Cold Steel: Canadian Journal of Surgery Podcast

In this episode we were honoured to once again have another icon of trauma surgery join us. Dr. Ernest E. Gene Moore is a trauma surgeon at the Denver General Hospital. In this episode we explore Dr. Moore’s early insights into the developments of acute care surgery as a specialty, how he defined not one but two major surgery journals, and how he continues to think about the evolution of surgery moving forward. 

Ernest E. “Gene” Moore, MD, was the Chief of Trauma at the Denver General Hospital for 36 years, Chief of Surgery for 28 years, and the first Bruce M. Rockwell Distinguished Chair in Trauma Surgery. He continues to serve as Vice Chairman for Research and is a Distinguished Professor of Surgery at the University of Colorado Denver (UCD), and has been the Editor of the Journal of Trauma since 2011.
Under Dr. Moore’s leadership, the Rocky Mountain Regional Trauma Center at Denver General became internationally recognized for innovative care of the injured patient, and its trauma research laboratory has been funded by the NIH for 35 consecutive years. In July 2018, the center was renamed the Ernest E Moore Shock Trauma Center at Denver Health.
Dr. Moore has served as president of nine academic societies, including the Society of University Surgeons, American Association for the Surgery of Trauma, International Association for the Trauma and Surgical Intensive Care, and the World Society of Emergency Surgery; and as Vice President for the American Surgical Association.

His awards include the Robert Danis Prize from the Society of International Surgeons, Orazio Campione Prize from the World Society of Emergency Surgery, Philip Hench Award from the University of Pittsburgh, Florence Sabin Award from the University of Colorado, Lifetime Achievement Award from the Society of University Surgeons, Lifetime Achievement Award for Resuscitation Science from the American Heart Association, Distinguished Investigator Award from the American College of Critical Medicine, Distinguished Investigator Award from the Shock Society, Lifetime Service Award from the International Association for Trauma and Surgical Intensive Care, and the Medallion for Scientific Achievement from the American Surgical Association. He has honorary fellowships in the Royal College of Surgeons of Edinburgh, the Royal College of Surgeons in Ireland, the Royal College of Surgeons of Thailand, and the American College of Emergency Physicians; and is an honorary member of the Brazilian Trauma Society, Colombian Trauma Society, Eastern Association for the Surgery of Trauma, European Society for Trauma and Emergency Surgery, North Pacific Surgical Association, and Trauma Association of Canada. Dr. Moore is coeditor of the textbook Trauma, in its 9th edition, Surgical Secrets in its 7th edition, and Trauma Induced Coagulopathy, in its 2nd edition; he has >1700 publications and has lectured extensively throughout the world.

He is married to Sarah Van Duzer Moore, M.D., an internist at the University of Colorado Denver, and they have two sons; Hunter, a transplant fellow at UCD and Peter, a pulmonary/critical care fellow, both at UCD. Dr. Moore’s additional interests include endurance sports, mountaineering, skiing, and wapiti pursuit. He lives by the principle to work hard you must play hard, with the understanding that family is the ultimate priority.

Links
1. AAST Interview w/ Dr. Moore: http://www.aast.org/assets/f658eae6-95c2-4258-9df0-58344a846882/635338644875870000/23-ernest-e-gene-moore-md-1993-1994-pdf

2. Dedication of Ernest E Moore Shock Trauma Center: https://www.denverhealth.org/news/2018/07/dedication-of-the-ernest-e-moore-shock-trauma-center-at-denver-health

3. WSES tribute to Dr. Moore: https://wjes.biomedcentral.com/articles/10.1186/s13017-018-0206-1

1. Dr. Harvey bio: https://irr-rimuhc.ca/edward-harvey/
2. Article on the previous Canadian Journal of Surgery Editors-in-Chief: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2386197/
3. Continuing a long tradition: the Canadian Journal of Surgery at 60. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5608575/
4. COPE committee on publication ethics: https://publicationethics.org/
5. A sampling of Dr. Harvey's editorials for CJS: http://canjsurg.ca/wp-content/uploads/2017/01/60-1-4.pdf and https://pubmed.ncbi.nlm.nih.gov/26011846/
6. Evidence-Based Medicine: Boom or Bust in Orthopaedic Trauma. https://pubmed.ncbi.nlm.nih.gov/31609888/

In this episode, we were lucky enough to have Dr. Clarence Wong. Dr. Wong is an interventional gastroenterologist at the University of Alberta. He gave us a masterclass on the approach to large polyp. We also talked about the development of screening guidelines in Alberta, and way to improve the quality of colonoscopies on a very practical level.

Tweet at us @CanJSurg or email us at [email protected].

Links:

1. Is 45 the new 50 in colorectal cancer screening? https://pubmed.ncbi.nlm.nih.gov/33077453/

2. https://www.healio.com/news/hematology-oncology/20201027/uspstf-expands-colorectal-cancer-screening-recommendation-to-include-adults-age-45-years#:~:text=All%20adults%20should%20begin%20to,initiation%20at%20age%2045%20years.

3. Managing difficult polyps: techniques and pitfalls. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3959925/

4. Geographic variation in the provider of screening colonoscopy in Canada: a population-based cohort study. http://cmajopen.ca/content/6/1/E126.full. 

5. Alberta CRC Screening Guidelines: https://actt.albertadoctors.org/CPGs/Lists/CPGDocumentList/colorectal-cancer-screening-guideline.pdf

6. DOPS Program in BC for Colon Screening: http://www.bccancer.bc.ca/screening/Documents/COLON_GuidelinesManual-DOPSCandidateResourceBooklet.pdf

7. CAG SEE course: https://www.cag-acg.org/education/see-program

Dr. Wong is a gastroenterologist and Associate Professor with the Division of Gastroenterology at the University of Alberta. He is an Attending Staff gastroenterologist at the Royal Alexandra Hospital, University of Alberta Hospital and the Cross Cancer Institute. He holds a BSc in Cellular and Molecular Biology from the University of Calgary and a MD degree from the University of Alberta. He is a Fellow of the Royal College of Physicians and Surgeons of Canada (RCPSC) in Internal Medicine and Gastroenterology having completed medical residency at McMaster University in Hamilton and the University of Alberta. During his training, Dr. Wong was awarded research fellowships from both the Alberta Heritage Foundation for Medical Research and the Canadian Association of Gastroenterology for translational research in Experimental Oncology. He has also completed a fellowship in endoscopic ultrasound and is a therapeutic endoscopist focusing on gastrointestinal cancers. He is the medical director of the Edmonton Endoscopic Ablation Program which treats Barrett’s esophagus and early upper gastrointestinal tract cancers. He is also the provincial medical director of the Alberta Colorectal Cancer Screening program (ACRCSP). His research interests include clinical and laboratory innovations in colon cancer screening and Barrett’s esophagus. He received funding from AHFMR and Alberta Innovates. Dr. Wong is a Past-President of the Alberta Society of Gastroenterology. He has received regional and national teaching awards for excellence in medical education including Endoscopy & Teacher of the Year from the UofA GI Residency Training Program, the University of Alberta Medical Students’ Association Teacher of the Year Award, the Canadian Association of Medical Education (CAME) Certificate of Merit, and the University of Alberta Rutherford Award for Excellence in Undergraduate Teaching.

Dr. Laws graduated from the University of British Columbia and obtained her medical degree from McMaster University. She completed a general surgery residency at the University of Calgary and a breast surgical oncology fellowship at Massachusetts General Hospital/Brigham and Women’s Hospital.

She is currently pursuing a Master of Public Health in epidemiology from the Harvard T.H. Chan School of Public Health. She is a member of the Society of Surgical Oncology (SSO) and the American Society of Breast Surgeons (ASBrS).

Dr. Laws’ clinical and research interests include optimizing oncologic outcomes after breast cancer surgery, improving cancer care delivery through implementation of evidence-based practices, as well as managing patients at high-risk for breast cancer.

We were lucky enough to get her expertise about a number of important topics, including neoadjuvant therapy for breast cancer, indications for axillary node dissection in 2020, and an approach to recurrent breast cancer. Finally, we delve into her experience as a patient, and how that shaped her practice as a surgeon.

Links:

1. Intraoperative Margin Assessment in Wire-Localized Breast-Conserving Surgery for Invasive Cancer: A Population-Level Comparison of Techniques. https://pubmed.ncbi.nlm.nih.gov/27406094/

2. Does intra-operative margin assessment improve margin status and re-excision rates? A population-based analysis of outcomes in breast-conserving surgery for ductal carcinoma in situ. https://pubmed.ncbi.nlm.nih.gov/30293241/ Breast Biopsy During Post-treatment Surveillance of Screen-Detected Breast Cancer Patients Yields High Rates of Benign Findings. https://pubmed.ncbi.nlm.nih.gov/32100221/

3. Margins in Breast-Conserving Surgery After Neoadjuvant Therapy. https://pubmed.ncbi.nlm.nih.gov/30128902/

4. KATHERINE trial: https://www.nejm.org/doi/full/10.1056/NEJMoa1814017

5. CREATE-X trial: https://www.nejm.org/doi/full/10.1056/NEJMoa1612645

6. RX-PONDER: https://www.nature.com/articles/s41598-019-49644-6

7. The surgeon who underwent surgery: How being a patient changed him. https://www.kevinmd.com/blog/2019/10/the-surgeon-who-underwent-surgery-how-being-a-patient-changed-him.html

This is the first in our new "Companion" series, meant to offer a discussion on new topics and events. We are lucky enough to be joined by Drs.  Kelly Vogt and Morad Hameed, both previous guests on the show.

In this episode we discuss the paper published in the CMAJ, "Relation between surgeon age and postoperative outcomes: a population-based cohort study" (https://www.cmaj.ca/content/192/15/E385). 

Send us your thoughts and comments by email at [email protected] or on twitter @CanJSurg!

Links:

1. Dr. Kelly Vogt bio: https://www.schulich.uwo.ca/generalsurgery/people/bio/kelly_vogt.html#:~:text=Vogt%20is%20a%20recipient%20of,Acute%20Care%20Surgery%20and%20Trauma.

2. Dr. Morad Hameed bio: https://surgery.med.ubc.ca/people/s-m-hameed/

3. Comment on “Comparison of Patient Outcomes of Surgeons Who Are US Versus International Medical Graduates”.https://journals.lww.com/annalsofsurgery/Citation/9000/Comment_on__Comparison_of_Patient_Outcomes_of.94281.aspx

4. The view from 10,000 procedures: technical tips and wisdom from master pancreatic surgeons to avoid hemorrhage during pancreaticoduodenectomy. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4660662/

In this episode, we were lucky enough again to be joined by Dr. David Feliciano. Dr. Feliciano is a world-renowned trauma surgeon and a passionate surgical historian. Today he joins us to talk about surgeons who won the Nobel Prize and the complex and rich history that surrounds them. 

Email us at [email protected] or send us a tweet @CanJSurg with your thoughts about this and all our previous episodes. 

Dr. David V. Feliciano received his medical degree in 1970 from Georgetown University in Washington, D.C. He completed his general surgery training at Mayo Clinic, in trauma at Wayne State University, and vascular surgery at Baylor College of Medicine (where he trained under Dr. DeBakey). He was Professor of Surgery at Emory University and Surgeon-in-Chief at Grady Memorial Hospital in Atlanta, Georgia from 1991 to 2011. He is now a Clinical Professor of Surgery at the University of Maryland and an attending surgeon at Shock Trauma.

Links:

1. Nobel Prize winners who were trained as surgeons.
Feliciano DV.Am Surg. 2009 Jan;75(1):15-9; quiz 97.PMID: 19213390 No abstract available. https://journals.sagepub.com/doi/abs/10.1177/000313480907500103?journalCode=asua

2. Alexis Carrel (1873-1944): Nobel Laureate, 1912.
Dente CJ, Feliciano DV.Arch Surg. 2005 Jun;140(6):609-10. doi: 10.1001/archsurg.140.6.609. https://jamanetwork.com/journals/jamasurgery/fullarticle/508657

3. Joseph E. Murray (1919- ): Nobel Laureate, 1990.
Cash MP, Dente CJ, Feliciano DV.Arch Surg. 2005 Mar;140(3):270-2. doi: 10.1001/archsurg.140.3.270.PMID: 15781791 No abstract available. https://jamanetwork.com/journals/jamasurgery/fullarticle/508445

4. Michael Houghton, Winner of 2020 Nobel Prize. https://www.ualberta.ca/michael-houghton-nobel-prize-2020.html

In this episode, we explore the many challenges facing an under-discussed topic: undergraduate surgical education. We were joined by Drs. Andreana Butter and Geoffrey Blair, current and former chairs of the Canadian Undergraduate Surgical Education Committee (CUSEC). 

Dr. Andreana Bütter completed medical school at the University of Ottawa and residency in General Surgery at Western University. During residency, she also pursued a year of research at the Montreal Children’s Hospital in pediatric surgery; specifically in the area of fetal surgery and congenital diaphragmatic hernia. This research culminated in her obtaining a Master of Science Degree from McGill University in 2001. Upon completing her General Surgery residency, she returned to Montreal for a Pediatric Surgery fellowship at Sainte Justine Hospital (Université de Montréal), which she completed in 2005. She then joined the Division of Pediatric Surgery and the Department of Pediatrics at the Children’s Hospital (LHSC) as an Assistant Professor in the Department of Surgery. In 2012, she was promoted to Associate Professor. She assumed the role of Associate Director of Surgical Education in July 2014. She is also a review editor for Frontiers in Pediatric Surgery journal.

Her clinical areas of interest include Pediatric Thoracic and General Surgery, such as congenital diaphragmatic hernia, bracing for pectus carinatum, nonoperative management of appendicitis and minimally invasive surgery. She helped develop the first Canadian Robotic Pediatric Surgery program. Her research interests are in the areas of fetal surgery with minimally invasive ways of correcting or improving outcomes for congenital anomalies such as bladder outlet obstruction and congenital diaphragmatic hernia.

Dr. Geoffrey Blair is a recently retired pediatric surgeon at the BC Children's Hospital in Vancouver, BC. Being a pediatric general surgeon, he took seriously the need for clinical investigation in the field of surgery. He pursued topics related to congenital anomalies, thyroid surgery, and pediatric surgical oncology. 

He was the UBC Pediatric Surgery Program Director for our site since 1993, and the Chief Examiner of the Royal College of Physicians and Surgeons since 2001. With the constant evolution of better surgical methods, he's concerned that older models of training and surgical resident assessment are not applicable to the current delivery of health care. Therefore, he continues to be enthusiastically engaged in educational research projects looking at pedagogical tools, such as "portfolio" based methods, to enhance learning and evaluation.

Links:

1. CUSEC Website: https://www.cusec-ccecp.com/

2. C-CASE is happening virtually on Oct 29 and 30th. Be sure to register! https://www.cusec-ccecp.com/about-1

Joe DuBose is a graduate of the Virginia Military Institute and the University of Virginia School of Medicine. He performed surgical training at Keesler Air Force Base Medical Center and the University of Virginia from 2001-2006. Additional fellowship training in surgical critical care and trauma surgery was completed at Los Angeles County + University of Southern California Hospital from 2006-2008. Lt Col DuBose has been a staff trauma surgeon and surgical intensivist at Wilford Hall Medical Center and as an assistant professor of surgery at R Adams Cowley Shock Trauma Center / University of Maryland since 2008. During that period he has deployed as a trauma director once to the Air Force Theater Hospital at Balad Air Base in Iraq (2009) and twice in support of Operation Enduring Freedom in Afghanistan (Kandahar-2010; Bagram Air Base 2011-2012). He presently holds the title of Clinical Professor at the University of Maryland Medical Center.

In this episode we talk to Dr. DuBose about his training pathway, his experience in the military, and about integrating his vascular training with his trauma background, which includes his thoughts about REBOA.

 As always, we love feedback and comments, and feel free to email us at [email protected] or on twitter @canjsurg . Thanks and enjoy the episode! 

Links: 

1. Evolving Paradigms In Vascular Injury Management. https://www.youtube.com/watch?v=YfSYEM797Gg

2. Dr. Dubose’s Tiger Country podcast! https://www.listennotes.com/podcasts/tiger-country-the-trauma-podcast-joseph-4L9V2rU8x53/

3. EMCrit 281 – Why Can’t Emergency Medicine and Trauma Surgery Just Get Along?https://emcrit.org/emcrit/emergency-medicine-and-trauma-surgery-just-get-along/

4. EMCrit170 – the ER REBOA Catheter with Joe DuBose. https://emcrit.org/emcrit/er-reboa/

5. The AAST prospective Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) registry: Data on contemporary utilization and outcomes of aortic occlusion and resuscitative balloon occlusion of the aorta (REBOA). https://pubmed.ncbi.nlm.nih.gov/27050883/

After graduating from the University of Alberta with a Bachelor of Science and M.D in 1990, Dr. Logsetty obtained his Diploma in Clinical Epidemiology from the University of Toronto in 1996 garnering many awards along the way.  Dr Logsetty completed the Surgical-Scientist Program at University of Toronto in 1994-1996.  He continued his training in fellowships in Acute Burn Care & Reconstructive Surgery at Ross Tilley Burn Centre in Wellesley Hospital in Toronto, Ontario (1996-1998) and in Critical Care of Burns at Harborview Medical Centre in Seattle, Washington (1998-1999).
He was appointed to the position of Associate Director of the Firefighters Burn Treatment Unit at the University of Alberta Hospital in 1999.  He was also the Director of Resident Research for the General Surgery Department at the University of Alberta Hospital from 2005 to 2007.  During his time at the University of Alberta Hospital he was promoted from Assistant Professor to Associate Professor.  In 2007 he was recruited by the University of Manitoba and the Health Sciences Centre to take on the position of Director of the brand new Burn Unit located at Health Sciences Centre in Winnipeg.  He remains an Associate Professor of Surgery at the University of Manitoba and was appointed the Director of Research for the Section of Plastic Surgery. 

In this episode, we get all fired up about burn care. We talk about training pathways for burn surgeons, burn resuscitation, operative management of burns, and finally about Dr. Logsetty’s innovative research into burn wound management. 

Links:

1. Dr. Logsetty’s nature review on burns: https://pubmed.ncbi.nlm.nih.gov/32054846/
2. Clinical Value of Debriding Enzymes as an Adjunct to Standard Early Surgical Excision in Human Burns; A Systematic Review: https://academic.oup.com/jbcr/advance-article-abstract/doi/10.1093/jbcr/iraa074/5840378?redirectedFrom=fulltext
3. Simple Derivation of the Initial Fluid Rate for the Resuscitation of Severely Burned Adult Combat Casualties: In Silico Validation of the Rule of 10. https://pubmed.ncbi.nlm.nih.gov/20622619/
4. Mental health outcomes of burn: A longitudinal population-based study of adults hospitalized for burns. https://europepmc.org/article/med/27049068
5. Bacteria-Responsive Single and Core-Shell Nanofibrous Membranes Based on Polycaprolactone/Poly(ethylene Succinate) for On-Demand Release of Biocides. https://pubs.acs.org/doi/10.1021/acsomega.8b03137

Henry A. Pitt, M.D. trained in surgery at Johns Hopkins and has been at the forefront of developing Hepato-Pancreato-Biliary (HPB) Surgery over the past three decades. His career has taken him to UCLA (1979), back to Johns Hopkins (1985) in Wisconsin (1997) and Indiana (2004), (2013) to Temple University Health System (TUHS) and now to Rutgers Cancer Center. He has served as president of the AOA Chapter in medical school , the Society of Clinical Surgery, the American Hepato-Pancreato-Biliary Association and the International Hepato-Pancreato-Biliary Association. He had funding for research in gallstone pathogenesis for 30 years. He has overseen surgical training programs at Johns Hopkins, the Medical College of Wisconsin (MCW) and at Indiana University (IU). His focus in recent years has been in quality, both at the hospital and the national level. His accomplishments have been honored by the Surgical Research Society of South Africa, the Surgical Research Society of Australia, the Tongi Medical College of Wuhan, China, the Second Military Medical College in Shanghai, China, and the Royal College of Surgeons of Edinburgh, Scotland.

We really delve deep with him on his initiatives to improve the quality of hpb surgery in the US, north America, and around the world. You can find him on twitter: https://twitter.com/HenryPittMD

Links:

1. Dr. Pitt’s first paper! On gentamicin levels in the biliary tree: https://academic.oup.com/jid/article/127/3/299/2189262
2. ACS-NSQIP has the potential to create an HPB-NSQIP option. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2742610/.
 Variation in Drain Management After Pancreatoduodenectomy: Early Versus Delayed Removal. https://pubmed.ncbi.nlm.nih.gov/29064899/
3. IHPBA: the first 25 years. https://www.ihpba.org/includes/moxiemanager/data/files/article.pdf