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BACKGROUND: Overtreatment is a cause of preventable harm and waste in health care. Little is known about clinician perspectives on the problem. In this study, physicians were surveyed on the prevalence, causes, and implications of overtreatment. METHODS: 2,106 physicians from an online community composed of doctors from the American Medical Association (AMA) masterfile participated in a survey. The survey inquired about the extent of overutilization, as well as causes, solutions, and implications for health care. Main outcome measures included: percentage of unnecessary medical care, most commonly cited reasons of overtreatment, potential solutions, and responses regarding association of profit and overtreatment. FINDINGS: The response rate was 70.1%. Physicians reported that an interpolated median of 20.6% of overall medical care was unnecessary, including 22.0% of prescription medications, 24.9% of tests, and 11.1% of procedures. The most common cited reasons for overtreatment were fear of malpractice (84.7%), patient pressure/request (59.0%), and difficulty accessing medical records (38.2%). Potential solutions identified were training residents on appropriateness criteria (55.2%), easy access to outside health records (52.0%), and more practice guidelines (51.5%). Most respondents (70.8%) believed that physicians are more likely to perform unnecessary procedures when they profit from them. Most respondents believed that de-emphasizing fee-for-service physician compensation would reduce health care utilization and costs. CONCLUSION: From the physician perspective, overtreatment is common. Efforts to address the problem should consider the causes and solutions offered by physicians.

Background The current available literature is not unanimous in reporting the utility of short-axis and long-axis techniques for radial artery cannulation in both adults and children. This study was designed to compare short-axis out-of-plane (SA-OOP) and long-axis in-plane (LA-IP) techniques in ultrasound-guided radial artery cannulation in adults. Methods In this prospective randomized controlled trial, 150 adult patients of American Society of Anesthesiologists physical status I-III aged between 18 and 70 years were included. All patients were randomized into two groups (group SA-OOP) and (group LA-IP) of 75 each undergoing ultrasound-guided radial artery cannulation. The primary outcome was successful cannulation in the first attempt. Secondary outcomes included antero-posterior arterial diameter, skin-to-artery distance, ultrasonic localization time, cannulation time, no of attempts to cannulate artery, cannula insertion failure, and vascular complications. Results First-attempt arterial cannulation was successful in 80 % of patients in the SA-OOP group as opposed to 82.6 % patients in the LA-IP group (p = 0.67). The time to cannulate the artery was similar between the two groups, but the time to localize artery was significantly higher in the long-axis technique (p < 0.001). Conclusions The first-attempt cannulation success rate and cannulation time in adult patients are similar in ultrasound-guided radial artery cannulation with both short-axis as well as long-axis techniques. Trial registration Clinical Trial Registry of India (CTRI/2015/02/005552)., Author(s): Sameer Sethi [sup.1] , Souvik Maitra [sup.1] , Vikas Saini [sup.1] , Tanvir Samra [sup.1] , S. K. Malhotra [sup.1] Author Affiliations: (1) 0000 0004 1767 2903grid.415131.3Anesthesia Department, Post [...]

Byline: Aditi. Jain, Aditi. Mehta, Usha. Singh, Vikas. Saini Sir, Oculocardiac reflex (OCR) is one of the most notorious complications associated with ophthalmic surgeries. We would like to report a [...]

Byline: B. Naik, Venkata. Ganesh, Vikas. Saini, Tanvir. Samra Sir, We describe a case in which a suction catheter inserted through the gastric drain channel of an i-gel™ (size 3) [...]

Byline: Vikas. Saini, Tanvir. Samra, Nitin. Ahuja, Sameer. SethiOBJECTIVES: Thrombosis and thrombophlebitis of the superficial venous system are common in hospitalized patients. Efficacy and safety of topical quick penetrating solution [...]

Byline: Deepanshu. Dhiman, Vikas. Saini, Sameer. Sethi, Tanvir. Samra Sir, Central venous cannulation (CVC) is a commonly performed procedure in emergency, critical care and perioperative period. The use of ultrasound [...]

Byline: Rohan. Magoon, Surender. Malhotra, Vikas. Saini, Ridhima. Sharma, Jasleen. Kaur Background and Aims: The external jugular vein (EJV), often used for resuscitation, has been underutilised for central venous catheterisation [...]

Byline: Neeru. Sahni, Manisha. Biswal, Komal. Gandhi, Kulbeer. Kaur, Vikas. Saini, Lakshminarayana. Yaddanapudi Objective: The aim was to analyze the impact of education and training of nurses on the incidence [...]

Byline: Vikas. Saini, Dinesh. Sardana, Tanvir. Samra, Sameer. Sethi Sir, Central venous cannulation (CVC) is an important procedure in the practice of anesthesiology and emergency medicine. Central venous catheters are [...]

Byline: Sunita. Saini, Sukhpal. Kaur, Karobi. Das, Vikas. Saini Context: Using the first drop or second drop of blood while measuring blood glucose (BG) values. Objective: The study was planned [...]

Byline: Vikas. Saini, Aakriti. Gupta, Tanvir. Samra Sir, The left subclavian vein was cannulated uneventfully using bony landmark technique in a 52-year-old male for hyperalimentation and administration of inotropes and [...]

Byline: S. Malhotra, K. Bharath, Vikas. Saini Background and Aims: Air-Q[sup]™ is a newly introduced airway device, which can be used to facilitate endotracheal intubation. The primary aim of this [...]

Byline: Tanvir. Samra, Vikas. Saini, Tenzin. Kyizom Introduction Neurologic injuries secondary to central neuraxial block are extremely rare. [sup][1] Aetiology could be traumatic or non-traumatic. The anatomical site of damage [...]

Byline: Tanvir. Samra, Vikas. Saini Sir, We read with interest the article written by Goyal et al . [sup][1] describing a case of coiling of central venous catheter (CVC) in [...]

Byline: Vikas. Saini, Dinesh. Sardana, Tanvir. Samra Sir, We read with interest the clinical profile and manifestations of snakebite patients from a Medical College in Rural Area of Himachal Pradesh. [...]

The article offers updates on health policies and health affairs reported on blogs and podcasts as of February 2020. Topics covered include the decision of U.S. President Donald Trump to overhaul the Medicare Shared Savings Program for accountable care organizations, how state budgets can find the balance between social versus medical services, and advancement of maternal and child health in Medicaid.