Background: The goals of this study were to analyze and compare breast implant preferences between US and European surgeons in terms of size, shape, and surface texturing. Furthermore, we set out to investigate the impact of BIA-ALCL scientific publications on surgeon practice patterns. Methods: Breast implant sales data from the USA and Europe dating from June 2013 to September 2018 were provided by one of the world’s leading breast implant manufactures (Mentor Worldwide LLC). Change-point analysis was used to identify when significant changes in sales trends occurred. These changes were compared with dates of government announcements and publications of landmark scientific articles regarding BIA-ALCL. Results: Our data demonstrate that US surgeons tend to prefer larger, smooth round implants compared with European surgeons, who prefer smaller, textured round implants. Despite these differences, medium-sized implants were still the most common size used between both regions. Sales trends illustrate an increase in smooth implants and a decrease in textured implants for both regions. Significant changes in trends align with publication dates of announcements and landmark scientific articles. Conclusions: We demonstrate definitive differences in implant preferences between the USA and Europe. We encourage physicians to continue their pursuit of publishing because it seems these publications affect medical device selection.
Since their earliest application, cardiac implantable electronic devices (CIEDs), such as pacemakers, implantable defibrillators, and left ventricular assist devices (LVADs), have proven beneficial in the prevention of fatal cardiac-related disorders. 1 The past 50 years have seen a sharp rise in cardiac implantable device use with a resultant decline in deaths from ischemic, myocardial, and cardiac rhythm causes. 2 As the indications and guidelines governing CIED use broaden, so too does their widespread employment. 3 The rate of CIED infections has mirrored their increased use with some studies suggesting that the rate of device infections has overshadowed their implantation rate. 4 Infections pose a severe burden on patients, lead to significant health care costs and lengthy hospital stays, and may also lead to mortality. 5 When compared with noninfectious cardiac device complications, pacemaker infections result in an 8.4-to 11.6-fold increase in mortality rates along with a mean hospitalization cost ranging from $31,149 to $55,003. 6 Although both pacemakers and LVADs are implantable cardiac devices, their infection profile and treatment differ significantly due to the size of the device and the need for an external power source for the LVAD. However, both demonstrate a wide range of infection rates, with the true incidence of infection remaining elusive. 7 Topkara et al report a pacemaker infection rate of between 13% and 80%; however, others estimate it to be between 2% and 4% with rates rising 124% between years 1990 to 1999 and a 57% rise from 2004 to 2006, respectively. 8,9 Similarly, infection rates related to LVAD placement demonstrate a large range of between 13% and 80% among recipients. 10 This wide variability in infection risk is in part due to different types of infections that have been included under the category of CIED-related infections. Various reports broadly included patients with surgical site infections, postoperative pneumonia, central venous catheter-related sepsis, and nosocomial urinary tract infections, in addition to infection of the CIED. 10 Various comorbidities may contribute to CIED infections. Patients of advanced age, with congestive heart failure, with a metastatic malignancy, on corticosteroid therapy, or with renal failure are more likely to develop CIED infections thereby increasing their mortality. 9 Device Infection Diagnosis PacemakersThe diagnosis of pacemaker infections is often challenging. Pocket site infections are diagnosed clinically, often presenting with inflammatory skin changes including pain, swelling, AbstractWith their rising benefits, cardiac implantable electronic devices (CIEDs) such as pacemakers and left ventricular assist devices (LVADs) have witnessed a sharp rise in use over the past 50 years. As indications for use broaden, so too does their widespread employment with its attendant rise of CIED infections. Such large numbers of infections have inspired various algorithms mandating treatment. Early diagnosis of inciting organisms is crucial to...
Innovation is vital for progress in any industry. Evolving technology, paired with human ingenuity, brings ideas for prototypes and business models. Many physicians conceptualize platforms to serve their patients; however, many struggle and ultimately fail to bring their product or service to market. Financing is often the limiting factor. Studies have proven venture capital (VC) funding to be a pivotal source for helping a business survive in its early stages. Plastic surgeons can benefit from learning how to seek out VC funding. In this presentation, common terminology and key players will be defined, from seed capital to angel investors. Doing recommended “homework” will help the plastic surgeon identify a financier tailored to their specific needs—ideally one with a focus in the medical space. A clear-cut approach to assembling a “pitch deck” presentation will be outlined to prepare the plastic surgeon for their first meeting. Insider pearls will be presented from the VC perspective. The plastic surgeon should be prepared to answer fundamental questions expected at different stages of the process. Nevertheless, each meeting also serves as an opportunity for the plastic surgeon to probe the VC firm and their intentions. The role of background checks, social media, and electronic profiles will be discussed. Transparency from both parties at all times can help establish a successful relationship, even if it ends in a referral to a better suited VC firm. Between January and September of 2017, $12.1 billion of seed and VC was invested into life science companies in the United States. Growth is exponential. The surgeon is at the frontier of developing ideas and cutting-edge products that help us serve our patients with enhanced care and improved outcomes. In seeking out the proper financier, your product or service can become a reality in the market, contributing to the betterment of medicine and plastic surgery.
Telehealth is a proven modality to better patient care, reduce health care cost, and increase provider efficiency. This article outlines the necessary steps for starting a telehealth program at a medical center or practice. A review of the current literature and health care-related laws was undertaken to identify the necessary steps and considerations for starting a telehealth program. Bootstrapping a telehealth program starts with the creation of concept and identification of need. Generation of a hotbed of support, from providers and patients, is key in gaining executive interest and idea investment. Development of a defined plan of implementation with the utilization of already available technologic assets facilitates ease of execution. Creation of a televisit platform, a patient portal for enrollment, and dedicated provider time for televisits to occur are the next steps in plan realization. Measuring results of patient satisfaction, number of visits, cost reduction, and scheduled procedures are powerful tools in support of the multifaceted expansion of a telehealth program. The authors believe that telehealth programs are critical to advancing patient care, reduction of costs, and increased productivity in the future of medicine.
Cost allocation for health care professionals can be an enigma within the health care system. Activity-based costing (ABC) is an accounting tool that allocates costs incurred through a company's practice of providing goods and services to the consumer. ABC can provide insight into inefficiencies across the supply chain and unlock excess capacity. This, in turn, can drive services provided toward generating more value for the hospital system. ABC can be tailored to focus upon a unit of measurement that holds value as it pertains to production. With time-driven ABC (Td-ABC), we look to use the advantages of both the fee-for-service and capitation model to transition to a value-based system. Providers are rewarded based on efficiencies and successful outcomes in patient care while disincentivizing poor outcomes and superfluous volume/expenditures. ABC, however, does not come without its own risks and disadvantages, and the user must exercise caution in applying this cost-allocating tool to avoid detriment to its practice. A review of the literature was conducted to analyze the implementation, medical application, and advantages and disadvantages of Td-ABC.
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