The Department of Veterans’ Affairs proposal to allow Advanced Practice Registered Nurses (APRNs) to have full and independent practice authority, preempting state laws that hold them back, has triggered another ugly fight between the medical and nursing professions. The American Nurses Association supports it, the AMA opposes it.
The fight over the VA’s proposal continues a long-standing battle that plays out regularly in state legislatures, as nurses have sought to expand their “scope of practice” and eliminate existing “physician supervision” requirements, while state medical societies have battled back.
Click http://www.medpagetoday.com/Blogs/CareerConsult/59416 for the full story
Editor’s corner: What the military can teach physician leaders
Like me, the national political conventions taking place these last two weeks might have you thinking more about leadership and the kind of leader the country so desperately needs right now.
But it’s not just the country that needs great leaders, it’s also healthcare. As decisions are made that will determine how our healthcare system will work in the future, it’s important the voices of doctors are heard in the discussion.
But too often, that’s not happening. Doctors don’t have a seat at the table and there’s agreement that competent, effective physician leaders are in short supply. To ensure physicians selected for leadership positions are successful, organizations must develop and support them, a message that was made loud and clear at the American College of Healthcare Executives earlier this year.
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FORTUNE by Laura Lorenzetti
A a big leap forward for cancer treatment.
IBM is teaming up with the federal government to bring Watson technology into America’s largest hospital and healthcare network. The initiative is one of the first public-private partnerships setup as part of Vice President Joe Biden’s Cancer Moonshot program.
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Wanted: 1,800 New VA Physicians
HealthLeaders Media News, June 28, 2016
Making the Department of Veterans Affairs health system an attractive place to work is a key priority in the wake of negative reports about wait times and reimbursements to physicians in the private sector.
Allen F. Morey, MD – Distinguished Contribution Awardfor outstanding contributions to the science and education of civilian and military urologists in the performance of urological reconstructive surgery as well as 18 years of philanthropic missions to Honduras.
Col. Paul A. Friedrichs, MD – Presidential Citation for outstanding leadership in the United States Air Force Medical Corps, for support of combat operations in Iraq, and for leadership in the AMA House of Delegates.
Roger R. Dmochowski, MD – Distinguished Service Award for outstanding leadership in the specialty of female pelvic medicine and reconstruction, and for development of AUA Guidelines.
The Defense Department is funding a device that produces 1,000 pills in 24 hours and raises the possibility that hospitals and pharmacies could make their own pills as needed.
By Martha Bebinger, WBUR. This story is part of a reporting partnership among NPR, WBUR and Kaiser Health News.
In a lab at the Massachusetts Institute of Technology, all the work that happens in a vast pharmaceutical manufacturing plant happens in a device the size of your kitchen refrigerator. And it’s fast. This prototype machine produces 1,000 pills in 24 hours, faster than it can take to produce some batches in a factory.
A $13 billion U.S. aircraft carrier is about to hit the open seas.
It’s the USS Gerald R. Ford (CVN-78), the most expensive and most advanced warship ever built. The ship was christened in November 2013 and is scheduled to be commissioned this month.
The Naval behemoth can house more than 4,500 people and weighs 90,000 tons. The CVN-78 is the lead ship in the Ford class of aircraft carriers, replacing some of the U.S. Navy’s existing Nimitz-class carriers. At first glance, both classes have a similar-looking hull, but the Ford class introduces a series of technical innovations designed to improve carrier’s operating efficiency, and reduce operating costs and crew requirements.
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The U.S. Air Force is developing a new bomber that promises to secure the U.S. advantage in modern warfare.
The next-generation long-range strike bomber, recently awarded to Northrop Grumman Corp. NOC, +0.18% for development, will not be designed to rely on as yet undeveloped technologies, as is so often the case with new aircraft and weaponry. Instead, the aircraft will combine and fully exploit existing advanced stealth technology, integrated software, ordnance and countermeasures.
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2016 James C. Kimbrough Awards
Clinical Research Awards
|1st||#10||MAJ Stephen Overholser, MC, USA|
|2nd||#1||CPT Jonathan T. Wingate, MC, USA|
|3rd||#14||MAJ Matthew C. Kasprenski, MC, USA|
Basic Science Awards
|1st||#5||LT Travis C. Allemang, MC, USN|
|2nd||#15||LCDR Randy K. Sulaver, MC, USNR|
|3rd||#4||CPT Jason Sedarsky, MC, USA|
Poster Session Winners
|1st||#41||2LT Bradley A. Potts, MSC, USA|
|2nd||#40||MAJ Stephen Overholser, MC, USA|
|3rd||#43||COL Robert C. Dean, MC, USA|
Honorary Lifetime Membership Award
for lifetime dedication and service to the SGSU.
Presented to: Martin L. Dresner, MD
HG Stevenson Award
for outstanding support and dedicated service to the SGSU.
Presented to: MAJ GEN Thomas P. Ball, MD, USAF RET
Prince Beach Award
for best paper (#19) presented by a society member staff physician as judged by chief residents.
Presented to: LCDR Eric T. Grossgold, MC, USN
Clare Scanlon Award
for outstanding administrative support and service to the society with respect to the annual Kimbrough Seminar as determined by the Course Director.
Presented to: Maria Salazar
Many thanks to Dr. John Barry for his diligence in taking the time to provide SGSU members these insights.
- Yes, I timed all of the presentations. Most of the residents were within the allotted time. Some of the members and guest faculty seemed to lose track of time the moment that first slide appeared and the first word was spoken.
- The Westin Riverwalk was a good venue for the meeting.
- In the military, the lower utilization of active surveillance for clinical stage I testicular seminoma when compared to national studies is probably due to frequent deployments and transfers.
- Robot-assisted retroperitoneal lymph node dissection has come of age for the non-chemotherapy-treated, non-seminomatous testis cancer patient.
- Active surveillance is becoming more widely accepted as a management option by men with low risk prostate cancer.
- TMPRSS2-ERG may become a therapeutic target for the treatment of prostate cancer.
- The identification of biochemical recurrence-associated genes could provide personalized risk stratification for men with clinically localized prostate cancer (Basic Science Prize Winner).
- The collagenase injection protocol for Peyronie’s disease seems to work about a third of the time, is expensive, and is associated with adverse events, including penile fracture.
- There is an association between chronic testicular pain and mental health diagnoses.
- The DOD-approved 2% testosterone gel works.
- It doesn’t seem to matter if a testicular artery is injured during varicocele repair.
- Access to urologic care for many Medicaid patients is restricted and variable by state. (Is greed the cancer of American medicine?)
- Urology residents are assets to patient care and attending urologist job satisfaction at the cost of increased OR times. Health care systems should continue to support post-graduate medical education.
- Prostatic urethral lifts are effective and do not adversely affect sexual function.
- Percutaneous nerve stimulation is effective for overactive bladder symptoms.
- The pattern of colorectal, genitourinary and lower extremity injury of the current conflicts is devastating and lessened by protective leg, lower abdominal and genital protective garments.
- Is there an association of hypospadias with fertilized farmland?
- A robotic-assisted vasovasostomy can be done as rapidly as an open kidney transplant.
- PSA increases with bariatric surgery-induced weight loss. “Why” is to be determined.
- There is discordance between the AUA Cryptorchid Guideline and practice patterns by pediatric urologists.
- Do glanular and coronal hypospadias need to be repaired in childhood (or ever)?
- Re-do laparoscopic spiral flap pyeloplasty works and takes a lot of OR time.
- A reminder call to patients the day before an appointment is a waste of time.
- American health care doesn’t do well in value (outcome ÷ cost) calculations.
- The AUA Consensus Statement on Advanced Practitioner Providers is worth a read.
- Read the AHLTA coding tip handout. It’s applicable to any practice that’s RVU-monitored.
- In addition to the urologist (and his or her clinical pathways) and anesthesiology services, treatment plans for the management of invasive bladder cancer patients should include a nurse coordinator, social service, financial counseling, nutrition, pharmacy, and medical oncology.
- The risk of exstrophy is increased in IVF babies; 7X in the US and 14X in Europe.
- There is no shame in staged repairs of urethral strictures or hypospadias.
- Current pelvic/abdominal radiation therapy may allow small bowel and cecum to be used for urinary diversion/reconstruction.
- Make friends with orthopedic and plastic surgeons if you plan to take care of patients with complications of radiation therapy.
- A smooth transition of care to the VA health care system needs to be done for our wounded warriors.
- The principles of reconstructive genitourinary surgery following combat injuries are the same in the UK as in the US except that sperm may discreetly be retrieved without a wounded veteran’s permission in the UK.
- A tumor thrombus that extends into hepatic veins is a bad sign.
- In a rat model, sacral nerve stimulation can be delayed until the final 50% of bladder filling.
- Ureteroscopic operative time is increased for lower pole, large and uric acid stones.
- Sperm can be cryopreserved after ultrasound-guided aspiration from the seminal vesicles of dismounted IED-injured men.
- Mesothelioma of the tunica vaginalis of the testis is rare and has a poor prognosis.
- Radical cystectomy is a morbidity-prone procedure, perhaps less so as attending surgeon involvement is increased.
- External genital reconstructive surgery in women with adrenal hyperplasia is successful, and there is no shame in doing more than one operation to get it right.
- Desmoplastic small round cell tumor is a rare soft tissue sarcoma that requires multimodal therapy.
- Erythrocytosis is common in hypogonadal men treated with testosterone pellets.
- Obesity was not a risk factor for stone-free or complication rates after tubeless percutaneous nephrolithotomy. (With a stone-free rate of ~50%, perhaps a nephrostomy tube should be left in for access in case residual stone burden needs to be treated in the next day or two?)
- A modified clock-face Mohs technique can be applied to malignant external genital lesions.
- Urology rotations in Veterans Administration Medical Centers are important for residency training.
- Shockwave lithotripsy can be a successful treatment for pancreatic duct stones.
- Blue light cystoscopy may (or may not) make a bladder melanoma more visible.
- The management of metastatic extramammary Paget’s disease is a challenge and often unsuccessful.
- Renal cell carcinoma metastases can become apparent outside the 5-year surveillance window.
- Abdominoscrotal hydrocele is a rare condition that is successfully treated with surgery.
- It’s rare to have a uterus in the scrotum of a patient with an ovotesticular disorder of sexual development.
- Venous thromboembolism and pulmonary embolus are reported in 4% and 1.5%, respectively, of radical cystectomy patients, and the mortality rate for the pulmonary emboli patients is 50%. (Let’s do something about it.)
- Perhaps more neurovascular bundles could be preserved in patients undergoing radical prostatectomy for high risk prostate cancer.
- IL-6, IL-10, and C-reactive protein may be useful markers of surgical stress. (Will their measurement improve patient care?)
- “Stone-free” is a vague outcome measure when a variety of imaging techniques is used.
- The history of calyceal catheterization for stone manipulation was but one of General Ball’s significant contributions to urology, and the podium presentation coupled with the awards ceremony honoring Dr. Ball at the banquet was one of the highlights of the meeting.
- Vibrators seem to work as well in men as they do in women.
- The presentation by Dr. Ian Thompson, Jr. about a common sense approach to prostate cancer biomarkers was a classic. Use the PCPTRC 2.0; use the percent free PSA; PSA < 1? Get another one in 10 years. Seek out the high risk prostate cancers and the ones likely to bother a man during his lifetime – and treat them – and monitor the others.
- There’s no shame in getting an opinion from a medical oncologist about the timing and sequencing of androgen deprivation and chemotherapy for metastatic prostate cancer.
- Perhaps “condemn” shouldn’t be used in a slide…
- Get a nutrition consult before and after radical cystectomy.
- Do a DRE before a TRUS-guided prostate biopsy, and don’t do a biopsy through stool.
- For In-Service and Board Exams, memorize the algorithms for a metabolic stone work up and the medical management of stone-forming patients.
- For male stress urinary incontinence, the “4-Cough Test” with slings for “drippers” and sphincters for “streamers” seems reasonable.
- Voiding diaries are good.
- If possible, don’t use mesh for female pelvic surgery. If you must, monofilament polypropylene type 1 with large pores is preferred.
- The AUA Overactive Bladder Guidelines are worth a read; at least a look at the algorithm.
- Sacral neuromodulation works.
- Colonel Buckley’s personal account of USAF ParaRescue Operations at the banquet was outstanding.
- Let’s do this again next year.
John M. Barry, MD
Members and Colleagues,
I would like to thank the members of the Society for attending our 63rd Annual James C. Kimbrough Urological Seminar, held at the Westin Riverwalk in San Antonio, Texas from January 13-17. Drs. Timothy Phillips and Steven Hudak as program directors planned an outstanding, educational meeting in the heart of the Riverwalk. I would like to recognize and commend them and their local administrative support for their efforts in organizing the meeting, along with the assistance of the DeSantis Management Group.
The meeting kicked off with the President’s Reception on Wednesday night, a time to meet old friends and make new ones, share ideas, and to network. On Thursday morning after opening remarks by SGSU President Dr. Thomas Rozanski and AUA Immediate Past President Dr. William Bohnert, the scientific program started with the Residents Competition and the evening ended with the GU Bowl.
The remaining sessions on Friday and Saturday included many prominent faculty, mostly from the local area to include the San Antonio Military Medical Center, and gave residents and staff the opportunity to present their research, either during the podium or moderated poster sessions. Saturday night ended with the Kathy and Preston Littrell Awards dinner with a fascinating presentation by keynote speaker Dr. Clifford Buckley on his experiences with the Air Force ParaRescue during the Vietnam conflict.
Sunday morning offered chief residents and recent graduates the chance to participate in mock oral boards to prepare them for the certifying examination of the American Board of Urology. This is offered at no cost for members – a great educational benefit.
Overall, the annual SGSU meetings give members an opportunity to meet friends, update medical knowledge, share ideas, and support the military training programs that help educate the future urologists of America. For the quality of the program and number of CMEs offered (24.5 CMEs were offered at this meeting), the annual James C. Kimbrough Urological Seminar remains an extremely valuable and economical way for military and former military urologist to stay abreast on the advances made in the specialty of urology. I ask each member to encourage past members and solicit potential new members to attend this great annual educational meeting.
Please plan to attend next year for the 64th James C. Kimbrough Urological Seminar in San Diego at the Sheraton Harbor Island Hotel from January 11-15, 2017. If you are attending the AUA Annual Meeting in May (also in San Diego), please be sure to make time to attend the SGSU Member Reception which will be held on Monday, May 9th from 1700-1900, and have potential new members stop by the SGSU booth (#4408).
Finally, if any of the members have an interest in serving on the Board of Directors of the Society, please let us know. We do ask that if you are considering serving on the board that you plan on attending the annual meetings.
Joseph Y. Clark, MD
- AUA Now Accepting 2018 Gallagher Health Policy Scholar Applications August 17, 2017
- VA Chief Wants to Get Rid of Healthcare Deadwood May 11, 2017
- Trump extends private-sector health care program for vets April 20, 2017
- Outlook Newsletter – March 2017 April 13, 2017
- Congrats to Kimbrough 2017 Award Winners March 18, 2017
- Kimbrough Meeting “take aways” – 2017 San Diego March 13, 2017
- Trump Names VA Secretary February 2, 2017
- SGSU and USAV Affiliation Approved in San Diego January 20, 2017
- VA Applies Bipartisan Provision To Enhance Medical Care December 26, 2016
- Departing DoD Official Reflects on Military Health System Improvements December 23, 2016