MedicalResearch.com Interview with:
Dr Tahir Hamid MRCP (UK), FESC
Department of Cardiology, Royal Albert Edward Infirmary
NHS Trust, Wigan, UK
MedicalResearch.com: What are the main findings of the study?Dr. Hamid:Traditionally patients undergoing diagnostic and interventional coronary artery procedures are kept Nil-by-mouth, but until yet there exists neither evidence nor clear guidance about the benefits of this practice in such patients. In our study performed at two National Health Services (NHS) institutes, we demonstrated in our 1916 patients, that such procedures could be undertaken without the need for being 4-6 hours fasting. None of our patients had major complications leading to pulmonary aspiration or emergency cardiac surgery.
MedicalResearch.com Interview with: David R. Urbach, M.D
From the Institute for Clinical Evaluative Sciences
Department of Surgery
Institute of Health Policy, Management and Evaluation
University of Toronto, the University Health Network
Toronto, ON M5G 2C4, Canada
MedicalResearch.com: What are the main findings of the study?Dr. Urbach: After surgical safety checklists were adopted by hospitals in Ontario, surgical outcomes—death after surgery, complications, length of stay, readmissions—did not improve substantially.
MedicalResearch.com Interview with:Brent J. Morris, M.D.
Shoulder and Elbow Surgery Fellowship
Texas Orthopaedic Hospital in affiliation with the University of Texas Houston Health Science Center, Houston, Texas
MedicalResearch.com: What are the main findings of the study? Dr. Morris: There are concerns that an increasing percentage of patients are receiving narcotics by “doctor shopping” or seeking narcotics from multiple providers. One in five of our postoperative orthopedic trauma patients received narcotics from one or more additional providers other than the treating surgeon.
Patients that doctor-shopped postoperatively had a significant increase in narcotic prescriptions, duration of narcotics, and morphine equivalent dose per day.
MedicalResearch.com Interview with:William G Ward, Sr. MD
Chair of Orthopaedic Surgery, Chief of Musculoskeletal Service Line - Guthrie Clinic
Sayre, Pennsylvania 18840
(Professor Emeritus - Wake Forest University Dept of Orthopaedic Surgery)
MedicalResearch.com: What are the main findings of this study?Dr. Ward:The main findings of the study include:
The use of disposable spun-lace “paper” gowns was associated with a dramatic decrease in the likelihood of culture-detected bacterial contamination on the surgeon’s gloved hand and gown sleeve.
For a double-gloved surgeon, changing the outer glove just prior to implant handling should decrease bacterial contamination from the surgeon by about 50%.
Bacteria suspended in saline solution transgressed the material of standard reusable scrub attire in 96% (26/27) of tested gowns and in 0% (0/27) of spun-lace disposable “paper” gowns. (more…)
MedicalResearch.com Interview with:Mr. Aneel Bhangu
West Midlands Research Collaborative,
Academic Department of Surgery
Queen Elizabeth Hospital
MedicalResearch.com: What are the main findings of the study? Mr. Bhangu: Out study was based on a novel collaborative approach, spanning 95 centres in the UK. It was led by surgical trainees, who form a natural network and work in a rotational pattern. These networks will mature to allow a future of clinical research to be embedded into routine NHS care.
Our study found no increase in complications based on weekend operating. It’s possible that patients present differently at weekends, or that surgeons select less complex patients to operate upon. A key secondary finding is that patients operated on at weekends were less likely to undergo laparoscopy. This means that they are exposed to different processes of care, which may introduce risk. This may be a surrogate marker for other differences in weekend care that require exploration.
MedicalResearch.com Interview with:Mike K.Liang, MD,
Department of Surgery,
The University of Texas Health
Sciences Center, Lyndon B. Johnson Hospital,Houston, TX 7702
MedicalResearch.com: What are the main findings of the study?Dr. Liang: Compared to suture repair, mesh repair of primary ventral hernias (umbilical, epigastric, spigelian, lumbar), the most common type of ventral hernias, is associated with fewer hernia recurrence but slightly more seromas and surgical site infections.
MedicalResearch.com Interview with: Sammy Elmariah, MD, MPH
Massachusetts General Hospital
MedicalResearch.com: What are the main findings of the study?Dr. Elmariah: Within the randomized PARTNER I trial, we evaluated the effect of left ventricular (LV) dysfunction on clinical outcomes after transcatheter and surgical aortic valve replacement (TAVR and SAVR, respectively) and the impact of valve replacement technique on recovery of LV function. We found that LV dysfunction, defined as an LV ejection fraction < 50%, had no impact on 30-day and 1-year mortality after either TAVR or SAVR. In those with baseline LV dysfunction, marked improvement in LV ejection fraction was observed within 30-days of valve replacement in approximately half of patients, with an equivalent degree of improvement observed after TAVR and SAVR. Permanent pacemaker at study entry, low mean aortic valve gradient, and high LV ejection fraction were associated with reduced odds of LV functional recovery after valve replacement.
MedicalResearch.com Interview with: Sadeq A. Quraishi, MD, MHA
Massachusetts General Hospital, Harvard Medical School
MedicalResearch.com: What are the main findings of the study?Dr. Quraishi: Our retrospective study suggests that there is an association between pre-operative 25-hydroxyvitamin D [25(OH)D] levels and the risk of hospital-acquired infections after gastric bypass surgery. In particular, patients with 25(OH)D levels <30 ng/ml before surgery were almost 4 times more likely to develop a surgical site infection within 30 days of surgery than patients with pre-operative 25(OH)D levels at 30 ng/ml or higher.
MedicalResearch.com Interview Invitation with:Monica Morrow MD
Anne Burnett Windfohr Chair of Clinical Oncology
Chief Breast Service memorial Sloan Kettering Cancer Center
MedicalResearch.com: What are the main findings of the study?Dr. Morrow:The study is the report of a Consensus panel examining the question of whether more widely clear lumpectomy margins than no ink on tumor decrease local recurrence. A metaanalysis of published literature was used as the primary evidence base for the conclusion.
MedicalResearch.com Interview with:Daniel A. Anaya, MD, FACS
Associate Professor of Surgery - Surgical Oncology
Michael E. DeBakey Department of Surgery
Baylor College of Medicine
Chief, General Surgery & Surgical Oncology SectionDirector, Liver Tumor Program
Michael E. DeBakey VA Medical Center Houston, TX 77030
Dr. Courtney J. Balentine, MD
First author and surgical resident at Baylor College of Medicine
MedicalResearch.com: What are the main findings of the study?Dr. Anaya: That a good proportion of patients having colorectal operations will need additional assistance to recover during the postoperative period, resulting in being discharged to other facilities (nursing facilities, skilled care, etc) after surgery, and that hospitals where a higher-volume of colorectal operations are performed are more likely to discharge patients back to home after surgery.
MedicalResearch.com Interview with: Dr. R.A. Badwe, MS
Director, Tata Memorial Centre
E. Borges Marg, Parel
Mumbai 400 012
MedicalResearch.com: What are the main findings of the study?Answer: The trial was a randomized control study involving 350 women with per primum metastatic breast cancer. These women were divided into two groups from February 2005 to May 2013. One group underwent surgery and radiotherapy (LRT) (n=173) while another group of 177 women were spared these (no LRT). Both groups had undergone six successful rounds of chemotherapy before their recruitment into the trial. Women who underwent surgery had the primary breast tumour and lymph nodes removed, followed by locoregional radiation therapy.
The primary endpoint of the study was overall survival (OS). At a median follow-up of 17 months, no difference was observed in OS between the groups; the OS rates were 19.2% and 20.5%, respectively, (HR = 1.04; 95%CI, 0.80-1.34; P = 0.79). The lack of a survival benefit is due to a trade-off between local control and distant disease progression. The results indicated that women who underwent surgery and had improved locoregional control and significantly worse distant progression-free survival compared with women who did not undergo surgery (HR = 1.41; 95% CI, 1.08-1.85; P = .01). Progression of distant disease was 42% more likely (P = .01) in the LRT arm whereas the risk of local progression was 84% lower with LRT.
MedicalResearch.com Interview with:Raine Sihvonen, M.D.
From the Department of Orthopedics and Traumatology
Hatanpää City Hospital, Tampere Finland
MedicalResearch.com: What are the main findings of the study?Dr. Järvinen: The main finding of the study is that arthroscopic partial meniscectomy
is not superior over sham-surgery (placebo) when treated patients with knee
pain attributable to degenerative meniscus tear, even in the
`best-case-scenario, that is patients with no knee OA.
MedicalResearch.com Interview with:Nita Ahuja, MD
Departments of Surgery and Oncology,
Johns Hopkins University School of Medicine
MedicalResearch.com: What are the main findings of the study?Dr. Ahuja: Across the nation, laparoscopic colectomy is performed about as frequently as open colectomy, despite being associated with a lower complication rate and a lower overall hospital cost. On the other hand, an exponentially growing prevalence was found with robotic colectomy, a procedure that has so far demonstrated only equivalent outcomes with laparoscopic colectomy but a higher overall cost.
MedicalResearch.com Interview with: Mehwish Qasim
PhD Candidate, Research & Teaching Assistant
Department of Health Management and Policy
University of Iowa, College of Public Health
MedicalResearch.com: What are the main findings of the study?Answer:This study focused on two questions: Do patients living in the poorest communities have worse post-surgical outcomes than those in the wealthiest communities? And has the level of these differences in post-surgical outcomes changed over time?
We found that although post-surgical outcomes improved in general from 2000-2009, (significant decreases in nine of twelve mortality and patient safety measures), patients from low-income areas had worse surgical outcomes than those from high-income areas for nine of twelve measures in both 2000 and 2009. The disparities in outcomes between low- and high-income groups did not change significantly for nine of the twelve measures.
MedicalResearch.com Interview with:Nina Berentzen
Centre for Nutrition, Prevention and Health Services
National Institute for Public Health and the Environment Bilthoven
MedicalResearch.com: What are the main findings of the study?Answer: This study in 11-12 year old children shows that self-reported characteristics of sleep quality were not associated with blood pressure and HbA1c; and that in girls, but not in boys, some sleep characteristics were associated with anthropometric outcomes (BMI, waist circumference) and cholesterol levels. More specifically, in girls, longer time in bed was associated with lower BMI and waist circumference; having night-time awakenings with higher total cholesterol, going late to bed while rising early with higher total and HDL cholesterol; and feeling sleepy/tired during daytime with lower HDL cholesterol and with higher total-to-HDL cholesterol ratio. We report new findings for daytime outcomes of sleep quality that were not studied before in relation to cardiometabolic risk; e.g. difficulty with getting up in the morning, feeling rested after waking, and feeling sleepy or tired during the day. Our study therefore offers insight not only in characteristics of sleep at night, but also in consequences of sleep during the day.
Dr. Mitchell S. Roslin, MD
Lenox Hill Hospital Manhattan Minimally Invasive & Bariatric Surgery
186 E 76th Street, 1st Floor New York, NY 10021.
MedicalResearch.com: What are the main findings of the study?Dr. Roslin: The cornerstone of medical management for weight loss and to prevent weight gain is to regulate glucose and insulin and prevent wide fluctuation. Yet, Gastric bypass, widely considered the gold standard operation, accentuates these fluctuations. The purpose of our study was to compare glucose tolerance of gastric bypass, sleeve gastrectomy and a modified version of duodenal switch that preserves adequate intestine. We found that all operations improve insulin resistance, but that duodenal switch normalizes the curve, whereas gastric bypass causes wide spikes in insulin and glucose.
MedicalResearch.com Interview withDr. Mary T Hawn MD
Center for Surgical, Medical Acute Care Research and Transitions (C-SMART), Birmingham Veterans Administration Hospital, Birmingham, Alabama
Section of Gastrointestinal Surgery, Department of Surgery
University of Alabama at Birmingham
MedicalResearch.com: What are the main findings of the study?Dr. Hawn: The risk of adverse perioperative cardiac events is elevated in patients with recent coronary stenting, but the risk does not differ by stent type and stabilizes for surgery more than 6 months following stenting.
MedicalResearch.com Interview with: Koji Ikeda, MD, PhD
Department of Cardiology
Graduate School of Medical Science,
Kyoto Prefectural University of Medicine
MedicalResearch.com: What are the main findings of the study? Dr. Ikeda: The main findings of this study is the identification of a novel mechanism that regulates glucose homeostasis and energy metabolism, provided by Ecscr. Consequently, Ecscr modifies the insulin sensitivity and the progression of obesity, indicating that Ecscr is a new target for the treatment of metabolic syndrome.
MedicalResearch.com Interview with:Marco D. Huesch, MBBS, Ph.D.
Assistant professor at the USC Sol Price School of Public Policy
Adjunct professor with Duke’s School of Medicine and Fuqua School of Business.
MedicalResearch.com: What are the main findings of the study?Answer: This study asked whether ‘learning by doing’ works backwards too, as ‘forgetting by not doing’. In an nutshell, the answer is ‘no’ among the Californian cardiac surgeons I examined with short breaks of around a month.
MedicalResearch.com Interview with:Conor P. Delaney, MD MCh PhD FRCSI FACS FASCRS
The Jeffrey L. Ponsky Professor of Surgical Education | Chief, Division of Colorectal Surgery | Vice-Chair, Department of Surgery | Director, CWRU Center for Skills and Simulation | Surgical Director, Digestive Health Institute | University Hospitals Case Medical Center | Case Western Reserve University | 11100 Euclid Avenue Cleveland, OH 44106-5047
MedicalResearch.com: What are the main findings of the study?Answer: Our goal was to see whether the transversus abdominis plane (TAP) block reduced complications and shortened the hospital stay of patients undergoing colorectal operations. The TAP block is a nerve block injection given at the conclusion of the operation which reduces pain in the operative area. Results showed that the mean hospital stay dropped to less than 2.5 days after the surgical procedure, significantly lower than the 3.7 days which the University Hospitals Case Medical Center Care pathway had already described for more than 1,000 consecutive patients. In our new study, we employed the TAP block and the Enhanced Recovery Pathway (ERP) on 100 patients. We found that 27 patients went home the next day and another 35 went home 48 hours after their operations. That is considerably better than the five or six days patients usually stay in the hospital after laparoscopic colorectal procedures, and certainly better than nine days often seen after an open operation. With a third of patients leaving the day after colorectal resection, we feel these results are significant.
MedicalResearch.com Interview with: Ta-Liang Chen, MD, PhD
Graduate Institute of Clinical Medical Science,
China Medical University, Taichung, Taiwan
MedicalResearch.com: What are the main findings of the study?Reply: Diabetes increases postoperative 30-day mortality, complications, and medical expenditures in patients undergoing in-hospital noncardiac surgeries.
MedicalResearch.com Interview with: Rakesh M. Suri MD, D.Phil.
Mayo Clinic College of Medicine, Rochester, Minnesota
MedicalResearch.com: What might clinicians “take home” from this study?
a. The contemporary outcomes of surgical correction of mitral regurgitation are excellent based upon results observed in this large multinational, multi-institutional study, Mitral valve surgery now has a low peri-operative risk of death or complications, and a very high likelihood of saving a patient’s own heart valve (>90% - repair); thereby avoiding the need for replacement with an artificial valve substitute.
b. All patients with severe degenerative mitral regurgitation are at risk for heart failure and/or death when surgical correction is delayed. A safe period of “watchful waiting” in those with severe mitral regurgitation due to flail leaflets, even in the absence of traditional Class I triggers for surgery (symptoms or left ventricular dilation/dysfunction) does not exist.
c. Prompt mitral valve surgery within months following the diagnosis of severe degenerative mitral regurgitation, even in those without symptoms, is associated with important and sustained long term benefits including a 40% decrease in death and 60% less heart failure risk, sustained many years following surgical intervention
MedicalResearch.com Interview with:Dr. Takahisa Fujikawa, MD, PhD, FACS.
Director, Dept of Surgery, Kokura Memorial Hospital,
3-2-1 Asano, Kokurakita-ku, Kitakyushu, Fukuoka 802-8555, JAPAN.
MedicalResearch.com: What are the main findings of the study?Answer:
A total of consecutive 1,075 patients undergoing abdominal laparoscopic surgery between 2005 and 2011, including 715 basic and 360 advanced laparoscopic surgeries, were reviewed. The perioperative management protocol consists of interruption of antiplatelet therapy (APT) one week before surgery and early postoperative re-institution in low thromboembolic risk patients (n=160, iAPT group), whereas preoperative APT was maintained in patients with high thromboembolic risk or emergent situation (n=52, cAPT group). Perioperative and outcome variables of cAPT and iAPT groups, including bleeding and thromboembolic complications, were compared to those of patients without APT (non-APT group, n=863).
No case suffering excessive intraoperative bleeding due to continuation of APT was observed. There were 10 postoperative bleeding complications (0.9%) and 3 thromboembolic events (0.3%), but surgery was free of both complications in cAPT group. No significant differences were found between the groups in operative blood loss, blood transfusion rate, and the occurrence of bleeding and thromboembolic complications.
Multivariable analyses showed that multiple antiplatelet agents (p=0.015) and intraoperative blood transfusion (p=0.046) were significant prognostic factors for postoperative bleeding complications. Increased thromboembolic complications were independently associated with high New York Heart Association class (p=0.019) and history of cerebral infarction (p=0.048), but not associated with APT use. (more…)
MedicalResearch.com Interview with Dr. Frank Sellke, MD
Chief of cardiothoracic surgery and co-director of the Cardiovascular Institute at Rhode Island, The Miriam and Newport hospitals
MedicalResearch.com: What are the main findings of the study?Dr. Sellke: The main findings of the study are that outcomes of repair of an ascending aortic dissection are improved under a full moon compared to other phases of the moon. This was with regard to both mortality and length of hospital stay. Interestingly, there was no correlation with season of the year.
MedicalResearch.com Interview with:Aneel Bhangu, MBChB, MRCS and Douglas M. Bowley, FRCS
Royal Centre for Defense Medicine, Birmingham, England
MedicalResearch.com: What are the main findings of the study? Answer: Our study was a meta-analysis, which combined the findings from 8 randomized controlled trials that included a total of 623 patients. The key finding was that delayed primary skin closure (DPC) for contaminated and dirty abdominal incisions may reduce the rate of surgical site infection. However, due to high risk of bias from the included studies, including flaws in study design, definitive evidence is lacking.
We believe that this meta-analysis represents an exciting development in biomedical publishing; this was a true collaboration between US and UK military surgeons to examine an area of major concern and interest to surgeons everywhere. This work uses experience hard-won on the battlefields of Iraq and Afghanistan, combined with published surgical trials, to inform both future research activity as well as military and civilian surgical practice. This cross-fertilization of ideas is one positive consequence of all the sacrifice and suffering of recent conflicts.
MedicalResearch.com Interview with Kenneth Ogan MD
Department of Urology
Emory University School of Medicine
1365 Clifton Rd. NE, Building B, Suite 1400
Atlanta, Georgia 30322
MedicalResearch.com: What are the main findings of the study?
Dr. Ogan: Surgical risk assessment is traditionally a very subjective process, and an evaluation that more accurately measures a patient’s physiologic reserve would greatly aid in surgical decision making. In this study we sought to further characterize frailty as an objective risk assessment tool in surgical patients. We prospectively measured the five component frailty criteria described by Fried et al.1 (weight loss, exhaustion, low activity, grip strength, and gait speed). Patients deemed “intermediately frail” and “frail” had twice the likelihood of experiencing any complication in the 30-day post-operative period.
MedicalResearch.com eInterview with Luca Weltert, MD
Cardiac Surgery Department of the European Hospital in Rome,
Presentation during the Plenary Scientific Session of the
93rd AATS Annual Meeting in Minneapolis.
MedicalResearch.com: What are the main findings of the study?Dr. Luca Weltert:This study illustrates the efficacy of Human Recombinant Erythropoietin (HRE) in avoiding blood transfusions in the heart surgery setting. And aside from complicated number, tables and statistics tells that HRE can reduce Blood Transfusions as much as 65%, while at the same time not exposing patients to any substantial added risk.
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