Voice Changes Common After Thyroid Cancer Surgery

MedicalResearch.com Interview with:

Megan Rist Haymart MD Associate Professor Metabolism, Endocrinology and Diabetes Clinic Michigan Medicine

Dr. Haymart

Megan Rist Haymart MD
Associate Professor
Metabolism, Endocrinology and Diabetes Clinic
Michigan Medicine

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Thyroid cancer is a common malignancy with surgery considered one of the primary treatments. Complications from thyroid surgery can lead to long-term voice problems. However, few studies have used validated scales to quantify the impact of thyroid surgery on patient voice. Prior work has largely focused on single institution studies with high volume surgeons or claims data with reports of specific nerve injury.

We surveyed a diverse cohort of patients affiliated with SEER sites Georgia and Los Angeles to identify the prevalence, severity and correlates of poor voice outcomes following surgery for differentiated thyroid cancer.

We found that out of 2,325 patients 25.8% reported voice changes lasting greater than 3 months after surgery, 12.7% had abnormal voice per a validated voice scale (Voice Handicap Index- 10), and 4.7% reported a diagnosis of vocal fold motion impairment. We also identified patient factors associated with abnormal voice 2-4 years post op.

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Surgical Safety Variations With Affiliation to a Top-Ranked Cancer Hospital

MedicalResearch.com Interview with:

Daniel Boffa, MD Professor of Surgery Yale School of Medicine

Dr. Boffa

Daniel Boffa, MD
Professor of Surgery
Yale School of Medicine 

MedicalResearch.com: What is the background for this study?

Response: We have previously demonstrated that top-ranked hospitals are significantly safer than their affiliates for complex cancer surgery (patients 1.4 times more likely to die after cancer surgery at affiliate hospitals).  A logical extension of this work was to compare affiliate hospitals to hospitals that were not affiliated with a top ranked hospital.
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Nerve Transfer Restores Hand Function in Spinal Cord Injury

MedicalResearch.com Interview with:

Natasha van Zyl, MBChB (Cape Town), FRACS FRACS Plastic and Reconstructive Surgeon Melbourne, Australia 

Dr Natasha van Zy

Dr. Natasha van Zyl, MBChB (Cape Town), FRACS
FRACS Plastic and Reconstructive Surgeon
Melbourne, Australia 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The estimated global incidence of spinal cord injury (SCI) from all causes is 40 to 80 new cases per million population per year which means that every year between 250 000 to 500 000 people worldwide suffer SCI (1)(chap 2 p 17). In Australia the age standardised, annual incident rate of persisting traumatic SCI for Australian residents aged 15 years and above is 11.8 cases per million.(2) Just over 50% of all spinal cord injuries  in Australia occur at the cervical level resulting in tetraplegia. (2)

Cervical spinal cord injury is a devastating, life-changing injury impacting almost every aspect of a person’s work, family and social life. Although compared to many other health conditions it has a relatively low incidence, it is certainly a high cost health condition, with the lifetime cost per tetraplegia incident case estimated to be AU$9.5 million.(3) For those living with tetraplegia improvement in hand function is their highest ranked goal.(4) As such, reconstruction of upper extremity function in cervical spinal cord injury is a crucial component of the surgical rehabilitation of people with mid/low cervical spinal cord injury as it has the capacity to restore critical functions such as elbow extension, wrist extension, grasp, key pinch and release. Traditionally these functions have been reconstructed using tendon transfers, which move a functioning muscle to a new insertion site to recreate the function of a paralysed muscle.(5)

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Cinematic Rendering of CT Scans Can Assist Surgeons in Preparation for Surgery

MedicalResearch.com Interview with:

Christian Krautz, MD Department of Surgery, Universitätsklinikum Erlangen Friedrich-Alexander-Universität Erlangen Nürnberg Erlangen, Germany

Dr. Krautz

Christian Krautz, MD
Department of Surgery, Universitätsklinikum Erlangen
Friedrich-Alexander-Universität Erlangen Nürnberg
Erlangen, Germany 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In this preclinical study that included 720 case evaluations, visualization with Cinematic Rendering allowed a more correct and faster comprehension of the surgical anatomy compared to conventional CT imaging independent from the level of surgical experience. Therefore,Cinematic Rendering is a tool that may assist HPB surgeons with preoperative preparation and intraoperative guidance through an improved interpretation of computed tomography imaging data.

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Unprofessional Behavior by Surgeons Linked to Surgical Complications in Their Patients

MedicalResearch.com Interview with:

William Cooper, M.D., M.P.H. Cornelius Vanderbilt Professor Pediatrics and Health Policy Associate Dean for Faculty Affairs Director, Center for Patient and Professional Advocacy Vanderbilt University Medical Center

Dr. Cooper

William Cooper, M.D., M.P.H.
Cornelius Vanderbilt Professor
Pediatrics and Health Policy
Associate Dean for Faculty Affairs
Director, Center for Patient and Professional Advocacy
Vanderbilt University Medical Center

MedicalResearch.com: What is the background for this study?  

Response: For surgical teams, high reliability and optimal performance are dependent on effective communication, mutual respect, and continuous situational awareness. Surgeons who model unprofessional behaviors may contribute to undermining a culture of safety, threaten teamwork, and thereby increase risk for medical errors and surgical complications.

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TAVR vs Surgical Aortic Valve Replacement Among Low-Risk Patients With Aortic Stenosis

MedicalResearch.com Interview with:

Fausto Biancari, Professor of Surgery, University of Turku, Finland Professor of Cardiothoracic Surgery, University of Oulu, Finland Heart Center, T-Hospital, Hämeentie Turku, Finland

Prof. Biancari

Fausto Biancari, MD, PhD
Professor
University of Turku and University
Oulu, Finland

MedicalResearch.com: What is the background for this study?

Response: Current data is scarce regarding the short- and midterm benefit of transcatheter aortic valve replacement (TAVR) compared to surgical aortic valve replacement (SAVR) in low-risk patients with severe aortic valve stenosis.

MedicalResearch.com: What are the main findings?

Response: In this observational study on 2841 low-risk patients with aortic valve stenosis from the Finnish nationwide FinnValve registry, propensity score matching analysis showed similar 30-day and three-year survival after TAVR and SAVR.

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Past and Present Smoking Raises Risk of Dermatology Surgery Complications

MedicalResearch.com Interview with:

Ian A. Maher, MD Department of Dermatology St Louis University, St Louis, Missouri

Dr. Maher

Ian A. Maher, MD
Department of Dermatology
St Louis University, St Louis, Missouri 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: One of our wonderful trainees at Saint Louis University was interested in the role of smoking in flap failures.  Dogma has been that smoking was a major risk factor for flap failures.  Looking at our database as well as published data, flap failures are a rare event, so rare as to be difficult to definitively associate with anything.  We decided to look more broadly at complications both acute (infections failures) and chronic (mainly cosmetic scarring associated) in flaps and grafts. Continue reading

Use of AV Grafts Drops in Dialysis Patients, But Still Room For Improvement

MedicalResearch.com Interview with:

Caitlin W. Hicks, M.D., M.S. Assistant Professor of Surgery Recipient of the Department of Surgery Rothman Early Career Development Award for Surgical Research Johns Hopkins Medicine

Dr. Hicks

Caitlin W. Hicks, M.D., M.S.
Assistant Professor of Surgery
Recipient of the Department of Surgery
Rothman Early Career Development Award for Surgical Research
Johns Hopkins Medicine

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Arteriovenous fistula are associated with better long-term patency, lower rates of infection, and lower long-term costs compared to arteriovenous graft. As a result, the Fistula First Catheter Last Guidelines recommend placement of an arteriovenous fistula over an AVG whenever possible.

We looked at individual physician utilization of AVF vs AVG for first-time AV access in Medicare beneficiaries. We found that the median physician utilization rate for AVG was only 18%, but that 21% of physicians use AVG in more than 34% of cases, which is above currently recommended  practice guidelines. 

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Traumatic Injuries Cost Medicare More Than Heart Failure, Pneumonia, Stroke or Heart Attacks

MedicalResearch.com Interview with:

Dr. Mark R. Hemmila MD Associate Professor of Surgery Division of Acute Care Surgery University of Michigan

Dr. Hemmila

Dr. Mark R. Hemmila MD
Associate Professor of Surgery
Division of Acute Care Surgery
University of Michigan 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Traumatic injury has a tendency to be thought of as a disease that preferentially impacts younger people.  We wanted to explore the prevalence and impact of traumatic injury within the population of patients for whom Medicare is the third party payer.  Continue reading

Despite Large Numbers of Female Gynecologic Surgeons, Gender Disparities and Harassment Persist

MedicalResearch.com – Responses

Marina Stasenko, MD Memorial Sloan Kettering Cancer Center

Dr. Stasenko
Photo: MSKCC

Marina Stasenko, MD
Memorial Sloan Kettering Cancer Center

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Sexual harassment is a form of discrimination that includes gender harassment, unwanted sexual attention, and sexual coercion. A recent report in Fortune magazine noted that over half of US women have experienced sexual harassment at some point in their lives. Until recently, much of the conversation about sexual harassment in the workplace has been relegated to private discussions behind closed doors. However, the MeToo movement has shined a spotlight on the pervasive nature of sexual harassment in various fields, like media and business world. Although there are more female physicians in practice today than ever before, with women accounting for over 50% of young physicians, sexual harassment and gender disparities continue to plague the field of medicine.

Despite the large female representation, gynecologic oncology is not immune from gender disparities. The Society of Gynecologic Oncology is a professional organization of over 2000 physicians, scientists, allied health professionals, nurses, and patient advocates dedicated to the care of patients with gynecologic cancer. As of 2015, 46% of members of the SGO were women, and that number is steadily growing. SGO leadership is also increasingly female – with 2 of the last 3 presidents being women.

Despite the large female representation, gynecologic oncology is not immune from gender disparities. The 2015 SGO practice survey noted that while 22% of male Gynecologic Oncologists held the rank of professor, only 11% of their female counterparts held the title. They also noted that the mean annual salary for male physicians was nearly 150,000$ greater than salary for female physicians.

Given the fact that there is little objective data on sexual harassment in gynecologic oncology, the objective of our study was to evaluate perceptions of sexual harassment and gender disparities among physician members of the Society of Gynecologic Oncology.

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Atrial Fibrillation Common After TAVR and Aortic Valve Replacement

MedicalResearch.com Interview with:
Rajat Kalra, MBCh
Cardiovascular Division
University of Minnesota, Minneapolis

MedicalResearch.com: What is the background for this study?

Response: New-onset atrial fibrillation after aortic valve procedures is thought to occur frequently after aortic valve procedures, such as transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (AVR). However, the incidence estimates and implications of this new-onset atrial fibrillation in the contemporary era are unclear.

We sought to examine the incidence of atrial fibrillation after aortic valve procedures, compare the incidence between TAVI and AVR, and evaluate the associated morbidity and mortality implications using a ‘big data’ approach. This big data approach employed the National Inpatient Sample and was validated in the New York State Inpatient Database. Both are publicly available datasets that are developed as part of the Healthcare Cost and Utilization Project, a federal-state-industry partnership that is sponsored by the Agency for Healthcare Research and Quality.  Continue reading

Cesarean Section: Multimodal Program Using Non-Opioid EXPAREL Reduced Pain and Need for Opioids After Surgery

MedicalResearch.com Interview with:
Ashraf Habib, MDChief of the Division of Women’s Anesthesia and Professor of AnesthesiologyDuke University Ashraf Habib, MD
Chief of the Division of Women’s Anesthesia
Professor of Anesthesiology
Duke University 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This was a multicenter study conducted in 13 clinical sites in the United States enrolling patients undergoing elective Cesarean-section and receiving spinal anesthesia. 186 patients were enrolled and randomized to receive EXPAREL, a long-acting, non-opioid option to manage postsurgical pain, administered via transversus abdominis plane (TAP) field block, mixed with plain bupivacaine or TAP block with plain bupivacaine alone. A TAP block numbs the nerves that supply the abdominal wall. We presented the data at the 51st Annual Meeting of the Society of Obstetric Anesthesia and Perinatology (SOAP) in Phoenix, AZ.

We aimed to collect clinical evidence that a multimodal postsurgical pain regimen using a TAP block with EXPAREL (bupivacaine liposome injectable suspension) together with regularly scheduled acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) could reduce opioid consumption more so than a standard multimodal pain control approach that combines TAP block with standard bupivacaine, regularly scheduled acetaminophen, and NSAIDs.

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Can Mindfulness-Based Training Reduce Stress and Burnout in Surgeons?

MedicalResearch.com Interview with:

Carter Lebares, MDAssistant Professor of SurgeryDirector, Center for Mindfulness in SurgeryDepartment of Surgery, UCSF

Dr. Lebares

Carter Lebares, MD
Assistant Professor of Surgery
Director, Center for Mindfulness in Surgery
Department of Surgery, UCSF 

MedicalResearch.com: What is the background for this study?

 Response: This study was inspired by extensive evidence of the effectiveness of mindfulness-based interventions (MBIs) for mitigating stress and enhancing performance in other high-stress populations like police and the military.  We know that overwhelming stress is related to burnout and to cognitive errors – two critical issues within surgery, today. This prompted us to tailor and streamline an MBI specifically for surgeons, and to test it in our trainees.

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Frailty Linked to Unplanned Readmissions After Elective Outpatient Surgery

MedicalResearch.com Interview with:
hospital-frailty-surgeryKara Anne Rothenberg.MD
Postdoctoral Research Fellow, Vascular Surgery
Shipra Arya, MD SM FACS
Associate Professor of Surgery
Stanford University School of Medicine

MedicalResearch.com: What is the background for this study?

Response: There is a growing body of literature showing that frailty, a syndrome where patients have increased vulnerability to a stressor (such as surgery), is associated with increased postoperative complications, failure to rescue, and hospital readmissions.

The Risk Analysis Index (RAI), is an easy to use frailty measurement tool that better predicts postoperative mortality than age or comorbidities alone. As the rates of outpatient surgeries rise nationwide, we noted that most of the surgical frailty studies focus only on inpatient surgeries. Elective, outpatient surgery is generally considered low risk for complications and unplanned readmissions, however we hypothesized that for frail patients, it might not be.

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Laser Microscope Can See and Treat Skin Without Cutting Into It

MedicalResearch.com Interview with:
Haishan Zeng, PhDDistinguished ScientistImaging Unit - Integrative Oncology DepartmentBC Cancer Research CentreProfessor of Dermatology, Pathology, and Physics, University of British ColumbiaVancouver, BC, Canada Haishan Zeng, PhD

Distinguished Scientist
Imaging Unit – Integrative Oncology Department
BC Cancer Research Centre
Professor of Dermatology, Pathology, and Physics, University of British Columbia
Vancouver, BC, Canada 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We developed a fast multiphoton microscope system that enables clinical imaging of the skin at the level of cellular resolution. With this system, we can see microstructures inside of the skin without cutting into it. We subsequently conceived the idea of directly treating the microstructures that are responsible for disease. We increased the laser power to generate intense localized heat to destroy the targeted structure. In this study, we demonstrated the feasibility of this new treatment by targeting and closing single blood vessels using our new microscope. 

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Addiction Risk: No One Opioid Safer Than Other After Surgery

MedicalResearch.com Interview with:

Marilyn M. Heng, MD, MPH, FRCSCOrthopaedic Trauma SurgeonAssistant Professor of Orthopaedic SurgeryHarvard Medical School

Dr. Heng

Marilyn M. Heng, MD, MPH, FRCSC
Orthopaedic Trauma Surgeon
Assistant Professor of Orthopaedic Surgery
Harvard Medical School 

MedicalResearch.com: What is the background for this study?  

Response: The ultimate background for this study does come from the larger context of the opioid epidemic that is seen worldwide but particularly in North America. Orthopaedic surgeons should take responsibility as being among the top prescribers of opioids.

The more specific background that led to this specific study was the observation that several colleagues would insist that a drug like hydromorphone was so dangerous that they would not prescribe it but seemed okay prescribing large amounts of oxycodone.  It seemed like an urban myth that the type of opioid was what made it dangerous, so that led us to do the study to see if there was evidence for that.  Continue reading

Roux-en-Y Gastric Bypass Linked to More Hip Fractures

MedicalResearch.com Interview with:

Elaine W. Yu, MD, MMSc Assistant Professor,  Harvard Medical School Director, Bone Density CenterEndocrine Unit, Massachusetts General Hospital 

Dr. Elaine Yu

Elaine W. Yu, MD, MMSc
Assistant Professor,  Harvard Medical School
Director, Bone Density Center
Endocrine Unit, Massachusetts General Hospital

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Roux-en-Y gastric bypass (RYGB) is a popular surgical weight loss procedure.  We have previously shown that gastric bypass leads to rapid high-turnover bone loss.

Bariatric procedures are being increasingly performed in older adults, and the clinical consequences of gastric bypass-associated skeletal changes in this vulnerable population have been unclear to date.  Thus, we used Medicare claims data to investigate fracture risk among older adults after gastric bypass, and in comparison to adults who received another bariatric procedure called adjustable gastric banding (AGB), which is thought to have fewer negative bone effects.

In our analysis, we found that patients undergoing Roux-en-Y gastric bypass were 73% more likely to fracture than those undergoing AGB. Importantly, we found that hip fracture risk increased nearly 180% after RYGB, and that fracture rates in patients aged 65 or older were similar to the overall group.  Continue reading

Gene Linked to Colon Cancer in Younger Patients Identified

MedicalResearch.com Interview with:

Valentine N. Nfonsam, MD, MS, FACSAssociate Professor of SurgeryProgram Director, General Surgery ResidencyColon and Rectal SurgeryDivision of Surgical OncologyUniversity of Arizona, Tucson

Dr. Nfonsam

Valentine N. Nfonsam, MD, MS, FACS
Associate Professor of Surgery
Program Director, General Surgery Residency
Colon and Rectal Surgery
Division of Surgical Oncology
University of Arizona, Tucson 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The overall incidence of colon cancer in the United states has gone down in the last few decades. However, there has been a significant increase in the incidence of sporadic colon cancer is young patients (<50 years old). The etiology of this phenomenon is likely multi-factorial.

These young patients do present with more advanced disease and with aggressive features. We demonstrated in our study that the colon cancer tumor biology was different between young and older patients. We also singled out a particular gene, Cartilage oligomeric Matrix Protein (COMP) which was significantly over-expressed in young patients and demonstrated its role in cancer proliferation and metastasis and also its potential as a prognostic biomarker since we were able to detect it in plasma.

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Stem Cell Therapy Improved Motor Deficit in Traumatic Brain Injury Trial

MedicalResearch.com Interview with:

Dr. David Okonkwo, M.D., Ph.D., Professor of Neurological surgery Director of the Neurotrauma Clinical Trials CenterUniversity of Pittsburgh

Dr. Okonkwo

Dr. David Okonkwo, M.D., Ph.D.,
Professor of Neurological surgery
Director of the Neurotrauma Clinical Trials Center
University of Pittsburgh

Dr. Okonkwo discusses the results from the STEMTRA Phase 2 trial evaluating the efficacy and safety of SB623 in patients with chronic motor deficit from traumatic brain injury.

The results were presented at the American Association of Neurological Surgeons (AANS), April 2019

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Traumatic brain injury (TBI) is a major cause of death and disability in the US and around the globe. The effects of TBI are often long-lasting, with more than one-third of severe TBI patients displaying a neuromotor abnormality on physical examination 2 years following injury and, yet, there are no effective treatments. The public health implications are staggering: there are approximately 1.4 million new cases of TBI in the US annually, resulting in over 50,000 deaths and 80,000 disabilities; over 5 million Americans currently suffer from long-term disability caused by TBI. A successful neuroregenerative or neurorestorative therapy, such as stem cell implantation, would have significant impact.

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Home Responsibilities Encourage Physician Mothers in Procedural Specialties To Consider Career Change

MedicalResearch.com Interview with:

Nelya Melnitchouk, MD,MScDirector, Program in Peritoneal Surface Malignancy, HIPECDr. Melnitchouk is an associate surgeon at Brigham and Women’s Hospital (BWH) and Brigham and Women’s Faulkner Hospital (BWFH) and instructor of surgery at Harvard Medical Schoo

Dr. Melnitchouk

Nelya Melnitchouk, MD,MSc
Director, Program in Peritoneal Surface Malignancy, HIPEC
Dr. Melnitchouk is an associate surgeon at Brigham and Women’s Hospital (BWH) and Brigham and Women’s Faulkner Hospital (BWFH) and
instructor of surgery at Harvard Medical School.

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Current literature on women in surgery show that female physicians, particularly those in procedural specialties, face many challenges in balancing responsibilities between work and home. We hypothesized that these challenges may affect career satisfaction more negatively for physician mothers in procedural specialties than those in nonprocedural specialties.

In our study, we found that physician mothers in procedural specialties who had more domestic responsibilities were more likely to report a desire to change careers than those in nonprocedural specialties.  Continue reading

Surgical Outcomes Found to be Better at ‘Brand Name’ than Affiliate Cancer Hospitals

MedicalResearch.com Interview with:

Daniel J. Boffa, MDAssociate Professor of Thoracic SurgeryYale School of Medicine

Dr. Boffa

Daniel J. Boffa, MD
Associate Professor of Thoracic Surgery
Yale School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Prominent cancer hospitals have been sharing their brands with smaller hospitals in the community.  We conducted a series of nationally representative surveys and found that a significant proportion of the U.S. public assumes that the safety of care is the same at all hospitals that share the same respected brand.  In an effort to determine if safety was in fact the same, we examined complex surgical procedures in the Medicare database.

We compared the chance of dying within 90 days of surgery between top-ranked hospitals, and the affiliate hospitals that share their brands.  When taking into account differences in patient age, health, and type of procedure, Medicare patients were 1.4 times more likely to die after surgery at the affiliate hospitals, compared to those having surgery at the top-ranked cancer hospitals.

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Racial Disparities in Kidney Transplants Persist Despite New Allocation System

MedicalResearch.com Interview with:

Sanjay Kulkarni, MD MHCM FACSAssociate Professor of Surgery & MedicineSurgical Director – Kidney Transplant ProgramMedical Director – Center for Living Organ DonorsScientific Director – Yale Transplant ResearchNew Haven, CT 06410

Dr. Kulkarni

Sanjay Kulkarni, MD MHCM FACS
Associate Professor of Surgery & Medicine
Surgical Director – Kidney Transplant Program
Medical Director – Center for Living Organ Donors
Scientific Director – Yale Transplant Research
New Haven, CT 06410

MedicalResearch.com: What is the background for this study?

Response: The kidney allocation system changed in December of 2014.

The aim of the new system was to increase transplant in patients who were highly sensitized (difficult matches based on reactive antibodies) and to improve access to underserved populations. Continue reading

Surgery Beneficial to Some HER2+ Metastatic Breast Cancer Patients

MedicalResearch.com Interview with:

Sharon S. Lum, MD, FACSProfessor in the Department of Surgery-Division of Surgical Oncology Medical Director of the Breast Health CenterLoma Linda University HealthLoma Linda University School of Medicine

Dr. Lum

Sharon S. Lum, MD, FACS, Professor
Department of Surgery-Division of Surgical Oncology
Medical Director of the Breast Health Center
Loma Linda University Health
Loma Linda University School of Medicine 

MedicalResearch.com: What is the background for this study?  

Response: Anecdotally, we observed that many patients with advanced HER2+ breast cancer have had tremendous responses to the new targeted therapies and the oncologists were referring them back to surgeons for consideration of local regional therapy.

While traditionally surgeons have avoided operating on metastatic breast cancer patients due to the patient’s likelihood of dying from their metastatic disease, these HER2+ patients seemed to be doing so well that surgery might make sense. In our surgical oncology clinic, we seemed to be operating more on these patients. Since these patients seemed to be living longer, they might survive long enough for their primary tumor to become a problem for them.

However, we did not have any data to support doing surgery in these cases. Prior studies have demonstrated mixed results regarding the survival benefit from surgery for stage IV breast cancer patients, but these were completed prior to routine use of anti-HER targeted therapies, so we wanted to further examine the role of surgery in HER2+ stage IV breast cancer patients.

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Is There a Risk of Bleeding With Ibuprofen After Tonsillectomy ?

MedicalResearch.com Interview with:

Gillian R. Diercks, MD, MPHInstructor in Otolaryngology, Harvard Medical SchoolDepartment of OtolaryngologyMassachusetts Eye and Ear InfirmaryBoston, Massachusetts

Dr. Diercks

Gillian R. Diercks, MD, MPH
Instructor in Otolaryngology, Harvard Medical School
Department of Otolaryngology
Massachusetts Eye and Ear Infirmary
Boston, Massachusetts 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Pediatric tonsillectomy is a commonly performed procedure, representing the second most common ambulatory surgery performed on children in the United States, with over half a million children undergoing the surgery annually.  A major concern for surgeons, patients, and their families is the issue of postoperative pain control as pain can last up to 10-14 days after surgery, be quite severe, and result in readmission to the hospital or ED visits for medications and dehydration.

In young children and children with sleep apnea we cannot safely administer narcotic pain medications at home.  This leaves limited options for pain control, including acetaminophen and ibuprofen.  However, there are concerns that ibuprofen could potentially increase bleeding risk after surgery because of its effects on platelet function in the blood.  At baseline, the risk of postoperative hemorrhage within the first two weeks after tonsillectomy is around 4.5%, with about 1-1.5% of children requiring a return to the operating room to control severe bleeding.  Our study set out to show that the risk of severe postoperative bleeding when ibuprofen is given for 9 days after tonsillectomy was not increased compared with the bleeding risk when acetaminophen was administered instead.

Our study could not conclude that the risk of bleeding is no different when ibuprofen is used, and was suggestive that the bleeding risk may actually be higher. Continue reading

Cardiac Surgery: No Difference in Outcomes Between Inhaled and IV Anesthesia

MedicalResearch.com Interview with:

Dr. Giovanni LandoniIntensive Care and Anesthesia Unit Associate professorUniversità Vita-Salute San Raffaele

Dr. Landoni

Dr. Giovanni Landoni
Intensive Care and Anesthesia Unit
Associate professor
Università Vita-Salute San Raffaele 

MedicalResearch.com: What is the background for this study?  

Response: Patients undergoing cardiac surgery are still at risk for perioperative complications. Studies to improve clinical outcomes this setting are important. Inhaled anesthetics have pharmacological properties which reduce myocardial infarction size by 50% in laboratory and animal studies and which might decrease postoperative mortality according to aggregated published randomized data.

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Minimally Invasive Uterine Fibroid Embolization Reduces Bleeding Risk and Preserves Uterus

MedicalResearch.com Interview with:
Dr. Jemianne Bautista-Jia,  MD
Radiology resident
Kaiser Permanente

MedicalResearch.com: What is the background for this study?

Response: There were a few patient experiences that took me by surprise. I had a patient come to clinic for an initial consultation for uterine fibroid embolization (UFE) and I asked her how she knew about the procedure. She told me that she heard about it on the radio. Another patient who came in told me she heard about it from a close friend. Why did these patients not hear about UFE from their primary physicians?

Being a woman, I know that if I had this condition I would prefer a minimally invasive option over surgery. Surgery comes with complications, and I definitely would not want an organ removed from my body if I could avoid it. Therefore I wanted to study UAE to hopefully provide additional objective data to the scientific community to support its use for the treatment of women with fibroids. Continue reading

Lack of Patient Education as a Cause of Increased Postoperative Opioid Use

MedicalResearch.com Interview with:

Dr. Alexis Colvin, MDAssociate Professor of Orthopedic SurgeryIcahn School of Medicine at Mount Sinai

Dr. Colvin

Dr. Alexis Colvin, MD
Associate Professor of Orthopedic Surgery
Icahn School of Medicine at Mount Sinai 

MedicalResearch.com: What is the background for this study?

Response: 40% of all opioid overdose deaths involve a prescription opioid and orthopaedic surgeons are the 3rd highest prescribers of opioids.  Set guidelines for post surgery opioid prescriptions have not been established.  Arthroscopic knee meniscectomy is one of the most common orthopaedic procedures.  The purpose of this study was to determine how many opioids were being prescribed  among a group of six sports fellowship trained orthopaedic surgeons versus how many patients were actually using.

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Lipomas: Deoxycholic Acid (Kybella®) Can Shrink Tumors Before Removal

MedicalResearch.com Interview with:

Hooman Khorasani, M.D. Cosmetic Surgeon & Mohs Skin Cancer Surgeon Icahn School of Medicine at Mt. Sinai

Dr. Khorasani

Hooman Khorasani, M.D.
Cosmetic Surgeon & Mohs Skin Cancer Surgeon
Icahn School of Medicine at Mt. Sinai

MedicalResearch.com: What is the background for this study?

Response: Lipomas are tumors composed of mature fat cells located just beneath the skin surface. They are the most common soft tissue tumor and are estimated to occur in 1% of the population. These benign tumors are more common in overweight individuals, diabetics, patients with elevated serum cholesterol, and those suffering from familial multiple lipomatosis. Most of these tumors are treated for cosmetic reasons; however, large lipomas can also cause significant functional impairment. Traditional treatment includes surgical removal and / or liposuction.

Deoxycholic acid is a member of the bile acid family that assists in the breakdown of fat. We investigated the use of deoxycholic acid injections to reduce the size of large lipomas prior to surgical removal.

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When Evaluating Teens for Surgery, Check Family Opioid Use

MedicalResearch.com Interview with:

Calista Harbaugh, MD House Officer, General Surgery Clinician Scholar, National Clinician Scholars Program Research Fellow, Michigan Opioid Prescribing Engagement Network University of Michigan 

Dr. Harbaugh

Calista Harbaugh, MD
House Officer, General Surgery
Clinician Scholar, National Clinician Scholars Program
Research Fellow
Michigan Opioid Prescribing Engagement Network
University of Michigan 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Nonmedical prescription opioid use and prescription opioid-related overdose remain significant concerns among adolescents and young adults. Among adolescents and young adults prescribed an opioid after surgery, prior work found that 4.8% of opioid-naïve patients develop new persistent use, filling additional opioid prescriptions at 3-6 months after surgery. This work found associations of persistent use with diagnoses such as chronic pain disorders, depression, anxiety, and prior substance use disorder. It is likely that for young patients, family members may also play an important role in development of new persistent use, but this has not previously been explored. We performed this study to evaluate whether long-term opioid use among family members was associated with prescription opioid fills among adolescents and young adults perioperatively – and we found that opioid-naïve adolescents and young adults who have 1 or more family members with long-term opioid use are more likely to fill at the time of surgery, during recovery, and in the long-term with a near-doubling of rates of new persistent use.

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Hip Fracture in Elderly: Longer Surgery and General Anesthesia Linked to Greater Risk of Post-Op Delirium

MedicalResearch.com Interview with:

Bheeshma Ravi, MD, PhD, FRCSC Scientist Sunnybrook Health Sciences Centre Holland Centre Toronto, ON

Dr. Ravi

Bheeshma Ravi, MD, PhD, FRCSC
Scientist
Sunnybrook Health Sciences Centre
Holland Centre
Toronto, ON

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Delirium is an acute change in mental status characterized by fluctuating disturbances of consciousness and attention. Elderly patients are prone to delirium after surgery; this contributes significantly to post-operative morbidity and can also lead to long-term disability.

Our study found that among older adults undergoing hip fracture surgery, both an increased duration of surgery and a general anesthetic are associated with an increased risk for post-operative delirium.​ 

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