Surgical Research
23 Mar Computerized Clinical Decision Support Systems Can Reduce Rate of Venous Thromboembolism
Posted at 23:34h
in Author Interviews, Clots - Coagulation, Electronic Records, JAMA, NYU/NYMC, Surgical Research
MedicalResearch.com Interview with:
Zachary Borabm, Research fellow
Hansjörg Wyss Department of Plastic Surgery
NYU Langone Medical Center
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Recent studies have shown that health care providers perform poorly in risk stratifying their patients for venous thromboembolism (VTE) which leads to inadequate VTE prophylaxis delivery, especially in surgical patients. Computerized Clinical Decision Support Systems (CCDSSs) are programs integrated into an electronic health record that have the power to aid health care providers. Using a meta-analysis study technique we were able to pool data from 11 studies, including 156,366 patients that either had CCDSSs intervention or routine care without CCDSSs.
Our main outcome measures were the rate of prophylaxis for VTE and the rate of actual VTE events. We found that CCDSSs increased the rate of VTE prophylaxis (odds ratio 2.35, p<0.001) and decreased the risk of VTE events (risk ratio 0.78, p<0.001).
19 Mar TAVR for Bicuspid Vs. Tricuspid Aortic Valve Stenosis
MedicalResearch.com Interview with: Sung-Han Yoon MD Clinical Trials, Cardiology, Developmental Biology Cedars-Sinai Medical Center, Los Angeles MedicalResearch.com: What is the background for this study? What are the main findings? Response: Transcatheter aortic valve replacement (TAVR) has become the standard treatment in inoperable patients in high surgical risk patients with symptomatic severe aortic stenosis (AS). However, major randomized trials excluded congenital bicuspid AS due to its unique morphological features. The indication of TAVR is expanding into a younger population, in which the frequency of bicuspid AS is higher. Therefore, we will encounter TAVR for bicuspid AS more frequently. However, the experience of TAVR in bicuspid AS is limited to small series. Therefore, we aim to evaluate the clinical outcomes of TAVR in bicuspid AS and compare them to tricuspid AS.19 Mar iFR Can Assess Need For Coronary Revascularization Without Adenosine
Posted at 23:13h
in Author Interviews, Heart Disease, Imperial College, Medical Imaging, Surgical Research
MedicalResearch.com Interview with:
[caption id="attachment_33035" align="alignleft" width="149"]
Dr. Davies[/caption]
Dr. Justin Davies PhD
Senior Reserch Fellow and Hononary Consultant Cardiologist
National Heart and Lung Institute,
Imperial College London
MedicalResearch.com: What is the background for this study?
Response: We know from the FAME study that compared to angiography alone, FFR guided revascularization improves long-term clinical outcomes for our patients. Despite this, adoption of FFR into everyday clinical practice remains stubbornly low. One major factor for this is the need for adenosine (or other potent vasodilator medications) in order to perform an FFR measurement. Adenosine is expensive, unpleasant for the patient, time consuming and even potentially harmful.
iFR is a newer coronary physiology index that does not require adenosine for its measurement. In the prospective, multi center, blinded DEFINE FLAIR study, 2492 patients were randomly assigned to either FFR guided revascularisation or iFR guided revascularization and followed up for a period of 1 year.
19 Mar Cardiovascular Procedures That Push the Line: High-Risk or Futility of Care?
MedicalResearch.com Interview with: [caption id="attachment_33090" align="alignleft" width="200"]
Dr. Adam Skolnick[/caption]
Adam Skolnick, MD
Cardiologist
Associate professor of medicine
NYU Langone Medical Center
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: I am privileged to serve on the ACC Program Planning Committee and helped to design this important session that seeks to determine the line between when a cardiovascular procedure is high risk and when it is futile. I am co-chairing the session with the incoming chair of the section on Geriatric Cardiology for the ACC, Dr. Karen Alexander from Duke.
We are practicing medicine at one of the most extraordinary times when there are so many devices and procedures to prolong and improve quality of life. It is critical to assess a patient's goals of care for a given intervention. In some patients, particularly those who are multiple degenerative chronic conditions, are frail and/or have cognitive impairment it is difficult to know when a given procedure multiple medical conditions will achieve a patient's goals. When is a procedure high risk, and when is it simply futile? This is the fine line upon which many cardiologists often find themselves.
The speakers present case examples of high risk patients considering TAVI, high risk PCI or CABG and mechanical support devices and with interaction from the audience work through when each procedure is high risk and when it is unlikely to achieve a patient's goals of care. We also have a dedicated talk on high risk procedures in patients with cognitive impairment, such as advanced dementia.
17 Mar Patients Who Quit Smoking Had Fewer Adverse Events After Knee Replacement
MedicalResearch.com Interview with: Amy Wasterlain, MD Fourth-year orthopaedic surgery resident NYU Langone Medical Center who led the study with Dr. Richard Iorio MedicalResearch.com: What is the background for this study? Response: We looked at smoking habits and outcomes for 539 smokers undergoing primary total hip or knee arthroplasty, 73 of whom participated in a pre-operative smoking cessation program. Patients who participated in program were 4.3 times more likely to quit than smokers who tried to quit on their own. Program participants also reduced their tobacco intake dramatically (10.6 fewer cigarettes/day) compared to smokers who didn’t participate (2.3 fewer cigarettes/day), even if they weren’t able to quit completely. Patients who completed the program before undergoing total knee arthroplasty had about 24% fewer adverse events (readmission, venous thromboembolism, stroke, urinary tract infection, pneumonia, and surgical site infection) than smokers who didn’t participate in the program.16 Mar Laypeople Perceive Facelift To Give More Youthful, Healthier Appearance
MedicalResearch.com Interview with: Lisa E. Ishii, MD, MHS Associate Professor of Otolaryngology - Head and Neck Surgery John Hopkins Medicine [caption id="attachment_32938" align="alignleft" width="80"]
Dr. Ishii[/caption]
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: There was a gap in our knowledge about what the average lay person thought about the impact of a facelift. We had information about what experts in the field like Dr. Swail thought, and some about what patients themselves thought, but nothing about lay people.
Patients who choose to have a facelift are typically concerned about the opinions of:
1) Themselves when they look in the mirror, and
2) Laypeople they encounter socially in society.
Our study showed for the first time that laypeople find people who have had a facelift to appear more attractive, more youthful, healthier and more successful than they were before their facelift.
11 Mar Stretta Procedure Improves GERD Symptoms, Reduces Need for PPIs
MedicalResearch.com Interview with: [caption id="attachment_32846" align="alignleft" width="142"]
Dr. Ronnie Fass[/caption]
Dr. Ronnie Fass, MD
Professor, School of Medicine
Case Western Reserve University
MedicalResearch.com: What is the background for this study?
Response: The endoscopic radiofrequency procedure (Stretta) has been used for more than a decade to treat patients with gastroesophageal reflux disease (GERD). Over time, there were several Meta-analyses with variable designs of the Stretta procedure providing conflicting results. Thus, the purpose of the current systematic review and meta-analysis was to determine the efficacy of the Stretta procedure using all currently available controlled and cohort studies.
09 Mar “Spillover” of Transfusion Practice from Trauma to Non-trauma Patients Without Strong Supporting Evidence
MedicalResearch.com Interview with: [caption id="attachment_32802" align="alignleft" width="132"]
Dr. Yeh[/caption]
Daniel Dante Yeh, MD FACC
Assistant Professor of Surgery Harvard Medical School Course Director
General/GI Surgery sub-internship Associate Course Director, Surgery Core Clerkship Associate Director, Surgical Intensive Care Unit Co-Director, Nutrition Support Unit Department of Surgery Division of Trauma,
Massachusetts General Hospital
Emergency Surgery, and Surgical Critical Care Boston, MA 02114
MedicalResearch.com: What is the background for this study?
Response: High Fresh Frozen Plasma to Red Blood Cells FFP:RBC transfusion ratio is a strategy which has emerged in the trauma literature as the preferred method of resuscitation for massively bleeding injured patients. However, this strategy has now spread to other patient populations which have never been formally studied. These populations include elective operations and even non-surgical patients. Giving excess FFP when it is not needed is not only wasteful, but may be harmful, as other studies have reported that FFP can cause problems with lung function, heart function, and immune function.
17 Feb Plastic Surgeons Define Ideal Female Lip Dimensions
MedicalResearch.com Interview with: [caption id="attachment_32130" align="alignleft" width="170"]
Dr. Brian Wong[/caption]
Brian J. F. Wong, MD, PhD
Division of Facial Plastic and Reconstructive Surgery
Department of Otolaryngology–Head and Neck Surgery
Beckman Laser Institute and Medical Clinic
Department of Biomedical Engineering
University of California, Irvine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Research in facial attractiveness is difficult because of the inherent subjectivity of rating. Most people can look at a face and instinctively tell you whether that face is attractive or not, by subconsciously picking up on biologic cues like fertility, coloration, and proportions.
14 Feb Alcohol-Based Skin Preps Can Fuel Surgical fFres
MedicalResearch.com Interview with: Edward L Jones, MD MS Assistant Professor Department of Surgery, Denver VA Medical Center and University of Colorado, Denver, CO MedicalResearch.com: What is the background for this study? What are the main findings? Response: Operating room fires continue to be an underreported source of sometimes catastrophic injuries to our patients and we could find no recent data evaluating common surgical skin antiseptics as a potential fuel for these flames. Manufacturers continue to recommend waiting at least 3 minutes for “drying” of an alcohol-based prep prior to a surgical start but cite no searchable studies to support this timeframe. We were curious if these alcohol-based preps were flammable and what impact a 3 minute delay had on their flammability. Thus we decided to study them in rigorous fashion.08 Feb Is the Benefit of Arthroscopic Meniscus Surgery a Placebo Effect?
MedicalResearch.com Interview with: [caption id="attachment_31841" align="alignleft" width="109"]
Dr. Jonas Thorlund[/caption]
Jonas Bloch Thorlund
Associate Professor (MSc, PhD)
Department of Sports Science and Clinical Biomechanics
Research Unit for Musculoskeletal Function and Physiotherapy
University of Southern Denmark
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Arthroscopic partial meniscectomy is a very common knee surgery. Research evidence has seriously questioned the effect of this type of surgery for degenerative meniscal tears in middle-aged and older patients. Most young patients with traumatic meniscal injury (from sports or similar) also undergo this type of surgery. There is a general understanding that young patients with traumatic tears experience larger improvements in patient reported pain, function and quality of life. However, evidence for this presumption is sparse.
06 Feb Variable Effects of Vitamin C on Post-Operative Atrial Fibrillation
MedicalResearch.com Interview with: [caption id="attachment_25990" align="alignleft" width="180"]
Dr. Harri Hemilae[/caption]
Harri Hemilä, MD, PhD
Department of Public Health
University of Helsinki
MedicalResearch.com: What is the background for this study?
Response: I have a long term interest in vitamin C. Previously I have shown that it alleviates exercise-induced bronchoconstriction (EIB) (http://dx.doi.org/10.1186/1710-1492-10-58 ) and shortens the duration of colds ( http://dx.doi.org/10.1371/journal.pmed.0020168 ). Now I had been following the literature and I noted that a number of randomized trials were being published about vitamin C for preventing post-operative atrial fibrillation (POAF). Therefore I reasoned that it is worthwhile to analyze that set of trials
02 Feb Donated Tissue Provides Surgeons Improved Ways to Repair and Reconnect Damaged or Severed Nerves
MedicalResearch.com Interview with: [caption id="attachment_31726" align="alignleft" width="250"]
Karen Zaderej[/caption]
Karen Zaderej
CEO, AxoGen
Karen Zaderej joined AxoGen in May 2006. She has served as President, Chief Executive Officer and a member of the Board of Directors of AxoGen, Inc. since May 2010. Prior to her current role, she served as Chief Operating Officer from October 2007 to May 2010 and as Vice President of Marketing and Sales from May 2006 to October 2007. From October 2004 to May 2006, Karen worked for Zaderej Medical Consulting, a consulting firm she founded that helped medical device companies build and execute successful commercialization plans. From 1987 to 2004, Karen worked at Ethicon, Inc., a Johnson & Johnson company, where she held senior positions in marketing, business development, research & development, and manufacturing. Karen is a Director of SEBio, a non-profit supporting the life science industry in the southeastern United States. Karen earned an MBA from the Kellogg Graduate School of Business at Northwestern University and a Bachelor of Science degree in Chemical Engineering from Purdue University.
MedicalResearch.com: Please tell us about yourself and how you became CEO at AxoGen.
Response: I met Jamie Grooms, co-founder of AxoGen, in 2005 and we had one of those meetings that change your life. Jamie is a serial entrepreneur and loves to start businesses. He had tried to make nerves in the past but had been unsuccessful. When he saw new technology at the University of Florida that explained some of the issues in regenerating nerves, he decided to found a company focused on nerve repair. In parallel, I had been in business development and strategic marketing for Johnson & Johnson and we had looked at the nerve repair market. We determined there was a significant unmet need in nerve repair, but we could not find any technology at that time that solved the surgical need. Several years later, I left J&J and started a consulting business focused on market development and commercialization of early stage med tech companies. Jamie and I met, and I found the technology I had been looking for years earlier. We had an exciting conversation about the potential to improve the lives of patients with nerve injuries. I saw the possibility to create an entire new segment in med tech, one dedicated to nerve repair. With that great potential in front of me, I closed my consulting business, moved to Florida, and joined the AxoGen team.
01 Feb Best Case/Worst Case Framework Helps Surgeons Communicate With Frail Seriously Ill Patients
MedicalResearch.com Interview with: [caption id="attachment_31637" align="alignleft" width="189"]
Dr. Margaret Schwarze[/caption]
Margaret L Schwarze, MD, MPP
Associate Professor
Division of Vascular Surgery
University of Wisconsin
MedicalResearch.com: What is the background for this study?
Response: Surgery can have life-altering consequences for frail older adults, yet many undergo an operation during the last year of life. Surgeons commonly rely on informed consent to disclose risks of discrete complications; however, this information is challenging for patients to interpret with respect to their goals and values.
Our research group developed a communication framework, called Best Case/Worst Case, to change how surgeons communicate with patients facing serious illness. Surgeons use the framework to describe the best, worst, and most likely scenarios to present a choice between valid treatment alternatives and help patients imagine how they might experience a range of possible treatment outcomes.
25 Jan Younger Colon Cancer Patients Receive More Chemotherapy But No Greater Survival Benefit
MedicalResearch.com Interview with: Kangmin Zhu, PhD, MD John P. Murtha Cancer Center, Walter Reed National Military Medical Center Professor at the Uniformed Services University of the Health Sciences in the Department of Preventive Medicine and Biostatistics Bethesda, Maryland MedicalResearch.com: What is the background for this study? Response: An article published on JAMA Surgery in 2015 showed more utilization of chemotherapy among young colon cancer patients. To demonstrate the study findings, we analyzed the data from the Department of Defense healthcare system, in which all members have the same level of access to medical care and therefore the potential effects of insurance status and types on research results can be reduced. MedicalResearch.com: What are the main findings? Response: The main findings were that young and middle-aged colon cancer patients were 2 to 8 times more likely to receive postoperative chemotherapy and 2.5 times more likely to receive multiagent regimens, compared with their counterparts aged 65 to 75 years. However, no matched survival benefits were observed for the young and middle-aged among patients who received surgery and postoperative chemotherapy.24 Jan Non-Surgical Stretta Therapy For Recalcitrant GERD
MedicalResearch.com Interview with: [caption id="attachment_31334" align="alignleft" width="126"]
Dr. Mark Noar[/caption]
Dr. Mark Noar
Director of The Heartburn and Reflux Study Center
Towson, MD
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The background for this study was developed out of a need to know whether the Stretta procedure was effective in both the short and long-term in all forms of reflux. This included standard refluxing patients who had never had surgery but also in the subpopulation of patients who had recurring reflux after having had reflux corrective surgery. The question to be answered was whether the Stretta procedure would be less effective, more effective, or just as effective in the patient who had had prior surgery compared to patients who did not have surgery.
The main findings were that independent of whether a patient had had surgery for the correction of reflux or just had standard reflux without prior surgery, the Stretta procedure was equally effective in all patient subgroups both in the short-term and the long-term.
24 Jan New Guidelines for Prevention, Detection and Management of Surgical Site Infections
MedicalResearch.com Interview with: [caption id="attachment_31455" align="alignleft" width="200"]
Dr. Kristen Ban[/caption]
Kristen A. Ban, MD
Loyola University
American College Surgery Clinical Scholar
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The American College of Surgeons previously released surgical site infections (SSI) guidelines, and we wanted to update them with the most recent literature to give surgeons a concise, comprehensive document of recommended practices to reduce SSI. We were very fortunate to partner with our colleagues and content experts at the Surgical Infection Society for this update. There are a few areas where we had additional literature to support new or different guidelines.
Blood glucose control is now recommended for all patients regardless of diabetic status. SSI reduction bundles have become very popular, and we emphasize that compliance must be high with all parts of these bundles to obtain the maximum benefit.
Finally, we recommend cessation of prophylactic antibiotics at incision closure with some exceptions (mainly in regard to implanted material/hardware).
20 Jan New Scoring System Guides Surgical Risks During Pregnancy
MedicalResearch.com Interview with: Adam Sachs MD Assistant Professor of Anesthesiology University of Connecticut School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: When women undergo appendectomy or cholecystectomy during pregnancy they are obviously concerned about the well being of their fetus. Unfortunately, the majority of the data available to council pregnant women is outdated and medical practice has significantly changed since their publication.13 Jan tPA Plus Mechanical Thrombectomy in Acute Ischemic Stroke?
MedicalResearch.com Interview with: [caption id="attachment_31220" align="alignleft" width="181"]
Dr. Vitor Mendes Pereira[/caption]
Vitor Mendes Pereira MD MSc
Division of Neuroradiology - Joint Department of Medical Imaging
Division of Neurosurgery - Department of Surgery
Toronto Western Hospital - University Health Network
Associate Professor of Radiology and Surgery
University of Toronto
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Our study is a pooled analysis of two large prospective stroke studies that evaluated the effectiveness of mechanical thrombectomy (MT) using one of the stent retrievers (Solitaire device ) in patients with acute ischemic stroke related to large vessel occlusion(LVO). It is known (after 5 randomized controlled trials in 2015) that IV rtPA alone failed to demonstrated benefit when compared to MT associated or not to rtPA. A question is still open: what it is the real benefit of IV rtPA in the context of LVO, particularly in centres that can offer mechanical thrombectomy within 60 minutes after qualifying imaging?
10 Jan Complex Surgical Equipment Can Make Cleaning and Sterilization Difficult
MedicalResearch.com Interview with: Alex Carignan, MD, MSc Department of Microbiology and Infectious Diseases Université de Sherbrooke, Quebec, Canada MedicalResearch.com: What is the background for this study? What are the main findings? Response: Although reports of iatrogenic transmission directly linked to surgical power tools (SPTs) are rare, the decontamination of such instruments is challenging due to their complex designs, which may restrict access to cleaning and sterilization agents, and because they often become contaminated after use. Most studies on infection risk with ultrasonic surgical power tools include patients who underwent phacoemulsification surgeries,but it is logical to assume that lumen contaminants, including bacteria and proteinaceous material from previous operations, may be found in neurosurgery SPTs as well. During June 2015, the infection control department at our institution was notified of an increase in the number of surgical site infection cases following craniotomy since January 2015. We investigated an outbreak of neurosurgical SSIs at a tertiary care hospital in Quebec, Canada, to identify the outbreak’s cause, and our investigation strongly suggests that modifying the reprocessing procedure of an ultrasonic surgical aspirator caused the outbreak.10 Jan Cangrelor With and Without Glycoprotein IIb/IIIa Inhibitors in Patients Undergoing PCI
Posted at 01:18h
in Author Interviews, Brigham & Women's - Harvard, Heart Disease, JACC, Surgical Research
MedicalResearch.com Interview with:
[caption id="attachment_31114" align="alignleft" width="120"]
Dr. Deepak L. Bhatt[/caption]
Deepak L. Bhatt, MD, MPH, FACC, FAHA, FSCAI, FESC
Executive Director of Interventional Cardiovascular Programs,
Brigham and Women’s Hospital Heart & Vascular Center
Professor of Medicine, Harvard Medical School
Boston, MA 02115
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Cangrelor is a potent, fast on, fast off, intravenous ADP receptor antagonist that is now available for use during PCI. Glycoprotein IIb/IIIa inhibitors are intravenous antiplatelet agents that work by a different mechanism. Doctors have asked whether there is any advantage to combining them or whether one class is preferable to the other during PCI.
We analyzed close to 25,000 patients from the CHAMPION trials. Cangrelor’s efficacy in reducing peri-procedural ischemic complications in patients undergoing PCI was present
irrespective of glycoprotein IIb/IIIa inhibitor administration. However, glycoprotein IIb/IIIa inhibitor use resulted in substantially higher bleeding rates, regardless of whether the patient was randomized to cangrelor or to clopidogrel.
Thus, in general, cangrelor and glycoprotein IIb/IIIa inhibitors should not routinely be combined. If an operator wishes to use a potent intravenous antiplatelet during PCI, cangrelor is similarly efficacious as glycoprotein IIb/IIIa inhibitors, but with less bleeding risk.
10 Jan Gastric Bypass Surgery Improves Quality of Life For Obese Teenagers, But Complications Not Rare
MedicalResearch.com Interview with: Dr Thomas H. Inge MD University of Colorado Denver School of Medicine Aurora, CO 80045 MedicalResearch.com: What is the background for this study? Response: Gastric bypass surgery helps severely obese teenagers lose weight and keep it off, according to the first long term follow up studies of teenagers who had undergone the procedure 5-12 years earlier. However, the studies show some patients will need further surgery to deal with complications or may develop vitamin deficiencies later in life, according to two studies published in The Lancet Diabetes & Endocrinology. Severe obesity is classified as having a BMI of 40 or over (around 100 pounds overweight) and affects around 4.6 million children and teenagers in the USA. It causes ill health, poor quality of life and cuts life expectancy. The studies are the first to look at long-term effects of gastric bypass surgery in teenagers. Until now, it has been unclear how successful the surgery is in the long-term and whether it can lead to complications. Thousands of teenagers are offered surgical treatment each year.09 Jan C-Section Rate Varies Across China from 4% to 64%
MedicalResearch.com Interview with: Jianmeng Liu, PhD, MD Professor in Epidemiology and Biostatistics Director, Institute of Reproductive and Child Health/key Laboratory of Reproductive Health Ministry of Health Director, Office for National Maternal and Child Health Statistics of China Peking University Health Science Center Beijing, China MedicalResearch.com: What is the background for this study? Response: Cesarean overuse can jeopardize maternal and child health. It has been widely concerned that cesarean rate in China is at an extremely high level. Concerns about “alarming” rates increased after a World Health Organization (WHO) report that 46.2% of births were delivered by cesarean in 2007-2008, based on analysis of deliveries in 21 hospitals of 3 provinces of China. Since 2002, reducing the cesarean rate has been a national priority, and a variety of policies, programs and activities have emerged at both the central and local governments. Previous national estimates of cesarean rates have been based on surveys with limited geographical coverage. Given the marked diversity of geography, economy, and life circumstances throughout China, survey estimates are likely to be sensitive to the area sampled. By analyzing county-level national data on cesarean rates that have been collected since 2008, this study aimed to determine the overall rate and change in rate of cesarean deliveries, examine geographic variation, and, in areas where declines occurred, assess changes in maternal and perinatal mortality.07 Jan Gastric Bypass Surgery Found Safe and Effective in Adolescent Severe Obesity
MedicalResearch.com Interview with: Dr Torsten Olbers PhD Department of Gastrosurgical Research Institute of Clinical Sciences University of Gothenburg, Sahlgrenska University Hospital Gothenburg Sweden MedicalResearch.com: What is the background for this study? What are the main findings? Response: The background to study was the lack of effective treatments for adolescents with severe obesity and the observation that many adults undergoing gastric bypass regret that they didn't´t do it earlier. The medical indication is to hopefully prevent development of diseases and organ damage due to cardiovascular risk factors and to enable them to have normalised psychosocial development (education, relation etc). In fact most of the adolescents undergoing surgery had parents having undergone surgery.22 Dec Study Supports Mesh Surgery for Incontinence But Not for Bowel or Bladder Prolapse
MedicalResearch.com Interview with: Dr Rachael Wood PhD Consultant in Public Health Medicine - women and children's health NHS National Services Scotland Information Services Division Edinburgh MedicalResearch.com: What is the background for this study? Response: Mesh surgery for female stress urinary incontinence and pelvic organ prolapse is currently controversial. Mesh surgery was introduced to overcome recognised limitations of traditional, non-mesh, surgery for these conditions, in particular extensive surgery and long hospital stays for incontinence and high failure/recurrence rates for prolapse. Mesh surgery may therefore offer additional benefits over traditional surgery. Mesh surgery may also carry additional risks however, with patient advocacy groups highlighting cases of severe, long term, mesh-related complications in some women who have undergone mesh surgery. We therefore used routinely available, population based hospital discharge records from Scotland to identify women having mesh and non-mesh procedures for incontinence and prolapse. We then followed the women up for up to 5 years to assess how often they were readmitted for complications or further incontinence or prolapse surgery.21 Dec Study Finds No Clear Benefit of Mesh For Prolapse Surgery
MedicalResearch.com Interview with: [caption id="attachment_30694" align="alignleft" width="140"]
Prof. Cathryn Glazener[/caption]
Prof. Cathryn Glazener PhD
Health Services Research Unit
University of Aberdeen
Aberdeen,UK
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Prolapse is a condition that affects up to half of all women after childbirth. Women notice a bulge or discomfort in their vaginas due to pressure from the bladder, bowel or womb moving downwards. Women who have surgery for their prolapse have a 3 in 10 chance of needing at least one more operation, so the success rate is not great. Gynaecologists hoped that by reinforcing their repairs the success rate would get better.
PROSPECT was a pragmatic, multicentre randomised controlled trial conducted in 35 centres across the UK. Women undergoing their first operation for prolapse were randomised to having a standard repair of the front or back wall of the vagina, or a repair reinforced by synthetic non-absorbable mesh, or a biological graft.
We found that, in contrast to previous research, women were just as likely to be cured after standard surgery rather than reinforced repairs. They were just as likely to have other symptoms such as bladder or sexual problems, and other adverse effects such as infection, bleeding or pain.
However, about 1 in 10 of the women who had mesh did have mesh exposure when a small portion of the mesh becomes visible through the vaginal wall. Although many women did not have symptoms, about half of those women needed a small operation to remove or bury the exposed mesh.
17 Dec Annual Report of Transcatheter Valve Therapy Registry
MedicalResearch.com Interview with: [caption id="attachment_30605" align="alignleft" width="132"]
Dr. Frederick Grover[/caption]
Frederick L. Grover, M. D.
Professor, Division of Cardiothoracic Surgery
Past Chair, Department of Surgery
University of Colorado School of Medicine-Anschutz Medical Campus
Aurora, CO
Past President, Society of Thoracic Surgeons
Vice Chair, Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Following approval of the first transcatheter aortic heart valve late in 2011 the TVT-R was established and data entry was mandated by CMS for all patients who were undergoing transcatheter valve therapy. Data is currently collected on transcatheter aortic valves (TAVR) from two companies, transcatheter mitral clip procedures (TMC), transcatheter mitral valve in valve or valve in ring procedures and aortic valve in valve procedures. A report is published annually jointly in the Journal of the American College of Cardiology (JACC) and the Annals of Thoracic Surgery (ATS). This report contains data from the beginning of 2012 through December 31, 2015. Peoperative risk factors, operative details and outcomes data are collected prior to procedures, during the hospitalization, 30 days post procedure and at one year and later data can be collected by linking to CMS administrative data.
For this annual report we concentrated on touching on some of the highlights since the length of the manuscript is limited. We discussed the trends in TAVR, since this is the most common procedure performed, the last two years’ experience in mitral clips since a very detailed paper was published on this last year, and the mitral valve in valve and ring since the results for this procedure were impressively good.
In regard to TAVR, 418 sites perform this procedure and the number of cases in 2015 increased from 16,295 in 2014 to 24,808. Very importantly, mortality and complications have been decreasing each year, probably related to improvements in the technology with smaller catheter and sheath sizes leading to less vascular complications, greater experience of those doing the procedures, a less sick group of patients going initially from those too ill to do an open operation on, to very high risk to high risk according to approval criteria. The age of the patients however is most often in the 80s.
16 Dec Technical and Clinical Considerations for Facial Feminization Surgery
MedicalResearch.com Interview with: Raúl J. Bellinga, MD, FEBOMS FACIALTEAM Surgical Group, Marbella High Care International Hospital, Marbella, Málaga, Spain MedicalResearch.com: What is the background for this study? What are the main findings? Response: Feminization rhinoplasty is one of the most common and important procedures in Facial Feminization Surgery. In this study our surgical group has evaluated...
15 Dec Surgery Versus 5% Imiquimod for Nodular and Superficial Basal Cell Carcinoma
MedicalResearch.com Interview with: Hywel C. Williams DSc, FMedSci, NIHR Senior Investigator Director of the NIHR Health Technology Assessment Programme http://www.nets.nihr.ac.uk/programmes/hta Professor of Dermato-Epidemiology and Co-Director of the Centre of Evidence-Based Dermatology, http://www.nottingham.ac.uk/research/groups/cebd/index.aspx University of Nottingham, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham UK [caption id="attachment_30519" align="alignleft" width="200"]
Basal Cell Skin Cancer-Wikipedia image[/caption]
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Our clinical trial of 5% imiquimod cream versus surgery for low risk basal carcinoma (BCC) of the skin was first prompted by a shocking lack of randomised controlled clinical trials for what is the commonest form of human cancer.
We had conducted a Cochrane systematic review prior to starting the study and found very few long term studies. An emerging literature on imiquimod cream at the time suggested that it might have a clinically useful effect for low risk BCC. All the studies were short term and industry supported, so with the support of Cancer Research UK (UK largest cancer charity), we undertook a large independent study to see how the cream compared to the reference standard of excision surgery with a 4mm margin for low risk superficial and nodular BCC.
Our three year results, published in Lancet Oncology, showed that surgery is clearly superior to imiquimod cream, with a success rate (absence of initial failure and no signs of recurrence at 3 years) of 98.4% compared to 83.6% for imiquimod. Nevertheless, the 83.6% success rate is still potentially useful, so we wanted to see whether these 3 year results were sustained. So we followed up your study participants for a total of 5 years and found that the response rates at 5 years were almost the same as those at 3 years (97.7% and 82.5% for surgery and imiquimod respectively).
Most treatment failures with imiquimod occurred early on ie in the first year of treatment. Our study shows that if initial treatment works, the benefits are sustained.