A new report by the Pew Center on the States found that between 2006 and 2009, the number of visits to the ER for dental issues rose by 16%. And about 20% of those visits were returning patients whose earlier treatment hadn’t been successful.

Those findings were based on a review of various health care organization and federal reports during that time period.

Patients seeking routine care in the emergency department has been an ongoing issue — that dental issues are more commonly being treated there now is simply another symptom of the problem.

But treating dental care in the ER comes with an additional set of complications. Like routine medical care, dental procedures are more costly and inefficiently handled in the ER. More troubling, most ERs do not have a dentist on staff, and may not have the best equipment on hand to properly care for dental issues — a situation that leads to frustration for patients and health care workers alike.

But the trend is most likely not going away. As with the increasing number of people forced to get routine medical care at the ER, dental ER trips are bound to increase as fewer people have access to dental insurance — or simply can’t afford it, or the often significant out-of-pocket costs that come with it.

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Two new studies, just published in the New England Journal of Medicine, found that established weight-loss surgeries were significantly more effective than other conventional treatments for Type 2 diabetes.

Patients who had the weight-loss surgeries experienced a complete remission of their diabetes, or failing that, needed less medicine than their counterparts who stuck with traditional medical treatments along with diet and exercise. Many of the surgical patients also experienced lower cholesterol levels and blood pressure.

The results were startling: In the first, at the Catholic University in Rome, after two years, two groups of surgical patients had complete remission rates of 75% and 95%. None of the medically controlled patients went into remission.

A second study at the Cleveland Clinic looked at similar groups of patients. Overall, these groups had lower remission rates (partly due to a stricter definition of “remission”). But one year after surgery the two surgical groups had remission rates of 42% and 37%. Only 12% of patients receiving medical treatment went into remission. (Note: Neither study included so-called “lap band” surgery as one of the treatments, because it does not alter the shape of the stomach.)

The studies are the first to scientifically examine the effect — long noticed by doctors working with bariatric surgery patients.

According to the researchers, even though obesity is a known factor in the onset of Type 2 diabetes, the surgeries didn’t control the disease simply by helping patient lose weight. Instead, it seems the anatomical changes to the organs actually changes the levels of various hormones that control how the body metabolizes fat and sugar.

While more effective treatments for diabetes are a godsend for many patients, many experts caution that bariatric surgery comes with its own risks, and isn’t necessarily a good choice for many patients.

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A recent study found that as many as 30% of doctors applying to obstetrics training programs made some “mistakes” about their credentials on their applications. Specifically, they took credit for being published in research journals that don’t appear to actually exist.

And many of those who had confirmed research published wrongly identified basic research and papers as a much more rigorous “peer-reviewed” study.

Those results are in line with similar prior studies in other specialties.

The researchers who conducted the study said that they hoped many of the errors were just that — honest mistakes — and not an attempt to embellish their credentials. But even in the best case scenario, such sloppiness and/or confusion from highly trained people who are charged with life-or-death decisions is troubling.

In the worst case, the docs assumed they could pull a fast one to make their application more impressive — and they may have succeeded.

The study was published in the most recent issue of Obstetrics & Gynecology.

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The study, published in Health Affairs, reviewed data on more than 28,000 patient visits to over 1,100 office-based physicians from a 2008 federal study. The information included data such as the doctors’ specialties, whether the doctors had access to EHRs, and the tests ordered at each visit.

The researchers found that even after controlling for factors like the physician specialty and patient demographics, doctors with EHR access ordered various imaging tests in just under 13% of patient visits. Their peers with electronic access ordered the tests in 18% of visits — while doctors who had computerized access ordered the tests in about 22% of visits.

The reasons for the difference aren’t entirely clear and may hinge on factors including the sophistication level of the software doctors are using and whether or not they look at prior test results. More advanced programs, such as those some large hospitals use, can tell a doctor the likelihood that a specific test for a specific patient will provide useful data. But most doctors have much more basic programs that wouldn’t provide such guidance.

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It’s long been known that replacing arthritic or otherwise non-functional knees can give patients dramatically improved quality of life in terms of reducing pain and increasing their mobility. But experts in the niche are also seeing significant gains in other areas, including weight loss and improved cardiovascular health.

Recently, researchers combed Medicare records to compare the long-term outlook for patients who had knee replacement surgery — and those who did not. Among other things, they found that after three years, those who received new knees had reduced their risk of heart failure by 11%. After seven years, their risk of death from any cause was 50% lower.

Granted, the study isn’t perfect: It was funded by a knee replacement manufacturer, and it wasn’t randomized. But researchers did control for patient age and overall health. So while the results don’t yet prove a direct causation, they do indicate that knee replacements can lead to significant improvement in other measures of health.

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Some researchers have theorized that the appendix actually harbors a reserve of “good” bacteria that can help fight off more troubling infections. New research is starting to provide support for the idea.

According to the hypothesis, serious gastrointestinal infections can rid our systems of beneficial bacteria that we need to function — but the appendix stores additional quantities of these good bugs, which our bodies use to replenish our GI tracts.

The theory was first put forward in 2007, and recent research has found data that appears to back it up.

The researchers looked at more than 250 patients with a history of recurrent C. difficile infections. C. difficile is a notoriously hard bug to treat, common among patients who have to take antibiotics for long periods of time. They found that patients who no longer had their appendix were more than twice as likely to experience a repeat bout of C. difficile.

No one is arguing that appendix removals should be done less often — an infected, ready-to-burst appendix is potentially life-threatening. But it does indicate that, at minimum, we should learn more about just what that tiny, sometimes trouble-making, organ can really do for us.

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A new poll anonymously surveyed U.S. surgeons about their alcohol use. According to the results, 15% of surgeons seem to have an alcohol dependance and/or are abusing booze. Among women surgeons, the number was 26%.

That’s much higher than the rates of alcohol abuse among the general public — usually around 8% to 12%, depending on which study is being used.

The researchers included only respondents who indicated absolute dependence on alcohol to function in their final tally. Doctors who indicated run-of-the-mill unhealthy drinking behavior shy of a diagnostic criteria weren’t included.

Doctors who said they had made a significant medical mistake in the past three months were more likely to also indicate either an alcohol problem or a mental health issue such as depression or general “burn out.”

The surgeons who were least likely to indicate issues with alcohol dependence in their responses were men, those who were older or had children and those who worked longer hours or spent more time on call.

The good news, such as it is, is that the amount of actual harm done to patients because a surgeon was under the influence is rare. (Of course, if you or your loved one is the one in a million that’s hurt, those odds are of little comfort.) Nonetheless, the researchers suggested it’s worth asking if drug and alcohol screening for doctors in general and surgeons in particular should be used more often.

The survey results appear in the most recent issue of Archives of Surgery.

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Researchers for the Physicians Committee for Responsible Medicine looked at hospital food in all 50 states. In places where you’d think the need for high-quality nutrition would be paramount, the opposite is served up all too often. The study found that many hospitals had up to five fast-food options on site. And even the non-fast food items on the menu tended to be overly processed as well as high in fat, sugar, sodium and cholesterol.

Poor quality food is a risk for patients — especially those with certain conditions like diabetes and heart disease. But it also makes it a lot harder for any staffers who put in particularly long hours to eat healthily. A 60- to 80-hour work week leaves precious little time for grocery shopping and making brown-bag lunches. And when pressed for time, few doctors or other employees will leave the facility to seek out healthier food options.

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The results show that on a number of issues, what patients want — and what the typical person’s end-of-life care actually is — are at odds with each other. Among the findings:

• Respondents said the most important parts of their end-of-their life care was making sure they weren’t a financial burden to their family (67% of patients) and that they were comfortable and not in pain (66%).
• 60% said that making sure their family didn’t get stuck making tough decisions about their care was “extremely important” — but only 44% had shared their end-of-life wishes with the person they designated to make decisions for them.
• 82% said it’s important to have their end-of-life wishes in writing, but only 23% have done so.
• Nearly 80% expressed interest in discussing end-of-life care issues with a doctor, but only 7% had done so.
• More than 80% think doctors should be paid for having end-of-life care discussions with their patients.
• 70% said they would prefer to die at home. In reality, the most recent statistics show 42% of Californians died in a hospital, and 18% in a nursing home. Only 32% of deaths occurred at home.

The survey reveals a combination of unrealistic expectations about end-of-life care and an unwillingness to discuss difficult issues until they’re unavoidable.

What is crystal clear is that doctors and other health care providers need to take a more proactive role in not only bringing these issues up with their patients (and their patients’ families), but doing so well before actual decisions have to be made. Health care pros should also be prepared to facilitate what is often a difficult discussion for families to have.

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Researchers at the University of Kansas examined over 500 unique email messages to patients from three general practitioners. The messages were collected over the span of three months, and all identifying info was removed.

They found some interesting trends and data points. Most of the messages (70%) were responses to emails initiated by patients, the rest were routine messages like test results, appointment reminders and the like. Of the patient-initiated messages, about 18% included complaints of one sort or another. Most (61%) were complaints about the progress of their illness, 17% were about their treatment, 13% were about a member of the medical staff, and 9% were complaints about the doctor.

On average, doctors took 23 hours to respond to patients, while patients wrote back within five hours. But a longer time-to-respond also correlated with more lengthier responses. The researchers said patients overall didn’t seem to mind the lag in response time.

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