Lack of Patient Education as a Cause of Increased Postoperative Opioid Use

MedicalResearch.com Interview with:

Dr. Alexis Colvin, MDAssociate Professor of Orthopedic SurgeryIcahn School of Medicine at Mount Sinai

Dr. Colvin

Dr. Alexis Colvin, MD
Associate Professor of Orthopedic Surgery
Icahn School of Medicine at Mount Sinai 

MedicalResearch.com: What is the background for this study?

Response: 40% of all opioid overdose deaths involve a prescription opioid and orthopaedic surgeons are the 3rd highest prescribers of opioids.  Set guidelines for post surgery opioid prescriptions have not been established.  Arthroscopic knee meniscectomy is one of the most common orthopaedic procedures.  The purpose of this study was to determine how many opioids were being prescribed  among a group of six sports fellowship trained orthopaedic surgeons versus how many patients were actually using.

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Accredited Hospitals Linked to Better Rectal Cancer Surgical Outcomes

MedicalResearch.com Interview with:

Alexis G. Antunez MS University of Michigan Medical School, Ann Arbor Center for Healthcare Outcomes and Policy University of Michigan, Ann Arbor

Alexis G. Antunez

Alexis G. Antunez MS
University of Michigan Medical School, Ann Arbor
Center for Healthcare Outcomes and Policy
University of Michigan, Ann Arbor

MedicalResearch.com: What is the background for this study?

Response: The American College of Surgeons Commission on Cancer is implementing a National Accreditation Program for Rectal Cancer (NAPRC), aiming to improve and standardize the quality of rectal cancer care in the United States. While this is a commendable goal, previous accreditation programs in other specialties have faced controversy around their uncertain impact on access to care. Furthermore, it is well established that the quality of rectal cancer care is associated with patients’ socioeconomic position. So, the NAPRC could have the unintended consequence of widening disparities and limiting access to high quality rectal cancer care for certain patient populations.  Continue reading

Does EEG Brain Monitoring During Surgery Reduce Post-Op Delirium?

MedicalResearch.com Interview with:

Michael Avidan, MBBCh, FCA SA Dr. Seymour and Rose T. Brown Professor of Anesthesiology Chief of the Division of Clinical and Translational Research Director of the Infrastructure of Quality Improvement, Research and Informatics Washington University School of Medicine St Louis, MO

Dr. Avidan

Michael Avidan, MBBCh, FCA SA
Dr. Seymour and Rose T. Brown Professor of Anesthesiology
Chief of the Division of Clinical and Translational Research
Director of the Infrastructure of Quality Improvement, Research and Informatics
Washington University School of Medicine
St Louis, MO 

MedicalResearch.com: What is the background for this study?

Response: Postoperative delirium, a temporary state of confusion and inattention, is common in older adults after major surgery. Delirium can be distressing to patients, family members and clinicians. It is associated with longer hospital stays, other medical complications, cognitive decline, and death.

Some previous studies have found that using electroencephalography (EEG) monitoring of the brain during general anesthesia decreases the occurrence of delirium following surgery.

Therefore we conducted a rigorous study to determine whether using information from the EEG to guide the safe reduction of inhaled anesthetic drugs would prevent postoperative delirium and improve other outcomes in older adults following major surgery.

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Safety of MRIs in Patients with Tattoos

MedicalResearch.com Interview with:

Dr. Martina Callaghan PhD Head of Physics & Senior Lecturer Wellcome Centre for Human Neuroimaging Institute of Neurology University College London London  

Dr. Callaghan

Dr. Martina Callaghan PhD
Head of Physics & Senior Lecturer
Wellcome Centre for Human Neuroimaging
Institute of Neurology
University College London
London

MedicalResearch.com:  What is the background for this study?  What are the main findings?

Response: As mirrors the situation in the general population, we found that an increasing number of volunteers who were seeking to enter cognitive neuroscience studies at our Centre had tattoos. However, the magnetic fields used in magnetic resonance imaging (MRI) pose a potential safety risk for people with tattoos. A number of case reports have described such incidents.  However, as these describe isolated cases retrospectively, there was not enough information to objectively assess the risk of tattoo-related adverse reactions for persons having an MRI scan.  Therefore, in 2011, we decided to embark upon this first prospective study to quantitatively assess this risk.

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Esophageal Cancer: HMIE Procedure Reduces Morbidity Without Sacrificing Efficacy

MedicalResearch.com Interview with:

Guillaume Piessen, MD, PhD University Hospital Centre Lille, France

Prof. Piessen

Guillaume Piessen, MD, PhD
University Hospital Centre
Lille, Franc

MedicalResearch.com: What is the background for this study?

Response: Patients requiring surgery for esophageal cancer fare better after undergoing a hybrid minimally invasive esophagectomy (HMIE) with a combined laparoscopy+thoracotomy procedure compared to an open esophagectomy (OE), according to results of the MIRO trial published in the last issue of the New England Journal Of Medicine (link article).

This French prospective multi-center randomized controlled study was funded by the French National Cancer Institute (Grant n° 1907). The study was conducted by Pr Mariette who sadely passed away in 2017 and Pr Piessen (Department of Digestive and Oncological Surgery, CHU Lille), under the hauspice of FRENCH (Fédération de Recherche EN Chirurgie) and FREGAT (French Eso-Gastric Tumors) working group (https://www.fregat-database.org/fr/).

Postoperative morbidity, especially pulmonary complications, affects more than half of patients after open esophagectomy for esophageal cancer.

Hybrid minimally invasive esophagectomy (HMIE) combines a laparoscopic abdominal phase with an open thoracotomy, which may have specific advantages including lower rate of pulmonary complications, without laparoscopic tumor dissection limiting potential tumor spillage and easier reproducibility of the technique [12].

Postoperative morbidity, especially pulmonary complications, affects more than half of patients after open esophagectomy for esophageal cancer.

Hybrid minimally invasive esophagectomy (HMIE) combines a laparoscopic abdominal phase with an open thoracotomy, which may have specific advantages including lower rate of pulmonary complications, without laparoscopic tumor dissection limiting potential tumor spillage and easier reproducibility of the technique [12].

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Dermatologist Discusses Personalized Approach to Skin Cancer Treatment

MedicalResearch.com Interview with:

Dr. Kristine A. Romine MD CEO and Founder of Camelback Dermatology & Skin Surgery Phoenix, AZ

Dr. Romine

Dr. Kristine A. Romine MD
CEO and Founder of Camelback Dermatology & Skin Surgery
Phoenix, AZ

MedicalResearch.com: Would you give a brief overview of the different types of skin cancer?

Response: There are multiple types of skin cancer, including: melanoma, basal cell carcinoma, squamous cell carcinoma, and actinic keratosis. Known as the deadliest form of skin cancer, melanoma develops when irreparable DNA damage results in malignant transformation of melanocytes. This type of skin cancer is most commonly caused by intense UV exposure from the sun or tanning beds, which activate mutations that lead skin cells to rapidly multiply and form malignant tumors. Melanoma can range in color from dark brown to black and are rarely red or even skin colored. They are usually irregular and asymmetrical. In 2018, there were an estimated 91,270 new cases of melanoma (American Cancer Society, 2018).

Basal cell carcinoma (BCC) is the most common type of skin cancer and cancer diagnosed. BCCs arise in the skins’ outermost layers. BCCs resemble open sores, red or pink plaques, pearly nodules with telangiectasia, or scars. It is estimated that 4.3 million BCCs are diagnosed in the U.S. every year (Skin Cancer Foundation, 2018).

Squamous cell carcinoma (SCC), the second most common type of skin cancer, arises from the squamous cells in the skin that have been exposed to UV over long periods of time. SCCs appear as scaly red or pink macules, papules, or plaques. They can be crusted and appear eroded and can commonly arise within a solar keratosis. More than 1 million cases of SCC are diagnosed in the U.S. every year (Skin Cancer Foundation, 2018).

Lastly, actinic keratoses (AKs) are the most common pre-cancerous skin growth that can develop into a SCC if left untreated. Similar to all other types, AKs are caused by exposure to UV light and, in rare cases, high exposures to x-rays. AKs can appear on sun-exposed areas, including the face, scalp, ears, shoulders, and legs. They resemble pink, scaly rough patches on the skin.

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What are the Patient Preferences that Determine Chose of Bariatric Surgery?

MedicalResearch.com Interview with:

Michael Rozier, S.J., Ph.D. Assistant Professor, Health Management and Policy College for Public Health and Social Justice St. Louis University

Dr. Rozier

Michael Rozier, S.J., Ph.D.
Assistant Professor, Health Management and Policy
College for Public Health and Social Justice
St. Louis University

MedicalResearch.com: What is the background for this study?

Response: Patients considering surgery for weight loss have several options, which differ in significant ways, such as expected weight loss, risk of complication, modification of diet, effect on other medical conditions, and more. Previous studies have asked patients why they chose one procedure over another.

Instead, we quantified the relative importance of the key characteristics of surgical options. Using a discrete choice experiment, potential patients were given profiles of two weight loss options. They were asked to select one profile based on key characteristics such as out-of-pocket costs, total weight loss, risk of complication, and five other factors.

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Advanced Prostate Cancer: Risk of Mortality with Surgery vs Radiotherapy

MedicalResearch.com Interview with:

Anthony Victor D'Amico, MD, PhD Professor and Chief, Genitourinary Radiation Oncology Harvard Medical School

Dr. D’Amico

Anthony Victor D’Amico, MD, PhD
Professor and Chief,
Genitourinary Radiation Oncology
Harvard Medical School

MedicalResearch.com: What is the background for this study?

Response: This study investigated whether surgery followed by the use of adjuvant low dose radiation and short course hormonal therapy as compared to high dose radiation and hormonal therapy could provide an equivalent low risk of death from prostate cancer amongst men presenting with aggressive and not infrequently fatal Gleason score 9 or 10 prostate cancer.

It has been shown previously (https://jamanetwork.com/journals/jama/fullarticle/2673969) and validated in the current study that surgery alone in such cases leads to a more then 2.5-fold increase in the risk of death from prostate cancer as compared to high dose radiation and hormonal therapy.  Continue reading

Who Does Better After Bariatric Surgery?

MedicalResearch.com Interview with:

Alison E. Field, ScD Professor and Chair of Epidemiology Brown University School of Public Heath Providence, RI

Dr. Field

Alison E. Field, ScD
Professor and Chair of Epidemiology
Brown University School of Public Heath
Providence, RI

MedicalResearch.com: What is the background for this study?  

Response: In the United States, approximately 40% of adults are obese. There are a range of treatment options, but relatively few people are able to lose weight and maintain the loss. The most effective treatment is bariatric surgery, but even among patients who have undergone bariatric surgery, there is a range in weight change patterns after surgery. This suggests that not all people with obesity are similar. There may be different causes and optimal treatment plans that vary by obesity subgroup. Our goal was to identify subgroups and to examine if they differed in terms of weight loss after bariatric surgery.

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Racial and Gender Disparities in CABG Surgery After First Heart Attack

MedicalResearch.com Interview with:

MedicalResearch.com Interview with: Dr. Srikanth Yandrapalli New York Medical College NYMC · Cardiology

Dr. Yandrapalli

Dr. Srikanth Yandrapalli
New York Medical College
NYMC · Cardiology

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Selection of coronary artery bypass grafting over percutaneous coronary intervention during an acute myocardial infarction is influenced by the extent of coronary artery disease and patient comorbidities. Prior studies have shown sex and racial differences in coronary artery diseaseburden.

We sought to identify if there are any sex and racial differences in the utilization of  coronary artery bypass grafting over percutaneous coronary intervention during a revascularized first  acute myocardial infarction in the US.

We found that males had a higher coronary artery bypass grafting rate than women, and compared to Whites, Blacks had lower coronary artery bypass grafting rate and Asians had higher coronary artery bypass grafting at the time of a first myocardial infarction.

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For Most Patients, Tennis Elbow is Self-Limiting

MedicalResearch.com Interview with:

Amin Mohamadi, MD, MPH Research Fellow Harvard Medical School Center for Advanced Orthopaedic Studies Beth Israel Deaconess Medical Center Boston, MA 02215

Dr. Mohamadi

Amin Mohamadi, MD, MPH
Research Fellow
Harvard Medical School
Center for Advanced Orthopaedic Studies
Beth Israel Deaconess Medical Center
Boston, MA 02215 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response:  “Tennis elbow” is a painful conditions caused by overuse of the tendons in the forearm, typically in a patient’s dominant arm. Overuses syndromes are resulted from repetitive stress injury without signs of inflammation. Tennis elbow afflicts more than 200,000 new patients in the United States every year, which is not only limited to athletes, but also laborers, food industry workers, manufacturers and office workers – anyone who uses the hands and wrists for hours each day. In addition, many clinicians and scientists believe that tennis elbow is a self-limited condition in which, the majority of patients will be symptom-free after a period of time. However, no meta-analysis has evaluated this notion.

Numerous treatments are available for patients to alleviate their pain and restore their pain-free grip strength but few high quality trials and meta-analyses have compared these treatments. In this largest meta-analysis to date, we compared results of 11 different treatment modalities evaluated in 36 randomized to identify if any of these treatments are more effective and safer than the others. Overall,  2746 patients were evaluated in our meta-analysis and we found that all of the evaluated treatments only showed a modest effect, at best , on pain relief and strength of grip. While there was only modest effect for some treatments, all of interventions increased risk of adverse events in comparison with placebo and none of them seemed to be safer than others.

In the next step we were curious to find out what will be outcome of patients who were treated with only placebo, a pill or injection without effective medication or sham treatment— when the therapeutic device was not turned on. Interestingly, we found that across all of clinical trials,  totally 92% of patients experienced substantial pain relief after a month of receiving only placebo or sham treatment. 

MedicalResearch.com: What should readers take away from your report?

Response: Our results imply that for most patients, tennis elbow is a self-limiting condition.  Based on this analysis, our overall recommendation is “wait and see”. However, for some groups “wait and see” may not be a feasible option, so we recommend for these groups an intervention that is most effective in short-term. Because almost all patients reported only minimal pain after the first four weeks, clinicians treating patients with tennis elbow may consider opting for a pain relief regimen to manage symptoms on a patient-to-patient basis. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Future research should investigate the outcome rest in comparison with those who continued their actives with same intensity. There are also some evidence showing particular exercises may be beneficial and finally future research can identify if any particular patients group are at higher risk for none pain resolutions.  

MedicalResearch.com: Is there anything else you would like to add?

Response: We evaluated almost all of the non-surgical treatments available for tennis elbow and showed that they provide only minimal effect over placebo. For example corticosteroids were more effective than placebo within the first 4 weeks but this effect was transient and did not seem to be effective after 4 weeks. In addition, 47 patients would be needed to get corticosteroid injections so that only 1 less patient suffer from pain compared with those who received placebo.

Citation:

Jayson Lian, Amin Mohamadi, Jimmy J. Chan, Phillip Hanna, David Hemmati, Aron Lechtig, Ara Nazarian. Comparative Efficacy and Safety of Nonsurgical Treatment Options for Enthesopathy of the Extensor Carpi Radialis Brevis: A Systematic Review and Meta-analysis of Randomized Placebo-Controlled Trials. The American Journal of Sports Medicine, 2018; 036354651880191 DOI: 10.1177/0363546518801914 

Nov 7, 2018 @ 9:28 pm

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

Most Surgical Patients Only Use About 25% Of Their Prescribed Opioids

MedicalResearch.com Interview with:
Joceline Vu, MD

Resident, PGY-5
Department of Surgery
University of Michigan 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: This study examined how much opioid patients use after surgery, and looked at factors that might predispose some patients to use more or less.

Patient opioid use after surgery is an interesting question that’s gained a lot of attention recently, because it’s different from other uses for opioids. If you have chronic pain, you’re probably going to use all of your prescription. But if you have surgery, you may not take all of your pills, and this leaves people with leftover pills that can be dangerous later.

From this study, we found that patients only use, on average, about quarter of their prescription, meaning that a lot of them are left with leftover pills. Moreover, we found that the biggest determinant of how much they used wasn’t how much pain they reported, or any other factor—it was how big their original prescription was.

What this means is that opioid use after surgery isn’t just determined by pain, but also by what surgeons prescribe. It’s important to keep this in mind as we try to reduce unnecessary opioid prescribing after surgical procedures.  Continue reading

Atrial Fibrillation after Percutaneous Foramen Ovale Closure

MedicalResearch.com Interview with:

Akram Elgendy MD Division of Cardiovascular Medicine University of Florida  

Dr. Elgendy

Akram Elgendy MD
Division of Cardiovascular Medicine
University of Florida  

MedicalResearch.com: What is the background for this study?

Response: Recent clinical trials have demonstrated that percutaneous patent foramen ovale closure is associated with lower risk of stroke recurrence in cryptogenic stroke patients. However, new-onset atrial fibrillation (AF) has been reported as a safety concern. To better understand the risk of new-onset AF, we performed a meta-analysis of PFO closure trials in patients with cryptogenic stroke and migraine.

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Why Are Children Not Receiving Adequate Treatment For Obesity?

MedicalResearch.com Interview with:
Dr. Janey Pratt, MD Clinical Associate Professor, Surgery Stanford UniversityDr. Janey Pratt, MD
Clinical Associate Professor, Surgery
Stanford University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In 2013 obesity became recognized as a disease.  The rate of pediatric obesity continues to rise.  Severe pediatric obesity is rising at a even faster rate than obesity in pediatrics.  Despite this Metabolic and Bariatric Surgery (MBS) remains underutilized in the treatment of severe pediatric obesity.  There is a significant amount of adult data and now pediatric data about effective treatments for severe obesity.  These support the use of MBS as a primary treatment for severe obesity in children. (BMI > 120% of 95th percentile with a comorbidity or BMI > 140% of 95th percentile).

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Mild Cognitive Decline 2-6 Months After Heart Valve Surgery

MedicalResearch.com Interview with

Mark Oldham, M.D. Assistant Professor of Psychiatry Medical Director, PRIME Medicine Proactive Integration of Mental Health Care in Medicine University of Rochester Medical Center

Dr. Oldham

Mark Oldham, M.D.
Assistant Professor of Psychiatry
Medical Director, PRIME Medicine
Proactive Integration of Mental Health Care in Medicine
University of Rochester Medical Center

MedicalResearch.com: What is the background for this study?

Response: Patients who have undergone coronary artery bypass graft (CABG) surgery and, specifically, those who have been placed on cardiopulmonary bypass (CPB) have received attention for the potential effects of such procedures on brain health. Heart valve surgery patients have received far less attention, which often leaves clinicians to extrapolate the data from CABG cohorts to their patients preparing to undergo valve surgery. However, there are many reasons why this is far less than ideal, especially as the CABG literature increasingly points to person- and procedure-specific factors as the determinants of postoperative cognitive outcomes.

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In Non-Locking Meniscal Knee Tears, Physical Therapy May Be As Good As Surgery

MedicalResearch.com Interview with:
"Meniscus adalah tisu/rawan berbentuk huruf C yang berfungsi mencegah dua tulang bergesel di antara satu sama lain di bahagian lutut. Tisu meniscus yang koyak berpunca kebiasaannya daripada bersukan yang melibatkan pergerakan lutut yang banyak. Warga emas" by Rawatan Alternatif Shah Alam is licensed under CC BY 2.0
Victor A. van de Graaf, MD
OLVG Ziekenhuis
Amsterdam

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Although meniscal surgeries are among the most frequently performed surgical procedures in orthopedic surgery, until just recently there were hardly any randomized trials proving its superiority over conservative treatment.

In this randomized clinical trial, including 321 patients with non-obstructive (e.g. no locking of the knee joint) meniscal tears, we found physical therapy non-inferior to arthroscopic partial meniscectomy. 

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Two Studies Evaluate OviTex Reinforced BioScaffolds for Hernia and Soft Tissue Repair

MedicalResearch.com Interview with:

Maarten Persenaire, MD Co-founder, Chief Medical Officer TELA Bio

Dr. Persenaire

Maarten Persenaire, MD
Co-founder, Chief Medical Officer
TELA Bio

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: OviTex Reinforced BioScaffolds (RBSs) are a novel distinct class of surgical implants that combine biologic and synthetic materials in a unique embroidered construction and design for hernia repair and soft tissue reconstruction. The two recent publications reported clinical results of OviTex RBS performance in inguinal and hiatal hernia repair.

Case series published in the International Journal of Surgery Open evaluated the role of OviTex RBSs in inguinal hernia repair to reduce the incidence of chronic postoperative pain. Thirty-one consecutive patients who had inguinal hernia repaired with OviTex RBSs were followed for an average of 12.6 months, during which time there were no reported recurrences, complications requiring surgical intervention or infections. None of the patients reported postoperative inguinal pain beyond the first days after surgery and none required a narcotic pain medication refill.

The second study published in the Journal of the Society of Laparoendoscopic Surgeons is the first reported series describing the use of OviTex RBSs in hiatal hernia repair. A retrospective chart review of 25 consecutive patients undergoing laparoscopic or open hiatal hernia repairs with mean follow-up of 14.2 months showed no recurrences. The hiatal hernia repairs with OviTex RBSs resulted in good to excellent control and resolution of symptoms, including heartburn, dysphagia, regurgitation, nausea and vomiting, dyspnea, and chest pain or discomfort.  Continue reading

Factor in Quality of Life When Deciding Radiotherapy vs Surgery in Patients With Oropharyngeal Cancer

MedicalResearch.com Interview with:

Dr. David Sher MD MPH Radiation Oncology, Harold C. Simmons Comprehensive Cancer Center UTSouthwestern Medical Center Associate Senior Editor International Journal of Radiation Oncology

Dr. Sher

Dr. David Sher MD MPH
Radiation Oncology,
Harold C. Simmons Comprehensive Cancer Center
UTSouthwestern Medical Center
Associate Senior Editor International Journal of Radiation Oncology

MedicalResearch.com: What is the background for this study?

Response: The prevalence of oropharyngeal cancer is rising rapidly, and the two primary therapeutic approaches – upfront radiation therapy or surgery resection – have both been improving in terms of acute and late toxicity profiles. There is significant debate as to which therapy is better, and comparative data are necessary to help physicians and patients decide which paradigm is preferred for a given clinical scenario. Although there is a lot of anecdotal experience in comparing the two treatments, there really is a lack of published data on the question, and this is where our study fits in. 

MedicalResearch.com: What is the background for this study? Were there significant quality-of-life differences between the two treatment modalities?

Response: The main findings were comparable outcomes in long-term survival, toxicity and even cost between primary radiation therapy and primary surgery. This equivalence highlights the importance of patient-centered decision-making and engaging patient preferences in their optimal treatment approach. There was clearly an increase in stomach tube use in patients receiving primary chemoradiotherapy, which may be an important consideration in some patients, depending on the expected functional outcome of initial surgery. This difference became non-significant after a short period of time, but it was real and may influence decision-making.

MedicalResearch.com: What should readers take away from your report?

Response: Readers should take away that there are no particularly large differences between these treatments. Survival, toxicity and cost are all comparable in the long-run. It was quite clear, though, that primary surgery was associated with a lower risk of gastrostomy tube use. Although the difference in tube use was negligible within a few months, the use of any feeding tube may be a deciding factor for some patients. We showed here this difference was due to concurrent chemotherapy during radiotherapy. This result echoes our clinical experience, but we were able to show this finding quite clearly. On the other hand, we also found that the increased dependence with radiation therapy was clearly short-lived, so patients should absolutely not consider this difference as a long-term problem preferentially associated with radiotherapy.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: It is critical for future research to consider the functional and quality-of-life outcomes in future comparisons of these different treatment approaches. Claims-based analyses such as this can uniquely show the “big picture” with respect to complications that require a medical treatment. However, more granular and subtle patient-reported outcomes are not included in this study, and they will be essential to help patients and physicians in the decision-making process.   

The study was funded by the Radiation Oncology Institute.

Citation:

Sher DJ, Agiro A, Zhou S, Day AT, DeVries A. Commercial Claims–Based Comparison of Survival and Toxic Effects of Definitive Radiotherapy vs Primary Surgery in Patients With Oropharyngeal Squamous Cell Carcinoma. JAMA Otolaryngol Head Neck Surg. Published online September 20, 2018. doi:10.1001/jamaoto.2018.1929

Sep 21, 2018 @ 3:05 pm 

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

Why Do Surgical Mesh Products Fail?

MedicalResearch.com Interview with:

Polypropylene (PP) mesh is currently used in both hernia and pelvic organ prolapses - Wikipedia Image

Polypropylene (PP) mesh is currently used in both hernia and pelvic organ prolapses – Wikipedia Image

Professor David Taylor
Trinity Centre for Bioengineering
Trinity College Dublin
The University of Dublin, Ireland

MedicalResearch.com: What is the background for this study?

Response: The study was motivated by the emerging clinical problem of the failure of surgical mesh products used for transvaginal operations. Increasing numbers of women are experiencing the failure of mesh used to treated vaginal prolapse, urinary incontinence and other pelvic organ conditions.

I carried out a survey of all existing research, including medical case reports, meta studies of clinical outcomes and biomechanics research on the material, which is a knitted plastic mesh. A phenomenon known as “mesh erosion” causes damage to surrounding tissues and organs and can leave the person in severe and lasting pain.  Continue reading

Patients Most Often Receive Breast Cancer Diagnosis By Phone

MedicalResearch.com Interview with:

Dr. Emily Albright, MD Surgical Oncology Missouri University Health Care

Dr. Albright

Dr. Emily Albright, MD
Surgical Oncology
Missouri University Health Care

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Traditional medicine had a paternalistic approach but more recent changes have transitioned into shared decision making and a patient centered approach. However, current research has not addressed the mode of communicating bad news to patients.

This study was designed to look at trends in modes of communication of a breast cancer diagnosis. This study identified a trend for patients to receive a diagnosis of breast cancer over the telephone in more recent years. Also noted was that of those receiving the diagnosis in person 40% were alone.

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High Burden of Trauma and Avoidable Surgical Deaths in US Prisons

MedicalResearch.com Interview with:

Tanya L. Zakrison, MHSc MD FRCSC FACS MPH Associate Professor of Surgery University of Miami Miller School of Medicine

Dr. Zakrison

Tanya L. Zakrison, MHSc MD FRCSC FACS MPH
Associate Professor of Surgery
University of Miami Miller School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Over 2 million people in the United States are incarcerated, the highest rate in the entire world.  To date no national statistics on surgical outcomes have been reported in this vulnerable patient population.  We examined 301 medical examiner’s reports from prisoner deaths in Miami-Dade County.  Excluding those with confounding medical conditions such as cirrhosis and cancer, we still found that one in five deaths were being attributed to trauma and reversible surgical diseases.   

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Invasive Procedures For Chronic Pain Have Not Been Proven to Work

MedicalResearch.com Interview with:

Wayne B. Jonas, MD Clinical Professor of Family Medicine Uniformed Services University and at Georgetown University School of Medicine

Dr. Jonas

Wayne B. Jonas, MD
Clinical Professor of Family Medicine
Uniformed Services University and at
Georgetown University School of Medicine

MedicalResearch.com: What is the background for this study?

Response: The search for non-drug approaches to chronic pain is a major recommendation in many recent guidelines for both pain management and reduction in the use of opioids. Surgical and invasive procedures are non-drug approaches often used for pain conditions like back pain and arthritis, so good evidence is needed to determine the safety and efficacy of these procedures. Properly done randomized, placebo controlled trials are the best way (the gold standard) to get that evidence, so we did a thorough evaluation of such research, using standard systematic review and meta-analysis methods.

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Active Shooter Incidents Involving Semi-automatic Rifles More Deadly

MedicalResearch.com Interview with:

Adil Haider, MD, MPH, FACS Kessler Director for the Center for Surgery and Public Health Brigham and Women’s Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health Deputy Editor of JAMA Surgery

Dr. Haider

Adil Haider, MD, MPH, FACS
Kessler Director for the Center for Surgery and Public Health
Brigham and Women’s Hospital, Harvard Medical School, and
Harvard T.H. Chan School of Public Health
Deputy Editor of JAMA Surgery

MedicalResearch.com: What is the background for this study?

Response: Firearm-related mortality is a public health issue. However, in the US, due in part to lack of funding, there is not enough research to inform the debate about firearms.

The question our group sought to answer was to understand if the presence of a semi-automatic weapon increased the number of victims killed or hurt during an active shooter incident. We chose to focus on these incidents given the availability of an FBI database detailing these active shooter incidents based on a strict definition and the similarities between such incidents that make a comparison valid.

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Surgeons Likely Overprescribing Opioids After Rhinoplasty

MedicalResearch.com Interview with:

David A. Shaye, M.D., FACS Instructor in Otolaryngology Harvard Medical School 

Dr. Shaye

David A. Shaye, M.D., FACS
Instructor in Otolaryngology
Harvard Medical School 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Cosmetic and functional rhinoplasty (nasal surgery) is the most common procedure we perform and traditionally post operative pain medication includes opioids.

In light of the recent opioid epidemic, we wished to investigate if patients pain was being treated over-treated by surgeons.

Of 173 Rhinoplasties that we performed, the majority of patients received post operative opioid tablets (an average of 28 tablets).  However 11% of patients did not fill these prescriptions at all, and only 2 of the 178 patients required refills.

We believe patients experienced less pain than surgeons anticipated.

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Robotic Surgery More Expensive But May Not Have Better Outcomes Than Traditional Surgery

MedicalResearch.com Interview with:
A robotically assisted surgical system: WikipediaChris Childers, M.D.

Division of General Surgery
David Geffen School of Medicine at UCLA
10833 Le Conte Ave., CHS 72-247
Los Angeles, CA 90095

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The robotic surgical approach has gained significant traction in the U.S. market despite mixed opinions regarding its clinical benefit. A few recent randomized trials have suggested there may be no clinical benefit of the robotic approach for some surgical procedures over the more traditional open or laparoscopic (“minimally-invasive”) approaches.

Previous studies have also suggested the robotic approach is very expensive, but until our study, there was no benchmark for the true costs (to the hospital) of using the robotic platform.

Our study analyzed financial statements from the main supplier of robotic technology. We found that the use of robotic surgery has increased exponentially over the past decade from approximately 136 thousand procedures in 2008 to 877 thousand procedures in 2017. The majority of these procedures were performed in the United States. While most people think of the robotic approach in urologic and perhaps gynecologic surgery, the fastest growing segment has been general surgery, for procedures such as colorectal resections, hernia repairs and gallbladder removals. In total, over 3 billion dollars was spent by hospitals to acquire and use robotic platforms in 2017 with 2.3 billion dollars in the United States. This equates to nearly $3,600 per procedure performed.

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