Baptist Hospital of Miami

Kendall, FL, United States

Baptist Hospital of Miami

Kendall, FL, United States
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News Article | May 16, 2017
Site: www.prweb.com

A new Consumer Reports analysis of more than 1,300 hospitals finds that 56 percent of U.S. hospitals have C-section rates above the national target for low-risk births. The report also reveals startling variations in C-section rates from hospital to hospital, even those within the same zip code. The message to mothers? Your biggest risk for an unnecessary C-section may be the hospital you choose. Roughly one in three babies born in this country, or about 1.3 million children each year, are now delivered by cesarean section, the most common surgery performed in U.S. hospitals. “Research suggests that for childbirth, women pick their doctor first, not their hospital. Our goal is to get women thinking about the hospital too, since the hospital you choose can play a big role in determining your risk of a C-section,” says Doris Peter, Ph.D., director, Consumer Reports Health Ratings Center. The C-section hospital ratings – all free – are available online at CR.org/hospitalratings. In many cases, cesarean sections are absolutely necessary. But often they are not: Almost half are done in situations where babies could be delivered vaginally instead, according to research. “Most hospitals are doing far too many unnecessary C-sections and women, armed with this data, can help Consumer Reports send a message to hospitals that we want them to improve,” said Peter. Consumer Reports’ goal is two-fold: first, to make C-section rates public to help new moms make smart choices, and second, to use the ratings as a mechanism to bring high rates down and thus drive positive marketplace change. The risk of having a C-section is higher in the Northeast and South, and lower in the West and Midwest. Four states had C-section rates of 30 percent or higher: West Virginia (31 percent), Florida (31 percent), Louisiana (32 percent), and Nebraska (34 percent, where there is only one hospital reporting data). And four states had rates below 18.5 percent: South Dakota (17 percent), Idaho (17 percent), New Mexico (17 percent), and Minnesota (18 percent). The national benchmark set by the U.S. Department of Health and Human Services is 23.9 percent or less. The variation among individual hospitals is even more dramatic. For large hospitals, C- section rates range from 7 percent at Crouse Hospital in Syracuse, New York, to 51 percent at South Miami Hospital in Miami, Florida. And just outside of Miami, Hialeah Hospital had the highest C-section rate (65 percent) of all hospitals rated by Consumer Reports. Even when hospitals are located within close proximity, variations in C-Section rates can be substantial. Consumer Reports found this pattern in multiple locations including the following cities: St. Louis, Missouri; Cincinnati, Ohio; and Fort Worth, Texas. “This variation is a critical point in our analysis because there is a big, important take away for moms. You cannot afford not to know the track record of the hospital where you’re delivering,” says Peter. Furthermore, in a recent study in the journal Birth, more than half of women said they would travel 20 miles farther to have their baby at a hospital with a C-section rate that was 20 percentage points lower. Some hospitals aren’t making it easy for women to know their C-section rates, Peter said. Consumer Reports does not have data for more than half of the estimated 3,000 hospitals that deliver babies because hospitals aren’t required to report that information to the public. “We applaud those hospitals who do share their C-section data, particularly the ones who do poorly. We see this as a critical step in the direction toward greater transparency and openness,” says Peter. Most worrisome are the hospitals that perform more than 5,000 births every year and do not publicly report their data, of which there are 28. Consumer Reports contacted the three hospitals with the most births and to date, only one, Memorial Hermann Greater Heights Hospital, responded. New York- Presbyterian Hospital in New York City and Northside Hospital in Atlanta did not respond to requests for comment. The following states had more than two of these large non-reporting hospitals: Florida, Maryland, New York, Pennsylvania, and Texas. New York has a total of eight non-reporting hospitals, most of which are located in New York City: Long Island Jewish Medical Center, New Hyde Park; Maimonides Medical Center, Brooklyn; Mount Sinai Hospital, NYC; Mount Sinai St. Lukes – Roosevelt, NYC; New York Methodist, Brooklyn; New York- Presbyterian Hospital, NYC; North Shore University Hospital, Manhasset; NYU Langone Medical Center, NYC. Overall, there were 216 hospitals with C-section rates above 33.3 percent for low-risk deliveries, earning CR’s worst rating. Of these hospitals, the 22 listed below were the ones that delivered the most babies within a year. Conversely, there were 203 hospitals with rates of 18.4 percent or lower, earning CR’s best rating. Twenty- two of them were hospitals that delivered a high volume of babies. South Miami Hospital, Miami, Fla     51 Richmond University Medical Center, Staten Island, NY     44 Hackensack University Medical Center, Hackensack, NJ     43 Woman’s Hospital of Texas, Houston, TX     41 Midland Memorial Hospital, Midland, TX     40 Inova Fairfax Hospital, Falls Church, VA     39 Las Palmas Medical Center, El Paso, TX     39 Texas Health Presbyterian Hospital, Plano, TX     39 Memorial Regional Hospital, Hollywood, FL     38 Henrico Doctors’ Hospital, Richmond, VA     37 Doctor’s Hospital at Renaissance, Edinburg, TX     37 Baptist Hospital of Miami, Miami, FL     37 Riverside Community Hospital, Riverside, CA     36 Bayshore Medical Center, Pasadena, TX     35 Jackson Health System, Miami, FL     35 Boca Raton Regional Hospital, Boca Raton, FL     34 St. Joseph’s Healthcare System, Paterson, NJ     34 Medical Center at Bowling Green, Bowling Green, KY     34 Baylor All Saints Medical Center at Fort Worth, Fort Worth, TX     34 Wesley Medical Center, Wichita, KS     34 Inova Alexandria Hospital, Alexandria, VA     34 Baptist Medical Center, San Antonio, TX     34 About Consumer Reports Consumer Reports is an independent, nonprofit organization that works side by side with consumers to create a fairer, safer, and healthier world. For 80 years, CR has provided evidence-based product testing and ratings, rigorous research, hard-hitting investigative journalism, public education, and steadfast policy action on behalf of consumers’ interests. Unconstrained by advertising or other commercial influences, CR has exposed landmark public health and safety issues and strives to be a catalyst for pro-consumer changes in the marketplace. From championing responsible auto safety standards, to winning food and water protections, to enhancing healthcare quality, to fighting back against predatory lenders in the financial markets, Consumer Reports has always been on the front lines, raising the voices of consumers. __________ MAY 2017 © 201​7​ Consumer Reports. The material above is intended for legitimate news entities only; it may not be used for advertising or promotional purposes. Consumer Reports® is an expert, independent, nonprofit organization whose mission is to work side by side with consumers to create a fairer, safer, and healthier world. We accept no advertising and pay for all the products we test. We are not beholden to any commercial interest. Our income is derived from the sale of Consumer Reports® magazine, ConsumerReports.org® and our other publications and information products, services, fees, and noncommercial contributions and grants. Our Ratings and reports are intended solely for the use of our readers. Neither the Ratings nor the reports may be used in advertising or for any other commercial purpose without our prior written permission. Consumer Reports will take all steps open to it to prevent unauthorized commercial use of its content and trademarks.


Renshaw A.A.,Baptist Hospital of Miami
Archives of Pathology and Laboratory Medicine | Year: 2010

UroVysion (Abbott Molecular Inc, Des Plaines, Illinois) is a US Food and Drug Administration-approved test for the diagnosis of urothelial carcinoma. Although widely used, there are a variety of different ways to evaluate and interpret the test, and questions remain about the test's cost effectiveness and reproducibility in actual clinical practice. I suggest that the College of American Pathologists has a unique opportunity to create educational programs focusing on borderline or difficult urine cytology and UroVysion samples to provide data upon which to make evidence-based decisions concerning the best use of these tests.


BACKGROUND: Atypical cells of undetermined significance (AUS) in thyroid fine-needle aspirates (FNAs) may have poor interobserver agreement. Some authors have suggested that "atrophic" microfollicles should be diagnosed as benign. This laboratory sought to determine whether criteria for this diagnosis could be improved by subcategorizing cases into specific patterns, including the atrophic pattern, and determining their risk of malignancy. METHODS: A series of 7089 FNAs were reviewed and correlated with subsequent resection specimens. Cases of AUS were reviewed and subclassified. RESULTS: Cases could be subcategorized into the following categories: 1) atypical, papillary carcinoma cannot be ruled out, 2) atypical, Hurthle cell neoplasm can not be ruled out, 3) cellular atrophic pattern, 4) scant atrophic pattern, and 5) cytologic atypia alone. Cytologic atypia alone (50%) and both atrophic patterns (21% and 34%) had a significant risk of malignancy. CONCLUSIONS: The majority of AUS cases in thyroid FNA can be subcategorized into 5 different patterns, all with associated significant risk of malignancy. "Atrophic" microfollicles are a significant risk factor for malignancy and should not be diagnosed as benign on the basis of lack of cytologic atypia. © 2011 American Cancer Society.


Renshaw A.A.,Baptist Hospital of Miami
American Journal of Clinical Pathology | Year: 2010

Repeated fine-needle aspiration of the thyroid is sometimes recommended after an atypical diagnosis. However, histologic follow-up for patients with a benign second aspirate is limited. I reviewed the results of all thyroid aspirations with repeated aspirations and surgical resection for the last 13 years at Baptist Hospital, Miami, FL, and Homestead Hospital, Homestead, FL, and combined these with the results of intraoperative cytology and the literature. During the period, a total of 7,089 cases were aspirated and 1,331 resections were performed. There were 6 (1.7%) of 361 false-negative cases. Relevant intraoperative cytology was available for 24 cases. The order of the diagnoses (benign then atypical, atypical then benign) did not significantly affect the risk of malignancy (15% and 9%; P = .30). Patients with an atypical and benign diagnosis had a risk of malignancy (15%) higher than a single negative aspirate (3%; P < .001) and lower than that of patients with a single atypical diagnosis (27%; P > .001). Repeated aspirates are not independent events. Patients with a benign diagnosis after an atypical diagnosis have a risk of malignancy between the risks of a single benign or atypical diagnosis. Cytologists should strive to better communicate this risk. © American Society for Clinical Pathology.


Villanueva T.,Baptist Hospital of Miami
Journal of Hospital Medicine | Year: 2010

Patients with acute coronary syndrome (ACS) undergo several transitions in care throughout the hospital stay, from prehospitalization to the postdischarge period when patients return to primary care. Hospitalist core competencies promote safe transitions in care for patients with ACS, including hospital discharge. These competencies also highlight the central role of the hospitalist in facilitating the continuity of care and as a key link between the patient and the primary care provider (PCP). Core competencies address key decision points and processes that occur during hospitalization for ACS including the initial evaluation and risk stratification, medication reconciliation, and discharge planning. Discharge is a crucial transition and one where hospitalists can both facilitate the transition to primary care and improve adherence to quality measures established for ACS. Poor communication during discharge reportedly results in postdischarge adverse events, most often related to medications and lack of follow-up related to pending test results. Standards for a safe discharge such as Project RED (Re-Engineered Discharge), initiatives to improve outcomes after discharge like Project BOOST (Better Outcomes for Older Adults Through Safe Transitions), and adaptive tools including the ACS Transitions Tool support timely and accurate communication of complex information between the hospitalist, the PCP, and the patient. While the role of hospitalists is evolving, it is clear that they have a central role in ensuring safe transitions in care for ACS. © 2010 Society of Hospital Medicine.


Uthoff H.,Baptist Hospital of Miami
Journal of vascular surgery | Year: 2012

This study presents the short-term and midterm results of direct percutaneous sac injection (DPSI) for postoperative endoleak treatment after endovascular aortic aneurysm repair (EVAR). Between March 1994 and November 2011, EVAR was performed in 986 patients. The median follow-up was 63 ± 45 months (range, 0-211 months). A retrospective analysis was performed. DPSI was used in 21 patients for 19 type II endoleaks and two endoleaks of undefined origin (EOUO), of which 12 (57%) were after failure of a previous endovascular treatment attempt. DPSI using thrombin (n = 16), coils (n = 7), gelfoam (n = 6), or glue (n = 3), or a combination, was technically feasible in all patients. Saccography during DPSI revealed a previously undetected type I endoleak in three patients. Immediate DPSI success was achieved in 16 of 18 procedures (88.9%), with two complications. Glue incidentally intravasated in the inferior vena cava, causing a clinically nonsignificant subsegmental pulmonary artery embolism in one patient, and the temporary development of a type III endoleak, possibly from graft puncture, in another. During a median follow-up of 39 months (interquartile range, 13-88 months) after DPSI, recurrent endoleaks were observed in nine patients (50.0%), one type I endoleak due to graft migration, five type II endoleaks, and three EOUO. The occurrence of a re-endoleak during follow-up was significantly associated with dual-antiplatelet medication (0% in patients without re-endoleak vs 44.4% in patients with re-endoleak; P = .023) and with a nonsignificant trend for the use of aspirin alone (33.3% in patients without re-endoleak vs 80% in patients with re-endoleak; P = .094). Re-endoleak occurred in 33.3% of the patients without antiplatelet medication and in 100% of patients with dual-antiplatelet medication (P = .026). Thrombin was used as the sole embolic agent during the initial DPSI in all patients with dual-antiplatelet therapy. No other factor was significantly associated with re-endoleaks. Reintervention was deemed necessary in six patients within a median of 10 months (interquartile range, 4-16 months) after DPSI, including six additional DPSI treatments in four patients with type II re-endoleaks, cuff placements in one type I endoleak, and endograft relining in one EOUO. This initial experience suggests that DPSI is feasible as a technique for endoleak treatment after EVAR. However, complications and endoleak recurrence remain a concern. The role of antiplatelet therapy and different embolic agents on long-term embolization success needs to be studied in more detail. Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.


Renshaw A.A.,Baptist Hospital of Miami
Diagnostic Cytopathology | Year: 2011

Fine-needle aspiration (FNA) of the thyroid for papillary carcinomas is highly sensitive. We sought to determine if the sensitivity of FNA for papillary carcinoma is correlated with the size of the tumor. We reviewed the results of thyroid resections for the last 12 years and correlated the findings with clinical and cytologic information. During the time period, a total of 1,331 resections were performed, and a total of 501 papillary carcinomas were identified, including 291 classic tumors, 65 follicular variants, and 145 "incidental" tumors. Sensitivity for all tumors was strongly correlated with tumor size and ranged from a sensitivity of 0-3% for tumors 2 mm or less, 90% for tumors 1-3 cm (220/244, P < 0.001) and 83% for tumors above 3 cm (47/59, P = 0.02). Abnormal FNAs of classic tumors were always recognized as papillary (262/262) compared to only 49% of follicular variants (32/65, P < 0.001). The sensitivity of FNA for papillary thyroid carcinoma is strongly correlated with tumor size. Tumors smaller than 0.5 cm and tumors larger than 3 cm may be more difficult to successfully aspirate on FNA, and the follicular variant may be more difficult to recognize as papillary. © 2010 Wiley-Liss, Inc.


Renshaw A.A.,Baptist Hospital of Miami
American Journal of Clinical Pathology | Year: 2011

Nondiagnostic thyroid fine-needle aspirations are associated with a risk of malignancy that can be reduced with repeated aspiration. However, the significance of repeated nondiagnostic aspirates is less well studied. This study assessed the risk of malignancy for repeated nondiagnostic aspirates from a large series of cases using the results of histologic follow-up. From a series of 7,089 aspirates, there were 1,671 nondiagnostic aspirates (23.6%), and 235 of these (14.1%) had histologic follow-up. The risk of malignancy for a single nondiagnostic aspirate was 20.0% (47/235). A total of 51 cases had repeated aspiration. The risk of malignancy for cases with a second nondiagnostic aspirate was 0% (0/23), which was significantly less than for patients with a single nondiagnostic aspirate (20.0%; P =.03). Patients with 2 sequential nondiagnostic thyroid aspirates have a very low risk of malignancy. Cytologists should strive to better convey this risk in their reports. © American Society for Clinical Pathology.


Renshaw A.,Baptist Hospital of Miami
Cancer Cytopathology | Year: 2010

BACKGROUND: The risk of malignancy for a benign diagnosis in a thyroid fine-needle aspiration is controversial because of lack of histologic follow-up. METHODS: The author reviewed the results of all thyroid aspirations with surgical resection performed during the past 13 years at Baptist Hospital of Miami and Homestead Hospital, Homestead, Florida, combined these procedures with those in the literature, and correlated risk of malignancy with percentage of biopsies performed. RESULTS: A total of 7089 aspirations and 1331 resections were performed. In the literature, the percentage of all benign cases that underwent resection ranged from 3% to 41%. Risk of malignancy decreased with an increased percentage of resections. The risk of malignancy for series with <8% of all benign aspirates resected was significantly higher than the risk for series with ≥8% of cases biopsied (15.1% vs 5.9%, P=.02). Logarithmic and linear estimates of risk of malignancy if 100% of cases were biopsied were 3% and 2.5%. CONCLUSIONS: The best estimate of the risk of malignancy for a benign diagnosis in a thyroid fine-needle aspiration is 2.5%-3%. This level of risk is affected by the percentage of benign cases that are resected. © 2010 American Cancer Society.


Renshaw A.A.,Baptist Hospital of Miami
Cancer Cytopathology | Year: 2010

Background: Recently reported Bethesda terminology suggests the use of the term "atypical follicular cells" for thyroid fine-needle aspirates. Previous work has suggested that some types of "atypical follicular cells" have different risks of malignancy. METHODS: The author reviewed the results of all thyroid aspirations with surgical resection performed during the past 13 years at our institution, subclassified the "atypical follicular cells," and compared their relative risk of malignancy. RESULTS: During the 13 years in question a total of 7089 cases were aspirated with 1331 resections. A total of 548 (14%) of all cases were classified as "atypical follicular cells," and 204 (37%) were resected with an overall risk of malignancy of 25%. The risk of malignancy for atypical follicular cells subclassified as "rule out papillary carcinoma" was significantly higher (38%) than the other atypical cells. The risk of "rule out Hurthle cell neoplasm" was, at 7%, significantly lower than the other cases of atypical follicular cells (P<.001 and P<.02, respectively). CONCLUSIONS: Different types of "atypical follicular cells" have significantly different risks of malignancy. This disparity of risk should be communicated by the cytologist. © 2010 American Cancer Society.

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