Podcasts about jama surg

https://bit.ly/4mDRbKKAula de Laringoscopia: O passo a passo para fazer do jeito certo.

Join Drs. Michael Rosen, Clayton Petro, and Sara Maskal as they review their recently published randomized controlled trial comparing open retromuscular Sugarbaker and Keyhole approaches to parastomal hernia repair   Hosts:    - Sara Maskal, MD, Cleveland Clinic  - Clayton Petro, MD, Cleveland Clinic  - Michael Rosen, MD, Cleveland Clinic  Learning Objectives:   - Understand the trial design - Review trial outcomes - Understand how to apply the outcomes to patients with parastomal hernias References:  - Maskal SM, Ellis RC, Fafaj A, et al. Open Retromuscular Sugarbaker vs Keyhole Mesh Placement for Parastomal Hernia Repair: A Randomized Clinical Trial. JAMA Surg. Published online June 12, 2024. doi:10.1001/jamasurg.2024.1686 https://pubmed.ncbi.nlm.nih.gov/38865142/ - Maskal SM, Thomas JD, Miller BT, Fafaj A, Zolin SJ, Montelione K, Ellis RC, Prabhu AS, Krpata DM, Beffa LR, Costanzo A. Open retromuscular keyhole compared with Sugarbaker mesh for parastomal hernia repair: Early results of a randomized clinical trial. Surgery. 2024 Mar 1;175(3):813-21. https://pubmed.ncbi.nlm.nih.gov/37770344/ - Moreno-Matias J, Serra-Aracil X, Darnell-Martin A, Bombardo-Junca J, Mora-Lopez L, Alcantara-Moral M, Rebasa P, Ayguavives-Garnica I, Navarro-Soto S. The prevalence of parastomal hernia after formation of an end colostomy. A new clinico-radiological classification. Colorectal Dis. 2009 Feb;11(2):173-7. doi: 10.1111/j.1463-1318.2008.01564.x. Epub 2008 May 3. PMID: 18462232. https://pubmed.ncbi.nlm.nih.gov/18462232/ ***SPECIALTY TEAM APPLICATION LINK: https://docs.google.com/forms/d/e/1FAIpQLSdX2a_zsiyaz-NwxKuUUa5cUFolWhOw3945ZRFoRcJR1wjZ4w/viewform?usp=sharing Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

LISTENER DISCRETION IS ADVISED. Lavery MD, Aulakh A, Christian MD. Benefits of targeted deployment of physician-led interprofessional pre-hospital teams on the care of critically Ill and injured patients: a systematic review and meta-analysis. Scand J Trauma Resusc Emerg Med. 2025 Jan 6;33(1) Other Citations: Bujak K, et al. Does the presence of physician-staffed emergency medical services improve the prognosis in out-of-hospital cardiac arrest? A propensity score matching analysis. Kardiol Pol. 2022;80(6) Fukuda T, et al.. Association of Prehospital Advanced Life Support by Physician With Survival After Out-of-Hospital Cardiac Arrest With Blunt Trauma Following Traffic Collisions: Japanese Registry-Based Study. JAMA Surg. 2018 Jun 20;153(6) Garner et al.. The Head Injury Retrieval Trial (HIRT): a single-centre randomised controlled trial of physician prehospital management of severe blunt head injury compared with management by paramedics only. Emerg Med J. 2015 Nov;32(11) Den Hartog et al.. Survival benefit of physician-staffed helicopter emergency medical services (HEMS) assistance for severely injured patients. Injury. 2015;46(7) Hesselfeldt R,et al.. Impact of a physician-staffed helicopter on a regional trauma system: a prospective, controlled, observational study. Acta Anaesthesiol Scand. 2013 May;57(5): Lyons J, et al. Impact of a physician - critical care practitioner pre-hospital service in Wales on trauma survival. Anaesthesia. 2021 Nov;76(11) Maddock A, et al. Prehospital critical care is associated with increased survival in adult trauma patients in Scotland. Emerg Med J. 2020 Mar;37(3):141-145. Moors XRJ, et al. A Physician-Based Helicopter Emergency Medical Services Was Associated With an Additional 2.5 Lives Saved per 100 Dispatches of Severely Injured Pediatric Patients. Air Med J. 2019 Jul-Aug;38(4) Yeguiayan JM, et al. Medical pre-hospital management reduces mortality in severe blunt trauma. Crit Care. 2011;15(1)

Send us a textIn dieser Folge des Journal Clubs geht es um die Frage des Risikos für kardiovaskuläre und cerebrovaskuläre Ereignisse im Rahmen der Narkose nach NSTEMI:Glance LG, Joynt Maddox KE, Thomas S, et al. Time Since Prior NSTEMI and Major Adverse Cardiovascular and Cerebrovascular Events After Noncardiac Surgery. JAMA Surg. Published online October 30, 2024. doi:10.1001/jamasurg.2024.4683Link zu den ESC Pocketguidelines: https://leitlinien.dgk.org/2023/nichtkardiale-chirurgische-eingriffe-ncs-version-2022/Mit im Studio: Samir Hmayed, wissenschaftlicher Mitarbeiter der Klinik für Anästhesiologie des UKHD

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

Date: August 19, 2024 Reference: Partyka et al. Serratus Anterior Plane Blocks for Early Rib Fracture Pain Management: The SABRE Randomized Clinical Trial. JAMA Surg 2024 Guest Skeptic: Dr. Sean Baldwin is an Emergency Physician practising in Sydney, Australia in both a large tertiary emergency department and a small regional emergency department. Interests include information […] The post SGEM#451: I've Become So Numb – Serratus Anterior Plane Blocks for Rib Fractures first appeared on The Skeptics Guide to Emergency Medicine.

VTE prophylaxis is more than just some squeezy leg socks and a one-size fits all dose of enoxaparin!  Ever wonder how VTE prophylaxis is similar to constipation?  Have you or a loved one been hurt by a hospital administrator telling you that VTE is a never event?  Come with us, and our special guest Dr. Bryan Cotton, on this journey to the frontier of research attempting to debunk this myth and improve patient care by reducing VTE rates in trauma patients.   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 - Brandon Parker, DO, Assistant Professor of Surgery, 5 years in practice University of Miami/Jackson Memorial Hospital/Ryder Trauma Center @BrandonParkerDO (X/twitter) - Bryan Cotton, MD, MPH, FACS, Professor of Surgery, 20 years in practice  University of Texas Health Science Center at Houston/Red Duke Trauma Institute at Memorial Herman Hospital @bryanacotton1 (X/twitter) Learning Objectives: - Describe the rationale for the addition of aspirin to chemoprophylactic regimens for VTE -  Identify appropriate screening systems for trauma patients at high risk for VTE -  Describe the rationale for monitoring anti factor Xa levels in the trauma population receiving VTE chemoprophylaxis - List the major conclusions of the two studies discussed regarding the addition of aspirin to VTE chemoprophylaxis regimens in trauma patients, and the change in antithrombin activity levels over time in relation to enoxaparin responsiveness in polytrauma patients Quick Hits: 1.     On adjusted analysis, the standard VTE PPX plus aspirin group had a lower OR of developing VTE, though limitations of this study highlight need for future prospective work 2.     Trauma patients often suffer from decreased activity of antithrombin 3, which may mediate the relatively higher rates of VTE in this population. 3.     Trauma patients who went on to develop VTE were more likely to not achieve satisfactory anti Xa levels, with a VTE rate of 30% in the never-responder group, the group for which Xa levels were never higher than 0.2 4.     Ex vivo supplementation of antithrombin seems to improve enoxaparin responsiveness.  Remember, enoxaparin and heparin are HELPING AT3, not the other way around References 1.     Lammers D, Scerbo M, Davidson A, et al. Addition of aspirin to venous thromboembolism chemoprophylaxis safely decreases venous thromboembolism rates in trauma patients. Trauma Surg Acute Care Open. 2023;8(1):e001140. doi:10.1136/tsaco-2023-001140 https://pubmed.ncbi.nlm.nih.gov/37936904/ 2.     Vincent LE, Talanker MM, Butler DD, et al. Association of Changes in Antithrombin Activity Over Time With Responsiveness to Enoxaparin Prophylaxis and Risk of Trauma-Related Venous Thromboembolism. JAMA Surg. 2022;157(8):713-721. doi:10.1001/jamasurg.2022.2214 https://pubmed.ncbi.nlm.nih.gov/35731524/ 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

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

How is each release of the TAR contributing to the final tension on the anterior and posterior fascia? Join Drs. Michael Rosen, Benjamin T. Miller, Sara Maskal, and Ryan C. Ellis as they discuss their group's recent cohort study of tensiometry in 100 TARs.  Hosts:  - Michael Rosen, Cleveland Clinic - Benjamin T. Miller, Cleveland Clinic - Sara Maskal, Cleveland Clinic - Ryan C. Ellis, Cleveland Clinic, @ryanellismd Learning objectives:  - Review the steps of a TAR - Understand the changes in tension on the anterior and posterior fascia with each step of the TAR - Think about the application this data has to similar operations References:  Miller BT, Ellis RC, Petro CC, Krpata DM, Prabhu AS, Beffa LRA, Huang LC, Tu C, Rosen MJ. Quantitative Tension on the Abdominal Wall in Posterior Components Separation With Transversus Abdominis Release. JAMA Surg. 2023 Dec 1;158(12):1321-1326. doi: 10.1001/jamasurg.2023.4847. PMID: 37792324; PMCID: PMC10551814. https://pubmed.ncbi.nlm.nih.gov/37792324/ Miller BT, Ellis RC, Walsh RM, Joyce D, Simon R, Almassi N, Lee B, DeBernardo R, Steele S, Haywood S, Beffa L, Tu C, Rosen MJ. Physiologic tension of the abdominal wall. Surg Endosc. 2023 Dec;37(12):9347-9350. doi: 10.1007/s00464-023-10346-w. Epub 2023 Aug 28. PMID: 37640951. https://pubmed.ncbi.nlm.nih.gov/37640951/ Ramirez OM, Ruas E, Dellon AL. "Components separation" method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg. 1990 Sep;86(3):519-26. doi: 10.1097/00006534-199009000-00023. PMID: 2143588. https://pubmed.ncbi.nlm.nih.gov/2143588/ Hope WW, Williams ZF, Rawles JW 3rd, Hooks WB 3rd, Clancy TV, Eckhauser FE. Rationale and Technique for Measuring Abdominal Wall Tension in Hernia Repair. Am Surg. 2018 Sep 1;84(9):1446-1449. PMID: 30268173. https://pubmed.ncbi.nlm.nih.gov/30268173/ 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

The American Board of Surgery In-Training Examination will officially be switching from reporting percentile scores by year level to percent of questions correct. What does this change mean for residents? Podcast hosts Dr. Ananya Anand, Dr. Joe L'Huillier, and Dr. Rebecca Moreci are joined by three fellow CoSEF members for this discussion: Dr. Gus Godley, Dr. Colleen McDermott, and Dr. Josh Roshal.  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. Gus Godley, University of Chicago, frederick.godley@uchicagomedicine.org, @GusGodley -Dr. Colleen McDermott, University of Utah, colleen.mcdermott@hsc.utah.edu -Dr. Josh Roshal, Brigham and Women's Hospital, jaroshal@utmb.edu, @Joshua_Roshal Learning Objectives:  Listeners will:  – Understand the changes to the ABSITE score reporting by the American Board of Surgery  – Describe both positive impacts and limitations of this change from the resident perspective – List possible ideas for further refinements to standardized exams in medicine   References:  -Yeo HL, Dolan PT, Mao J, Sosa JA. Association of Demographic and Program Factors With American Board of Surgery Qualifying and Certifying Examinations Pass Rates. JAMA Surg. Jan 1 2020;155(1):22-30. doi:10.1001/jamasurg.2019.4081 https://pubmed.ncbi.nlm.nih.gov/31617872/ -Sathe TS, Wang JJ, Yap A, Zhao NW, O'Sullivan P, Alseidi A. Proposed Reforms to the American Board of Surgery In-Training Examination (ABSITE). https://www.ideasurg.pub/proposed-absite-reforms/ -Miller AT, Swain GW, Midmar M, Divino CM. How Important Are American Board of Surgery In-Training Examination Scores When Applying for Fellowships? J Surg Educ. 2010;67(3):149-151. doi:10.1016/j.jsurg.2010.02.007  https://pubmed.ncbi.nlm.nih.gov/20630424/ -Savoie KB, Kulaylat AN, Huntington JT, Kelley-Quon L, Gonzalez DO, Richards H, Besner G, Nwomeh BC, Fisher JG. The pediatric surgery match by the numbers: Defining the successful application. J Pediatr Surg. 2020;55(6):1053-1057. doi:10.1016/j.jpedsurg.2020.02.052 https://pubmed.ncbi.nlm.nih.gov/32197826/ -Alnahhal KI, Lyden SP, Caputo FJ, Sorour AA, Rowe VL, Colglazier JJ, Smith BK, Shames ML, Kirksey L. The USMLE® STEP 1 Pass or Fail Era of the Vascular Surgery Residency Application Process: Implications for Structural Bias and Recommendations. Annals of Vascular Surgery. 2023;94:195-204. doi:10.1016/j.avsg.2023.04.018  https://pubmed.ncbi.nlm.nih.gov/37120072/ -Williams M, Kim EJ, Pappas K, Uwemedimo O, Marrast L, Pekmezaris R, Martinez J. The impact of United States Medical Licensing Exam (USMLE) step 1 cutoff scores on recruitment of underrepresented minorities in medicine: A retrospective cross‐sectional study. Health Sci Rep. 2020;3(2):e2161. doi:10.1002/hsr2.161 https://pubmed.ncbi.nlm.nih.gov/32318628/ -Lucey CR, Saguil A. The Consequences of Structural Racism on MCAT Scores and Medical School Admissions: The Past Is Prologue. Academic Medicine. 2020;95(3):351. doi:10.1097/ACM.0000000000002939 https://pubmed.ncbi.nlm.nih.gov/31425184/ -Natanson H, Svrluga S. The SAT is coming back at some colleges. It's stressing everyone out. Washington Post. https://www.washingtonpost.com/education/2024/03/18/sat-test-policies-confuse-students/. Published March 19, 2024. Accessed April 5, 2024. -de Virgilio C, Yaghoubian A, Kaji A, Collins JC, Deveney K, Dolich M, Easter D, Hines OJ, Katz S, Liu T, Mahmoud A, Melcher ML, Parks S, Reeves M, Salim A, Scherer L, Takanishi D, Waxman K.. Predicting Performance on the American Board of Surgery Qualifying and Certifying Examinations: A Multi-institutional Study. Archives of Surgery. 2010;145(9):852-856. doi:10.1001/archsurg.2010.177 https://pubmed.ncbi.nlm.nih.gov/20855755/ -Weighted test content from the ABS:  https://www.absurgery.org/wp-content/uploads/2023/01/GS-ITE.pdf -USMLE program announces upcoming policy changes | USMLE. Accessed April 9, 2024. https://www.usmle.org/usmle-program-announces-upcoming-policy-changes   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

In this second of a two part podcast special Iain and Simon go through twenty of the top papers from the last year or so, as presented by Simon at the Big Sick Conference in Zermatt earlier this year. All the details and more discussion can be found on the blog site. In Part 2 they discuss papers about major haemorrhage, trauma, cardiac arrest and more.  In Part 1 they discuss all things airway, including where we should be intubating patients needing immediate haemorrhage control. VL vs DL, the effect of blade size on intubation success, whether small adult ventilation bags are better than larger versions, intubating comatose poisoned patients, and more.  Papers Jansen JO et al. Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta in Trauma Patients With Exsanguinating Hemorrhage: The UK-REBOA Randomized Clinical Trial. JAMA. 2023 Nov 21;330(19):1862-1871. doi: 10.1001/jama.2023.20850. PMID: 37824132; PMCID: PMC10570916. Davenport R et al. Early and Empirical High-Dose Cryoprecipitate for Hemorrhage After Traumatic Injury: The CRYOSTAT-2 Randomized Clinical Trial. JAMA. 2023 Nov 21;330(19):1882-1891. doi: 10.1001/jama.2023.21019. PMID: 37824155; PMCID: PMC10570921. PATCH-Trauma Investigators and the ANZICS Clinical Trials Group; Prehospital Tranexamic Acid for Severe Trauma. N Engl J Med. 2023 Jul 13;389(2):127-136. doi: 10.1056/NEJMoa2215457. Epub 2023 Jun 14. PMID: 37314244. Shepherd JM et al Safety and efficacy of artesunate treatment in severely injured patients with traumatic hemorrhage. The TOP-ART randomized clinical trial. Intensive Care Med. 2023 Aug;49(8):922-933. doi: 10.1007/s00134-023-07135-3. Epub 2023 Jul 20. PMID: 37470832; PMCID: PMC10425486. Bouzat P et al. Efficacy and Safety of Early Administration of 4-Factor Prothrombin Complex Concentrate in Patients With Trauma at Risk of Massive Transfusion: The PROCOAG Randomized Clinical Trial. JAMA. 2023 Apr 25;329(16):1367-1375. doi: 10.1001/jama.2023.4080. PMID: 36942533; PMCID: PMC10031505. Torres CM, Kent A, Scantling D, Joseph B, Haut ER, Sakran JV. Association of Whole Blood With Survival Among Patients Presenting With Severe Hemorrhage in US and Canadian Adult Civilian Trauma Centers. JAMA Surg. 2023 May 1;158(5):532-540. doi: 10.1001/jamasurg.2022.6978. Erratum in: JAMA Surg. 2023 Apr 5;: PMID: 36652255; PMCID: PMC9857728. Marsden MER, Kellett S, Bagga R, Wohlgemut JM, Lyon RL, Perkins ZB, Gillies K, Tai NR. Understanding pre-hospital blood transfusion decision-making for injured patients: an interview study. Emerg Med J. 2023 Nov;40(11):777-784. doi: 10.1136/emermed-2023-213086. Epub 2023 Sep 13. PMID: 37704359; PMCID: PMC10646861. Wohlgemut JM, Pisirir E, Stoner RS, Kyrimi E, Christian M, Hurst T, Marsh W, Perkins ZB, Tai NRM. Identification of major hemorrhage in trauma patients in the prehospital setting: diagnostic accuracy and impact on outcome. Trauma Surg Acute Care Open. 2024 Jan 12;9(1):e001214. doi: 10.1136/tsaco-2023-001214. PMID: 38274019; PMCID: PMC10806521. Cheskes S, Verbeek PR, Drennan IR, McLeod SL, Turner L, Pinto R, Feldman M, Davis M, Vaillancourt C, Morrison LJ, Dorian P, Scales DC. Defibrillation Strategies for Refractory Ventricular Fibrillation. N Engl J Med. 2022 Nov 24;387(21):1947-1956. doi: 10.1056/NEJMoa2207304. Epub 2022 Nov 6. PMID: 36342151. Siddiqua N, Mathew R, Sahu AK, Jamshed N, Bhaskararayuni J, Aggarwal P, Kumar A, Khan MA. High-dose versus low-dose intravenous nitroglycerine for sympathetic crashing acute pulmonary edema: a randomised controlled trial. Emerg Med J. 2024 Jan 22;41(2):96-102. doi: 10.1136/emermed-2023-213285. PMID: 38050078. Wilkinson-Stokes M, Betson J, Sawyer S. Adverse events from nitrate administration during right ventricular myocardial infarction: a systematic review and meta-analysis. Emerg Med J. 2023 Feb;40(2):108-113. doi: 10.1136/emermed-2021-212294. Epub 2022 Sep 30. PMID: 36180168. Patterson T, Perkins GD, Perkins A, Clayton T, Evans R, Dodd M, Robertson S, Wilson K, Mellett-Smith A, Fothergill RT, McCrone P, Dalby M, MacCarthy P, Firoozi S, Malik I, Rakhit R, Jain A, Nolan JP, Redwood SR; ARREST trial collaborators. Expedited transfer to a cardiac arrest centre for non-ST-elevation out-of-hospital cardiac arrest (ARREST): a UK prospective, multicentre, parallel, randomised clinical trial. Lancet. 2023 Oct 14;402(10410):1329-1337. doi: 10.1016/S0140-6736(23)01351-X. Epub 2023 Aug 27. PMID: 37647928. Issa EC, Ware PJ, Bitange P, Cooper GJ, Galea T, Bengiamin DI, Young TP. The “Syringe Hickey”: An Alternative Skin Marking Method for Lumbar Puncture. J Emerg Med. 2023 Mar;64(3):400-404. doi: 10.1016/j.jemermed.2023.01.013. PMID: 37019501.

With the increasing popularity of artificial intelligence, its uses are quickly becoming not only a part of everyday life, but also training in surgery. Those of us without much understanding of the technology might be intimidated by this nebulous topic, or worry that we won't be able to comprehend the advancements to come to the field. Luckily, we're joined by a leading expert in the use of AI in surgery, Dr. Dan Hashimoto. He breaks down some examples of how AI is being used in surgical education, the role surgeons should play in these advancements, and some tips for how we can critically appraise work in the field of AI if we don't understand the technology ourselves. Join hosts Nicole Brooks, MD, Judith French, PhD and Jeremy Lipman, MD, MHPE for this exciting conversation.  Learning Objectives 1.     Listeners will describe how AI is being applied to surgical education. 2.     Listeners will identify the roles surgeons without training in AI can play in developing the use of AI in surgery.  3.     Listeners will explain the regulatory and ethical considerations that must be addressed with the implementation of AI in surgical education.  4.     Listeners will consider principles for critically evaluating research or technology in AI for application or use in their own educational or surgical practice. References Laplante S, Namazi B, Kiani P, Hashimoto DA, Alseidi A, Pasten M, Brunt LM, Gill S, Davis B, Bloom M, Pernar L, Okrainec A, Madani A. Validation of an artificial intelligence platform for the guidance of safe laparoscopic cholecystectomy. Surg Endosc. 2023 Mar;37(3):2260-2268. doi: 10.1007/s00464-022-09439-9. Epub 2022 Aug 2. PMID: 35918549. https://pubmed.ncbi.nlm.nih.gov/35918549/ Hashimoto DA, Varas J, Schwartz TA. Practical Guide to Machine Learning and Artificial Intelligence in Surgical Education Research. JAMA Surg. 2024 Jan 3. doi: 10.1001/jamasurg.2023.6687. Epub ahead of print. PMID: 38170510. https://pubmed.ncbi.nlm.nih.gov/38170510/ We now have over 725 episodes!  The easiest way to find specific topics or episodes is on our website https://app.behindtheknife.org/home or on our new Apple/Android app.  You can search or browse by topic, podcast series, etc., making it much easier to navigate than podcast players.  iOS: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android: https://play.google.com/store/apps/details?id=com.btk.app PREMIUM BUNDLE: https://app.behindtheknife.org/bundle/95 Please email hello@behindtheknife.org to learn more about our premium bundle and institutional discounts. Premium Bundle Includes: General Surgery Oral Board Audio Review Trauma Surgery Video Atlas Colorectal Surgery Oral Board Audio Review Surgical Oncology Surgery Oral Board Audio Review Vascular Surgery Surgery Oral Board Audio Review Cardiothoracic Surgery Surgery Oral Board Audio Review

Join BTK eduction fellows, Drs. Nina Clark and Jon Williams along with guests Drs. Sharmila Dissanaike and Paula Ferrada for a discussion on whether it's time for a paradigm shift toward a circulation-first approach to trauma resuscitation. Hosts: Nina Clark, MD and Jon Williams, MD Guests: Sharmila Dissanaike, MD - Texas Tech University Health Sciences Center, Lubbock, TX Paula Ferrada, MD - Inova, Fairfax, VA References: Ferrada P, Dissanaike S. Circulation First for the Rapidly Bleeding Trauma Patient-It Is Time to Reconsider the ABCs ofTrauma Care. JAMA Surg. 2023 Aug 1;158(8):884-885. doi: 10.1001/jamasurg.2022.8436. PMID: 37195675. https://pubmed.ncbi.nlm.nih.gov/37195675/ Ferrada P, Ferrada R, Jacobs L, Duchesne J, Ghio M, Joseph B, Taghavi S, Qasim ZA, Zakrison T, Brenner M,Dissanaike S, Feliciano D. Prioritizing Circulation to Improve Outcomes for Patients with Exsanguinating Injury: ALiterature Review and Techniques to Help Clinicians Achieve Bleeding Control. J Am Coll Surg. 2024 Jan 1;238(1):129-136. doi: 10.1097/XCS.0000000000000889. Epub 2023 Nov 28. PMID: 38014850; PMCID: PMC10718219. https://pubmed.ncbi.nlm.nih.gov/38014850/ ***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

2023 was an exciting year for Surgical Palliative Care research! Join Drs. Katie O'Connell, Ali Haruta, Lindsay Dickerson, and Virginia Wang from the University of Washington to discuss two seminal randomized controlled trials in the Surgical Palliative Care space. 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 Hospice & 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: ·    Discuss the current state of the RCT literature in Palliative Care & Surgical Palliative Care ·    Understand the primary outcomes of the Shinall and Aslakson trials as related to perioperative specialty palliative care intervention ·    Identify limitations in existing surgical palliative care RCTs & further opportunities for study ·    Identify underlying differences between medical oncology and surgical oncology patient populations References: 1.  Shinall MC, Martin SF, Karlekar M, et al. Effects of Specialist Palliative Care for Patients Undergoing Major Abdominal Surgery for Cancer: A Randomized Clinical Trial. JAMA Surg. 2023;158(7):747–755. doi:10.1001/jamasurg.2023.1396 https://pubmed.ncbi.nlm.nih.gov/37163249/ 2.  Aslakson RA, Rickerson E, Fahy B, et al. Effect of Perioperative Palliative Care on Health-Related Quality of Life Among Patients Undergoing Surgery for Cancer: A Randomized Clinical Trial. JAMA Netw Open. 2023;6(5):e2314660. doi:10.1001/jamanetworkopen.2023.14660 https://pubmed.ncbi.nlm.nih.gov/37256623/ 3.  Ingersoll LT, Alexander SC, Priest J, et al. Racial/ethnic differences in prognosis communication during initial inpatient palliative care consultations among people with advanced cancer. Patient Educ Couns. 2019;102(6):1098-1103. doi:10.1016/j.pec.2019.01.002 https://pubmed.ncbi.nlm.nih.gov/30642715/ 4.  Bakitas M, Lyons KD, Hegel MT, et al. Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the Project ENABLE II randomized controlled trial. JAMA. 2009;302(7):741-749. doi:10.1001/jama.2009.1198 https://pubmed.ncbi.nlm.nih.gov/19690306/ 5.  Corn BW, Feldman DB, Hull JG, O'Rourke MA, Bakitas MA. Dispositional hope as a potential outcome parameter among patients with advanced malignancy: An analysis of the ENABLE database. Cancer. 2022;128(2):401-409. doi:10.1002/cncr.33907 https://pubmed.ncbi.nlm.nih.gov/34613617/ 6.  El-Jawahri A, LeBlanc TW, Kavanaugh A, et al. Effectiveness of Integrated Palliative and Oncology Care for Patients With Acute Myeloid Leukemia: A Randomized Clinical Trial. JAMA Oncol. 2021;7(2):238-245. doi:10.1001/jamaoncol.2020.6343 https://pubmed.ncbi.nlm.nih.gov/33331857/ 7.  More about the metrics from both the Shinall and Aslakson studies: a.     FACT-G – https://www.facit.org/measures/fact-g b.     FACIT-Pal – https://www.facit.org/measures/facit-pal c.     PROMIS-29 – https://heartbeat-med.com/resources/promis-29/ d.     PROPr (PROMIS-Preference) score – https://www.proprscore.com/ ***Fellowship Application - https://forms.gle/5fbYJ1JXv3ijpgCq9*** 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://app.behindtheknife.org/podcast-category/palliative-care

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.  

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.  

Making a discovery that changes how we practice is one of the most exciting things about the fields of medicine and surgery. In this episode, join endocrine surgeons Drs. Barb Miller, John Phay, Priya Dedhia, and Surgical Oncology Fellow Dr. Samantha Ruff from The Ohio State University. Hear Dr. Phay tell the story of how parathyroid autofluorescence was discovered and the work that has gone on since that day. The group discusses several articles focusing on intraoperative adjuncts used to identify parathyroid tissue during thyroid and parathyroid surgery.  Hosts: Barbra S. Miller, MD (Moderator), Clinical Professor of Surgery, John Phay, MD, Clinical Professor of Surgery, Priya H. Dedhia, MD, PhD, Assistant Professor of Surgery, Samantha Ruff, MD, Surgical Oncology Fellow, Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio. Twitter handles:  Barbra Miller - @OSUEndosurgBSM John Phay – @JohnPhayMD Priya Dedhia – @priyaknows  Samantha Ruff - @SamRuff_MD Learning objectives:  1) Understand the background of the discovery of parathyroid autofluorescence 2) Describe various intraoperative adjuncts utilized to identify parathyroid tissue 3) Compare and contrast the advantages and disadvantages of using autofluorescence versus indocyanine green for identification of parathyroid tissue   4) Recognize the impact of use of intraoperative imaging adjuncts on postoperative hypocalcemia (short and long-term) 5) Understand the general safety issues for the parathyroid imaging techniques discussed References: 1. Benmiloud, F., G. Godiris-Petit, R. Gras, et al., Association of Autofluorescence-Based Detection of the Parathyroid Glands During Total Thyroidectomy With Postoperative Hypocalcemia Risk: Results of the PARAFLUO Multicenter Randomized Clinical Trial. JAMA Surg, 2020. 155(2): p. 106-12 DOI: 10.1001/jamasurg.2019.4613. https://pubmed.ncbi.nlm.nih.gov/31693081/ 2. Kahramangil, B. and E. Berber, Comparison of indocyanine green fluorescence and parathyroid autofluorescence imaging in the identification of parathyroid glands during thyroidectomy. Gland Surg, 2017. 6(6): p. 644-8 DOI: 10.21037/gs.2017.09.04. https://pubmed.ncbi.nlm.nih.gov/29302480/ 3. Paras, C., M. Keller, L. White, et al., Near-infrared autofluorescence for the detection of parathyroid glands. J Biomed Opt, 2011. 16(6): p. 067012 DOI: 10.1117/1.3583571. https://pubmed.ncbi.nlm.nih.gov/21721833/ 4. Vidal Fortuny, J., V. Belfontali, S.M. Sadowski, et al., Parathyroid gland angiography with indocyanine green fluorescence to predict parathyroid function after thyroid surgery. Br J Surg, 2016. 103(5): p. 537-43 DOI: 10.1002/bjs.10101. https://pubmed.ncbi.nlm.nih.gov/26864909/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out other Behind the Knife endocrine episodes: https://behindtheknife.org/podcast-category/endocrine/

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.  

In unserer neuen Folge besprechen wir den Einfluss guter Zusammenarbeit zwischen Chirurgen und Anästhesisten auf das postoperative Ergebnis nach komplexer Oberbauchchirurgie. Die Autoren kommen aus dem schönen kanadischen Bundesstaat Ontario. Außerdem beantworten wir eine Hörerfrage. Viel Spaß Hallet J, Sutradhar R, Jerath A, d'Empaire PP, Carrier FM, Turgeon AF, McIsaac DI, Idestrup C, Lorello G, Flexman A, Kidane B, Kaliwal Y, Chan WC, Barabash V, Coburn N, Eskander A. Association Between Familiarity of the Surgeon-Anesthesiologist Dyad and Postoperative Patient Outcomes for Complex Gastrointestinal Cancer Surgery. JAMA Surg. 2023 May 1;158(5):465-473. doi: 10.1001/jamasurg.2022.8228. Erratum in: JAMA Surg. 2023 Apr 5;: PMID: 36811886; PMCID: PMC9947805.

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.  

Welcome to Episode 7 of the BSCOS Paediatric Orthopaedic Digest (POD)cast with guest Mr Alwyn Abraham @AlwynUK from Leicester Royal Infirmary! He's a true all-rounder as a paediatric orthopaedic & adult limb reconstruction surgeon, current clinical lead, Training Programme Director & keen on global health including developing a partnership with Gondar, North Ethiopia!    We scoured 35 journals & highlighted the most impactful studies that we feel can change practice or improve outcomes in Paediatric Orthopaedics.  Follow Updates on @BSCOS_UK    REFERENCES: 1.    The Incidence of Posttraumatic Stress Symptoms in Children. May et al. J Am Acad Orthop Surg Glob Res Rev. August 2023. PMID: 37579777   2.    Comparison of Clinical Prediction Rules in Pre-school Aged Children With Septic Hip Arthritis Due to Different Pathogens. Hagedoorn et al. J Pediatr Orthop. September 2023. PMID: 37253715   3.    Surgical treatment of septic arthritis of the hip in children: arthrotomy compared with repeated aspiration-lavage. Cohen et al. Int Orthop. June 2023. PMID: 36899196   4.    How common are refractures in childhood? Amilon et al. Bone Joint J. August 2023. PMID: 37524339   5.    Slow-motion smartphone video improves interobserver reliability of gait assessment in ambulatory cerebral palsy. Brodke et al. J Child Orthop. June 2023. PMID: 37565008   6.    The role of Gender in Operative Autonomy in orthopaedic Surgical Trainees (GOAST). Downie S, BORCo Collaborative et al. Bone Joint J. July 2023.PMID: 37399113.   7.    Surgeon Sex and Long-Term Postoperative Outcomes Among Patients Undergoing Common Surgeries. Wallis et al. JAMA Surg. August 2023. PMID: 37647075   8.    Faster Rate of Correction with Distal Femoral Transphyseal Screws Versus Plates in Hemiepiphysiodesis for Coronal-Plane Knee Deformity: Age- and Sex-Matched Cohorts of Skeletally Immature Patients. McGinley et al. J Bone Joint Surg Am. August 2023. PMID: 37418510.   9.    Peri-Implant Fracture After Distal Femur Percutaneous Epiphysiodesis Using Transphyseal Screws. Shaw KG & Sanders J. J POSNA. May 2023.    10. Predicting Rates of Angular Correction After Hemiepiphysiodesis in Patients With X-Linked Hypophosphatemic Rickets. Grote et al. J Pediatr Orthop. July 2023. PMID: 36952253   11. Ultrasonography or Radiography for Suspected Pediatric Distal Forearm Fractures. Snelling et al (BUCKLED Trial Group). N Engl J Med. June 2023. PMID: 37256975   12.  Reliability and Reference Norms of Single Heel-Rise Test Among Children: A Cross-sectional Study. Mishra et al. J Foot Ankle Surg. May-June 2023.  PMID: 36396548     Follow Hosts: @AnishPSangh @AlpsKothari @Pranai_B See you all in December for the Christmas 2023 Episode!!!   

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/

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/

Join Drs. Tatiana Cardenas, Liz Dauer and Zaffer Qasim chat with Drs. Paula Ferrada and Sharven Taghavi about ED vs OR intubation in patients with hemorrhagic shock.  They address  ABC vs CAB, the physiology of intubation of patients in shock and reconsidering the dogma.   Supplemental Material:  Ferrada P, Dissanaike S. Circulation First for the Rapidly Bleeding Trauma Patient-It Is Time to Reconsider the ABCs of Trauma Care. JAMA Surg. 2023 May 17. doi: 10.1001/jamasurg.2022.8436. Epub ahead of print. PMID: 37195675.

Have you transitioned a portion of your practice to the robot, but would be hesitant to book an urgent/call case on the robot? Have you wondered if the robot might be useful in your emergency or acute care surgery practice? Join University of Washington MIS Surgeons, Drs. Andrew Wright, Nicole White, and Nick Cetrulo, and Resident Drs. Ben Vierra and Paul Herman as they discuss the growing use of the robot for acute cases and provide tips on appropriate case selection.  Hosts:  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  Learning objectives:   - Describe the importance of the MIS approach in EGS  - Review 3 articles on robotic EGS outcomes  1) Robotic surgery in emergency setting: 2021 WSES position paper  2) Emergent robotic versus laparoscopic surgery for perforated gastrojejunal ulcers: a retrospective cohort study of 44 patients  3) Urgent robotic subtotal colectomy for severe acute ulcerative colitis has comparable periop outcomes to laparoscopic surgery  - Discuss factors influencing appropriate case selection for urgent/emergent robotic cases  - Discuss value as it pertains to robotic EGS  References  1.     Havens JM, Peetz AB, Do WS, Cooper Z, Kelly E, Askari R, Reznor G, Salim A. The excess morbidity and mortality of emergency general surgery. J Trauma Acute Care Surg. 2015 Feb;78(2):306-11. doi: 10.1097/TA.0000000000000517. PMID: 25757115.  2.     Scott JW, Olufajo OA, Brat GA, Rose JA, Zogg CK, Haider AH, Salim A, Havens JM. Use of National Burden to Define Operative Emergency General Surgery. JAMA Surg. 2016 Jun 15;151(6):e160480. doi: 10.1001/jamasurg.2016.0480. Epub 2016 Jun 15. PMID: 27120712.   3.     Arnold M, Elhage S, Schiffern L, Lauren Paton B, Ross SW, Matthews BD, Reinke CE. Use of minimally invasive surgery in emergency general surgery procedures. Surg Endosc. 2020 May;34(5):2258-2265. doi: 10.1007/s00464-019-07016-1. Epub 2019 Aug 6. PMID: 31388806.  4.     Sheetz KH, Claflin J, Dimick JB. Trends in the Adoption of Robotic Surgery for Common Surgical Procedures. JAMA Netw Open. 2020 Jan 3;3(1):e1918911. doi: 10.1001/jamanetworkopen.2019.18911. PMID: 31922557; PMCID: PMC6991252.   5.     de'Angelis N, Khan J, Marchegiani F, Bianchi G, Aisoni F, Alberti D, Ansaloni L, Biffl W, Chiara O, Ceccarelli G, Coccolini F, Cicuttin E, D'Hondt M, Di Saverio S, Diana M, De Simone B, Espin-Basany E, Fichtner-Feigl S, Kashuk J, Kouwenhoven E, Leppaniemi A, Beghdadi N, Memeo R, Milone M, Moore E, Peitzmann A, Pessaux P, Pikoulis M, Pisano M, Ris F, Sartelli M, Spinoglio G, Sugrue M, Tan E, Gavriilidis P, Weber D, Kluger Y, Catena F. Robotic surgery in emergency setting: 2021 WSES position paper. World J Emerg Surg. 2022 Jan 20;17(1):4. doi: 10.1186/s13017-022-00410-6. PMID: 35057836; PMCID: PMC8781145.   6.     Robinson TD, Sheehan JC, Patel PB, Marthy AG, Zaman JA, Singh TP. Emergent robotic versus laparoscopic surgery for perforated gastrojejunal ulcers: a retrospective cohort study of 44 patients. Surg Endosc. 2022 Feb;36(2):1573-1577. doi: 10.1007/s00464-021-08447-5. Epub 2021 Mar 24. PMID: 33760973.   7.     Anderson M, Lynn P, Aydinli HH, Schwartzberg D, Bernstein M, Grucela A. Early experience with urgent robotic subtotal colectomy for severe acute ulcerative colitis has comparable perioperative outcomes to laparoscopic surgery. J Robot Surg. 2020 Apr;14(2):249-253. doi: 10.1007/s11701-019-00968-5. Epub 2019 May 10. PMID: 31076952.  8.     Gangemi A, Danilkowicz R, Bianco F, Masrur M, Giulianotti PC. Risk Factors for Open Conversion in Minimally Invasive Cholecystectomy. JSLS. 2017 Oct-Dec;21(4):e2017.00062. doi: 10.4293/JSLS.2017.00062. PMID: 29238153; PMCID: PMC5714218.  9.     Bhama AR, Wafa AM, Ferraro J, Collins SD, Mullard AJ, Vandewarker JF, Krapohl G, Byrn JC, Cleary RK. Comparison of Risk Factors for Unplanned Conversion from Laparoscopic and Robotic to Open Colorectal Surgery Using the Michigan Surgical Quality Collaborative (MSQC) Database. J Gastrointest Surg. 2016 Jun;20(6):1223-30. doi: 10.1007/s11605-016-3090-6. Epub 2016 Feb 3. PMID: 26847352.  10.   https://www.east.org/about-east/news-and-events/news/details/320/east-robotic-surgery-for-the-acute-care-surgeon-webinar-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 MIS episodes here: https://behindtheknife.org/podcast-category/minimally-invasive/

Andrew Gabrielson, MD (@urogabe) is currently a resident at the Brady Urological Institute and Department of Urology at Johns Hopkins.  He is a budding pediatric urologist and developed an interest in surgical ergonomics and physical well-being before he started residency.  He is an integral member of the Society of Surgical Ergonomics and well-published in the field despite his young age!  He gives us lots of practical knowledge for the operating room (how to stand, how to set up your room, gel pads and shoes!) and a framework for incorporating ergonomics as a thought process to enhance our physical well-being as surgeons.  In addition, he talks about his experience and how following an interest piqued during undergraduate and medical school turned into a passion for the remainder of his professional life!  Enjoy!  Lots of links below including data supporting a lot of the discussion. Society of Surgical Ergonomicshttps://www.societyofsurgicalergonomics.org/Twitter: @SocSurgErgo Epidemiology of work-related pain among surgeonsEpstein, S. et al. Prevalence of work- related musculoskeletal disorders among surgeons and interventionalists: a systematic review and meta-analysis. JAMA Surg. 153, e174947–e174947 (2018).Stucky, C. H. et al. Surgeon symptoms, strain, and selections: systematic review and meta- analysis of surgical ergonomics. Ann. Med. Surg. 27, 1–8 (2018)Intraoperative and perioperative stretchingPark, A. E. et al. Intraoperative “Micro Breaks” with targeted stretching enhance surgeon physical function and mental focus: a multicenter cohort study. Ann. Surg. 265, 340–346 (2017).Hallbeck, M. S. et al. The impact of intraoperative microbreaks with exercises on surgeons: a multicenter cohort study. Appl. Ergon. 60, 334–341 (2017).Dorion, D. & Darveau, S. Do micropauses prevent surgeon's fatigue and loss of accuracy associated with prolonged surgery? An experimental prospective study. Ann. Surg. 257, 256–259 (2013).Monitor Placementvan Det, M. J., Meijerink, W. J., Hoff, C., Totte, E. R. & Pierie, J. P. Optimal ergonomics for laparoscopic surgery in minimally invasive surgery suites: a review and guidelines. Surg. Endosc. 23, 1279–1285 (2009).Omar, A. M., Wade, N. J., Brown, S. I. & Cuschieri, A. Assessing the benefits of “gaze- down” display location in complex tasks. Surg. Endosc. 19, 105–108 (2005).Erfanian, K., Luks, F. I., Kurkchubasche, A. G., Wesselhoeft, C. W. Jr. & Tracy, T. F. Jr. In- line image projection accelerates task performance in laparoscopic appendectomy. J. Pediatr. Surg. 38, 1059–1062 (2003).Hanna, G. B., Shimi, S. M. & Cuschieri, A. Task performance in endoscopic surgery is influenced by location of the image display. Ann. Surg. 227, 481–484 (1998).Table HeightBerguer, R., Smith, W. D. & Davis, S. An ergonomic study of the optimum operating table height for laparoscopic surgery. Surg. Endosc. 16, 416–421 (2002).van Veelen, M. A., Kazemier, G., Koopman, J., Goossens, R. H. & Meijer, D. W. Assessment of the ergonomically optimal operating surface height for laparoscopic surgery. J. Laparoendosc. Adv. Surg. Tech. A. 12, 47–52 (2002).Manasnayakorn, S., Cuschieri, A. & Hanna, G. B. Ergonomic assessment of optimum operating table height for hand- assisted laparoscopic surgery. Surg. Endosc. 23, 783–789 (2009).Gel matsHaramis, G. et al. Prospective randomized evaluation of FOOT gel pads for operating room staff COMFORT during laparoscopic renal surgery. Urology 76, 1405–1408 (2010).Graversen, J. A. et al. Prospective randomized evaluation of gel mat foot pads in the endoscopic suite. J. Endourol. 25, 1793–1796 (2011).Cognitive ErgonomicsChrouser KL

In unserer neuen Folge sprechen wir über die unterschiedlichen Typen der totalen Pankreatektomie und ihre jeweilige postoperative Morbidität. Diesbezüglich diskutieren wir spannende Daten aus Heidelberg. Über 1000 Datensätze wurden hierfür ausgewertet. Außerdem thematisieren wir Kontraindikationen der Vacuumtherapie. Loos M, Al-Saeedi M, Hinz U, Mehrabi A, Schneider M, Berchtold C, Müller-Stich BP, Schmidt T, Kulu Y, Hoffmann K, Strobel O, Hackert T, Büchler MW. Categorization of Differing Types of Total Pancreatectomy. JAMA Surg. 2022 Feb 1;157(2):120-128. doi: 10.1001/jamasurg.2021.5834. PMID: 34787667; PMCID: PMC8600456.

Please join BTK's Dr. Nina Clark and Dr. Shreya Gupta for a discussion with Dr. Edward Barksdale on the important and sensitive topic of the underrepresented in medicine.   Society of Black Academic Surgeons: https://www.sbas.net/ References:  Yeo HL, Abelson JS, Symer MM, Mao J, Michelassi F, Bell R, Sedrakyan A, Sosa JA. Association of Time to Attrition in Surgical Residency With Individual Resident and Programmatic Factors. JAMA Surg. 2018 Jun 1;153(6):511-517. doi: 10.1001/jamasurg.2017.6202. PMID: 29466536; PMCID: PMC5875388. McFarling, U.L. ‘It was stolen from me': Black doctors are forced out of training programs at far higher rates than white residents. STAT. 6/20/2022. Accessed online: 10/1/2022. https://www.statnews.com/2022/06/20/black-doctors-forced-out-of-training-programs-at-far-higher-rates-than-white-residents/ Haruno LS, Chen X, Metzger M, et al. Racial and Sex Disparities in Resident Attrition Among Surgical Subspecialties. JAMA Surg. Published online February 08, 2023. doi:10.1001/jamasurg.2022.7640 **Fellowship application link: https://forms.gle/PiKM2MMQpE5jSAeW7 Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out other recent episodes here: https://behindtheknife.org/listen/

In this episode, Dr. Elliot Richards, a true physician-scientist and Director of Research in the Department of Reproductive Endocrinology and Infertility at the Cleveland Clinic, shares about his experience and studies regarding uterine transplant. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/jcX2MH --- SHOW NOTES Dr. Richards describes uterine transplant in the modern era as truly “patient-driven” and due to “patient-demand.” He begins the episode by detailing the history of uterine transplant, which was initially attempted in the 1930s, even before the first successful renal transplant 20 years later. More recently, successful uterine transplants were first conducted in Saudi Arabia, Sweden, Turkey, and now in a few United States institutions (e.g. Cleveland Clinic, University of Alabama at Birmingham, University of Pennsylvania, and Baylor). He then addresses arguments or concerns against uterine transplant. Ultimately, Dr. Richards encourages listeners to identify infertility as a disease and one that warrants treatment, prompting the use of uterine transplant. The physicians then discuss the process of uterine transplant. In current trials, the majority of patients are people with a diagnosis of mullein agenesis. Dr. Richards highlights that this population does not reflect the actual population that suffers from absolute uterine factor infertility (AUFI) and that he hopes that access to the procedure will expand for a more diverse patient population. He then describes the types of uterine donors (e.g., directed donor, non-director donor, deceased donor model, etc.) that are utilized by different institutions; the surgical process of the transplant itself; immunosuppression and pregnancy; as well as fertilization via IVF. The episode ends with Dr. Richards discussing success rates by citing his prior studies, which includes a 74% 1-year graft survival and 83% live birth rate among those with a viable graft at 1 year. Specifically within the Cleveland Clinic study population, one patient delivered the first second baby last September. Future directions regarding uterine transplant include better understanding the costs of the procedure, shortage of available donors, identifying the true demand, leveraging minimally invasive surgical techniques, and fallopian tube preservation. --- RESOURCES “The Danish Girl” 2015 film directed by Tim Hooper “Uterus Transplant Animation Recipient” by Cleveland Clinic - ​​https://www.youtube.com/watch?v=13DwQ0HbuXc “Cleveland Clinic Delivers Second Baby from Uterus Transplant” by Cleveland Clinic - https://www.youtube.com/watch?v=XJuedpL14AQ Lefkowitz A, Edwards M, Balayla J. The Montreal Criteria for the Ethical Feasibility of Uterine Transplantation. Transpl Int. 2012 Apr;25(4):439-47. Johannesson L, Richards E, Reddy V, Walter J, Olthoff K, Quintini C, Tzakis A, Latif N, Porrett P, O'Neill K, Testa G. The First 5 Years of Uterus Transplant in the US: A Report From the United States Uterus Transplant Consortium. JAMA Surg. 2022 Sep 1;157(9):790-797.

Please join BTK education fellow, Nina Clark, MD (University of Washington) along with Elina Serrano, MD, MPH (University of Washington) and Minerva Romero Arenas, MD (Weill Cornell Medicine) for a discussion inspired by the experience of trainees who are underrepresented in medicine.   Latino Surgical Society: https://www.latinosurgicalsociety.org/ Society of Black Academic Surgeons: https://www.sbas.net/ References:  Yeo HL, Abelson JS, Symer MM, Mao J, Michelassi F, Bell R, Sedrakyan A, Sosa JA. Association of Time to Attrition in Surgical Residency With Individual Resident and Programmatic Factors. JAMA Surg. 2018 Jun 1;153(6):511-517. doi: 10.1001/jamasurg.2017.6202. PMID: 29466536; PMCID: PMC5875388. McFarling, U.L. ‘It was stolen from me': Black doctors are forced out of training programs at far higher rates than white residents. STAT. 6/20/2022. Accessed online: 10/1/2022. https://www.statnews.com/2022/06/20/black-doctors-forced-out-of-training-programs-at-far-higher-rates-than-white-residents/ Haruno LS, Chen X, Metzger M, et al. Racial and Sex Disparities in Resident Attrition Among Surgical Subspecialties. JAMA Surg. Published online February 08, 2023. doi:10.1001/jamasurg.2022.7640 **Fellowship application link: https://forms.gle/PiKM2MMQpE5jSAeW7 Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out other recent episodes here: https://behindtheknife.org/listen/

In this episode the Endocrine Surgery team at BTK goes over two cases to review the American Association of Endocrine Surgeons Guidelines for Adrenalectomy.  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. Na Eun Kim 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  Yip L, Duh QY, Wachtel H, Jimenez C, Sturgeon C, Lee C, Velázquez-Fernández D, Berber E, Hammer GD, Bancos I, Lee JA, Marko J, Morris-Wiseman LF, Hughes MS, Livhits MJ, Han MA, Smith PW, Wilhelm S, Asa SL, Fahey TJ 3rd, McKenzie TJ, Strong VE, Perrier ND. American Association of Endocrine Surgeons Guidelines for Adrenalectomy: Executive Summary. JAMA Surg. 2022 Oct 1;157(10):870-877. doi: 10.1001/jamasurg.2022.3544. PMID: 35976622; PMCID: PMC9386598. Schumm M, Hu MY, Sant V, Kim J, Tseng CH, Sanz J, Raman S, Yu R, Livhits M. Automated extraction of incidental adrenal nodules from electronic health records. Surgery. 2023 Jan;173(1):52-58. doi: 10.1016/j.surg.2022.07.028. Epub 2022 Oct 4. PMID: 36207197. M. Conall Dennedy, Anand K. Annamalai, Olivia Prankerd-Smith, Natalie Freeman, Kuhan Vengopal, Johann Graggaber, Olympia Koulouri, Andrew S. Powlson, Ashley Shaw, David J. Halsall, Mark Gurnell, Low DHEAS: A Sensitive and Specific Test for the Detection of Subclinical Hypercortisolism in Adrenal Incidentalomas, The Journal of Clinical Endocrinology & Metabolism, Volume 102, Issue 3, 1 March 2017, Pages 786–792, https://doi.org/10.1210/jc.2016-2718 Amar, L., Pacak, K., Steichen, O. et al. International consensus on initial screening and follow-up of asymptomatic SDHx mutation carriers. Nat Rev Endocrinol 17, 435–444 (2021). https://doi.org/10.1038/s41574-021-00492-3 **Fellowship application link: https://forms.gle/PiKM2MMQpE5jSAeW7 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/

Join the Behind the Knife HPB team as we dive deeper into the complex world of IPMNs with a journal article review of a recent JAMA Surgery publication and the first author of the article! Learning Objectives: In this episode, we discuss the article, “Progression vs Cyst Stability of Branch-Duct Intraductal Papillary Mucinous Neoplasms After Observation and Surgery.”  This article describes a multicenter retrospective study of centers in Italy, Korea, Singapore, and the US that specifically assessed what dynamic variables are associated with malignant progression in pathologically proven IMPNs under at least a year of initial surveillance.  Hosts: Timothy Vreeland, MD, FACS (@vreelant) is an Assistant Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center Daniel Nelson, DO, FACS (@DWNelsonHPB) is an Associate Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at William Beaumont Army Medical Center Connor Chick, MD (@connor_chick) is a PGY-6 General Surgery resident at Brooke Army Medical Center Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a PGY-5 General Surgery resident at Brooke Army Medical Center Beth Carpenter, MD (@elizcarpenter16) is a PGY-4 General Surgery resident at Brooke Army Medical Center Guest:  Dr. Giovanni Marchegiani is a pancreas surgeon within the department of general and pancreatic surgery at the University of Verona in Italy.  His research interests include exocrine and cystic neoplasms of the pancreas.  He is the first author of the study discussed in the episode in addition to over 100 additional scientific, peer-reviewed articles. Journal Article: 1.     Marchegiani G, Pollini T, Andrianello S, et al. Progression vs Cyst Stability of Branch-Duct Intraductal Papillary Mucinous Neoplasms After Observation and Surgery. JAMA Surg. 2021;156(7):654–661. doi:10.1001/jamasurg.2021.1802 Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out other HPB episodes here: https://behindtheknife.org/podcast-category/hepatobiliary/

Dr. Justin Kreuter, Transfusion Medicine attending at Mayo Clinic, joins Alex and Venk on the podcast to talk about transfusion in its many dimensions. We talk through a model of evaluation for patients with life threatening bleeding, how to interpret tests, the science behind the 1:1:1 ratio of trauma transfusion practice and much much more! CONTACTS Twitter - @AlwaysOnEM; @VenkBellamkonda; @KreuterMD Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch; @KreuterMD Email - AlwaysOnEM@gmail.com REFERENCES & LINKS Lab medicine rounds podcast link: https://news.mayocliniclabs.com/homepage/podcasts-2/lab-medicine-rounds/ Holcomb JB, Tilley BC, Baraniuk S, et al. Transfusion of plasma, plaeteles, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma – the PROPPR Randomized Clinical Trial. JAMA. 2015; 313(5):471-482 Holcomb JB, Del Junco DJ, Fox EE, et al. The prospective observational multicenter major trauma transfusion (PROMTT) study: comparative effectiveness of a time-varying treatment with competing risks. JAMA Surg. 2013 Feb;148(2):127-136 J-Y Borg et al. FEIBA in the treatment of acquired hemophilia A: results from the prospective multicentre French ‘FEIBA dans l'hemophilie A acquise' (FEIBHAC) registry. Haemophilia. 2015 May;21(3):330-337 Sharp G, Young CJ. Point of care viscoelastic assay devices (rotational thromboelastometry and thromboelastography): a primer or surgeons. Anz J Surg. 2019 Apr;89(4):291-295 Hospital Liaison Committee for Jehovah's Witnesses: https://www.jw.org/en/medical-library/strategies-downloads/hospital-liaison-committees-jehovahs-witnesses/

In unserer neuen Folge sprechen wir über Sinn und Unsinn der robotischen Leistenhernienversorgung. Die RIVAL-Studie aus den USA nahm sich im Jahre 2020 dieser Thematik an. Außerdem sprechen wir aus gegebenen Anlass über Entwicklungshilfe in Ruanda. Prabhu AS, Carbonell A, Hope W, Warren J, Higgins R, Jacob B, Blatnik J, Haskins I, Alkhatib H, Tastaldi L, Fafaj A, Tu C, Rosen MJ. Robotic Inguinal vs Transabdominal Laparoscopic Inguinal Hernia Repair: The RIVAL Randomized Clinical Trial. JAMA Surg. 2020 May 1;155(5):380-387. doi: 10.1001/jamasurg.2020.0034. PMID: 32186683; PMCID: PMC7081145.

In this episode, our team discusses the recent paper from JAMA Surgery Association of Whole Blood With Survival Among Patients Presenting With Severe Hemorrhage in US and Canadian Adult Civilian Trauma Centers. Join us as we explore some of the history of blood transfusions, how we got to where we are today, and the role whole blood transfusion may play going forward Hosts:  Elliott R. Haut, MD, PhD, a senior, nationally recognized name in trauma and acute care surgery at Johns Hopkins University. Dr. Haut is a past president of The Eastern Association for the Surgery of Trauma (EAST) and editor-in-chief of Trauma Surgery and Acute Care Open. Marcie Feinman, MD, MEHP, the current program director of General Surgery Residency at Sinai Hospital of Baltimore and editorial board member of SCORE. She received her Masters in Education in the Health Professions from Johns Hopkins.  David Sigmon, MD, MMEd, a PGY-7 resident at the University of Illinois at Chicago who will be a fellow at Lincoln Medical Center in the Bronx next year. He did two years of research in surgical education at the University of Pennsylvania where he also received his Master's in Medical Education.  LITERATURE Torres CM, Kent A, Scantling D, Joseph B, Haut ER, Sakran JV. Association of whole blood with survival among patients presenting with severe hemorrhage in US and Canadian adult civilian trauma centers. JAMA Surg. Published online January 18, 2023.  https://pubmed.ncbi.nlm.nih.gov/36652255/ Sperry JL, Guyette FX, Brown JB, et al. Prehospital plasma during air medical transport in trauma patients at risk for hemorrhagic shock. N Engl J Med. 2018;379(4):315-326. https://pubmed.ncbi.nlm.nih.gov/30044935/   Moore HB, Moore EE, Chapman MP, et al. Plasma-first resuscitation to treat haemorrhagic shock during emergency ground transportation in an urban area: a randomised trial. Lancet. 2018;392(10144):283-291. https://pubmed.ncbi.nlm.nih.gov/30032977/   Cannon JW, Khan MA, Raja AS, et al. Damage control resuscitation in patients with severe traumatic hemorrhage: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2017;82(3):605-617. https://pubmed.ncbi.nlm.nih.gov/28225743/   Howley IW, Haut ER, Jacobs L, Morrison JJ, Scalea TM. Is thromboelastography (Teg)-based resuscitation better than empirical 1:1 transfusion? Trauma Surg Acute Care Open. 2018;3(1):e000140. https://pubmed.ncbi.nlm.nih.gov/29766129/   Guyette FX, Brown JB, Zenati MS, et al. Tranexamic acid during prehospital transport in patients at risk for hemorrhage after injury: a double-blind, placebo-controlled, randomized clinical trial. JAMA Surg. 2020;156(1):11-20. https://pubmed.ncbi.nlm.nih.gov/33016996/   Smart BJ, Haring RS, Zogg CK, et al. A faculty-student mentoring program to enhance collaboration in public health research in surgery. JAMA Surg. 2017;152(3):306-308. https://pubmed.ncbi.nlm.nih.gov/27973649/   National Academies of Sciences E. A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths after Injury.; 2016. https://nap.nationalacademies.org/catalog/23511/a-national-trauma-care-system-integrating-military-and-civilian-trauma   Braverman MA, Smith A, Pokorny D, et al. Prehospital whole blood reduces early mortality in patients with hemorrhagic shock. Transfusion. 2021;61 Suppl 1:S15-S21.  https://pubmed.ncbi.nlm.nih.gov/34269467/ **Specialty team application link - https://forms.gle/DwrRcMYDaP3a3LaQA Please email hello@behindtheknife.org with any questions. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out other trauma episodes here: https://behindtheknife.org/podcast-category/trauma/

Die WHO warnt seit mehr als 20 Jahren vor einem weltweiten Problem. Allein in Deutschland gelten zwei Drittel der Männer und die Hälfte der Frauen als übergewichtig oder sogar adipös. Je mehr Kilos, desto größer ist das Risiko für gravierende Folgeerkrankungen: Fettleber, Diabetes Typ 2, Krebs. Was kann die Medizin tun, wenn Abnehmen mit Ernährungsumstellung nicht gelingt? Wissenschaftsjournalistin Nele Rößler hat zu neuen Forschungsansätzen recherchiert und mit einer Betroffenen gesprochen. Im Gespräch mit Host Maja Bahtijarević erklärt sie, inwiefern Hormone der Schlüssel zu sein scheinen, welche Rolle der Grundumsatz des Körpers spielt und warum manche Adipositas-Forscher geradezu euphorisch über neue Medikamente sprechen. Die gute Nachricht: Viele Erkrankungen sind reversibel, wenn man das Gewicht in den Griff kriegt. Doch mit ein bisschen Sport allein ist es nicht getan, besonders bei Kindern. DIE HINTERGRUNDINFORMATIONEN • WHO-Stellungnahme zur Bekämpfung von Adipositas | WHO, Juni 2022 https://www.who.int/europe/de/news/item/24-06-2022-who-begins-subregional-policy-dialogues-to-fight-obesity#:~:text=Adipositas%20wird%20oft%20als%20eine,Region%20entweder%20%C3%BCbergewichtig%20oder%20adip%C3%B6s. • Sinkende Lebenserwartung in den USA| Ärzteblatt, Dezember 2019 https://www.aerzteblatt.de/blog/108208/Sinkende-Lebenserwartung-in-den-USA • Begleiterkrankungen durch Übergewicht | WHO-Report, 2000 https://pubmed.ncbi.nlm.nih.gov/11234459/ • Zusammenhang zwischen Übergewicht und Diabetes Typ 2 | Bundesärztekammer, 2021 https://www.ddg.info/fileadmin/user_upload/05_Behandlung/01_Leitlinien/Evidenzbasierte_Leitlinien/2021/diabetes-2aufl-vers1-llr.pdf • Steigendes Krebsrisiko durch Diabetes Typ 2 | Pearson-Stuttard J., Tsilidis K. et al: Type 2 Diabetes and Cancer: An Umbrella Review of Observational and Mendelian Randomization Studies. Cancer Epidemiol Biomarkers Prev 1 Juni 2021; 30 (6): 1218–1228. https://doi.org/10.1158/1055-9965.EPI-20-1245 • Warum könnte Übergewicht Krebserkrankungen begünstigen? | Schlesinger, S., Neuenschwander, M., Barbaresko, J. et al. Prediabetes and risk of mortality, diabetes-related complications and comorbidities: umbrella review of meta-analyses of prospective studies. Diabetologia 65, 275–285 (2022). https://doi.org/10.1007/s00125-021-05592-3 • Pressemitteilung des Unternehmens Eli Lilly zur Wirksamkeit des Medikaments Tirzepatid | Eli Lilly, April 2022 https://investor.lilly.com/news-releases/news-release-details/lillys-tirzepatide-delivered-225-weight-loss-adults-obesity-or • Wirksamkeit von Tirzepatid gegen Adipositas und Diabetes Typ 2 | Sonja Klein, Gelbe Liste, Juli 2021 https://www.gelbe-liste.de/diabetologie/tirzepatid-antidiabetikum • Studie zur Wirksamkeit von Tirzepatid | Rosenstock J., Fernández Landó L. et al. Efficacy and safety of a novel dual GIP and GLP-1 receptor agonist tirzepatide in patients with type 2 diabetes (SURPASS-1): a double-blind, randomised, phase 3 trial: The Lancet Juni 26 2021 https://doi.org/10.1016/S0140-6736(21)01324-6 • EMA-Zulassung für Tirzepatid | Europäische Arzneimittelagentur, November 2022 https://eur-lex.europa.eu/legal-content/DE/TXT/PDF/?uri=CELEX:52020DC0474 • Studie zur Langzeitwirkung eines Magenbypass | Adams Ted D., McKinlay R. et al. Weight and Metabolic Outcomes 12 Years after Gastric Bypass | NEJM September 21, 2017: DOI: 10.1056/NEJMoa1700459 https://pubmed.ncbi.nlm.nih.gov/28930514/ • Vergleich der Wirksamkeit einer Magenbypass-Operation und einer Magenverkleinerung | McTigue KM, Wellman R, Nauman E, et al. Comparing the 5-Year Diabetes Outcomes of Sleeve Gastrectomy and Gastric Bypass: The National Patient-Centered Clinical Research Network (PCORNet) Bariatric Study. JAMA Surg. 2020;155(5):e200087. doi:10.1001/jamasurg.2020.0087 • Monogene Formen der Adipositas | Uniklinikum Ulm, aufgerufen Januar 2023 https://www.uniklinik-ulm.de/kinder-und-jugendmedizin/sektionen-ambulanzen-und-arbeitsbereiche/sektion-paediatrische-endokrinologie-und-diabetologie/klinische-studien-und-experimentelle-forschung/experimentelle-forschung/monogene-formen-der-adipositas-leptin-und-leptinrezeptor.html • Therapie- und Folgekosten durch Diabetes Typ 2| Deutsche Diabetes-Gesellschaft, 2021 https://www.ddg.info/presse/die-diabetes-epidemie-direkte-und-indirekte-gesundheitskosten-gehen-in-die-milliarden • Vorschläge der WHO: Strategien gegen Übergewicht | WHO European Regional Obesity Report 2022 https://apps.who.int/iris/bitstream/handle/10665/353747/9789289057738-eng.pdf

Die WHO warnt seit mehr als 20 Jahren vor einem weltweiten Problem. Allein in Deutschland gelten zwei Drittel der Männer und die Hälfte der Frauen als übergewichtig oder sogar adipös. Je mehr Kilos, desto größer ist das Risiko für gravierende Folgeerkrankungen: Fettleber, Diabetes Typ 2, Krebs. Was kann die Medizin tun, wenn Abnehmen mit Ernährungsumstellung nicht gelingt? Wissenschaftsjournalistin Nele Rößler hat zu neuen Forschungsansätzen recherchiert und mit einer Betroffenen gesprochen. Im Gespräch mit Host Maja Bahtijarević erklärt sie, inwiefern Hormone der Schlüssel zu sein scheinen, welche Rolle der Grundumsatz des Körpers spielt und warum manche Adipositas-Forscher geradezu euphorisch über neue Medikamente sprechen. Die gute Nachricht: Viele Erkrankungen sind reversibel, wenn man das Gewicht in den Griff kriegt. Doch mit ein bisschen Sport allein ist es nicht getan, besonders bei Kindern. DIE HINTERGRUNDINFORMATIONEN • WHO-Stellungnahme zur Bekämpfung von Adipositas | WHO, Juni 2022 https://www.who.int/europe/de/news/item/24-06-2022-who-begins-subregional-policy-dialogues-to-fight-obesity#:~:text=Adipositas%20wird%20oft%20als%20eine,Region%20entweder%20%C3%BCbergewichtig%20oder%20adip%C3%B6s. • Sinkende Lebenserwartung in den USA| Ärzteblatt, Dezember 2019 https://www.aerzteblatt.de/blog/108208/Sinkende-Lebenserwartung-in-den-USA • Begleiterkrankungen durch Übergewicht | WHO-Report, 2000 https://pubmed.ncbi.nlm.nih.gov/11234459/ • Zusammenhang zwischen Übergewicht und Diabetes Typ 2 | Bundesärztekammer, 2021 https://www.ddg.info/fileadmin/user_upload/05_Behandlung/01_Leitlinien/Evidenzbasierte_Leitlinien/2021/diabetes-2aufl-vers1-llr.pdf • Steigendes Krebsrisiko durch Diabetes Typ 2 | Pearson-Stuttard J., Tsilidis K. et al: Type 2 Diabetes and Cancer: An Umbrella Review of Observational and Mendelian Randomization Studies. Cancer Epidemiol Biomarkers Prev 1 Juni 2021; 30 (6): 1218–1228. https://doi.org/10.1158/1055-9965.EPI-20-1245 • Warum könnte Übergewicht Krebserkrankungen begünstigen? | Schlesinger, S., Neuenschwander, M., Barbaresko, J. et al. Prediabetes and risk of mortality, diabetes-related complications and comorbidities: umbrella review of meta-analyses of prospective studies. Diabetologia 65, 275–285 (2022). https://doi.org/10.1007/s00125-021-05592-3 • Pressemitteilung des Unternehmens Eli Lilly zur Wirksamkeit des Medikaments Tirzepatid | Eli Lilly, April 2022 https://investor.lilly.com/news-releases/news-release-details/lillys-tirzepatide-delivered-225-weight-loss-adults-obesity-or • Wirksamkeit von Tirzepatid gegen Adipositas und Diabetes Typ 2 | Sonja Klein, Gelbe Liste, Juli 2021 https://www.gelbe-liste.de/diabetologie/tirzepatid-antidiabetikum • Studie zur Wirksamkeit von Tirzepatid | Rosenstock J., Fernández Landó L. et al. Efficacy and safety of a novel dual GIP and GLP-1 receptor agonist tirzepatide in patients with type 2 diabetes (SURPASS-1): a double-blind, randomised, phase 3 trial: The Lancet Juni 26 2021 https://doi.org/10.1016/S0140-6736(21)01324-6 • EMA-Zulassung für Tirzepatid | Europäische Arzneimittelagentur, November 2022 https://eur-lex.europa.eu/legal-content/DE/TXT/PDF/?uri=CELEX:52020DC0474 • Studie zur Langzeitwirkung eines Magenbypass | Adams Ted D., McKinlay R. et al. Weight and Metabolic Outcomes 12 Years after Gastric Bypass | NEJM September 21, 2017: DOI: 10.1056/NEJMoa1700459 https://pubmed.ncbi.nlm.nih.gov/28930514/ • Vergleich der Wirksamkeit einer Magenbypass-Operation und einer Magenverkleinerung | McTigue KM, Wellman R, Nauman E, et al. Comparing the 5-Year Diabetes Outcomes of Sleeve Gastrectomy and Gastric Bypass: The National Patient-Centered Clinical Research Network (PCORNet) Bariatric Study. JAMA Surg. 2020;155(5):e200087. doi:10.1001/jamasurg.2020.0087 • Monogene Formen der Adipositas | Uniklinikum Ulm, aufgerufen Januar 2023 https://www.uniklinik-ulm.de/kinder-und-jugendmedizin/sektionen-ambulanzen-und-arbeitsbereiche/sektion-paediatrische-endokrinologie-und-diabetologie/klinische-studien-und-experimentelle-forschung/experimentelle-forschung/monogene-formen-der-adipositas-leptin-und-leptinrezeptor.html • Therapie- und Folgekosten durch Diabetes Typ 2| Deutsche Diabetes-Gesellschaft, 2021 https://www.ddg.info/presse/die-diabetes-epidemie-direkte-und-indirekte-gesundheitskosten-gehen-in-die-milliarden • Vorschläge der WHO: Strategien gegen Übergewicht | WHO European Regional Obesity Report 2022 https://apps.who.int/iris/bitstream/handle/10665/353747/9789289057738-eng.pdf

In this episode, Drs. Amy Park and Mark Hoffman welcome Dr. Angela Chaudhari, Chief of Gynecology and Gynecologic Surgery at Northwestern Memorial Hospital, to share her experience promoting a culture of physician wellness as the Director of the P2P Network for Physician Peer Support. --- SHOW NOTES Dr. Chaudhari discusses how her inspiration to advocate for physician wellness began when she herself was experiencing feelings of burnout. Initially an open ear for colleagues on an individual level, Dr. Chaudhari was later trained on the topic of wellness through the Scholars of Wellness Program and received her Organization Leadership and Coaching Certificate at Northwestern University. Dr. Chaudhari then explains that, through the program, volunteers from both medical and non-medical backgrounds are trained to provide support for those experiencing adverse events, “compassion fatigue,” and discriminatory patient experiences. In addition, peers are also available to provide feedback or education. Specific metrics for the program include retention, wellbeing scores, and culture surveys to identify “pain points'' within the Institution. Next, the doctors discuss the topic of “work-life integration,” rather than work-life balance, and how to promote this in your own practice. While acknowledging that it may be difficult to advocate for yourself and set boundaries early on in your career, the group emphasizes the role of mentorship and how this can empower trainees/learners to take action sooner rather than later. The episode ends with a discussion on creating culture in your workplace. The doctors express sentiments that maintaining an intentional, positive outlook and treating all colleagues with respect is a key aspect in promoting wellness. In addition, they encourage listeners to acknowledge difficult situations and to share personal experiences to further promote an environment of support and growth. --- RESOURCES Define Measure Analyze Improve Control (DMAIC) Process: https://asq.org/quality-resources/dmaic Stolarski A, Moseley JM, O'Neal P, Whang E, Kristo G. Retired Surgeons' Reflections on Their Careers. JAMA Surg. 2020;155(4):359–361. doi:10.1001/jamasurg.2019.5476

HAPPY NEW YEAR! Welcome to Episode 5 of the BSCOS Paediatric Orthopaedic Digest (POD)cast with guest Ms Emily Baird @emilyjanebaird from the Royal Hospital for Sick Children in Edinburgh @OrthoPaeds. We read 35 journals (SO YOU DON'T HAVE TO!) & highlight the most impactful studies that we feel can change practice or improve outcomes in Paediatric Orthopaedics. Follow Updates on @BSCOS_UK REFERENCES: 1. A Universal C-arm Language Improves OR Morale. Nielsen & Bauer. JPOSNA. Nov 2022. DOI: https://doi.org/10.55275/JPOSNA-2022-536 2. Risk of Noise-Induced Hearing Loss for Orthopaedic Surgeons. Kwan et al. J Bone Joint Surg Am. PMID 36170382 3. Prospective, Randomized Ponseti Treatment for Clubfoot: Orthopaedic Surgeons Versus Physical Therapists. Chen et al. J Pediatr Orthop. Feb 2023. PMID: 36607913 4. Tibialis anterior tendon transfer using bone anchor for dynamic supination in Congenital Talipes Equinovarus. Ayub et al. J Pediatr Orthop B. Jan 2023. PMID: 35834789 5. Pain Catastrophizing Influences Preoperative and Postoperative Patient-Reported Outcomes in Adolescent Idiopathic Scoliosis. Ramo et al. J Bone Joint Surg Am. Nov 2022. PMID: 35984014 6. A nociceptive neuronal ensemble in the dorsomedial prefrontal cortex underlies pain chronicity. Qi et al. Nature. Dec 2022. PMID: 36516746 7. Hip reconstruction in closed triradiate cartilage: long‐term outcomes in patients with cerebral palsy. Schlemmer et al. Arch Orthop Trauma Surg. Dec 2022. PMID: 34050376 8. How are adults who had Perthes' disease functioning? : results of over 900 participants from an international web-based survey. Kim et al (International Perthes Study Group). Bone Joint J. Dec 2022. PMID: 36453046 9. Angular deformities after percutaneous epiphysiodesis for leg length discrepancy. Weinmayer et al. J Child Orthop.Oct 2022. PMID: 36238144 10. Management of iatrogenic ulnar nerve palsies after cross pinning of pediatric supracondylar humerus fractures: A systematic review. Graff et al. J Child Orthop. Oct 2022. PMID: 36238145 11. Development and Validation of a Mobile Application for Measuring Tibial Torsion. Min et al. J Bone Joint Surg Am. Dec 2022. PMID: 36126146 12. Using Job Analysis for Identifying the Desired Competencies of 21st-Century Surgeons for Improving Trainees Selection. Gazit et al. J Surg Education. Jan 2023. PMID: 36175291 13. Correlation Between Postoperative Antimicrobial Prophylaxis Use and Surgical Site Infection in Children Undergoing Nonemergent Surgery. He et al. JAMA Surg. Dec 2022. PMID: 36260310 14. Patient and Family Perspectives on Terms for Obesity. Puhl et al. Pediatrics. Dec 2022. PMID: 36404759 Follow Hosts: @AnishPSangh @AlpsKothari @Pranai_B

Join this discussion of some of the recent literature surrounding EMS care of traumatic brain injury with Dr. Al Lulla. This is the perfect confluence of advancing evidence, relatively straightforward interventions, and a patient population where we can definitely improve prehospital outcomes. See where the literature, education, and protocol implementation can meet to improve TBI outcomes in your EMS service. REFERENCES 1. Spaite DW, Hu C, Bobrow BJ, et al. Optimal Out-of-Hospital Blood Pressure in Major Traumatic Brain Injury: A Challenge to the Current Understanding of Hypotension. Ann Emerg Med. 2022 Jul;80(1):46-59. 2. Spaite DW, Bobrow BJ, Keim SM, et al. Association of Statewide Implementation of the Prehospital Traumatic Brain Injury Treatment Guidelines With Patient Survival Following Traumatic Brain Injury: The Excellence in Prehospital Injury Care (EPIC) Study. JAMA Surg. 2019 Jul 1;154(7):e191152.

On this episode of BackTable OBGYN, we introduce our co-host Dr. Amy Park, the Section Head of Female Pelvic Medicine & Reconstructive Surgery at the Cleveland Clinic. She and Dr. Mark Hoffman raise awareness about the importance of surgeon ergonomics in preventing work-related musculoskeletal (MSK) injuries and optimizing career longevity. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/vpfOUm --- SHOW NOTES Dr. Park, a co-founder of the Society of Surgical Ergonomics, begins the episode by sharing her personal experience with a work-related shoulder injury and how it inspired her to prioritize surgeon ergonomics in her daily practice. She and Dr. Hoffman then encourage listeners to acknowledge the role of optimizing factors such as table height, body posture, and more in order to maximize the longevity of a surgeon's career and thus patient care. The co-hosts then cover pitfalls commonly identified in normal, open surgery (e.g. excessive neck flexion, truncal deviation, arm abduction) and laparoscopic surgery (e.g. body posture, monitor height). They transition to highlight possible resolutions to these pitfalls, including anti-fatigue mats, appropriate footwear, and proper posturing; ultimately addressing a need for further research in this aspect of medicine. Lastly, they cover the role of robotic surgery and the potential to either mitigate or worsen the risk for work-related MSK injuries. The episode wraps up with a call to bring awareness to the value of surgeon ergonomics and to proactively impart this knowledge onto trainees, as the overall goal for surgeons is likely to continue operating and impacting patient care. --- RESOURCES Epstein S, Sparer EH, Tran BN, et al. Prevalence of Work-Related Musculoskeletal Disorders Among Surgeons and Interventionalists: A Systematic Review and Meta-analysis. JAMA Surg. 2018;153(2):e174947. doi:10.1001/jamasurg.2017.4947 Society of Surgical Ergonomics: https://www.societyofsurgicalergonomics.org The FIRST Trial: http://www.thefirsttrial.org The SECOND Trial: http://www.thesecondtrial.org

In a continuing series focused on vascular surgery, host Rick Greene, MD, FACS, talks to vascular surgeon Marie L. Crandall MD, MPH, FACS, about venous thromboembolism. Dr. Crandall is Professor and Associate Chair, Research; Chief, Division of Acute Care Surgery; Program Director, General Surgery Residency, Department of Surgery, University of Florida Jacksonville. *Addendum from Dr. Crandall: “The timing of VTE prophylaxis after neurosurgical intervention for TBI can be challenging.  However, this JAMA Surg retrospective cohort study demonstrated that prophylaxis before 72hrs was associated with greater risk of reintervention and mortality and after 72 hours was associated with greater risk of VTE but not mortality.  This suggests that perhaps 3 days would be safest balance for most patients after neurosurgical intervention for TBI.”  Learn more about Selected Readings in General Surgery, an American College of Surgeons publication that highlights highly relevant and practice-changing information from the world's most prominent medical journals.  #SurgicalReadings

Join us after hours at Dr. Bryan A. Cotton's pop-up bourbon bar at the AAST 2022 Meeting in Chicago. In this FANTASTIC & FUN episode, we talk amongst friends about cutting edge research at this year's meeting. To no one's surprise, coagulopathy, damage control resuscitation, whole blood, and factor replacement therapy just happen to be but a few of the topics discussed on Rounds.Time Stamps:00:12 AAST 2022 - Intro00:42 Sex diamoprhisms in coagulation01:52 Hemostatic profiles of female donors02:48 Pediatric whole blood (WB) is safe03:10 WB for TBI03:31 Leukoreduction is unnecessary05:30 TXA, TEG  and trauma06:44 STAAMP trial07:21 TXA: go early, big or go home07:52 Calcium...early!09:33 Canadian perspective on TXA and TEG – Neil Perry from London, ON11:25 Nori Bradley from Edmonton, AB13:53 Jordan Weinberg, not Canadian – Phoenix, AZ16:12 Issues with WB – COMBAT vs PAMPer17:31 Cold stored platelets18:22 Rapid transfusers and whole blood: Only the strong survive!!19:42 How are we doing with our resuscitation? 1:1:1 is just the beginning, not the end!21:44 Timing is everything!23:38 Plasma first resuscitation: “…God damn good!” -BAC24:37 Dr. Joshua B. Brown - Pittsburgh, PA25:31 More Canadian perspectives with Perry and Bradley29:48 Less is best!31:27 Prothrombin complex concentrate: Yay or nay?32:18 More on the endotheliopathy of trauma33:38 Just messing around and having a blast34:22 What was the best bourbon tonight?References:CRASH-2 trial collaborators, Shakur H, Roberts I, Bautista R, Caballero J, Coats T, Dewan Y, El-Sayed H, Gogichaishvili T, Gupta S, Herrera J, Hunt B, Iribhogbe P, Izurieta M, Khamis H, Komolafe E, Marrero MA, Mejía-Mantilla J, Miranda J, Morales C, Olaomi O, Olldashi F, Perel P, Peto R, Ramana PV, Ravi RR, Yutthakasemsunt S. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010 Jul 3;376(9734):23-32. doi: 10.1016/S0140-6736(10)60835-5. Epub 2010 Jun 14. PMID: 20554319.Gruen DS, Guyette FX, Brown JB, Okonkwo DO, Puccio AM, Campwala IK, Tessmer MT, Daley BJ, Miller RS, Harbrecht BG, Claridge JA, Phelan HA, Neal MD, Zuckerbraun BS, Yazer MH, Billiar TR, Sperry JL. Association of Prehospital Plasma With Survival in Patients With Traumatic Brain Injury: A Secondary Analysis of the PAMPer Cluster Randomized Clinical Trial. JAMA Netw Open. 2020 Oct 1;3(10):e2016869. doi: 10.1001/jamanetworkopen.2020.16869. PMID: 33057642; PMCID: PMC7563075.Guyette FX, Brown JB, Zenati MS, Early-Young BJ, Adams PW, Eastridge BJ, Nirula R, Vercruysse GA, O'Keeffe T, Joseph B, Alarcon LH, Callaway CW, Zuckerbraun BS, Neal MD, Forsythe RM, Rosengart MR, Billiar TR, Yealy DM, Peitzman AB, Sperry JL; STAAMP Study Group. Tranexamic Acid During Prehospital Transport in Patients at Risk for Hemorrhage After Injury: A Double-blind, Placebo-Controlled, Randomized Clinical Trial. JAMA Surg. 2020 Oct 5;156(1):11–20. doi: 10.1001/jamasurg.2020.4350. Epub ahead of print. Erratum in: JAMA Surg. 2021 Jan 1;156(1):105. PMID: 33016996; PMCID: PMC7536625.Moore HB, Moore EE, Chapman MP, McVaney K, Bryskiewicz G, Blechar R, Chin T, Burlew CC, Pieracci F, West FB, Fleming CD, Ghasabyan A, Chandler J, Silliman CC, Banerjee A, Sauaia A. Plasma-first resuscitation to treat haemorrhagic shock during emergency ground transportation in an urban area: a randomised trial. Lancet. 2018 Jul 28;392(10144):283-291. doi: 10.1016/S0140-6736(18)31553-8. Epub 2018 Jul 20. PMID: 30032977; PMCID: PMC6284829.Pusateri AE, Moore EE, Moore HB, Le TD, Guyette FX, Chapman MP, Sauaia A, Ghasabyan A, Chandler J, McVaney K, Brown JB, Daley BJ, MSupport the show

In this episode we sit down with the Chief of Trauma, Surgical Critical Care, Burns,  & Acute Care Surgery at the University of Arizona, Dr. Bellal Joseph, who share with us his thoughts and research findings on hot topics including frailty, geriatric trauma, leadership, and more.Timestamps:00:12  Introductions01:30  What is frailty? Your physiologic NOT chronologic body.06:58  Injured elderly trauma patients can have good outcomes07:30  Trauma specific frailty index10:48  Failure to rescue13:57  Geriatricians and the trauma surgeons 15:08  4Ms-What Matters, Mobility, Mentation, Medication16:48  Geriatric cohorting/wards22:24  ACS geriatric centers of excellence 29:35  Brain Injury Guidelines (BIG)38:17  The importance of teamwork & servant leadership40:28  Imposter syndrome43:19  Leadership considerations45:25  Final thoughtsReferences:Joseph B, Friese RS, Sadoun M, Aziz H, Kulvatunyou N, Pandit V, Wynne J, Tang A, O'Keeffe T, Rhee P. The BIG (brain injury guidelines) project: defining the management of traumatic brain injury by acute care surgeons. J Trauma Acute Care Surg. 2014 Apr;76(4):965-9. doi: 10.1097/TA.0000000000000161. PMID: 24662858.Joseph B, Obaid O, Dultz L, Black G, Campbell M, Berndtson AE, Costantini T, Kerwin A, Skarupa D, Burruss S, Delgado L, Gomez M, Mederos DR, Winfield R, Cullinane D; AAST BIG Multi-institutional Study Group. Validating the Brain Injury Guidelines: Results of an American Association for the Surgery of Trauma prospective multi-institutional trial. J Trauma Acute Care Surg. 2022 Aug 1;93(2):157-165. doi: 10.1097/TA.0000000000003554. Epub 2022 Mar 28. PMID: 35343931.vJoseph B, Pandit V, Haider AA, Kulvatunyou N, Zangbar B, Tang A, Aziz H, Vercruysse G, O'Keeffe T, Freise RS, Rhee P. Improving Hospital Quality and Costs in Nonoperative Traumatic Brain Injury: The Role of Acute Care Surgeons. JAMA Surg. 2015 Sep;150(9):866-72. doi: 10.1001/jamasurg.2015.1134. PMID: 26107247.Joseph B, Pandit V, Sadoun M, Zangbar B, Fain MJ, Friese RS, Rhee P. Frailty in surgery. J Trauma Acute Care Surg. 2014 Apr;76(4):1151-6. doi: 10.1097/TA.0000000000000103. PMID: 24662884.Orouji Jokar T, Ibraheem K, Rhee P, Kulavatunyou N, Haider A, Phelan HA, Fain M, Mohler MJ, Joseph B. Emergency general surgery specific frailty index: A validation study. J Trauma Acute Care Surg. 2016 Aug;81(2):254-60. doi: 10.1097/TA.0000000000001120. PMID: 27257694.Support the show

In this episode, Marc and Mo are joined by special guests Matt Schmitz (JBJS Deputy Editor for Social Media; San Antonio Military Medical Center; Uniformed Services University of the Health Sciences; Brooke Army Medical Center) and Patrick Osborn (Brooke Army Medical Center; Baptist Health System) in a discussion on the research being done by the Major Extremity Trauma and Rehabilitation Consortium (METRC) and how the knowledge gained has impacted the ability of the orthopaedic surgeon to treat the injured warrior. Links: Major Extremity Trauma Research Consortium (METRC). Outcomes Following Severe Distal Tibial, Ankle, and/or Mid/Hindfoot Trauma: Comparison of Limb Salvage and Transtibial Amputation (OUTLET). J Bone Joint Surg Am. 2021 Sep 1;103(17):1588-1597. doi: 10.2106/JBJS.20.01320. PMID: 33979309. https://bit.ly/3QOCd4a Major Extremity Trauma Research Consortium (METRC). Effect of Intrawound Vancomycin Powder in Operatively Treated High-risk Tibia Fractures: A Randomized Clinical Trial. JAMA Surg. 2021 May 1;156(5):e207259. doi: 10.1001/jamasurg.2020.7259. Epub 2021 May 12. PMID: 33760010. https://bit.ly/3cirkso Subspecialties: Trauma Rehabilitation

In JAMA Surgery wurden 2021 die Ergebnisse einer amerikanischen Umfrage publiziert, die der Frage nachging, ob Chirurginnen ein erhöhtes Risiko für eine Infertilität und Schwangerschaftskomplikationen haben. Chirurginnen werden zu einem späteren Zeitpunkt schwanger, machen häufiger von Methoden der Reproduktionsmedizin Gebrauch, haben häufiger Fehlgeburten und mehr Komplikationen während der Schwangerschaft. Sind die Ergebnisse auf das deutsche Gesundheitssystem übertragbar?Rangel EL, et al.. Incidence of Infertility and Pregnancy Complications in US Female Surgeons. JAMA Surg. 2021;156(10):905-915.

The medical directors revisit one of our old favorites "The Serial Killers Series" to discuss 5 trauma killers to keep in your front brain as you are preparing or caring for a sick trauma patient. If you've not considered your differential diagnosis until patient contact and initial evaluation then you're too late. Following this episode, you'll be ready to evaluate, act and prevent acute hemorrhage, obstructive shock, hypoxia, traumatic brain injury and DIC in your sickest trauma patients. REFERENCES 1. Childress K, et al. Prehospital End-tidal Carbon Dioxide Predicts Mortality in Trauma Patients. Prehosp Emerg Care. 2018 Mar-Apr;22(2):170-174. 2. Androski CP Jr, et al. Case Series on 2g Tranexamic Acid Flush From the 75th Ranger Regiment Casualty Database. Journal of Special Operations Medicine : a Peer Reviewed Journal for SOF Medical Professionals. 2020 ;20(4):85-91. 3. Taghavi S, et al. An Eastern Association for the Surgery of Trauma multicenter trial examining prehospital procedures in penetrating trauma patients. J Trauma Acute Care Surg. 2021 Jul 1;91(1):130-140. 4. Sims CA, et al. Effect of Low-Dose Supplementation of Arginine Vasopressin on Need for Blood Product Transfusions in Patients With Trauma and Hemorrhagic Shock: A Randomized Clinical Trial. JAMA Surg. 2019 Nov 1;154(11):994-1003. 5. Kupas DF, et al. Glasgow Coma Scale Motor Component ("Patient Does Not Follow Commands") Performs Similarly to Total Glasgow Coma Scale in Predicting Severe Injury in Trauma Patients. Ann Emerg Med. 2016 Dec;68(6):744-750. 6. Rankin CJ, et al. A review of transfusion- and trauma-induced hypocalcemia: Is it time to change the lethal triad to the lethal diamond? J Trauma Acute Care Surg. 2020 Mar;88(3):434-439. 7. Laan DV, et al. Chest wall thickness and decompression failure: A systematic review and meta-analysis comparing anatomic locations in needle thoracostomy. Injury. 2016 Apr;47(4):797-804.

The mortality rate for unstable pelvic hemorrhage due to blunt trauma remains around 30 percent. However, technological advances promise to finally make a dent. But on the cutting edge, it's not clear which treatments should be used when to maximize lives saved. With life-threatening pelvic exsanguination, time is critical. Do you know when to rush to pack the pelvis? Do you know when to deploy a REBOA instead? Are there scenarios where you should do both? Join Drs. Urréchaga, Neeman, and Rattan from Ryder Trauma Center in Miami as they try to tease out answers using two studies hot off the presses with seemingly contradictory results. Learning Objectives: Blunt Pelvic Hemorrhage ·       Expanding knowledge of management strategies for blunt pelvic hemorrhage ·       Describe propensity score matching and its use in non-randomized studies ·       Compare outcomes of REBOA and preperitoneal pelvic packing (PPP) ·       Critically appraise study design and methods of studies References 1.     S. Mikdad, I.A.M. van Erp, M.E. Moheb, et al. Pre-peritoneal pelvic packing for early hemorrhage control reduces mortality compared to resuscitative endovascular balloon occlusion of the aorta in severe blunt pelvic trauma patients: A nationwide analysis. Injury. 2020; 51:1834–1839. doi.org/10.1016/j.injury.2020.06.003 2.     S. Asmar, L. Bible, M. Chehab, et al. Resuscitative Endovascular Balloon Occlusion of the Aorta vs Pre-Peritoneal Packing in Patients with Pelvic Fracture. Journal of the American College of Surgeons. 2021; 232(1):17-26. doi.org/10.1016/j.jamcollsurg.2020.08.763 3.     B. Joseph, M. Zeeshan, J.V. Sakran, et al. Nationwide Analysis of Resuscitative Endovascular Balloon Occlusion of the Aorta in Civilian Trauma. JAMA Surg. 2019;154(6):500-508. doi:10.1001/jamasurg.2019.0096 Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Writing Group for the CODA Collaborative. Patient factors associated with appendectomy within 30 days of initiating antibiotic treatment for appendicitis. JAMA Surg 2022 Jan 12; [e-pub]. Now, investigators have explored in a secondary analysis of  The CODA Collaborative. A randomized trial comparing antibiotics with appendectomy for appendicitis. N Engl J Med 2020 Oct 5; [e-pub]. (data from a previous randomized antibiotics-versus-surgery trial (NEJM JW Gen Med Dec 1 2020 and N Engl J Med 2020; 383:1907). Have looke at the data to see could we predict factors that make you more likely to appendectomy and fail antibiotic therapy.  They identified 735 patients who had been randomized to antibiotic treatment; 154 (21%) of these patients underwent appendectomy within 30 days. Overall, 29% of patients in the antibiotics group underwent appendectomy within 90 days (41% of those with appendicolith vs. 25% without). The authors suggest hey maybe this appendicolith is the magic answer of who will fail therapy—maybe!! BUT remember this is secondary analysis so this is only hypothesis generating even a secondary analysis of a rct is just hypothesis. You need a new RCT to actually show causation.  Also as stated in the editorialists note that in subsequent analyses of this same data set, nearly 50% of patients underwent appendectomy within 2 years, regardless of the presence of an appendicolith, so an initial nonsurgical approach might only delay surgery. Some say 50% still going to surgery is terrible but I say even if 50% prevented from having surgery that is still 50% of people are being prevented from a surgery      Acetazolamide to Prevent Adverse Altitude Effects in COPD and Healthy Adults | NEJM Evidence Trial 1 was a randomized, double-blind, parallel-design trial in which 176 patients with COPD were treated with acetazolamide capsules (375 mg/day) or placebo- COPD patients had oxygen saturation measured by pulse oximetry of 92% or greater  primary outcome in trial 1 was the incidence of the composite end point of altitude-related adverse health effects (ARAHE)== Criteria for ARAHE included acute mountain sickness (AMS) and symptoms or findings relevant to well-being and safety, such as severe hypoxemia, requiring intervention. In trial 1 of patients with COPD, 68 of 90 (76%) receiving placebo and 42 of 86 (49%) receiving acetazolamide experienced ARAHEThe number needed to treat (NNT) to prevent one case of ARAHE was 4EVEN at NNT of 4 you  have to realize that still 50% of those with COPD required intervention to go back down to lower level.   Trial 2 comprised 345 healthy lowlanders.The primary outcome in trial 2 was the incidence of acute mountain sickness AMS assessed at 3100 m by the Lake Louise questionnaire score (the scale of self-assessed symptoms ranges from 0 to 15 points, indicating absent to severe, with 3 or more points including headache, indicating acute mountain sickness AMS).In trial 2 of healthy individuals, 54 of 170 (32%) receiving placebo and 38 of 175 (22%) receiving acetazolamide experienced acute mountain sickness AMS  The NNT to prevent one case of acute mountain sickness AMS was 10 (95% CI, 5 to 141).So use the acetazolamide still 1 in 5 individuals experience acute mountain sickness    Annals for Hospitalists Inpatient Notes - Clinical Pearls—Stopping, Starting, and Optimizing Guideline-Directed Medical Therapy in Patients Hospitalized for Heart Failure With Reduced Ejection Fraction | Annals of Internal Medicine (acpjournals.org) Treat with??Foundational medical therapy for HFrEF consists of comprehensive disease-modifying quadruple medical therapy, including angiotensin receptor–neprilysin inhibitors (ARNIs), β-blockers, mineralocorticoid receptor antagonists, and sodium–glucose cotransporter-2 inhibitors (1). Quadruple medical therapy is estimated to cumulatively reduce the relative risk for death by 73% over 2 years, with a number needed to treat of 3.9 to save 1 life  compared with traditional therapy using an ACEI and a β-blocker, treating a 55-year-old patient with comprehensive disease-modifying quadruple therapy projects to increase life expectancy by more than 6 years Approximately 1 in 4 patients hospitalized for worsening HFrEF die or are rehospitalized within 30 days of discharge --- Deferring in-hospital initiation is consistently associated with medications never being initiated in the outpatient setting, or initiated after substantial delaySTART THEM IN THE HOSPITAL-- There is no evidence to suggest that “go slow,” “one medication change at a time,” or “defer to outpatient” approaches improve medication tolerance or accomplish anything beneficial  If you mix a bunch of moon pies in a trash can you get what sounds like a great time but if you mix a bunch of cow pies in a trash can you just get poop Clearly seen in this next article Vitamin D supplementation for the treatment of migraine: A meta-analysis of randomized controlled studies - ClinicalKey  meta-analysis aims to explore the efficacy of vitamin D for migraine patients. Six RCTs and 301 patients were included in the meta-analysis. On average these people were having around 7 migraines per months and compared to control the vit d group decrease headache days by about 1.5 per month compared to placebo or UC So you say vit d works for something!!Not so fast Remember I would like a 25 yr old cut my hair by not 5 five year olds…. Sadly these studies were 5 yr olds UC could be nothing. Well vit d beating nothing isn't hard, we know placebo is real Even beating placebo isn't hard when it is open label or you are not blinded to the active arm. If I say, yes you are getting this drug vit d that will help your headaches you are going to believe it much more than if I just give you a pamphlet.  The authors in the discussion state “Higher vitamin D levels is associated with lower risk of migraine “ Well ya that is true but having a higher vitamin d level is also associated with going outside more. And going outside more is associated with no having a migraine.  High vit d level is amazing!! I love it but replacing it still seems to do nothing however if you want a high level and want to go outside and get a high level then I think that is a great idea and speaking of great ideas—    Here is a sad but enlightening article— Home pregnancy test use and timing of pregnancy confirmation among people seeking health care - ClinicalKey The researchers found that 74% of survey respondents took a home pregnancy test as the first step in confirming a suspected pregnancy;  Respondents who took home pregnancy tests confirmed pregnancy 10 days earlier than those who first tested at a clinic. (duh statements- if you test at home you find out sooner, this is so obvious an a no brainer--- BUT Confirmation of pregnancy at greater than 7 weeks' gestational age was higher among adolescents, Latina versus white women, food-insecure versus -secure women, and people with unplanned pregnancies. Those that did not test at home cited concerns about test accuracy (42%) and difficulties accessing one (26%). While overall 1/5 21% confirmed pregnancy at ≥7 weeks gestation, confirmation at ≥7 weeks was higher among adolescents versus young adults (47%!! vs 13%, p = 0.001), Latina versus white women (28% vs 11%, p = 0.02), food insecure versus secure women (28% vs 17%, p = 0.06), and people with unplanned versus planned/mistimed pregnancies (25% vs 13%, p = 0.07). Latina and food insecure women discover their pregnancy at the same time or rate as individuals with unplanned pregnancy!!! one in 5 confirm pregnancy at 7 weeks gestation or later and in those Latina, poor, or unplanned It is ¼ at >7weeks this obviously effects prenatal care and Gestational bans in the first trimester will disproportionately prevent young people, people of color, and those living with food insecurity from being able to access abortion.This is tough but it is this data that reminds me and should remind us that life is not equal and healthcare is not equal and certain populations and groups do need our help more than others.

During this episode of the Pursuit of Health Podcast we pick up on our topic of Infertility as a Health Concern with a remarkably accomplished guest physician, Dr. Chrissy Guidry. After years of medical and surgical training in Louisiana, Ohio and California, she is now the Medical Director of the Emergency General Surgery & Advanced Trauma Life Support Service at Tulane Medical Center and the Associate Program Director of General Surgery at Tulane University. As an Assistant Professor of Surgery at Tulane School of Medicine she serves as a mentor and advocate for many young student physicians. Amongst her many accomplishments and innumerable services on professional committees, she has recently added a focus on addressing Female Infertility Amongst Physicians. She explains that she has been carrying out this effort in collaboration with the American Medical Women's Association (AMWA) who has recently made a concerted effort to bring this issue out to the public and the medical profession. This began with an AMWA-sponsored Physician Fertility Summit at which Dr. Guidry was amongst the many guest physician leaders and speakers shedding light on this little discussed topic. During our visit with Dr. Guidry, she bravely shared with our audience her own personal issues regarding infertility so that others may know that they are not alone. She explains that Female Infertility amongst physicians is 3-4 times higher than the general population and that much research is needed to understand both the causes of this medical condition and how to best prevent and treat it. Dr. Guidry reveals many of the obstacles, biases and misconceptions regarding infertility and family planning amongst physicians. She stressed that this is an issue that can seriously affect women physicians and their families. She advocates for early awareness of this issue amongst those she mentors and her colleagues. Together, Dr. Fethke and Dr, Guidry agree that physicians wishing to have children are more well-rounded and healthy people when they are able to do so, thus improving their professional and personal lives. Through organizations like AMWA and RESOLVE, Dr Guidry is optimistic that the issue of Physician Infertility is now out in the open. She strongly believes that physicians have a unique platform to address this issue for themselves and the public at large in order to improve awareness and access to infertility-related medical care. She looks forward to a day when physicians can study and practice in environments that are supportive and proactive for all physicians who are in need of evaluating their fertility as a significant component of their physical and psychosocial health. Dr. Guidry poinantly finishes our fascinating and emotional discussion by emphasizing, “ It is time for this discussion to be out in the open so people know they are not alone.” Finally, Dr. Guidry wants everyone to be aware of the upcoming AMWA and RESOLVE sponsored three seminars occurring in February through April 2022 entitled Moving the Fertility Conversation Forward. We at the Pursuit of Health Podcast can be reached for audience feedback on this episode as well as past and future episodes. We can be reached at drfethkemd on Facebook and Instagram, as well as our website at drfethkemd.com. Refernces: 1. Marshall AL, Arora VM, Salles A. Acad Med, 2020;95(5):679. 2. Stentz NC et al. J Womens Health. 2016;25:1059.J Womens Health (Larchmt)2016 Oct;25(10):1059-1065. doi: 10.1089/jwh.2015.5638. 3. Chandra A et al. www.cdc.gov/nchs/ data/series/sr_23/sr23_025.pdf. 4. Kemkes-Grottenthaler A. J Biosoc Sci. 2003;35:213 5. https://www.nytimes.com/2021/09/13/health/women-doctors-infertility.html 6. JAMA Surg 2021 Oct 1;156(10):905-915. doi: 10.1001/jamasurg.2021.3301. 

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.  

Join Drs. Ashlie Nadler, Jordan Nantais and Graham Skelhorne-Gross as they tackle Cancer Emergencies.   Case 1 - Learning Points: These are complex patients and multidisciplinary care should be provided with input from oncology.  A step-up approach should be used, starting with medical management prior to considering surgery in appropriate patients. Highly selected patients may benefit from surgery, namely those with a high performance status, a prognosis of months if the bowel obstruction was resolved, minimal carcinomatosis, and a single transition point. Diversion, bypass, or resection are all options, but a patient's capacity to heal related to recent systemic therapy needs to be taken into account.  Consent for surgery should focus on goals of care, quality of life, and achievable outcomes, and highlight the inherent risk in patients with advanced disease and a limited lifespan.  Case 2 - Learning Points: Colorectal malignancy is an exceedingly common cause of general surgical emergency and requires a thoughtful, systematic approach The role of stenting as a bridge to surgery in obstructing distal colon malignancy is somewhat controversial but can help to avoid permanent stomas; however there is some potential risk of perforation and possibly disease recurrence Treatment decisions should take place in the context of an informed discussion with the patient and consideration of both quantity and quality of life whenever possible Consistent involvement of a multidisciplinary team, including radiology, enterostomal therapy, and surgical oncology can be extremely useful in guiding complex decisions References: Shariff F, Bogach J, Guidolin K, Nadler A. Malignant Bowel Obstruction Management Over Time: Are We Doing Anything New? A Current Narrative Review. Ann Surg Oncol. 2021 Oct 18. doi: 10.1245/s10434-021-10922-1. Epub ahead of print. Ripamonti C, Gerdes H and Easson A. Management of malignant bowel obstruction. Eur J Cancer 2008 May;44(8):1105-15 Chen, T, Huang, Y. & Wang, G. Outcome of colon cancer initially presenting as colon perforation and obstruction. World J Surg Onc 15, 164 (2017).  Olmsted C, Johnson A, Kaboli P, et al. Use of palliative care and hospice among surgical and medical specialties in the Veterans Health Administration. JAMA Surg. 2014;149(11):1169–75. Dunn GP, Martensen R, Weissman D.  Surgical palliative care: a resident's guide. Essex: American College of Surgeons; 2009. Biondo S, Martí-Ragué J, Kreisler E, et al. A prospective study of outcomes of emergency and elective surgeries for complicated colonic cancer. Am J Surg. 2005;189:377–83. National Comprehensive Cancer Network. https://www.nccn.org/. Accessed October 15, 2021. Shariat-Madar B, Jayakrishnan TT, Gamblin TC, Turaga KK. Surgical management of bowel obstruction in patients with peritoneal carcinomatosis. J Surg Oncol. 2014 Nov;110(6):666-9. doi: 10.1002/jso.23707.  Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Adam and Dr. Sheahan join Miss Eilidh Gunn and Dr. Steven Yule to discuss human factors engineering, coaching, and the Non-technical Skills for Surgeons (NOTSS) taxonomy and how they can be applied to improving vascular surgery.  Professor Steven Yule (@NOTSS_lab) is the Chair of Behavioural Sciences at the University of Edinburgh, Associate Professor at Harvard, and Director of Non-Technical Skills at the Royal College of Surgeons of Edinburgh. He is a Human Factors scientist and organizational psychologist. He is internationally recognized for his research on non-technical skills, patient safety, and simulation in surgery. His interests are in peer and computer assessments of surgical performance from video, safety in low and middle-income contexts, surgical coaching, sabermetrics, and astronaut training for long-duration spaceflight. He is also currently the program Director for MSc Patient Safety and Clinical Human Factors at Edinburgh University. To Learn More about NOTSS: RCSEd Let's Talk Surgery Podcast: Performance Project Enhancing Surgical Performance: A Primer on Non-technical Skills NOTSS Handbook Non-technical Skills for Surgeons RCSEd Website Non-Technical Skills for Surgeons Website (notss.org) The future training of non-technical skills for surgeons (NOTSS) - YouTube Relevant links Moulton CA, Regehr G, Mylopoulos M, MacRae HM. Slowing down when you should: a new model of expert judgment. Acad Med. 2007 Oct;82(10 Suppl):S109-16. Hu YY, Peyre SE, Arriaga AF, et al. Postgame analysis: using video-based coaching for continuous professional development. J Am Coll Surg. 2012;214(1):115-124. Sudol NT, Guaderrama NM, Honsberger P, et al. Prevalence and Nature of Sexist and Racial/Ethnic Microaggressions Against Surgeons and Anesthesiologists. JAMA Surg. 2021 May 1;156(5):e210265. CIEHF White Paper: Human Factors for Health Care and Social Care Ariadne Labs Co-hosts Miss Eilidh Gunn (@eil1_g) is currently a PhD candidate in Clinical Surgery at the University of Edinburgh. Her research interests are human factors, non-technical skills and surgical coaching. Dr. Mal Sheahan is a regular contributor to the podcast, editor for Vascular Specialist and co-chair of the SVS wellness taskforce overseeing their new initiative in peer coaching. If you enjoy our content, please contribute to Support Audible Bleeding! Help us improve through our ALL NEW Listener Survey! Follow us on Twitter: @AudibleBleeding

https://www.youtube.com/watch?v=EBhEjYhVoZk Goggin K et al. Reductions in parent interest in receiving antibiotics following a 90-second video intervention in outpatient pediatric clinics. J Pediatr 2020 Jun 15; [e-pub]. (https://doi.org/10.1016/j.jpeds.2020.06.027) acute respiratory tract illnesses (ARTIs; cough, congestion, sore throat, and earache) is a PROBLEM with a capital P. or maybe I should say its a pain in the A with a capital A and that A of course is referring to antibiotics-- parents want antibiotics, sometimes demand antibiotics and no matter what you say, its hard to say no time and time and time again and eventually EVERYONE and yes I mean everyone will eventually give an antibiotic when they in their heart of heart knows it is likely not indicated. BUT what if we could educate our pts before we walked in the room. In this study they surveyed 1051 parents about their knowledge of and interest in receiving antibiotics for their children. Surveys were conducted before and after parents watched a professionally created 90-second cartoon-- I dont have access to the cartoon but I didnt find a two minute cartoon on youtube and it is the in the show notes-- just go to details of this podcast! how do you get to the details?? if you are listening to this podcast on apple you click the little dots in the lower right hand corner, click go to show, then it goes to this show and click on details and BAM its magic all the information about this show. and ths me there is a listener named paul and I wont give the last name but you emailed me about an article and for the life of me I can’t find that article back so please re email me andrewbuelt@gmail.com back to the study in this survey Parents rated their interest in receiving an antibiotic using a visual analogue scale ranging from 0-100, with 0 being “I definitely do not want an antibiotic,” 50 “Neutral,” and 100 “I absolutely want an antibiotic.” at baseline average score was 57 and it reduced down to 47 BUT if you were one of the parents that scored much higher say a mean around 83 which is geting close to the 100 “I absolutely want an antibiotic.” your score dropped down to 63 which is much closer to neutral!! This gives you a chance to not write antibiotics if not needed- i dont take care of kids 1-5 but if I did EVERY parent would be watching this video or it would be on repeat for the education videos. last episode I talked about breast cancer screening and the age old saying is when it rains it pours which is clearly seen in this paper Le Blanc JM et al. Association of Medicaid expansion under the Affordable Care Act with breast cancer stage at diagnosis. JAMA Surg 2020 Jul 1; [e-pub]. (https://doi.org/10.1001/jamasurg.2020.1495) Affordable Care Act (ACA) went into full effect in early 2014. luckily for us as of 2018, 37 states, including the District of Columbia had adopted Medicaid expansion and 14 had not. this is prime time to look to see what happens when all of a sudden these women have insurance and can get mammograms! Ideally we should see a burst of new early cancers that then prevent all these really aggressive late cancers!! riiiiiight?? in this retrospective cohort analysis they looked at Stage at diagnosis was compared between patients who were uninsured, had Medicaid or Medicare, or were privately covered during the preexpansion years (2012-2013) and postexpansion years (2015-2016) Stage at diagnosis (early [stage 0 or 1] vs. late [stage 3 or 4]) was assessed by state and insurance status for pre-expansion years (2012–2013) compared with postexpansion years (2015–2016). “Between 2007 and 2012, the percentage of late-stage cancer was around 12% for those that were insurance or had medicaid”- this makes sense if you have insurance all things being equal all states should have pretty equal rates of breast cancer BUT Patients with late-stage cancer who were uninsured in nonexpansion states exhibited a 1 percentage–point non significant decline from 24.2% to 23.5% (P = .14), whereas patients with late-stage cancer who were uninsured or had Medicaid in the expansion states saw a significant decrease from 21.8% to 19.3% (P  10 and roughly 1 in 10 were started on thyroid therapy with TSH in normal range. Sometimes I really get worried how do you know that hip pain is osteoarthritis and not a strangulated inguinal hernia Does this patient have hip osteoarthritis?: The rational clinical examination systematic review Metcalfe D, Perry DC, Claireaux HA, et al. JAMA. 2019;322(23):2323-2333. doi: 10.1001/jama.2019.19413. Let’s say your patient has hip or groin pain. How do you know if it’s osteoarthritis (OA)? results in the end Six studies with 1,110 patients; 509 (38%) had radiographic hip OA. The following features were found to be useful: Squat causing posterior pain (likelihood ratio [LR] +6.1) Groin pain on passive adduction or abduction (LR +5.7) to rule out OA is normal passive hip adduction (LR –0.25) while these are not high LR ratios over 10 that we would hope for, if you combine a couple of them together they can work synergistically to give you a higher likelihood ratio and more secure diagnosis.

This week we're joined by "Dr. Joe Jo". Dr. Jo is a female resident, somewhere in this country (maybe). We break down her experience in orthopedics, her current pregnancy and the challenges surrounding that, as well as what's special about her favorite bone! Like, subscribe, comment on the video. We're also on iTunes, Spotify, and any other podcast platform. Links to all of our episodes as well as our platforms can be found at www.orthotalkpod.com References from this episode: Gender bias in surgery https://pubmed.ncbi.nlm.nih.gov/32432703/ Greenberg CC, Greenberg JA. Gender Bias and Stereotypes in Surgical Training: Is It Really Women Residents We Need to Worry About? [published online ahead of print, 2020 May 20]. JAMA Surg. 2020;10.1001/jamasurg.2020.1561. doi:10.1001/jamasurg.2020.1561 https://pubmed.ncbi.nlm.nih.gov/31617875/ Park KY, Chaiet SR, Greenberg CC. Diversity and Inclusion-One Size Does Not Fit All [published online ahead of print, 2019 Oct 16]. JAMA Surg. 2019;10.1001/jamasurg.2019.4082. doi:10.1001/jamasurg.2019.4082 https://pubmed.ncbi.nlm.nih.gov/30048312/ Pories SE, Turner PL, Greenberg CC, Babu MA, Parangi S. Leadership in American Surgery: Women are Rising to the Top. Ann Surg. 2019;269(2):199-205. doi:10.1097/SLA.0000000000002978

Ref: Cohen RV, Pereira TV, Aboud CM, et al. Effect of Gastric Bypass vs Best Medical Treatment on Early-Stage Chronic Kidney Disease in Patients With Type 2 Diabetes and Obesity: A Randomized Clinical Trial. JAMA Surg. Published online June 03, 2020. doi:10.1001/jamasurg.2020.0420

Episode Length: 28:38 Author: Vande Walle et. al. Publication: Development and Assessment of the Wisconsin Surgical Coaching Rubric. JAMA Surg. 2020 Apr 22 Purpose: In this study, they set out to “evaluate the validity” of a tool that measures the performance of a surgical coach. Additional reading: In his classic and hugely popular 2011 essay in the New Yorker (link: https://www.newyorker.com/magazine/2011/10/03/personal-best) “Personal Best” surgeon-author influencer Atul Gawande asks why doctors don’t have formal coaches. Voting for Methodology and Impact: 21:15 Follow our co-hosts on Twitter! Jason R. Frank: @drjfrank  Jonathan Sherbino: @sherbino  Linda Snell: @LindaSMedEd  Lara Varpio: @LaraVarpio Lara Varpio's Disclaimer: The views expressed in this manuscript are solely those of the authors and do not necessarily reflect those of the Uniformed Services University of the Unites States Department of Defense.  Want to learn more about KeyLIME? Click here! Full transcript for this Episode can be found here.

For our first episode of 2020, we investigate claims related to the application of cricoid pressure. Claim 1. Cricoid pressure reduces the risk of pulmonary aspiration. Claim 2. Landmark technique is able to accurately identify the cricoid cartilage. Claim 3. Cricoid pressure should be routinely applied in all rapid-sequence intubations. Our guest today is Dr. Jerome Crowley, an adult cardiothoracic anesthesiologist and intensivist at the Massachusetts General Hospital. Connect with us @DepthAnesthesia on Twitter or depthofanesthesia@gmail.com. Thanks for listening! Please rate us on iTunes and share with your colleagues.  Music by Stephen Campbell, MD.  -- References Cricoid pressure to control regurgitation of stomach contents during induction of anaesthesia. Sellick BA. Lancet. 1961;2:404–406. Smith KJ, Dobranowski J, Yip G, Dauphin A, Choi PT. Cricoid pressure displaces the esophagus: an observational study using magnetic resonance imaging. Anesthesiology. 2003;99:60–64. Rice MJ, Mancuso AA, Gibbs C, Morey TE, Gravenstein N, Deitte LA. Cricoid pressure results in compression of the postcricoid hypopharynx: the esophageal position is irrelevant. Anesth Analg. 2009;109:1546–1552 Lee D, Czech AJ, Elriedy M, Nair A, El-Boghdadly K, Ahmad I. A multicentre prospective cohort study of the accuracy of conventional landmark technique for cricoid localisation using ultrasound scanning. Anaesthesia. 2018;73:1229–1234. Smith CE, Boyer D. Cricoid pressure decreases ease of tracheal intubation using fiberoptic laryngoscopy (WuScope system. Can J Anesth. 2002;49:614–619. The Effectiveness of Cricoid Pressure for Occluding the Esophageal Entrance in Anesthetized and Paralyzed Patients: An Experimental and Observational Glidescope Study. Anesth Analg. 2014 Mar;118(3):580-6. doi: 10.1213/ANE.0000000000000068. Effect of cricoid pressure compared with a sham procedure in the rapid sequence induction of anesthesia: the IRIS randomized clinical trial. Birenbaum A, Hajage D, Roche S, et al; IRIS Investigators Group. JAMA Surg. 2019;154:9–17. Flucker CJ, Hart E, Weisz M, Griffiths R, Ruth M. The 50-millilitre syringe as an inexpensive training aid in the application of cricoid pressure. Eur J Anaesthesiol 2000; 17: 443–447.

Contributor: Jared Scott, MD Educational Pearls In a 4 yr period at 2 hospital systems, unprofessional behavior of surgeons was monitored via a complaint system. Number of complaints was compared with surgical complications.  In 13000 patients over this period, the number of surgical complications was found to vary with the number of complaints. Surgeons with  with zero complaints had a 10% complication rate, 1-3 complaints had a 14% rate, and those with >4 and an 11.9% rate.  There was statistical significance that persisted after adjustment for a variety of patient factors It never hurts to be professional!  References Cooper WO, Spain DA, Guillamondegui O, et al. Association of Coworker Reports About Unprofessional Behavior by Surgeons With Surgical Complications in Their Patients. JAMA Surg. 2019;154(9):828–834. doi:https://doi.org/10.1001/jamasurg.2019.1738 Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD

So as promised, and following on from our previous shock episode, this time we've covered the topic of shock in Trauma. It's a massive topic and one that we all, yet again, can make a huge difference for our patients' outcomes.  There is some crossover as you'd expect from the concepts and assessment that we covered in our Shock episode, so we'd recommend taking a listen to that one first. Make sure you have a comfy seat and plenty of refreshments to keep you going for this one as we cover the following; Definition Aetiology Hypovolaemic shock Neurogenic shock Obstructive shock Cardiogenic shock Physiology; Traumatic coagulopathy Other diagnostics Controlling external haemorrhage Pelvic binders REBOA Avoiding coagulopathy BP targets & permissive hypotension Fluid choices & supporting evidence TEG/ROTEM Calcium TXA Vasopressors Preventing hypothermia Relieving obstruction Interventional radiology Damage control surgery As always we’d love to hear any thoughts or comments you have on the website and via twitter, and make sure you take a look at the references and guidelines linked below to draw your own conclusions. Enjoy! Simon, Rob & James References Shock;The Resus Room podcast REBOA;The Resus Room podcast External Haemorrhage;The Resus Room podcast Blood;PHEMCAST TEG & ROTEM;FOAMcast Major Trauma guideline;NICE Resuscitative endovascular balloon occlusion of the aorta (REBOA):a population based gap analysis of trauma patients in England and Wales Nationwide Analysis of Resuscitative Endovascular Balloon Occlusion of the Aorta in Civilian Trauma. Joseph B. JAMA Surg. 2019 The Pre-hospital Management of Pelvic Fractures: Initial Consensus Statement. I Scott. FPHC. 2012 RePHILL;Birmingham University Trials Assessment and Treatment of Spinal Cord Injuries and Neurogenic Shock;Fox A. JEMS Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. Holcomb JB. JAMA. 2015 Risks and benefitsof hypotensive resuscitation in patients with traumatic hemorrhagic shock: a meta-analysis. Owattanapanich N. Scand J Trauma Resusc Emerg Med. 2018 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.Roberts I. Health Technol Assess. 2013 TEG and ROTEM for diagnosing trauma‑induced coagulopathy (disorder of the clotting system) in adult trauma patients with bleeding;Cochrane Review. 2015  Optimal Dose, Timing and Ratio of Blood Products in Massive Transfusion: Results from a Systematic Review.McQuilten ZK. Transfus Med Rev. 2018 Prehospital Plasma during Air Medical Transport in Trauma Patients at Risk for Hemorrhagic Shock.Sperry JL. N Engl J Med. 2018

In this episode, we discuss important and "hot" articles thus far in 2019. These articles include: Testing for pulmonary embolism in pregnant patients Van der pol LM, Tromeur C, Bistervels IM, et al. Pregnancy-Adapted YEARS Algorithm for Diagnosis of Suspected Pulmonary Embolism. N Engl J Med. 2019;380(12):1139-1149. Langlois E, Cusson-dufour C, Moumneh T, et al. Could the YEARS algorithm be used to exclude pulmonary embolism during pregnancy? Data from the CT-PE-pregnancy study. J Thromb Haemost. 2019; In Press Asymptomatic bacteriuria guidelines from the Infectious Disease Society of America (IDSA) Nicolle LE, Gupta K, Bradley SF, et al. Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2019. Dosing of benzodiazepines in seizures Sathe AG, Tillman C, Coles LD, et al. Underdosing of benzodiazepines in patients with status epilepticus enrolled in Established Status Epilepticus Treatment Trial. Acad Emerg Med. 2019 Jun 4. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in trauma patients Joseph B et al. Nationwide analysis of resuscitative endovascular balloon occlusion of the aorta in civilian trauma. JAMA Surg 2019. Mar 20. Mortality following opioid overdose Weiner SG, Baker O, Bernson D, Schuur JD. One-Year Mortality of Patients After Emergency Department Treatment for Nonfatal Opioid Overdose. Ann Emerg Med. 2019; In Press Thanks for listening! Jeremy Faust and Lauren Westafer

En el programa de esta semana (EP 158) seguimos hablando de infecciones de protesis articulares. Esta vez, en referencia al uso profiláctico de antibioticos y al riesgo de infecciones de protesis articular en asociación con bacteriemias.   Referencias: Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg. 2017;152(8):784-791. doi:10.1001/jamasurg.2017.0904 Published online May 3, 2017. Corrected on June 21, 2017.  Proceedings of the International Consensus Meeting on Periprosthetic Joint Infection. 2013 Meeri Honkanene y colaboradores. Periprosthetic Joint Infections as a Consequence of Bacteremia. Open Forum Infect Dis. Mayo 2019. Rodriguez y colaboradores. Acute haematogenous prosthetic joint infection: prospective evaluation of medical and surgical management. Clin Microbiol Infect 2010; 16: 1789–1795. The use of prophylactic antibiotics prior to dental procedures in patients with prosthetic joints Evidence-based clinical practice guideline for dental practitioners—a report of the American Dental Association Council on Scientific Affairs. JADA Jan 2015. 145 (1): 11-16.   La Frase de la Semana: Esta semana nos valemos nuevamente de Benjamín Franklin. (1706-90) quien fue estadista, autor, editor, científico, inventor y diplomático. Nacio en una familia de pocos recursos en la ciudad de Boston y tuvo poca educación formal. Sin embargo, se hizo rico con un exitoso negocio de impresión en Filadelfia. Fue un participante muy activo en los asuntos públicos en Filadelfia, donde ayudó a lanzar una biblioteca, un hospital y una universidad (la Universidad de Pensilvania), y fue aclamado, entre otros proyectos, por sus experimentos con electricidad. Durante la Revolución Americana, sirvió en el Segundo Congreso Continental y ayudó a redactar la Declaración de Independencia en 1776. También negoció el Tratado de París de 1783 que puso fin a la Guerra de la Independencia (1775-83). En 1787, en su último acto significativo de servicio público, fue delegado a la convención que produjo la Constitución de los Estados Unidos. Como inventor ideo el pararayos, los lentes bifocales, y el catéter urinario flexible. La frase dice: “No habrá Justicia hasta que los que no se ven afectados estén tan indignados como los que están afectados”  

Torsdag den 2. maj blev der afholdt Copenhagen Critical Care symposium. Vi deltog, bla. med en podcast hvor vi tog en snak med næsten alle talerne. Her får du deres 3-4 take homes points fra netop deres tale. Vi snakker om ledelse, opbygning af kultur, brandsårsbehandling og meget mere. Hør podcasten hvor de nyeste anbefalinger om brandsårsbehandling gennemgås, behandling for Rhabdomyolyse analyseres. Akronymet MONA aflives af Kardiolog Jens Rosenberg. En fantastisk session om lederskab og meget mere. Se tiderne for de forskellige emner her under 02:00 Lederskab med Thomas Bøllingtoft Knudsen,Randi Beier & Ture Larsen, Roger Harris14:50 Massetilskadekomst med Christina Hernon (US), Dan Lou Isbye og Kristian Andersen29:50 Critical care er ikke ét speciale med Monika Afzali Rubin og Karl Høeg40:15 Toxikologi - Christina Hernon (US), 45:21 Brandsår - Rikke Holmgaard, Christian Overgaard Steensen & Martin Risom Vestergaard51:50 Mythbusters - Jens Rosenberg, Jens Michelsen, Thomas Bøllingtoft Knudsen01:01:11 Critical Care litteratur update 2019 - Thomas Strøm ogLars Simon Rasmussen Abonner eller hent via iTunes for iOS og for android via Podbean. Nu også via TUNE IN Se vores egen Karl Høeg som vært på FOAMmedic Talk hvor han interviewer Læge Monika Afzali Rubin https://www.youtube.com/watch?v=WnrmbQCqPTg Links og referencer: Se hele cphcc2019 på vores søster blog scanFOAM https://www.youtube.com/watch?v=WLYujtTXfLQ Paper battle mellem Thomas Strøm og Lars S. Rasmussen, her er de fire artikler som blev debatteret, hør vores snak ved 01:01:11 i podcasten: Timing of Renal-Replacement Therapy in Acute Kidney Injury and Sepsis.Barbar SD, Dargent A, Quenot JP. N Engl J Med. 2019 Jan 24;380(4):399. Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults. Casey JD, Janz DR, Russell DW, Vonderhaar DJ, Joffe AM, Dischert KM, Brown RM, Zouk AN, Gulati S, Heideman BE, Lester MG, Toporek AH, Bentov I, Self WH, Rice TW, Semler MW; PreVent Investigators and the Pragmatic Critical Care Research Group. N Engl J Med. 2019 Feb 28;380(9):811-821 Effect of Cricoid Pressure Compared With a Sham Procedure in the Rapid Sequence Induction of Anesthesia: The IRIS Randomized Clinical Trial. Birenbaum A, Hajage D, Roche S, Ntouba A, Eurin M, Cuvillon P, Rohn A, Compere V, Benhamou D, Biais M, Menut R, Benachi S, Lenfant F, Riou B; IRIS Investigators Group. JAMA Surg. 2019 Jan 1;154(1):9-17 Sodium bicarbonate therapy for patients with severe metabolic acidaemia in the intensive care unit (BICAR-ICU): a multicentre, open-label, randomised controlled, phase 3 trial. Jaber S, Paugam C, Futier E, Lefrant JY, Lasocki S, Lescot T, Pottecher J, Demoule A, Ferrandière M, Asehnoune K, Dellamonica J, Velly L, Abback PS, de Jong A, Brunot V, Belafia F, Roquilly A, Chanques G, Muller L, Constantin JM, Bertet H, Klouche K, Molinari N, Jung B; BICAR-ICU Study Group. Lancet. 2018 Jul 7;392(10141):31-40 Støt FOAMmedics arbejde med 5 eller 10 kr pr. podcast. Hvis du har lyst til at støtte vores arbejde med at lave lækker lyd og skrift så klik ind på 10er.dk og støt os med 5, 10 eller 15 pr. podcast episode, så bliver vi så sindsygt stolte og glade. Eller klik på 10'er logo her under og en pop-up løsning kommer frem.

In this 109th episode we pick up where we left off in episode 108 and discuss the intraoperative use of non-opioid adjuncts. References: Wick EC, Grant MC and Wu CL. Postoperative Multimodal Analgesia Pain Management With Nonopioid Analgesics and Techniques A Review. JAMA Surg. 2017;152(7):691-697. Bahr MP, Williams BA. Esmolol, Antinociception, and Its Potential Opioid-Sparing … Continue reading "Episode 109: Non-Opioid Adjuncts with Drs. Grant and Bicket part 2"

Author: Aaron Lessen, MD Educational Pearls: Retrospective study looking at type of transportation and mortality outcomes for patients with penetrating trauma Mortality was 2.2 % for those brought in by private vehicle compared to 11.6% by EMS     Editor’s note: the above is raw mortality - even after risk adjustments the odds ratio of death was statistically significant for penetrating injuries, which held true even over multiple trauma systems. Shout out to Dr Haut as well! References: Wandling MW, Nathens AB, Shapiro MB, Haut ER. Association of Prehospital Mode of Transport With Mortality in Penetrating Trauma: A Trauma System-Level Assessment of Private Vehicle Transportation vs Ground Emergency Medical Services. JAMA Surg. 2018 Feb 1;153(2):107-113. doi: 10.1001/jamasurg.2017.3601. PubMed PMID: 28975247; PubMed Central PMCID: PMC5838586. Summary by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD

This week we review 1) Rattlesnake Bites: “Rattlesnake Envenomation.” VetFolio, www.vetfolio.com/toxicology/rattlesnake-envenomation. “The Use of Rattlesnake (Crotaline) Antivenom.” Using Activated Charcoal in Medical Toxicology | California Poison Control System | UCSF, calpoison.org/news/use-rattlesnake-crotaline-antivenom. “Rattlesnake Antivenin (Antivenin (Crotalidae) Polyvalent): Side Effects, Interactions, Warning, Dosage & Uses.” RxList, www.rxlist.com/rattlesnake-antivenin-drug.htm#warnings_precautions. 2) Fatty Acid Supplements: “Effects of n-3 Fatty Acid Supplements in Diabetes Mellitus”. N Engl J Med 2018; 379:1540-1550. DOI: 10.1056/NEJMoa1804989. 3) Anesthesia Use in Children: O'leary JD, Janus M, Duku E, et al. Influence of Surgical Procedures and General Anesthesia on Child Development Before Primary School Entry Among Matched Sibling Pairs. JAMA Pediatr. 2018 Nov 5. [Epub ahead of print]. doi: 10.1001/jamapediatrics.2018.3662. 4) Surgery for Liver Metastases: Ratti F, Fiorentini G, Cipriani F, Catena M, Paganelli M, Aldrighetti L. Laparoscopic vs Open Surgery for Colorectal Liver Metastases. JAMA Surg. July 18, 2018. doi:10.1001/jamasurg.2018.2107 Welcome to TalkingMed, the podcast where we discuss current medical news. Contact: talkingmedpodcast@gmail.com Twitter: @TalkingMedPod Song credit: Levels of Greatness by Scott Holmes from the Free Music Archive, used under CCBY Attribution License, modified from the original. Disclaimer: The information presented on this podcast are our own personal views, opinions, and research on the subject matter and do not represent those of our institution or our department. Anything discussed on this podcast should not be considered medical advice. Please contact a professional if you have any medical concerns. All content found on TalkingMed, including text, images, audio, or other formats were created for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have learned it from TalkingMed. Under no circumstances shall Vivek, Stephen, TalkingMed, any guests or contributors to the podcast or blog, or any employees, associates, or affiliates of TalkingMed be responsible for damages arising from use of the podcast or blog. This podcast or blog should not be used in any legal capacity whatsoever, including but not limited to establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the podcast or blog. You hereby acknowledge that nothing contained on TalkingMed shall constitute financial, investment, legal and/or other professional advice and that no professional relationship of any kind is created between you and the TalkingMed. You hereby agree that you shall not make any financial, investment, legal and/or other decision based in whole or in part on anything contained on TalkingMed. Nothing on TalkingMed or included as a part of TalkingMed should be construed as an attempt to offer or render a medical opinion or otherwise engage in the practice of medicine. If you think you may have a medical emergency, call your doctor, go to the emergency department, or call 911 immediately.  The content may contain health- or medical-related materials or discussions regarding sexually explicit disease states. If you find these materials offensive, you may not want to use this content.

We've heard a lot about advanced airway management recently, with some really significant publications over the last few months and in the last few weeks in JAMA we've had another! Cricoid pressure during emergency anaesthesia and for those at high risk of aspiration has been common place for more than half a century. But it's a topic that has caused quite some debate. On one hand it has the potential to reduce aspiration, a very real and potentially very serious complication of RSI. But on the other it has the potential to hinder the view on laryngoscopy and decrease first pass success. The founding evidence for cricoid pressure has always been a little soft. In this podcast we look at the background of cricoid pressure and then run through this key paper, discussing the implications it holds for both pre and in-hospital advanced airway management. As always we'd love to hear any thoughts or comments you have on the website and via twitter, we look forward to hearing from you. Enjoy! Simon, Rob & James References Effect of Cricoid Pressure Compared With a Sham Procedure in the Rapid Sequence Induction of Anaesthesia: The IRIS Randomized Clinical Trial. Birenbaum A. JAMA Surg 2018 Cricoid pressure to control regurgitation of stomach contents during induction of anaesthesia. Sellick BA Lancet.1961 Safer Prehospital Anaesthesia 2017;AAGBI JC: Cricoid Pressure and RSI, do we still need it?St Emlyn’s Cricoid: To press, or not to press?(Hinds and May)  

Three-Year Outcomes of Bariatric Surgery vs Lifestyle Intervention for Type 2 Diabetes Mellitus Treatment: A Randomized Clinical Trial. JAMA Surg. 2015 Jul 1

Un estudio publicado el 20 de septiembre 2017 en la revista Journal of the American Medical Association (JAMA) sugiere que el transporte en ambulancia terrestre no está asociado a un aumento en sobrevivencia, y que el transporte en vehículo privado puede inclusive disminuir la mortalidad de pacientes de trauma penetrante. El dogma de mover a la víctima. Los cursos de primeros auxilios recomiendan a la ciudadanía a no mover a las víctimas hasta que no llegue la ayuda con el objetivo de que no se empeore su situación actual. Es importante recordar que la incidencia de fracturas inestables de la columna cervical luego de trauma penetrante es sumamente baja. En este estudio se demostró que solamente 0.4% de los pacientes con herida por arma de fuego al cuello tenían una lesión inestable de columna. Todos los pacientes que tenían lesión inestable tenían signos neurológicos. Esto es parte de la razón por la cual no se inmovilizan los pacientes con trauma penetrante que no tengan signos neurológicos. En este episodio anterior del ECCpodcast hablamos de cuándo NO es necesario inmovilizar al paciente de trauma. Objetivo: Controlar el sangrado El objetivo del manejo del paciente con una lesión penetrante es controlar el sangrado en primera instancia. En segunda instancia, sería no permitir que se forme un shock obstructivo o un compartimiento por el aumento en la presión (pleura, pericardio, o intracranial). El sangrado en una extremidad puede ser fácilmente tratado en la escena con un torniquete. Sin embargo, el sangrado interno posiblemente requiera una cirugía para poderlo controlar. El determinante de cuánta sangre se pierde en el paciente con trauma penetrante es qué tan rápido puede aplicarse el torniquete, o realizar la cirugía. Para realizar la cirugía hacen falta varias cosas: El paciente fue transportado lo antes posible desde la escena al hospital. El hospital seleccionado fue el apropiado. El equipo de cirugía estaba preparado para intervenir. El estudio demostró que transportar el paciente de trauma penetrante en un vehículo privado no aumenta la mortalidad pues se está contribuyendo al objetivo. Pero esto es cierto solo si el paciente es transportado al hospital apropiado. Hospital apropiado Una de las características de los centros de trauma es que tienen un equipo disponible 24/7 para recibir, e intervenir, al paciente de trauma. Si usted transporta a un paciente de trauma a un centro de trauma, es probable que el sistema esté listo para recibirlo y atenderlo apropiadamente. No obstante, un aviso previo no está mal. Alertar al equipo de trauma de que un paciente críticamente lesionado va de camino es una forma de mejorar el tiempo y la calidad de la respuesta si el equipo se prepara. Esto plantea un problema en el estudio. En un escenario urbano es posible que algunas ciudades cuenten con múltiples centros de trauma, pero muchas no. Si el paciente es transportado simplemente al hospital "más cercano", es posible que se esté retrasando el cuidado definitivo y esto es detrimental para el paciente de trauma. En este episodio del ECCpodcast hablamos sobre cómo seleccionar el hospital apropiado. Por lo tanto, las conclusiones de este estudio, si es que pudieran ser generalizables, solamente aplican en el contexto de un sistema urbano donde es más probable que el paciente sea transportado a un centro de trauma capaz. En teoría el sistema de emergencias médicas debe tener controles para evitar que este tipo de paciente vaya al "hospital más cercano", y vaya de inicio al lugar correcto: el centro de trauma nivel 1 (o nivel 2). Otra limitación del estudio El otro aspecto a considerar de este estudio es que solo se evaluaron los pacientes que fueron transportados inicialmente a un centro de trauma nivel 1 ó 2. En la escala del Colegio Americano de Cirujanos, el nivel 1 es el nivel más alto (con más capacidad de atención médica inmediata). Por lo tanto, si se incluyen también los pacientes que fueron transportados a otros hospitales (que no son centros de trauma), es posible que haya una diferencia. No cambie la práctica pero considere oportunidades Por el momento todo sigue igual. Las ambulancias van a ser despachadas para los pacientes con trauma penetrante, los paramédicos deben controlar los sangreados externos y transportar a los pacientes con sangrado interno al hospital mas cercano que pueda corregir el problema. Esto es lo que enseña el curso Prehospital Trauma Life Support (PHTLS). Pero considere cómo podemos proveer más oportunidades al educar a otros primeros respondedores, como los policías, quienes en muchas ocasiones recurren a transportar al paciente en su vehículo o patrulla debido a que la ambulancia no puede llegar de inmediato. Referencias Wandling MW et al. Association of prehospital mode of transport with mortality in penetrating trauma: A trauma system–level assessment of private vehicle transportation vs ground emergency medical services. JAMA Surg 2017 Sep 20; [e-pub]. (http://dx.doi.org/10.1001/jamasurg.2017.3601) https://jamanetwork.com/journals/jamasurgery/article-abstract/2654239?redirect=true https://journals.lww.com/jtrauma/Abstract/2011/04000/Unstable_Cervical_Spine_Fracture_After_Penetrating.17.aspx http://www.eccpodcast.com/hospital-mas-apropiado/ http://www.eccpodcast.com/nexus/