The Stars Know
Dr. Howard[/caption]
David H. Howard, PhD
Professor, Health Policy and Management
Rollins School of Public Health
Emory University, Atlanta, Georgia
MedicalResearch.com: What is the background for this study?
Response: Application of the False Claims Act (FCA) to medically unnecessary care is controversial, both in the courts and in the Department of Justice. Although there haven’t been many FCA suits against hospitals and physicians for performing unnecessary percutaneous coronary interventions (PCIs), the suits that have occurred have been against some of the highest-volume hospitals and physicians. Some cardiologists have been sentenced to prison.
Prof. MacKay[/caption]
Prof Stuart MacKay BSc (Med) MB BS (Hons) FRACS
Honorary Clinical Professor Otolaryngology Head and Neck Surgery
Clinical Professor at University of Wollongong Graduate School of Medicine
Adjunct Professor Faculty of Health Sciences
MedicalResearch.com: What is the background for this study?
Dr. Bartlett[/caption]
Edmund K Bartlett, M.D.
Department of Surgery/Division of Surgical Oncology
Memorial Sloan Kettering Cancer Center
New York, New York
MedicalResearch.com: What is the background for this study?
Response: Indications for adjuvant therapy for resected, high-risk melanoma is a controversial and rapidly-evolving topic in melanoma treatment. Immunotherapy treatments targeting PD-1 have significantly improved survival in advanced-stage disease, but the magnitude of survival benefit in stage III disease--particularly stage IIIA--remains unclear. Recently, 31-GEP (a gene expression profiling assay) has been studied as a risk-stratifying tool to identify patients who are at higher risk for systemic recurrence. Ideally such a tool could identify patients most likely to benefit from immunotherapy treatment in the adjuvant setting (when all visible disease has been removed).
Dr. Spitzer[/caption]
Sarabeth Spitzer, MD
Co-Chair of Board, Scrubs Addressing the Firearm Epidemic (SAFE)
Department of Surgery, Brigham and Women’s Hospital
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Firearm injury is a significant cause of morbidity and mortality in the United States, resulting in almost 40,000 deaths annually in the United States, but very little is known about the epidemiology of nonfatal firearm injuries. Nonfatal firearm injuries can have significant long-term morbidity and are associated with significant cost. We found that there were over 81,000 nonfatal firearm injuries in California over the study period. Over the period, there was a decrease in nonfatal firearm injuries by 38.1%, driven primarily by a decrease in assault injuries.
One example of a large fibroid-Wikipedia image[/caption]
Response: Uterine fibroids are the most common non-cancerous tumour in women of childbearing age. They are associated with heavy bleeding, lower chances of having children and reduced quality of life. Traditional surgical options were either to remove the fibroids (myomectomy) or completely remove the womb. A newer approach, known as uterine artery embolization, involves blocking the blood supply to the fibroids in the womb.
Fibroids may be associated with infertility and problems during pregnancy, including miscarriage and preterm birth. As more women are having children at a later age, fibroids are becoming more of an issue for them and safe and effective fertility sparing treatments are needed.
Both treatments improve quality of life, but myomectomy will provide greater benefit to women on average.
MedicalResearch.com: What should readers take away from your report?
Response: This study is the largest to date comparing women treated with either myomectomy or uterine-artery embolization for their fibroids. It was completed in hospitals across the UK, and included a substantial number of women of African-Caribbean ethnicity, who are more likely have bothersome fibroids, so we can be confident that the findings are important and relevant.
Women, including those desiring a future pregnancy, should be provided with the evidence generated by the FEMME trial to enable to make a fully informed decision regarding their fibroid treatment.
Some surgeons prefer to use human cartilage from the septum, ears, or ribs. But, other surgeons prefer to use synthetic implants made of either Gore-Tex or silicone. Before you get a nose job from the best rhinoplasty surgeons, it is important to know which material is best for you. Before you choose Gore-Tex or silicone, you should take time to talk to your surgeon and work together to pick the material that will give you the look you want. An augmentation rhinoplasty takes about 90 minutes, but the change to your face will last a lifetime.
Dr. Mattos[/caption]
Leonardo Mattos, PhD
Head of Biomedical Robotics Lab
Advanced Robotics Department
Istituto Italiano di Tecnologia
Genova, Italy
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We have been working on robotic microsurgery for several years, and have developed robotic technology for it that is getting ready for use on humans. Then, 5G started to become a reality here in Italy, and we wanted to test if it could be used to enable remote telesurgery. So we joined forces with Vodafone Italia to realize this study and proof of concept demonstration.
Telesurgery has been a dream for over 20 years, and has been demonstrated already back in 2001. However, the wide scale adoption of the technology has been limited by many factors, including the limited availability of surgical robots and the lack of a telecommunication network that is fast and reliable enough for such operation. Recent technological progress is changing this scenario, with surgical robots being used in hospitals around the world and high-performance telecommunications system becoming widely available. This study shows that telesurgery is now feasible using the newest 5G telecommunication networks, enabling us to consider a large scale adoption of the technology.
Dr. Gaudino[/caption]
Mario Fl Gaudino MD
Professor of Cardiothoracic Surgery
Department of Cardiothoracic Surgery
Weill Cornell Medicine
MedicalResearch.com: What is the background for this study?
Response: The radial artery is currently used in less than 10% of CABG procedures in the US.
MedicalResearch.com: What are the main findings?
Response: The JAMA paper provides convincing evidence that the use of the radial artery rather than the saphenous vein to complement the internal thoracic artery for CABG is associated with improved long-term outcomes.
Dr. Wong[/caption]
Carlos KH Wong, PhD, MPhil, BSc
Department of Family Medicine and Primary Care
LKS Faculty of Medicine
The University of Hong Kong
MedicalResearch.com: What is the background for this study?
Response: The background is that bariatric surgery has been widely indicated for the management of obesity and related comorbidities. However, there are uncertainties pertaining to the risks of post-bariatric severe hypoglycaemia (SH), cardiovascular diseases (CVDs), end-stage kidney diseases (ESKDs) and all-cause mortality in obese patients with Type 2 diabetes mellitus (T2DM), especially among Asian populations.
Dr. Brown[/caption]
Chase Brown, MD
Associate Fellow, Leonard Davis Institute of Health Economics
Integrated Cardiac Surgery Resident
Hospital of the University of Pennsylvania
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Dr. Desai[/caption]
Nimesh D. Desai, MD, PhD
Director, Thoracic Aortic Surgery Research Program
Associate Professor of Surgery
Hospital of the University of Pennsylvania
MedicalResearch.com: What is the background for this study?
Dr. Chase Brown: Opioid use in the United States is a public health emergency. We know that opioids prescribed after general surgery operations to patients who never received them within the year prior to their surgery are at increased risk for continuing to take opioids months later. However, this has not been studied in patients undergoing cardiac surgery, who often times have more severe post-operative pain.
Our goal in this study was to determine how many patients after cardiac surgery and are opioid naive are continuing to take opioids within 90-180 days after their surgery.
Dr. Charles-de-Sá[/caption]
Charles-de-SáM.D., Ph.D.
Rio de Janeiro, Brazil
MedicalResearch.com: What is the background for this study?
Response: Our clinical trial was based on our clinical skin observations in areas submitted to a lipotransfer previously, an ordinary practice in plastic surgery. These clinical observations lead us to investigate what will be the key element played in these findings. Our scientific support investigation addressed the Dardick1and Zuk, P2 studies, that demonstrated fibroblastic-like cells in adipose tissue with regenerative ability. Our clinical trial proposal is to investigate the adipose-derived stem cell (ADSC) role in the photoaged skin. The direct endpoint of the study was to assess the histological benefits provided by the subdermal ADSC injection. Mesenchymal stem cells were obtained from lipoaspirates, expanded in vitro, and introduced into the facial skin of 20 patients submitted after three to four months to a face-lifting surgery. In the retrieved skin, immunocytochemical and ultrastructural analysis quantified elastic matrix components, cathepsin-K, metalloprotease MMP-12, and the macrophage M2 markers: CD68, CD206 and heme-oxygenase-1.An overview of the trial steps is described in the infographic.
Dr. Myers[/caption]
Sara P. Myers, M.D., Ph.D.
University of Pittsburgh School of Medicine
MedicalResearch.com: What is the background for this study?
Response: Compared to other fields, medicine, and especially academic surgery and its subspecialties, trail with respect to gender diversity. Considering that these fields were traditionally male-dominated, two issues that may present ongoing challenges to the retention and promotion of women are pro-male bias and negative stereotypes about women. Training specific to pursuing a surgical career begins in residency, so it is important to understand how these issues affect motivation and achievement during this formative period.
In our study we first evaluated the association between pro-male bias and research-related career engagement using a survey methodology, and then looked at whether evoking negative stereotypes about women was associated with reduced performance on a simulated technical skill assessment called the Fundamentals of Laparoscopic Surgery (FLS) assessment.
Dr. Cavanaugh[/caption]
Alyson Cavanaugh, PT, PhD
Joint Doctoral Program in Epidemiology
University of California, San Diego/ San Diego State University
MedicalResearch.com: What is the background for this study?
Response: More than 700,000 total knee replacements are performed annually in the United States, but there is a racial disparity in outcomes after the surgery. If the knee replacement procedure is considered a highly effective treatment, why don't black women present with the same outcomes as whites?
Physical function when going into surgery has a large impact on the potential functional outcomes after surgery. Our hypothesis was that black women were presenting to surgery with poorer physical function, which was contributing to poorer functional outcomes after surgery.
Dr. Wei Bao[/caption]
Wei Bao, MD, PhD
Assistant Professor
Department of Epidemiology,
College of Public Health,
University of Iowa,
Iowa City, IA 52242 and
[caption id="attachment_50383" align="alignleft" width="128"]
Dr. Yangbo Sun[/caption]
Dr. Yangbo Sun, PhD
(Former postdoc research scholar at University of Iowa)
Tenure-track Assistant Professor
The University of Tennessee Health Science Center.
MedicalResearch.com: What is the background for this study?
Response: Obesity is a rising epidemic in the United States and worldwide. Bariatric surgery has been shown to be the most effective and durable treatment for clinically morbid obesity which is difficult to reverse through traditional approaches such as lifestyle intervention. There has been long-standing uncertainty and debate regarding the value of pre-operative weight loss as a requirement for bariatric surgery. Meanwhile, one of the major indicators for surgery outcomes is 30-day mortality after surgery, which is especially important for bariatric surgery because the vast majority of the patients undergoing bariatric surgery are voluntary and if the surgery were not performed, they are not supposed to die in short term.
So far, the association of pre-operative weight loss with 30-day mortality after bariatric surgery remains unclear. Therefore, in this study, we examined the associations of pre-operative BMI and weight loss with 30-day mortality following bariatric surgery using a large database among ~500,000 patients who underwent bariatric surgery in the United States and Canada.
Dr. Reitz[/caption]
Katherine Moll Reitz, MD
General Surgery Resident
University of Pittsburgh
MedicalResearch.com: What is the background for this study?
Response: Surgical interventions both save lives and improve the quality of those lives each day. However, these same interventions and the recovery thereafter are a major physiologic stressor. Younger, more resilient patients tend to recover faster, with fewer postoperative complications when compared to older, frailer patients undergoing the same surgical treatments. Therefore, investigators at University of Pittsburgh and UPMC have begun focusing on prehabilitation in order to optimize at risk patients preoperatively. Just as an athlete would train for an upcoming event, prehabilitation (including smoking cessation, healthy eating, and physical activity increases) prepares or trains patients for their surgical intervention and can improve their postoperative outcomes.
Currently, there is no medication available to aid in this training process, improving patients’ response to the physiologic stress of surgery. Therefore, we are interested in exploring potential safe, well tolerated medical therapies which can optimize patients as pharmacologic prehabilitation.
Dr. Pincus[/caption]
Pincus MD PhD
Division of Orthopaedic Surgery, Department of Surgery
University of Toronto
Sunnybrook Health Sciences Centre, Division of Orthopaedic Surgery
ICES, Toronto, Ontario, Canada
MedicalResearch.com: What is the background for this study?
Response: Controversy exists among arthroplasty surgeons and patients about the best surgical approach for total hip arthroplasty (THA) - one of the most common operations performed worldwide. In the last few years, the direct anterior approach has become increasingly popular compared to posterior and lateral approaches, partially as a result of advertising to patients. We sought to determine whether a direct anterior surgical approach was associated with lower surgical complications compared to lateral and posterior approaches.
Dr. Salminen[/caption]
Paulina Salminen MD PhD
Chief and Professor of surgery
Turku University, Finland
MedicalResearch.com: What is the background for this study?
Response: Appendectomy has been the standard treatment for uncomplicated acute appendicitis and currently one of the most commonly performed surgical procedures. We now know that there are two different forms of acute appendicitis: the more common milder uncomplicated acute appendicitis and the more severe complicated acute appendicitis. While the complicated form is primarily still treated surgically, in recent years evidence from randomised trials and meta-analyses show that antibiotics are a safe and efficient treatment of uncomplicated acute appendicitis also at long-term follow-up.
Quality of life (QOL) and patient satisfaction after antibiotic therapy or appendectomy for uncomplicated acute appendicitis have been studied previously in a pediatric population but not in an adult population. Our aim was to compare long-term quality of life and patient satisfaction after antibiotic therapy and appendectomy for the treatment of uncomplicated acute appendicitis in patients enrolled in the original APPAC trial.
The most obvious take away is that correcting the magnesium levels can help patients to normalize calcium levels due to the synergy between the two....
Dr. Herrera-Escobar[/caption]
Juan P. Herrera-Escobar, MD, MPH
Research Director, Long-term Outcomes in Trauma
Center for Surgery and Public Health, Brigham and Women's Hospital
Instructor in Surgery, Harvard Medical School
MedicalResearch.com: What is the background for this study?
Response: Firearm injuries are a pressing public health problem in the United States. Until now, most of the research on this problematic has focused on mortality, which of course is critical, but is only one piece of the story. For every person who dies from a firearm injury, three survive every year. As trauma systems continue to improve and save more lives every year, our attention should start shifting to the impact that firearm injuries have on survivors.
Dr. Courcoulas[/caption]
Anita P. Courcoulas MD, MPH, FACS
Anthony M. Harrison MD Chair and
Professor of Surgery
Chief, MIS Bariatric & General Surgery
University of Pittsburgh Medical Center
MedicalResearch.com: What is the background for this study?
Response: Fewer published studies in bariatric surgery address long term adverse outcomes or problems that can occur after different operations. In addition, a lack of standardized reporting of potential adverse events limits the understanding of these issues.
This paper results from one of the largest studies of bariatric surgery ever undertaken and includes both gastric bypass and gastric sleeve, the 2 most common operations performed in the U.S. and worldwide at the current time. This study leverages large data sets from the electronic health record linked to insurance claims and death indices. This is real-world data coming from a population-based cohort of 33,560 adults at 10 sites in 4 clinical data research networks throughout the U.S., so it may be different from data that accrues from a longitudinal observational study or randomized trial. Patients and other important stakeholders in bariatric surgery were critical to the design, conduct, and dissemination of results from this study.
Dr. Sheetz[/caption]
Kyle Sheetz, MD
Clinical Year 4
Resident, General Surgery
Michigan Medicine
MedicalResearch.com: What is the background for this study?
Response: There are concerns that robotic surgery is increasing for common surgical procedures with limited evidence and unclear clinical benefit. Prior studies describing the use of robotic surgery relied upon claims or billing data to identify robotic operations from laparoscopic or open ones. This may lead to inaccuracies as claims data may not provide specific codes for robotic operations.
Dr. Golshan[/caption]
Mehra Golshan, MD, MBA
Dr. Abdul Mohsen & Sultana Al-Tuwaijri Distinguished Chair
Surgical OncologyDirector of Breast Surgical Oncology Fellowship
Associate Professor, Harvard Medical School
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Triple negative breast cancer is an aggressive form of breast cancer that often requires chemotherapy. In this study we provided neoadjuvant chemotherapy with or without a PARP inhibitor and showed that many women who were originally ineligible for breast conservation (lumpectomy) became eligible after treatment.
If lumpectomy was tried it was usually successful. Many more women in the US compared to Europe and Asia chose mastectomy when lumpectomy was an option even when genetics is negative.
Dr. Anderson[/caption]
MedicalResearch.com Interview with:
Matilda Anderson MBBS MBS
General Surgery Trainee/Public Health/Researcher
Footscray, Victoria, Australia
MedicalResearch.com: What is the background for this study?
Response: Female representation in the surgical workforce is increasing. Previous studies have shown higher infertility rates and adverse pregnancy outcomes in this population. We aimed to accurately define the available research in this area and provide some basic recommendations about how workplaces can support their female surgical residents and surgeons.
On a more personal note- Dr Anderson is a female surgical resident and have seen countless pregnant colleagues remove themselves from operating rooms with the concern about how the conditions may affect their pregnancies. Dr. Anderson met Associate Professor Goldman at Harvard University (a leading expert on occupational reproductive hazards) and collaborated to explore this area further.
Dr. Wheeler[/caption]
Ben Wheeler,MB ChB(Otago) DCH PhD CCE FRACP
Paediatrician, Associate
Department of Women's and Children's Health (Dunedin)
University of Otag
MedicalResearch.com: What is the background for this study?
Response: All tongues have a frenulum, which is a small band of tissue that helps connect them to the floor of the mouth. Tongue tie (or ankyloglossia) is when this frenulum causes restriction to the movement of the tongue, and can interfere with successful breastfeeding in infants. This may be improved with an operation to cut the frenulum of the tongue (frenotomy). Internationally, tongue-tie diagnosis and treatment has increased substantially (reported at over 10-15% in some locations). This has led to growing concerns of potential overtreatment. The surgical treatment is often discussed as a minor surgery with little risk, but there is growing awareness this may not be the case. There is a paucity of studies examining moderate to severe complications following frenotomy.
Therefore we aimed to determine rates of moderate to severe complications of tongue tie procedures presenting to hospital-based paediatricians in New Zealand, and describe this population.
Dr. Krittanawong[/caption]
Chayakrit Krittanawong, MD
Section of Cardiology
Baylor College of Medicine
Houston, TX
MedicalResearch.com: What is the background for this study?
Response: Transcatheter Aortic valve Implantation (TAVI) has emerged as equally effective alternative to surgical aortic valve replacement (SAVR) to treat severe aortic stenosis (AS) in all risk groups. In particular, less is known about the heart failure (HF) patients who undergo TAVI. Whether certain subtypes of HF respond differently after TAVI remains a mystery.
In this study, we sought to assess and compare the incidence and predictors of in-hospital mortality among patients with heart failure with preserved ejection fraction (HFREF) versus heart failure with preserved ejection fraction (HFPEF).
Dr. Vella[/caption]
Michael A. Vella, M.D., M.B.A.
Assistant Professor of Surgery
Division of Acute Care Surgery and Trauma
University of Rochester School of Medicine and Dentistry
MedicalResearch.com: What is the background for this study?
Response: There is a lot of (appropriate) focus on the mortality statistics related to gun violence, but sometimes we forget about the large number of survivors of gunshot wounds. We wanted to specifically look at the long term physical and mental health outcomes in this patient population.
Dr. Ellis[/caption]
Ryan J. Ellis, MD MS
General Surgery Resident
Surgical Outcomes and Quality Improvement Center (SOQIC)
Northwestern Medicine
MedicalResearch.com: What is the background for this study?
Response: Burnout has emerged as a significant problem affecting the entire healthcare workforce and it has been likely to myriad downstream problems such as increases in medical errors, alcoholism, and depression. Despite the attention on clinician burnout, there are significant gaps in our understanding of how the workplace environment may lead to burnout. Moreover, there are particular concerns about the workplace environment in training, specifically with regards to abuse, discrimination, and harassment.
We had the opportunity to survey all U.S. general surgery residents to comprehensively define the frequency of workplace mistreatment and its relationship with burnout and suicidal thoughts among surgical residents.