In 1989, the U.S. House of Representatives introduced the Omnibus Budget Reconciliation Act that was passed in the same year. The law established the "relative value unit," meant to quantify medical services. The relative value unit consists of three parts: the work relative value, the practice expense relative value, and the malpractice relative value. The work relative value unit is "based on the relative resources incorporating physician time and intensity required in furnishing the service." 1 The practice expense relative value unit takes into account "the nonphysician clinical and nonclinical labor of the practice, as well as expenses for building space, equipment, and office supplies." The malpractice relative value unit considers "the cost of malpractice insurance premiums." Of all three, the work relative value unit constitutes the largest component of the total relative value unit. For every service, the relative value units are calculated and then multiplied by a dollar conversion factor (approximately $35). This value became the metric for Medicare payments to physicians. 2 The concept of using a relative value scale of medical services to determine cost of care is not new. In 1978, a major study introduced this idea for surgery, where cost was determined with a formula that used the variables of time, complexity, investment in professional training, and overhead expenses. 3 Time was determined by adding the
Background Psychosocial distress, depression, or anxiety can occur in up to 50% of women after a breast cancer diagnosis and mastectomy. The purpose of this study was to assess the potential benefit of lavender oil as a perioperative adjunct to improve anxiety, depression, pain, and sleep in women undergoing microvascular breast reconstruction. Methods This was a prospective, single-blinded, randomized, controlled trial of 49 patients undergoing microvascular breast reconstruction. Patients were randomized to receive lavender oil or placebo (coconut oil) throughout their hospitalization. The effect of lavender oil on perioperative stress, anxiety, depression, sleep, and pain was measured using the hospital anxiety and depression scale, Richards–Campbell Sleep Questionnaire, and the visual analogue scale. Results Twenty-seven patients were assigned to the lavender group and 22 patients were assigned to the control group. No significant differences were seen in the perioperative setting between the groups with regard to anxiety (p = 0.82), depression (p = 0.21), sleep (p = 0.86), or pain (p = 0.30) scores. No adverse events (i.e., allergic reaction) were captured, and no significant differences in surgery-related complications were observed. When evaluating the entire cohort, postoperative anxiety scores were significantly lower than preoperative scores (p < 0.001), while depression scores were significantly higher postoperatively as compared with preoperatively (p = 0.005). Conclusion In the setting of microvascular breast reconstruction, lavender oil and aromatherapy had no significant adverse events or complications; however, there were no measurable advantages pertaining to metrics of depression, anxiety, sleep, or pain as compared with the control group.
utologous breast reconstruction is associated with improved long-term satisfaction and greater psychosocial well-being compared with implant-based reconstruction. 1,2 With respect to the timing of reconstruction, superior aesthetic outcomes, improved well-being, and lower overall health care costs have resulted in approximately 70 percent of breast reconstruction patients undergoing a form of immediate rather than delayed breast reconstruction. 2-5 However, significant comorbidities and the need for postmastectomy radiation therapy may cause some surgeons to defer immediate autologous breast reconstruction in favor of a delayed approach.
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