Author Interviews, BMJ, Cancer Research, Surgical Research, Transplantation / 02.05.2014

MedicalResearch.com Interview with: Rajeev Desai SpR Gastroenterology, City Hospital Birmingham Honorary Clinical Research Fellow University Hospital Birmingham / NHS Blood and Transplant, Bristol MedicalResearch: What are the main findings of the study? Dr. Desai: This study of a large national cohort of organ donors shows that, following careful assessment and selection, organs from some donors with a previous history of cancer can be used safely for transplantation. The risks of accepting such organs for transplantation should be balanced with risks of non-acceptance and its consequences including delayed transplantation or non-transplantation. (more…)
Author Interviews, Breast Cancer, Mayo Clinic, Surgical Research, Weight Research / 02.05.2014

Tina Hieken, M.D. Associate Professor of Surgery Mayo Clinic,Rochester, MinnMedicalResearch.com Interview with: Tina Hieken, M.D. Associate Professor of Surgery Mayo Clinic,Rochester, Minn   MedicalResearch.com: What are the main findings of the study? Dr. Hieken: Among more than 1,300 newly diagnosed invasive breast cancer patients, 36 percent of whom were obese (BMI ≥ 30), preoperative axillary ultrasound with fine needle aspiration biopsy of suspicious lymph nodes identified metastasis to the lymph nodes in 36 percent of patients found to be node-positive at operation.  For all BMI categories (normal, overweight, obese) axillary ultrasound was predictive of pathologic nodal status (p<0.0001).  The sensitivity of axillary ultrasound did not differ across BMI categories while specificity and accuracy were better for overweight and obese patients, respectively, than for normal weight patients.  Furthermore, patients across all BMI categories who had suspicious axillary lymph nodes on ultrasound and had a positive fine needle aspiration biopsy had significantly more positive lymph nodes at operation, an average of five metastatic nodes, and an overall higher nodal disease burden at operation. (more…)
Author Interviews, Surgical Research, Weight Research / 30.04.2014

Mr. David Bowrey, MD FRCS (Gen Surg) MMedEd FHEA Consultant General / Oesophagogastric Surgeon & Honorary Senior Lecturer, Dept Cancer Studies, Training Programme Director for Core Surgery, East Midlands South University Hospitals of Leicester NHS Trust, Leicester Royal InfirmaryMedicalResearch.com Interview with: Mr. David Bowrey, MD FRCS (Gen Surg) MMedEd FHEA  Consultant General / Oesophagogastric Surgeon & Honorary Senior Lecturer, Dept Cancer Studies, Training Programme Director for Core Surgery, East Midlands South University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary MedicalResearch.com: What are the main findings of this study? Dr. Bowrey: Of 103 patients who had undergone Roux en Y gastric bypass surgery, changes in appetite, taste and smell were noted in 97%, 73% and 42% respectively. Seventy-three percent of patients developed aversions to certain types of foods, most frequently meat, starch and dairy produce. The change in taste sensation for the three common modalities of "sweet", "salt" and "sour" was decreased in some patients and increased in other patients. Patients who experienced food aversions typically experienced more weight loss than patients not developing aversions. (more…)
Author Interviews, JAMA, Surgical Research / 22.04.2014

MedicalResearch.com Interview with: Rustam Al-Shahi Salman Professor of clinical neurology and MRC senior clinical fellow, University of Edinburgh Honorary consultant neurologist, NHS Lothian upcoming JAMA publication:MedicalResearch.com Interview with: Rustam Al-Shahi Salman Professor of clinical neurology and MRC senior clinical fellow University of Edinburgh Honorary consultant neurologist, NHS Lothian MedicalResearch.com: What are the main findings of the study? Prof. Al-Shahi Salman: Patients with arteriovenous malformations (abnormal connection between arteries and veins) in the brain that have not ruptured had a lower risk of stroke or death for up to 12 years if they received conservative management of the condition compared to an interventional  treatment. Interventional treatment for brain arteriovenous malformations (bAVMs) with procedures such as neurosurgical excision, endovascular embolization, or stereotactic radiosurgery can be used alone or in combination to attempt to obliterate bAVMs. Because interventions may have complications and the untreated clinical course of unruptured bAVMs can be benign, some patients choose conservative management (no intervention). Guidelines have endorsed both intervention and conservative management for unruptured brain arteriovenous malformations. Whether conservative management is superior to interventional treatment for unruptured bAVMs is uncertain because of the lack of long-term experience, according to background information in the article. (more…)
Author Interviews, Surgical Research / 17.04.2014

MedicalResearch.com Interview with: Dr. Dr. Oliver Muensterer MD Ph.D Division of Pediatric Surgery New York Medical College Maria Fareri Children's Hospital of Westchester Medical Center Valhalla, NY 10595, USAOliver Muensterer MD Ph.D Division of Pediatric Surgery New York Medical College Maria Fareri Children's Hospital of Westchester Medical Center Valhalla, NY 10595, USA   MedicalResearch.com: What are the main findings of the study? Dr. Muensterer: We looked at the functionality of Google Glass, a novel head-mounted mobile computer with integrated display, camera, microphone, and speaker, in the clinical environment. While the technology has a lot of promise to be useful for pediatric surgeons, in its current version, it also has significant limitations. The most obvious utilities are hands-free photo- and videodocumentation, looking up medical terminology on the internet, help with coding and billing activities, and hands-free telecommunication. (more…)
Author Interviews, Colon Cancer, JAMA, Surgical Research / 16.04.2014

MedicalResearch.com Interview Invitation Dorna Jafari, M.D. and Michael J Stamos, MD Professor of Surgery John E. Connolly Chair, Department of Surgery University of California, Irvine Orange, CA 92868 MedicalResearch.com: What are the main findings of the study? Answer: Surgeons are faced with an aging population and data regarding outcomes is rare given that many studies preclude the elderly from the study population. Therefore, it is difficult to accurately discuss risk of surgical resection given the lack of data. Therefore we aimed to report the national trends and outcomes of colorectal cancer treatment in the elderly population. We demonstrated that the majority of resections are performed in patients >65yeras old. There is a trend towards a decrease in incidence of colorectal resection and a decrease in rate of mortality during 2001-2010.  However, the unique physiological changes associated with aging contribute to increase morbidity and morality as demonstrated by our findings. In fact patients >85 years have a 472% increase in risk-adjusted mortality during a hospital admission compared to younger patients. However, despite the substantially higher mortality and morbidity associated with age, there has been a marked improvement in surgical outcomes in the elderly population. (more…)
Mayo Clinic, Pain Research, Surgical Research / 05.04.2014

Dr. Juliane Bingener-Casey, M.D. Mayo Clinic in Rochester, Minn.MedicalResearch.com Interview with: Dr. Juliane Bingener-Casey, M.D. Mayo Clinic in Rochester, Minn. MedicalResearch.com:  What are the study’s main findings? Dr. Bingener-Casey:  “Patient-reported outcomes such as pain and fatigue are sensitive tools to detect how well patients recover from surgery. These patient-reported outcome results are different for men and women and for older versus younger people.” (more…)
Author Interviews, Outcomes & Safety, Surgical Research / 28.03.2014

dr_najma_ahmedMedicalResearch.com Interview with: Dr. Najma Ahmed Trauma and Acute Care Surgeon, St. Michael's Hospital Residency Training Director, General Surgery, University of Toronto   MedicalResearch.com: What are the main findings of this study: Dr. Ahmed: The main findings if the study were that the recent reduction of resident duty hours to much less than 80 hours decreases health outcomes in patients, has adverse educational outcomes for residents and does not improve wellness in surgery. (more…)
Author Interviews, Endocrinology, Gastrointestinal Disease, JAMA, Johns Hopkins, Surgical Research / 24.03.2014

Elizabeth C. Wick, MD Assistant Professor,Department of Surgery The Johns Hopkins Hospital, Baltimore, MarylandMedicalResearch.com Interview with: Elizabeth C. Wick, MD Assistant Professor,Department of Surgery The Johns Hopkins Hospital, Baltimore, Maryland   MedicalResearch.com: What are the main findings of the study? Dr. Wick: The main finding is the high variability in physician practice for prescribing steroids and the lack of clear guidance as to best practice in the literature. (more…)
Author Interviews, BMJ, Heart Disease, Outcomes & Safety, Surgical Research / 17.03.2014

Dr Tahir Hamid MRCP (UK), FESC Department of Cardiology, Royal Albert Edward Infirmary NHS Trust, Wigan, UKMedicalResearch.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. (more…)
Author Interviews, NEJM, Outcomes & Safety, Surgical Research / 13.03.2014

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, CanadaMedicalResearch.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. (more…)
Addiction, Opiods, Orthopedics, Pharmacology, Surgical Research / 11.03.2014

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, TexasMedicalResearch.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. (more…)
Author Interviews, Hospital Acquired, Infections, NIH, Surgical Research, University of Pennsylvania, Wake Forest / 09.03.2014

William G Ward, Sr. MD Chair of Orthopaedic Surgery, Chief of Musculoskeletal Service Line - Guthrie Clinic One Guthrie Square Sayre, Pennsylvania 18840 (Professor Emeritus - Wake Forest University Dept of Orthopaedic Surgery)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:
  1. 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.
  2. For a double-gloved surgeon, changing the outer glove just prior to implant handling should decrease bacterial contamination from the surgeon by about 50%.
  3. 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…)
Author Interviews, BMJ, Outcomes & Safety, Surgical Research / 06.03.2014

MedicalResearch.com Interview with: Mr. Aneel Bhangu West Midlands Research Collaborative, Academic Department of Surgery Queen Elizabeth Hospital Birmingham UK 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. (more…)
Author Interviews, JAMA, Surgical Research / 20.02.2014

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. (more…)
Author Interviews, Heart Disease, Surgical Research / 19.02.2014

Sammy Elmariah, MD, MPH Massachusetts General Hospital Boston, MAMedicalResearch.com Interview with: Sammy Elmariah, MD, MPH Massachusetts General Hospital Boston, MA   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. (more…)
Author Interviews, JAMA, Surgical Research, Vitamin D / 19.02.2014

Sadeq A. Quraishi, MD, MHA Massachusetts General Hospital, Harvard Medical School Boston, MassachusettsMedicalResearch.com Interview with: Sadeq A. Quraishi, MD, MHA Massachusetts General Hospital, Harvard Medical School Boston, Massachusetts 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. (more…)
Author Interviews, Breast Cancer, Journal Clinical Oncology, Radiation Therapy, Sloan Kettering, Surgical Research / 12.02.2014

dr_monica_morrow 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. (more…)
Author Interviews, Baylor College of Medicine Houston, JAMA, Outcomes & Safety, Surgical Research / 17.01.2014

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 and 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. (more…)
Author Interviews, Breast Cancer, Surgical Research / 17.01.2014

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. (more…)
Author Interviews, NEJM, Orthopedics, Surgical Research / 26.12.2013

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. (more…)
Author Interviews, Gastrointestinal Disease, JAMA, Johns Hopkins, Surgical Research / 22.12.2013

Nita Ahuja, MD Departments of Surgery and Oncology, Johns Hopkins University School of Medicine, Baltimore, MarylandMedicalResearch.com Interview with: Nita Ahuja, MD Departments of Surgery and Oncology, Johns Hopkins University School of Medicine Baltimore, Maryland 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. (more…)
Author Interviews, Surgical Research / 25.11.2013

Mehwish Qasim PhD Candidate, Research & Teaching Assistant Department of Health Management and Policy University of Iowa, College of Public HealthMedicalResearch.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. (more…)
Allergies, Author Interviews, Heart Disease, Metabolic Syndrome, Pediatrics, Sleep Disorders, Surgical Research / 16.11.2013

MedicalResearch.com Interview with: Nina Berentzen Centre for Nutrition, Prevention and Health Services National Institute for Public Health and the Environment Bilthoven The Netherlands 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. (more…)
Author Interviews, Diabetes, Surgical Research, Weight Research / 14.10.2013

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 Interview with:

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. (more…)
Author Interviews, Heart Disease, JAMA, Surgical Research / 09.10.2013

Dr. 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 BirminghamMedicalResearch.com Interview with Dr. 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. (more…)
Author Interviews, Genetic Research, Metabolic Syndrome, Nature, Surgical Research, Weight Research / 13.09.2013

MedicalResearch.com Interview with: Koji Ikeda, MD, PhD Assistant Professor Department of Cardiology Graduate School of Medical Science, Kyoto Prefectural University of Medicine Kyoto, Japan 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. (more…)
Author Interviews, Duke, Heart Disease, Outcomes & Safety, Surgical Research / 05.09.2013

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 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. (more…)