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Mayo Clinic, Urology / 20.05.2014

MedicalResearch.com Interview with: Sarah P. Psutka, MD Fellow in Urologic Oncology Department of Urology, Mayo Clinic MedicalResearch: What are the main findings of each study?  Dr. Psutka: In this study, we analyzed 1335 patients who underwent radical cystectomy at the Mayo clinic between 1996 and 2006. We categorized patients who stayed in the hospital longer than 10 days, putting them in the top 25th percentile of the length of stay, as having a prolonged hospital stay. We noted that prolonged hospital stay was associated with adverse postoperative outcomes, including serious complications and early postoperative death. Patients who had a prolonged length of stay had a higher burden of comorbidities, American Society of Anesthesiologist score, and their Eastern Cooperative Oncology Group Score. A multivariable analysis, holding these factors and other clinically relevant potential confounders constant, revealed that only the ECOG performance score independently predicted whether or not a patient had a prolonged hospital course following radical cystectomy. (more…)
Author Interviews, Cancer Research, JAMA, Surgical Research / 10.05.2014

Dr. Carlo Riccardo Rossi, MD Melanoma and Sarcoma Unit, Veneto Institute of Oncology Surgery Branch, Department of Surgery Oncology, and Gastroenterology, University of Padova, Padova, ItalyMedicalResearch.com Interview with: Dr. Carlo Riccardo Rossi, MD Melanoma and Sarcoma Unit, Veneto Institute of Oncology Surgery Branch, Department of Surgery Oncology, and Gastroenterology, University of Padova, Padova, Italy MedicalResearch: What are the main findings of the study? Dr. Rossi: A total of 90% patients undergone lymph node dissection for melanoma had 12, 7, 14, 6 and 13 excised lymph nodes (10th percentile of the distribution) after 3 level axillary, 3 level or less neck, 4 level or more neck, inguinal, or ilio-inguinal dissections, respectively. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Mayo Clinic, Outcomes & Safety / 09.05.2014

MedicalResearch Interview with: Dr. David Cook MD Professor in the Department of Anesthesiology Division of Cardiovascular Anesthesiology Center for the Science of Health Care Delivery Mayo Clinic College of Medicine Rochester, Minnesota. MedicalResearch: What are the main findings of the study? Dr. Cook: The main finding of the study was that segmentation of a population of surgical patients into groups of higher and lower complexity allowed us to apply a standardized practice, focused factory model to surgical care delivery. A standardized care model improved care process measures such as time on mechanical ventilation or duration of a bladder catheter indwelling. The model reduced resource utilization, decreasing patient time in all care environments (operating room, ICU and on ?the floor?). The care model improved outcomes at 30 days and reduced the costs overall and in every care environment. In addition to the absolute improvements in quality and in cost, the standardized care model reduced variation in all measured variables. That reduction in variation may be even more important than the improved outcomes or reduced costs because we now know it is possible to make the health care experience predictable for these patients. That predictability is critically important to patients and providers, but it also has implications for health care metrics and payment models. (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 / 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…)
Author Interviews, Heart Disease, Kidney Disease / 06.04.2014

Judith Kooiman Department of Thrombosis and Hemostasis Leiden University Medical Center Leiden, The NetherlandsMedicalResearch.com Interview with: Judith Kooiman Department of Thrombosis and Hemostasis Leiden University Medical Center Leiden, The Netherlands   MedicalResearch.com: What are the main findings of the study? Dr. Kooiman: The main finding of our study is that trans radial PCI (TRI) is associated with a significantly lower risk of AKI compared with trans femoral PCI (TFI), after adjustment for confounding factors. (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, 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, Health Care Systems, Lancet, Nursing, University of Pennsylvania / 04.03.2014

Professor Linda H Aiken PhD, FAAN, FRCN, RN Claire M. Fagin Leadership Professor in Nursing, Professor of Sociology Director of the Center for Health Outcomes and Policy Research Center for Health Outcomes and Policy Research University of Pennsylvania School of NursingMedicalResearch.com Interview with: Professor Linda H Aiken PhD, FAAN, FRCN, RN Claire M. Fagin Leadership Professor in Nursing, Professor of Sociology Director of the Center for Health Outcomes and Policy Research Center for Health Outcomes and Policy Research University of Pennsylvania School of Nursing MedicalResearch.com: Austerity measures and health-system redesign to minimise hospital expenditures risk adversely affecting patient outcomes. Against that backdrop, can you start by letting us know the background of the study?  Prof. Aiken: European Surgical Outcomes Study in 28 countries showed higher than necessary deaths after surgery. A comparable study in the US showed that despite the nation spending hundreds of millions of dollars on improving patient safety, there were no improvements in adverse outcomes after surgery in US hospitals between 2000 and 2009.  Clearly it is time to consider new solutions to improving hospital care for surgical patients, who make up a large proportion of all hospital admissions.  Our study was designed to determine whether there are risks for patients of reducing hospital nurse staffing, and what, if any, are the benefits to patients of moving to a more educated nurse workforce. (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, 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, 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, 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…)
Author Interviews, Case Western, Cleveland Clinic, Cost of Health Care, Pain Research, Surgical Research / 30.08.2013

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. (more…)
Diabetes, Surgical Research / 30.08.2013

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. (more…)
Author Interviews, Clots - Coagulation, Surgical Research / 16.08.2013

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…)
Author Interviews, Frailty, Surgical Research / 09.07.2013

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. (more…)