Podcast appearances and mentions of ann surg

Play Episode Listen Later Apr 14, 2025 32:43

In 2002 a group of surgeons got together and radically changed surgical training forever. They just got together again... They call themselves the Blue Ribbon Committee. When they met in 2002 they addressed critical issues such as residency structure, specialization, work-life balance, and simulation-based training. Now, with rapid advancements in medicine and education, BRC II has revisited these topics and introduced new priorities to ensure that surgical education meets the demands of the modern era. In this episode, we are joined by Dr. Steven Stain, co-chair of BRC II and a leader in surgical education. Dr. Stain shares insights into the motivations behind the second committee, its key findings, and how competency-based education, entrustable professional activities (EPAs), and other innovations are shaping the future of surgical training. Join hosts Pooja Varman MD, Judith French PhD, and Jeremy Lipman MD, MHPE for an engaging discussion on what surgical educators, trainees, and institutions need to know about the new recommendations from BRC II and the future of surgical education. Learning Objectives By the end of this episode, listeners will be able to 1. Under the origins and impact of the first Blue Ribbon Committee (BRC I) 2. Explain the factors that led to the formation of the BRC II and its major recommendations 3. Identify challenges and opportunities in modern surgical education 4. Discuss the role of competency-based education and EPAs in training future surgeons 5. Recognize how institutions and educators can adapt to BRC II recommendations References 1. Recommendations on Surgical Education and Training in the United States: 2024. Ann Surg. 2024;280(4):535. doi:10.1097/SLA.0000000000006360 https://pubmed.ncbi.nlm.nih.gov/38814074/ 2. Blue Ribbon Committee II Advises Sweeping Changes in Surgical Education. ACS. Accessed January 12, 2025. https://www.facs.org/for-medical-professionals/news-publications/news-and-articles/bulletin/2024/may-2024-volume-109-issue-5/blue-ribbon-committee-ii-advises-sweeping-changes-in-surgical-education/ ***Fellowship Application Link: https://forms.gle/PQgAvGjHrYUqAqTJ9 Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

united states training journal identify recommendations recognize committee explain stain acs sla blue ribbon epas surgical education ann surg

Minimal-invasive Leberchirurgie: Robotik auf dem Vormarsch?

Play Episode Listen Later Mar 7, 2025 29:59

Die minimal-invasive Leberchirurgie entwickelt sich stetig weiter, doch welche Methode bietet die besseren Ergebnisse – die Roboter-assistierte oder die laparoskopische Leberresektion? In dieser Folge diskutieren wir eine neue internationale Multicenter-Studie mit über 10.000 Patienten, die die perioperativen Ergebnisse beider Verfahren vergleicht. Dabei werfen wir einen Blick auf Vorteile, Herausforderungen und die zukünftige Rolle der Robotik in der hepatobiliären Chirurgie. Viel Freund beim Hören Moderation: PD Dr. med. Christoph Paasch Gast: Prof. Roland Croner, einer der Co-Autoren der Studie. Besprochene Publikation: Sijberden JP, Hoogteijling TJ, Aghayan D, Ratti F, Tan EK, Morrison-Jones V, Lanari J, Haentjens L, Wei K, Tzedakis S, Martinie J, Osei Bordom D, Zimmitti G, Crespo K, Magistri P, Russolillo N, Conci S, Görgec B, Benedetti Cacciaguerra A, D'Souza D, Zozaya G, Caula C, Geller D, Robles Campos R, Croner R, Rehman S, Jovine E, Efanov M, Alseidi A, Memeo R, Dagher I, Giuliante F, Sparrelid E, Ahmad J, Gallagher T, Schmelzle M, Swijnenburg RJ, Fretland ÅA, Cipriani F, Koh YX, White S, Lopez Ben S, Rotellar F, Serrano PE, Vivarelli M, Ruzzenente A, Ferrero A, Di Benedetto F, Besselink MG, Sucandy I, Sutcliffe RP, Vrochides D, Fuks D, Liu R, D'Hondt M, Cillo U, Primrose JN, Goh BKP, Aldrighetti LA, Edwin B, Abu Hilal M; International consortium on Minimally Invasive Liver Surgery (I-MILS). Robotic Versus Laparoscopic Liver Resection in Various Settings: An International Multicenter Propensity Score Matched Study of 10.075 Patients. Ann Surg. 2024 Jul 1;280(1):108-117. doi: 10.1097/SLA.0000000000006267. Epub 2024 Mar 14. PMID: 38482665; PMCID: PMC11161239. Unter folgendem Link können bei der Landesärztekammer Brandenburg 2 Fortbildungspunkte erworben werden. Der Kursinhalt umfasst stets 3 Folgen: https://lernportal.laekb.de/goto.php?target=crs_3487&client_id=laekb.

Journal Review in Trauma Surgery: Whole Blood Resuscitation in Trauma

Play Episode Listen Later Mar 3, 2025 28:49

Do you find yourself saying: “Hey, what's the big idea with that newfangled whole blood in the refrigerator next to the trauma bay?” Like using whole blood but not sure why? Don't like using whole blood but not sure why? Join us for a 30 minute power session in whole blood where we try to get you the information you need to know! Hosts: - Michael Cobler-Lichter, MD, PGY4/R2: University of Miami/Jackson Memorial Hospital/Ryder Trauma Center @mdcobler (X/twitter) - Eva Urrechaga, MD, PGY-8, Vascular Surgery Fellow University of Pennsylvania Recent graduate of University of Miami/Jackson Memorial Hospital/Ryder Trauma Center General Surgery Residency @urrechisme (X/twitter) - Eugenia Kwon, MD, Trauma/Surgical Critical Care Attending: Loma Linda University Recent graduate of University of Miami/Jackson Memorial Hospital/Ryder Trauma Center Trauma/CC Fellowship - Jonathan Meizoso, MD, MSPH Assistant Professor of Surgery, 6 years in practice University of Miami/Jackson Memorial Hospital/Ryder Trauma Center @jpmeizoso (twitter) Learning Objectives: - Describe the proposed benefits of whole blood resuscitation in trauma - Identify current problems with synthesizing the existing literature on whole blood resuscitation in trauma - Propose needed areas for future research regarding whole blood resuscitation in trauma Quick Hits: 1. There is significant heterogeneity in study design across whole blood resuscitation studies, complicating comparison 2. There is likely a mortality benefit to whole blood resuscitation in trauma, however this is likely dependent on the specific population 3. Future research directions should focus on prospective randomized work to try and better quantify the exact benefit of whole blood, and determine in which populations this benefit is actually realized References 1. Hazelton JP, Ssentongo AE, Oh JS, Ssentongo P, Seamon MJ, Byrne JP, Armento IG, Jenkins DH, Braverman MA, Mentzer C, Leonard GC, Perea LL, Docherty CK, Dunn JA, Smoot B, Martin MJ, Badiee J, Luis AJ, Murray JL, Noorbakhsh MR, Babowice JE, Mains C, Madayag RM, Kaafarani HMA, Mokhtari AK, Moore SA, Madden K, Tanner A 2nd, Redmond D, Millia DJ, Brandolino A, Nguyen U, Chinchilli V, Armen SB, Porter JM. Use of Cold-Stored Whole Blood is Associated With Improved Mortality in Hemostatic Resuscitation of Major Bleeding: A Multicenter Study. Ann Surg. 2022 Oct 1;276(4):579-588. doi: 10.1097/SLA.0000000000005603. Epub 2022 Jul 18. PMID: 35848743. https://pubmed.ncbi.nlm.nih.gov/35848743/ 2. Sperry JL, Cotton BA, Luther JF, Cannon JW, Schreiber MA, Moore EE, Namias N, Minei JP, Wisniewski SR, Guyette FX; Shock, Whole Blood, and Assessment of Traumatic Brain Injury (SWAT) Study Group. Whole Blood Resuscitation and Association with Survival in Injured Patients with an Elevated Probability of Mortality. J Am Coll Surg. 2023 Aug 1;237(2):206-219. doi: 10.1097/XCS.0000000000000708. Epub 2023 Apr 11. PMID: 37039365; PMCID: PMC10344433. https://pubmed.ncbi.nlm.nih.gov/37039365/ 3. Meizoso JP, Cotton BA, Lawless RA, et al. Whole blood resuscitation for injured patients requiring transfusion: A systematic review, meta-analysis, and practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2024;97(3):460-470. doi:10.1097/TA.0000000000004327 https://pubmed.ncbi.nlm.nih.gov/38531812/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

university future blood trauma journal md survival identify surgery shock mortality propose epub sla pmid resuscitation pgy trauma surgery eastern association learning objectives describe ann surg

Hemorrhagic Shock with Dr. Matthew Borgman

PedsCrit

Play Episode Listen Later Nov 18, 2024 48:45

Matthew A. Borgman, M.D. is a Professor of Pediatrics in the Division of Pediatric Critical Care at the University of Texas Southwestern. Dr. Borgman graduated from Uniformed Services University (USU), he completed Pediatric Residency at Brooke Army Medical Center in 2007, followed by a fellowship in Critical Care at Boston Children's Hospital. He is a prolific author in pediatric trauma management which has helped redefine the care of injured children. He is also the former national chair of the Pediatric Trauma Society Research Committee and has co-authored the 2022 Pediatric Traumatic Hemorrhagic Shock Consensus Conference Recommendations. Learning Objectives:By the end of this podcast, listeners should be able to:Define pediatric hemorrhagic shock and massive transfusion.Develop a guideline-based clinical approach to managing a child with hemorrhagic shock.Explore an expert's approach to managing a child with hemorrhagic shock where the evidence might not be clear. References:Russell et al. Pediatric traumatic hemorrhagic shock consensus conference recommendations. J Trauma Acute Care Surg. 2023 Jan 1;94(1S Suppl 1):S2-S10. Spinella et al. Transfusion Ratios and Deficits in Injured Children With Life-Threatening Bleeding. Pediatr Crit Care Med. 2022 Apr 1;23(4):235-244. Gaines et al. Low Titer Group O Whole Blood In Injured Children Requiring Massive Transfusion. Ann Surg. 2023 Apr 1;277(4):e919-e924. Moore et al. Fibrinolysis Shutdown in Trauma: Historical Review and Clinical Implications. Anesth Analg. 2019 Sep;129(3):762-773.Roberts et al. The CRASH-2 trial: a randomised controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients. Health Technol Assess. 2013 Mar;17(10):1-79. Dewan et al. CRASH-3 - tranexamic acid for the treatment of significant traumatic brain injury: study protocol for an international randomized, double-blind, placebo-controlled trial. Trials. 2012 Jun 21;13:87.Spinella et al. Survey of transfusion policies at US and Canadian children's hospitals in 2008 and 2009. Transfusion. 2010 Nov;50(11):2328-35.Whitton TP, Healy WJ. Clinical Use and Interpretation of Thromboelastography. ATS Sch. 2023 Jan 9;4(1):96-97. MATIC-2: Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the showHow to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show. Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.

Journal Review in Colorectal Surgery: Diverticulitis

Play Episode Listen Later Nov 4, 2024 32:08

You have a patient with another episode of acute uncomplicated diverticulitis. This is the third episode. Do they need antibiotics? Is surgery the next step? What is their risk of recurrence with or without surgery? Tune in to find out! Join Drs. Peter Marcello, Jonathan Abelson, Tess Aulet and special guest Dr. Jason Hall MD, MPH as they discuss high yield papers discussing diverticulitis. Learning Objectives: 1. Describe the impact on quality of life for patients who undergo surgery or non-operative management of diverticulitis 2. Discuss the indications for surgery in patients with diverticulitis 3. Describe ongoing clinical trials in management of diverticulitis References: Santos A, Mentula P, Pinta T, et al. Quality-of-Life and Recurrence Outcomes Following Laparoscopic Elective Sigmoid Resection vs Conservative Treatment Following Diverticulitis: Prespecified 2-Year Analysis of the LASER Randomized Clinical Trial. JAMA Surg. 2023;158(6):593–601. doi:10.1001/jamasurg.2023.0466 https://pubmed.ncbi.nlm.nih.gov/37074706/ Bolkenstein HE, Consten ECJ, van der Palen J, van de Wall BJM, Broeders IAMJ, Bemelman WA, Lange JF, Boermeester MA, Draaisma WA; Dutch Diverticular Disease (3D) Collaborative Study Group. Long-term Outcome of Surgery Versus Conservative Management for Recurrent and Ongoing Complaints After an Episode of Diverticulitis: 5-year Follow-up Results of a Multicenter Randomized Controlled Trial (DIRECT-Trial). Ann Surg. 2019 Apr;269(4):612-620. doi: 10.1097/SLA.0000000000003033. PMID: 30247329. https://pubmed.ncbi.nlm.nih.gov/30247329/ Hall J, Hardiman K, Lee S, Lightner A, Stocchi L, Paquette IM, Steele SR, Feingold DL; Prepared on behalf of the Clinical Practice Guidelines Committee of the American Society of Colon and Rectal Surgeons. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Treatment of Left-Sided Colonic Diverticulitis. Dis Colon Rectum. 2020 Jun;63(6):728-747. doi: 10.1097/DCR.0000000000001679. PMID: 32384404. https://pubmed.ncbi.nlm.nih.gov/32384404/ Hall JF, Roberts PL, Ricciardi R, Read T, Scheirey C, Wald C, Marcello PW, Schoetz DJ. Long-term follow-up after an initial episode of diverticulitis: what are the predictors of recurrence? Dis Colon Rectum. 2011 Mar;54(3):283-8. doi: 10.1007/DCR.0b013e3182028576. PMID: 21304297. https://pubmed.ncbi.nlm.nih.gov/21304297/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

journal treatments prepared results outcome mph american society colon sla pmid recurrent diverticulitis dcr learning objectives colorectal surgery jama surg ann surg

Der Einfluss des Beckenbodentraining auf das Low Anterior Resection Syndrom (LARS)

Play Episode Listen Later Oct 4, 2024 16:46

In dieser Folge spreche ich, Christoph Paasch, allein über eine randomisierte Studie aus Belgien. Die Autoren haben den Einfluss des Beckenbodentraining auf das LARS untersucht. Viel Freude beim Hören Christoph Paasch Besprochene Publikation: Asnong A, D'Hoore A, Van Kampen M, Wolthuis A, Van Molhem Y, Van Geluwe B, Devoogdt N, De Groef A, Guler Caamano Fajardo I, Geraerts I. The Role of Pelvic Floor Muscle Training on Low Anterior Resection Syndrome: A Multicenter Randomized Controlled Trial. Ann Surg. 2022 Nov 1;276(5):761-768. doi: 10.1097/SLA.0000000000005632. Epub 2022 Jul 27. PMID: 35894434; PMCID: PMC9534049. Unter folgendem Link können bei der Landesärztekammer Brandenburg 2 Fortbildungspunkte erworben werden. Der Kursinhalt sind stets 3 Folgen. https://lernportal.laekb.de/goto.php?target=crs_3487&client_id=laekb

unter einfluss studie landes brandenburg viel freude belgien epub syndrom anterior sla pmid der einfluss die autoren resection ann surg

Clinical Challenges in Burn Surgery: Burn Resuscitation - Titrating and Troubleshooting

Play Episode Listen Later Sep 9, 2024 26:50

A patient with a large TBSA burn injury is transferred to a regional burn center. You are faced with some difficult clinical decisions as the resuscitation proves to be challenging. Join Drs. Tam Pham, Rob Cartotto, Julie Rizzo, Alex Morzycki and Jamie Oh as they discuss the clinical challenges in titrating and troubleshooting during acute burn resuscitation. Hosts: · Dr. Tam Pham: UW Medicine Regional Burn Center · Dr. Robert Cartotto: University of Toronto, Ross Tilley Burn Centre · Dr. Julie Rizzo: Brooke Army Medical Center · Dr. Alex Morzycki: UW Medicine Regional Burn Center · Dr. Jamie Oh: UW Medicine Regional Burn Center Learning Objectives: · Understand the role of colloids as complement/rescue to standard crystalloid fluid titration. · Identify the fluid threshold associated with development of abdominal compartment syndrome · Understand the role of continuous renal replacement therapy for patients with acute kidney injury during the resuscitation phase. · List specific patient populations who may experience a more difficult resuscitation. References: 1. Ivy ME, Atweh NA, Palmer J, et al. Intra-abdominal hypertension and abdominal compartment syndrome in burn patients. J Trauma 2000 https://pubmed.ncbi.nlm.nih.gov/11003313/ 2. Cartotto R, Johnson LS, Savetamal A, et al. American Burn Association Clinical Practice Guidelines on Burn Shock Resuscitation. J Burn Care Res 2023 https://pubmed.ncbi.nlm.nih.gov/38051821/ 3. Greenhalgh DG, Cartotto R, Taylor SL, et al. Burn Resuscitation practices in North America: results of the Acute Burn ResUscitation Prospective Trial (ABRUPT). Ann Surg 2023 https://pubmed.ncbi.nlm.nih.gov/34417368/ 4. Cartotto R, Callum J. A review of the use of human albumin in burn patients. J Burn Care Res 2012 https://pubmed.ncbi.nlm.nih.gov/23143614/ 5. Cruz MV, Carney BC, Luker JN, et al. Plasma ameliorates endothelial dysfunction in burn injury. J Surg Res 2019 https://pubmed.ncbi.nlm.nih.gov/30502286/ 6. Falhstrom K, Boyle C, Makic MBF. Implementation of a nurse-driven burn resuscitation protocol: a quality improvement project. Critical Care Nurses 2013 https://pubmed.ncbi.nlm.nih.gov/23377155/ 7. Salinas J, Chung KK, Mann EA, et al. Computerized decision support system improves fluid resuscitation following severe burns: an original study. Crit Care Med 2011 https://pubmed.ncbi.nlm.nih.gov/21532472/ 8. Kenney CL, Singh P, Rizzo J, et al. Impact of alcohol and methamphetamine use on burn resuscitation. J Burn Care Res 2023 https://pubmed.ncbi.nlm.nih.gov/37227949/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

challenges toronto north america impact burn identify surgery clinical references implementation plasma troubleshooting intra resuscitation hosts dr critical care nurses computerized crit care med j trauma ann surg

Sofortige oder verzögerte Appendektomie?

Play Episode Listen Later Jul 26, 2024 22:50

In unserer aktuellen Folge besprechen wir eine Nichtunterlegenheitsstudie aus Kanada. Die Autoren verglichen in einer randomisierten Studie das postoperative Outcome nach verzögerter und sofortiger Appendektomie. Viel Freude beim Hören Gast: Prof. Dr. med. Roland Croner (Magdeburg) Moderation: PD Dr. med. Christoph Paasch (Brandenburg an der Havel) Besprochene Publikation: Patel SV, Zhang L, Mir ZM, Lemke M, Leeper WR, Allen LJ, Walser E, Vogt K. Delayed Versus Early Laparoscopic Appendectomy for Adult Patients With Acute Appendicitis: A Randomized Controlled Trial. Ann Surg. 2024 Jan 1;279(1):88-93. doi: 10.1097/SLA.0000000000005996. Epub 2023 Jul 13. PMID: 37436871. Unter folgendem Link können bei der Landesärztekammer Brandenburg 2 Fortbildungspunkte erworben werden. Der Kursinhalt sind stets 3 Folgen. https://lernportal.laekb.de/goto.php?target=crs_3487&client_id=laekb

unter outcome studie landes kanada brandenburg viel freude epub verz sla pmid die autoren gerte ann surg

Journal Review in Minimally Invasive Surgery: Robotic Cholecystectomy and Bile Duct Injury

Play Episode Listen Later Jun 10, 2024 32:07

Laparoscopic cholecystectomy was introduced approximately 30 years ago and quickly became the gold standard due to multiple benefits over open cholecystectomy. It ushered in the laparoscopic revolution but also increased the number of bile duct injuries. Through the dedicated efforts of many the rate of bile duct injury has been reduced, now mirroring open cholecystectomy. The robotic surgery revolution is well underway and unsurprisingly this technology has been applied to cholecystectomy. Given the devastating nature of bile duct injury and the history of increased injury with the last major shift in operative approach, we examine the current literature on the comparative safety of robotic-assisted cholecystectomy vs. laparoscopic cholecystectomy. 1. Andrew Wright, UW Medical Center – Montlake and Northwest, @andrewswright 2. Nick Cetrulo, UW Medical Center - Northwest, @Trules25 3. Nicole White, UW Medical Center - Northwest 4. Paul Herman, UW General Surgery Resident PGY-3, @paul_herm 5. Ben Vierra, UW General Surgery Resident PGY-2 @benvierra95 Learning objectives: 1. Examine the history of the laparoscopic cholecystectomy and review the efforts to reduce bile duct injury (SAGES Safe Cholecystectomy Task Force and Multi-Society Practice Guideline) 2. Review literature on causes and prevention of bile duct injury 3. Review a recent article on robotic cholecystectomy vs laparoscopic cholecystectomy outcomes 4. Describe precautions that might mitigate expected increase in bile duct injury as a new approach is applied References 1. https://www.sages.org/publications/guidelines/safe-cholecystectomy-multi-society-practice-guideline/ 2. https://www.sages.org/safe-cholecystectomy-program/ 3. MacFadyen BV Jr, Vecchio R, Ricardo AE, Mathis CR. Bile duct injury after laparoscopic cholecystectomy. The United States experience. Surg Endosc. 1998 Apr;12(4):315-21. doi: 10.1007/s004649900661. PMID: 9543520. https://pubmed.ncbi.nlm.nih.gov/9543520/ 4. Keus F, de Jong JA, Gooszen HG, van Laarhoven CJ. Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Database Syst Rev. 2006 Oct 18;(4):CD006231. doi: 10.1002/14651858.CD006231. PMID: 17054285. https://pubmed.ncbi.nlm.nih.gov/17054285/ 5. Way LW, Stewart L, Gantert W, Liu K, Lee CM, Whang K, Hunter JG. Causes and prevention of laparoscopic bile duct injuries: analysis of 252 cases from a human factors and cognitive psychology perspective. Ann Surg. 2003 Apr;237(4):460-9. doi: 10.1097/01.SLA.0000060680.92690.E9. PMID: 12677139; PMCID: PMC1514483. https://pubmed.ncbi.nlm.nih.gov/12677139/ 6. Kalata S, Thumma JR, Norton EC, Dimick JB, Sheetz KH. Comparative Safety of Robotic-Assisted vs Laparoscopic Cholecystectomy. JAMA Surg. 2023;158(12):1303–1310. doi:10.1001/jamasurg.2023.4389 https://pubmed.ncbi.nlm.nih.gov/37728932/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

united states learning journal injury robotics northwest references sla pmid bile duct laparoscopic minimally invasive surgery andrew wright cochrane database syst rev nicole white paul herman cholecystectomy jama surg ann surg

Journal Review in Hepatobiliary Surgery: ctDNA & Colorectal Liver Metastasis

Play Episode Listen Later May 2, 2024 34:33

Circulating tumor DNA, more commonly referred to as ctDNA, has emerged as an attractive and potentially highly sensitive biomarker for patients with colorectal cancer. But what exactly is ctDNA, does it have any prognostic value for patients with colorectal liver metastasis, and how can it be incorporated into the management of said patients? In this episode from the HPB team at Behind the Knife, listen in on the discussion about ctDNA and its role in the perioperative management of colorectal liver metastasis. Hosts Anish J. Jain MD (@anishjayjain) is a T32 Research Fellow at the University of Texas MD Anderson Cancer Center within the Department of Surgical Oncology. Timothy E. Newhook MD, FACS (@timnewhook19) is an Assistant Professor within the Department of Surgical Oncology. He is also the associate program director of the HPB fellowship at the University of Texas MD Anderson Cancer Center. Jean-Nicolas Vauthey MD, FACS (@VautheyMD) is Professor of Surgery and Chief of the HPB Section, as well as the Dallas/Fort Worth Living Legend Chair of Cancer Research in the Department of Surgical Oncology at The University of Texas MD Anderson Cancer Center Learning Objectives: -Develop an understanding of what circulating tumor DNA (ctDNA) is. -Develop an understanding of what makes ctDNA unique from other “tumor markers” like CEA. -Develop an understanding of the prognostic value of ctDNA for colorectal liver metastasis (CRLM). -Develop an understanding of the current role of ctDNA in the perioperative treatment of patients with CRLM. -Develop an understanding of how ctDNA can be incorporated into future treatment algorithms for patients undergoing hepatic resection for CRLM. Papers Referenced (in the order they were mentioned in the episode): 1) Newhook TE, Overman MJ, Chun YS, et al. Prospective Study of Perioperative Circulating Tumor DNA Dynamics in Patients Undergoing Hepatectomy for Colorectal Liver Metastases. Ann Surg. 2023;277(5):813-820. https://pubmed.ncbi.nlm.nih.gov/35797554/ 2) Nishioka Y, Chun YS, Overman MJ, et al. Effect of Co-mutation of RAS and TP53 on Postoperative ctDNA Detection and Early Recurrence after Hepatectomy for Colorectal Liver Metastases. J Am Coll Surg. 2022;234(4):474-483. https://pubmed.ncbi.nlm.nih.gov/35290266/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

Journal Review in Emergency General Surgery: Appendicitis

Play Episode Listen Later Apr 15, 2024 21:46

Can appendicitis wait until the morning? Join Drs. Ashlie Nadler, Jordan Nantais, Graham Skelhorne-Gross, and Marika Sevigny from our Emergency General Surgery Team as they discuss the role of deferring appendectomies from overnight to the next morning. Paper 1: Patel SV, Zhang L, Mir ZM, Lemke M, Leeper WR, Allen LJ, Walser E, Vogt K. Delayed Versus Early Laparoscopic Appendectomy for Adult Patients With Acute Appendicitis: A Randomized Controlled Trial. Ann Surg. 2024 Jan 1;279(1):88-93. https://pubmed.ncbi.nlm.nih.gov/37436871/ -Non-inferiority randomized controlled trial comparing delayed appendectomy group with surgery taking place after 0600 the morning following a decision to operate versus the immediate appendectomy group with surgery taking place between 8pm and 4am and within 6 hours of a decision to operate -A priori non-inferiority margin of 15% for 30-day complications -Intention-to-treat analysis with risk difference -12% in favor of the delayed group (p < 0.001) -Superiority as on per protocol analysis -Underpowered at 91% due to early closure of study due to loss of reliable day time emergency triage operating time Paper 2: Jalava K, Sallinen V, Lampela H, Malmi H, Steinholt I, Augestad KM, Leppäniemi A, Mentula P. Role of preoperative in-hospital delay on appendiceal perforation while awaiting appendicectomy (PERFECT): a Nordic, pragmatic, open-label, multicentre, non-inferiority, randomised controlled trial. Lancet. 2023 Oct 28;402(10412):1552-1561. https://pubmed.ncbi.nlm.nih.gov/37717589/ -Non-inferiority randomized controlled trial comparing appendectomy within 8 hours versus 24 hours -No difference in rate of perforation on intention-to-treat or per protocol analyses Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out more recent episodes: https://app.behindtheknife.org/listen

journal intention nordic lancet superiority appendicitis lepp emergency general surgery ann surg

Pelvic Exenteration Surgery Series Episode 3: Posterior and Lateral Compartment Tumours

Play Episode Listen Later Jan 22, 2024 37:35

Join Professor Michael Solomon, Dr Kilian Brown and Dr Jacob Waller from Royal Prince Alfred Hospital in Sydney, Australia, for this special four part series on pelvic exenteration surgery for locally advanced and recurrent rectal cancer. Learn about these ultra-radical procedures which go beyond the traditional TME planes that we learn during surgical training, and into all compartments of the pelvis. Episode 3 outlines the radical technical approaches to posterior and laterally invasive tumours, including en bloc iliac vascular resection and reconstruction, as well as radical sacrectomy techniques. Each episode in this series features a different international guest surgeon. In episode 3, the RPA team are joined by Dr Oliver Peacock from the University of Texas MD Anderson Cancer Centre, USA. Technical descriptions and videos: Shaikh I, Holloway I, Aston W, Littler S, Burling D, Antoniou A, Jenkins JT; Complex Cancer Clinic St Mark's Hospital London. High subcortical sacrectomy: a novel approach to facilitate complete resection of locally advanced and recurrent rectal cancer with high (S1-S2) sacral extension. Colorectal Dis. 2016 Apr;18(4):386-92. doi: 10.1111/codi.13226. PMID: 26638828. https://pubmed.ncbi.nlm.nih.gov/26638828/ Brown KGM, Solomon MJ, Austin KKS, Lee PJ, Stalley P. Posterior high sacral segmental disconnection prior to anterior en bloc exenteration for recurrent rectal cancer. Tech Coloproctol. 2016 Jun;20(6):401-404. doi: 10.1007/s10151-016-1456-0. Epub 2016 Mar 21. PMID: 27000857. https://pubmed.ncbi.nlm.nih.gov/27000857/ Sutton PA, Solomon M, Sasidharan P, Lee P, Austin K. Abdominolithotomy sacrectomy for the management of locally recurrent rectal cancer: video vignette. Br J Surg. 2021 Aug 19;108(8):e257. doi: 10.1093/bjs/znab105. PMID: 34089593. https://pubmed.ncbi.nlm.nih.gov/34089593/ Drami I, Fletcher JA, Corr A, West MA, Aston W, Hellawell G, Burns EM, Jenkins JT. Total pelvic exenteration with 'high and wide' sacrectomy for recurrent rectal cancer: A video vignette. Colorectal Dis. 2022 Dec;24(12):1625-1626. doi: 10.1111/codi.16230. Epub 2022 Jul 18. PMID: 35730692. https://pubmed.ncbi.nlm.nih.gov/35730692/ References: Rajendran S, Brown KGM, Solomon MJ. Oncovascular surgery for advanced pelvic malignancy. Br J Surg. 2023 Jan 10;110(2):144-149. doi: 10.1093/bjs/znac414. PMID: 36427187. https://pubmed.ncbi.nlm.nih.gov/36427187/ Austin KK, Solomon MJ. Pelvic exenteration with en bloc iliac vessel resection for lateral pelvic wall involvement. Dis Colon Rectum. 2009 Jul;52(7):1223-33. doi: 10.1007/DCR.0b013e3181a73f48. PMID: 19571697. https://pubmed.ncbi.nlm.nih.gov/19571697/ Rogers AC, Jenkins JT, Rasheed S, Malietzis G, Burns EM, Kontovounisios C, Tekkis PP. Towards Standardisation of Technique for En Bloc Sacrectomy for Locally Advanced and Recurrent Rectal Cancer. J Clin Med. 2021 Oct 25;10(21):4921. doi: 10.3390/jcm10214921. PMID: 34768442; PMCID: PMC8584798. https://pubmed.ncbi.nlm.nih.gov/34768442/ van Kessel CS, Waller J, Steffens D, Lee PJ, Austin KKS, Stalley PD, Solomon MJ. Improving Surgical Outcomes in Pelvic Exenteration Surgery: Comparison of Prone Sacrectomy with Anterior Cortical Sacrectomy Techniques. Ann Surg. 2023 Jul 24. doi: 10.1097/SLA.0000000000006040. Epub ahead of print. PMID: 37485983. https://pubmed.ncbi.nlm.nih.gov/37485983/ ***Fellowship Application - https://forms.gle/5fbYJ1JXv3ijpgCq9*** Please visit https://app.behindtheknife.org/home to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here https://app.behindtheknife.org/listen

united states university australia surgery technical technique pelvic epub lateral rpa sla pmid posterior compartment tumours tme dcr royal prince alfred hospital s1 s2 surgery series ann surg

Journal Review in Surgical Education: The Salary of Resident Physicians

Play Episode Listen Later Jan 11, 2024 46:10

As the cost of living continues to rise, the salary and housing stipends of resident physicians are not keeping pace. Dr. Melissa Drezdzon and Dr. Jed Calata from the Medical College of Wisconsin have explored these issues in depth and share their insights. Join hosts Dr. Ananya Anand, Dr. Joe L'Huillier, and Dr. Rebecca Moreci and their special guests as they discuss the salary of resident physicians. Hosts: –Dr. Ananya Anand, Stanford University, @AnanyaAnandMD, ananya_anand@stanford.edu –Dr. Joseph L'Huillier, University at Buffalo, @JoeLHuillier101, josephlh@buffalo.edu –Dr. Rebecca Moreci, Louisiana State University, @md_moreci, morecir@med.umich.edu –COSEF: @surgedfellows Special guests: -Dr. Melissa Drezdzon, Medical College of Wisconsin, @mdrezdzonmd, mdrezdzon@mcw.edu -Dr. Jed Calata, Medical College of Wisconsin, jcalata@mcw.edu Learning Objectives: Listeners will: – Appreciate the discrepancy between cost of living increases and stagnant resident salaries – Describe how residency salaries are funded – Recall the regional variation in resident stipends and access to affordable housing across the united states – List possible solutions for addressing this issue References: Drezdzon MK, Cowley NJ, Sweeney DP, Peterson CY, Ridolfi TJ, Ludwig KA, Evans DB, Calata JF. Going for Broke: The Impact of Cost of Living on Surgery Resident Stipend Value. Ann Surg. 2023 Dec 1;278(6):1053-1059. doi: 10.1097/SLA.0000000000005923. Epub 2023 May 25. PMID: 37226808. https://pubmed.ncbi.nlm.nih.gov/37226808/ Drezdzon, M.K., Cowley, N.J., Sweeney, D.P., Peterson CY, Ridolfi TJ, Ludwig KA, Calata JF. A costly threat to GME: the housing crisis and residency training. Global Surg Educ 2, 85 (2023). https://doi.org/10.1007/s44186-023-00157-x ***Fellowship Application - https://forms.gle/5fbYJ1JXv3ijpgCq9*** Video Link: https://www.youtube.com/watch?v=4DYJIxCrsDE Please visit https://app.behindtheknife.org/home to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here https://app.behindtheknife.org/listen

ACC Practice Made Perfect: Fertility and Reproductive Health: ACC and AMWA Efforts to Address the Issues

Play Episode Listen Later Dec 18, 2023 18:11

Welcome to a new series, “Conversations Around Fertility and Reproductive Health” sponsored by ACC's Women in Cardiology (WIC) Section and led by Dr. Kamala Tamirisa. This final episode is hosted by Dr. Gina Lundberg, WIC Leadership Council Chair, who hosts Drs. Noel Bairey-Merz and Pamela Douglas and for a discussion on the leadership efforts at institutional, organizational, and the individual level, as WIC leaders reading issues surrounding infertility and pregnancy complications. The impact of the American Medical Women's Association (AMWA) is also noted. These cardiovascular experts describe what every woman must know before and in medical school, during training and career path, as a mentor/program director/attending physician/peer about family planning when pursuing (or planning to pursue) a career in cardiology. References: Lai K, Garvey EM, Velazco CS, et al. High infertility rates and pregnancy complications in female physicians indicate a need for culture change. Ann Surg 2023;277:367-72. Rangel EL, Castillo-Angeles M, Easter SR, et al. Incidence of infertility and pregnancy complications in US female surgeons. JAMA Surg 2021;156:905–15.

women practice effort address fertility acc drs reproductive health incidence wic made perfect american medical women amwa jama surg ann surg

ACC Practice Made Perfect: Fertility and Reproductive Health: Juggling Act of Family, Planning, and Career Goals

Play Episode Listen Later Dec 4, 2023 24:25

Welcome to a new series, “Conversations Around Fertility and Reproductive Health” sponsored by ACC's Women in Cardiology (WIC) Section and led by Dr. Kamala Tamirisa. In this episode, Dr. Tamirisa hosts Drs. Annabelle Volgman and Eugene Yang who will discuss the practical aspects of family, career, and the juggling act, and take-home messages based on their experience. Drs. Volgman and Yang describe what every woman must know before and in medical school, during training and career path, as a mentor/program director/attending physician/peer about family planning when pursuing (or planning to pursue) a career in cardiology. Suggested Materials: References: Lai K, Garvey EM, Velazco CS, et al. High infertility rates and pregnancy complications in female physicians indicate a need for culture change. Ann Surg 2023;277:367-72. Rangel EL, Castillo-Angeles M, Easter SR, et al. Incidence of infertility and pregnancy complications in US female surgeons. JAMA Surg 2021;156:905–15.

women practice fertility acc references yang drs reproductive health family planning career goals incidence made perfect juggling act jama surg ann surg

Eine Folge zum Weltpankreastag! Die Rolle der Chemotherapie in der Behandlung des resezierten Pankreaskarzinoms

Play Episode Listen Later Dec 1, 2023 21:20

In unserer neuen Folge, aufgenommen im schönen Karlsruhe, geht es um das Zusammenspiel von Chemotherapiezyklen, kumulativen Dosen und Überleben nach resezierten Pankreaskarzinomen. Gesprochen wurde in Karlsruhe mit Prof. Dr. Jochen Gaedcke. Hierbei handelt es sich um eine Folge zum Weltpankreastag! Viel Spaß Wu VS, Elshami M, Stitzel HJ, Lee JJ, Hue JJ, Kyasaram RK, Hardacre JM, Ammori JB, Winter JM, Selfridge JE, Mohamed A, Chakrabarti S, Bajor D, Mahipal A, Ocuin LM. Why the Treatment Sequence Matters: Interplay Between Chemotherapy Cycles Received, Cumulative Dose Intensity, and Survival in Resected Early-stage Pancreas Cancer. Ann Surg. 2023 Oct 1;278(4):e677-e684. doi: 10.1097/SLA.0000000000005830. Epub 2023 Feb 21. PMID: 37071769.

prof survival behandlung eine folge karlsruhe zusammenspiel die rolle epub hierbei sla pmid dosen gesprochen chemotherapie pankreaskarzinoms ann surg

ACC Practice Made Perfect: Fertility and Reproductive Health: Personal Stories to Inform and Normalize

Play Episode Listen Later Nov 20, 2023 25:30

Welcome to a new series, “Conversations Around Fertility and Reproductive Health” sponsored by ACC's Women in Cardiology (WIC) Section and led by Dr. Kamala Tamirisa. In this episode, Dr. Tamirisa hosts Drs. Gillian Murtaugh and Julia Grapsa who will discuss their personal journey to parenthood as WIC, including family planning, pregnancy, and infertility issues. Drs. Murtaugh and Grapsa describe what every woman must know before and in medical school, during training and career path, as a mentor/program director/attending physician/peer about planning pregnancy while pursuing (or planning to pursue) a career in cardiology. Suggested Materials: References: Lai K, Garvey EM, Velazco CS, et al. High infertility rates and pregnancy complications in female physicians indicate a need for culture change. Ann Surg 2023;277:367-72. Rangel EL, Castillo-Angeles M, Easter SR, et al. Incidence of infertility and pregnancy complications in US female surgeons. JAMA Surg 2021;156:905–15.

women practice fertility acc drs personal stories inform normalize reproductive health incidence wic made perfect murtaugh jama surg ann surg julia grapsa

Practice Made Perfect, Fertility & Reproductive Health, Women in Cardiology

Play Episode Listen Later Nov 6, 2023 15:09

Welcome to a new series, “Conversations Around Fertility and Reproductive Health” sponsored by ACC's Women in Cardiology Section and led by Dr. Kamala Tamirisa. In this episode, Dr. Tamirisa hosts Dr. Torie Comeaux Plowden for a discussion on family planning, pregnancy, and infertility issues for women in medicine, specifically cardiology. Dr. Comeaux Plowden describes what every woman must know before and in medical school, during training and on her career path, as a mentor/program director/attending physician/peer about the planning and timing of pregnancy while pursuing (or planning to pursue) a career in cardiology. Suggested Materials: Lai K, Garvey EM, Velazco CS, et al. High infertility rates and pregnancy complications in female physicians indicate a need for culture change. Ann Surg 2023;277:367-72. Rangel EL, Castillo-Angeles M, Easter SR, et al. Incidence of infertility and pregnancy complications in US female surgeons. JAMA Surg 2021;156:905–15.

women practice fertility acc cardiology reproductive health incidence made perfect jama surg ann surg

The Red Hot Painful Swollen Foot (16 Oct 2023)

Clinical Conversations

Play Episode Listen Later Oct 16, 2023 61:40

This week Dr Jonathan Bardgett discusses how to manage patients with a red hot painful swollen foot with Dr Callum Mutch. Jonathan and Callum discuss diagnostics, treatment and examples of different case presentations. Dr Mutch is an infection doctor working in Edinburgh with his time split between the microbiology lab and the infectious diseases ward. He has recently undertaken a medical education fellowship focusing on Simulation Based Mastery Learning and Digital Education. Outside of work he is the co-host of the Infectious Diseases Insight of Two Specialists (ID:IOTS) podcast. Disclaimer: Please always refer to the most up-to-date local antimicrobial guidelines -- Useful Links-- NICE guideline [NG141]: Cellulitis and erysipelas: antimicrobial prescribing - https://www.nice.org.uk/guidance/NG141 Sullivan T, de Barra E. Diagnosis and management of cellulitis. Clin Med (Lond). 2018 Mar;18(2):160-163. - doi: https://doi.org/10.7861/clinmedicine.18-2-160 MicroGuide App: https://apps.apple.com/gb/app/microguide/id447171786 / https://play.google.com/store/apps/details?id=com.xancu.utreat&pli=1 NHS Scotland Antimicrobial Companion app: https://www.antimicrobialcompanion.scot/ Shorter is better - https://www.bradspellberg.com/shorter-is-better NG141 Summary of the Evidence on Antibiotic prophylaxis for the prevention of recurrent cellulitis and erysipelas - https://www.nice.org.uk/guidance/ng141/chapter/Summary-of-the-evidence#antibiotic-prophylaxis-for-the-prevention-of-recurrent-cellulitis-and-erysipelas Differentials: Lipodermatosclerosis - https://cks.nice.org.uk/topics/venous-eczema-lipodermatosclerosis/, DVT NICE guideline NG158 - https://www.nice.org.uk/guidance/NG158 Fernando SM, Tran A, Cheng W, Rochwerg B, Kyeremanteng K, Seely AJE, Inaba K, Perry JJ. Necrotizing Soft Tissue Infection: Diagnostic Accuracy of Physical Examination, Imaging, and LRINEC Score: A Systematic Review and Meta-Analysis. Ann Surg. 2019 Jan;269(1):58-65. - doi: https://doi.org/10.1097/sla.0000000000002774 Infectious diseases tag on Education Portal - https://learning.rcpe.ac.uk/tag/index.php?tc=1&tag=Infectious%20Diseases ID:IOTS podcast - https://idiotspodcasting.buzzsprout.com/ (https://idiotspodcasting.buzzsprout.com/1782416/9227705-6-skin-and-soft-tissue-infection and https://idiotspodcasting.buzzsprout.com/1782416/9227743-7-necrotising-fasciitis) Recording Date: 28 June 2023 -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE Events -- https://events.rcpe.ac.uk/ Feedback: cme@rcpe.ac.uk

Clinical Challenges in Surgical Palliative Care: “When the horse is out of the barn: Skills to avoid offering surgical overtreatment at the end of life"

Play Episode Listen Later Sep 25, 2023 22:20

Surgeons are trained to, well…do surgery, but is that always the right treatment for the patient? Not offering surgery can be a challenge, especially when you're consulted about a sick patient in the middle of the night and the clinical momentum is moving toward the OR. Join Drs. Katie O'Connell, Ali Haruta, Lindsay Dickerson, and Virginia Wang from the University of Washington as we discuss how to recognize when a surgery is potentially not beneficial and communicate serious news with the patient and consulting team. Hosts: Dr. Katie O'Connell (@katmo15) is an assistant professor of surgery at the University of Washington. She is a trauma surgeon, palliative care physician, director of surgical palliative care, and founder of the Advance Care Planning for Surgery clinic at Harborview Medical Center, Seattle, WA. Dr. Ali Haruta is a PGY7 current palliative care fellow at the University of Washington, formerly a UW general surgery resident and Parkland trauma/critical care fellow. Dr. Lindsay Dickerson (@lindsdickerson1) is a PGY5 general surgery resident and current surgical oncology fellow at the University of Washington. Dr. Virginia Wang is a PGY2 general surgery resident at the University of Washington. Learning Objectives: Identify when a patient's disease course is unlikely reversible by surgery Learn to avoid defaulting to offering potentially non-beneficial surgical treatment for patients at the end-of-life Learn to recommend comfort-focused treatments for patients at the end-of-life Develop the communication skill of delivering serious news References: 1. Cooper Z, Courtwright A, Karlage A, Gawande A, Block S. Pitfalls in communication that lead to nonbeneficial emergency surgery in elderly patients with serious illness: description of the problem and elements of a solution. Ann Surg. Dec 2014;260(6):949-57. doi:10.1097/SLA.0000000000000721 2. VitalTalk. One page Guides. https://www.vitaltalk.org/guides/ 3. VitalTalk. Using Ask-Tell-Ask to Make a Recommendation. https://www.vitaltalk.org/using-ask-tell-ask-to-make-a-recommendation/ 4. VitalTalk. What's a Headline? https://www.vitaltalk.org/whats-a-headline/ 5. Zaza SI, Zimmermann CJ, Taylor LJ, Kalbfell EL, Stalter L, Brasel K, Arnold RM, Cooper Z, Schwarze ML. Factors Associated With Provision of Nonbeneficial Surgery: A National Survey of Surgeons. Ann Surg. 2023 Mar 1;277(3):405-411. doi: 10.1097/SLA.0000000000005765. Epub 2022 Nov 24. PMID: 36538626; PMCID: PMC9905263. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out other surgical palliative care episodes here: https://behindtheknife.org/podcast-category/palliative-care/

Journal Review in Hepatobiliary Surgery: Advances in Liver Venous Deprivation and Hypertrophy

Play Episode Listen Later Sep 11, 2023 33:45

For patients with insufficient future liver remnant (FLR) volume, adequate hypertrophy after Portal Venous Embolization (PVE) is associated with reduced likelihood of post-operative hepatic insufficiency. But what happens when PVE isn't enough to obtain adequate volume prior to surgery? In this episode from the HPB team at Behind the Knife, listen in on the discussion about advances in venous deprivation techniques that can potentially increase resection rates and hypertrophy Hosts Anish J. Jain MD (@anishjayjain) is a T32 Research Fellow at the University of Texas MD Anderson Cancer Center within the Department of Surgical Oncology. Timothy E. Newhook MD, FACS (@timnewhook19) is an Assistant Professor within the Department of Surgical Oncology. He is also the associate program director of the HPB fellowship at the University of Texas MD Anderson Cancer Center. Jean-Nicolas Vauthey MD, FACS (@VautheyMD) is Professor of Surgery and Chief of the HPB Section, as well as the Dallas/Fort Worth Living Legend Chair of Cancer Research in the Department of Surgical Oncology at The University of Texas MD Anderson Cancer Center Learning Objectives: - Develop an understanding of Portal Venous Embolization (PVE) - Develop an understanding of Sequential Hepatic Venous Embolization (HVE) - Develop an understanding of Radiological Simultaneous Porto-hepatic Venous Embolization (RASPE) - Develop an understanding of the traditional two-stage hepatectomy with PVE - Develop an understanding of the Fast Track Two-Stage Hepatectomy Papers Referenced (in the order they were mentioned in the episode): 1) Niekamp AS, Huang SY, Mahvash A, Odisio BC, Ahrar K, Tzeng CD, Vauthey JN. Hepatic vein embolization after portal vein embolization to induce additional liver hypertrophy in patients with metastatic colorectal carcinoma. Eur Radiol. 2020 Jul;30(7):3862-3868. doi: 10.1007/s00330-020-06746-4. Epub 2020 Mar 7. PMID: 32144462. 2) Laurent C, Fernandez B, Marichez A, Adam JP, Papadopoulos P, Lapuyade B, Chiche L. Radiological Simultaneous Portohepatic Vein Embolization (RASPE) Before Major Hepatectomy: A Better Way to Optimize Liver Hypertrophy Compared to Portal Vein Embolization. Ann Surg. 2020 Aug;272(2):199-205. doi: 10.1097/SLA.0000000000003905. PMID: 32675481. 3) Nishioka Y, Odisio BC, Velasco JD, Ninan E, Huang SY, Mahvash A, Tzeng CD, Tran Cao HS, Gupta S, Vauthey JN. Fast-track two-stage hepatectomy by concurrent portal vein embolization at first-stage hepatectomy in hybrid interventional radiology / operating suite. Surg Oncol. 2021 Dec;39:101648. doi: 10.1016/j.suronc.2021.101648. Epub 2021 Aug 16. PMID: 34438236. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen/

Journal Review in Endocrine Surgery: AAES Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism - Part 2 of 2

Play Episode Listen Later Jul 27, 2023 42:15

In this two-part series, we come to you LIVE! from the 2023 Annual meeting of the American Association of Endocrine Surgeons in Birmingham, Alabama. If you think evaluating and managing patients with primary hyperparathyroidism is difficult, patients with secondary and tertiary hyperparathyroidism can be even more difficult to evaluate and manage. Join Drs. Barb Miller, Sophie Dream, Jessica Liu McMullin, and Herb Chen as they break down the controversies and complexities associated with evaluation and management of these patients and discuss the recently published AAES guidelines on the definitive surgical management of patients with secondary and tertiary renal hyperparathyroidism. Part 1 focuses on the impetus for creation of these guidelines, the differences in evaluation and indication for surgery when seeing patients with renally mediated hyperparathyroidism, and preoperative planning. Part 2 focuses on intraoperative and postoperative management, parathyroid autotransplantation, and renal transplant recipients. Hosts: - Barbra S. Miller, MD (Moderator), Clinical Professor of Surgery, The Ohio State University, @OSUEndosurgBSM - Sophie Dream, MD, Assistant Professor of Surgery, Medical College of Wisconsin, @SDreamMD, - Jessica Liu McMullin, MD, Endocrine Surgery Fellow, University of Alabama – Birmingham, @jess_mcmullin - Herbert Chen, MD, Professor and Chair of Surgery, University of Alabama – Birmingham, @herbchen Learning objectives: - Understand the epidemiology and pathogenesis of kidney-related parathyroid disease and how these entities differ from primary hyperparathyroidism - Describe the diagnosis of kidney-related hyperparathyroidism and its different presentations - Define the indications for surgical intervention - Recognize the different approaches and extents of surgery for treating the different types of renally mediated hyperparathyroidism including thymectomy and parathyroid autotransplantation - Detail methods for safe and effective perioperative management References: - Dream S, Kuo LE, Kuo JH, Sprague SM, Nwariaku FE, Wolf M, Olson JA Jr, Moe SM, Lindeman B, Chen H. The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism. Ann Surg. 2022 Sep 1;276(3):e141-e176. doi: 10.1097/SLA.0000000000005522. Epub 2022 Jul 18. PMID: 35848728. - Wilhelm SM, Wang TS, Ruan DT, et al. The American Association of Endocrine Surgeons Guidelines for definitive management of primary hyperparathyroidism. JAMA Surg. 2016;151:959–968. - Ketteler M, Block GA, Evenepoel P, et al. Executive summary of the 2017 KDIGO Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) Guideline Update: what's changed and why it matters. Kidney Int. 2017;92:26–36. - Andress DL, Coyne DW, Kalantar-Zadeh K, et al. Management of secondary hyperparathyroidism in stages 3 and 4 chronic kidney disease. Endocr Pract. 2008;14:18–27. - Cozzolino M, Brancaccio D, Gallieni M, et al. Pathogenesis of parathyroid hyperplasia in renal failure. J Nephrol. 2005;18:5–8. - Lau WL, Cobi Y, Kalantar-Zadeh K. Parathyroidectomy in the management of secondary hyperparathyroidism. Clin J Am Soc Nephrol. 2018;13:952–961. - Parfrey PS, Chertow GM, Block GA, et al. The clinical course of treated hyperparathyroidism among patients receiving hemodialysis and the effect of cinacalcet: the EVOLVE trial. J Clin Endocrinol Metab. 2013;98:4834–4844. - Costa-Hong V, Jorgetti V, Gowdak LH, et al. Parathyroidectomy reduces cardiovascular events and mortality in renal hyperparathyroidism. Surgery. 2007;142:699–703. - McManus C, Oh A, Lee JA, et al. Timing of parathyroidectomy for tertiary hyperparathyroidism with end-stage renal disease: a cost-effectiveness analysis. Surgery. 2021;169:94–101. - Finnerty BM, Chan TW, Jones G, et al. Parathyroidectomy versus cinacalcet in the management of tertiary hyperparathyroidism: surgery improves renal transplant allograft survival. Surgery. 2019;165:129–134. Suture Kit: Purchase on suturekit.com Purchase on Amazon How-to Video Series Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out other endocrine episodes here: https://behindtheknife.org/podcast-category/endocrine/

Journal Review in Endocrine Surgery: AAES Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism - Part 1 of 2

Play Episode Listen Later Jul 24, 2023 33:01

In this two-part series, we come to you LIVE! from the 2023 Annual meeting of the American Association of Endocrine Surgeons in Birmingham, Alabama. If you think evaluating and managing patients with primary hyperparathyroidism is difficult, patients with secondary and tertiary hyperparathyroidism can be even more difficult to evaluate and manage. Join Drs. Barb Miller, Sophie Dream, Jessica Liu McMullin, and Herb Chen as they break down the controversies and complexities associated with evaluation and management of these patients and discuss the recently published AAES guidelines on the definitive surgical management of patients with secondary and tertiary renal hyperparathyroidism. Part 1 focuses on the impetus for creation of these guidelines, the differences in evaluation and indication for surgery when seeing patients with renally mediated hyperparathyroidism, and preoperative planning. Part 2 focuses on intraoperative and postoperative management, parathyroid autotransplantation, and renal transplant recipients. Hosts: - Barbra S. Miller, MD (Moderator), Clinical Professor of Surgery, The Ohio State University, @OSUEndosurgBSM - Sophie Dream, MD, Assistant Professor of Surgery, Medical College of Wisconsin, @SDreamMD, - Jessica Liu McMullin, MD, Endocrine Surgery Fellow, University of Alabama – Birmingham, @jess_mcmullin - Herbert Chen, MD, Professor and Chair of Surgery, University of Alabama – Birmingham, @herbchen Learning objectives: - Understand the epidemiology and pathogenesis of kidney-related parathyroid disease and how these entities differ from primary hyperparathyroidism - Describe the diagnosis of kidney-related hyperparathyroidism and its different presentations - Define the indications for surgical intervention - Recognize the different approaches and extents of surgery for treating the different types of renally mediated hyperparathyroidism including thymectomy and parathyroid autotransplantation - Detail methods for safe and effective perioperative management References: - Dream S, Kuo LE, Kuo JH, Sprague SM, Nwariaku FE, Wolf M, Olson JA Jr, Moe SM, Lindeman B, Chen H. The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism. Ann Surg. 2022 Sep 1;276(3):e141-e176. doi: 10.1097/SLA.0000000000005522. Epub 2022 Jul 18. PMID: 35848728. - Wilhelm SM, Wang TS, Ruan DT, et al. The American Association of Endocrine Surgeons Guidelines for definitive management of primary hyperparathyroidism. JAMA Surg. 2016;151:959–968. - Ketteler M, Block GA, Evenepoel P, et al. Executive summary of the 2017 KDIGO Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) Guideline Update: what's changed and why it matters. Kidney Int. 2017;92:26–36. - Andress DL, Coyne DW, Kalantar-Zadeh K, et al. Management of secondary hyperparathyroidism in stages 3 and 4 chronic kidney disease. Endocr Pract. 2008;14:18–27. - Cozzolino M, Brancaccio D, Gallieni M, et al. Pathogenesis of parathyroid hyperplasia in renal failure. J Nephrol. 2005;18:5–8. - Lau WL, Cobi Y, Kalantar-Zadeh K. Parathyroidectomy in the management of secondary hyperparathyroidism. Clin J Am Soc Nephrol. 2018;13:952–961. - Parfrey PS, Chertow GM, Block GA, et al. The clinical course of treated hyperparathyroidism among patients receiving hemodialysis and the effect of cinacalcet: the EVOLVE trial. J Clin Endocrinol Metab. 2013;98:4834–4844. - Costa-Hong V, Jorgetti V, Gowdak LH, et al. Parathyroidectomy reduces cardiovascular events and mortality in renal hyperparathyroidism. Surgery. 2007;142:699–703. - McManus C, Oh A, Lee JA, et al. Timing of parathyroidectomy for tertiary hyperparathyroidism with end-stage renal disease: a cost-effectiveness analysis. Surgery. 2021;169:94–101. - Finnerty BM, Chan TW, Jones G, et al. Parathyroidectomy versus cinacalcet in the management of tertiary hyperparathyroidism: surgery improves renal transplant allograft survival. Surgery. 2019;165:129–134. Suture Kit: Purchase on suturekit.com Purchase on Amazon How-to Video Series Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out other endocrine episodes here: https://behindtheknife.org/podcast-category/endocrine/

Clinical Challenges in Hernia Surgery: Loss of Domain

Play Episode Listen Later Jun 29, 2023 39:25

In their BTK debut, the Hernia team from Carolinas Medical Center discusses how to approach a hernia patient with loss of domain. This Clinical Challenges episode reviews strategies that optimize patients and provide them with the best chance of fascial closure. So, tune in, and enjoy a data driven conversation with our newest hernia enthusiasts! Hosts: - Sullivan "Sully" Ayuso, MD - PGY4 General Surgery Resident, sullivan.ayuso@gmail.com, Carolinas Medical Center - Monica Polcz, MD - Clinical Fellow (PGY-8) in Abdominal Wall Reconstruction, monica.polcz@atriumhealth.org, Carolinas Medical Center - Vedra Augenstein, MD FACS - Associate Professor of Surgery (11 years in practice), vedra.augenstein@gmail.com, Carolinas Medical Center B - Todd Heniford, MD FACS - Professor of Surgery (25 years in practice), todd.heniford@gmail.com, Carolinas Medical Center Links to articles: - Katzen et al, Open Preperitoneal Ventral Hernia Repair: Prospective Observational Study of Quality Improvement Outcomes over 18 Years and 1,842 patients, Surgery, 2022 https://pubmed.ncbi.nlm.nih.gov/36280505/ - Bernardi et al, Primary Fascial Closure During Laparoscopic Ventral Hernia Repair Improves Patient Quality of Life: A Multicenter, Blinded Randomized Trial, Ann Surg, 2020 https://pubmed.ncbi.nlm.nih.gov/31365365/ - Deerenberg et al, The Effects of Preoperative Botulinum Toxin A on Abdominal Wall Reconstruction, J Surg Res, 2021 https://pubmed.ncbi.nlm.nih.gov/33360691/ - Bueno-Lledó, Preoperative Progressive Pneumoperitoneum and Botulinum Toxin A in Patients with Large Incisional Hernia, Hernia, 2017 https://pubmed.ncbi.nlm.nih.gov/28124308/ - Maloney et al, Twelve Years of Component Separation Technique in Abdominal Wall Reconstruction, Surgery, 2021 https://pubmed.ncbi.nlm.nih.gov/31358348/ - Ayuso et al, Delayed Primary Closure (DPC) of the Skin and Subcutaneous Tissues Following Complex, Contaminated Abdominal Wall Reconstruction (AWR): A Propensity-Matched Study, Surg Endo, 2022 https://pubmed.ncbi.nlm.nih.gov/34018046/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out more hernia episodes here: https://behindtheknife.org/podcast-category/hernia/

challenges loss patients effects skin surgery clinical domain katzen maloney btk ayuso hernia bernardi twelve years carolinas medical center ann surg

Clinical Challenges in Pediatric Surgery: Common Pediatric Surgery Scenarios

Play Episode Listen Later May 8, 2023 27:25

Please join Drs. Brian Gray, Amanda Jensen and Manisha Bhatia from Indiana University as they discuss the nuances of 3 common pediatric general surgery scenarios. Journal Article links: Nguyen HN, Navarro OM, Bloom DA, Feinstein KA, Guillerman RP, Munden MM, et al. Ultrasound for Midgut Malrotation and Midgut Volvulus: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2022;218(6):931-9. https://pubmed.ncbi.nlm.nih.gov/35107311/ Plut D, Phillips GS, Johnston PR, Lee EY. Practical Imaging Strategies for Intussusception in Children. AJR Am J Roentgenol 2020;215(6):1449-63. https://pubmed.ncbi.nlm.nih.gov/33084362/ Markel TA, Scott MR, Stokes SM, Ladd AP. A randomized trial to assess advancement of enteral feedings following surgery for hypertrophic pyloric stenosis. J Pediatr Surg 2017;52(4):534-9. https://pubmed.ncbi.nlm.nih.gov/27829521/ St Peter SD, Holcomb GW, 3rd, Calkins CM, Murphy JP, Andrews WS, Sharp RJ, et al. Open versus laparoscopic pyloromyotomy for pyloric stenosis: a prospective, randomized trial. Ann Surg 2006;244(3):363-70. https://pubmed.ncbi.nlm.nih.gov/16926562/ Dalton BG, Gonzalez KW, Boda SR, Thomas PG, Sherman AK, St Peter SD. Optimizing fluid resuscitation in hypertrophic pyloric stenosis. J Pediatr Surg 2016;51(8):1279-82. https://pubmed.ncbi.nlm.nih.gov/26876090/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out other pediatric surgery episodes here: https://behindtheknife.org/podcast-category/pediatric/

children challenges open clinical optimizing drs scenarios indiana university ultrasounds pediatric surgery journal article brian gray intussusception amanda jensen ann surg j pediatr surg

Journal Review in Breast Surgery: Surgical Resection of the Primary Tumor in Metastatic Breast Cancer

Play Episode Listen Later Apr 24, 2023 42:56

De novo metastatic breast cancer represents 6% of all new breast cancer diagnoses. This figure has not changed at all over the past 20 years; however, systemic therapy options have evolved dramatically during this time and have significantly increased life expectancy for these patients. While surgical management of the primary tumor in the setting of metastatic disease has typically been reserved for palliative indications, surgeons are now being asked to consider resecting the primary tumor to potentially increase overall survival. In this episode, we will use a case study to examine the data that should inform our conversations and decisions when we encounter patients with metastatic breast cancer who are interested in having their primary tumor resected. Links: Khan, S.A., S. Schuetz, and O. Hosseini (2022). Primary-Site Local Therapy for Patients with De Novo Metastatic Breast Cancer: An Educational Review. Ann Surg Oncol; 29: 5811-5820. https://link.springer.com/article/10.1245/s10434-022-11900-x Khan, S.A. et al (2022). Early Local Therapy for the Primary Site in De Novo Stage IV Breast Cancer: Results of a Randomized Clinical Trial (E2108). J Clin Oncol; 40(9): 978-987. https://ascopubs.org/doi/10.1200/JCO.21.02006?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed Badwe, R. et al (2015). Locoregional treatment versus no treatment of the primary tumor in metastatic breast cancer: an open-label randomized controlled trial. Lancet Oncol; 16: 1380-1388. https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(15)00135-7/fulltext Fitzal, F. et al (2019). Impact of Breast Surgery in Primary Metastasized Breast Cancer: Outcomes of the Prospective Randomized Phase III ABCSG-28 POSYTIVE Trial. Ann Surg; 269(6): 1163-1169. https://journals.lww.com/annalsofsurgery/Abstract/2019/06000/Impact_of_Breast_Surgery_in_Primary_Metastasized.24.aspx Soran, A. et al (2018). Randomized Trial Comparing Resection of Primary Tumor with No Surgery in Stage IV Breast Cancer at Presentation: Protocol MF07-01. Ann Surg Oncol; 25: 3141-3149. https://link.springer.com/article/10.1245/s10434-018-6494-6 Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out other breast surgery episodes here: https://behindtheknife.org/podcast-category/breast/

impact journal patients primary abstract tumors surgical metastatic breast cancer breast surgery resection hosseini z39 jco piis1470 j clin oncol lancet oncol ann surg

Intrakorporale oder extrakorporale Anastomose nach robotischer Hemikolektomie?

Play Episode Listen Later Apr 21, 2023 24:49

Mit Prof. Croner sprechen wir mal wieder über die Robotik in der Kolonchirurgie. Diesmal im Focus: Anastomosen nach Hemikolektomie. Wir haben uns eine gut designte RCT aus Dänemark herausgesucht. Dohrn N, Yikilmaz H, Laursen M, Khesrawi F, Clausen FB, Sørensen F, Jakobsen HL, Brisling S, Lykke J, Eriksen JR, Klein MF, Gögenur I. Intracorporeal Versus Extracorporeal Anastomosis in Robotic Right Colectomy: A Multicenter, Triple-blind, Randomized Clinical Trial. Ann Surg. 2022 Nov 1;276(5):e294-e301. doi: 10.1097/SLA.0000000000005254. Epub 2021 Oct 13. PMID: 35129520.

triple diesmal epub mit prof sla pmid rct robotik randomized clinical trial ann surg anastomose

Der Einfluss des reduzierten Drucks in der Laparoskopie auf die Rekonvaleszenz nach kolorektalen Eingriffen.

Play Episode Listen Later Jan 13, 2023 22:57

Wir besprechen den Einfluss des reduzierten Drucks in der Laparoskopie auf die Rekonvaleszenz nach kolorektalen Eingriffen. Eine tolle translationale Studie, die wir in Magdeburg besprochen haben. Viel Spaß Albers KI, Polat F, Helder L, Panhuizen IF, Snoeck MMJ, Polle SBW, de Vries H, Dias EM, Slooter GD, de Boer HD, Diaz-Cambronero O, Mazzinari G, Scheffer GJ, Keijzer C, Warlé MC; RECOVER Study Collaborators. Quality of Recovery and Innate Immune Homeostasis in Patients Undergoing Low-pressure Versus Standard-pressure Pneumoperitoneum During Laparoscopic Colorectal Surgery (RECOVER): A Randomized Controlled Trial. Ann Surg. 2022 Dec 1;276(6):e664-e673. doi: 10.1097/SLA.0000000000005491. Epub 2022 Jul 13. PMID: 35822730; PMCID: PMC9645538.

recovery einfluss studie epub magdeburg sla pmid der einfluss eingriffen drucks ann surg laparoskopie

Ep. 10 What is a Surgical Coach, and Why Do I Need One? with Dr. Cara King

BackTable OBGYN

Play Episode Listen Later Dec 29, 2022 61:51

In this episode, Dr. Cara King, the Fellowship Director for Minimally Invasive Gynecologic Surgery at Cleveland Clinic and a member of the Board of Directors of the Academy for Surgical Coaching, discusses the topic of surgical coaching and its benefits for physicians, trainees, and learners. The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/8NpBpF --- SHOW NOTES Dr. King begins the episode by describing surgical coaching as an act of asking open-ended questions, determining where a “coachee” is currently at, identifying their goals, and then empowering them to make specific actions that are needed to close this gap. During the discussion, she emphasizes the importance of prioritizing self-assessment as a coach. Dr. King then explains how to find a surgical coach through the Academy for Surgical Coaching. The process requires a “coachee” to complete a form that identifies their personal goals, and then the “coachee” is paired with a coach from the pool of physicians from various specialties. Coaching experiences are performed through various platforms (e.g., in-person, video-based, etc.) and are ideally conducted for 3-, 6-, or 12-month periods. Dr. King also covers how outcomes and metrics are evaluated, describing the differences between technical and non-technical (e.g., judgment) skills. The doctors transition to emphasize the importance of incorporating coaching into a surgeon's practice. Dr. King shares 2 methods to do so, including (1) replacing 1-hour of grand rounds or meetings with 1 hour of coaching sessions, as well as (2) integrating coaching at the level of national societies (e.g., American Association of Gynecologic Laparoscopists). The doctors go on to highlight also incorporating coaching at the level of medical schools and residency in order to instill the mentality of continual improvement early on in a physician's career. The episode ends with Dr. King sharing the steps to becoming a surgical coach through the Academy for Surgical Coaching, which includes a paid certification program. --- RESOURCES Atul Gawande, “Personal Best”: https://www.newyorker.com/magazine/2011/10/03/personal-best The Academy for Surgical Coaching: https://surgicalcoaching.org Greenberg CC, Byrnes ME, Engler TA, Quamme SPR, Thumma JR, Dimick JB. Association of a Statewide Surgical Coaching Program With Clinical Outcomes and Surgeon Perceptions. Ann Surg. 2021 Jun 1;273(6):1034-1039.

director coach coaching board academy american association surgical cleveland clinic personal best fellowship director cmefy ann surg

Extended versus Standard CME

Play Episode Listen Later Dec 23, 2022 25:14

Mit Prof. Croner besprechen wir in Magdeburg ein tolles Paper aus dem Annals of Surgery. In einer randomisierten Studie wurde der Einfluss einer ausgedehnten CME eines Sigmakarzinoms evaluiert. Planellas P, Marinello F, Elorza G, Golda T, Farrés R, Espín-Basany E, Enríquez-Navascués JM, Kreisler E, Cornejo L, Codina-Cazador A. Extended Versus Standard Complete Mesocolon Excision in Sigmoid Colon Cancer: A Multicenter Randomized Controlled Trial. Ann Surg. 2022 Feb 1;275(2):271-280. doi: 10.1097/SLA.0000000000005161. PMID: 34417367.

surgery esp einfluss studie cme jm magdeburg mit prof annals farr sla pmid enr ann surg

Clinical Challenges in Breast Surgery: Surgical Management of Metastatic Breast Cancer

Play Episode Listen Later Dec 5, 2022 37:19

De novo metastatic breast cancer represents 6% of all new breast cancer diagnoses. This figure has not changed at all over the past 20 years; however, systemic therapy options have evolved dramatically during this time and have significantly increased life expectancy for these patients. While surgical management of the primary tumor in the setting of metastatic disease has typically been reserved for palliative indications, surgeons are now being asked to consider resecting the primary tumor to potentially increase overall survival. In this episode, we will use a case study to examine the data that should inform our conversations and decisions when we encounter patients with metastatic breast cancer who are interested in having their primary tumor resected. Links: § Khan, S.A., S. Schuetz, and O. Hosseini (2022). Primary-Site Local Therapy for Patients with De Novo Metastatic Breast Cancer: An Educational Review. Ann Surg Oncol; 29: 5811-5820. https://link.springer.com/article/10.1245/s10434-022-11900-x § Khan, S.A. et al (2022). Early Local Therapy for the Primary Site in De Novo Stage IV Breast Cancer: Results of a Randomized Clinical Trial (E2108). J Clin Oncol; 40(9): 978-987. https://ascopubs.org/doi/10.1200/JCO.21.02006?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed § Badwe, R. et al (2015). Locoregional treatment versus no treatment of the primary tumor in metastatic breast cancer: an open-label randomized controlled trial. Lancet Oncol; 16: 1380-1388. https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(15)00135-7/fulltext § Fitzal, F. et al (2019). Impact of Breast Surgery in Primary Metastasized Breast Cancer: Outcomes of the Prospective Randomized Phase III ABCSG-28 POSYTIVE Trial. Ann Surg; 269(6): 1163-1169. https://journals.lww.com/annalsofsurgery/Abstract/2019/06000/Impact_of_Breast_Surgery_in_Primary_Metastasized.24.aspx § Soran, A. et al (2018). Randomized Trial Comparing Resection of Primary Tumor with No Surgery in Stage IV Breast Cancer at Presentation: Protocol MF07-01. Ann Surg Oncol; 25: 3141-3149. https://link.springer.com/article/10.1245/s10434-018-6494-6 Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our other clinical challenges episodes here: https://behindtheknife.org/podcast-series/clinical-challenges/

challenges impact patients khan clinical abstract metastatic breast cancer breast surgery soran surgical management hosseini z39 jco piis1470 j clin oncol lancet oncol ann surg

Podcast 824: Catheter-Related Blood Infections

Emergency Medical Minute

Play Episode Listen Later Oct 25, 2022 3:00

Contributor: Travis Barlock, MD Educational Pearls: Catheter related blood infections were thought to be caused by skin flora seeding the catheter. Thus, significant effort is applied to sterility and skin preparation. However, studies have shown that bacteria growing on the tip of the catheter is not consistent with growth on cultures of skin. Staphylococcus epidermidis is commonly found on cultures of catheter sites. It has also been found in the gut flora of >50% of ICU patients. Rates of catheter related blood infections have been decreased through oral decontamination and early feeding. These findings suggest enteral bacterial translation as a major source of blood stream infection. References O'Grady NP, Alexander M, Burns LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis. 2011;52(9):e162-e193. doi:10.1093/cid/cir257 von Eiff C, Becker K, Machka K, Stammer H, Peters G. Nasal carriage as a source of Staphylococcus aureus bacteremia. Study Group. N Engl J Med. 2001;344(1):11-16. doi:10.1056/NEJM200101043440102 ALTEMEIER WA, HUMMEL RP, HILL EO. Staphylococcal enterocolitis following antibiotic therapy. Ann Surg. 1963;157(6):847-858. doi:10.1097/00000658-196306000-00003 Marshall JC, Christou NV, Horn R, Meakins JL. The microbiology of multiple organ failure. The proximal gastrointestinal tract as an occult reservoir of pathogens. Arch Surg. 1988;123(3):309-315. doi:10.1001/archsurg.1988.01400270043006 Mrozek N, Lautrette A, Aumeran C, et al. Bloodstream infection after positive catheter cultures: what are the risks in the intensive care unit when catheters are routinely cultured on removal?. Crit Care Med. 2011;39(6):1301-1305. doi:10.1097/CCM.0b013e3182120190 Atela I, Coll P, Rello J, et al. Serial surveillance cultures of skin and catheter hub specimens from critically ill patients with central venous catheters: molecular epidemiology of infection and implications for clinical management and research. J Clin Microbiol. 1997;35(7):1784-1790. doi:10.1128/jcm.35.7.1784-1790.1997 Tani T, Hanasawa K, Endo Y, et al. Bacterial translocation as a cause of septic shock in humans: a report of two cases. Surg Today. 1997;27(5):447-449. doi:10.1007/BF02385710 Summarized by Kirsten Hughes, MS4 | Edited by John Spartz, MS4 & Erik Verzemnieks, MD In an effort to promote diversity, equity, and inclusion in Emergency Medicine, The Emergency Medical Minute is proud to present our 2nd annual Diversity and Inclusion Award. We support increasing the representation of underrepresented groups in medicine and extend this award to individuals applying to emergency medicine residencies during the 2022-2023 cycle. For information on award eligibility and the application process, visit https://emergencymedicalminute.com/edi-award/ Donate to EMM today!

Clinical Challenges in Bariatric Surgery: Revisional Bariatric Surgery

Play Episode Listen Later Sep 22, 2022 34:47

The number of patients seeking evaluation for revisional bariatric surgery is increasing. Wondering how to approach the work-up for these patients and what surgical options may be best for them? An introduction to the work-up and potential revisional bariatric surgery options are included in this episode from your bariatric surgery team at UNMC! Hosts: Ivy Haskins, MD Corrigan McBride, MD Tiffany Tanner, MD Journal Articles discussed: 1. Berger ER, Clements RH, Morton JH, Huffman KM, Wolfe BM, Nguyen NT, Ko CY, Hutter MM. The Impact of Different Surgical Techniques on Outcomes in Laparoscopic Sleeve Gastrectomies: The First Report from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Ann Surg. 2016; 264.3: 464-473. 2. Haskins IN, Jackson HT, Graham AE, Chen S, Sparks AD, Lin PP, Vaziri K. The Effect of Bougie Size and Distance from the Pylorus on Dehydration after Laparoscopic Sleeve Gastrectomy: An Analysis of the ACS-MBSAQIP Database. Surg Obes Relat Dis. 2019; 15.10: 1656-1661. 3. Toro JP, Lin E, Patel AD, Davis SS, Sanni A, Urrego HD, Sweeney JF, Srinivasan JK, Small W, Mittal P, Sekhar A, Moreno CC. Association of Radiographic Morphology with Early Gastroesophageal Reflux Disease and Satiety Control after Sleeve Gastrectomy. J Am Coll Surg. 2014; 219.3: 430-438. 4. Maselli DB, Alqahtani AR, Dayyeh BKA, Elahmedi M, Storm AC, Matar R, Nieto J, Teixeira A, Al Khatry M, Neto MG, Kumbhari V, Vargas EJ, Jaruvongvanich V, Mundi MS, Deshumkh A, Itani MI, Farha J, Chapman CG, Sharaiha R. Revisional Endoscopic Sleeve Gastroplasty of Laparoscopic Sleeve Gastrectomy: An International, Multicenter Study. 5. Campos GM, Mazzini GS, Altieri MS, Docimo S, DeMaria EJ, Rogers AM. ASMBS Position Statement on the Rationale for Performance of Upper Gastrointestinal Endoscopy Before and After Metabolic and Bariatric Surgery. Surg Obes Relat Dis. 2021; 17.5: 837-847. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out other bariatric surgery episodes here: https://behindtheknife.org/podcast-category/bariatric/

challenges performance impact wondering distance clinical outcomes metabolic dehydration rationale bariatric surgery unmc ann surg

Journal Review in Colorectal Surgery: Kono-S Anastomosis and Stem Cells in Crohn's Disease

Play Episode Listen Later Sep 15, 2022 35:23

You are faced with a young patient with ileal Crohn's disease. He requires an ileocolic resection. Which type of anastomosis do you perform? You also see another patient with complex perianal fistulas and the patient asks about the safety and efficacy of stem cells for fistula closure. What do you tell the patient? Join Dr. Carole Richard, Dr. François Dagbert and Dr. Maher Al Khaldi in their conversation about the Kono-S anastomosis after ileocolic resections and stem cell therapy for perianal complex fistulas for Crohn's disease. Learning objectives - To understand the rationale for the Kono-S anastomosis and the way it is fashioned. - To explain the possible advantages of the Kono-S anastomosis following ileocolic resection. - To explain the possible advantages of stem cell therapy for complex perianal fistulas. - To understand which patient population might be eligible for future stem cell therapy for complex perianal fistulas. References In order throughout the episode: Article 1: Luglio G, Rispo A, Imperatore N, Giglio MC, Amendola A, Tropeano FP, Peltrini R, Castiglione F, De Palma GD, Bucci L. Surgical Prevention of Anastomotic Recurrence by Excluding Mesentery in Crohn's Disease: The SuPREMe-CD Study - A Randomized Clinical Trial. Ann Surg. 2020 Aug;272(2):210-217. doi: 10.1097/SLA.0000000000003821. PMID: 32675483. Article 2: Panés J, García-Olmo D, Van Assche G, Colombel JF, Reinisch W, Baumgart DC, Dignass A, Nachury M, Ferrante M, Kazemi-Shirazi L, Grimaud JC, de la Portilla F, Goldin E, Richard MP, Leselbaum A, Danese S; ADMIRE CD Study Group Collaborators. Expanded allogeneic adipose-derived mesenchymal stem cells (Cx601) for complex perianal fistulas in Crohn's disease: a phase 3 randomised, double-blind controlled trial. Lancet. 2016 Sep 24;388(10051):1281-90. doi: 10.1016/S0140-6736(16)31203-X. Epub 2016 Jul 29. PMID: 27477896. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our library of colorectal episodes and videos here: https://behindtheknife.org/podcast-category/colorectal/

journal disease garc pan crohn expanded stem cells lancet epub sla pmid kono colorectal surgery ann surg

VOS: MASH - Part 1

Audible Bleeding

Play Episode Listen Later Aug 4, 2022 33:53

Vascular Origin Stories is a podcast series that explores the fun and engaging stories that shaped vascular surgery. Today's episode will be the first part of a multi-episode series exploring how the young battalion surgeons serving in MASH units in the Korean war pioneered wartime vascular repair. This episode introduces the Mobile Army Surgical Hospital (MASH), as well as some of the real-life stories from the surgeons unknowingly changing the field of medicine, which inspired the hit movie and TV series M*A*S*H. We'll look at what caused arterial repair to be removed from the army surgical handbook after WWI and how changing medical education helped create the environment for ingenuity in the MASH units. In part 2, we'll explore in detail the individual stories of adversity, courage, and perseverance that led to the re-introduction of arterial repair in the military. Major sources for the episode are linked below, and a full reference list can be found at the bottom of the page. Articles In Ukraine, Gruesome Injuries and Not Enough Doctors to Treat Them, by Michael Schwirtz and Lynsey Addari Korea, M*A*S*H, and the accidental pioneers of vascular surgery by Dr. Steven Friedman, MD Books Of Life and Limb: Surgical Repair of the Arteries in War and Peace, 1880-1960 by Dr. Justin Barr, MD, PhD MASH: An Army Surgeon in Korea by Dr. Otto Apel, MD and Pat Apel MASH: A Novel About Three Army Doctors by Richard Hooker References Robinson, A. Galen: Life Lessons from Gladiatorial Contests. The Lancet Perspective. Vol 382, Is. 9904. November 2013. Friedman, S.G. A History of Vascular Surgery. Futura Publishing. 1989. Van Way, C. War and Trauma: A History of Military Medicine. Mo Med. 2016 Jul-Aug;113(40:260-263 Hernigou, P. Ambroise Pare II: Pare's contributions to amputation and ligature. Int Orthop. 2013 Apr; 37(4): 769-772 Van Way, C. War and Trauma: A History of Military Medicine- PArt II. Mo Med. 2016 Sep-Oct; 113 950:336-340 Apel, O. Apel, P. MASH: An Army Surgeon in Korea. The University Press of Kentucky. 1998. King, B. Jatoi, I. The Mobile Army Surgical Hospital (MASH): A Military and Surgical Legacy. Journal of the National Medical Association. Vol. 97, No 5. May 2005. Friedman, S. Korea, MASH and the Accidental Pioneers of Vascular Surgery. Journal of Vascular Surgery. 2007. Wesselingh, R. From Milites Medici to Army Medics- A two Thousand Year Tradition of Military Medicine. Journal of Military and Veterans' Health. Vol 16, No 4 Gabriel, R. Between Flesh and Steel: A History of Military Medicine from the Middle Ages to the War in Afghanistan. Potomac Books. 2016 Jorgensen,T.J. How Marie Curie Brought X-Ray Machines To the Battlefield. Smithsonian Magazine. Oct 11. 2017 Of Life and Limb: Surgical Repair of the Arteries in War and Peace, 1880-1960. Joseph Barr. University of Rochester Press; 1st edition. November 1, 2019. Duffy, T.P. The Flexner Report- 100 Years Later. Yale Journal of Biological Medicine. 2011 Sep;84(3): 269-276 Andrew Dale. Band of Brother: Creators of Modern Vascular Surgery. Deweese. 1996 John Kobler. The Reluctant Surgeon, a Biography of John Hunter. Doubleday and Company. 1960 Eugene Custers, Ollen ten Cate.The History of Medical Education in Europe and the United States, With Respect to Time and Proficiency. Academic Medicine. March 2018-Vol. 93 Is. 3S Kapp, K. Talbot, G. John Hunter, The Father of Scientific Surgery. The American College of Surgeons. Poster CC2017 “Alpha Omega Alpha' History”. Website Kenneth M. Ludmerer. Learning to Heal: The Development of American Medical Education. Basic Books, Inc., Publishers. New York. 1985 Richard Hooker and WC Heinz. MASH: A Novel About Three Army Surgeons. Pocket Books. 1968. Jahnke Jr., E.J., Seeley S.F. Acute vascular injuries in the Korean War: an analysis of 77 consecutive cases. Ann Surg. 1953; 138: 158-177 Author + Host: Marlene Garcia-Neuer (@GarciaNeuer) is a PGY1 General Surgery Resident at Mayo Clinic Arizona. Calling all medical students! Submit your questions for the mailbag episode! Ask us any question related to vascular surgery, and have it answered on the podcast. Include the following: Your name, school, year, and to whom you want to address the question (resident, fellow, attending, or someone specific). Send them in writing or voice-recorded format. Send them to audiblebleeding@vascularsociety.org. Follow us on Twitter @audiblebleeding Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation. Credits: Author: Marlene Garcia-Neuer Editor: Sharif Ellozy Reviewer: Eilidh Gunn Music and Sound Effects from Pixabay, special thanks to ZakharValaha and BlenderTimer.

Journal Review in Colorectal Surgery: Timing of Biologics and Surgery in the Setting of Crohn's Disease

Play Episode Listen Later Jul 21, 2022 30:44

You get consulted on a 34-year-old with ileocolic Crohn's disease on Humira. You determine he needs surgery for recurrent partial obstructions. When do you do the surgery? How long should he be off his biologic medication? When to restart it post op? Join Drs. Abelson, Marcello and Aulet as they take us through two articles to help us figure it out! Learning Objectives: 1. Describe the complications of biologic medications in the peri-operative period 2. List the different classifications of medications for Crohn's disease 3. Discuss the approach to managing timing of surgery for patients with crohn's disease Articles: Cohen BL, Fleshner P, Kane SV et al. Prospective Cohort Study to Investigate the Safety of Preoperative Tumor Necrosis Factor Inhibitor Exposure in Patients With Inflammatory Bowel Disease Undergoing Intra-abdominal Surgery. Gastroenterology. 2022 Apr 10;S0016-5085(22)00359-6. doi: 10.1053/j.gastro.2022.03.057. Online ahead of print. Brouquet A, Maggiori L, Zerbib P, Lefevre JH, Denost Q, Germain A, Cotte E, Beyer-Berjot L, Munoz-Bongrand N, Desfourneaux V, Rahili A, Duffas JP, Pautrat K, Denet C, Bridoux V, Meurette G, Faucheron JL, Loriau J, Guillon F, Vicaut E, Benoist S, Panis Y; GETAID chirurgie group. Anti-TNF Therapy Is Associated With an Increased Risk of Postoperative Morbidity After Surgery for Ileocolonic Crohn Disease: Results of a Prospective Nationwide Cohort. Ann Surg. 2018 Feb;267(2):221-228. doi: 10.1097/SLA.0000000000002017. PMID: 29300710. Steele S, et al. The ASCRS Textbook of Colon and Rectal Surgery, fourth ed. 2022. https://link.springer.com/book/10.1007/978-3-030-66049-9 Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

online safety journal disease timing surgery crohn investigate colon marcello sla gastroenterology pmid biologics increased risk humira learning objectives colorectal surgery rectal surgery ann surg

Antibiotische Therapie der milden Divertikulitis - Ist sie wirklich notwendig?

Play Episode Listen Later Jun 24, 2022 23:38

Im Gespräch mit Prof. Croner. Wir sprechen in unseren neuen Folge über eine klinische Studie aus dem schönen Spanien, die die Notwendigkeit der antibiotische Therapie einer milden Divertikulitis evaluiert hat. Die Ergebnisse haben uns überrascht und wurden auch schon in der aktuellen S3-Leitlinie zur Sigmadivertikulitis eingearbeitet. Mora-Lopez, L., et al., Efficacy and Safety of Nonantibiotic Outpatient Treatment in Mild Acute Diverticulitis (DINAMO-study): A Multicentre, Randomised, Open-label, Noninferiority Trial. Ann Surg, 2021. 274(5): p. e435-e442. Außerdem haben wir wieder einen interessanten Ratschlag aus der Kategorie "Avoiding common surgical errors". Viel Spaß

open safety prof wirklich im gespr studie spanien therapie notwendigkeit efficacy die ergebnisse ratschlag notwendig randomised ann surg

Wann kann der Kostaufbau bei Patienten mit akuter Pankreatitis begonnen werden?

Play Episode Listen Later May 27, 2022 25:27

In unserer 12. Folge sprechen Prof. Croner und Ich über eine randomisierte Studie aus Spanien. Sie beschäftigt sich mit der Frage, wann der Kostaufbau bei Patienten mit akuter Pankreatitis begonnen werden kann. Die Ergebnisse sind verblüffend. Ramirez-Maldonado, E., et al., Immediate Oral Refeeding in Patients With Mild and Moderate Acute Pancreatitis: A Multicenter, Randomized Controlled Trial (PADI trial). Ann Surg, 2021. 274(2): p. 255-263. Viel Spaß

prof kann wann studie spanien patienten begonnen die ergebnisse bei patienten pankreatitis ann surg

Paradigmenwechsel in der Narbenhernienchirurgie, das Jahr 2004

Play Episode Listen Later Apr 29, 2022 25:30

In der 10. Folge ist wieder Prof. Kersting dabei. Wir sprechen über die Narbenhernienversorgung. Mit der Studie von Burger und Jeekel kam es zum Pradigmenwechsel - Stichwort Mesheinlage - Burger, J.W., et al., Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg, 2004. 240(4): p. 578-83; discussion 583-5.

mit prof burgers studie das jahr paradigmenwechsel kersting ann surg

Journal Review in Endocrine Surgery: The Great Debate of UCLA Endocrine Surgery

Play Episode Listen Later Mar 10, 2022 46:56

In this episode from the Endocrine Surgery team at BTK we go through three controversial topics in endocrine surgery and cite pertinent articles during a lively debate format. We debate the role of four-gland exploration versus focused exploration for parathyroid disease. Indications for parathyroidectomy are hotly contested. And finally, we discuss the role and relevance of using a nerve monitor. Tune in to see if Dr. Yeh and Dr. Wu remain collegiate after recording this episode… Dr. Michael Yeh is a Professor of Surgery at UCLA and serves as Section Chief of the UCLA Endocrine Surgery program which he established. Dr. Masha Livhits is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department Dr. James Wu is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department Dr. Vivek Sant is an Endocrine Surgery Fellow at UCLA in his first year of fellowship Dr. Rivfka Shenoy is a PGY-5 General Surgery Resident at UCLA who has completed two years of research Dr. Max Schumm is a PGY-5 General Surgery Resident at UCLA who has completed two years of research. He is a future endocrine surgeon. Important Papers Norlén O, Wang KC, Tay YK, Johnson WR, Grodski S, Yeung M, Serpell J, Sidhu S, Sywak M, Delbridge L. No need to abandon focused parathyroidectomy: a multicenter study of long-term outcome after surgery for primary hyperparathyroidism. Ann Surg. 2015 May;261(5):991-6. doi: 10.1097/SLA.0000000000000715. PMID: 25565223. Schneider DF, Mazeh H, Sippel RS, Chen H. Is minimally invasive parathyroidectomy associated with greater recurrence compared to bilateral exploration? Analysis of more than 1,000 cases. Surgery. 2012 Dec;152(6):1008-15. doi: 10.1016/j.surg.2012.08.022. Epub 2012 Oct 12. PMID: 23063313; PMCID: PMC3501613. Jinih M, O'Connell E, O'Leary DP, Liew A, Redmond HP. Focused Versus Bilateral Parathyroid Exploration for Primary Hyperparathyroidism: A Systematic Review and Meta-analysis. Ann Surg Oncol. 2017 Jul;24(7):1924-1934. doi: 10.1245/s10434-016-5694-1. Epub 2016 Nov 28. PMID: 27896505. Silverberg SJ, Shane E, Jacobs TP, Siris E, Bilezikian JP. A 10-year prospective study of primary hyperparathyroidism with or without parathyroid surgery. N Engl J Med. 1999 Oct 21;341(17):1249-55. doi: 10.1056/NEJM199910213411701. Erratum in: N Engl J Med 2000 Jan 13;342(2):144. PMID: 10528034. Seib CD, Meng T, Suh I, Harris AHS, Covinsky KE, Shoback DM, Trickey AW, Kebebew E, Tamura MK. Risk of Fracture Among Older Adults With Primary Hyperparathyroidism Receiving Parathyroidectomy vs Nonoperative Management. JAMA Intern Med. 2022 Jan 1;182(1):10-18. doi: 10.1001/jamainternmed.2021.6437. PMID: 34842909; PMCID: PMC8630642. Yeh MW, Zhou H, Adams AL, Ituarte PH, Li N, Liu IL, Haigh PI. The Relationship of Parathyroidectomy and Bisphosphonates With Fracture Risk in Primary Hyperparathyroidism: An Observational Study. Ann Intern Med. 2016 Jun 7;164(11):715-23. doi: 10.7326/M15-1232. Epub 2016 Apr 5. PMID: 27043778. Zanocco K, Butt Z, Kaltman D, Elaraj D, Cella D, Holl JL, Sturgeon C. Improvement in patient-reported physical and mental health after parathyroidectomy for primary hyperparathyroidism. Surgery. 2015 Sep;158(3):837-45. doi: 10.1016/j.surg.2015.03.054. Epub 2015 May 29. PMID: 26032828. Barczyński M, Konturek A, Cichoń S. Randomized clinical trial of visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy. Br J Surg. 2009 Mar;96(3):240-6. doi: 10.1002/bjs.6417. PMID: 19177420. Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

relationships professor risk journal ucla assistant professor surgery analysis great debates wu epub sla btk indications pmid randomized yeh new england journal of medicine erratum pgy section chief m15 jama intern med ann intern med endocrine surgery james wu general surgery resident ann surg

Episodio 25. El Diamante letal en trauma

99% Emergencias

Play Episode Listen Later Feb 9, 2022 8:23

En este nuevo episodio hablo del Diamante letal en trauma. Pasamos de la triada letal con la acidosis, coagulopatía e hipotermia y añadimos hipocalcemia en el manejo al paciente con trauma grave. Espero que os guste. Bibliografía consultada: - Ditzel, Ricky, Anderson, Justin, Eisenhart, William, Rankin, Cody, DeFeo, Devin, Oak, Sangki, et al. (2020). A review of transfusion- and trauma-induced hypocalcemia: Is it time to change the lethal triad to the lethal diamond?. Journal of Trauma and Acute Care Surgery, 88, 434-439. https://doi.org/10.1097/TA.0000000000002570 - Bjerkvig CK, Strandenes G, Eliassen HS, Spinella PC, Fosse TK, Cap AP, Ward KR. "Blood failure" time to view blood as an organ: how oxygen debt contributes to blood failure and its implications for remote damage control resuscitation. Transfusion. 2016;56(Suppl 2):S182-S189. - Dyer M, Neal MD. Defining the lethal triad. In: Pape HC, Peitzman A, Rotondo M, Giannoudis P, eds. Damage Control Management in the Polytrauma Patient. Cham, Switzerland: Springer; 2017:41-53. - Dobson GP, Letson HL, Sharma R, Sheppart FR, Cap AP. Mechanisms of early trauma-induced coagulopathy: the clot thickens or not? J Trauma. 2015;79(2):301-309. - Eddy VA, Morris JA Jr., Cullinane DC. Hypothermia, coagulopathy, and acidosis. Surg Clin North Am. 2000;80(3):845-854. - Niles SE, McLaughlin DF, Perkins JG, Wade CE, Li Y, Spinella PC, Holcomb JB. Increased mortality associated with the early coagulopathy of trauma in combat casualties. J Trauma. 2008;64(6):1459-1465. - Martini WZ, Holcomb JB. Acidosis and coagulopathy: the differential effects on fibrinogen synthesis and breakdown in pigs. Ann Surg. 2007;246(5):831-835. - Armand R, Hess JR. Treating coagulopathy in trauma patients. Transfus Med Rev. 2003;17(3):223-231. - Hastbacka J, Pettila V. Prevalence and predictive value of ionized hypocalcemia among critically ill patients. Acta Anaesthesiol Scand. 2003;47:1264-1269. - Cherry RA, Bradburn E, Carney DE, Shaffer ML, Gabbay RA, Cooney RN. Do early ionized calcium levels really matter in trauma patients? J Trauma. 2006;64(4):774-779. - Holcomb JB, Jenkins D, Rhee P, et al. Damage control resuscitation: directly addressing the early coagulopathy of trauma. J Trauma. 2007;62(2):307-310. - Lier H, Krep H, Schroeder S, Stuber F. Preconditions of hemostasis in trauma: a review. The influence of acidosis, hypocalcemia, anemia, and hypothermia on functional hemostasis in trauma. J Trauma. 2008;65(4):951-960. - Hoffman M, Monroe DM. Coagulation 2006: a modern view of hemostasis. Hematol Oncol Clin North Am. 2007;21:1-11. - Hoffman M. A cell-based model of coagulation and the role of factor VIIa. Blood Rev. 2003;17(suppl 1):S1-S5. - Ho KM, Leonard AD. Concentration-dependent effect of hypocalcaemia on mortality of patients with critical bleeding requiring massive transfusion: a cohort study. Anaesth Intensive Care. 2011;39(1):46-54. - Magnotti LJ, Bradburn EH, Webb DL, Berry SD, Fischer PE, Zarzaur BL, Schroeppel TJ, Fabian TC, Croce MA. Admission ionized calcium levels predict the need for multiple transfusions: a prospective study of 591 critically ill trauma patients. J Trauma. 2011;70(2):391-397. - Kornblith LZ, Howard BM, Cheung CK, et al. The whole is greater than the sum of its parts: hemostatic profiles of whole blood variants. J Trauma Acute Care Surg. 2014;77(6):818-827. - Li K, Xu Y. Citrate metabolism in blood transfusions and its relationship due to metabolic alkalosis and respiratory acidosis. Int J Clin Exp Med. 2015;8(4):6578-6584. - Giancarelli A, Liu-Deryke X, Birrer K, Hobbs B, Alban R. Hypocalcemia in trauma patients receiving massive transfusion. J Surg Res. 2016;202:182-187. - Webster S, Todd S, Redhead J, Wright C. Ionised calcium levels in major trauma patients who received blood in the emergency department. Emerg Med J. 2016;33(8):569-572. - Kyle T, Greaves I, Beynon A, Whittaker V, Brewer M, Smith J. Ionised calcium levels in major trauma patients who received blood en route to a military medical treatment facility. Emerg Med J. 2017;35(3):176-179. - MacKay EJ, Stubna MD, Holena DN, Reilly PM, Seamon MJ, Smith BP, Kaplan LJ, Cannon JW. Abnormal calcium levels during trauma resuscitation are associated with increased mortality, increased blood product use, and greater hospital resource consumption: a pilot investigation. Anesth Analg. 2017;125(3):895-901. - Shackelford SA, Del Junco DJ, Powell-Dunford N, Mazuchowski EL, Howard JT, Kotwal RS, Gurney J, Butler FK Jr., Gross K, Stockinger ZT. Association of prehospital blood product transfusion during medical evacuation of combat casualties in Afghanistan with acute and 30-day survival. JAMA. 2017;318(16):1581-1591. - DailyMed - Teruflex blood bag system anticoagulant citrate phosphate dextrose adenine (CPDA-1) - anticoagulant citrate phosphate dextrose adenine (cpda-1) solution. US National Library of Medicine. 2012. - Cap AP, Gurney J, Spinella PC, et al. Damage Control Resuscitation (CPG ID:18). Joint Trauma Service Clinical Practice Guideline. Joint Trauma System, the Department of Defense Center of Excellence for Trauma. 2019. - Pedersen KO. Binding of calcium to serum albumin. II. Effect of pH via competitive hydrogen and calcium ion binding to the imidazole groups of albumin. Scand J Clin Lab Invest. 1972;29(1):75-83. - Maxwell MJ, Wilson MJ. Complications of blood transfusion. BJA Educ. 2006;6(6):225-229. - Lang RM, Fellner SK, Neumann A, Bushinsky DA, Borow KM. Left ventricular contractility varies directly with blood ionized calcium. Ann Intern Med. 1988;108(4):524-529.

Episode 50 - Whole Blood & Modern Hemostatic Resuscitation Strategies with Dr. Bryan A. Cotton

Trauma ICU Rounds

Play Episode Listen Later Jan 29, 2022 43:16

In this, our 50th episode, we are in Austin, TX, for the Annual EAST Scientific Meeting where we are joined by Dr. Bryan A. Cotton who shares his expertise and knowledge regarding the use of whole blood (WB) in trauma patients. From the use of whole blood in prior military conflicts to the design and successful implementation of one of the only prospective randomized controlled trials of modified whole blood use in trauma patients, Dr. Cotton provides an incredible overview of the potential benefits of whole blood or as he refers to it - "the dying blood product". Also covered in expert fashion are the role of other hemostatic products and strategies including tranexamic acid, fibrinogen concentrates, and a plasma first resuscitation strategy. Time Stamps:01:16 The rationale for whole blood & a 1:1:1 transfusion strategy04:24 Military experience with WB: What's old is new again!05:44 Modified WB vs. Component Therapy RCT06:02 Leukoreduction of WB07:00 Type-specific WB09:38 Platelet function in WB vs. aphaeresis platelets11:58 Warm fresh WB vs. cold stored12:55 The whole is greater than the sum of its parts15:02 What do we mean by low-titer WB?19:14 O+ vs. O- WB & the potential for alloimmunization24:39 Transfusion reactions & safety of WB in trauma patients25:40 Prehospital WB for the win27:32 LITES Network28:27 Hemorrhage control, 1:1:1, viscoelastic assays, cryoprecipitate & fibrinogen concentrate32:00 BAC's thoughts on tranexamic acid (TXA)34:47 BAC's thoughts on hypertonic saline (HTS) for COVID-1938:51 Final thoughts & future directionsRecommended Readings:Cotton BA, Podbielski J, Camp E, Welch T, del Junco D, Bai Y, Hobbs R, Scroggins J, Hartwell B, Kozar RA, Wade CE, Holcomb JB; Early Whole Blood Investigators. A randomized controlled pilot trial of modified whole blood versus component therapy in severely injured patients requiring large volume transfusions. Ann Surg. 2013 Oct;258(4):527-32; discussion 532-3.Williams J, Merutka N, Meyer D, Bai Y, Prater S, Cabrera R, Holcomb JB, Wade CE, Love JD, Cotton BA. Safety profile and impact of low-titer group O whole blood for emergency use in trauma. J Trauma Acute Care Surg. 2020 Jan;88(1):87-93. McGinity AC, Zhu CS, Greebon L, Xenakis E, Waltman E, Epley E, Cobb D, Jonas R, Nicholson SE, Eastridge BJ, Stewart RM, Jenkins DH. Prehospital low-titer cold-stored whole blood: Philosophy for ubiquitous utilization of O-positive product for emergency use in hemorrhage due to injury. J Trauma Acute Care Surg. 2018 Jun;84(6S Suppl 1):S115-S119. Sperry JL, Guyette FX, Brown JB, Yazer MH, Triulzi DJ, Early-Young BJ, Adams PW, Daley BJ, Miller RS, Harbrecht BG, Claridge JA, Phelan HA, Witham WR, Putnam AT, Duane TM, Alarcon LH, Callaway CW, Zuckerbraun BS, Neal MD, Rosengart MR, Forsythe RM, Billiar TR, Yealy DM, Peitzman AB, Zenati MS; PAMPer Study Group. Prehospital Plasma during Air Medical Transport in Trauma Patients at Risk for Hemorrhagic Shock. N Engl J Med. 2018 Jul 26;379(4):315-326. doi: 10.1056/NEJMoa1802345. PMID: 30044935.Yazer MH, Jackson B, Sperry JL, Alarcon L, Triulzi DJ, Murdock AD. Initial safety and feasibility of cold-stored uncrossmatched whole blood transfusion in civilian trauma patients. J Trauma Acute Care Surg. 2016 Jul;81(1):21-6. doi: 10.1097/TA.0000000000001100. PMID: 27120323.Websites:LITES Networkhttps://www.litesnetwork.orgSouthwest Texas Regional Advisory Councilhttps://www.strac.org/bloodSupport the show (https://www.patreon.com/traumaicurounds)

Clinical Challenges in Pediatric Surgery: Neuroblastoma Management

Play Episode Listen Later Jan 17, 2022 27:50

Please join Drs. Brian Gray, Amanda Jensen and Manisha Bhatia from Indiana University as they discuss neuroblastoma management in pediatric surgery. Journal Article links: Croteau N, Nuchtern J, LaQuaglia MP. Management of Neuroblastoma in Pediatric Patients. Surg Oncol Clin N Am 2021;30(2):291-304. https://pubmed.ncbi.nlm.nih.gov/33706901/ Madonna MB, Newman E. Handbook for Children with Neuroblastoma. Updated Spring 2018. Cancer Committee American Pediatric Surgical Association. 2018. https://www.pedsurglibrary.com/apsa/ub?cmd=repview&type=682-76&name=4_1884004_PDF https://www.pedsurglibrary.com/apsa/ub?cmd=repview&type=682-76&name=4_1884004_PDF Newman EA, Abdessalam S, Aldrink JH, Austin M, Heaton TE, Bruny J, et al. Update on neuroblastoma. J Pediatr Surg 2019;54(3):383-9. https://pubmed.ncbi.nlm.nih.gov/30305231/ Nuchtern JG, London WB, Barnewolt CE, Naranjo A, McGrady PW, Geiger JD, et al. A prospective study of expectant observation as primary therapy for neuroblastoma in young infants: a Children's Oncology Group study. Ann Surg 2012;256(4):573-80. https://pubmed.ncbi.nlm.nih.gov/22964741/ Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

children challenges management clinical drs handbook indiana university pediatric patients neuroblastoma pediatric surgery journal article brian gray amanda jensen ann surg j pediatr surg

Journal Review in Surgical Education: Operative Performance Assessment

Cold Steel: Canadian Journal of Surgery Podcast

Play Episode Listen Later Dec 2, 2021 35:05

5 years of General Surgery residency? Check. Case numbers? Check. Ready for independent practice? Hmmm. Join Drs. John D. Mellinger, Jeremy Lipman, Judith French, and Amy Han as we discuss the past, present and future of operative assessment. Learning objectives: In this episode, we discuss the current practices of operative assessment in surgical training and the opportunities for improvement. We delve into evidence-based framework for operative performance assessment outlined in “A Proposed Blueprint for Operative Performance Training, Assessment, and Certification.” We explore the distinction between high versus low frequency operations, standards setting, training of assessors, and the role of technology in improving reliability, generalizability, and frequency of operative assessments. References: Bansal N, Simmons KD, Epstein AJ, Morris JB, Kelz RR. Using Patient Outcomes to Evaluate General Surgery Residency Program Performance. JAMA Surg. 2016;151(2):111–119. doi:10.1001/jamasurg.2015.3637 Bell RH Jr, Biester TW, Tabuenca A, et al. Operative experience of residents in US general surgery programs: a gap between expectation and experience. Ann Surg. 2009;249(5):719-724. doi:10.1097/SLA.0b013e3181a38e59 Williams RG, Sanfey H, Chen XP, Dunnington GL. A controlled study to determine measurement conditions necessary for a reliable and valid operative performance assessment: a controlled prospective observational study. Ann Surg. 2012;256(1):177-187. doi:10.1097/SLA.0b013e31825b6de4 Williams RG, George BC, Bohnen JD, et al. A Proposed Blueprint for Operative Performance Training, Assessment, and Certification. Ann Surg. 2021;273(4):701-708. doi:10.1097/SLA.0000000000004467 Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

learning performance journal certification hmmm john d sla operative general surgery mellinger surgical education jama surg ann surg

E103 Teodor Grantcharov on the OR Blackbox

Play Episode Listen Later Nov 25, 2021 60:38

Dr. Teodor Grantcharov (https://twitter.com/TGrantcharovMD?s=20) is a bariatric surgeon at St. Michael's Hospital in Toronto. Dr. Grantcharov is world renowned for his work on the OR blackbox, a platform that allows for immense data capture (video, audio, physiologic) as well as advanced analytics. We asked Dr. Grantcharov about what it took to develop the OR blackbox, not just technologically, but culturally and institutionally. You can find out more about the OR blackbox at surgicalsafety.com. Links: 1. Quantifying recall bias in surgical safety: a need for a modern approach to morbidity and mortality reviews. https://pubmed.ncbi.nlm.nih.gov/30693745/ 2. Twitter discussion on best methods for recording open cases: https://twitter.com/ameerfarooq/status/1335675502313447426 3. OR Black Box: https://www.surgicalsafety.com/ 4. Gordon, L, Reed, C, Sorensen, JL, Schulthess, P, Strandbygaard, J, Mcloone, M et al.. Perceptions of safety culture and recording in the operating room: understanding barriers to video data capture. Surg Endosc. 2021; :. doi: 10.1007/s00464-021-08695-5. PubMed PMID:34608519 . 5. Nensi, A, Palter, V, Reed, C, Schulthess, P, Mcloone, M, Grantcharov, T et al.. Utilizing the Operating Room Black Box to Characterize Intraoperative Delays, Distractions, and Threats in the Gynecology Operating Room: A Pilot Study. Cureus. 2021;13 (7):e16218. doi: 10.7759/cureus.16218. PubMed PMID:34367818 PubMed Central PMC8341265. 6. Levin, M, McKechnie, T, Kruse, CC, Aldrich, K, Grantcharov, TP, Langerman, A et al.. Surgical data recording in the operating room: a systematic review of modalities and metrics. Br J Surg. 2021;108 (6):613-621. doi: 10.1093/bjs/znab016. PubMed PMID:34157080 . 7. Gallant, JN, Brelsford, K, Sharma, S, Grantcharov, T, Langerman, A. Patient Perceptions of Audio and Video Recording in the Operating Room. Ann Surg. 2021; :. doi: 10.1097/SLA.0000000000004759. PubMed PMID:33630449 . Bio (http://stmichaelshospitalresearch.ca/researchers/teodor-grantcharov/): Dr. Teodor Grantcharov completed his surgical training at the University of Copenhagen, and a doctoral degree in Medical Sciences at the University of Aarhus in Denmark. Dr. Grantcharov is a Professor of Surgery at the University of Toronto. He holds the Keenan Chair in Surgery at St. Michael's Hospital in Toronto. Dr. Grantcharov is the inaugural Director of the International Centre for Surgical Safety – a multidisciplinary group of visionary scientists with expertise in design, human factors, computer- and data science, and healthcare research. He previously held Canada Research Chair in Simulation and Surgical Safety and was awarded the Queen Elizabeth II diamond jubilee medal for his contributions to clinical research and patient safety in Canada. Dr. Grantcharov was awarded the honorary fellowship of the Imperial College in London, the honorary medal of the Bulgarian and Danish surgical societies and multiple national and international awards for his contributions to surgical education and surgical safety. Dr. Grantcharov's clinical interest is the area of minimally invasive surgery, while his academic focus is in the field of surgical innovation and patient safety. He has become internationally recognized as a leader in this area with his work on curriculum design, assessment of competence and impact of surgical performance on clinical outcomes. Dr. Grantcharov developed the Surgical Black Box, which aims to transform the safety culture in medicine and introduce modern safety management systems in the high-risk operating room environment. Dr. Grantcharov has more than 200 peer-reviewed publications and more than 200 invited presentations in Europe, South- and North America. He sits on numerous committees with Surgical Professional Societies in North America and Europe. He sits on the Editorial Boards of the British Journal of Surgery and Surgical Endoscopy.

Podcast 727: Antibiotics for Diverticulitis

Emergency Medical Minute

Play Episode Listen Later Nov 8, 2021 3:35

Contributor: Aaron Lessen, MD Educational Pearls: Classically, diverticulitis is diagnosed via CT scan and patients are discharged home on antibiotics if they are without complication The DINAMO study is a multicenter open-label RCT that evaluated if it is safe to not give antibiotics to patients with mild acute diverticulitis Found no difference in readmission, return visits to ED, pain control, or likelihood of surgical intervention between the group that was sent home with antibiotics and the group without Medical societies have not reached a consensus on this issue, likely further studies need to be completed References Mora-López L, Ruiz-Edo N, Estrada-Ferrer O, et al. Efficacy and Safety of Nonantibiotic Outpatient Treatment in Mild Acute Diverticulitis (DINAMO-study): A Multicentre, Randomised, Open-label, Noninferiority Trial. Ann Surg. 2021;274(5):e435-e442. doi:10.1097/SLA.0000000000005031 *Image from Hellerhoff, CC BY-SA 3.0 , via Wikimedia Commons Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at https://emergencymedicalminute.org/cme-courses/ and create an account. Donate to EMM today! Diversity and Inclusion Award

diversity open safety md medical found antibiotics efficacy cc by sa sla rct dinamo emm diverticulitis randomised ama pra category ann surg

Clinical Challenges in Minimally Invasive Surgery: Post-Inguinal Hernia Repair Chronic Pain

Play Episode Listen Later Oct 28, 2021 39:17

Post-operative pain is a challenging topic most surgeons would prefer not to have to think about, and post-inguinal hernia repair pain can be a particular pain in the…groin. Drs. Mike Weykamp, Andrew Wright, and Nick Cetrulo from the University of Washington provide a framework for approaching these challenging patients to help clarify when and how to best evaluate post-inguinal hernia repair pain and identify the patients who might benefit from surgical intervention. Referenced Articles and Videos: 1. D Chen. Mapping for inguinal chronic pain: An approach that all surgeons can do. Your Session: Abdominal Wall Hernia - Provocative Questions in the Practice of Hernia Repair held during the 2017 SAGES Annual Meeting in Houston, TX https://www.youtube.com/watch?v=Yx5zSS3CA-U 2. J Lange, R Kaufmann, A Wijsmuller, J Pierie, R Ploeg, P Amid. An international consensus algorithm for management of chronic postoperative inguinal pain. Hernia 2015. https://pubmed.ncbi.nlm.nih.gov/25138620/ 3. P Amid. Radiologic Images of Meshoma A New Phenomenon Causing Chronic Pain After Prosthetic Repair of Abdominal Wall Hernias. JAMA Surgery 2004. https://jamanetwork.com/journals/jamasurgery/fullarticle/397607 4. McCormack K, Scott NW, Go PM, Ross S, Grant AM; EU Hernia Trialists Collaboration. Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev. https://pubmed.ncbi.nlm.nih.gov/12535413/ 5. Campanelli G, Pascual MH, Hoeferlin A, Rosenberg J, Champault G, Kingsnorth A, Miserez M. Randomized, controlled, blinded trial of Tisseel/Tissucol for mesh fixation in patients undergoing Lichtenstein technique for primary inguinal hernia repair: results of the TIMELI trial. Ann Surg. 2012 https://pubmed.ncbi.nlm.nih.gov/22395092/ 6. Jeroukhimov I, Wiser I, Karasic E, Nesterenko V, Poluksht N, Lavy R, Halevy A. Reduced postoperative chronic pain after tension-free inguinal hernia repair using absorbable sutures: a single-blind randomized clinical trial. J Am Coll Surg. 2014. https://pubmed.ncbi.nlm.nih.gov/24210149/ 7. Novik B, Nordin P, Skullman S, Dalenbäck J, Enochsson L. More Recurrences After Hernia Mesh Fixation With Short-term Absorbable Sutures: A Registry Study of 82 015 Lichtenstein Repairs. Arch Surg. 2011. https://jamanetwork.com/journals/jamasurgery/fullarticle/406587 8. Barazanchi AW, Fagan PV, Smith BB, Hill AG. Routine Neurectomy of Inguinal Nerves During Open Onlay Mesh Hernia Repair: A Meta-analysis of Randomized Trials. Ann Surg. 2016. https://pubmed.ncbi.nlm.nih.gov/26756767/ 9. Bakker WJ, Aufenacker TJ, Boschman JS, Burgmans JPJ. Lightweight mesh is recommended in open inguinal (Lichtenstein) hernia repair: A systematic review and meta-analysis. Surgery. 2020. https://pubmed.ncbi.nlm.nih.gov/31672519/ Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

Climate Change and Patient Outcomes: How We Can Make an Impact

WEMcast

Play Episode Listen Later Sep 7, 2021 47:39

In this session host Stephen Wood speaks with Dr Louis Nguyen and Dr Liz Yates, surgeons and researchers at the Brigham and Women's Hospital in Boston discuss the impact of climate change on healthcare and patient outcomes. Dr Yates and Dr Nguyen discussed the large carbon footprint of the healthcare industry, especially in developed nations. This includes the large amount of waste that stems from pre-made kits as well as other disposables. Similarly, the amount of energy that is dedicated to healthcare accounts for a large carbon footprint among industries. This leads to a discussion on the impact of climate change on patient accounts. The focus was on surgical patients and how issues like heat islands and lack of access to air conditioning can result in higher morbidity and mortality. This extends to other patient populations including OBGYN patients, pulmonary patients as well as the vulnerable young and elderly. More concerning is how this impact seems greater for marginalized and underserved populations. The group spent the remainder of the conversation discussing how everyone can make an impact with even small, local actions. Louis Nguyen Bio: Dr Louis Nguyen is a vascular and endovascular surgeon at Brigham & Women's Hospital and Associate Professor of Surgery at Harvard Medical School. Within the Department of Surgery, he serves as the Vice-Chair for Digital Health Systems; and within the Division of Vascular & Surgery, he is the Director of Clinical and Outcomes Research, as well as the Director of Quality, Safety, and Value. His interest in Environmental Sustainability focuses on minimizing the environmental impact from healthcare through education and implementation programs Liz Yates Bio: Elizabeth Yates, MD, MPH is a general surgery resident at Brigham and Women's Hospital. She has completed three years of clinical training and is currently completing a research fellowship at the Center for Surgery and Public Health, focusing on sustainable surgical care delivery and the impact of climate change on surgical outcomes. Show Notes: Matthew J. Eckelman, Kaixin Huang, Robert Lagasse, Emily Senay, Robert Dubrow, Jodi D. Sherman. Health Care Pollution And Public Health Damage In The United States: An Update. Health Affairs, December 2020 Rizan C, Steinbach I, Nicholson R, Lillywhite R, Reed M, Bhutta MF. The Carbon Footprint of Surgical Operations: A Systematic Review. Ann Surg. 2020 Dec;272(6):986-995.

Clinical Challenges in Trauma Surgery: Penetrating Cardiac Trauma