surgery Tag
12 Aug Factors Identifying Risk of Poor Weight Loss After Bariatric Surgery Identified
MedicalResearch.com Interview with: [caption id="attachment_26834" align="alignleft" width="143"]
Dr. Michelle Lent[/caption]
Dr. Michelle R. Lent, PhD
Geisinger Obesity Institute
Geisinger Clinic
Danville, Pennsylvania
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: More than one-third of adults in the United States live with obesity. Currently, the most effective treatment for obesity is bariatric surgery. Bariatric surgery patients are expected to lose 30 to 40 percent of their body weight, but not all patients are able to lose this amount of weight and others experience weight regain. Why some patients succeed in weight loss over time, while others are less successful, remains unclear.
In this study, we evaluated over 200 patient characteristics in relation to long-term weight loss after bariatric surgery (7 years or longer), including gender, age and weight at the time of surgery, lab tests, medical conditions and medications, among others. We found that patients who used insulin, had a history of smoking, or used 12 or more medications before surgery lost the most weight, while patients with high cholesterol, older patients and patients with higher body mass indexes at the time of surgery lost the least amount of weight after surgery.
12 Aug New Onset Atrial Fibrillation Strongest Predictor of Stroke After TAVR
MedicalResearch.com Interview with: [caption id="attachment_21314" align="alignleft" width="120"]
Dr. Josep Rodés-Cabau[/caption]
Josep Rodés-Cabau, MD
Director, Catheterization and Interventional Laboratories
Quebec Heart and Lung Institute
Professor, Faculty of Medicine, Laval University
Quebec City, Quebec, Canada
MedicalResearch.com: What is the background for this study?
Response: Transcatheter aortic valve replacement (TAVR) is increasingly used in patients with severe aortic stenosis deemed at prohibitive or high surgical risk. Recently, a randomized trial demonstrated the non-inferiority of TAVR compared to surgical aortic valve replacement in intermediate risk patients for the outcome of death and disabling stroke at 2 years. Therefore, TAVR indications are likely to expand to younger and lower risk patients in the near future.
While the short-term (30-day) cerebrovascular event (CVE) rate post-TAVR has decreased over time, it remains the most dreadful complication of TAVR, and still occurs in 2% to 3% of patients. A few dedicated studies identified numerous predictors of CVE which mainly differ from one study to another. However, identifying the risk factors of CVE is of paramount relevance in clinical practice to implement preventive strategies, either instrumental (embolic protection devices) or pharmacological in high-risk patients. Thus, we performed a systematic review and meta-analysis using random-effect models to provide pooled estimates of sixteen (8 patient-related and 8 procedural-related) clinically-relevant predictors of CVE within 30 days post TAVR.
06 Aug IV Iron Administered Post-Op May Improve Surgical Outcomes
MedicalResearch.com Interview with: Clinical Professor Alhossain A.Khalafallah Menzies Institute for Medical Research, University of Tasmania, Australia Consultant Haematologist Senior Staff Specialist Launceston General Hospital, Australia MedicalResearch.com: What is the background for this study? Response: 1. Iron deficiency is one of the most common nutritional deficiencies worldwide, affecting up to one third of the population worldwide. 2. Prevalence of anaemia in orthopaedic surgery ranges between 10-20% with the main cause of anaemia identified as nutritional deficiency. 3. New intravenous iron preparations have been developed at a higher purchase price than oral iron. Iron carboxymaltose, as one example, remains underutilised in the treatment of perioperative anaemia. 4. To our knowledge, this study is the first to compare the efficacy, safety and long term effect on iron stores and length of hospital stay in the postoperative anaemia setting.05 Aug Early Hysterectomy With Preserved Ovaries Doubles Risk of Hot Flashes and Night Sweats
MedicalResearch.com Interview with: [caption id="attachment_26763" align="alignleft" width="208"]
Louise Wilson[/caption]
Louise Wilson PhD Candidate
The University of Queensland
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Hysterectomy remains one of the most common gynecological procedures worldwide, with rates highest among women aged between 40 and 50. Between 30 and 40% of women aged in their 40s and 50s experience hot flushes and night sweats (vasomotor symptoms) that can greatly impact upon their overall quality of life. There is consistent evidence that women who have a hysterectomy and both ovaries removed are more likely to report more frequent or severe vasomotor symptoms, probably due to the abrupt decline in estrogen levels post-surgery.
For women who have a hysterectomy with ovaries retained, the evidence is less clear. We wanted to increase our understanding of the symptom experiences of these women. We examined 17 years of data from more than 6,000 women in the Australian Longitudinal Study on Women’s Health. Approximately one in five of the women had a hysterectomy with ovarian conservation before the age of 50.
We found that a third of these women experienced hot flushes that persisted in the long term, and around one in five were afflicted by constant night sweats. These rates were double those of women who did not have a hysterectomy over the 17-year study period, and could not be explained by differences in lifestyle or socio-economic factors.
05 Aug Suturing With Thicker Thread To Prevent Preterm Delivery Increases Risk of Miscarriage
MedicalResearch.com Interview with: [caption id="attachment_26708" align="alignleft" width="149"]
Dr. David Macintyre[/caption]
Dr David A MacIntyre
MRC Career Development Fellow
Lecturer in Reproductive Systems Medicine
Institute of Reproductive and Developmental Biology
Department of Surgery and Cancer
Imperial College
London UK
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Preterm birth is the leading cause of death in children under 5 years of age. One of the first things that can happen to a women before suffering a preterm birth is early opening of the cervix, which is the neck of the womb. This also puts her and the baby at risk of infection. One of the few preventative treatments available for these women is a cervical cerclage. This is when a surgeon uses one of two types of suture thread to stitch the cervix closed. This provides mechanical support to the pregnancy and is thought to help prevent infections from ascending from the vaginal into the uterus. One type of suture thread used is thin, monofilament nylon, which appears similar to fishing line. The other is a thicker thread - around 5mm thick - that is comprised of smaller threads woven together like a shoe lace. The thicker woven thread - called multifilament - is used in around 80 per cent of procedures as surgeons believe it to be stronger, and more efficient at holding the cervix closed. In this study, we first looked at 671 women who had the procedure at five UK hospitals over the last ten years. Around half had the thinner 'fishing line' thread, while the other half had the thicker 'shoe lace' thread.
The results revealed the thicker thread was associated with increased rate of intrauterine death compared to the thinner thread (15 per cent compared 5 per cent). The rate of intrauterine death in a normal pregnancy is around 0.5%. The thicker tape was also associated with an increased preterm birth rate compared to the thinner tape - 28 per cent compared to 17 per cent. The rate of preterm birth among the general population is around 7 per cent, but the cervical stitch procedure is only performed on women already deemed at high risk of premature birth. We then conducted a second study with 50 women who were due to have the cervical stitch procedure. Half received the thinner thread, while half received the thicker thread. We monitored the women at 4, 8 and 16 weeks after the procedure through ultrasound scans and analysis of bacteria in their reproductive tract. The results suggested that women who received the thicker thread had increased inflammation around the cervix. There was also increased blood flow, which is associated with the cervix opening before labour. Crucially, we also found that women who received the thicker thread had more potentially harmful bacteria in the vagina and around the cervix.
28 Jul Safety-Net Hospitals Can Reduce Costs By Shifting Complex Surgery Patients to Other Hospitals
Posted at 01:01h
in Author Interviews, Cost of Health Care, Health Care Systems, JAMA, Surgical Research
MedicalResearch.com Interview with:
[caption id="attachment_26484" align="alignleft" width="160"]
Dr. Richard Hoehn[/caption]
Richard Hoehn, MD
Resident in General Surgery
College of Medicine
University of Cincinnati
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: A recent study from our research group (Hoehn et al, JAMA Surgery, 2015) found that safety-net hospitals perform complex surgery with higher costs compared to other hospitals, and that these higher costs are potentially due to intrinsic differences in hospital performance.
In this analysis, we decided to simulate different policy initiatives that attempt to reduce costs at safety-net hospitals. Using a decision analytic model, we analyzed pancreaticoduodenectomy performed at academic hospitals in the US and tried to reduce costs at safety-net hospitals by either
1) reducing their mortality,
2) reducing their patients’ comorbidities and complications, or
3) sending their patients to non-safety-net hospitals for their surgery.
While reducing mortality had a negligible impact on cost and reducing comorbidities/complications had a noticeable impact on cost, far and away the most successful way to reduce costs at safety-net hospitals, based on our model, was to send patients away from safety-net hospitals for their pancreaticoduodenectomy.
27 Jul No Difference in Outcomes at 12 Weeks With Robotic vs Open Prostate Surgery
MedicalResearch.com Interview with: [caption id="attachment_26533" align="alignleft" width="139"]
Prof. Robert Gardiner[/caption]
Prof Robert A Gardiner AM
The University of Queensland Centre for Clinical Research
Royal Brisbane & Women’s Hospital, Herston
Brisbane,Australia
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We wanted to determine whether one approach gave better results than the other at 12 weeks and 24 months after surgery with respect to the quality of life outcomes of urinary, sexual and bowel function and return to usual activities as well as oncological outcomes.
There was no significant statistical difference between the robotic and open surgical approach for these parameters at the early time-point of 12 weeks follow-up.
27 Jul Rubber Band vs Artery Ligation Surgery for Hemorrhoids Compared
MedicalResearch.com Interview with: [caption id="attachment_26515" align="alignleft" width="200"]
Mr. Steven Brown[/caption]
Mr Steven Brown MBChB, BMedSci,
FRCS, MD
Reader in Surgery
Honorary Secretary to the ACPGBI
Consultant colorectal surgeon
University of Sheffield, UK
MedicalResearch.com: What is the background for this study?
Response: Haemorrhoids are common. One in 4 of us will at some time have symptoms that can be directly attributed to piles. Whilst most symptoms will settle spontaneously or with improvement to our lifestyle, there remains a large group of patients who require intervention to reduce symptomatology. Numerous interventions exist ranging from relatively minor office therapy to procedures that may take several weeks to recover from. Haemorrhoidal artery ligation (HAL) is one of the more recent surgical operations for haemorrhoidal therapy. It has been introduced certainly into the UK associated with a significant element of media hype purporting ‘painless surgery for piles’. Substantial subsequent medical literature has also suggested an efficacy rivaling other more invasive procedures. Too good to be true? Perhaps. Several systematic reviews have highlighted the lack of good quality data as evidence for the advantages of the technique. A well designed randomized controlled trial was required.
The existing literature on haemorrhoidal artery ligation at the time of the trial suggested the procedure was most effective for less symptomatic haemorrhoids (those that are associated with bleeding and/or minor prolapse; grade II or mild III piles). These type of haemorrhoids also tend to be the most common requiring intervention. The most frequently used alternative procedure for these grade of haemorrhoids in the UK is rubber band ligation (RBL), a simple office therapy not requiring anaesthetic. Hence participants with this grade of haemorrhoids were chosen as the participants with RBL as the comparator. Multiple outcomes were investigated but a patient reported outcome measure of recurrence was chosen as the primary outcome.
25 Jul More Trauma Centers Can Reduce Quality By Decreasing Volume of Patients
MedicalResearch.com Interview with: [caption id="attachment_26463" align="alignleft" width="100"]
Dr. Joshua Brown[/caption]
Joshua Brown, M.D., M.S., research fellow
Division of Trauma and General Surgery
University of Pittsburgh School of Medicine
MedicalResearch.com: What is the background for this study?
Response: A trauma center is a hospital equipped to immediately provide specialized care to patients suffering from major traumatic injuries, such as falls, car crashes, burns or shootings. In the U.S., the American College of Surgeons sets criteria and conducts reviews for trauma center validation, and the individual states ultimately grant trauma center designation. In Pennsylvania, trauma centers are granted “Level” designations based on their capabilities, ranging from Level-I (highest) to Level-IV (lowest).
We examined records of nearly 840,000 seriously injured patients seen at 287 trauma centers between 2000 and 2012. The centers averaged 247 severely injured patients per year, and 90 percent of the cases involved blunt injury. We compared the expected death rate for each center if everything involving each trauma patient’s care had gone perfectly to the center’s actual death rate.
22 Jul Kaiser Study Reports Clustering of Basal Cell Skin Cancers in Northern California
MedicalResearch.com Interview with: G. Thomas (Tom) Ray Division of Research, Kaiser Permanente 2000 Broadway Oakland, CA 94612-2304 MedicalResearch.com: What is the background for this study? [caption id="attachment_18144" align="alignleft" width="158"]
Basal cell skin cancer[/caption]
Response: Basal cell carcinoma (BCC) is the most common cancer in the United States. BCCs tend to develop on sun-exposed areas such as the head and neck and are typically treated with various surgical techniques in an outpatient setting. Although BCCs are rarely fatal, they have been estimated to be among the most costly cancers in the Medicare population due to their high incidence. Yet because these cancers are not tracked by national registries the way, for example, melanoma is, basal cell carcinomas have been difficult to study. Incidence rates in the past have tended to rely on surveys such as those by the National Cancer Institute. And studies using disease codes have, until recently, been difficult because the codes used for basal cell carcinoma and squamous cell carcinoma were the same.
Since 1997, Kaiser Permanente Northern California (KPNC) has had computerized pathology results that allowed us to develop an internal registry of BCC cancers. In addition to having detailed information about basal cell cancer patients, we also had detailed information on the underlying population - KPNC members – which allowed us to determine incidence rates of BCC by age, sex, and most importantly for this study, by geographic location. This is because we know the residential location of all KPNC members at any given time – both those that get basal cell cancer and those who do not. This combination of a validated BCC registry with a well-defined population at-risk gave us the unique ability to investigate the spatial distribution of BCC in Northern California and assess whether there existed geographic clustering of basal cell cancers. Although the investigation of spatial clustering of other cancers is fairly common, no such analyses have been performed for basal cell cancer in the United States.
15 Jul Animal Study Shows Gastric Bypass Surgery May Reverse Diabetes
MedicalResearch.com Interview with: Xiang Gao, PhD State Key Laboratory of Pharmaceutical Biotechnology and MOE Key Laboratory of Model Animal for Disease Study Model Animal Research Center Nanjing Biomedical Research Institute and the Collaborative Innovation Center of Genetics and Development Nanjing University MedicalResearch.com: What is the background for this study? Response: Duodenum-jejunum gastric bypass (DJB) surgery has been used to treat morbid diabetic patients. However, neither the suitability among patients nor the mechanisms of this surgical treatment is well understood. Our research is based on a new mouse strain named Timo as type 2 diabetes model caused by brain-derived neurotrophic factor (Bdnf) deficiency. We hope to figure out whether DJB surgery can reverse the metabolic defects in this type of diabetes. If yes, what is the possible mechanisms. MedicalResearch.com: What are the main findings? Response: Our research showed that duodenum-jejunum gastric bypass surgery could cure diabetes of genetic (mutation) origin. We also showed that the alteration of gut microflora abundance and improved metabolism preceded the inflammation alleviation and BDNF protein levels increase after DJB surgery.15 Jul After Inpatient Surgery, Over Half Adults Experience Some Loss of Independence
MedicalResearch.com Interview with: [caption id="attachment_26055" align="alignleft" width="120"]
Dr. Julia Berian,[/caption]
Julia Berian, MD, MS
ACS Clinical Research Scholar
American College of Surgeons
Chicago, IL 60611
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The US population is rapidly aging and older adults consume a disproportionate share of operations. Older adults experience a high rate of postoperative complications, which can affect quality of life. In this study, function, mobility and living situation are considered together as independent living. The study examined a large surgical database for the occurrence of loss of independence (defined as a decline in function or mobility, or increased care needs in one's living situation) and its relationship to traditional outcomes such as readmission and death after the time of discharge. Patients included in the study were age 65 or older and underwent an inpatient surgical operation. Loss of independence was assessed at the time of discharge. Readmission and death-after-discharge were assessed up to 30 days postoperatively.
05 Jul Despite Variety of Products and Techniques, Surgeons Still Searching For Ideal Mesh For Hernia Repair
MedicalResearch.com Interview with: [caption id="attachment_25851" align="alignleft" width="200"]
Dr. Stephen Ferzoco[/caption]
Stephen Ferzoco, MD, FACS
Chief of General Surgery
Atrius Health in Boston
MedicalResearch.com Editor's Note: Dr. Stephen Ferzoco, a prominent active, academic surgeon, discusses the complexities of surgery for hernia repair.
MedicalResearch.com: What is the background for this surgery? How many patients are affected by clinically significant hernias?
Response: A hernia is a common condition where soft tissue breaches a weak spot in the abdominal wall. Hernias can affect the abdomen (ventral) or the groin (inguinal). In the U.S. there are about 350,000 ventral hernia procedures each year; these hernia patients present a range of complexity to the surgeon, with some of these procedures being among the most difficult cases for surgeons to manage. Inguinal hernias are even more common, with about 750,000 total procedures performed in the U.S. each year.
24 Jun Breast Cancer Surgery Can Be Improved By Turning Patient Over For MRI
Posted at 15:29h
in Author Interviews, Breast Cancer, Brigham & Women's - Harvard, MRI, Surgical Research
MedicalResearch.com Interview with:
[caption id="attachment_25507" align="alignleft" width="120"]
Dr. Eva Gombos[/caption]
Eva C. Gombos, MD
Assistant Professor, Radiology
Harvard Medical School
Brigham and Women’s Hospital
MedicalResearch.com: What is the background for this study?
Response: Treatment of early stage breast cancer, breast-conserving therapy (BCT), which consists of lumpectomy followed by whole-breast irradiation, requires re-excision 20 %–40% of patients due to positive margins.
Breast MR is the imaging modality with the highest sensitivity to detect breast cancer. However, patients who undergo breast MR imaging have not experienced reduced re-excision or improved survival rates.
Our hypothesis is that supine (performed with patient lying on her back) MR imaging within the operating room can be used to plan the extent of resection, to detect residual tumor immediately after the first attempt at definitive surgery, and to provide feedback to the surgeon within the surgical suite. The aim of this study was to use intraoperative supine MR imaging to quantify breast tumor deformation and displacement secondary to the change in patient positioning from imaging (prone performed the patient lying on her stomach) to surgery (supine) and to evaluate the residual tumor immediately after BCT.
23 Jun Patients With a Normal EKG after TAVI Rarely Require a New Pacemaker
MedicalResearch.com Interview with: Dr. Stefan Toggweiler, MD Heart Center, Luzerner Kantonsspital Lucerne, Switzerland MedicalResearch.com: What is the background for this study? Response: Transcatheter aortic valve replacement (TAVR) is increasingly used for the treatment of aortic stenosis in inoperable and high-risk patients. It is well known that TAVR is associated with acute and delayed occurrence of conduction disorders. Namely, delayed high-degree atrioventrcular block is a feared complication. Thus, patients are usually monitored by telemetry for a few days, but there is currently no consensus on the duration of telemetry. In this study, we evaluated how the postprocedural ECG determines the need for permanent pacemaker implantation in patients undergoing TAVR.23 Jun Patients More Likely to Trust Physicians Who Disclose Bias
MedicalResearch.com Interview with: [caption id="attachment_25468" align="alignleft" width="152"]
Dr. Sunita Sah[/caption]
Sunita Sah MD PhD
Management & Organizations
Johnson Graduate School of Management
Cornell University
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Sah: Physicians often recommend the treatment they specialize in, e.g., surgeons are more likely to recommend surgery than non-surgeons. Results from an observational study and a randomized controlled laboratory experiment found that when physicians revealed their bias toward their own specialty, patients were more likely to report increased trust in the physician’s expertise and take the treatment in accordance with the physician’s specialty.
07 Jun Transfemoral TAVI More Beneficial than Surgery For Some With Aortic Stenosis
MedicalResearch.com Interview with: [caption id="attachment_25005" align="alignleft" width="100"]
Dr. Giovanni Esposito[/caption]
Giovanni Esposito MD, PhD
Associate Professor of Cardiology
Department of Advanced Biomedical Sciences
Federico II University, Naples
Napoli - Italy and
Giuseppe Gargiulo, MD
PhD Student
Federico II University of Naples, ItalyMedicalResearch.com: What is the background for this study? What are the main findings? Dr. Esposito: Aortic stenosis (AS) is the most frequent type of valvular heart disease in Europe and North America. As soon as symptoms occur, the prognosis of severe AS is poor, with majority of patients dying within 2 to 5 years. Unfortunately medical therapy of AS has no significant effects on patient survival, therefore the only treatment able to improve patient prognosis is valve replacement. Until 2002, the only treatment strategy was the surgical aortic valve replacement (SAVR). SAVR requires an open-heart procedure and cannot be offered to all patients with AS due to their advanced age and presence of comorbidities that make them inoperable or at high-risk for surgery. In the last decade, the less invasive percutaneous approach called transcatheter aortic valve implantation (TAVI) has demonstrated to be a valid alternative to SAVR for those patients deemed inoperable or at high risk for SAVR. After the first percutaneous intervention performed by Alain Cribier in 2002, TAVI has rapidly accumulated growing interest and enthusiasm that led to the first PARTNER trial guiding current guideline recommendations. Both American and European guidelines recommend to perform TAVI in all patients judged inoperable, and to consider TAVI as an alternative in high-risk patients, but with a Class IIb and a preference to SAVR. However, scientific evidence on TAVI exploded in the last few years, the guidelines cited are outdated (2014 and 2012 respectively), we have today 5 randomized trials and many other observational studies including patients with different pre-procedural risk (i.e lo-to-intermediate and high-risk), as well as long-term results of prior studies (i.e. 5-year follow-up of the PARTNER trial and 3-year of the US CoreValve trial), therefore we conducted a systematic review and meta-analysis comparing clinical outcomes, including short- and mid-term mortality, of adult patients with severe aortic stenosis undergoing either TAVI or SAVR with the aim to update this comparison and offer new perspectives.
07 Jun Coronary Catheterization Through Wrist Reduces Access Complications and Hospital Stay
Posted at 01:06h
in Author Interviews, Baylor University Medical Center Dallas, Heart Disease, Surgical Research
MedicalResearch.com Interview with:
[caption id="attachment_24971" align="alignleft" width="168"]
Dr. Jeffrey Schussler[/caption]
Jeffrey M. Schussler, MD, FACC, FSCAI, FSCCT, FACP
Baylor Scott & White Health Care System
Cardiology: Baylor University Medical Center, Dallas, Tx
Medical Director: CVICU Hamilton Heart and Vascular Hospital
Professor of Medicine: Texas A&M School of Medicine
MedicalResearch.com: What is the background for this study?
Dr. Schussler: For the past few years, there has been an increased interest in performing coronary catheterization through the wrist. This is a technique that has been done (with great success and low complication rate) in other countries for years, with adoption rates >90% in some places. The US has been slower to adopt performing catheterization from the wrist, but the rate of using this approach has grown tremendously in the last 5 years. While less than 5% of all interventions were done using radial access previously, it now appraches 30% nationally. This increased rate of adoption been spurred on by studies which have shown lower incidences of complications, as well as some mortality benefit, and in particular in those patients who are highest risk for complications.
04 Jun Listening To Music Reduces Anxiety During Awake Eye Surgery
MedicalResearch.com Interview with: Dr Gilles Guerrier Cochin University Hospital Paris, France MedicalResearch.com: What is the background for this study? Dr. Guerrier: Awake eye surgery is particularly stressful for patients. Music has long been known to reduce anxiety, minimise the need for sedatives, and make patients feel more at ease. The purpose of this pilot study was to evaluate the effect of music on anxiety in outpatients undergoing elective eye surgery under topical (local) anaesthesia. The music played was specifically composed to ease anxiety following strict criteria, including instrumental pieces only using a decreasing tempo and a progressive decrease in the number of instruments playing. Each patient was able to choose from a panel of 16 recorded music styles according to their own preferences, and listened through high quality headphones. There were various styles available, including jazz, flamenco, Cuban, classical and piano. The music was provided by MUSIC CARE, a Paris-based company that produces music aimed at preventing and managing pain, anxiety and depression.22 May Respiratory and Urinary Tract Infections Common in TAVR Patients
Posted at 11:39h
in Author Interviews, Heart Disease, Hospital Acquired, Infections, Surgical Research
MedicalResearch.com Interview with:
[caption id="attachment_24564" align="alignleft" width="180"]
Dr. Nombela Franco[/caption]
Luis Nombela-Franco, MD, PhD
Structural cardiology program.
Interventional Cardiology department.
Hospital Clínico San Carlos, Cardiovascular Institute
Madrid, Spain
(Dr. Nombela-Franco, has a special interest in interest on percutaneous treatment of structural heart disease and coronary interventions with special focus on chronic total occlusion)
MedicalResearch.com: What is the background for this study?
Dr. Nombela-Franco: In-hospital infections are one of the most common complications that may occur following medical and surgical admissions, significantly impacted length of hospital stay, costs and clinical outcomes. In addition, approximately one third of hospital-acquired infections are preventable.
Transcatheter aortic valve replacement (TAVR) is currently the standard of care for symptomatic patients with severe aortic stenosis deemed at high surgical risk or inoperable. Patients undergoing TAVR have several comorbidities and the invasive (although less invasive the surgical treatment) nature of the procedure and peri-operative care confers a high likelihood in-hospital infections in such patients. This study analyzed the incidence, predictive factors and impact of in-hospital infections in patients undergoing transcatheter aortic valve implantation.
21 May ACS Surgical Risk Calculator Reliably Guides Decision Making
MedicalResearch.com Interview with: [caption id="attachment_24528" align="alignleft" width="150"]
Dr. Mark Cohen[/caption]
Mark E. Cohen, PhD
Statistical Manager
Continuous Quality Improvement
Division of Research and Optimal Patient Care
American College of Surgeons
Chicago, IL
MedicalResearch.com: What is the background for this study?
Dr. Cohen: The ACS NSQIP Surgical Risk Calculator (built from 2.7 million patient records from nearly 600 hospitals) has been widely adopted as a decision aid and informed consent tool by surgeons and patients. Predictive accuracy can be assessed in terms of discrimination, calibration, and combined discrimination and calibration. In this study, we focused primarily on calibration. Calibration refers to the consistency of agreement between observed and predicted risk across the range of predicted risk. One would not want, for example, a model that dramatically overestimates risk for low-risk patients and underestimates risk for high-risk patients – this sort of systematic error, if of sufficient magnitude, would make a risk calculator unacceptable for clinical use. We also assessed the potential benefits of statistical recalibration using restricted cubic splines.
MedicalResearch.com: What are the main findings?
Dr. Cohen: Without recalibration, the Risk Calculator was shown to have excellent calibration, though there was, at times, a slight tendency for predicted risk to be overestimated for lowest- and highest-risk patients and underestimated for moderate-risk patients. After recalibration this distortion was eliminated.
05 May Oophorectomy Linked To Increased Risk of Colon Cancer
MedicalResearch.com Interview with: [caption id="attachment_24075" align="alignleft" width="144"]
Dr. Josefin Segelman[/caption]
Josefin Segelman MD, PhD
Senior consultant colorectal surgeon
Department of Molecular Medicine and Surgery
Karolinska Institutet
Ersta Hospital
Stockholm Sweden
MedicalResearch.com: What is the background for this study?
Dr. Segelman: Hormonal factors influence the development of colorectal cancer. Observational studies and clinical trials have reported a protective effect of hormone replacement therapy and oral contraceptives. Oophorectomy alters endogenous levels of sex hormones, but the effect on colorectal cancer risk is unclear. Removal of the ovaries alters levels of sex hormones in both pre- and postmenopausal women. In premenopausal women, bilateral oophorectomy is followed by surgical menopause as the endogenous estrogen levels drop. Both before and after natural menopause, bilateral oophorectomy promptly decreases endogenous androgen levels by half as the ovaries and adrenals are equally important for androgen production.
MedicalResearch.com: What are the main findings?
Dr. Segelman: The present nationwide cohort study explored the association between removal of the ovaries for benign indications and subsequent risk of colorectal cancer. Among 195 973 women who underwent the procedure from 1965 – 2011, there was a 30% increased risk of colorectal cancer compared with the general population. After adjustment for various factors, women who underwent bilateral oophorectomy had a higher risk of rectal cancer than those who had unilateral oophorectomy (HR 2.28, 95% CI 1.33-3.91).
04 May What Are There Fewer Women in Surgical Subspecialties?
MedicalResearch.com Interview with: [caption id="attachment_24030" align="alignleft" width="142"]
Dr. Alison Fecher[/caption]
Alison M. Fecher, MD
Assistant Professor of Surgery
Indiana University Health
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Fecher: It has long been known that female faculty are underrepresented in departments of surgery at U.S. medical schools. Our study wanted to identify obstacles women face in entering certain surgical subspecialties and in career advancement. We found that women are poorly represented in some of the most competitive subspecialties, including cardiothoracic and transplant surgery. We also found that women tend to advance more slowly up the career ladder, with many of them spending more years at the assistant professor level than their male counterparts. One reason for this may be that they tend to publish less peer-reviewed articles than male faculty; however, our results show that the publications of female faculty often has a greater impact on the field, as measured by citations and recentness of articles.
03 May Mount Sinai Dermatologist Discusses Surgery for Skin Cancer
MedicalResearch.com Interview with: [caption id="attachment_23672" align="alignleft" width="132"]
Dr. Desiree Ratner[/caption]
Desiree Ratner, MD
Director, Comprehensive Skin Cancer Program,
Mount Sinai Beth Israel and Professor of Dermatology
Icahn School of Medicine at Mount Sinai
MedicalResearch.com: How big is the problem of skin cancer in the US?
Dr. Ratner: Skin cancer is an enormous problem in the United States and the numbers are increasing every year. There are over 2 million cases of basal cell carcinoma per year, over 700,000 cases of squamous cell carcinoma per year, and over 140,000 cases of melanoma per year in the U.S. alone.
MedicalResearch.com: What type of patients do you evaluate and treat?
Dr. Ratner: My practice is limited to skin cancer, so most of my patients are referred to me by general dermatologists for surgery. I see patients who require Mohs surgery for non-melanoma skin cancers, excisions for non-melanoma skin cancers, and other surgical procedures for a variety of other benign and malignant lesions.
18 Apr No Consensus on Antibiotic Prophylaxis Prior To Pediatric Surgery
MedicalResearch.com Interview with: [caption id="attachment_23541" align="alignleft" width="120"]
Dr. Thomas Sandora[/caption]
Thomas J. Sandora, M.D., M.P.H.
Senior Associate Physician in Medicine; Hospital Epidemiologist; Medical Director, Infection Control
Boston Children’s Hospital
Associate Professor of Pediatrics, Harvard Medical School
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Sandora: Giving antibiotics before certain types of operations results in lower rates of surgical site infections. However, there are limited data about which pediatric operations require antibiotic prophylaxis. We examined national variability in antibiotic prophylaxis for the 45 most commonly performed pediatric operations at children's hospitals in the U.S. We found that antibiotic use was considered appropriate for only 64.6% of cases, with a high degree of variability within procedures and between hospitals.
14 Apr Adding Lumbar Fusion to Laminectomy Improves Long-Term Quality of Life
MedicalResearch.com Interview with: [caption id="attachment_23431" align="alignleft" width="138"]
Dr. Zoher Ghogawala[/caption]
Zoher Ghogawala MD FACS
Department of Neurosurgery
Lahey Hospital and Medical Center
Burlington, MA 01805
MedicalResearch.com: What is the background for this study?
Dr. Ghogawala: There is enormous practice variation around the utilization of lumbar spinal fusion in the United States and across the world. In the United States, lumbar spinal fusion utilization has increased to 465,000 hospital-based procedures in 2011 according to a report from the AHRQ (published in 2014). Spinal fusion accounts now for the highest aggregate hospital cost (12.8 billion dollars in 2011) of any surgical procedure performed in US hospitals. What is problematic is that there are no top tier studies that address the question of whether or not adding a lumbar spinal fusion when performing a simple decompression is necessary or helpful. The question is whether we perform too many fusions in the United States.
The SLIP study is the first class I study that demonstrates that the addition of a lumbar fusion when performing a lumbar laminectomy to decompress spinal nerves improves health-related quality of life for patients suffering from low back pain and sciatica from lumbar stenosis with spondylolisthesis - a very common cause of low back pain caused by nerve compression associated with one spinal bone being slightly out of alignment.
MedicalResearch.com: What are the main findings?
Dr. Ghogawala:
1) Adding a lumbar fusion when performing a lumbar laminectomy results in superior health-related quality of life at 2,3, and 4 years after surgery.
2) Patients with fusion obtained durable results but 14% required re-operation for problems adjacent to their fusion over the 4 year study period.
3) Lumbar laminectomy alone provided good results for 70% of patients. There was less blood loss and faster recovery for these patients. On the other hand, the outcomes were less durable. One in three patients who underwent a lumbar laminectomy alone required re-operation within 4 years because their back became unstable. These patients underwent fusion and their health-related quality of life improved.
12 Apr Surgical Site Infection Reduction Program Penalizes Major Teaching and Advanced Care Hospitals
Posted at 11:23h
in Author Interviews, Hospital Acquired, JAMA, Outcomes & Safety, Surgical Research
MedicalResearch.com Interview with:
[caption id="attachment_23379" align="alignleft" width="128"]
Dr. Christina Minami[/caption]
Christina A. Minami, MD
Surgical Outcomes and Quality Improvement Center
Department of Surgery, Feinberg School of Medicine,
Center for Healthcare Studies, Feinberg School of Medicine
Northwestern University, Chicago, Illinois
MedicalResearch.com: What is the background for this study?
Dr. Minami: An earlier study by our group demonstrated a seemingly paradoxical relationship between hospital quality and hospital penalization in the Hospital-Acquired Condition, or HAC, Reduction Program. Basically, of those hospitals that were penalized more frequently were those that were major teaching hospitals, had more quality accreditations, and had better performance on process and outcome measures. When CMS released that surgical-site infections were going to be added to the HAC scoring, we decided to see if these additional measures might exhibit the same paradoxical association between quality and penalization.
MedicalResearch.com: What are the main findings?
Dr. Minami: The SSI measures follow the same trend as was previously illustrated. Basically, the hospitals who were in the bottom 25% (that is, those who were the worst performers) were more often those that were major teaching hospitals, with more quality accreditations, and offered more advanced services. It’s possible that this is due in part to surveillance bias, or “the more you look, the more you find” phenomenon. Also, what do we really call an infection? The National Healthcare Safety Network has specific definitions and guidelines, but there are still different data collections used by different hospitals.
31 Mar Epidemic of Burnout Among Physicians, Especially Surgeons, Is Increasing
MedicalResearch.com Interview with: [caption id="attachment_23046" align="alignleft" width="144"] Dr. Francesca Dimou[/caption] Francesca M Dimou, MD Research Fellow University of Texas Medical Branch Galveston, TX MedicalResearch.com: What is the background for this study? Dr. Dimou: Burnout is a syndrome defined by emotional exhaustion, depersonalization, and a low sense of personal accomplishment. Over the past decade the problem of physician...
16 Mar Hospital Stays Provide Opportunity to Vaccinate High Risk Patients
Posted at 13:48h
in Annals Internal Medicine, Author Interviews, Flu - Influenza, Kaiser Permanente, Surgical Research, Vaccine Studies
MedicalResearch.com Interview with:
[caption id="attachment_22564" align="alignleft" width="142"]
Dr. Sarah Tartoff[/caption]
Sara Y. Tartof, PhD, MPH
Kaiser Permanente Southern California Department of Research & Evaluation
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Tartof: The flu is a highly contagious respiratory infection that can cause serious complications, hospitalizations and, in some cases, even death. Some people, such as older adults, young children and people with certain health conditions, are at high risk for serious complications. In addition to recommending annual flu vaccination for people 6 months of age and older, the Centers for Disease Control and Prevention recommends that hospitalized patients who are eligible receive the flu vaccine before discharge.
Historically, inpatient rates of vaccination have been low. There has been concern among surgeons that vaccinating patients while they are in the hospital can contribute to increased risk of vaccine-related fever or muscle pain, which might be incorrectly attributed to surgical complications. However, there have been no data to support that concern. The objective of this study was to provide clinical evidence that would either substantiate or refute concerns about the safety of perioperative vaccination.