strategies and increasingly using provider-sponsored health plans to take full risk for more patients.The challenges of independent practice are leading many primary care physicians to choose employment at system-affiliated groups.In the two years since Medicaid eligibility was first expanded under the ACA, San Diego's Medi-Cal managed care enrollment almost doubled to 700,000. Many Medi-Cal enrollees without a regular primary care provider sought care at hospital emergency departments, and access gaps for many kinds of specialty care and behavioral health care were even more severe.San Diego County's commitment to providing health care for low-income residents continues to be limited, although the county Health and Human Services Agency has become more active in fostering collaborations between health and other social services

The “Principal Purpose” Driven Life: How Hospitals Should Apply ERISA’s Church Plan Exemption After Advocate v. Stapleton

The United States’ health care industry is filled with numerous protections for individuals and entities who have objections based on religious beliefs and moral convictions. For example, there is a long history of conscience protections for individuals that object to performing or assisting in the performance of abortion or sterilization procedures or assisted suicide (including euthanasia or mercy killing). Over time, as more medical entities declare affiliation with religious entities, Congress has expanded conscience protections to cover more than just the daily activities of medical professionals. Generally, churches have to comply with the Employee Retirement Income Security Act (ERISA or the Act) just like any other employer. Yet, Congress provided an exception from ERISA for the administration of “church plans.” This exemption has existed for many years without issue until recently, when this exemption became the subject of increased litigation. ERISA defines “church plan” to apply more broadly than merely to plans covering people who work in houses of worship; schools, nursing homes, and hospitals may also comply if they are controlled or owned by religious entities. Most recently, questions have risen regarding whether the employee pension plans used by religiously-affiliated hospitals have been correctly classified as “church plans” exempt from ERISA. The answers to these questions carry with it large consequences because qualified church plans are excused from certain coverage, vesting, benefit accrual, and funding requirements of ERISA and the Internal Revenue Code (IRC) that otherwise apply to tax-qualified plans. In the 2017 landmark case Advocate Health Care Network v. Stapleton, one question that had long been debated between circuit courts regarding the extent of this exemption was resolved; the Court determined that a plan established and maintained by a church includes a plan maintained by a principal purpose organization. This ruling means that any religiously-controlled entity that manages an employee benefit plan no longer must be created by a religious entity in order to qualify for this exemption. Regardless of how (and by whom) the entity was first established, an organization may still take advantage of this exemption from ERISA as long as the entity is maintained by a principal purpose organization. This Supreme Court ruling is far from a full resolution of the issue. Advocate left a few issues unresolved, such as the definition of “principle purpose organization.” This leaves religiously-affiliated hospitals in a sticky place: unsure if they qualify for—and therefore can rely on—the ERISA church exemption. Since there are many potentially devastating effects on non-qualifying hospitals that mistakenly relied on this exemption, it is important for the qualifying factors to be clear. No longer should religiously-affiliated hospitals seek and rely on non-binding (and sometimes inaccurate) private letter rulings (PLRs) issued by the IRS in order to determine their exemption status. In Part I, this Comment will discuss ERISA’s church plan exemption pre- and post-Advocate. Additionally, it will cover a brief overview of the history of employee benefit plans in the healthcare system and describe the roles of different governmental entities. In Part II, this Comment will discuss the landmark case Advocate v. Stapleton and its impact on the employee benefit industry, and the current status of ERISA’s principal purpose requirement. Last, Part III will suggest a new set of factors that each religiously-controlled hospital and its employee benefit subcommittees can rely on in determining if it meets the “principal purpose” requirement

Analysis of conference abstract-to-publication rate in UK orthopaedic research

Presentation of research at orthopaedic conferences is an important component for surgical evidence-based practice. However, there remains uncertainty as to how many conference abstracts proceed to achieve full-text publication for wider dissemination. This study aimed to determine the abstract-to-publication rate (APR) of research presented in the largest hip and knee orthopaedic meetings in the UK, and to identify predictive factors which influence the APR.All published abstracts (N=744) from the 2006, 2008, 2009 and 2010 British Hip Society (BHS) and the 2007, 2009, 2010, and 2011 British Association for Surgery of the Knee (BASK) annual conference meetings were examined by four researchers independently. To determine whether abstracts had been published in full-text form, Google Scholar, Medline and EMBASE evidence databases were used to verify full-text publication (FTP) status. Variables including: sample size, statistical significance, grade of the first author, research affiliated institution and research design were extracted and analysed to identify whether these were associated with FTP.176 out of 744 abstracts achieved FTP status (APR: 23.7%). Factors associated with FTP status included statistically significant results (p0.05).APR of the assessed BHS and BASK annual conference presentations are low in comparison to other scientific meetings. Encouragement should be provided to clinicians and academics to submit their work for publication to address this short-fall, thereby enhancing the potential for full-text research publications to inform evidence-based orthopaedics

Narrow networks on the health insurance exchanges: What do they look like and how do they affect pricing? A case study of texas

The Affordable Care Act has engendered significant changes in the design of health insurance products. We examine the “narrowness” of hospital networks affiliated with plans offered in the first year of the marketplaces. Using data from Texas, we find limited evidence of a tight link between pricing and a simple measure of network breadth, or a more complex measure of network value derived from a logit model of hospital choice. The state's largest insurer priced its narrow networks at a fairly constant discount relative to its broad networks, notwithstanding significant variation in its broad-narrow gap across geographic markets in Texas. </jats:p

Cleveland Hospital Systems Expand Despite Weak Economy

Tracks developments in metropolitan Cleveland's healthcare market during the recession, including capacity expansions at Cleveland Clinic and University Hospitals, shifting of costs from employers to employees, pressure on the safety net, and reform

Organizing for Higher Performance: Case Studies of Organized Delivery Systems

Offers lessons learned from healthcare delivery systems promoting the attributes of an ideal model as defined by the Fund: information continuity, care coordination and transitions, system accountability, teamwork, continuous innovation, and easy access

Identification of a novel TSC2 c.3610G > A, p.G1204R mutation contribute to aberrant splicing in a patient with classical tuberous sclerosis complex: a case report

Background: Tuberous sclerosis complex (TSC) is an autosomal dominant disorder characterized by hamartomas in any organ systems. Mutations in the TSC1 or TSC2 gene lead to the dysfunction of hamartin or tuberin proteins, which cause tuberous sclerosis complex. Case presentation: We describe the clinical characteristics of patients from a Chinese family with tuberous sclerosis complex and analyze the functional consequences of their causal genetic mutations. A novel heterozygous mutation (c.3610G &gt; A) at the last nucleotide of exon 29 in TSC2 was identified. On the protein level, this variant was presumed to be a missense mutation (p.Gly1204Arg). However, the splicing assay revealed that this mutation also leads to the whole TSC2 exon 29 skipping, besides the wild-type transcript. The mutated transcript results in an in-frame deletion of 71 amino acids (p.Gly1133_Thr1203del) and its ratio with the normal splice product is of about 44:56. Conclusions: The novel c.3610G &gt; A TSC2 mutation was identified in association with tuberous sclerosis complex. And it was proven to code both for a missense-carrying transcript (56%), and for an isoform lacking exon 29 (44%)

A logistic regression model for microalbuminuria prediction in overweight male population

Background: Obesity promotes progression to microalbuminuria and increases the risk of chronic kidney disease. Current protocols of screening microalbuminuria are not recommended for the overweight or obese.&#xd;&#xa;&#xd;&#xa;Design and Methods: A cross-sectional study was conducted. The relationship between metabolic risk factors and microalbuminuria was investigated. A regression model based on metabolic risk factors was developed and evaluated for predicting microalbuminuria in the overweight or obese.&#xd;&#xa;&#xd;&#xa;Results: The prevalence of MA reached up to 17.6% in Chinese overweight men. Obesity, hypertension, hyperglycemia and hyperuricemia were the important risk factors for microalbuminuria in the overweight. The area under ROC curves of the regression model based on the risk factors was 0.82 in predicting microalbuminuria, meanwhile, a decision threshold of 0.2 was found for predicting microalbuminuria with a sensitivity of 67.4% and specificity of 79.0%, and a global predictive value of 75.7%. A decision threshold of 0.1 was chosen for screening microalbuminuria with a sensitivity of 90.0% and specificity of 56.5%, and a global predictive value of 61.7%.&#xd;&#xa;&#xd;&#xa;Conclusions: The prediction model was an effective tool for screening microalbuminuria by using routine data among overweight populations