Podcasts about jama surgery

Episode 160: Grab the Ultimate Ad Script right HERE - https://join.digitaltrailblazer.com/ultimate-ad-scriptOne of the biggest struggles for online business owners is generating consistent, high-quality traffic and leads. Many entrepreneurs get stuck trying different strategies like webinars or challenges, but when they don't see sales, they blame the strategy itself. The real issue? They simply don't have enough people in their funnel to properly test and optimize their approach.In this episode, Victoria and Oksana teach us how they scaled their health coaching business from $18K to $460K annually using a strategic paid ads approach that focuses heavily on retargeting. They share their proven system of running ads to webinars and VSLs, then using client testimonial videos as retargeting ads to address common objections and nurture warm audiences. Their retargeting strategy generated 12-20x return on ad spend by continuously nurturing anyone who had engaged with their content.About Viktoriya and Oksana: Viktoriya and Oksana are internationally recognized twin sisters, award-winning immunology scientists, and pioneers in cellular healing.As creators of the Rapid Immunocellular Repair™ Program, they helped hundreds of high-performance professionals over 40 achieve peak health and become symptom-free naturally—often in just 30 days.Their groundbreaking work has been published in leading scientific journals including Cancer Letters, JAMA Surgery, and the Journal of Surgical Research since 2010.They also gained global recognition in the groundbreaking documentary Legacy Makers, selected from over 7,000 applicants for their innovation in health.They are sought-after international speakers, presenting at leading global medical conferences.Through their science-backed, supplement-free approach, Viktoriya and Oksana are redefining the future of rapid, natural healing for elite professionals worldwide.Register for Viktoriya & Oksana's Free Masterclass: https://go.autoimmunecellularhealing.com/info326541-6488 Connect with Viktoriya and Oksana:https://viktoriyaandoksana.com/ https://www.instagram.com/viktoriyaandoksana/ https://www.facebook.com/viktoriyaandoksana https://www.linkedin.com/in/viktoriyaandoksana/ https://www.youtube.com/@viktoriyaandoksanaGrab the Ultimate Ad Script right HERE - https://join.digitaltrailblazer.com/ultimate-ad-script✅ Connect With Us:Website - https://DigitalTrailblazer.comFacebook - https://www.facebook.com/digitaltrailblazerTikTok: https://www.tiktok.com/@digitaltrailblazerTwitter: https://twitter.com/DgtlTrailblazerInstagram: https://www.instagram.com/DigitalTrailblazer

Interview with Julie Hallet, MD, MSc, author of Familiarity of the Surgeon-Anesthesiologist Dyad and Major Morbidity After High-Risk Elective Surgery. Hosted by Amalia Cochran, MD. Related Content: Familiarity of the Surgeon-Anesthesiologist Dyad and Major Morbidity After High-Risk Elective Surgery Association of Familiarity of the Surgeon-Anesthesiologist Dyad With Major Morbidity After Surgery

SHOW NOTESWhat impact does surgery have on the body?Intentional trauma Physiological response Psychosocial impact StressWhen we think about surgery, it's essential to understand that it triggers a significant reaction in the body known as the 'stress response.' This response is a complex interplay of hormonal and metabolic changes directly linked to the degree of tissue damage during surgery. It can intensify if there are any complications after the operation. Let's break it down: The whole process starts when the hypothalamic-pituitary-adrenal axis, or HPA axis, kicks into gear. This leads to a surge in hormones like cortisol, growth hormone, glucagon and catecholamines. These hormones are important because they help the body cope with stress by boosting energy availability and adjusting other bodily functions.Ebb phase (0-48hrs)Increased catabolism of stored glycogen (glycogenolysis)Suppression of insulin secretion → transient hyperglycemiaIncreased catecholamines, cortisol, and inflammatory cytokines (IL-6, TNF-α)Flow phase (3-10 days)Hypermetabolism (increased BMR)Increased protein catabolism → muscle breakdown (to provide amino acids for tissue repair and immune function)Increased lipolysis (fat breakdown) for energySustained insulin resistance → continued hyperglycemiaEnhanced GNG Pro-inflammatory response → increased cytokines and acute-phase protein productionIn the initial stages after surgery, the body releases a wave of pro-inflammatory cytokines. These cytokines jumpstart the healing process by promoting inflammation, which is important for healing surgical wounds. However, to keep this inflammation from going overboard, the body soon follows up with anti-inflammatory cytokines.These inflammatory processes have widespread effects across the body. For example, they can influence how the hypothalamus regulates body temperature or how the liver produces certain proteins that help fight infection and aid in wound healing.But here's where it gets even more interesting: other hormones like glucagon, cortisol, and adrenaline also play a role in modulating these responses. They can affect everything from your blood sugar levels to how your cardiovascular system handles the stress.So, why is all this important? Well, by understanding and managing these responses effectively, we can significantly improve how patients recover from surgery. It's all about helping the body maintain balance during a time when it's incredibly vulnerableDisruption of Metabolic Homeostasis: Surgery often disrupts the body's normal metabolic balance, notably through insulin resistance, where cells fail to respond effectively to insulin, leading to 'diabetes of the injury.' Insulin Resistance and Hyperglycemia: Insulin resistance can cause high blood sugar levels, significantly increasing the risk of surgical complications and mortality. Post-surgery, the body may enter a catabolic state, breaking down muscle instead of fat, which impairs wound healing, weakens the immune system, and reduces muscle strength. Increased Risks for Vulnerable Groups: Elderly, diabetics, and cancer patients are particularly at risk due to their compromised metabolic and inflammatory states. These groups have less physiological reserve, leading to pronounced catabolic states and increased risk of severe post-operative complications. Impact on Recovery and Outcomes: The metabolic chaos from insulin resistance to protein loss not only delays recovery but also exacerbates risks of infection and other complications. Effective management of these changes is crucial for improving surgical outcomes and ensuring that patients thrive post-surgery.ERAS helps to mitigate these by Surgery isn't just about the physical repair or removal of tissue; it triggers a cascade of stress responses in the body that can complicate recovery. These include everything from the psychological impacts of anxiety and the physiological effects of fasting to direct tissue damage and the systemic reactions to it, such as fluid shifts and hormonal imbalances.Key Components of ERAS:Comprehensive Care: ERAS isn't just a single technique but a suite of practices designed to address every aspect of the patient's journey — before, during, and after surgery. This approach aims to minimise the stress responses by controlling pain, reducing fasting times, optimising fluid management, and promoting early mobility.Minimising Fasting: One traditional practice that ERAS revises significantly is the preoperative fasting rule. Old guidelines that required fasting from midnight before surgery are now replaced with more lenient, evidence-based practices that allow intake of clear fluids up to two hours and solids up to six hours before surgery. This change helps maintain normal blood glucose levels, reduces stress, and decreases the body's shift into a catabolic (muscle-degrading) state.Nutritional Optimisation: ERAS protocols emphasise the importance of not entering surgery in a depleted state. By allowing a carbohydrate-rich drink shortly before surgery, patients are better hydrated and less anxious, which in turn reduces insulin resistance and preserves muscle mass — critical factors in speeding up recovery post-surgery. Post-operatively, oral nutrition may be delayed by the medical team until bowel function returns, typically taking close to a week. This delay is stated to reduce postoperative complications such as abdominal distension and nausea/vomiting.For the first several days post surgery fluids of limited nutritional value such as water are provided to patient until tolerance is established leading to insufficient nutrition intake during this time increasing the risk of malnutrition. The ERAS protocol promotes early oral intake within 24 hours post surgery departing from traditional fasting practices. Research suggests that between 40-50% of surgical patients have some degree of malnutrition. Pre-operative malnutrition is an independent predictor of poor post-operative outcomes. Therefore addressing malnutrition is a key component of the ERAS protocol.Immune-Enhancing Diets: Post-surgery nutrition is just as crucial. ERAS encourages diets rich in nutrients that bolster the immune system and enhance wound healing. This includes omega-3 fatty acids, which help modulate the inflammatory response; arginine, which supports protein synthesis and tissue growth; glutamine, which is vital for cellular health and recovery; and nucleotides, which are essential for rapid cell division and immune function .Immuno-nutrition is a specialised medical nutrition therapy that has been shown to adjust the body's inflammatory response: It incorporates specific nutrients like omega-3 fatty acids, arginine, polyunsaturated fatty acids, and nucleotides. It's typically recommended starting 5-7 days before surgery and continuing post-operatively for over 7 days or until oral intake meets at least 60% of the patient's nutritional requirements.How can we use this info to optimize surgical outcomes?Patient education Early nutrition pre and post surgery - Minimise fasting time What is ERAS? How does it differ from traditional care/practice?Introduced by Henrik Kehlet in 1997, the Enhanced Recovery After Surgery (ERAS) protocol has revolutionised surgical practices by optimising perioperative care. A key aspect of ERAS is its interdisciplinary approach, involving healthcare professionals from various specialties to minimise surgical stress and facilitate recovery. What is malnutrition?Malnutrition, is defined as an involuntary reduction in body weight, muscle mass and physical capabilities, affects up to 65% of surgical patients and can worsen during hospital stays. Enhancing nutritional status and promoting functional nutrition therapy is essential, even forpatients without evident malnutrition, particularly when prolonged perioperative oral intake challenges arise. Addressing malnutrition is essential for preventing surgical complications, prolongedhospital stays and higher healthcare costs. What are the benefits of ERAS for the patient?It has been shown that the key physiological benefits include:-enhances the body's anabolic processes-promotes wound healing, which is critical for patient recovery.-Reduces the risk of nutritional depletion-Minimises insulin resistance, a common issue post-surgery, allowing for better blood sugar control and improved metabolic function.-Reduce protein catabolism-And lowers the risk of pressure injuries, which can develop due to extended immobility after surgery.What are the benefits of ERAS from a healthcare perspective? From a healthcare perspective, ERAS has been shown to-shorter length of hospital stay for patients,-Lower risk of ICU transfer rates-reduce readmission rates-And all of these improvements lead to lower healthcare costs, not just for the hospital but for the overall healthcare system, as fewer complications and shorter stays reduce the financial strain.Step 1: Screen & StrengthenIf you've lost any weight unintentionally in the lead up to surgery, or been eating poorly because of a reduced appetite, you may be at risk of malnutrition and it's really important to address this prior to surgery. Research suggests that between 40-50% of surgical patients have some degree of malnutrition. Pre-operative malnutrition is an independent predictor of poor post-operative outcomes. Addressing malnutrition is a key component of the ERAS protocol and why it's effective in improving surgical outcomes for patients.Book an appointment with a dietitian who can guide you on appropriate dietary changes to minimise muscle loss, build you up and optimise nutritional status and stores pre-op. A well-nourished body tolerates surgery better, heals faster, has a stronger immune system to fight infection, and experiences fewer complications.Step 2: Consider Immunonutrition If you're planned for major surgery, especially certain cancer and abdominal surgeries, consider the use of an immunonutrition supplement in the 5-7 days pre op. These are the supplements loaded with arginine, n3s, glutamine and nucleotides to support the immune system and reduce inflammatory responses, potentially leading to fewer infections and better recovery.Step 3: Build Your Strength & Energy Stores prior to surgery Carb load with food in the days leading up to surgery - think that big bowl of pasta a footy player would have the night before the grand final. ERAS protocols have significantly reduced or eliminated long periods of "nil by mouth" (NBM) before surgery.Ask your surgical team exactly when you need to stop eating solid food – it might be much later than you think, often around 6 hours before surgery for a light meal. For clear fluids, it could be as little as 2 hours before!We'll make the most of every second to prevent unnecessary dehydration, hunger, anxiety, and preserve your body's energyStep 4: The Pre-Surgery Carb Load using clear fluidsMany ERAS protocols include a special carbohydrate-rich drink taken a few hours before surgery. Your hospital may provide this, but if they don't, we can organise orders for you or point you in the right direction.  It's usually a clear, sweet drink. Think of it as topping off your fuel tank right before the 'race'."These have been shown to reduce post-operative insulin resistance (which can slow healing), help maintain muscle strength, can reduce nausea, and improve overall wellbeing. It basically tells your body it's in a 'fed' state, not a 'starvation' state, heading into surgery.This is best done with tailor made medical nutrition drinks as they come prepped with the correct doses of maltodextrin-polymer carbs and a lower osmolality than other solutions, which essentially means they gentler on your gut and better for gastric emptying so they don't linger in your gut during surgery. Always follow surgical instructions, but ideally we're aiming for 100 grams of carbohydrate the night before surgery and about 50 grams of carbohydrate in clear fluids approximately 2 hours before anesthesia. This might look like 4 x 200ml drinks the night before, and 2 the morning of surgery If you can't access these drinks, apple or cranberry juice are reasonable replacements.  Drop us an email or message or give us a call if you'd like advice on where to get pre-op and immunonutrition supplement drinks. Then we move on to post op and Step 5 which is aiming to eat early.  ERAS encourages starting to eat and drink as soon as it's safe after surgery – often within hours, not days!As soon as your team says it's okay, try sipping water, then progress to other clear fluids, and then light foods as tolerated. Even small, frequent amounts help. This helps to stimulates your gut to start working again, reducing the risk of ileus – a slow, sleepy bowel, provides energy for healing, and can help you feel more normal, faster.If you haven't been told you can eat or drink, keep asking the question! You are your best advocate! Another tip that can help here is step 6:  Chew GumIf your team allows it, start chewing sugar-free gum several times a day once you're able. It sounds simple, but it can be surprisingly helpful in mimicking eating even when you're not allowed to, and can stimulate your digestive system to return to usual function sooner and reduce the risk of ileus.Step 7 is to Nourish to Heal This is where we bring in our good friend protein to optimise tissue repair and recovery Include protein rich food at each meal, and chat to us if you're finding this difficult because there are plenty of hacks if you're not feeling up to chicken breast and steak! And finally step 8 is to Listen to Your BodyWhile ERAS encourages early eating, we always want you to be tuned in to your body's cues and speaking up to your medical team and us if something doesn't feel right. There are plenty of interventions that can be used to keep you comfortable while still optimising your nutrition to get the best outcomes from surgery. Weimann, A., Braga, M., Carli, F., Higashiguchi, T., Hübner, M., Klek, S., et al. (2021). ESPEN practical guideline: Clinical nutrition in surgery. Clinical Nutrition, 40(7), 4745-4761.Weimann, A., Braga, M., Carli, F., Higashiguchi, T., Laviano, A., Ljungqvist, O., et al. (2017). ESPEN guideline: Clinical nutrition in surgery. Clinical Nutrition, 36(3), 623-650.Gustafsson, U. O., Scott, M. J., Schwenk, W., Demartines, N., Roulin, D., Francis, N., et al. (2019). Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations: 2018. Clinical Nutrition, 38(2), 576-586. (Note: The ERAS® Society website, erassociety.org, is the primary source for the most current and comprehensive suite of procedure-specific guidelines.)Ljungqvist, O., Scott, M., & Fearon, K. C. (2017). Enhanced Recovery After Surgery: A review. JAMA Surgery, 152(3), 292-298.Thiele, R. H., Raghunathan, K., Brudney, C. S., Campos, S., Candiotti, K., Chaves, S., et al. (2016). American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on perioperative fluid management in adults. Perioperative Medicine, 5, 26. (Note: This is an example of ASER/POQI consensus; look for other relevant POQI statements on specific surgical procedures and their nutritional components.)Soon, K., Levy, G. M., Cusack, L. A., Varma, S., & Nicholson, G. A. (2020). The effect of preoperative carbohydrate loading on patient outcomes in elective surgery: A systematic review and meta-analysis. Systematic Reviews, 9(1), 254.Lewis, S. J., Egger, M., Sylvester, P. A., & Thomas, S. (2001). Early enteral feeding versus "nil by mouth" after gastrointestinal surgery: systematic review and meta-analysis of controlled trials. BMJ, 323(7316), 773-776.Osland, E. J., Hossain, M. A., Khan, S., & Memon, M. A. (2014). Effect of timing of oral feeding on patient outcomes after elective colorectal surgery: A systematic review and meta-analysis. Journal of Gastrointestinal Surgery, 18(5), 1039-1051.Braga, M., Gianotti, L., Nespoli, L., Radaelli, G., & Di Carlo, V. (2002). Nutritional approach in malnourished surgical patients: a prospective randomized study. Archives of Surgery, 137(2), 174-180.Marimuthu, K., Varadhan, K. K., Ljungqvist, O., & Lobo, D. N. (2012). A meta-analysis of the effect of combinations of enhanced recovery after surgery (ERAS) interventions on postoperative outcomes. Annals of Surgery, 255(4), 640-649.

Interview with Anne P. Cameron, MD and Glenn T. Werneburg, MD, PhD, authors of Foley Catheter Management: A Review. Hosted by Amalia Cochran, MD. Related Content: Foley Catheter Management

Today, we're diving into one of the most challenging and high-stakes procedures in trauma medicine—prehospital resuscitative thoracotomy (RT) for traumatic cardiac arrest (TCA). Joining me is Dr Mike Christian, the senior author of a recent study published in JAMA Surgery, which examines the impact of prehospital RT in London's Air Ambulance (LAA) system over two decades. TCA is often seen as a condition with a poor prognosis but for select patients—particularly those suffering from cardiac tamponade—prehospital RT has been shown to improve survival rates when performed within minutes of arrest. This study is the largest of its kind, analysing over 600 cases and shedding light on the effectiveness of RT, the critical time windows, and the factors that influence outcomes.In this episode, we'll explore the study's key findings, discuss the operational and ethical challenges of performing RT in the field, and consider what this means for the future of prehospital trauma care. The paper can be found here: https://jamanetwork.com/journals/jamasurgery/fullarticle/2830622A review and appraisal of the paper can be found here: https://www.stemlynsblog.org/laa-resuscitative-thoracotomy/This is an advertisement from BetterHelp.Stress and anxiety affect all of us—whether it's the daily pressures of work, life, or the unexpected moments that throw us off balance. As pre-hospital professionals, we see firsthand how mental health can impact lives, yet we often neglect our well-being.Anxiety can manifest in ways we don't always recognise—headaches, sleepless nights, or even feeling constantly on edge. In a world that demands more, sometimes the best thing you can do is pause, reflect, and seek support. Therapy isn't just for those in crisis—it's about learning coping strategies, setting boundaries, and becoming the best version of yourself.BetterHelp is the world's largest online therapy platform, connecting you with professionals specialising in anxiety and more. Take control of your mental health today. Our listeners get 10% off their first month at BetterHelp.com/CAREPODThis podcast is sponsored by PAX.Whatever kind of challenge you have to face - with PAX backpacks you are well-prepared. Whether on water, on land or in the air - PAX's versatile, flexible backpacks are perfectly suitable for your requirements and can be used in the most demanding of environments. Equally, PAX bags are built for comfort and rapid access to deliver the right gear at the right time to the right patient. To see more of their innovative designed product range, please click here:⁠https://www.pax-bags.com/en/⁠

In today's episode, Dr. Mitchell Posner, Dr. Sarah Shubeck, and Dr. Jelani Williams on the University of Chicago Medicine's new Comprehensive Cancer Center. Scheduled to open in 2027, the new center is a seven-floor, 575,000-square-foot building planned to have 80 private beds and 90 consultation and outpatient rooms. At the moment, the center is anticipated to see 200,000 outpatient visits and 5000 inpatient admissions annually. This would be the city of Chicago's first freestanding cancer pavilion.How will we ensure that this new center prioritizes the community's needs? In Chicago's South Side, cancer death rates are twice the national average, and cancer is also the second-leading cause of death on the South Side behind heart disease. In this conversation, you'll hear about the center's development, what patients can expect, and most importantly, the Department of Surgery's commitment to ensure the cancer center supports those who are most vulnerable. Dr. Mitchell Posner is the Thomas D. Jones Distinguished Service Professor of Surgery, Chief of the Section of General Surgery, and the Chief Clinical Officer of the University of Chicago Medicine Comprehensive Cancer Center. From clinical trials for cancer treatment to his more than 250 articles, abstracts, and book chapters, Dr. Posner is a leading authority in the management of upper gastrointestinal cancers. He is frequently voted among the country's best doctors. He is the past president of the Society of Surgical Oncology. He is deputy editor of the Annals of Surgical Oncology and section editor for the gastrointestinal cancer section of the journal Cancer. He served as chairman of the Gastrointestinal Committee of the American College of Surgeons Oncology Group (ACOSOG).Dr. Sarah Shubeck is an Assistant Professor in the Department of General Surgery. She is a Breast Surgical oncologist specializing in breast surgery, cancer, and benign disease treatment. In addition to her clinical practice, Dr. Shubeck's research has been published in many journals including Cancer, JAMA Surgery, and Annals of Surgical Oncology.Dr. Jelani Williams is a 5th-year general surgery resident at the University of Chicago. He is an aspiring surgical oncologist and attended the Eastern Virginia Medical School. He has published research on predictive models and surgery for metastatic pancreatic neuroendocrine tumors as well as the use of machine learning to distinguish benign and malignant thyroid nodules amongst other topics. Deep Cuts: Exploring Equity in Surgery comes to you from the Department of Surgery at the University of Chicago, which is located on Ojibwe, Odawa and Potawatomi land.Our executive producer is Tony Liu. Our senior producers are Alia Abiad, Caroline Montag, and Chuka Onuh. Our production team includes Megan Teramoto, Ria Sood, Ishaan Kumar, and Daniel Correa Bucio. Our senior editor and production coordinator is Nihar Rama. Our editorial team also includes Beryl Zhou and Julianna Kenny-Serrano. The intro song you hear at the beginning of our show is “Love, Money Part 2” from Chicago's own Sen Morimoto off of Sooper Records. Our cover art is from Leia Chen.A special thanks this week to Dr. Jeffrey Matthews — for his leadership, vision, and commitment to caring for the most vulnerable in our communities. Let us know — what have you most enjoyed about our podcast. Where do you see room for improvement? You can reach out to us on Instagram @deepcutssurgery. Find out more about our work at deepcuts.surgery.uchicago.edu.

Interview with Timothy M. Pawlik, MD, PhD, MPH, MTS, MBA, author of Molecular Testing and Targeted Therapies in Hepatobiliary Cancers: A Review. Hosted by Amalia Cochran, MD. Related Content: Molecular Testing and Targeted Therapies in Hepatobiliary Cancers

Interview with Marko Kraljević, MD, and Ralph Peterli, MD, authors of Long-Term Outcomes of Laparoscopic Roux-en-Y Gastric Bypass vs Laparoscopic Sleeve Gastrectomy for Obesity: The SM-BOSS Randomized Clinical Trial. Hosted by Amalia Cochran, MD. Related Content: Long-Term Outcomes of Laparoscopic Roux-en-Y Gastric Bypass vs Laparoscopic Sleeve Gastrectomy for Obesity

Interview with Jake Awtry, MD, and Antoine Duclos, MD, PhD, authors of Association Between Surgeon Stress and Major Surgical Complications. Hosted by Amalia Cochran, MD. Related Content: Association Between Surgeon Stress and Major Surgical Complications

Interview with Ryan Howard, MD, MS, and Dana Telem, MD, MPH, authors of Use of Biologic and Biosynthetic Mesh for Ventral Hernia Repair in Current Practice. Hosted by Amalia Cochran, MD. Related Content: Use of Biologic and Biosynthetic Mesh for Ventral Hernia Repair in Current Practice

Osteopathic education in surgery has undergone significant changes, especially with the transition to a single ACGME accreditation system in 2020. Despite initial concerns about equitable access and representation, studies have highlighted increasing competitiveness of osteopathic medical students in surgical residency matches and comparable outcomes between allopathic and osteopathic surgeons, affirming the quality of osteopathic training. In this episode, we talk with Dr. Kristen Conrad-Schnetz, recent president of the American College of Osteopathic Surgeons (ACOS) and General Surgery program director at Cleveland Clinic South Pointe Hospital, about osteopathy in general surgery. We delve into the role of osteopathic principles in surgical training and practice and the impact of transitioning to a single accreditation system. Dr. Conrad-Schnetz shares insights on overcoming misconceptions about DO surgeons and her vision for the future of osteopathic recognition in surgery.  Join hosts Pooja Varman MD, Judith French PhD, and Jeremy Lipman MD, MHPE for this exciting conversation with Kristen Conrad-Schnetz, DO.  Learning Objectives By the end of this episode, listeners will be able to  1.     List the four tenets of osteopathic medicine 2.     Identify how osteopathic principles and practices can be incorporated into surgical practice 3.     Explain the significance of osteopathic recognition in residency programs 4.     Discuss strategies for promoting equity for DO surgery residents References 1.  Williamson TK, Martinez VH, Ojo DE, et al. An analysis of osteopathic medical students applying to surgical residencies following transition to a single graduate medical education accreditation system. Journal of Osteopathic Medicine. 2024;124(2):51-59. doi:10.1515/jom-2023-0118 https://pubmed.ncbi.nlm.nih.gov/37921195/ 2.  Russell TA, Yoshida R, Men M, et al. Comparison of Outcomes for Patients Treated by Allopathic vs Osteopathic Surgeons. JAMA Surgery. Published online October 16, 2024. doi:10.1001/jamasurg.2024.4580 https://pubmed.ncbi.nlm.nih.gov/39412774/ 3.  Etheart I, Krise SM, Burns JB, Conrad-Schnetz K. The Effect of Single Accreditation on Medical Student Match Rates in Surgical Specialties. Cureus. 2021;13(4):e14301. doi:10.7759/cureus.14301 https://pubmed.ncbi.nlm.nih.gov/33968513/ 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

Interview with Marja A. Boermeester, MD, PhD, and Charlotte L. Van Veldhuisen, MD, authors of Long-Term Outcomes of Early Surgery vs Endoscopy First in Chronic Pancreatitis: Follow-Up Analysis of the ESCAPE Randomized Clinical Trial. Hosted by Amalia Cochran, MD. Related Content: Long-Term Outcomes of Early Surgery vs Endoscopy First in Chronic Pancreatitis

Self-reflection is key to choosing what med schools to apply to. Listener Virginia dropped us a line at https://theshortcoat.com/tellus to ask us how she might go about selecting from the 195 med schools in the US to build her list of schools to send her application to. M1s Chase Larsson, Sarah Lowenberg, Luke Geis, and M4 Katie Higham-Kessler look back on how they made their decisions, taking into account family proximity, costs, personal interests, geography, and vibes! Also, an unsurprising JAMA Surgery review of the risks associated with professional slap fighting. And the group practices a necessary medical school skill: confidence in the face of uncertainty (AKA speaking on things about which they know nothing).

Interview with Christopher D. Witiw, MD, and Armaan K. Malhotra, MD, authors of Traumatic Brain Injury and Unemployment and Personal Income Loss. Hosted by Amalia Cochran, MD. Related Content: Unemployment and Personal Income Loss After Traumatic Brain Injury

Interview with Pauliina Homsy, MD, PhD, and Patrik Lassus, MD, PhD, An Update on the Survival of the First 50 Face Transplants Worldwide. Hosted by Amalia Cochran, MD. Related Content: An Update on the Survival of the First 50 Face Transplants Worldwide

Dr. Melina Kibbe, the Dean of the University of Virginia's School of Medicine, is our latest guest for the podcast. She is an active, practicing vascular surgeon who has maintained an independently funded basic science/translational research laboratory since 2003. Her clinical practice is focused on the care of patients with vascular disease. As a surgeon-scientist, she has been performing independent research and mentoring trainees in the conduct of hypothesis-driven research. To date, she has mentored 41 postdoctoral fellows, 9 graduate students, 13 medical students, and 21 undergraduate students in research. She also has had significant experience with clinical research and clinical trials, having served as national PI or site PI of gene-and cell-based therapies for critical limb ischemia and peripheral artery disease. She previously held the Colin G. Thomas Jr. Distinguished Professorship and Chair of the Department of Surgery at UNC School of Medicine. Kibbe is also the editor-in-chief for the journal JAMA Surgery, and past president for the Association for Academic Surgery, Midwestern Vascular Surgical Society, and the Association of VA Surgeons. Eli and Sofia greatly enjoyed their conversation with Dr. Kibbe. She exhibited a strong energy of excitement and enthusiasm throughout the interview, which made for a great episode. We hope you enjoy listening to our conversation!

Interview with Philip R. de Reuver, MD, PhD, and Daan J. Comes, MD, authors of Restrictive Strategy vs Usual Care for Cholecystectomy in Patients With Gallstones and Abdominal Pain: 5-Year Follow-Up of the SECURE Randomized Clinical Trial. Hosted by Amalia Cochran, MD. Related Content: Restrictive Strategy vs Usual Care for Cholecystectomy in Patients With Abdominal Pain and Gallstones

Interview with Erika L. Rangel, MD, MS, and Lauren M. Janczewski, MD, MS, authors of Pregnancy and Parenthood Among US Surgical Residents. Hosted by Amalia Cochran, MD. Related Content: Pregnancy and Parenthood Among US Surgical Residents

A substantial collection of evidence indicates that the fallopian tube serves as the primary site of origin for a large portion of high-grade serous ovarian cancers. As a result, clinical practice guidelines (including from the ACOG) recommend salpingectomy for permanent contraception- when necessary- rather than simple tubal ligation. But an August 2023 publication, in JAMA Network Open, stated that women who undergo a salpingectomy are no more or less at risk of ovarian cancer compared to traditional tubal ligation. Why? In this episode, we will summarize this controversial publication and contrast that to a systematic review the following month, in September 2023 in JAMA Surgery, which provides an alternative conclusion. Should we still perform opportunistic salpingectomies (OS) rather than tubal ligations in the average-risk patient? We'll explain the data and provide clinical pearls for practice at the end of the episode. Thank you, Bret, for this clinical conundrum as a podcast episode recommendation! You ask…we do!

Interview with Adrian Diaz, MD, MPH, and Andrew M. Ibrahim, MD, MSc, authors of Variation in Postoperative Outcomes Across Federally Designated Hospital Star Ratings. Hosted by Amalia Cochran, MD. Related Content: Variation in Postoperative Outcomes Across Federally Designated Hospital Star Ratings

Interview with Felipe M. Kristensson, MD, and Magdalena Taube, PhD, author of Breast Cancer Risk After Bariatric Surgery and Influence of Insulin Levels: A Nonrandomized Controlled Trial. Hosted by Amalia Cochran, MD. Related Content: Breast Cancer Risk After Bariatric Surgery and Influence of Insulin Levels

This is part 2 of a series looking at perioperative medicine, with a few updates from CONVERGE on the effectiveness of mobilization postop and coffee for faster return of bowel function, and a revisit to the Society for Perioperative Quality Improvement (SPAQI) for pulm, GI, and dietary meds. Quick note: we don't discuss dietary meds in depth at all since there are so many of them and the yield is low, so look to the links below! | 00.44 - Early mobilization is associated with reduced time in the hospital [JAMA Surgery 2023] | | 02.08 - Your local coffee shop's next bespoke coffee formulation: NGT coffee for early gut mobility! [AJS 2023] | | 03.04 - SPAQI position paper on Pulmonary and GI associated medications [Mayo clin proc 2021] | | 05.14 - SPAQI position paper on Dietary supplements [Mayo Clin proc 2021] | | 05.56 - Closing | [The appearance of external hyperlinks does not constitute endorsements by UCSF of the linked websites, or the information, products, or services contained therein. UCSF does not exercise any editorial control over the information found therein, nor does UCSF make any representation of their accuracy or completeness. All information contained in this episode are the opinions of the respective speakers and not necessarily the views their respective institutions or UCSF, and is only provided for information purposes, not to diagnose or treat.] Music by Amit Apte. Surgery Vectors by Vecteezy

Interview with Paulina Salminen, MD, PhD, and Jussi Haijanen, MD, PhD, authors of Three-Year Outcomes of Oral Antibiotics vs Intravenous and Oral Antibiotics for Uncomplicated Acute Appendicitis: A Secondary Analysis of the APPAC II Randomized Clinical Trial. Hosted by Amalia L. Cochran, MD. Related Content: Three-Year Outcomes of Oral Antibiotics vs Intravenous and Oral Antibiotics for Uncomplicated Acute Appendicitis

Interview with Laura Koskenvuo, MD, PhD, and Ville Sallinen, MD, PhD, authors Morbidity After Mechanical Bowel Preparation and Oral Antibiotics Prior to Rectal Resection: The MOBILE2 Randomized Clinical Trial. Hosted by Amalia Cochran, MD. Related Content: Morbidity After Mechanical Bowel Preparation and Oral Antibiotics Prior to Rectal Resection

Dr. Harry Barbee out of Johns Hopkins University recently co-authored a meta-analysis in JAMA Surgery, examining postoperative regret for those people seeking gender-affirming care. We talk about how many people *actually* regret receiving surgery, how that compares with general postoperative regret in the cisgender population, the politics and misinformation influencing the bad science in this area of study, and what we can do about it.    Another piece by Dr. Barbee advocating for sanctuary locations for gender-affirming care: Transgender Youths and Sanctuaries for Gender-Affirming Care    Are you an expert in something and want to be on the show? Apply here! Please please pretty please support the show on patreon! You get ad free episodes, early episodes, and other bonus content!

Interview with Daniel Reim, MD, and Tara Catharina Mueller, MD, authors Intraoperative Wound Irrigation for the Prevention of Surgical Site Infection After Laparotomy: A Randomized Clinical Trial by CHIR-Net. Hosted by Amalia Cochran, MD. Related Content: Intraoperative Wound Irrigation for the Prevention of Surgical Site Infection After Laparotomy

Interview with Deborah E. Farr, MD, and Herbert Zeh III, MD, authors Safety and Feasibility of Single-Port Robotic-Assisted Nipple-Sparing Mastectomy. Hosted by Amalia Cochran, MD. Related Content: Safety and Feasibility of Single-Port Robotic-Assisted Nipple-Sparing Mastectomy

Interview with Mark Coburn, MD, and Ana Kowark, MD, authors of Preoperative Midazolam and Patient-Centered Outcomes of Older Patients: The I-PROMOTE Randomized Clinical Trial. Hosted by Amalia Cochran, MD. Related Content: Preoperative Midazolam and Patient-Centered Outcomes of Older Patients

Dr. Zach Cost and Dr. Tem Bendapudi join the show to discuss the literature pertaining to tranexamic acid and thromboembolic risk. Dr. Zach Cost is an anesthesia resident at the Massachusetts General Hospital. Dr. Pavan (“Tem”) Bendapudi holds a joint faculty appointment in the Division of Hematology and Blood Transfusion Service and is assistant professor of medicine at Harvard Medical School. This podcast was recorded as part of the Depth of Anesthesia podcast elective. Thanks for listening! If you enjoy our content, leave a 5-star review on Apple Podcasts and share our content with your colleagues. — Follow us on Instagram @DepthofAnesthesia and on Twitter (X) @DepthAnesthesia for podcast and literature updates. Email us at depthofanesthesia@gmail.com with episode ideas or if you'd like to join our team. Music by Stephen Campbell, MD. — 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. Henry DA, Carless PA, Moxey AJ, et al. Anti‐fibrinolytic use for minimising perioperative allogeneic blood transfusion. Cochrane Database of Systematic Reviews. 2011;(1). doi:10.1002/14651858.CD001886.pub3 Ker K, Edwards P, Perel P, Shakur H, Roberts I. Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis. BMJ. 2012;344:e3054. doi:10.1136/bmj.e3054 Myles PS, Smith JA, Forbes A, et al. Tranexamic Acid in Patients Undergoing Coronary-Artery Surgery. New England Journal of Medicine. 2017;376(2):136-148. doi:10.1056/NEJMoa1606424 Devereaux PJ, Marcucci M, Painter TW, et al. Tranexamic Acid in Patients Undergoing Noncardiac Surgery. New England Journal of Medicine. 2022;386(21):1986-1997. doi:10.1056/NEJMoa2201171 POISE 3 PeriOperative ISchemic Evaluation-3 (POISE-3) study Shakur H, Roberts I, Fawole B, et al. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum hemorrhage (WOMAN): an international, randomized, double-blind, placebo-controlled trial. The Lancet. 2017;389(10084):2105-2116. doi:10.1016/S0140-6736(17)30638-4 Roberts I, Shakur-Still H, Afolabi A, et al. Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial. The Lancet. 2020;395(10241):1927-1936. doi:10.1016/S0140-6736(20)30848-5 Taeuber I, Weibel S, Herrmann E, et al. Association of Intravenous Tranexamic Acid With Thromboembolic Events and Mortality: A Systematic Review, Meta-analysis, and Meta-regression. JAMA Surgery. 2021;156(6):e210884. doi:10.1001/jamasurg.2021.0884

Interview with Mariam N. Hantouli, MD, and Giana H. Davidson, MD, MPH, authors of Operative vs Nonoperative Management of Acute Cholecystitis During the Different Trimesters of Pregnancy. Hosted by Amalia Cochran, MD. Related Content: Operative vs Nonoperative Management of Acute Cholecystitis During the Different Trimesters of Pregnancy

We are excited to bring you a fantastic episode today where we are joined by two guest experts to discuss the recent JAMA Surgery manuscript, “Clinical Implications of Removing Race-Corrected Pulmonary Function Tests for African American Patients Requiring Surgery for … Continue reading →

Join the Hernia Team from Carolinas Medical Center as they discuss applications of artificial intelligence in predicting outcomes for patients undergoing abdominal wall reconstruction. Emerging technologies are allowing us to understand hernia patients who are at risk for increased surgical complexity and postoperative complications – find out more in this Journal Review episode. Hosts: Dr. Sullivan “Sully” Ayuso, Chief Resident, Carolinas Medical Center, @SAyusoMD   Dr. Todd Heniford, Chief of GI & MIS, Carolinas Medical Center, @THeniford   Dr. Vedra Augenstein, Professor of Surgery, Carolinas Medical Center, @VedraAugenstein  Dr. Monica Polcz, Attending Surgeon, Baptist Health (FL)  Learning Objectives: Provide and introduction to artificial intelligence Develop an understanding of the applications of artificial intelligence in surgical outcome prediction for patients undergoing hernia repair Learn how risk stratification of hernia patients can affect their care References: Elhage et al, Development and Validation of Image-Based Deep Learning Models to Predict Surgical Complexity and Complications in Abdominal Wall Reconstruction, JAMA Surgery, 2021 https://pubmed.ncbi.nlm.nih.gov/34232255/ Ayuso et al, Predicting Rare Outcomes in Abdominal Wall Reconstruction Using Image-Based Deep Learning Models, Surgery, 2023  https://pubmed.ncbi.nlm.nih.gov/36229252/  Hassan et al, Novel Machine Learning Approach for Prediction of Hernia Recurrence, Surgical Complication, and 30-Day Readmission after Abdominal Wall Reconstruction, JACS, 2022 https://pubmed.ncbi.nlm.nih.gov/35426406/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out more Behind the Knife hernia episodes: https://behindtheknife.org/podcast-category/hernia/

Interview with Seema A. Khan, MD, author of Presurgical Oral Tamoxifen vs Transdermal 4-Hydroxytamoxifen in Women With Ductal Carcinoma In Situ: A Randomized Clinical Trial. Hosted by Amalia Cochran, MD. Related Content: Presurgical Oral Tamoxifen vs Transdermal 4-Hydroxytamoxifen in Women With Ductal Carcinoma In Situ

For surgeons and patients, deciding if and when to operate can be challenging. Often, the way surgeons communicate about these decisions doesn't make things any easier for themselves or their patients. And, surgeons often spend the majority of their conversations with patients describing anatomical details and exactly how they plan to ‘fix it', with little discussion of what that ‘fix' will do for a patient's overall goals. Instead, what if your surgeon told you that the operation she was discussing could help with only 4 things: live longer, feel better, prevent disability, or obtain a diagnosis? And, what if your surgeon openly discussed the expected ‘bad stuff' of post-operative recovery, instead of rotely reciting a list of possible complications? We invited Gretchen Schwarze and Justin Clapp to discuss with us these communication strategies, which are the focus of a series of 4 Viewpoints recently published in JAMA Surgery. I love this series of articles because each presents a component of a practical, patient-centered approach to patient-surgeon communication and decision making, and language surgeons (and surgical trainees) can start using in their next patient visit. We hope you enjoy this episode. Take a look at some of these links to learn more: Innovations in Surgical Communication series: Provide Your Opinion, Don't Hide It Focus on the Goals of Surgery Promote Deliberation, Not Technical Education Present the Downsides of Surgery, Not Just Risks Dr. Schwarze's article, “Identifying Patterns in Preoperative Communication about High-Risk Surgical Intervention'' in which surgeons used “fix-it” language in 92% of conversations and did not establish an overall goal of treatment 80% of the time. South Park “Underpants Gnomes” Orthopaedics vs Anesthesia   By: Alexis Colley  

Interview with Stanley Kalata, MD, MS, and Kyle H. Sheetz, MD, MS, authors of Comparative Safety of Robotic-Assisted vs Laparoscopic Cholecystectomy. Hosted by Amalia Cochran, MD. Related Content: Comparative Safety of Robotic-Assisted vs Laparoscopic Cholecystectomy

Interview with Leonard J. Lobo, MD, and Jason M. Long, MD, MPH, authors of Outcomes Following Lung Transplant for COVID-19–Related Complications in the US. Hosted by Amalia Cochran, MD. Related Content: Outcomes Following Lung Transplant for COVID-19–Related Complications in the US

Interview with Walter P. Weber, MD, author of Association of Axillary Dissection With Systemic Therapy in Patients With Clinically Node-Positive Breast Cancer. Hosted by Amalia Cochran, MD. Related Content: Association of Axillary Dissection With Systemic Therapy in Patients With Clinically Node-Positive Breast Cancer

People who are regular cannabis users are at an increased risk of experiencing complications  after surgery, according to a study by researchers with UTHealth Houston. The study was published in a recent issue of JAMA Surgery. Joining me to talk about cannabis use disorder and the findings of the study is Paul Potnuru, MD. Dr Potnuru is the assistant professor in the Department of Anesthesiology, Critical Care and Pain Medicine at McGovern Medical School at UTHealth Houston and the first author of the study.

Interview with Ryan C. Ellis, MD, and Ajita S. Prabhu, MD, authors of Transfascial Fixation vs No Fixation for Open Retromuscular Ventral Hernia Repairs: A Randomized Clinical Trial. Hosted by Amalia Cochran, MD. Related Content: Transfascial Fixation vs No Fixation for Open Retromuscular Ventral Hernia Repairs

Interview with Trine O. Eskesen, MD, PhD, and Jacob Steinmetz, MD, PhD, authors of Association of Trauma With Long-Term Risk of Death and Immune-Mediated or Cancer Disease in Same-Sex Twins. Hosted by Amalia Cochran, MD. Related Content: Association of Trauma With Long-Term Risk of Death and Immune-Mediated or Cancer Disease in Same-Sex Twins

Interview with Ville Sallinen, MD, PhD, and Alexandre Santos, MD, authors of 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. Hosted by Amalia Cochran, MD. Related Content: Quality-of-Life and Recurrence Outcomes Following Laparoscopic Elective Sigmoid Resection vs Conservative Treatment Following Diverticulitis

Interview with Derek F. Amanatullah, MD, PhD, and Henry C. Cousins, MPhil, authors of Assessment of Team Dynamics and Operative Efficiency in Hip and Knee Arthroplasty. Hosted by Amalia Cochran, MD. Related Content: Assessment of Team Dynamics and Operative Efficiency in Hip and Knee Arthroplasty

Today I will speak with Jonathan Morrison, an architecture correspondent for The Times.  In this role, he has written about subjects as diverse as life on Mars, drone-killing lasers, billion-pound football stadiums, and a pink unicorn glove puppet named Mr. Grunwald.     His articles have also been published in Medium, The Sunday Times, Medium, The American Surgeon, JAMA Surgery, The JAMA Network, Physical Review B, The Good Men Project, KnowTechie, and AIR MAIL.   In today's episode, we will be discussing the following: Succession Planning in leading architecture firms It's one of the biggest challenges a firm will face: what happens when the founder or founders move on? Precedent examples of how practices such as RSHP, NBBJ, Arups, Grimshaw, and others   To learn more about Jonathan visit his: Link: https://www.ing-media.com/insights/the-practice-of-succession Website: https://www.thetimes.co.uk/profile/jonathan-morrison?page=1 Twitter: https://twitter.com/JMorrison_Times   ► Feedback? Email us at podcast@businessofarchitecture.com   ► Access your free training at http://SmartPracticeMethod.com/   ► If you want to speak directly to our advisors, book a call at https://www.businessofarchitecture.com/call   ► Subscribe to my YouTube Channel for updates:   https://www.youtube.com/c/BusinessofArchitecture   *******   For more free tools and resources for running a profitable, impactful, and fulfilling practice, connect with me on: Facebook: https://www.facebook.com/groups/businessofarchitecture Instagram: https://www.instagram.com/enoch.sears/ Website: https://www.businessofarchitecture.com/ Twitter: https://twitter.com/BusinessofArch Podcast: http://www.businessofarchitecture.com/podcast iTunes: https://podcasts.apple.com/us/podcast/business-architecture-podcast/id588987926 Android Podcast Feed: http://feeds.feedburner.com/BusinessofArchitecture-podcast Google Podcasts: https://podcasts.google.com/feed/aHR0cHM6Ly9idXNpbmVzc29mYXJjaGl0ZWN0dXJlLmxpYnN5bi5jb20vcnNz   *******   Access the FREE Architecture Firm Profit Map video here: http://freearchitectgift.com   Download the FREE Architecture Firm Marketing Process Flowchart video here: http://freearchitectgift.com     Carpe Diem!

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/

Gabapentin is the 10th most prescribed drug in the United States and use is increasing.  In 2002, 1% of adults were taking gabapentinoids (gabapentin and or pregabalin).  By 2015 that number increased to 4% of US adults. There are a lot of reasons that may explain the massive increase in use of these drugs.  One thing is clear, it is not because people are using it for FDA approved indications.  The FDA-approved indications for gabapentin are only for treating patients with partial seizures or postherpetic neuralgia. However, most gabapentin prescriptions are written off-label indications. On today's podcast we talk all about the Gabapentinoids - Gabapentin and Pregabalin - with Tasce Bongiovanni, Donovan Maust and Nisha Iyer.   It's a big episode covering a lot of topics. First, Nisha, a pain and palliative care pharmacist, starts us off with discussing the pharmacology of gabapentin and pregabalin, including common myths like they work on the GABA system (which is weird given the name of the drug).   Tasce, a surgeon and researcher, reviews the use of gabapentin in the perioperative setting and the research she had done on the prolonged use of newly prescribed gabapentin after surgery (More than one-fifth of older adults prescribed gabapentin postoperatively continue to take it more than 3 months later).  Donovan discusses the growth of “mood stabilizers/antiepileptics” (e.g. valproic acid and gabapentin), in nursing homes, particularly patients with Alzheimer's disease and related dementias. This includes a JAGS study recently published in 2022 showing that we seem to be substituting one bad drug (antipsychotics and opioids) with another bad drug (valproic acid and gabapentin). Lastly, we also addressed a big reason for the massive uptake of gabapentinoids: an intentional and illegal strategy by the makers of these drugs to promote off-label use by doing things like creating low-quality, industry-funded studies designed to exaggerate the perceived analgesic effects of these drug.  This long and sordid history of gabapentin and pregabalin is beautifully described in Seth Landefeld and Mike Steinman 2009 NEJM editorial. I could go on and on, but listen to the podcast instead and for a deeper dive, take a look at the following articles and studies: Gabapentin in the Perioperative setting: Prolonged use of newly prescribed gabapentin after surgery. J Am Geriatr Soc. 2022 Perioperative Gabapentin Use in Older AdultsRevisiting Multimodal Pain Management JAMA IM. 2022 Effect of Perioperative Gabapentin on Postoperative Pain Resolution and Opioid Cessation in a Mixed Surgical Cohort.  JAMA Surgery 2018 Gabapentin and mood stabilizers in the Nursing Home Setting: Antiepileptic prescribing to persons living with dementia residing in nursing homes: A tale of two indications. JAGS 2022 Trends in Antipsychotic and Mood Stabilizer Prescribing in Long-Term Care in the U.S.: 2011-2014 JAMDA 2020 Efficacy of Gabapentinoids: Gabapentinoids for Pain: Potential Unintended Consequences. AFP 2019 Gabapentin for chronic neuropathic pain in adults. Cochrane Database of Systematic Reviews Review. 2017 The Illegal Marketing Practices by Pharma promoting ineffective: The Neurontin Legacy — Marketing through Misinformation and Manipulation NEJM 2009 Narrative review: the promotion of gabapentin: an analysis of internal industry documents. Annals of IM. 2006  

Interview with Andrzej A. Piatkowski, MD, PhD, author of Effect of Total Breast Reconstruction With Autologous Fat Transfer Using an Expansion Device vs Implants on Quality of Life Among Patients With Breast Cancer: A Randomized Clinical Trial. Hosted by Amalia Cochran, MD. Related Content: Effect of Total Breast Reconstruction With Autologous Fat Transfer Using an Expansion Device vs Implants on Quality of Life Among Patients With Breast Cancer

Interview with Crisanto M. Torres, MD, MPH, and Joseph V. Sakran, MD, MPH, MPA, authors of Association of Whole Blood With Survival Among Patients Presenting With Severe Hemorrhage in US and Canadian Adult Civilian Trauma Centers. Hosted by Amalia Cochran, MD. Related Content: Association of Whole Blood With Survival Among Patients Presenting With Severe Hemorrhage in US and Canadian Adult Civilian Trauma Centers

Interview with Arjen van der Veen, MD, PhD, and Richard van Hillegersberg, MD, PhD, authors of Cost-effectiveness of Laparoscopic vs Open Gastrectomy for Gastric Cancer: An Economic Evaluation Alongside a Randomized Clinical Trial. Hosted by Amalia Cochran, MD. Related Content: Cost-effectiveness of Laparoscopic vs Open Gastrectomy for Gastric Cancer

In this episode, our team discusses the management of traumatic rib fractures including pearls and pitfalls. Join as we discuss the current standards of treatment as well as controversies in how to manage these patients! 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 incoming 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 Terry SM, Shoff KA, Sharrah ML. Improving blunt chest wall injury outcomes: introducing the pic score. J Trauma Nurs. 2021;28(6):386-394. https://pubmed.ncbi.nlm.nih.gov/34766933/ Witt CE, Bulger EM. Comprehensive approach to the management of the patient with multiple rib fractures: a review and introduction of a bundled rib fracture management protocol. Trauma Surg Acute Care Open. 2017;2(1):e000064. https://tsaco.bmj.com/content/2/1/e000064 Utter GH, McFadden NR. Rib fractures, the evidence supporting their management, and adherence to that evidence base. JAMA Netw Open. 2020;3(3):e201591-e201591. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2763488 Dehghan N, Nauth A, Schemitsch E, et al. Operative vs nonoperative treatment of acute unstable chest wall injuries: a randomized clinical trial. JAMA Surgery. Published online September 21, 2022. https://jamanetwork.com/journals/jamasurgery/article-abstract/2796556 Kasotakis G, Hasenboehler EA, Streib EW, et al. Operative fixation of rib fractures after blunt trauma: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2017;82(3):618-626. https://pubmed.ncbi.nlm.nih.gov/28030502/ 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/

Dr. Michael Rosen returns to Behind the Knife – this time to discuss his RCT investigating biologic vs. synthetic mesh for single-stage repair of contaminated ventral hernias. Read the full article here in JAMA Surgery: https://jamanetwork.com/journals/jamasurgery/article-abstract/2788222 Dr. Rosen is the director for the Center of Abdominal Core Health at the Cleveland Clinic and has written the “Atlas of Abdominal Wall Reconstruction”. Want to learn more about his work and the Hernia Quality Collaborative? Catch up on Dr. Rosen's previous episode on Behind the Knife:  Episode #21 (August 15, 2015): Hernias, Abdominal Wall Reconstruction, and Quality Collaboratives https://behindtheknife.org/podcast/21-hernias-abdominal-wall-recon-and-quality-collaboratives-dr-michael-rosen/ Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.