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AVAILABLE ONLINE. PASS IT ON. TWINCITIES.MDNEWS.COM TWIN CITIES | December 2009 | A BUSINESS & PRACTICE MANAGEMENT MAGAZINE | ABOUT PHYSICIANS | FROM PHYSICIANS | FOR PHYSICIANS Regions Hospital Certified Level l Pediatric Trauma Care Healing Wounded Warriors A Closer Look at Laparoscopic Surgery REVIEW ONLY © 2008 SUNSHINE MEDIA, INC. UNAUTHORIZED USE OF THIS DOCUMENT IS STRICTLY PROHIBITED.

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AVAILABLE ONLINE. PASS IT ON.

T W I N C I T I E S . M D N E W S . C O M

TWIN CITIES | December 2009 |

! A BUSINESS & PRACTICE MANAGEMENT MAGAZINE | ABOUT PHYSICIANS | FROM PHYSICIANS | FOR PHYSICIANS !

Regions HospitalCertified Level l Pediatric Trauma Care

Healing Wounded Warriors

A Closer Look at Laparoscopic Surgery

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Twin Cities MD NEWS ! DECEMBER 2009 | 1""

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+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +

FEATURESREGIONS HOSPITAL

4We are fortunate to have a Level I pediatric trauma center here in the Twin Cities. Regions Hospital, partnering with Gillette Children’s Specialty Healthcare, has gone through the requirements and guidelines to be one of a few health care organizations throughout the country to be certified as a Level l pediatric trauma center. Read more about this exciting accomplishment in this issue’s cover story.HEALING WOUNDED WARRIORS 24Using Internet-based resources, a dynamic clinic and a collaborative spirit, three physicians are working to transform the way returning soldiers are treated for post-traumatic stress disorder.A CLOSER LOOK AT LAPAROSCOPIC SURGERY 26The emergence and increasing popularity of laparoscopic surgical techniques has changed the way physicians and patients view many common surgeries.

DEPARTMENTSFINANCE 9The Psychology of Successful Wealth Accumulation

CURRENT TOPICS 16Green Tea and Good HealthTHE SPINAL COLUMN 18Laparoscopic AdvancesPRACTICE MANAGEMENT

28Use Social Networks to Find New Employees

ON THE COVERThe trauma team staff is ready and waiting for a patient to arrive. For pediatric patients, the attending physician and nurse will go without their mask to ensure that the pediatric patient and their family see a friendly face upon arrival.

4

TWIN CITIES

A Closer Look at Laparoscopic 26

Wounded

24

Twin Cities MD NEWS ! DECEMBER 2009 | 1""

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2 | Twin Cities MD NEWS ! DECEMBER 2009

WW ELCOME TO DECEMBER’S issue of MD News. As we approach the end of another year, I’d like to

take a moment to thank you for supporting MD News and our sponsors. This last year has brought a lot of changes to the magazine, but I hope they are ones you’ve enjoyed. In addition to the usual clinical topics, our editorial strategy has branched out to other areas in an effort to serve you better. From offering tips for better practice management to addressing ethical issues of all kinds, we hope you’ve found the content interesting and insightful.

For 2010, we’ll delve into a variety of new clinical topics, including prenatal health, advances in cataract surgery and diabetes. You’ll also see the usual updates in other areas of medicine, including cardiology, orthopaedics and oncology. New columns will include practice management, a Q&A with a national expert and other current topics that are relevant to your professional endeavors.

In this December issue of MD News, we bring you Regions Hospital and how it became the first Level l pediatric trauma center in Minnesota. Once again, this article shares how dedicated local physicians and health care organizations are committed to providing some of the best care in the country. You will also find an intriguing feature on efforts to treat our veterans with post-traumatic stress disorder, as well as updates on the latest medical studies and research findings, pointers for managing your practice and a unique look at what is happening in the local medical field.

If you have questions, concerns or ideas for the upcoming year, please contact me, as I am always available.

Don’t forget to visit twincities.mdnews.com to view digital editions of current and past issues of MD News Twin Cities edition.

Thanks for reading,

Troy AndersonPublisher

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[email protected]

1173 Savanna Trail

Victoria, MN 55386

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FROM THE PUBLISHER "

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Contributing Writers: Steven C. Finkelstein, Joel Greenwald, Glenn R. Buttermann, Marian Deegan____________________________________

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Manager of Human Resources: Carrie Hildreth_______________________________________MD News is published by Sunshine Media, Inc.735 Broad Street, Suite 708 Chattanooga, TN 37402 (423) 266-3234 | sunshinemedia.com

Although every precaution is taken to ensure accuracy of published materials, MD News cannot be held responsible for opinions expressed or facts supplied by its authors. Copyright 2009, Sunshine Media, Inc. All rights reserved. Reproduction in whole or in part without written permission is prohibited.

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Contact Information Send press releases and all other information related to this local edition of MD News to [email protected].

Twin Cities

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4 | Twin Cities MD NEWS ! DECEMBER 2009

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OF THE THOUSANDS OF hospitals across the country, only a small subset has the resources, manpower, skills, training and equipment to meet adult trauma center criteria. Within

that subset, less than 20 hospitals have the additional experi-ence and equipment to qualify for Level I pediatric trauma center certification.

Regions Hospital’s standing as a Level I pediatric trauma center treating 450 children per year is over 10 years in the mak-ing. The hospital had been providing trauma care for decades and was officially verified as a Level I adult trauma center by the ACS in 1993. In 1999, the ACS issued a set of guidelines defining required capabilities to qualify a hospital as a Level I adult trauma center with pediatric commitment. In 2007, these pediatric trauma guidelines were revised to make requirements for special pediatric care recognition even more stringent.

“The ACS recognized that pediatric trauma care is very uncommon,” explains Dr. Michael McGonigal, Director of Trauma Services at Regions Hospital. “There are sig-nificant portions of the country where there is no pediatric center available to severely injured children. The ACS wanted to make sure that the adult trauma centers had some pediatric capabilities.”

Partnering with Gillette Children’s Specialty Healthcare and

COVER FEATURE

Regions Hospital

CERTIFIED LEVEL 1 PEDIATRIC TRAUMA CARE

By Marian Deegan

IN JUNE OF THIS YEAR, REGIONS HOSPITAL BECAME ONE OF APPROXIMATELY 18

HOSPITALS IN THE NATION TO BE CERTIFIED BY THE AMERICAN COLLEGE

OF SURGEONS (ACS) AS A LEVEL I PEDIATRIC TRAUMA CENTER.

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Twin Cities MD NEWS ! DECEMBER 2009 | 5""

The newly expanded emergency center at Regions Hospital opened in July 2009 and has doubled in size.

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6 | Twin Cities MD NEWS ! DECEMBER 2009

benefiting from their pediatric-specific resources on the Regions Hospital campus, the hospital found that it met almost all of the 2006 requirements for a Level II trauma pediatric center. The administration decided to take the further step to add the resources required for Level I pediatric certification. Under Dr. McGonigal’s guidance, the hospitals spent a year and a half restructuring and adding the needed resources to pass muster.

“We are very fortunate to be able to draw on the rich set of resources available through Gillette Children’s Specialty Healthcare within our building and on our campus,” acknowl-edges Dr. McGonigal. “The remaining certified Level I pediatric trauma centers across the country are either free-standing children’s hospitals or academic university centers with a big children’s component.”

Level I pediatric trauma center certification requires a specific set of special resources. Perhaps the most specialized resource is a multidisciplinary team of pediatric surgeons. “Pediatric surgery is a very small specialty and a key component of any pediatric trauma program,” notes Dr. McGonigal. “There are four lynchpin specialties: pediatric surgery, emergency medicine, orthopaedics and neurosurgery. Fewer than 20 pediatric surgeons practice in the entire state of Minnesota. Regions Hospital is affiliated with

seven of the approximately 11 pediatric surgeons practicing in the Twin Cities. The pediatric trauma program also includes three pediatric neurosurgeons and five pediatric orthopaedic surgeons, as well as pediatric intensivists certified in critical care, and excellent plastic and facial surgeons.”

Gillette Children’s Specialty Healthcare also provides the required separate pediatric intensive care unit on the Regions Hospital campus that is capable of handling children ranging from newborns to age 18. Diagnostic equipment for children is much smaller than that used in an adult trauma center, and radiation doses are an issue of concern. “We have learned that the younger the child, the more sensitive that child is to radiation,” explains Dr. McGonigal. “A single CT scan over a child’s lifetime adds a fraction of a percent risk for cancer. We’ve modified our diagnostic techniques to use as little radiation as possible. The quality of images decreases as the amount of radiation decreases, but we work with the radiologists to develop protocols balancing accuracy and risk. We want to get enough information to be accurate, while reducing the radiation dose so that there’s as little risk as possible of complications in the future.”

Every physician in the core specialties, surgery, neurosurgery, emergency medicine and orthopaedics, is required to maintain at least 16 hours a year of trauma-related continuing education. A portion of training must be pediatric trauma-related education. All staff must be trained to know procedures and drug doses for very small children.

Although it is not required for ACS qualification, Regions Hospital also provides pediatric and advanced life support (PALS) courses to physicians and nurses. Regions Hospital requires each of its 10 trauma surgeons and nurses in the intensive care unit and emergency department to be PALS certified.

“This is an internal standard, not a certification requirement,” Dr. McGonigal points out. “The ACS evaluation of a facility’s commitment to pediatric trauma includes consideration of less tangible factors. We set out to meet all the requirements, but then I stepped back and considered the fact that our trauma surgeons get called to the emergency department for a major trauma case whether the patient is a child or an adult. What could we do to make those surgeons more qualified to see and care for children? I decided to set up an internal requirement that every surgeon must have PALS training, as well as at least four hours of pediatric-trauma related education per year. This way, if a child develops serious problems like arrhythmia or cardiac or respiratory arrest, everybody knows what to do. That requirement upped the ante. When a reviewer comes in and says, ‘What makes your first responder better than they were when you were an adult trauma center?’ I can point to PALS

Several new requirements were met to achieve a Level l pediatric trauma focus. Staff eagerly listens as Dr. McGonigal, Director of Trauma Services, explains a required process.

COVER FEATURE

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Twin Cities MD NEWS ! DECEMBER 2009 | 7""

training as an example of our ongoing commitment to be the absolute best in providing care for these children.”

Field training for EMS providers and paramedics emphasizes pediatrics. “The Regions system provides a lot of training to pre-hospital agencies in the east metro area and Western Wisconsin,” says Dr. McGonigal. “Pediatric care is a separate part of the paramedic curriculum. Our classes address pediatric trauma, and other pediatric emergencies, like asthma, as well.”

The most frequent causes of pediatric trauma evolve with a child’s development. From infancy through age 5 or 6, falls are the major cause of trauma. Regrettably, trauma caused by abuse and neglect is also a factor. Once children become older and more mobile, the majority of trauma injuries shift toward high-impact situations. “Children start falling off or crashing their bikes,” notes Dr. McGonigal. “When they reach 16 and begin driving, accident-related trauma increases due to the large number of motor vehicle crashes in this age group.”

Pregnant women also fall under the purview of pediatric trauma care. “A pregnant woman is two patients,” explains Dr. McGonigal. “Our first consideration is the mother. If she is in shock, the baby is at risk. Once we have the mother stabilized, we turn our attention to the unborn baby. We had a case in the last week involving a pregnant woman in a motor vehicle crash. After the mother was stabilized, we saw that the baby was in distress, and an emergency C-section was performed to deliver the baby. For situations where the baby isn’t stable, we deliver as quickly as possible. Thankfully, these cases are pretty uncommon.” Regions Hospital treats approximately 10 to 15 pregnant women for trauma each year.

One of the most readily noticeable distinctions between adult and pediatric trauma care is the emphasis on an approach that reassures and comforts injured children. A team of 12 people in cap, mask and gown normally meets adult trauma patients, but a large masked team can be unsettling for a child. At Regions Hospital, when a child is wheeled in, the doctors and nurses in direct contact will not wear caps or masks unless there are body fluid exposure issues. “It helps if a child can see the face of the person talking with them,” Dr. McGonigal explains. “We also make a concerted effort to get a parent in the room and next to the child to calm them with comfort and support.”

“Children are more delicate than adults,” adds Dr. Brad Feltis, Pediatric Trauma Medical Director and one of Regions Hospital’s pediatric surgeons. “The priority patient conditions of children are different from those of adults. Children are less able to tolerate breathing and heart issues than adults are. It’s much easier for a child’s heart to stop as the result of respiratory, bleeding or cardiac difficulty.”

“Another difference in treating injured children versus adults is your mind set about what else is going on in the patient’s life,” Dr. Feltis continues. “With a traumatically injured adult, concerns include heart, lungs and other potential comorbidi-ties. Is there emphysema or cardiac disease? Risk of stroke? None of that comes into play with an acutely traumatized child. For children, the questions are very different. What’s the child’s home environment? What is the mechanism of the accident? In my practice, I only deal with children, and I bring that perspective to the trauma bay just as I do in the operating room. You think in a different way. You think a lot more about the parents. One thing I’ve learned in my years of taking care of kids is that adults will tolerate a lot of discomfort for themselves, but they won’t tolerate discomfort for their children.”

With Regions Hospital and Gillette Children’s Specialty Healthcare on the same campus, the transition between the two facilities is seamless. Here, a trauma patient that was originally cared for at Regions Hospital is now saying goodbye to the staff at Gillette Children’s Specialty Healthcare, as she is ready to depart for home.

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8 | Twin Cities MD NEWS ! DECEMBER 2009

Regions Hospital has developed procedures to specifically address the concerns of the parents of injured children. “The welfare of the injured child is always first and foremost,” says Dr. Feltis, “but we have a mechanism in place to begin parent counseling as soon as they come though the door. We have a counseling team to address parent concerns while the trauma team is resuscitating or evaluating the patient. As soon as the physician has completed resuscitation, he or she makes it a point to interact with the family for as long as the family needs. This can be a challenge, but it can also be one of the most rewarding parts of our job. You can’t form a patient relationship with a 4-year-old the way you can with an adult patient. In pediatrics, the real bond

is developed with the family, and that’s one of the most enjoyable, or most difficult, aspects of our work, depending on the outcome.”

Given heightened parental concerns in a trauma atmosphere that is frightening to children, Regions Hospital physicians are aggressive about pain control. “If we are suturing, for example,” says Dr. Feltis, “our preference is to sedate the child and make them unaware of their surroundings during the procedure. Of course, if this presents a risk to the patient, we will do what is medically right even if parents pressure us to do otherwise. We understand that it is hard for a parent to think rationally when their child is injured. Our hospital is particularly sensitive to issues like these because our mindset is tuned to caring for children.”

A small but developing body of research literature shows that survival outcomes for seriously injured children are better in a trauma center than in a nontrauma center, and that treatment in a pediatric trauma center results in even better survival outcomes than if the child is treated in an adult trauma center. “The differ-ence is a matter of percentage points,” says Dr. McGonigal. “If you are the parent of one of those percentage points, that difference means everything.”

“The initiative by the American College of Surgeons to require of trauma centers that take care of children with an added level of dedication and experience shifted the landscape of pediatric trauma care,” declares Dr. Feltis. “It is incredibly rewarding to be in a program where I have absolutely every-thing that I need at my disposal at any time of the day or night. Approximately 90% of our patients are survivors. Adults don’t do as well in trauma situations. Children are a mystery. We frequently see unexpected recoveries — you could call them miracles — that we can’t explain. When we can fix a child and make them good as new, that makes our day.

“From my standpoint,” Dr. Feltis continues, “a Level I pediatric trauma center is the absolute best place for any child with a significant trauma injury. Until we were certi-fied, the upper Midwest was devoid of pediatric trauma centers. Now, Regions is where you want to bring a severely injured child. A significant component of our care is our pediatric rehabilitation center in partnership with Gillette, which is really a jewel in the upper Midwest. Our injured kids have access to some of the best rehabilitation resources in the country. That specialty and level of treatment makes a night and day difference in care.”

“The best part of my day is getting to talk to the patients or their families,” reflects Dr. McGonigal. “I appreciate the protectiveness of parents and the bond they have with their children. We are not just treating the child, we are treating their entire family.”

For more information about the Level I trauma center f or chi ldren feat ur ing Reg ion s Hospita l and Gi l le t te Children’s Specialty Healthcare, or to schedule CME’s or case reviews, contact Tracy Larsen, R.N., at (651) 254-9531 or [email protected]. !

A LifeLink III helicopter lands at Regions Hospital. More than 400 patients are brought to Regions Hospital by air transportation each year.

Dr. McGonigal, Director of Trauma Services at Regions Hospital

COVER FEATURE

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Twin Cities MD NEWS ! DECEMBER 2009 | 9""

The Psychology of Successful Wealth AccumulationLessons from Behavioral Finance By Steven C. Finkelstein, CFP, and Joel Greenwald M.D., CFP

WHERE DOES YOUR money go? How does it end up at its final destination? Is it based on rational action or

is there more to the equation?Traditional economics assumes that we

all act rationally, especially when it comes to money decisions, but what about our psychological biases that subconsciously interfere with our “rational” ability to make good financial decisions and accumulate wealth? It’s called behavioral finance and is such an important topic that it earned Daniel Kahneman and Vernon Smith a Nobel Prize in Economics in 2002.

So, what is behavioral finance and what does it have to do with you as a physician? Behavioral finance studies the intersec-tion of psychology and economics and teaches us some quite interesting and valuable lessons.

In preparing this article, we drew upon the experiences of Minnesota accounting firms that specialize in physicians and medical practices. We interviewed the following accountants:

+ Nate Wayne and Mark Franklin of DS&B

+ Farley Kaufmann and Stacie Usem of Lurie Besikof Lapidus & Company, LLP

+ Kelly Salwei of Olsen Thielen

All three firms agreed that some physi-cians do indeed have difficulty living within their means. Many physicians, whether in smaller independent practices or larger multispecialty groups, have a compensation system of a base salary or draw and then

See Page 11

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#FINANCE

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We’re the bestat what we undo.Cancer can turn a life upside down. At Minnesota Oncology, we turn a cancer diagnosis around. Fear becomes hope, and hope becomes life after cancer.

Here, cancer is up against the best and brightest oncology specialists.We combine the most current treatments based on the latest researchwith the most personal care possible. And Minnesota Oncologyis close to home with nine Twin Cities locations.

(651) 602.5335minnesotaoncology.com

Burnsville • Coon Rapids • Edina • Fridley • Maplewood • Minneapolis • St. Paul • Waconia • Woodbury

Philip Dien, MD

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Twin Cities MD NEWS ! DECEMBER 2009 | 1 1""

periodic bonuses or distributions based on production and cash flow.

At Lurie Besikof Lapidus & Company, LLP, they’ve found that doctors often base their spending on their highest income years rather than their poorest years.

At DS&B, Nate Wayne has observed the same behavior, especially among younger doctors who have pent up demand from the relatively low-income levels of residency and fellowship. DS&B advises clients to try not to treat the periodic distributions of practice income as part of normal spending because during a down cycle the distribu-tions can decrease or even disappear.

At Olsen Thielen, Kelly Salwei has seen overspending, particularly with the purchase of luxury homes, at the expense of making retirement contributions or saving money for children’s college funds.

Farley Kaufmann summarized his advice to clients as follows, “Hold back on your desires until you have cash to buy them. Don’t live ahead of your income.” And, for physicians just entering practice, “Don’t start your life on credit.”

Take Note of Mental AccountingUnderstanding the influence of behav-

ioral finance can be helpful by taking advantage of a concept called mental accounting. Mental accounting refers to the practice of categorizing and treating money differently depending on where it comes from, where it is kept or how it is spent.

A simple yet successful example is the old-fashioned Christmas Club at the bank. By setting aside money at the onset of the year and labeling it “for Christmas use,” it is less likely to be dipped into and more likely to still be there at the end of the year. While sometimes seeming illogical, the ability to put money into different “mental accounts” may make it easier to save for future goals.

On the other hand, mental accounting can be harmful. Let’s look at the different value people place on earned income as opposed to gift income. That is, we’ll spend $100 we find on the street or receive as a gift with less thought than the $100 we’ve earned from our practice. Gift money is mentally categorized as “found” money. You didn’t have it before, so what’s the

harm in not having it again?When money arrives in a lump sum,

such as a bonus or practice distribution, people tend to react in one of two extreme ways. It either goes into immediate off limits into a “wealth” account, or it goes into the “found” money category and a large purchase is typically made.

Park Your ‘Found’ MoneyTo the extent that you fall prey to

carelessly spending that “found” money, you can also train yourself to wait. Take your bonus/distribution and park it in a bank account or money market right away. Make your parking minimum three to six months before you can decide what to do with the cash. By then, the urge to splurge has subsided, and you’re more likely to treat it as hard-earned money.

Another error that Salwei at Olsen Thielen has seen physicians make is invest-ing that money in a company suggested by a friend or family member, rather than for valid business reasons. At Sterling Retirement Resources, we’ve seen this first hand. Physicians come to us with portfolios heavily weighted in health care companies due to their familiarity with their drug or device products.

Forgo the Familiarity BiasBehavioral finance recognizes this as

familiarity bias, a tendency towards invest-ing in what is familiar. The problem is, people confuse familiarity with knowledge. While you may like a particular companies’ products or people, that “familiarity” does not judge whether that companies’ stock is a good investment or not.

This invest-in-what-you-know approach is the same bias that leads employees to invest heavily in their companies’ stock when it is offered as an investment choice in the 401(k) plan. This is a risky strategy as your biggest asset — your job — is already tied to the fortunes of your company.

A third and final example of psy-chological bias that affects physicians’ financial outcomes was noted by Nate Wayne at DS&B. He indicated physicians are “victims of their own experience.” In other words, if you’ve never experienced something, you can’t imagine it happen-

ing. In the last couple of years, Wayne evidenced this in regards to both declining practice income and decreasing home values. His clients did not believe that either their home values or their incomes could decline and therefore did not prepare for that possibility.

What are You Anchoring?In behavioral finance this bias is

referred to as anchoring. Anchoring is the tendency we all have of latching onto an idea or fact and using it as a reference point for future decisions. If you’ve only ever experienced rising home values, it’s difficult to conceive of a scenario where home values actually decline. If you’ve never experienced a decline in practice income, you can’t conceive of, and don’t make plans for, that eventuality.

We at Sterling Retirement Resources, and the CPAs we interviewed, work extensively with physicians and their practices. Part of our job is to keep our clients from undermining their f inancial plans by fa lling prey to such common psychological errors in dealing with their money. We’ve just scratched the surface in this article, discussing three of these biases: mental accounting, familiarity bias and anchoring. If you find these insights useful, you can explore the field of behavioral finance more fully in “Why Smart People Make Big Money Mistakes” by Gary Belsky and Thomas Gilovich and “Beyond Greed & Fear” by Hersh Shefrin.

Steven C. Finkelstein, CFP, and Joel Greenwald, M.D., CFP, are principals of Sterling Retirement Resources, Inc. in St. Louis Park, MN. Visit www.sterlingretire-ment.com for more information. !

Some Advisory Services offered through AdvisorNet Financial, Inc. Registered Representatives offering securities and some investment advisory services through Financial Network Investment Corporation a Full Service Broker Dealer, Member SIPC.

Financial Network, Sterling Retirement Resources and AdvisorNet Financial are not affiliated.

Continued from Page 9

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F O L LOW I N G H I G H - P R O F I L E BREACHES of medical ethics in the news, Congress, medical schools and the drug industry

have examined potential conflicts of interest between pharmaceutical com-panies and physicians. The Institute of Medicine joined the call for change with its 2009 report.

Since 2007, the relationship between physicians and pharmaceutical company representatives has diminished. Sales reps are no longer allowed to leave branded notepads and pens and often have to make an appointment to see a physician — or are not welcome at the practice at all.

According to the New York-based consulting group TNS Healthcare, out of 100 sales reps, only 37 leave free samples and 20 speak to a physician. With this

decline in the return on investment, the number of sales reps is projected to decline to 75,000 from a high of 102,000 in 2007.

Sign of the TimesTo this point, many of the attempts

to inject transparency in the physician-drug company relationship have been voluntary measures. Medical societies have announced plans to refuse money from the drug industry for continuing medical education as well as branded merchandise offered at meetings.

Although relationships between physi-cians and the drug industry are not forbidden, guidelines could preserve the valuable connections between research and clinical care and preserve the integrity of scientific achievements. To join the conversation, the Institute of

Medicine issued a report outlining 16 recommendations to avoid conflicts of interest. Here are a few highlights:

+ Institutions that perform clinical care, develop clinical practice guidelines and educational programs and per-form medical research should adopt conflict of interest policies, strengthen disclosure policies and standardize disclosure formats and content.

+ U.S. Congress, working with bio-technology, medical device and pharmaceutical companies, should create a program for the national reporting of payments made by those companies.

+ Medical researchers, research institu-tions and academic centers should restrict the participation of researchers who use human subjects when they have conflicts of interest.

+ Teaching hospitals, academic medical centers and professional societies should reform industry relationships in medical education and educate physicians about potential conflicts of interest.

+ Health care providers, community physicians, hospitals and professional societies should work together to reform the financial relationship between community physicians and the drug industry.

Drawing the Line on Free Pens++++++++++++++++ +++++ + +++++ +++++++++++++++

ETHICS "

See Page 19

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1 6 | Twin Cities MD NEWS ! DECEMBER 2009

Green Tea and Good HealthDURING THE LAST few decades, green tea has gained

popularity due to its reputation of aiding in the prevention and treatment of various health problems and diseases.

Green tea, which originated in China, is a type of tea made solely with the minimally oxidized leaves of Camellia sinensis. The Chinese have been using green tea for more than 4,000 years to help treat problems such as headaches and infections. Because of this, green tea has become the subject of many scientific and medical studies in an effort to unveil exactly what its healing qualities may be. Results from these studies continue to suggest that green tea may be useful for several health conditions.

CholesterolResearch shows that green tea consumption may

lower total cholesterol levels while raising high-density lipoproteins. According to research from the University of Maryland Medical Center, one population-based clinical

study discovered that men who drink green tea are more likely to have lower total cholesterol levels than those who do not. In addition, results from one animal study suggested that the polyphenols found in green tea may prevent the body from absorbing cholesterol, while also aiding in its excretion from the body.

CancerWhile it has not been proven that green tea prevents can-

cer, emerging clinical studies do show that a link may exist between green tea and the disease. Several population-based clinical studies have shown that green tea may help protect against cancer, as green tea’s antioxidants — catechins — inhibit the specific enzyme activities that lead to cancer. They may also repair DNA deviations caused by oxidants. These catechins are thought to prevent cancer growth by:

+ Identifying oxidants before cell injuries can occur

+ Preventing the growth of tumor cells

+ Reducing the incidence and size of chemically induced tumors

In addition, the National Cancer Institute states that studies have also found that the liver, skin and stomach cancers found in mice decreased in size after the mice were exposed to the antioxidants found in green tea.

Bone HealthWhile the lowering of cholesterol and the prevention and

treatment of cancer are two of the most widely discussed benefits of green tea, new research in Hong Kong has found that green tea may also benefit bone health, as researchers suggest that it may help prevent and treat osteoporosis, as well as other bone diseases.

The study, which was conducted by the Institute of Chinese Medicine at the Chinese University of Hong Kong, exposed a group of cultured rat osteoblast-like cells to epigallocatechin, gallocatechin and gallocatechin gallate — three chemicals found in green tea — for several days. Ultimately, they found that one catechin in particular — epigallocatechin — stimulated key enzymes that promote bone growth by up to 79%. Epigallocatechin was also found to increase the mineralization in the cells, which strengthens bones. In conclusion, these findings showed that epigallocatechin had positive effects on bone metabolism through a double process of promoting osteoblastic activity and inhibiting osteoclast differentiations. !

+++++++++++++++++++++++++ ++++++ +++++++++++++++++++++++++++++CURRENT TOPICS"

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#CURRENT TOPICS

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Laparoscopic AdvancesThorascopic Spinal SurgeryBy Glenn R. Buttermann, M.D., Midwest Spine Institute

E NDOSCOPIC SURGICAL TECH-NIQUES have been applied to the spine with varying degrees of success. In the early 1990s,

laparoscopic techniques were used for spinal fusion of the lumbosacral disc. Using retroperitoneal balloons for expo-sure, endoscopic techniques were also used in the lumbar spine to access the lumbar discs above L5-S1. Discectomies and anterior interbody fusions are performed through working portals. There was a steep learning curve. The overall success rate was less than that for the conventional mini-open procedure,

the complication rates were higher and this technique fell out of favor.

Although interest waned for poste-rior lumbar endoscopic decompression/discectomies, there has been continued interest in endoscopic treatment of the thoracic spine. Thorascopic techniques have evolved, and although there is also a learning curve (as in any other endoscopic technique), the thoraco-scopic techniques seem to have earned their keep. Unlike most endoscopic procedures, which treat “soft tissues,” spine surgery is unique in that “hard tissues” (bone and tough, degenerated

annulus) are treated. Instrumentation of the spine or removal of the disc uses a greater degree of force than that required for soft tissue procedures encountered in other surgical fields. Although visualization is superb with thorascopic techniques, dexterity is decreased because of long lever arms working outside the chest. Miscalculations of any forceful maneu-vers may be hazardous.

Current thorascopic techniques are typically spinal fusion for degenerative or deformity conditions in which the disc is excised, and then bone graft is

+++++++++++++++++++++++++++++ ++++++ +++++++++++++++++++++++++++++++++THE SPINAL COLUMN"

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inserted along with bone graft extend-ers/substitutes. Instrumentation, such as for scoliosis or multilevel fusions, can be performed, but they require additional working portals. An advan-tage, even with use of multiple portals, is that recovery is still substantially less than doing a conventional thora-cotomy. Early instrumentation systems through thorascopic spinal surgery were of minimalist approach and were not robust enough, resulting in screw breakage, rod breakage or screw pull-out. Instrumentation has been refined so that current thorascopic fusion techniques and instrumentation have now yielded success rates comparable to open techniques.

Our current thorascopic spinal surgery techniques have been developed over

+ The National Institutes of Health should revise current U.S. Public Hea lt h S er v ice re g la t ion s to require institutional conf lict of interest policies.

+ Oversight bodies and other interested groups, such as government agencies and private health insurers, should provide incentives for institutions that adopt and implement conflict of interest policies.

Reactions to the report are mixed with some physicians praising its recommen-dations and others remarking that the guidelines do not go far enough. Although the majority of the recommendations are voluntary solutions, stronger legislative action to avoid potential problems will likely be created in the future. !

Continued from Page 19

the last 13 years. The approach may be employed either through the right or left side. Preoperatively, patients typically have epidural catheter placement for highly effective postoperative analgesia. Our results have found that with one and two-level thorascopic interbody fusions, one can avoid instrumentation and use bracing alone for postoperative immobilization. The key to success is having cortical purchase of the implants or grafts to avoid subsidence and to evaluate patients for osteopenia or osteo-porosis preoperatively as this requires treatment to insure success. Our current techniques now have a fusion rate of over 95%. Post-thoracotomy syndrome has been virtually eliminated, and patients have enjoyed high clinical outcomes. !+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

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Sunshine Media is proud to present Digital Editions, a state-of-the-art media solution that signifi cantly enhances the engagement, reach, and value of your presence in M.D. News magazine. These search-engine optimized, Flash-enabled Digital Editions take your message beyond the printed page, allowing your advertisement or feature article to be viewed 24/7 by anyone from anywhere in the world.

With Digital Editions, your target audience will enjoy the traditional “page fl ip” feel of a magazine, while deepening the reader experience and increasing your company or practice’s exposure exponentially via links to your website, e-mail address, and other valuable resources as featured within the publication.

To maximize the effectiveness of this new resource, each local Digital Edition will be prominently displayed on the home page of its website. The site also includes a Digital Editions archive so your message can be accessed indefi nitely by anyone in the world.

For more information on how you can appear within a Digital Edition of M.D. News magazine, or to view a sample of this state-of-the-art media solution, call your local M.D. News publisher or visit http://tanderson.mdnews.com.

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EXTENDING YOUR MESSAGE

W O R L D W I D E

Prostate Cancer Risk Associated With Body Size

A team of researchers at the University of Hawaii at Monoa’s Cancer Research Center of Hawaii have found a link between body mass and a man’s risk for prostate cancer. According to the study, a man’s body mass, along with weight gain and loss over time, can

influence his risk for developing prostate cancer.

Published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research, the study focused on a multiethnic population of 83,879 men between the ages of 45 and 75. During the trial period of three years, 5,554 of the men studied developed prostate cancer.

Researchers observed that being overweight or obese in older adult-hood was associated with a higher risk of prostate cancer in white and native Hawaiian men.

Although obesity has long been identified as a risk factor for can-cer, researchers believe this study may provide insight into how weight gain may affect different ethnic groups.

Shortage of American Heart Surgeons

According to a report released by the American College of Cardiology (ACC), the United States could face a shortage of 16,000 cardiolo-gists by the year 2050. Currently, the shortage of cardiac specialists in the U.S. is roughly 3,000, but researchers expect this number to increase dramatically in the coming years.

As baby boomers continue to age beyond 65, researchers believe car-ing for this population will require the services of more cardiologists. In order to meet the demands of this population, the United States will require almost double the amount of specialists in 2050 as it had in 2000. Although the need for cardiologists will continue to rise, fewer cardiology-training positions are available for young doctors pur-suing the specialization following medical school. Based upon surveys

++++++++++++++++ +++++ + +++++ +++++++++++++++

NEWS "

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Sunshine Media is proud to present Digital Editions, a state-of-the-art media solution that signifi cantly enhances the engagement, reach, and value of your presence in M.D. News magazine. These search-engine optimized, Flash-enabled Digital Editions take your message beyond the printed page, allowing your advertisement or feature article to be viewed 24/7 by anyone from anywhere in the world.

With Digital Editions, your target audience will enjoy the traditional “page fl ip” feel of a magazine, while deepening the reader experience and increasing your company or practice’s exposure exponentially via links to your website, e-mail address, and other valuable resources as featured within the publication.

To maximize the effectiveness of this new resource, each local Digital Edition will be prominently displayed on the home page of its website. The site also includes a Digital Editions archive so your message can be accessed indefi nitely by anyone in the world.

For more information on how you can appear within a Digital Edition of M.D. News magazine, or to view a sample of this state-of-the-art media solution, call your local M.D. News publisher or visit http://tanderson.mdnews.com.

Digital Editions

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+++++++++++++++++++++++++++++++++

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EXTENDING YOUR MESSAGE

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2 2 | Twin Cities MD NEWS ! DECEMBER 2009

of current medical schools, the ACC found that many institutions are re-ducing their focus on cardiology due to the belief that family physicians will be able to provide heart disease care in the future.

Published in the Journal of the American College of Cardiology, researchers suggested funding an increased number of fellowship posi-tions as an immediate plan to reduce the projected shortfall.

Researchers Identify Disease-Fighting Cell Trigger

In a study published in Nature Immunology, researchers claim to have discovered a gene that causes blood stem cells to turn into Natural Killer (NK) immune cells. This discovery could potentially help boost

immune activity and lead to new cancer treatments.

Performed by scientists at Imperial College London and the Medical

++++++++++++++++ +++++ + +++++ +++++++++++++++

NEWS "

Continued from Page 22

Research Council’s Institute for Medical Research, the study re-moved the NK gene from laboratory mice, but left all other blood and immune cells intact. In doing so, researchers believe they can gain further insight into autoimmune system diseases including mul-tiple sclerosis and diabetes, which a re assumed to be caused by ma l f unct ioning NK cel ls. By furthering research of NK cells, scientists could develop new ways of treating diseases.

Researchers also identified the gene E4bp4 responsible for acti-vating NK cells. This discovery may allow scientists to develop medicines that can increase NK activity and subsequently fight diseases, including cancer. !

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Erasing Stereotypes

One of the most sizeable obstacles for returning soldiers suffering from post-traumatic stress disorder (PTSD) is the stigma that still surrounds the condition. It can prevent them from receiving the treatment they need to integrate back into society. While the military has, in recent years, taken steps to remove any shame that might surround PTSD, the truth is that many soldiers are still not receiving the treatment they need to function in a normal, healthy way.

“The incidence of PTSD for veterans returning from Vietnam was approximately 17%,” says Blake Tearnan, Ph.D., consulting and clinical psychologist and President of HealthNetSolutions.com. “It is considerably higher for veterans exposed to combat in Iraq and Afghanistan. There are several reasons for this, including multiple tours of duty. PTSD is a very disabling problem with multiple medical and psychological comorbidities. Studies controlling for age, socioeconomic status, minority status, combat exposure, alcohol use and pack-year history demonstrate veterans with PTSD consistently report a greater number of health problems than veterans without PTSD.”

Seeing Individuals

Those treating returning veterans must take special care to see each one as an individual, and evaluate his or her needs on an individual basis in order to be an effective, positive force in each person’s life.

“I think it is important to avoid stereotyping veterans as we have sometimes done with Vietnam veterans,” says William Danton, Ph.D., ABPP, clinical professor of psychiatry and behavioral sciences at the University of Nevada School of Medicine and the Associate Chief of Staff for Mental Health at the VA Sierra Nevada Health Care System. “Each combat theater is different, and each veteran is different in how his or her experience has affected him or her, and the reintegration process varies from case to case.”

Healing Wounded Warriors

Using Internet-based resources, a dynamic clinic and a collaborative spirit, three physicians are working to

transform the way returning soldiers are treated for post-traumatic stress disorder (PTSD).

Warren S. Gilbert, M.D., a Commander in the U.S. Naval Reserve, is an ER trauma specialist with the 4th Marine Division, 4th Medical Battalion and serves as Commanding Officer of a shock trauma platoon. During his three tours of duty in Iraq and Afghanistan, Dr. Gilbert noticed the soldiers he treated were developing emotional and psychological problems from the stresses of combat.

“I have seen what effects combat can have on service mem-bers, and I am familiar with the current tools being used to evaluate them for possible emotional and psychological condi-tions as a result of combat experiences,” Dr. Gilbert says. “In my opinion, the evaluation forms and processes currently being used are inadequate and insufficient to truly identifying and addressing individuals who may have potentially significant psychological distress as a result of combat tours.”

DEVELOPING AN ASSESSMENTDr. Gilbert began meeting with Blake H. Tearnan,

Ph.D., consulting and clinical psychologist and President of HealthNetSolutions.com, through the Wounded Warrior Project

(an organization devoted to helping veterans transition into civilian life). The duo began formulating a more effective tool to evaluate returning veterans for psychological trauma: the Medical Disability Report-Trauma (MDR-T).

The anonymous questionnaire, which includes items about stress management and coping skills, is designed to give physicians and nurses in local communities access to a valuable screening tool to help veterans who are returning to their communities.

“The MDR-T is a self-report instrument,” says Dr. Tearnan. “It can be completed in about 20 minutes. It is important that the veteran complete the questionnaire in an open and honest fashion. However, scales are included in the design of the questionnaire to detect tendencies to exaggerate or minimize responses.”

The questionnaire can be completed during the course of an office visit. After the assessment, the primary care physician can use the results to determine if the veteran is experiencing mood disturbances. If so, the veteran should be referred to the appropriate clinic.

CREATING TREATMENT MODALITIESDr. Tearnan and William Danton, Ph.D., ABPP, clinical pro-

fessor of psychiatry and behavioral sciences at the University of Nevada School of Medicine and the Associate Chief of Staff for Mental Health at the VA Sierra Nevada Health Care System, work together at ClinicAD, a clinic for anxiety and depression in Nevada, to develop dynamic treatment options for returning veterans.

“We have two programs in development,” says Dr. Danton. “One is a multimodal treatment program that uses Richard Rahe’s Brief Stress and Coping Inventory [BSCI] to assess stress and coping in a number of domains.”

The second treatment method involves the development of virtual reality (VR) as a tool to help desensitize patients.

“Computer-generated virtual environments help the veteran desensitize and practice coping skills in traumatic situations,” says Dr. Danton. “We have had good results using VR with flying phobias and fear of public speaking, and we believe that current research supports its use with some cases of PTSD.” !

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Twin Cities MD NEWS ! DECEMBER 2009 | 2 5""

Erasing Stereotypes

One of the most sizeable obstacles for returning soldiers suffering from post-traumatic stress disorder (PTSD) is the stigma that still surrounds the condition. It can prevent them from receiving the treatment they need to integrate back into society. While the military has, in recent years, taken steps to remove any shame that might surround PTSD, the truth is that many soldiers are still not receiving the treatment they need to function in a normal, healthy way.

“The incidence of PTSD for veterans returning from Vietnam was approximately 17%,” says Blake Tearnan, Ph.D., consulting and clinical psychologist and President of HealthNetSolutions.com. “It is considerably higher for veterans exposed to combat in Iraq and Afghanistan. There are several reasons for this, including multiple tours of duty. PTSD is a very disabling problem with multiple medical and psychological comorbidities. Studies controlling for age, socioeconomic status, minority status, combat exposure, alcohol use and pack-year history demonstrate veterans with PTSD consistently report a greater number of health problems than veterans without PTSD.”

Seeing Individuals

Those treating returning veterans must take special care to see each one as an individual, and evaluate his or her needs on an individual basis in order to be an effective, positive force in each person’s life.

“I think it is important to avoid stereotyping veterans as we have sometimes done with Vietnam veterans,” says William Danton, Ph.D., ABPP, clinical professor of psychiatry and behavioral sciences at the University of Nevada School of Medicine and the Associate Chief of Staff for Mental Health at the VA Sierra Nevada Health Care System. “Each combat theater is different, and each veteran is different in how his or her experience has affected him or her, and the reintegration process varies from case to case.”

Healing Wounded Warriors

Using Internet-based resources, a dynamic clinic and a collaborative spirit, three physicians are working to

transform the way returning soldiers are treated for post-traumatic stress disorder (PTSD).

Warren S. Gilbert, M.D., a Commander in the U.S. Naval Reserve, is an ER trauma specialist with the 4th Marine Division, 4th Medical Battalion and serves as Commanding Officer of a shock trauma platoon. During his three tours of duty in Iraq and Afghanistan, Dr. Gilbert noticed the soldiers he treated were developing emotional and psychological problems from the stresses of combat.

“I have seen what effects combat can have on service mem-bers, and I am familiar with the current tools being used to evaluate them for possible emotional and psychological condi-tions as a result of combat experiences,” Dr. Gilbert says. “In my opinion, the evaluation forms and processes currently being used are inadequate and insufficient to truly identifying and addressing individuals who may have potentially significant psychological distress as a result of combat tours.”

DEVELOPING AN ASSESSMENTDr. Gilbert began meeting with Blake H. Tearnan,

Ph.D., consulting and clinical psychologist and President of HealthNetSolutions.com, through the Wounded Warrior Project

(an organization devoted to helping veterans transition into civilian life). The duo began formulating a more effective tool to evaluate returning veterans for psychological trauma: the Medical Disability Report-Trauma (MDR-T).

The anonymous questionnaire, which includes items about stress management and coping skills, is designed to give physicians and nurses in local communities access to a valuable screening tool to help veterans who are returning to their communities.

“The MDR-T is a self-report instrument,” says Dr. Tearnan. “It can be completed in about 20 minutes. It is important that the veteran complete the questionnaire in an open and honest fashion. However, scales are included in the design of the questionnaire to detect tendencies to exaggerate or minimize responses.”

The questionnaire can be completed during the course of an office visit. After the assessment, the primary care physician can use the results to determine if the veteran is experiencing mood disturbances. If so, the veteran should be referred to the appropriate clinic.

CREATING TREATMENT MODALITIESDr. Tearnan and William Danton, Ph.D., ABPP, clinical pro-

fessor of psychiatry and behavioral sciences at the University of Nevada School of Medicine and the Associate Chief of Staff for Mental Health at the VA Sierra Nevada Health Care System, work together at ClinicAD, a clinic for anxiety and depression in Nevada, to develop dynamic treatment options for returning veterans.

“We have two programs in development,” says Dr. Danton. “One is a multimodal treatment program that uses Richard Rahe’s Brief Stress and Coping Inventory [BSCI] to assess stress and coping in a number of domains.”

The second treatment method involves the development of virtual reality (VR) as a tool to help desensitize patients.

“Computer-generated virtual environments help the veteran desensitize and practice coping skills in traumatic situations,” says Dr. Danton. “We have had good results using VR with flying phobias and fear of public speaking, and we believe that current research supports its use with some cases of PTSD.” !

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2 6 | Twin Cities MD NEWS ! DECEMBER 2009

Single Incision Laparoscopy

Single incision laparoscopy surgery (SILS) is gaining ground as more surgeries can now be performed through one port. A 1-inch incision in the navel can be used to insert two instruments and a camera to ultimately remove a kidney the size of an orange. Surgeons have used the technique for other procedures as well, and even when larger incisions are needed, scars can be hidden in the skin folds of the navel.

The benefits of SILS range from improved pain management after the procedure to improved cosmesis, since no visible scar appears in the navel.

The emergence and increasing popularity of laparoscopic surgical techniques has changed the way physicians and

patients view many common surgeries.One of the greatest advantages of laparoscopic surgeries is that

both surgery and technique are designed to enhance the qual-ity of life for the patient. Virtually across the board — whether the surgeon is performing a gastric bypass or removing uterine fibroids — the surgery is associated with a reduction in risk and a shortened recovery period for patients. However, laparoscopic techniques present some issues for the surgeon.

LAPAROSCOPIC HURDLESSome of the most obvious complications associated with

performing laparoscopic surgery involve the limited surgical field, which can hinder the surgeon in two areas: loss of hand dexterity and limited field of vision.

Due to the small incisions and long, narrow instruments used in laparoscopic surgery, the human hand is typically unable to reach its full potential. This lack of dexterity in both the hand and the instrument makes some complex laparoscopic procedures difficult.

The two-dimensional view offered by a laparoscope can also limit the surgeon’s vision, specifically the element of depth perception.

OVERCOMING LIMITATIONSOne of the most recent and best methods of conquering the

limitations of traditional laparoscopic surgery is robot-assisted surgery. The most popular version of this method is the da Vinci Surgical System.

The da Vinci Surgical System robot addresses both major concerns about laparoscopic surgery:

small and provide dexterity that is unparalleled, even by the human hand.

robot is both three-dimensional and magnified, which ulti-mately enhances what the surgeon would be able to see with his or her naked eye. There are also some hand-assisted surgical options that re-

quire the surgeon to insert a hand through a pressurized sleeve. The surgeon’s other hand is used to hold an instrument, and a laparoscope is used to provide a view into the operative field.

The U.S. Food and Drug Administration has approved several devices used in hand-assisted laparoscopic surgery. They include Dexterity Device, Intromit, Hand port and Omni port. Surgeons who are learning laparoscopic techniques can use these systems, and the systems also provide the benefit of being less expensive than robotic surgery systems.

As more and more hospitals select surgeons who are experi-enced in laparoscopic techniques and systems like the da Vinci Surgical System, it becomes clear that surgeons who wish to stay on the cutting edge of technology must invest in learning these techniques.

A CHOICE FOR WOMENSome of the most recent advances in laparoscopic capabili-

ties are in the field of gynecology. Laparoscopic myomectomy is an excellent option for the removal of uterine fibroids, which affect more than 40% of American women. Rather than an open procedure, which requires a large abdominal incision, this procedure is performed using one small abdominal incision and a second incision through the umbilicus. The recovery time for

A Closer Look at Laparoscopic Surgery

this procedure is typically restricted to one night in the hospital, and the patient is fully recovered after two to three weeks.

Laparoscopy has also become the first choice technique for both diagnosing and treating endometriosis. Through one incision, a laparoscope can provide a view into the abdomen that will help a physician see any endometrial tissue. A similar procedure can later be used to present a view of the tissue to be removed by either a laser or electrocautery. !"

A Brief History

While modern laparoscopy might be a purely 20th century innovation, the earliest recorded endoscopy was contemporaneous with Hippocrates, who championed minimally invasive techniques. His account of laparoscopic surgery involves the examination of the rectum through the use of a speculum and using air to inflate the intestines.

Other attempts, using various sources of light, were made throughout history until 1910, when Hans Christian Jacobaeus completed the first laparoscopic operation on a human and published an article on the peritoneal, pleural and pericardial cavities.

Throughout the latter half of the 1900s, following World War I and World War II, advances continued and the refinement of techniques led to laparoscopic surgery as we think of it today.

In 1972, H.C. Clarke brought laparoscopic surgery international attention when he invented and patented instruments, published a paper defining the benefits of laparoscopic surgery and recorded a short film on the technique.

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Twin Cities MD NEWS ! DECEMBER 2009 | 2 7""

Single Incision Laparoscopy

Single incision laparoscopy surgery (SILS) is gaining ground as more surgeries can now be performed through one port. A 1-inch incision in the navel can be used to insert two instruments and a camera to ultimately remove a kidney the size of an orange. Surgeons have used the technique for other procedures as well, and even when larger incisions are needed, scars can be hidden in the skin folds of the navel.

The benefits of SILS range from improved pain management after the procedure to improved cosmesis, since no visible scar appears in the navel.

The emergence and increasing popularity of laparoscopic surgical techniques has changed the way physicians and

patients view many common surgeries.One of the greatest advantages of laparoscopic surgeries is that

both surgery and technique are designed to enhance the qual-ity of life for the patient. Virtually across the board — whether the surgeon is performing a gastric bypass or removing uterine fibroids — the surgery is associated with a reduction in risk and a shortened recovery period for patients. However, laparoscopic techniques present some issues for the surgeon.

LAPAROSCOPIC HURDLESSome of the most obvious complications associated with

performing laparoscopic surgery involve the limited surgical field, which can hinder the surgeon in two areas: loss of hand dexterity and limited field of vision.

Due to the small incisions and long, narrow instruments used in laparoscopic surgery, the human hand is typically unable to reach its full potential. This lack of dexterity in both the hand and the instrument makes some complex laparoscopic procedures difficult.

The two-dimensional view offered by a laparoscope can also limit the surgeon’s vision, specifically the element of depth perception.

OVERCOMING LIMITATIONSOne of the most recent and best methods of conquering the

limitations of traditional laparoscopic surgery is robot-assisted surgery. The most popular version of this method is the da Vinci Surgical System.

The da Vinci Surgical System robot addresses both major concerns about laparoscopic surgery:

small and provide dexterity that is unparalleled, even by the human hand.

robot is both three-dimensional and magnified, which ulti-mately enhances what the surgeon would be able to see with his or her naked eye. There are also some hand-assisted surgical options that re-

quire the surgeon to insert a hand through a pressurized sleeve. The surgeon’s other hand is used to hold an instrument, and a laparoscope is used to provide a view into the operative field.

The U.S. Food and Drug Administration has approved several devices used in hand-assisted laparoscopic surgery. They include Dexterity Device, Intromit, Hand port and Omni port. Surgeons who are learning laparoscopic techniques can use these systems, and the systems also provide the benefit of being less expensive than robotic surgery systems.

As more and more hospitals select surgeons who are experi-enced in laparoscopic techniques and systems like the da Vinci Surgical System, it becomes clear that surgeons who wish to stay on the cutting edge of technology must invest in learning these techniques.

A CHOICE FOR WOMENSome of the most recent advances in laparoscopic capabili-

ties are in the field of gynecology. Laparoscopic myomectomy is an excellent option for the removal of uterine fibroids, which affect more than 40% of American women. Rather than an open procedure, which requires a large abdominal incision, this procedure is performed using one small abdominal incision and a second incision through the umbilicus. The recovery time for

A Closer Look at Laparoscopic Surgery

this procedure is typically restricted to one night in the hospital, and the patient is fully recovered after two to three weeks.

Laparoscopy has also become the first choice technique for both diagnosing and treating endometriosis. Through one incision, a laparoscope can provide a view into the abdomen that will help a physician see any endometrial tissue. A similar procedure can later be used to present a view of the tissue to be removed by either a laser or electrocautery. !"

A Brief History

While modern laparoscopy might be a purely 20th century innovation, the earliest recorded endoscopy was contemporaneous with Hippocrates, who championed minimally invasive techniques. His account of laparoscopic surgery involves the examination of the rectum through the use of a speculum and using air to inflate the intestines.

Other attempts, using various sources of light, were made throughout history until 1910, when Hans Christian Jacobaeus completed the first laparoscopic operation on a human and published an article on the peritoneal, pleural and pericardial cavities.

Throughout the latter half of the 1900s, following World War I and World War II, advances continued and the refinement of techniques led to laparoscopic surgery as we think of it today.

In 1972, H.C. Clarke brought laparoscopic surgery international attention when he invented and patented instruments, published a paper defining the benefits of laparoscopic surgery and recorded a short film on the technique.

REVIEW ONLY

© 2008 SUNSHINE MEDIA, INC. UNAUTHORIZED USE OF THIS DOCUMENT IS STRICTLY PROHIBITED.

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2 8 | Twin Cities MD NEWS ! DECEMBER 2009

(612) 296-80802801 Hennepin Ave. S.

Minneapolis, MN 55408www.weber-law.com

Committed To The Best Legal Outcome Possible Through Diligence And Resourcefulness

Health Law – Weber Law O!ce focuses on the legal needs of the health care community, including professional licensure issues,

regulatory compliance, business and employment contracts, estate and business succession planning, and trial work.

Weber Law O!ce provides quality legal services for your business and personal needs.

Michael J. Weber is a former Assistant Attorney General, and he has served as legal counsel for the Board of Medical Practice.

In 2000, he founded Weber Law O!ce.

Tired of going through piles of resumes and cover letters trying to find potential mployees for your medical practice? Social networking could be the answer.

A June 2009 CareerBuilder.com survey found that 45% of employers used social networking websites to screen job applicants. Out of the 2,600 hiring managers that participated in the survey, 29% used Facebook, 26% used LinkedIn and 21% used MySpace to screen potential employees. Approximately 11% searched blogs and 7% of employers searched Twitter.

Social networking can have a huge impact on whether or not you decide to hire a job applicant. A variety of factors, including the candidate’s professional qualifications, references and personality can be explored by viewing an applicant’s social networking profile.

Possible job candidates may lose out

on jobs if employers find inappropriate photographs, comments on using drugs, discriminatory comments or confidential information from a previous employer on their profiles.

How Social Networks Can Enhance Your Practice

Many physicians are just now learning the importance of social networking sites. By using a variety of social networks, physicians can find qualified people to fill job openings through personal referrals and look at a wider field of job applicants, since many social network users have hundreds of contacts.

Job applicants can be found and interviewed at a faster rate thanks to advanced applications on networking sites, cutting down on the time and paperwork physicians and human resources managers typically dedicate

to looking at potential candidates.While job search sites such as

Ca reerBuilder.com, Indeed.com, Monster.com and Craigslist.com have all been popular choices to post and view job listings, social networks have the advantage of connecting coworkers, friends and family members to one another to share important information.

Social network search companies such as Appirio and Jobvite can help employers narrow the field by letting current employees refer friends that meet job requirements.

Appirio is installed by a company looking to hire new employees and used by its current employees as an application on Facebook. The application tool notifies employees of new job openings and alerts them to which of their friends might be qualified to fill the spot. The list of possible candidates is available privately only to the employee, not the employer or Appirio. That employee can then send a referral to their friend, streamlining the referral process for both the employer and the job applicant. Additionally, if a potential job applicant is hired, Appirio’s tracking tool finds which employee referred the candidate and offers a referral bonus.

Another similar service, Jobvite, includes Facebook, LinkedIn and Twitter as a part of its searching capabilities. Jobvites can be passed from person to person within each social network. If a recipient receives a job, their Jobvite can be tracked back to the original sender, even if it has been passed on up to six times.

While MySpace and Facebook encour-age socialization, certain social networks, like LinkedIn, were created to make professional information available to potential employers. Online communities such as BrightFuse.com can help employ-ers find potential employees through personal referrals, as well as letting job applicants display their professional portfolio online. !

Use Social Networks to Find New Employees

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The Heartland HomeHealth Care and

Hospice professionalsmake it easy for

patients to be homefor the holidays.

To refer your home care orhospice patient call:Roseville (651) 633-6522St. Cloud (320) 654-1136Rochester (507) 292-117024 hours a day, 7 days a week admission.

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