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  • Journal Review in Trauma Surgery: Whole Blood Resuscitation in Trauma

    Journal Review in Trauma Surgery: Whole Blood Resuscitation in Trauma
    2025/03/03
    Do you find yourself saying: “Hey, what’s the big idea with that newfangled whole blood in the refrigerator next to the trauma bay?” Like using whole blood but not sure why? Don’t like using whole blood but not sure why? Join us for a 30 minute power session in whole blood where we try to get you the information you need to know!

    Hosts:
    - Michael Cobler-Lichter, MD, PGY4/R2:
    University of Miami/Jackson Memorial Hospital/Ryder Trauma Center
    @mdcobler (X/twitter)

    - Eva Urrechaga, MD, PGY-8, Vascular Surgery Fellow
    University of Pennsylvania
    Recent graduate of University of Miami/Jackson Memorial Hospital/Ryder Trauma Center General Surgery Residency
    @urrechisme (X/twitter)

    - Eugenia Kwon, MD, Trauma/Surgical Critical Care Attending:
    Loma Linda University
    Recent graduate of University of Miami/Jackson Memorial Hospital/Ryder Trauma Center Trauma/CC Fellowship

    - Jonathan Meizoso, MD, MSPH Assistant Professor of Surgery, 6 years in practice
    University of Miami/Jackson Memorial Hospital/Ryder Trauma Center
    @jpmeizoso (twitter)

    Learning Objectives:
    - Describe the proposed benefits of whole blood resuscitation in trauma

    - Identify current problems with synthesizing the existing literature on whole blood resuscitation in trauma

    - Propose needed areas for future research regarding whole blood resuscitation in trauma

    Quick Hits:
    1. There is significant heterogeneity in study design across whole blood resuscitation studies, complicating comparison

    2. There is likely a mortality benefit to whole blood resuscitation in trauma, however this is likely dependent on the specific population

    3. Future research directions should focus on prospective randomized work to try and better quantify the exact benefit of whole blood, and determine in which populations this benefit is actually realized

    References

    1. Hazelton JP, Ssentongo AE, Oh JS, Ssentongo P, Seamon MJ, Byrne JP, Armento IG, Jenkins DH, Braverman MA, Mentzer C, Leonard GC, Perea LL, Docherty CK, Dunn JA, Smoot B, Martin MJ, Badiee J, Luis AJ, Murray JL, Noorbakhsh MR, Babowice JE, Mains C, Madayag RM, Kaafarani HMA, Mokhtari AK, Moore SA, Madden K, Tanner A 2nd, Redmond D, Millia DJ, Brandolino A, Nguyen U, Chinchilli V, Armen SB, Porter JM. Use of Cold-Stored Whole Blood is Associated With Improved Mortality in Hemostatic Resuscitation of Major Bleeding: A Multicenter Study. Ann Surg. 2022 Oct 1;276(4):579-588. doi: 10.1097/SLA.0000000000005603. Epub 2022 Jul 18. PMID: 35848743.
    https://pubmed.ncbi.nlm.nih.gov/35848743/

    2. Sperry JL, Cotton BA, Luther JF, Cannon JW, Schreiber MA, Moore EE, Namias N, Minei JP, Wisniewski SR, Guyette FX; Shock, Whole Blood, and Assessment of Traumatic Brain Injury (SWAT) Study Group. Whole Blood Resuscitation and Association with Survival in Injured Patients with an Elevated Probability of Mortality. J Am Coll Surg. 2023 Aug 1;237(2):206-219. doi: 10.1097/XCS.0000000000000708. Epub 2023 Apr 11. PMID: 37039365; PMCID: PMC10344433.
    https://pubmed.ncbi.nlm.nih.gov/37039365/

    3. Meizoso JP, Cotton BA, Lawless RA, et al. Whole blood resuscitation for injured patients requiring transfusion: A systematic review, meta-analysis, and practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2024;97(3):460-470. doi:10.1097/TA.0000000000004327
    https://pubmed.ncbi.nlm.nih.gov/38531812/

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    29 分
  • How Do You Maintain Relationships as a Surgeon? A BTK Roundtable

    How Do You Maintain Relationships as a Surgeon? A BTK Roundtable
    2025/02/27
    Join the BTK crew as they discuss how surgeons maintain relationships despite the demanding nature of their profession. The speakers are surgeons at different career stages (residents, fellows, attendings) and they share tips and tricks for maintaining relationships with significant others, children, parents, and friends.

    ***Scroll to the bottom and download our Coloring and Activity book for Kids here: https://app.behindtheknife.org/home

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    36 分
  • Journal Review in Bariatric Surgery: Pediatric Bariatric Surgery

    Journal Review in Bariatric Surgery: Pediatric Bariatric Surgery
    2025/02/24
    Join the Behind the Knife Bariatric Surgery Team as they kick off 2025 with a crucial discussion on pediatric and adolescent bariatric surgery. Drs. Matt Martin, Adrian Dan and Katherine Cironi delve into the latest ASMBS guidelines, comparing long-term outcomes of gastric bypass and sleeve gastrectomy in adolescents versus adults. They explore key comorbidities, including type 2 diabetes, hypertension, and orthopedic issues, and emphasize the importance of early intervention. This episode also tackles the complex ethical considerations surrounding surgery in this vulnerable population, including consent, multidisciplinary care, and the evolving role of medical therapies like GLP-1 agonists. Show Hosts: - Matthew Martin - Adrian Dan - Katherine Cironi Learning Objectives: · Identify the current ASMBS guidelines for pediatric and adolescent bariatric surgery, including BMI thresholds and associated comorbidities. · Describe common comorbidities seen in the pediatric population eligible for bariatric surgery, such as type 2 diabetes, hypertension, and orthopedic issues. · Compare and contrast long-term outcomes of bariatric surgery (gastric bypass and sleeve gastrectomy) in adolescents and adults, including remission rates of comorbidities and reoperation rates. · Discuss the importance of a multidisciplinary approach, including psychological and ethical considerations, when evaluating adolescent patients for bariatric surgery. · Explain the ethical framework used in evaluating adolescents for bariatric surgery, including consent/assent, parental involvement, and addressing potential coercion. · Recognize the evolving role of medical management (e.g., GLP-1 agonists) in conjunction with or as an alternative to bariatric surgery in adolescents. Article #1: Inge 2019 – Five-year outcomes of gastric bypass in adolescents as compared with adults https://pubmed.ncbi.nlm.nih.gov/31461610/ - The cumulative effect of sustained severe obesity (BMI >35) from adolescence into adulthood increases the likelihood of diabetes, hypertension, respiratory conditions, kidney dysfunction, walking limitations, and venous edema in legs/feet (when compared to adults that did not report severe obesity in adolescence) - American Society for Metabolic and Bariatric Surgery (ASMBS) guidelines for adolescents who should be considered for bariatric surgery: BMI is ≥35 with a co-morbidity or if they have a BMI ≥40 (class 3 obesity, 140% of the 95th percentile) - This article utilizes the Teen-Longitudinal Assessment of Bariatric Surgery (TEENS LAB) and LABS (adults) databases to evaluate the outcomes of adolescents vs. adults who underwent bariatric surgery Roux-en-Y gastric bypass (2006-2009) - 161 adolescents (13-19 at the time of surgery) with severe obesity (BMI>35) vs 396 adults (25-50 years old at the time of surgery) who have remained obese (BMI>30) since adolescence - Both groups had the gastric bypass procedure as their primary bariatric operation - Both groups had unadjusted similar demographics, however, BMI was higher in adolescence (54) when compared to adults (51) - Results were analyzed using linear mixed and Poisson mixed models to analyze weight and coexisting conditions - After surgery, adolescents were significantly more likely than adults to have remission of type 2 diabetes and hypertension - Increased likelihood of remission of diabetes due to the shorter duration of diabetes, lower baseline glycated Hgb, less use of medications, and increased baseline C-peptide levels - Increased vascular stiffness in adults along with a longer duration of hypertension make the cessation of hypertension less responsive with surgery in adults - No significant difference in percent weight changes between adolescents and adults 5 years after surgery - Both adults and adolescent groups had decreased rates of hypertriglyceridemia and low HDL levels, albeit not significantly different when comparing the two groups - Of note, the rate of abdominal reoperations was significantly higher among adolescents (20%) than among adults (16%) with cholecystectomy representing nearly half the procedures in both groups - Limitations - At baseline, adults had a high prevalence of both diabetes and hypertension - only 14% of adolescents had diabetes vs 31% of adults - Only 30% of adolescents had hypertension vs 61% of adults Article #2: Ryder 2024 – Ten-year outcomes after bariatric surgery in adolescents https://pubmed.ncbi.nlm.nih.gov/39476348/ - The goal is to discuss the long-term durability of weight loss and remission of coexisting conditions in adolescents after bariatric surgery - This article utilizes the Teen-Longitudinal Assessment of Bariatric Surgery (TEENS LABS) database to evaluate the 10-year outcomes in adolescents who underwent gastric bypass or sleeve gastrectomy - 260 adolescents with an average age of 17 years old at the time of surgery (ages ranged from 13-19 ...
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    35 分
  • Generational Dynamics in Surgical Education

    Generational Dynamics in Surgical Education
    2025/02/20
    You're a new attending leading a busy surgical service. You’re tasked with teaching a team that includes every learner from medical students to junior and senior residents—all from different generations. How do you adapt your teaching style to effectively reach everyone? Dr. Abbey Fingeret, Endocrine Surgeon at University of Nebraska and passionate Surgical Educator, joins our host, Dr. Elizabeth Maginot, to explore strategies for engaging learners across generations and creating inclusive, dynamic teaching environments.
    Hosts:
    • Dr. Abbey Fingeret, MD, MHPTT, FACS: Associate Professor, University of Nebraska Medical Center Department of Surgery, Division of Surgical Oncology, Twitter: @DrFingeret
    • Dr. Elizabeth Maginot, MD: General Surgery Resident and BTK Surgical Education Fellow, University of Nebraska Medical Center, Twitter: @e_magination95
    Learning Objectives:
    - Understand the defining characteristics of Baby Boomers, Gen X, Millennials, and Gen Z, and how these traits influence their learning and teaching styles in medical education.
    - Explore how to adapt teaching strategies for multigenerational learners by understanding and addressing their unique perceptions of education, feedback, and expectations in the clinical setting.
    - Discuss methods to build a positive learning environment that fosters collaboration and inclusivity across all levels of trainees.
    - Recognize the strengths and challenges different generations bring to medical education and how to leverage these to enhance team learning and patient care."

    References
    Stillman, D., & Stillman, J. (2017). Gen Z@ work: How the next generation is transforming the workplace. HarperCollins. https://pubmed.ncbi.nlm.nih.gov/?term=Stillman%2C+D.%2C+%26+Stillman%2C+J.+%282017%29.+Gen+Z%40+work%3A+How+the+next+generation+is+transforming+the+workplace.+HarperCollins.

    Elmore, T., & McPeak, A. (2019). Generation Z unfiltered: Facing nine hidden challenges of the most anxious population. Poet Gardener Publishing.

    Twenge, J. M. (2023). Generations: The Real Differences Between Gen Z, Millennials, Gen X, Boomers, and Silents—and What They Mean for America's Future. Simon and Schuster.

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    37 分
  • Clinical Challenges in Surgical Oncology: Neuroendocrine Tumors of the Small Bowel

    Clinical Challenges in Surgical Oncology: Neuroendocrine Tumors of the Small Bowel
    2025/02/17
    Join the Behind the Knife Surgical Oncology Team as we discuss the presentation, work-up, and management of neuroendocrine tumors of the small bowel.

    Learning Objectives:
    In this episode, we review the basics of neuroendocrine (NE) tumors of the small bowel, including how to evaluate patients with presenting symptoms consistent with NE tumors, initial work-up, staging, and management. We discuss key concepts including DOTATATE scans and medical therapies high yield for direct patient care and board exams.

    Hosts:
    Timothy Vreeland, MD, FACS (@vreelant) is an Assistant Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center

    Daniel Nelson, DO, FACS (@usarmydoc24) is Surgical Oncologist/HPB surgeon at Kaiser LAMC in Los Angeles.

    Connor Chick, MD (@connor_chick) is a 2nd Year Surgical Oncology fellow at Ohio State University.

    Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a 1st Year Surgical Oncology fellow at MD Anderson.

    Beth (Elizabeth) Barbera, MD (@elizcarpenter16) is a PGY-6 General Surgery resident at Brooke Army Medical Center

    Links to Paper Referenced in this Episode:
    Strosberg J, El-Haddad G, Wolin E, Hendifar A, Yao J, Chasen B, Mittra E, Kunz PL, Kulke MH, Jacene H, Bushnell D, O'Dorisio TM, Baum RP, Kulkarni HR, Caplin M, Lebtahi R, Hobday T, Delpassand E, Van Cutsem E, Benson A, Srirajaskanthan R, Pavel M, Mora J, Berlin J, Grande E, Reed N, Seregni E, Öberg K, Lopera Sierra M, Santoro P, Thevenet T, Erion JL, Ruszniewski P, Kwekkeboom D, Krenning E; NETTER-1 Trial Investigators. Phase 3 Trial of 177Lu-Dotatate for Midgut Neuroendocrine Tumors. N Engl J Med. 2017 Jan 12;376(2):125-135. doi: 10.1056/NEJMoa1607427. PMID: 28076709; PMCID: PMC5895095.
    https://pubmed.ncbi.nlm.nih.gov/28076709/

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    41 分
  • A Digital Education Manifesto: How You Can Make Great Content

    A Digital Education Manifesto: How You Can Make Great Content
    2025/02/13
    Join Patrick Georgoff to learn more about how YOU can make amazing digital education content. At Behind the Knife we are often asked how to create digital education content. Thanks to the democratization of technology and rise of the creator economy, all of the tools are at your fingertips. Would you like to enhance your next lecture, grant application, manuscript submission, or patient educational material? You can, even if you are part luddite! You don't need a publisher, advanced computer skills, or tons of money. Don't believe us? Listen to this short podcast for tipsand tricks on how you can make great content.

    Patrick Georgoff (@georgoff) is an Acute Care Surgeon at Duke University. He went to medical school at the University of Pennsylvania, completed General Surgery residency and Surgical Critical Care fellowship at the University of Michigan, and a Trauma Surgery fellowship at the University of Texas in Houston. His clinical practice includes the full spectrum of Acute Care Surgery in addition to elective hernia surgery. Patrick is deeply involved in surgical education and the is the Associate Program of the General Surgery Residency at Duke and Co-Director of Behind the Knife. He is passionate about trauma system performance and holds the position of associate Trauma Medical Director at Duke.

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    20 分
  • Journal Review in Hernia Surgery: Sugarbaker versus Keyhole for Retromuscular Parastomal Hernia Repair

    Journal Review in Hernia Surgery: Sugarbaker versus Keyhole for Retromuscular Parastomal Hernia Repair
    2025/02/10
    Join Drs. Michael Rosen, Clayton Petro, and Sara Maskal as they review their recently published randomized controlled trial comparing open retromuscular Sugarbaker and Keyhole approaches to parastomal hernia repair

    Hosts:
    - Sara Maskal, MD, Cleveland Clinic
    - Clayton Petro, MD, Cleveland Clinic
    - Michael Rosen, MD, Cleveland Clinic
    Learning Objectives:
    - Understand the trial design
    - Review trial outcomes
    - Understand how to apply the outcomes to patients with parastomal hernias

    References:
    -     Maskal SM, Ellis RC, Fafaj A, et al. Open Retromuscular Sugarbaker vs Keyhole Mesh Placement for Parastomal Hernia Repair: A Randomized Clinical Trial. JAMA Surg. Published online June 12, 2024. doi:10.1001/jamasurg.2024.1686 https://pubmed.ncbi.nlm.nih.gov/38865142/
    - Maskal SM, Thomas JD, Miller BT, Fafaj A, Zolin SJ, Montelione K, Ellis RC, Prabhu AS, Krpata DM, Beffa LR, Costanzo A. Open retromuscular keyhole compared with Sugarbaker mesh for parastomal hernia repair: Early results of a randomized clinical trial. Surgery. 2024 Mar 1;175(3):813-21. https://pubmed.ncbi.nlm.nih.gov/37770344/
    - Moreno-Matias J, Serra-Aracil X, Darnell-Martin A, Bombardo-Junca J, Mora-Lopez L, Alcantara-Moral M, Rebasa P, Ayguavives-Garnica I, Navarro-Soto S. The prevalence of parastomal hernia after formation of an end colostomy. A new clinico-radiological classification. Colorectal Dis. 2009 Feb;11(2):173-7. doi: 10.1111/j.1463-1318.2008.01564.x. Epub 2008 May 3. PMID: 18462232. https://pubmed.ncbi.nlm.nih.gov/18462232/

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    36 分
  • Clinical Challenges in Colorectal Surgery: Parastomal Hernias

    Clinical Challenges in Colorectal Surgery: Parastomal Hernias
    2025/02/06
    You are planning to perform an APR on a patient with rectal cancer. How will you create your permanent stoma? Is there a role for prophylactic mesh? Post operatively at one year surveillance they have developed a parastomal hernia, when do you fix it and how? Join Drs. Abelson, Marcello and Aulet and special guest Dr. Paul Sturrock as they discuss key management considerations.
    Learning Objectives:
    1. Describe the different types of parastomal hernia repairs
    2. List indications for repair of parastomal hernias
    3. Discuss the approach to managing parastomal hernias
    Articles:
    Steele S, et al. The ASCRS Textbook of Colon and Rectal Surgery, fourth ed. 2022. https://link.springer.com/book/10.1007/978-3-030-66049-9
    J C Goligher, Extraperitoneal colostomy or ileostomy, British Journal of Surgery, Volume 46, Issue 196, September 1958, Pages 97–103, https://doi.org/10.1002/bjs.18004619602

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    34 分