Cold Steel: Canadian Journal of Surgery Podcast

This week we had the pleasure of speaking with Dr. Mark Hamilton on the podcast. Dr. Hamilton is a neurosurgeon at the Foothills Medical Centre in Calgary. Dr. Hamilton helped us walk through a number of neurosurgical issues that are pertinent to general surgeons, such as hydrocephalus, the role of craniectomy in traumatic brain injuries, and DVT prophylaxis in patients with traumatic brain injuries. 

As always, send your comments and feedback to [email protected].

Links:

1. Treatment of hydrocephalus. https://pubmed.ncbi.nlm.nih.gov/19410156/

2. RESCUE - ICP trial in NEJM. https://www.nejm.org/doi/full/10.1056/nejmoa1605215

3. ICP monitoring in TBI. https://www.nejm.org/doi/full/10.1056/nejmoa1207363

4.  Reducing the risks of proximal and distal shunt failure in adult hydrocephalus (the shout-Qi initiative). https://fluidsbarrierscns.biomedcentral.com/articles/10.1186/s12987-019-0156-3

Bio (https://hbi.ucalgary.ca/profiles/dr-mark-hamilton):

Dr. Hamilton graduated from McGill University Medical School in 1983. He did his Neurosurgery Residency at the University of Calgary and received his FRCSC in 1991. He did Fellowship training in cerebrovascular, skull base and Pediatric Neurosurgery at the Barrow Neurological Institute in Phoenix, Arizona and joined the University of Calgary Department of Clinical Neurosciences in 1994 where he is currently a Professor of Neurosurgery with additional appointments in the Department of Surgery and the Department of Pediatrics. He was the Chief of the Division of Pediatric Neurosurgery from 2002-2011 and is the current Director of the Adult Hydrocephalus Program. 

Dr. Hamilton established the University of Calgary Adult Hydrocephalus Program and started the University of Calgary Adult Hydrocephalus Clinic in 2008. Dr. Hamilton is the chair of the international Adult Hydrocephalus Clinical Research Network (AHCRN) which has eight clinical sites in three countries, President of the Hydrocephalus Society (International Society for Hydrocephalus and Cerebrospinal Fluid Disorders (ISHCSF)) and a member of the Board of Directors of the Hydrocephalus Association (HA) and the Medical Advisory Board (MAB) of HA and a member of the Board of Directors of Hydrocephalus Canada.. He was recently the Congress President for “Hydrocephalus 2015” the 7th annual meeting of the ISHCSF. Dr. Hamilton is a member of the Editorial Boards of The Journal of Neurosurgery, The Canadian Journal of Neurological Sciences, Fluids and Barriers of the CNS, and PLOS One. His main clinical and research interests are the diagnosis and management of hydrocephalus in adults.

We were lucky enough in June to interview a true Canadian icon, Dr. Liane Feldman (https://twitter.com/lianefeldman?s=20)! Dr. Feldman is the Chief of the Division of General Surgery at McGill University and the newest president of the Society of American Gastrointestinal and Endoscopic Surgeons or SAGES. We really wanted to try to understand – what does it mean to be a minimally invasive surgeon? Where does Dr. Feldman see SAGES going in the future? And finally, we discuss the work Dr. Feldman did to help create the Fundamental Use of Surgical Energy or FUSE program. The FUSE program is now a core part of North American surgery programs and helps residents to understand the actual mechanics of surgical energy devices – in other words, what exactly is the difference between blue and yellow on the bovie??? For all this and more, stay with us.

Links:

1. SAGES: https://www.sages.org/

2. SAGES twitter (bot!): https://twitter.com/SAGES_Updates?s=20

3. James IV Traveling Fellowship report: https://jamesivassociationsurgeons.com/report_liane_feldman_md.php

4. FUSE program: https://www.fuseprogram.org/

This week we were joined by THE Dr. Walt Biffl, of the Biffl score for blunt cerebrovascular injury. We picked Dr. Biffl’s brain  on what goes into generating good clinical guidelines. We then delve into his work on blunt cerebrovascular disease, and finally, on pancreatic trauma. As always, sends your questions, thoughts, and comments to [email protected]. 

Links:

1. A tribute to Ernest E. “Gene” Moore. https://wjes.biomedcentral.com/articles/10.1186/s13017-018-0206-1

2. Duodeno-pancreatic and extrahepatic biliary tree trauma: WSES-AAST guidelines. https://wjes.biomedcentral.com/articles/10.1186/s13017-019-0278-6

3. WTA guidelines. https://www.westerntrauma.org/western-trauma-association-algorithms/

4. Evidence-based medicine in trauma/acute care surgery- what does that look like? https://pubmed.ncbi.nlm.nih.gov/30274801/

5. Biffl scale on Radiopaedia. https://radiopaedia.org/articles/biffl-scale-for-blunt-cerebrovascular-injury

Dr. Christopher "Chip" Doig is an intensivist at the Foothills Medical Centre in Calgary, Alberta, Canada. We focused on a number of ethical issues in the ICU, from donation after cardiac death to the idea of “futility”, and how to discuss that with patients and their families. Finally, we try to understand how Dr. Doig remains so fresh after all these years as an intensivist. 

Links:

1. Resumption of Cardiac Activity after Withdrawal of Life-Sustaining Measures. https://www.nejm.org/doi/full/10.1056/NEJMoa2022713

2. Ethics roundtable debate: Patients and surrogates want 'everything done' – what does 'everything' mean? https://ccforum.biomedcentral.com/articles/10.1186/cc5016

3. The name of the dog. https://www.nejm.org/doi/full/10.1056/nejmp1806388

Biography (from U of C website)
Dr Christopher Doig (better known as Chip) graduated from the University of Saskatchewan (MD with distinction), trained in Vancouver and Calgary with specialization in Internal Medicine and Critical Care Medicine. He has additional training in clinical epidemiology and health care ethics. Dr. Doig is a tenured Professor in the Departments of Critical Care Medicine, Medicine and Community Health Sciences in the Cumming School of Medicine, University of Calgary. He is a past Department Head for Community Health Sciences, and immediate past head for the Department of Critical Care Medicine, He has held other leadership roles including as a President and on the Board of the Alberta Medical Association (AMA), the board of the Canadian Medical Association (CMA), and STARS (Shock, Trauma and Rescue Society).

Dr. Doig has been recognized with a number of local, provincial, national, and international awards. These include: the McLeod Distinguished Achievement Award for Faculty from the University of Calgary, AHS President’s Excellence Award in Quality Improvement for the provincial ICU delirium initiative (co-lead), AMA Medal for Distinguished Service (contributions to developing critical care in Alberta), CMA Dr. William Marsden Award in Medical Ethics, the E. Garner King Award from the Canadian Critical Care Society, The Royal Life Saving Society Bronze Benefactor Medal (for work with STARS), and the Global Sepsis Award (Alberta Sepsis Network) from the Global Sepsis Alliance.

Dr. Doig’s publications include in leading medical journals including Nature Medicine, New England Journal of Medicine, JAMA, Canadian Medical Association Journal, Academic Medicine and leading critical care journals including the American Journal of Critical Care Medicine, Critical Care Medicine, Intensive Care Medicine, and the Journal of Critical Care. Dr. Doig’s publications cover a breadth of translational medicine, clinical trials, outcomes-based research involving large cohorts and complex datasets, medical ethics, and medical education.

Dr. Doig’s experience provides a unique perspective on acute care delivery involving critically ill patients, quality improvement and patient safety, public engagement, and engagement with government on health policy issues. Dr. Doig is currently developing methods to evaluate physician performance Dr. Doig’s ongoing education includes enrolment in a Master’s in Health Economics (London School of Economics) and a Master’s of Public Policy (Harris School of Public Policy, University of Chicago).

Chip is most proud to be a father to 4 fantastic kids, and 30 years married to Suzanne. He enjoys time off in the mountains (biking, hiking and skiing), swimming, and playing soccer (currently ranked second in his family in goal scoring but hoping to improve). He is the Vogel Team Captain of Canadian National Medical Soccer playing at the World Medical Football Championships.

The Solving Healthcare podcast hosted by Kwadwo Kyeremanteng has launched medical podcasting in Canada into a whole new level. Dr. K is an intensivist based out of Ottawa, and his podcast, solving healthcare, has been a tremendous source of excellent information on COVID, medicine, exercise, nutrition, and so much more. As if he wasn’t busy enough, Dr. K has now also created the Solving Wellness platform, an online website and community that is targeted at wellness for healthcare workers. It was an absolute pleasure to throw down with Dr. K. We talk about our shared Edmontonian heritage, his work with the Solving Healthcare podcast, and the Solving Wellness platform. 

We are excited to announce that Cold Steel listeners can receive a free membership on the Solving Wellness platform if you go to the solving wellness website: www.drkwadwo.ca/solvingwellness and enter promo code: coldsteel. There are only 10 free memberships, so hurry to join! Remaining listeners can still get a 15% discount on their membership fees at Solving Wellness if you use promo code coldsteel15. 

Twitter:
Dr. K: https://twitter.com/kwadwo777?s=20
Solving Healthcare podcast: https://twitter.com/KwadCast?s=20

1. Solving Healthcare podcast: https://drkwadwo.ca/

2. Solving Wellness: www.drkwadwo.ca/solvingwellness

3. Resource Optimization Network: https://www.resourceoptimizationnetwork.com/

4. Pareto Principle: https://en.wikipedia.org/wiki/Pareto_principle

5. Suicide and self-harm in adult survivors of critical illness: population based cohort study: https://pubmed.ncbi.nlm.nih.gov/33952509/

In this episode, repeat guest and co-editor in chief of CJS Dr. Ed Harvey joins us to discuss “innovation”. Innovation is one of those buzzwords that everyone loves to throw around and use, but rarely do we actually think about what it means to do innovative work and how we might be more innovative. Dr. Harvey is an orthopedic surgeon at McGill University in Montreal, and is involved in several startups developing new devices. We’d love to hear your thoughts – what makes someone “innovative”? What can we do to create environments that encourage innovation? Send us an email at [email protected] or tweet at us @canjsurg. 

Check out our previous interview with Dr. Harvey here: https://soundcloud.com/cjs-podcast/e49-ed-harvey-on-the-canadian-journal-of-surgery-and-ebm-in-surgery

Links:

1. Parodi and development of vascular graft: https://vascularnews.com/endovascular-revolution-in-the-aorta-25-years-of-a-landmark-case/

2. Crossing the Chasm: https://www.harpercollins.com/products/crossing-the-chasm-3rd-edition-geoffrey-a-moore?variant=32130444066850

3. The Pitch podcast: https://gimletmedia.com/shows/the-pitch

4. The Hard Thing About Hard Things: https://www.chapters.indigo.ca/en-ca/books/the-hard-thing-about-hard/9780062273208-item.html

Bio (adapted from https://rimuhc.ca/-/edward-harvey-md): 

Dr. Harvey is a Professor of Surgery and Senior Scientist at Centre for Translational Biology at McGill University. His research focuses on the repair and recovery of the orthopaedic trauma patient. Encompassing fundamental and clinical aspects of healing, his interests include implant and fracture optimization, stem cells and neovascularization, biosensors and evaluation of novel hardware and surgical approaches to expedite fracture repair, and innovation and business models in surgical discovery. He actively collaborates with basic scientists, clinicians and others to drive mutual research goals.

Dr. Carl Brown (https://twitter.com/drcarl_vancouvr?s=20) is a colorectal surgeon at St. Paul’s Hospital in Vancouver, British Columbia. He gave us a masterclass on rectal cancer, starting really with the history of rectal cancer surgery to the evidence around neodjuvant therapy and then giving us a peek at the future of rectal cancer treatment. We then discuss how we should best adopt new technology such a TEM or taTME. A reminder to listeners that we know have the transcripts for all our episodes available on the CJS website – this is a handy written resource to go over, especially for detailed masterclasses like this one. As always, we welcome your feedback on twitter @canjsurg or via email at [email protected].

Dr. Brown on Twitter: @drcarl_vancouvr

Links:

1. Techniques and technology evolution of rectal cancer surgery: a history of more than a hundred years. https://www.tandfonline.com/doi/full/10.1080/13645706.2016.1198381

2. Swedish Rectal Cancer trial in NEJM on preop radiotherapy- https://www.nejm.org/doi/full/10.1056/nejm199704033361402.

3. German Rectal cancer trail on preop vs post op radiotherapy - https://www.nejm.org/doi/full/10.1056/nejmoa040694

4. Dutch rectal cancer trail on preoperative radiotherapy plus TME (published in NEJM) - https://www.nejm.org/doi/full/10.1056/nejmoa010580

5. The "Holy" Plane of Rectal Cancer surgery by Healds - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1291757/

6. Rates of Circumferential Resection Margin Involvement Vary Between Surgeons and Predict Outcomes in Rectal Cancer Surgery (Phil Quirke) - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1422458/

7. CCTG CO.28 primary endpoint analysis: Neoadjuvant chemotherapy, excision and observation for early rectal cancer, the NEO trial. https://ascopubs.org/doi/abs/10.1200/JCO.2021.39.15_suppl.3508

8. Transanal endoscopic microsurgery: a review (by Dr. Brown in CJS) - http://canjsurg.ca/vol57-issue2/57-2-127/

9. Hey, I just did a new operation!: Introducing innovative procedures and devices within an academic health center. https://pubmed.ncbi.nlm.nih.gov/24866545/

10. IDEAL Collaboration: https://www.ideal-collaboration.net/

Dr. Jillian Horton (https://twitter.com/JillianHortonMD?s=20) is an an internist at Max Rady College of Medicine in Winnipeg and the author of "We Are All Perfectly Fine". In the book, Dr. Horton beautifully explores burnout and her own personal journey in medicine. We talked to her about the process of writing and the vulnerability involved with such an honest depiction of her own struggles, as well as where we can go with the culture of medicine to make training better. 

Links:

1. We Are All Perfectly Fine: https://www.harpercollins.ca/9781443461634/we-are-all-perfectly-fine/

2. Med Life with Dr. Horton: https://www.cmaj.ca/medlife

3. The ‘good’ doctor: It’s time to stop treating character like an afterthought in medicine – and everywhere else. https://www.theglobeandmail.com/opinion/article-the-good-doctor-its-time-to-stop-treating-character-like-an/

Bio (from https://www.gold-foundation.org/newsroom/news/dr-jillian-horton-2020-afmc-gold-humanism-award/):

Dr. Horton is a general internist who serves in multiple leadership positions at University of Manitoba’s Max Rady College of Medicine in Winnipeg, including: inaugural Director of the college’s and Faculty of Health Sciences programs in Physician and Learner Wellness; Director of the Alan Klass Health Humanities Program; and Associate Chair of the Department of Internal Medicine. Dr. Horton previously served as the Associate Dean of Undergraduate Student Affairs at the medical college. She has won numerous awards for mentorship, professionalism, and teaching.

Read full transcript here: http://canjsurg.ca/e82-chuck-vollmer-masterclass-on-pancreatic-fistulas/

Dr. Charles "Chuck" Vollmer joined us again for this episode for a masterclass on pancreatic fistulas. Please listen to our previous episode with Dr. Vollmer for more about him, his career, and his fascination with all things pancreas.

Previous episode with Dr. Vollmer: https://soundcloud.com/cjs-podcast/e33-chuck-vollmer-on-peer-review-and-productivity

Bibliography for this episode:

1. The Surgery of the Pancreas. https://www.amazon.com/Surgery-Pancreas-richard-cattell/dp/B0000CIKY7

2. Pancreaticoduodenectomy for Islet Carcinoma : A Five-Year Follow-Up
A O Whipple. https://pubmed.ncbi.nlm.nih.gov/17858621/

3. Of Fistula and Football. https://pubmed.ncbi.nlm.nih.gov/32976277/

4. Decision points in pancreatoduodenectomy: Insights from the contemporary experts on prevention, mitigation, and management of postoperative pancreatic fistula. https://pubmed.ncbi.nlm.nih.gov/33892952/

5. The Fistula Risk Score Catalog: Toward Precision Medicine for Pancreatic Fistula After Pancreatoduodenectomy. https://pubmed.ncbi.nlm.nih.gov/32541227/

6. Taking Theory to Practice: Quality Improvement for Pancreaticoduodenectomy and Development and Integration of the Fistula Risk Score. https://pubmed.ncbi.nlm.nih.gov/29981917/

7. Risk Prediction for Development of Pancreatic Fistula Utilizing the ISGPF Classification Scheme. https://pubmed.ncbi.nlm.nih.gov/18175170/

8. Postoperative pancreatic fistula: an international study group (ISGPF) definition. https://pubmed.ncbi.nlm.nih.gov/16003309/

9.  Defining the practice of pancreatoduodenectomy around the world. https://www.sciencedirect.com/science/article/pii/S1365182X15320165

10. The Influence of Intraoperative Blood Loss on Fistula Development Following Pancreatoduodenectomy. https://pubmed.ncbi.nlm.nih.gov/33201132/

11. Extended Experience with a Dynamic, Data-Driven Selective Drain Management Protocol in Pancreaticoduodenectomy: Progressive Risk Stratification for Better Practice. https://pubmed.ncbi.nlm.nih.gov/32081751/

12. Early versus late drain removal after standard pancreatic resections: results of a prospective randomized trial. https://pubmed.ncbi.nlm.nih.gov/20622661/

We were joined this week by Drs. Rhea Liang (https://twitter.com/LiangRhea?s=20) and Simon Fleming (https://twitter.com/OrthopodReg?s=20) to talk about bullying, psychological safety, and culture change in surgery. We hope that the episode can be an opportunity for discussion and reflection for listeners.

Links:

1. RCS England Theatre podcast: https://anchor.fm/rcseng/episodes/Culture-Change-Why-do-we-need-culture-change-ekeo1v/a-a3djbs4

2. Simon Fleming: I launched an anti-bullying campaign to change culture in healthcare -https://blogs.bmj.com/bmj/2019/04/10/simon-fleming-i-launched-an-anti-bullying-campaign-to-change-culture-in-healthcare/

3. Operate with Respect: https://www.surgeons.org/en/about-racs/about-respect

4. Why do women leave surgical training? A qualitative and feminist study. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32612-6/fulltext

5. All of us have a survivorship bias in regard to how we were trained in medicine. https://blogs.bmj.com/bmj/2020/11/30/all-of-us-have-a-survivorship-bias-in-regard-to-how-we-were-trained-in-medicine/

Bios: 

Associate Professor Rhea Liang (twitter: @LiangRhea) is a general and breast surgeon on the Gold Coast. She is a surgical educationalist, Surgical Discipline Lead at Bond University and the immediate past Chair of the Operating With Respect Education Committee, RACS. She also researches, advocates and consults widely in diversity and equity issues.

Simon Fleming (twitter: @OrthopodReg) is a London-based Trauma and Orthopaedic registrar. While passionate about Orthopaedics, surgical training & mentoring, he has special interests in hand surgery, competency decisions & combating bullying, undermining, harassment and the lack of diversity and equity in healthcare. He undoes all the good work he does in the gym with a love of great food and tries to change the world in his spare time.