Next up in our series on the hot topics in surgery, we are joined by Dr. Michael Englesbe to discuss the opioid epidemic. He takes us through some of the statistics and provides an excellent Tips & Tricks on how much we should actually be prescribing after specific surgeries. https://www.opioidprescribing.info/ http://michigan-open.org/

Hot Topics in Surgery: Opioid Epidemic with Dr. Englesbe

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A patient with a large TBSA burn injury presents to a local emergency department and you are the only surgeon on duty that evening. With snow covered roads and poor visibility, the patient requires initial stabilization prior to transfer to the regional burn center. You are faced with some difficult clinical decisions as you begin their resuscitation. Join Drs. Tam Pham, Rob Cartotto, Julie Rizzo, Alex Morzycki and Jamie Oh as they discuss the clinical challenges in initiating burn resuscitation, pitfalls in long-distance transport, and more. 



Hosts:

·       Dr. Tam Pham: UW Medicine Regional Burn Center



·       Dr. Robert Cartotto: University of Toronto, Ross Tilley Burn Centre 



·       Dr. Julie Rizzo: Brooke Army Medical Center 



·       Dr. Alex Morzycki: UW Medicine Regional Burn Center



·       Dr. Jamie Oh: UW Medicine Regional Burn Center



Learning Objectives:

·       Describe initial fluid strategies, including the recommendations of the Advanced Burn Life Support (ABLS) course, traditional resuscitation formulas, and the Rule of 10.  



·       Describe logistical and medical challenges of long-distance transport to a regional burn center.



·       Understand recent advances learned from recent conflicts in military burn casualty care. 



·       List options for intravenous access. 



·       Understand endpoints of resuscitation, including adjuncts which may help guide fluid titration. 





1.     Cartotto R, Johnson LS, Savetamal A, et al. American Burn Association Clinical Practice Guidelines on Burn Shock Resuscitation. J Burn Care Res 2023



https://pubmed.ncbi.nlm.nih.gov/38051821/



2.     Renz EM, Cancio LC, Barillo DJ, et al. Long-Range Transport of War-Related Burn Casualties. J Trauma 2008 https://pubmed.ncbi.nlm.nih.gov/18376156/



3.     Adibfar A, Camacho F, Rogers AD, Cartotto R. The Use of Vasopressors During Acute Burn Resuscitation. Burns 2021 https://pubmed.ncbi.nlm.nih.gov/33293152/



4.     Chung KK, Wolf SE, Cancio LC, et al. Resuscitaiton of Severely Burned Military Casualties: Fluid Begets More Fluid. J Trauma 2009 https://pubmed.ncbi.nlm.nih.gov/19667873/



5.     Chung KK, Salinas J, Renz EM, et al. Simple Derivation of the Initial Fluid Rate for the Resuscitation of Severely Burned Adult Combat Casualties: in Silico Validation of the Rule of 10, J Trauma 2009 https://pubmed.ncbi.nlm.nih.gov/20622619/



Joint Trauma System Clinical Practice Guideline (CPG)-Burn Care, updated 2022 



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Clinical Challenges in Burn Surgery: Burn Resuscitation - Getting Things Started

Your patient was in a terrible car crash and is currently intubated with multiple traumatic injuries that will need surgery. Family has just arrived and all they’ve heard is that he has a broken leg. How do you share this serious news with family? What do you do when they become angry, cry or bombard you with questions that you don’t have answers to? Join the surgical palliative care team from the University of Washington as we role play a difficult conversation with a standardized patient. We will identify common challenges that arise and discuss key skills to navigate these situations.



Hosts: 



Dr. Katie O’Connell (@katmo15) is an assistant professor of surgery at the University of Washington. She is a trauma surgeon, palliative care physician, director of surgical palliative care, and founder of the Advance Care Planning for Surgery clinic at Harborview Medical Center, Seattle, WA.



Dr. Ali Haruta is a PGY7 current palliative care fellow at the University of Washington, formerly a UW general surgery resident and Parkland trauma/critical care fellow. 



Dr. Lindsay Dickerson (@lindsdickerson1) is a PGY5 general surgery resident and current surgical oncology research fellow at the University of Washington.



Dr. Virginia Wang is a PGY2 general surgery resident at the University of Washington.



Learning Objectives:



·      Identify common pitfalls encountered during difficult conversations

·      Learn how to synthesize complex medical information and construct a succinct headline statement to deliver a digestible take-home message

·      Develop skills to respond to emotional cues using empathetic statements



References:



·      “Responding to Emotion.” Vitaltalk. Accessed March 4, 2024. https://www.vitaltalk.org/guides/responding-to-emotion-respecting/

·      “Serious News.” Vitaltalk. Accessed March 4, 2024. https://www.vitaltalk.org/guides/serious-news/



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Clinical Challenges in Surgical Palliative Care: Communication Skills for Difficult Conversations

Circulating tumor DNA, more commonly referred to as ctDNA, has emerged as an attractive and potentially highly sensitive biomarker for patients with colorectal cancer. But what exactly is ctDNA, does it have any prognostic value for patients with colorectal liver metastasis, and how can it be incorporated into the management of said patients? In this episode from the HPB team at Behind the Knife, listen in on the discussion about ctDNA and its role in the perioperative management of colorectal liver metastasis.  



Hosts

Anish J. Jain MD (@anishjayjain) is a T32 Research Fellow at the University of Texas MD Anderson Cancer Center within the Department of Surgical Oncology.



Timothy E. Newhook MD, FACS (@timnewhook19) is an Assistant Professor within the Department of Surgical Oncology. He is also the associate program director of the HPB fellowship at the University of Texas MD Anderson Cancer Center. 



Jean-Nicolas Vauthey MD, FACS (@VautheyMD) is Professor of Surgery and Chief of the HPB Section, as well as the Dallas/Fort Worth Living Legend Chair of Cancer Research in the Department of Surgical Oncology at The University of Texas MD Anderson Cancer Center



Learning Objectives:

-Develop an understanding of what circulating tumor DNA (ctDNA) is. 

-Develop an understanding of what makes ctDNA unique from other “tumor markers” like CEA.

-Develop an understanding of the prognostic value of ctDNA for colorectal liver metastasis (CRLM). 

-Develop an understanding of the current role of ctDNA in the perioperative treatment of patients with CRLM.

-Develop an understanding of how ctDNA can be incorporated into future treatment algorithms for patients undergoing hepatic resection for CRLM.



Papers Referenced (in the order they were mentioned in the episode):



1)    Newhook TE, Overman MJ, Chun YS, et al. Prospective Study of Perioperative Circulating Tumor DNA Dynamics in Patients Undergoing Hepatectomy for Colorectal Liver Metastases. Ann Surg. 2023;277(5):813-820.

https://pubmed.ncbi.nlm.nih.gov/35797554/



2)    Nishioka Y, Chun YS, Overman MJ, et al. Effect of Co-mutation of RAS and TP53 on Postoperative ctDNA Detection and Early Recurrence after Hepatectomy for Colorectal Liver Metastases. J Am Coll Surg. 2022;234(4):474-483.

https://pubmed.ncbi.nlm.nih.gov/35290266/



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Journal Review in Hepatobiliary Surgery: ctDNA & Colorectal Liver Metastasis

Taking a lactating patient the OR? Prescribing antibiotics? What about a CT scan with IV contrast? Pump and dump, right? WRONG. It's time to get educated! Today, we review the finer points of caring for our lactating patients. 



In this episode Dr. Patrick Georgoff is joined by Dr. Austin Eckhoff, general surgery resident at Duke University, Dr. Annie Dotson, family medicine and breastfeeding medicine physician at Duke University, and Dr. Katrina Mitchell, breast surgeon at Ridley Tree Cancer Center in Santa Barbara, CA. 



Resources: 

https://www.bfmed.org/ 

https://www.e-lactancia.org/ 

https://physicianguidetobreastfeeding.org/



- - 



TRASH THE PUMP & DUMP: https://physicianguidetobreastfeeding.org/trash-the-pump-and-dump/trash-pump-dump/



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Is "Pump and Dump" Outdated?  An Update on Lactating Patients

The American Board of Surgery In-Training Examination will officially be switching from reporting percentile scores by year level to percent of questions correct. What does this change mean for residents? Podcast hosts Dr. Ananya Anand, Dr. Joe L’Huillier, and Dr. Rebecca Moreci are joined by three fellow CoSEF members for this discussion: Dr. Gus Godley, Dr. Colleen McDermott, and Dr. Josh Roshal. 



Hosts:



–Dr. Ananya Anand, Stanford University, @AnanyaAnandMD, ananya_anand@stanford.edu



–Dr. Joseph L’Huillier, University at Buffalo, @JoeLHuillier101, josephlh@buffalo.edu



–Dr. Rebecca Moreci, Louisiana State University, @md_moreci, morecir@med.umich.edu



–COSEF: @surgedfellows



Special guests: 



-Dr. Gus Godley, University of Chicago, frederick.godley@uchicagomedicine.org, @GusGodley



-Dr. Colleen McDermott, University of Utah, colleen.mcdermott@hsc.utah.edu



-Dr. Josh Roshal, Brigham and Women’s Hospital, jaroshal@utmb.edu, @Joshua_Roshal



Learning Objectives: 



Listeners will:

 – Understand the changes to the ABSITE score reporting by the American Board of Surgery 



– Describe both positive impacts and limitations of this change from the resident perspective



– List possible ideas for further refinements to standardized exams in medicine  



References:

 -Yeo HL, Dolan PT, Mao J, Sosa JA. Association of Demographic and Program Factors With American Board of Surgery Qualifying and Certifying Examinations Pass Rates. JAMA Surg. Jan 1 2020;155(1):22-30. doi:10.1001/jamasurg.2019.4081 https://pubmed.ncbi.nlm.nih.gov/31617872/



-Sathe TS, Wang JJ, Yap A, Zhao NW, O’Sullivan P, Alseidi A. Proposed Reforms to the American Board of Surgery In-Training Examination (ABSITE). https://www.ideasurg.pub/proposed-absite-reforms/



-Miller AT, Swain GW, Midmar M, Divino CM. How Important Are American Board of Surgery In-Training Examination Scores When Applying for Fellowships? J Surg Educ. 2010;67(3):149-151. doi:10.1016/j.jsurg.2010.02.007 

https://pubmed.ncbi.nlm.nih.gov/20630424/



-Savoie KB, Kulaylat AN, Huntington JT, Kelley-Quon L, Gonzalez DO, Richards H, Besner G, Nwomeh BC, Fisher JG. The pediatric surgery match by the numbers: Defining the successful application. J Pediatr Surg. 2020;55(6):1053-1057. doi:10.1016/j.jpedsurg.2020.02.052 https://pubmed.ncbi.nlm.nih.gov/32197826/



-Alnahhal KI, Lyden SP, Caputo FJ, Sorour AA, Rowe VL, Colglazier JJ, Smith BK, Shames ML, Kirksey L. The USMLE® STEP 1 Pass or Fail Era of the Vascular Surgery Residency Application Process: Implications for Structural Bias and Recommendations. Annals of Vascular Surgery. 2023;94:195-204. doi:10.1016/j.avsg.2023.04.018 

https://pubmed.ncbi.nlm.nih.gov/37120072/



-Williams M, Kim EJ, Pappas K, Uwemedimo O, Marrast L, Pekmezaris R, Martinez J. The impact of United States Medical Licensing Exam (USMLE) step 1 cutoff scores on recruitment of underrepresented minorities in medicine: A retrospective cross‐sectional study. Health Sci Rep. 2020;3(2):e2161. doi:10.1002/hsr2.161 https://pubmed.ncbi.nlm.nih.gov/32318628/



-Lucey CR, Saguil A. The Consequences of Structural Racism on MCAT Scores and Medical School Admissions: The Past Is Prologue. Academic Medicine. 2020;95(3):351. doi:10.1097/ACM.0000000000002939 https://pubmed.ncbi.nlm.nih.gov/31425184/



-Natanson H, Svrluga S. The SAT is coming back at some colleges. It’s stressing everyone out. Washington Post. https://www.washingtonpost.com/education/2024/03/18/sat-test-policies-confuse-students/. Published March 19, 2024. Accessed April 5, 2024.



-de Virgilio C, Yaghoubian A, Kaji A, Collins JC, Deveney K, Dolich M, Easter D, Hines OJ, Katz S, Liu T, Mahmoud A, Melcher ML, Parks S, Reeves M, Salim A, Scherer L, Takanishi D, Waxman K.. Predicting Performance on the American Board of Surgery Qualifying and Certifying Examinations: A Multi-institutional Study. Archives of Surgery. 2010;145(9):852-856. doi:10.1001/archsurg.2010.177 https://pubmed.ncbi.nlm.nih.gov/20855755/



-Weighted test content from the ABS: 

https://www.absurgery.org/wp-content/uploads/2023/01/GS-ITE.pdf



-USMLE program announces upcoming policy changes | USMLE. Accessed April 9, 2024. https://www.usmle.org/usmle-program-announces-upcoming-policy-changes

 

Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  



If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen


Hot Topics in Surgery: Opioid Epidemic with Dr. Englesbe

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