Author Interviews, JAMA, Surgical Research / 17.02.2017

MedicalResearch.com Interview with: [caption id="attachment_32130" align="alignleft" width="170"]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 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.
Author Interviews, Surgical Research / 14.02.2017

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.
Author Interviews, BMJ, Orthopedics, Pain Research, Surgical Research / 08.02.2017

MedicalResearch.com Interview with: [caption id="attachment_31841" align="alignleft" width="109"]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 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.
Author Interviews, Heart Disease, Surgical Research, Vitamin C / 06.02.2017

MedicalResearch.com Interview with: [caption id="attachment_25990" align="alignleft" width="180"]Dr-Harri-Hemilae.jpg 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
Author Interviews, Surgical Research / 02.02.2017

MedicalResearch.com Interview with: [caption id="attachment_31726" align="alignleft" width="250"]Karen Zaderej 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.
Author Interviews, Frailty, JAMA, Outcomes & Safety, Surgical Research / 01.02.2017

MedicalResearch.com Interview with: [caption id="attachment_31637" align="alignleft" width="189"]Margaret L Schwarze, MD, MPP Associate Professor Division of Vascular Surgery University of Wisconsin 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.
Author Interviews, Cancer Research, Colon Cancer, JAMA, Surgical Research / 25.01.2017

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.
Author Interviews, Gastrointestinal Disease, Surgical Research / 24.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31334" align="alignleft" width="126"]Dr. Mark Noar Director of The Heartburn and Reflux Study Center Towson, MD 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.
Author Interviews, Hospital Acquired, Infections, Surgical Research / 24.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31455" align="alignleft" width="200"]Kristen A. Ban, MD Loyola University American College Surgery Clinical Scholar 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).
Anesthesiology, Author Interviews, JAMA, OBGYNE, Surgical Research / 20.01.2017

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.
Author Interviews, Emergency Care, JAMA, Stroke, Surgical Research / 13.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31220" align="alignleft" width="181"]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 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?
Author Interviews, Hospital Acquired, Infections, Surgical Research, Technology / 10.01.2017

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.
Author Interviews, Brigham & Women's - Harvard, Heart Disease, JACC, Surgical Research / 10.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31114" align="alignleft" width="120"]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 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.
Author Interviews, Lancet, Pediatrics, Surgical Research, Weight Research / 10.01.2017

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.
Author Interviews, Global Health, JAMA, OBGYNE, Surgical Research / 09.01.2017

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.
Author Interviews, Lancet, Pediatrics, Surgical Research, Weight Research / 07.01.2017

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.
Author Interviews, Lancet, OBGYNE, Surgical Research / 22.12.2016

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.
Author Interviews, Gender Differences, Lancet, OBGYNE, Surgical Research / 21.12.2016

MedicalResearch.com Interview with: [caption id="attachment_30694" align="alignleft" width="140"]Prof. Cathryn Glazener PhD Health Services Research Unit University of Aberdeen Aberdeen,UK 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.
Author Interviews, Heart Disease, JACC, Surgical Research / 17.12.2016

MedicalResearch.com Interview with: [caption id="attachment_30605" align="alignleft" width="132"]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 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.
Author Interviews, Cancer Research, Dermatology, Surgical Research / 15.12.2016

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"]Hywel C. Williams 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.
Author Interviews, Education, JAMA, Surgical Research / 15.12.2016

MedicalResearch.com Interview with: [caption id="attachment_30490" align="alignleft" width="150"]Mohammed Al-Omran, MD, MSc, FRCSC Head, Division of Vascular Surgery St. Michael’s Hospital Professor, Department of Surgery University of Toronto Dr. Mohammed Al-Omran[/caption] Mohammed Al-Omran, MD, MSc, FRCSC Head, Division of Vascular Surgery St. Michael’s Hospital Professor, Department of Surgery University of Toronto MedicalResearch.com: What is the background for this study? What are the main findings? Response: General surgery residency is among the most demanding clinical training programs in medicine. Several studies have suggested surgical residents have a relatively high attrition rate; however, no study has systematically reviewed the overall prevalence and causes of attrition among general surgery residents. We included over 20 studies representing 19,821 general surgery residents in our review. Most studies were from the US. We found the pooled estimate of attrition prevalence among general surgery residents was 18%. Female residents were more likely to leave than male (25% versus 15%), and residents were most likely to leave after their first training year (48%). Departing residents most commonly switched to another medical specialty (such as anaesthesia, plastic surgery, radiology or family medicine) or relocated to another general surgery program. The most common causes of attrition were uncontrollable lifestyle (range of 18% to 88%) and transferring to another specialty (range of 18% to 39%).
Author Interviews, Breast Cancer, Chemotherapy, Mammograms, MD Anderson, Surgical Research / 12.12.2016

MedicalResearch.com Interview with: [caption id="attachment_30458" align="alignleft" width="175"]Henry M. Kuerer, MD, PhD, FACS</strong> Executive Director, Breast Network Programs MD Anderson Cancer Network PH and Fay Etta Robinson Distinguished Professor in Research Department of Breast Surgical Oncology Director, Breast Surgical Oncology Training Program Dr. Henry M. Kuerer[/caption] Henry M. Kuerer, MD, PhD, FACS Executive Director, Breast Network Programs MD Anderson Cancer Network PH and Fay Etta Robinson Distinguished Professor in Research Department of Breast Surgical Oncology Director, Breast Surgical Oncology Training Program MedicalResearch.com: What is the background for this study? Response: Worldwide, triple negative and HER2 positive breast cancers, combined, account for about 370,000 women diagnosed annually. With recent advances in neoadjuvant systemic therapy (NST, chemotherapy and targeted therapy given before surgery) for both subsets, the pCR (pathologic complete response- when no residual cancer is found) rates found at the time of surgery in these populations can be as high as 60 percent. This high rate of pCR naturally raises the question of whether surgery is required for all patients, particularly those who will receive adjuvant radiation. We believe surgery may potentially be redundant – at least for these two subtypes of breast cancer – because of such a high chance for no evidence of disease at the time of pathological review. If there’s no cancer left after the patient has received chemotherapy and the patient is going to receive local radiation therapy, is surgery actually needed? The challenge has been that standard breast imaging methods cannot accurately predict residual disease after NST. However, by doing the same image-guided percutaneous needle biopsies after neoadjuvant systemic therapy that we do at time of diagnosis, our preliminary research reveals that we may be able to accurately predict which women will have cancer or not.
Author Interviews, Dermatology, Electronic Records, JAMA, Outcomes & Safety, Surgical Research / 08.12.2016

MedicalResearch.com Interview with: Sophia Akhiyat M.D. Candidate, Class of 2017 The George Washington University School of Medicine and Health Sciences METEOR Fellowship MedicalResearch.com: What is the background for this study? What are the main findings? Response: Our study was inspired by one of Choudhry et al,1 in which patients' preferences for skin biopsy result disclosure was surveyed at melanoma clinics affiliated with several academic institutions. We sought to broaden participant inclusion criteria by evaluating patients' preferences at a general dermatology clinic at an academic center. Our findings support that the highest ranked patient-preferred method for receiving skin biopsy results was through an online portal. Patients also reported that the most important factors when selecting a modality for communication were the amount of information given and time available to discuss results. We also observed a relationship between a younger patient age range and online portal experience as well as a preference for biopsy notification via online portal. 1Choudhry A, Hong J, Chong K, et al. Patients' Preferences for Biopsy Result Notification in an Era of Electronic Messaging Methods. JAMA Dermatol. 2015;151(5):513-521.
Author Interviews, NEJM, Orthopedics, Surgical Research, Thromboembolism / 06.12.2016

MedicalResearch.com Interview with: [caption id="attachment_30279" align="alignleft" width="187"]Suzanne C. Cannegieter, M.D., Ph.D. Einthoven Laboratory Leiden University Medical Center The Netherlands Dr. Suzanne Cannegieter,[/caption] Suzanne C. Cannegieter, M.D., Ph.D. Einthoven Laboratory Leiden University Medical Center The Netherlands MedicalResearch.com: What is the background for this study? What are the main findings? Response: Patients who undergo arthroscopic knee surgery and patients who are treated with casting of the lower leg are at increased risk for venous thromboembolism (VTE). It is uncertain whether thromboprophylaxis is effective in these situations to prevent VTE. For both indications, several trials have been performed to evaluate the effectiveness of anticoagulant prophylaxis. However, an overall risk–benefit balance could not be established because of methodologic shortcomings; hence, there has been reluctance to establish international guidelines regarding the use of anticoagulant therapy for either of these indications.
Author Interviews, Dermatology, Surgical Research, Telemedicine, UT Southwestern / 05.12.2016

MedicalResearch.com Interview with: [caption id="attachment_30246" align="alignleft" width="120"]Rajiv Nijhawan MD Department of Dermatology The University of Texas Southwestern Medical Center Dallas Dr. Rajiv Nijhawan[/caption] Rajiv Nijhawan MD Department of Dermatology The University of Texas Southwestern Medical Center Dallas MedicalResearch.com: What is the background for this study? What are the main findings? Response: From a healthcare perspective, we are constantly working to improve access to patients, and telemedicine has proved to be an excellent platform for this goal especially in the field of dermatology. In regards to surgical dermatology, the role of telemedicine has been limited. The ubiquity of smartphones with photograph capability has provided an opportunity for patients to take self-acquired photographs (selfies) easily. Our experience has been that few patients who call with post-operative concerns have major issues (e.g. infection, bleeding, etc.) while the majority of concerns are minor in nature, and patients are often seeking reassurance. Our study shows that the majority of concerns can easily be triaged and managed through patient-directed photography without burdening the patient to take time off work for another appointment, find transportation/travel (many of our patients travel hours for their visits), wait to see the provider, etc. This option of triaging a post-operative concern essentially immediately through the use of patient-directed photographs provides the opportunity for immediate feedback on the patient’s concerns and likely reduces anxiety while making the process as patient-centered as possible. In addition, it allows the physician to be as efficient as possible by not having to overbook his/her schedule to accommodate these often non-urgent concerns.
Accidents & Violence, Anemia, Author Interviews, Hematology, Surgical Research, Technology / 05.12.2016

MedicalResearch.com Interview with: [caption id="attachment_30198" align="alignleft" width="133"]Allan Doctor, MD Pediatric Critical Care Medicine Professor of Pediatrics and (Associate) Biochemistry Washington University School of Medicine & Saint Louis Children’s Hospital St. Louis, Missouri Dr. Allan Doctor[/caption] Allan Doctor, MD Pediatric Critical Care Medicine Professor of Pediatrics and (Associate) Biochemistry Washington University School of Medicine & Saint Louis Children’s Hospital St. Louis, Missouri MedicalResearch.com: What is the background for this study? What are the main findings? Response: Our research team has developed the first nanoscale artificial cells designed to emulate vital functions of natural red blood cells. If ultimately confirmed safe for use in humans, this nanotechnology-based product, called ‘ErythroMer’, could represent a new and innovative alternative to blood transfusions that would be especially valuable in situations where stored blood is needed, but difficult to obtain or use, such as in pre-hospital or battlefield settings. The artificial cells are designed to be freeze-dried, stored for extended periods at ambient temperatures, and simply reconstituted with water for immediate use. This year, the National Academy of Sciences estimated that 30,000 civilian trauma deaths/year are preventable and of these, two-thirds arise from hemorrhage in the pre-hospital phase of care. One key goal for our team is to advance treatment for trauma victims or soldiers in austere environments by initiating resuscitation in the field, particularly when transport is prolonged. ErythroMer could be a blood substitute that medics carry in their pack and literally take it out, add water, and inject. There are currently no simple, practical means to bring transfusion to most trauma victims outside of hospitals. Delays in resuscitation significantly impact outcomes; it is our goal to push timely, effective care to field settings.
Author Interviews, Frailty, JAMA, Surgical Research, University of Pittsburgh / 01.12.2016

MedicalResearch.com Interview with: [caption id="attachment_30060" align="alignleft" width="200"]Daniel E. Hall, MD, MDiv, MHSc, FACS Associate Professor of Surgery University of Pittsburgh Staff Surgeon VA Pittsburgh Healthcare System Core Investigator VA Center for Health Equity Research and Promotion. PIttsburgh, PA Dr. Daniel E. Hall[/caption] Daniel E. Hall, MD, MDiv, MHSc, FACS Associate Professor of Surgery University of Pittsburgh Staff Surgeon VA Pittsburgh Healthcare System Core Investigator VA Center for Health Equity Research and Promotion. PIttsburgh, PA MedicalResearch.com: What is the background for this study? What are the main findings? Response: A growing body of research demonstrates that frailty is a more powerful predictor of postoperative outcomes than risk-prediction models based on age or comorbidity alone. However, it has not been clear if surgeons could intervene on frailty to improve outcomes. This study reports what we believe to be the first ever demonstration that it is not only feasible to screen an entire health system for frailty, but that it is possible to act on that information to improve outcomes. Every patient evaluated for elective surgery was screened for frailty with a brief tool that takes 1-2 minutes to complete. Those identified as potentially frail and thus at greater risk for poor surgical outcomes received an ad-hoc administrative review aimed at optimizing perioperative care. After implementing the frailty screening initiative, we observed a 3-fold increase in long-term survival at 6 and 12 months—even after controlling for age, frailty, and predicted mortality.
AHA Journals, Author Interviews, Gender Differences, Heart Disease, Surgical Research / 27.11.2016

MedicalResearch.com Interview with: Dr. Stefano Savonitto  Director, Division of Cardiology Manzoni Hospital MedicalResearch.com: What is the background for this study? What are the main findings? Response: Over the last 15 years, there has been a shift from fibrinolytic therapy for STEMI to primary angioplasty, which required a re-organization of the whole STEMI treatment network. Besides the higher reperfusion efficiency of primary angioplasty, as compared to lytic therapy, it has been a global upgrade of the STEMI care system that has reduced the rate of no reperfusion. Elderly patients and women (who are, on average, also older than men) had theoretically the most to gain from this shift, but little data were available to assess this benefit. In the present paper, we have shown that “lack of reperfusion” was reduced dramatically across all age groups and in both sexes, with a progressive and uniform increase in primary angioplasty, and a significant reduction in mortality. Almost as expected, elderly women were the category with the most relevant mortality benefit. Nevertheless, after adjustment for age and other confounders, women continue to experience a higher mortality as compared to men. In the discussion of the paper, we propose some hypotheses for this persistently higher mortality in women.
Author Interviews, NEJM, Outcomes & Safety, Surgical Research / 22.11.2016

MedicalResearch.com Interview with: [caption id="attachment_29912" align="alignleft" width="200"]Alan Karthikesalingam MD PhD, NIHR Academic Clinical Lecturer in Vascular Surgery St George's Vascular Institute London, UK Dr. Alan Karthikesalingam[/caption] Alan Karthikesalingam MD PhD, NIHR Academic Clinical Lecturer in Vascular Surgery St George's Vascular Institute London, UK MedicalResearch.com: What is the background for this study? What are the main findings? Response: The background for this study was that the typical diameter at abdominal aortic aneurysm (AAA)  repair, and the population incidence of AAA repair, have been known to vary considerably between different countries. This study aimed to observe whether a discrepancy in the population incidence rate of AAA repair between England and the USA was seen alongside a discrepancy in population rates of AAA-related mortality or AAA rupture in those countries.