Critical Care

Each year more than 70 million post-surgical patients are prescribed opioids. Research shows 1 in 15 will go on to use the medications long term, potentially putting them at risk for addiction and overdose.

Host Dr. Brian McDonough sits down with Dr. Susan Downey, a board-certified plastic surgeon, to talk about opioid abuse and what alternative prescription options are available instead of narcotics.

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Many critically ill patients are unable to make medical decisions for themselves. Family members or close friends are often asked to serve as surrogate decision makers. However, expectations about a patient's overall prognosis sometimes differ between physicians and surrogate decision makers.

Researchers from the University of Pittsburgh enrolled 99 physicians and 229 surrogates who made decisions for 174 critically ill patients in a new study. They found that in about half of the cases, surrogates were substantially more optimistic about a patient's prognosis compared to physicians and that the physician's estimates were much more accurate than that of surrogates.

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Trauma care is one of the most complex health system infrastructures in the US. Depending on the type of injury sustained, a patient may require multidisciplinary intervention from any and/or every medical and surgical specialty, as well as all branches of allied health professionals, at a moment's notice. Given these requirements, the notion to physically move an entire trauma care center, from its staff and patient populations to its equipment, records, and maintenence operations, is a daunting challenge. At Penn Medicine, this monumental task was recently undertaken and completed successfully. Leading the effort was Garry L. Scheib, Chief Operating Officer of the University of Pennsylvania Health System, and Executive Director of the Hospital of the University of Pennsylvania. He joins host Frank Russomano to reflect on lessons learned from overseeing one of the biggest trauma care transition projects in American history.

The Gender, Sexuality and HIV Prevention Center at Ann & Robert H Lurie Children's Hospital of Chicago is the first of its kind facilty for adolescent patients. Host Dr. Jennifer Caudle welcoms the center's director, Dr. Robert Garofalo. Dr. Garofalo will share the center's mission of supporting multidisciplinary academic subjects including sexual health, gender, sexuality, HIV prevention and health disparities which affect adolescent and young adult populations at risk of acquiring HIV. The Center partners with similar organizations throughout the country in creating an environment where clinicians, academics and scientists can collaborate to design projects with public health significance.

Robert Garofalo, MD, MPH, is Professor of Pediatrics and Preventive Medicine at Northwestern University Feinberg School of Medicine. He is also an Attending Physician at Lurie Children's, where he directs the Adolescent/Young Adult HIV Program. Dr. Garofalo is a national authority on LGBT health issues, adolescent sexuality, and HIV clinical care and prevention.

This week, Mark and Margaret speak with Dr. Deane Marchbein, President of the American Board of Medecins Sans Frontieres (Doctors Without Borders). Dr. Marchbein joined MSF in 2006 to work as an anesthesiologist in MSF's surgical program in Ivory Coast. She has worked with MSF in Democratic Republic of Congo, Haiti, Libya, Nigeria, South Sudan, and Syria, and as a medical doctor in Libya and Lebanon.

A New Orleans hospital, after Hurricane Katrina, was surrounded on all sides by several feet of water. The power was out, and as time went on without restoration of basic operations, rumors began circulating of the hospital being overrun by looters. It was a period of total chaos with breakdowns in institutional leadership, compromises in patient care, and in some cases, clinical decisions with deadly consequences. Dr. Sheri Fink, author of Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital, takes us on a tour of the aftermath of these events, and the public outcries that both villified and defended the healthcare workers involved.

Click here for Part 1 of this fascinating two-part exploration of the disaster, a hospital's response, and the repercussions that have rippled through its affected staff, patients, and families years later.

In her book, Five Days at Memorial, physician and reporter Sheri Fink reconstructs 5 days at Memorial Medical Center and draws the reader into the lives of those who struggled mightily to survive and to maintain life amid chaos. Drawing from a culmination of six years of reporting, Dr. Fink unspools the mystery of what happened in those days, bringing listeners into a hospital fighting for its life and into a conversation about the most terrifying form of health care rationing.

Click here for Part 2 of this fascinating two-part exploration of the disaster, a hospital's response, and the repercussions that have rippled through its affected staff, patients, and families years later.

Dr. Maurice Pickard welcomes author Scott McGaugh to discuss the subject of his book "Surgeon in Blue: Jonathan Letterman, the Civil War Doctor Who Pioneered Battlefield Care." Through their discussion, listeners will discover how one lone surgeon, Jonathan Letterman, reshaped military medicine over the course of four major Civil War battles and a single year. Letterman, confronted by thousands of wounded lying abandoned on the battlefield, a sickly and malnourished Union army, and obscenely filthy military camps, took steps that make battlefield survival possible for our soldiers today.

Matthew Miller had just pedaled up a mountain pass. He was 20, a member of the University of Virginia triathlon club, so fit his resting pulse was 42! He was on top of the world in so many ways, in love, with dreams of attending medical school. And then, cycling along the Blue Ridge Parkway in Virginia, tragedy struck. The real story is not what happened, but what happened after.

Host Dr. John Russell is joined by Pulitzer Prize winning journalist Michael Vitez to share the humbling story of Matt's survival and recovery. The author first chronicled Matt Miller's story for his newspaper, The Philadelphia Inquirer. The response from readers was so overwhelming - and Matt's continued recovery so remarkable - that Vitez immersed himself in Matt's world. The Road Back is not only about a young man's drive to reclaim his life, but about the people who rode with him, rescued him, helped him heal, and saw up close his amazing comeback.

Presenting this session of Grand Rounds is Dr. Gordon Ewy, professor and chief of cardiology at the University of Arizona College of Medicine.

To view the complete video recording of this and other Grand Rounds sessions from the University of Arizona College of Medicine, visit their website.