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  • SHOWNOTES


    Learn more about our Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship course and preview a full chapter here: https://app.behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship

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    DOMINATE THE DAY

  • You're the new intern on your first night of night float. First page, right off the bat – AFib with rates into the 150s. What's your next move?! Dr. Nathan Anderson takes the anxiety out of approaching Atrial Fibrillation in the post-operative patient. Join him and Dr. Elizabeth Maginot as they discuss this very common post-operative you're guaranteed to see on the wards.

    Hosts:
    - Dr. Nathan Anderson, Internal Medicine Associate Professor and Hospitalist, University of Nebraska
    - Dr. Elizabeth Maginot, General Surgery Resident and BTK Surgical Education Fellow, University of Nebraska Medical Center, Twitter: @e_magination95

    Learning Objectives:
    - Discuss the underlying pathophysiological mechanisms that contribute to the development of atrial fibrillation in the postoperative setting.
    - Critically approach the different management options for atrial fibrillation in the post-cardiac and non-cardiac surgery settings, including rate versus rhythm control, indications for cardioversion, and the role of anticoagulation.
    - Identify common risk factors for atrial fibrillation in the post-operative setting.
    - Discuss long-term management and follow-up strategies for patients who develop atrial fibrillation after surgery.

    References:
    1. Bhave PD, Goldman LE, Vittinghoff E, Maselli J, Auerbach A. Incidence, predictors, and outcomes associated with postoperative atrial fibrillation after major noncardiac surgery. AmericanHeart Journal. 2012;164(6):918-924. doi:10.1016/j.ahj.2012.09.004
    https://pubmed.ncbi.nlm.nih.gov/23194493/
    2. Gialdini G, Nearing K, Bhave PD, et al.. Perioperative Atrial Fibrillation and the Long-term Risk ofIschemic Stroke. JAMA. 2014;312(6):616. doi:10.1001/jama.2014.9143
    https://pubmed.ncbi.nlm.nih.gov/25117130/
    3. Snow V, Weiss KB, LeFevre M, McNamara R, Bass E, Green LA, Michl K, Owens DK, Susman J, Allen DI, Mottur-Pilson C; AAFP Panel on Atrial Fibrillation; ACP Panel on Atrial Fibrillation.Management of newly detected atrial fibrillation: a clinical practice guideline from the AmericanAcademy of Family Physicians and the American College of Physicians. Ann Intern Med. 2003 Dec16;139(12):1009-17. doi: 10.7326/0003-4819-139-12-200312160-00011. PMID: 14678921.
    https://pubmed.ncbi.nlm.nih.gov/14678921/
    4. A Comparison of Rate Control and Rhythm Control in Patients with Atrial Fibrillation. NewEngland Journal of Medicine. 2002;347(23):1825-1833. doi:10.1056/nejmoa021328
    https://pubmed.ncbi.nlm.nih.gov/12466506/

    Learn more about our Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship course and preview a full chapter here: https://app.behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship

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    DOMINATE THE DAY

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  • Parastomal hernias are some of the toughest cases in abdominal wall reconstruction. Join Drs. Ajita Prabhu, Lucas Beffa, Sara Maskal and Ryan Ellis as they talk through their approach to these difficult cases.

    Hosts:
    - Ajita Prabhu, MD, Cleveland Clinic, @aprabhumd1
    - Lucas Beffa, MD, Cleveland Clinic, @BeffaLukeMD
    - Ryan Ellis, MD, Cleveland Clinic, @EllisMD2020
    - Sara Maskal, MD, Cleveland Clinic

    Learning Objectives:
    - Review anatomy of parastomal abdominal wall hernias
    - Review perioperative pitfalls and tips for staying out of trouble
    - Review common surgical approaches to repair

    References:
    - Maskal SM, Ellis RC, Miller BT. Parastomal hernia repair, trying to optimize the impossible reconstruction. Hernia. 2024 Apr 28:1-6. https://pubmed.ncbi.nlm.nih.gov/38678529/
    - 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/

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  • A patient with a large TBSA burn injury is transferred to a regional burn center. You are faced with some difficult clinical decisions as the resuscitation proves to be challenging. Join Drs. Tam Pham, Rob Cartotto, Julie Rizzo, Alex Morzycki and Jamie Oh as they discuss the clinical challenges in titrating and troubleshooting during acute burn resuscitation.

    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:
    · Understand the role of colloids as complement/rescue to standard crystalloid fluid titration.
    · Identify the fluid threshold associated with development of abdominal compartment syndrome
    · Understand the role of continuous renal replacement therapy for patients with acute kidney injury during the resuscitation phase.
    · List specific patient populations who may experience a more difficult resuscitation.

    References:

    1. Ivy ME, Atweh NA, Palmer J, et al. Intra-abdominal hypertension and abdominal compartment syndrome in burn patients. J Trauma 2000
    https://pubmed.ncbi.nlm.nih.gov/11003313/
    2. 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/
    3. Greenhalgh DG, Cartotto R, Taylor SL, et al. Burn Resuscitation practices in North America: results of the Acute Burn ResUscitation Prospective Trial (ABRUPT). Ann Surg 2023
    https://pubmed.ncbi.nlm.nih.gov/34417368/
    4. Cartotto R, Callum J. A review of the use of human albumin in burn patients. J Burn Care Res 2012
    https://pubmed.ncbi.nlm.nih.gov/23143614/
    5. Cruz MV, Carney BC, Luker JN, et al. Plasma ameliorates endothelial dysfunction in burn injury. J Surg Res 2019
    https://pubmed.ncbi.nlm.nih.gov/30502286/
    6. Falhstrom K, Boyle C, Makic MBF. Implementation of a nurse-driven burn resuscitation protocol: a quality improvement project. Critical Care Nurses 2013
    https://pubmed.ncbi.nlm.nih.gov/23377155/
    7. Salinas J, Chung KK, Mann EA, et al. Computerized decision support system improves fluid resuscitation following severe burns: an original study. Crit Care Med 2011
    https://pubmed.ncbi.nlm.nih.gov/21532472/
    8. Kenney CL, Singh P, Rizzo J, et al. Impact of alcohol and methamphetamine use on burn resuscitation. J Burn Care Res 2023
    https://pubmed.ncbi.nlm.nih.gov/37227949/

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  • Are you ready to DOMINATE surgery? Well let's go! Perform at the highest level on day one of your rotation using our easy to navigate text, tables, flashcards, podcasts, and videos. Go beyond rote memorization and learn what really matters. We are talking practical, high-yield, and engaging content all available at your fingertips. Get the information you need to know FAST. Whether it's learning how to two-hand tie, work up a patient with a colon mass, or organizing yourself for rounds, Behind the Knife has got you covered.

    Today's episode includes 2 sample episodes from this course. Learn more and preview a full chapter here: https://app.behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship

    More Behind the Knife Student Resources: https://app.behindtheknife.org/students

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

    DOMINATE THE DAY

  • Are you ready to DOMINATE surgery? Well let's go! Perform at the highest level on day one of your rotation using our easy to navigate text, tables, flashcards, podcasts, and videos. Go beyond rote memorization and learn what really matters. We are talking practical, high-yield, and engaging content all available at your fingertips. Get the information you need to know FAST. Whether it's learning how to two-hand tie, work up a patient with a colon mass, or organizing yourself for rounds, Behind the Knife has got you covered.

    Today's episode includes 2 sample episodes from this course. Learn more and preview a full chapter here: https://app.behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship

    More Behind the Knife Student Resources: https://app.behindtheknife.org/students

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

    DOMINATE THE DAY

  • Join for the fifth episode in the Association of Out Surgeons and Allies (AOSA) series for a comprehensive discussion of what the general surgeon needs to know prior to operating on a patient who has previously undergone gender affirming surgery.

    Host:
    Dan Scheese, MD
    Andrew Schlussel, DO, Colorectal and General Surgeon, Charlie Norwood VA Medical Center

    Guests:
    Dr. Megan Lane (She/her)
    [email protected]
    Dr. Lane is a plastic surgery resident at the University of Michigan who is planning on going into Gender Affirming Surgery and general reconstruction. She completed a research fellowship in the National Clinician Scholars Program and focused primarily on patient-reported outcomes in gender affirming surgery.

    Dr. Amy Suwanabol
    [email protected]
    Dr. Suwanabol is a colorectal surgeon at the University of Michigan and the Ann Arbor VA. She assists the gender affirming surgeons at the University of Michigan in performing robotic-assisted vaginoplasty. Her research focuses on optimizing quality of life among surgical patients and their families, surgeon well-being, and cancer survivorship.

    Dr. Monica Llado-Farrulla
    [email protected]
    Dr. Llado-Farrulla was born and raised in Puerto-Rico, completed general surgery residency followed by plastic surgery residency at Tulane and Penn, respectively. She pursued a year of training in advanced gender surgery and is now currently at OHSU. Her practice largely focuses on facial feminization, chest affirming surgeries, phalloplasty, autologous breast reconstruction, and limb salvage.

    Learn more and get involved with AOSA: https://www.outsurgeons.org

    Twitter/X: @OutSurgeons

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  • Have you ever been confused about the concept of brain death, or struggled to explain brain death to a patient’s family or your fellow clinicians? Join the Behind the Knife Surgical Palliative Care team and our special guest, neurologist & neurointensivist Dr. Sarah Wahlster, as we explore the 2023 Pediatric & Adult Brain Death/Death by Neurologic Criteria Consensus Practice Guideline and what this updated guideline means for our practice in surgical palliative care!

    Hosts:
    Dr. Katie O’Connell (@katmo15) is an Associate Professor of Surgery at the University of Washington in the division of Trauma, Burn, and Critical Care Surgery. 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 in Seattle, WA.

    Dr. Virginia Wang is a PGY-3 General Surgery resident at the University of Washington.

    Guest:
    Dr. Sarah Wahlster (@SWahlster) is an Associate Professor of Neurology at the University of Washington. She is a neurologist, neurointensivist, and Program Director of the Neurocritical Care Fellowship at Harborview Medical Center in Seattle, WA.

    Learning Objectives:
    · Understand the concept of assent and how it can be helpful in communicating with families of patients who have sustained brain death
    · Explain the main steps required for diagnosis of brain death (prerequisites, clinical exam, apnea testing, ancillary testing)
    · Understand key differences between the 2023 guideline and previous (2010 & 2011) guidelines
    · Be able to name the 3 accepted modalities of ancillary testing for brain death
    · Know basic communication best practices with families of patients who have sustained brain death from the surgical palliative care perspective (consistency of language & messaging; avoidance of phrases such as “life-sustaining treatment”, “comfort-focused measures”)

    References:

    1. Greer, D. M., Kirschen, M. P., Lewis, A., Gronseth, G. S., Rae-Grant, A., Ashwal, S., Babu, M. A., Bauer, D. F., Billinghurst, L., Corey, A., Partap, S., Rubin, M. A., Shutter, L., Takahashi, C., Tasker, R. C., Varelas, P. N., Wijdicks, E., Bennett, A., Wessels, S. R., & Halperin, J. J. (2023). Pediatric and Adult Brain Death/Death by Neurologic Criteria Consensus Guideline. Neurology, 101(24), 1112–1132. https://doi.org/10.1212/WNL.0000000000207740

    2. Lewis, A., Kirschen, M. P., & Greer, D. (2023). The 2023 AAN/AAP/CNS/SCCM Pediatric and Adult Brain Death/Death by Neurologic Criteria Consensus Practice Guideline: A Comparison With the 2010 and 2011 Guidelines. Neurology. Clinical practice, 13(6), e200189. https://doi.org/10.1212/CPJ.0000000000200189

    3. AAN Interactive Brain Death/Death by Neurologic Criteria Evaluation Tool – https://www.aan.com/Guidelines/BDDNC

    4. AAN Brain Death/Death by Neurologic Criteria Checklist – https://www.aan.com/Guidelines/Home/GetGuidelineContent/1101

    5. Kirschen, M. P., Lewis, A., & Greer, D. M. (2024). The 2023 American Academy of Neurology, American Academy of Pediatrics, Child Neurology Society, and Society of Critical Care Medicine Pediatric and Adult Brain Death/Death by Neurologic Criteria Determination Consensus Guidelines: What the Critical Care Team Needs to Know. Critical care medicine, 52(3), 376–386. https://doi.org/10.1097/CCM.0000000000006099

    6. Greer, D. M., Shemie, S. D., Lewis, A., Torrance, S., Varelas, P., Goldenberg, F. D., Bernat, J. L., Souter, M., Topcuoglu, M. A., Alexandrov, A. W., Baldisseri, M., Bleck, T., Citerio, G., Dawson, R., Hoppe, A., Jacobe, S., Manara, A., Nakagawa, T. A., Pope, T. M., Silvester, W., … Sung, G. (2020). Determination of Brain Death/Death by Neurologic Criteria: The World Brain Death Project. JAMA, 324(11), 1078–1097. https://doi.org/10.1001/jama.2020.11586

    7. Lele, A. V., Brooks, A., Miyagawa, L. A., Tesfalem, A., Lundgren, K., Cano, R. E., Ferro-Gonzalez, N., Wongelemegist, Y., Abdullahi, A., Christianson, J. T., Huong, J. S., Nash, P. L., Wang, W. Y., Fong, C. T., Theard, M. A., Wahlster, S., Jannotta, G. E., & Vavilala, M. S. (2023). Caseworker Cultural Mediator Involvement in Neurocritical Care for Patients and Families With Non-English Language Preference: A Quality Improvement Project. Cureus, 15(4), e37687. https://doi.org/10.7759/cureus.37687

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

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  • Our oral board review course includes 100 scenarios that meticulously cover 115 SCORE core topics. Each scenario includes two parts. The first part is a perfectly executed oral board scenario that mimics the real thing. Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as general surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test.

    All of our premium courses are available via our website and apps (iOS and Android). Users can take notes, pin chapters and download content for offline viewing.

    Learn more about the General Surgery Oral Board Review Course at https://app.behindtheknife.org/premium

    **Institutional Discounts Available - Please email [email protected] to learn more.**

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  • Need a dose of inspiration? You found it here. This interview with Dr. Ammar Darwish will have you in awe. Dr. Darwish is a general and trauma surgery at Manchester University NHS Foundation Trust and Medical Director at The David Nott Foundation (https://davidnottfoundation.com/). Dr. Darwish volunteers for intensely dangerous but highly impactful surgical humanitarian missions in conflict zones around the world. In fact, he has been deployed to over 50 global humanitarian missions in the last 15 years. He is passionate about helping victims of conflict and natural disaster by better equipping and training doctors who care for them.

    Want to learn more about the Nott Foundation? Good! You should. Check out their website for more: https://davidnottfoundation.com/

    Interview with Dr. David Knott: https://app.behindtheknife.org/podcast/war-doctor-david-nott-on-surgery-in-war-zones

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  • Join our Emergency General Surgery team as we talk about the dreaded difficult duodenum. We discuss two cases on a common disease that has now become a rarity in surgical management. We cover principles of combined assessment and resuscitation, diagnosis and helpful adjuncts, and multidisciplinary and surgical management.

    Hosts: Drs. Ashlie Nadler, Jordan Nantais and Graham Skelhorne-Gross

    We have come a long way from managing duodenal emergencies with vagotomies since the widespread use of proton pump inhibitors. But surgeons and trainees still need to gain competence in managing duodenal emergencies, despite the dearth of operative interventions often encountered. We discuss the two most common presentations related to duodenal ulcers - bleeding and perforation. We focus on resuscitation, damage-control surgery, and the role of non-surgical management options.

    Learning Objectives:
    - Learn to investigate and resuscitate patients with upper gastrointestinal bleeding
    - Develop an approach to the management of upper gastrointestinal bleeding
    - Understand the risks and benefits of various surgical techniques for dealing with perforated duodenal ulcers

    References:

    Tarasconi, A., Coccolini, F., Biffl, W.L. et al. Perforated and bleeding peptic ulcer: WSES guidelines. World J Emerg Surg 15, 3 (2020). https://doi.org/10.1186/s13017-019-0283-9

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  • Join Drs. Galandiuk, Bolshinsky, Kavalukas, and Simon as they discuss the controversial management of colon cancer of the splenic flexure. What procedure do you perform? Does it matter? Tune in to hear the discussion!

    Hosts:
    - Susan Galandiuk MD, University of Louisville, Louisville, Kentucky, @DCREdInChief
    - Vladimir Bolshinsky MD, Peninsula Health, Victoria, Australia, @bolshinskyv
    - Sandy Kavalukas MD, University of Louisville, Louisville, Kentucky, @sandykava
    - Hillary Simon DO, University of Louisville, Louisville, Kentucky, @HillaryLSimon

    Producer:
    - Manasa Sunkara MS3, University of Louisville, Louisville, Kentucky, @manasasunkara12

    Learning objectives:
    - Review surgical procedure options for splenic flexure cancer.
    - Understand the importance of confirming the location of the tumor with imaging and/or endoscopically, perioperatively.
    - Discuss surgical principles of operating in the left upper quadrant.

    References:
    de’Angelis, et al. Extended right colectomy, left colectomy, or segmental left colectomy for splenic flexure carcinomas: a European multicenter propensity score matching analysis. Surg Endosc. 2021 (35) :661–672.
    https://pubmed.ncbi.nlm.nih.gov/32072288/

    Degiuli M, et al. Segmental Colonic Resection Is a Safe and Effective Treatment Option for Colon Cancer of the Splenic Flexure: A Nationwide Retrospective Study of the Italian Society of Surgical Oncology-Colorectal Cancer Network Collaborative Group. Dis Colon Rectum. 2020 Oct;63(10):1372-1382.
    https://pubmed.ncbi.nlm.nih.gov/32969880/

    Manceau G, et al. What Is the Optimal Elective Colectomy for Splenic Flexure Cancer: End of the Debate? A Multicenter Study From the GRECCAR Group With a Propensity Score Analysis. Dis Colon Rectum. 2022 Jan 1;65(1):55-65.
    https://pubmed.ncbi.nlm.nih.gov/34882628/

    Okazaki T, et al. Two Types of Variational Arteries' Courses From the Superior Mesenteric Artery to Supply the Splenic Flexure: Gross Anatomical Study. Dis Colon Rectum. 2024 Jan 1;67(1):120-128.
    https://pubmed.ncbi.nlm.nih.gov/37493262/

    Pang AJ, Marinescu D, Morin N, Vasilevsky CA, Boutros M. Segmental resection of splenic flexure colon cancers provides an adequate lymph node harvest and is a safe operative approach - an analysis of the ACS-NSQIP database. Surg Endosc. 2022 Aug;36(8):5652-5659.
    https://pubmed.ncbi.nlm.nih.gov/34973078/

    Rusli SM, et al. Laparoscopic D3 oncological resection in splenic flexure cancer: Technical details and its impact on long-term survival. Colorectal Dis. 2023 Mar;25(3):431-442.
    https://pubmed.ncbi.nlm.nih.gov/36281503/

    Sakamoto K, et al. Drainage pattern of the splenic flexure vein and its accompanying arteries using three-dimensional computed tomography angiography: a single-centre study of 600 patients. Colorectal Dis. 2023 Aug;25(8):1679-1685.
    https://pubmed.ncbi.nlm.nih.gov/37221647/

    Vargas, HD. Gaining Mesenteric Length following Colorectal Resection: Essential Maneuvers to Avoid Anastomotic Tension. Clin Colon Rectal Surg. 2023 Jan 13;36(1):37-46.
    https://pubmed.ncbi.nlm.nih.gov/36643828/

    Vogel JD, et al. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Colon Cancer. Dis Colon Rectum. 2022 Feb 1;65(2):148-177.
    https://pubmed.ncbi.nlm.nih.gov/34775402/

    Video References

    “Splenic Flexure Cancers.” Lahey Hospital & Medical Center. Disease of the Colon and Rectum Journal Club. February 28, 2022. https://www.youtube.com/watch?v=87HXHQYMxe4&list=PLMBNyGA6TZajQn4UlDyKxrLakFZb7SC_2&index=23

    Varela, C. and Yang, S. Laparoscopic-Assisted Colonic Resection for Splenic-Flexure Cancer With D3 Lymphadenectomy, Diseases of the Colon & Rectum 66(6):p e295-e297, June 2023. https://journals.lww.com/dcrjournal/pages/collectiondetails.aspx?TopicalCollectionID=138&ParentCollection=109

    ***TRUELEARN LINK: https://truelearn.referralrock.com/l/BTKPODCAST/
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  • Our Colorectal Surgery Oral Board Audio Review includes 51 high-yield scenarios designed for Colorectal Surgeons by Colorectal Surgeons.

    Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as colorectal surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test.

    Learn more about the full set of 51 scenarios here: https://behindtheknife.teachable.com/p/btk-colorectal-surgery-oral-board-review-course

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

  • Our Surgical Oncology Oral Board Audio Review includes 46 high-yield scenarios that cover all of the SCORE CGSO topics designed for Surgical Oncology Surgeons by Surgical Oncology Surgeons.

    Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as surgical oncology surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test.

    Learn more about the course and see all the episode topics here: https://app.behindtheknife.org/premium/surgical-oncology-oral-board-audio-review

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  • Our Vascular Surgery Oral Board Audio Review includes 72 high-yield scenarios that cover the majority of the VSCORE topics designed for Vascular Surgeons by Vascular Surgeons.

    Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as vascular surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test.

    Learn more about the full set of 72 scenarios here: https://app.behindtheknife.org/course-details/vascular-surgery-oral-board-audio-review

    Our Vascular Surgery Oral Board Book is available on Amazon here: https://www.amazon.com/dp/B0CZ8ZBF83

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  • Pregnancy leads to many physiologic changes, and thyroid and parathyroid disorders alter that physiology even more leading to complex laboratory interpretation and decision-making impacting both mother and fetus. In this episode, join endocrine surgeons Drs. Barb Miller, John Phay, Priya Dedhia, and Surgical Oncology Fellow Dr. Vennila Padmanaban from The Ohio State University. Hear about normal and abnormal thyroid and parathyroid physiology and treatment of patients with thyroid cancer. The group discusses several articles focusing on current guidelines from the American Thyroid Association as well as other key studies.

    Hosts: Barbra S. Miller, MD (Moderator), Clinical Professor of Surgery, John Phay, MD, Clinical Professor of Surgery, Priya H. Dedhia, MD, PhD, Assistant Professor of Surgery, Vennila Padmanaban, MD, Surgical Oncology Fellow, Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.

    Twitter handles:
    Barbra Miller - @OSUEndosurgBSM
    John Phay – @JohnPhayMD
    Priya Dedhia – @priyaknows
    Vennila Padmanaban - @vennilapadmanMD

    Learning objectives:
    1) Understand normal changes in thyroid and parathyroid physiology during pregnancy
    2) Describe the impact of thyroid and parathyroid dysregulation on maternal and fetal health
    3) Compare and contrast management of thyroid and parathyroid disorders during pregnancy vs. non-pregnancy
    4) Recognize the importance of multidisciplinary care of patients with thyroid and parathyroid disorders

    References:
    1. Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, Grobman WA, Laurberg P, Lazarus JH, Mandel SJ, Peeters RP, Sullivan S. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid. 2017 Mar;27(3):315-389. doi: 10.1089/thy.2016.0457. Erratum in: Thyroid. 2017 Sep;27(9):1212. doi: 10.1089/thy.2016.0457.correx. PMID: 28056690
    https://pubmed.ncbi.nlm.nih.gov/28056690/
    2. Jee SB, Sawal A. Physiological Changes in Pregnant Women Due to Hormonal Changes. Cureus. 2024 Mar 5;16(3):e55544. doi: 10.7759/cureus.55544. PMID: 38576690; PMCID: PMC10993087
    https://pubmed.ncbi.nlm.nih.gov/38576690/
    3. Patel, Kepal N. MD; Yip, Linwah MD; Lubitz, Carrie C. MD, MPH; Grubbs, Elizabeth G. MD; Miller, Barbra S. MD; Shen, Wen MD; Angelos, Peter MD; Chen, Herbert MD; Doherty, Gerard M. MD; Fahey, Thomas J. III MD; Kebebew, Electron MD; Livolsi, Virginia A. MD; Perrier, Nancy D. MD; Sipos, Jennifer A. MD; Sosa, Julie A. MD; Steward, David MD; Tufano, Ralph P. MD; McHenry, Christopher R. MD; Carty, Sally E. MD. The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults. Annals of Surgery 271(3):p e21-e93, March 2020. DOI: 10.1097/SLA.0000000000003580
    https://pubmed.ncbi.nlm.nih.gov/32079830/
    4. Appelman-Dijkstra NM, Pilz S. Approach to the Patient: Management of Parathyroid Diseases Across Pregnancy. J Clin Endocrinol Metab. 2023 May 17;108(6):1505-1513. doi: 10.1210/clinem/dgac734. PMID: 36546344; PMCID: PMC10188304
    https://pubmed.ncbi.nlm.nih.gov/36546344/
    5. Eremkina A, Bibik E, Mirnaya S, Krupinova J, Gorbacheva A, Dobreva E, Mokrysheva N. Different treatment strategies in primary hyperparathyroidism during pregnancy. Endocrine. 2022 Sep;77(3):556-560. doi: 10.1007/s12020-022-03127-3. Epub 2022 Jul 12. PMID: 35821184
    https://pubmed.ncbi.nlm.nih.gov/35821184/

    TRUELEARN LINK: https://truelearn.referralrock.com/l/BTKPODCAST/
    Discount code: BTKPODCAST

    Using the discount code, you can get a discount of $25 off our Residency (General surgery, anesthesiology, OBGYN, Psychiatry, Peds, Neurology, Emergency Medicine, Internal Medicine, and Family Medicine), USMLE, andCOMLEX SmartBank subscriptions of 90-days or more. The code can also be applied for 15% off our allied healthSmartBanks (PA, Nurse Practitioner, Pharmacy, PT, OT, etc.).

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  • Does the adult thymus have a purpose and function? Are there any long-term health effects of thymectomy? Tune in to another Swedish Thoracic surgery journal review where we discuss the recent paper out of the NEJM which reports on the health consequences of thymus removal in adults. This paper has been widely picked up by the media and our patients frequently bring it into the office. Listen as we discuss the study population, methods, and potential applications of this paper.

    Learning Objectives:

    - Review the purpose and function of the thymus.
    - Discuss the population, methods, and results of this trial.
    - Discuss the application of this paper and how it may or may not impact clinical practice for thoracic surgeons.

    Hosts:

    Chloe E. Hanson, MD, PGY-3
    Kelly Daus MD, PGY-4
    Peter White, MD, Thoracic Surgery Attending
    Brian Louie, MD, Thoracic Surgery Attending

    Reference Material:

    Kooshesh KA, Foy BH, Sykes DB, Gustafsson K, Scadden DT. Health Consequences of Thymus Removal in Adults. N Engl J Med. 2023;389(5):406-417.

    https://pubmed.ncbi.nlm.nih.gov/37530823/

    Lin TM, Chang YS, Hou TY, et al. Risk of incident autoimmune diseases in patients with thymectomy. Ann Clin Transl Neurol. 2020;7(7):1072-1082.

    https://pubmed.ncbi.nlm.nih.gov/32478484/

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  • Did you know that 13% of trauma patients who go home with an opioid prescription will develop opioid dependence? Multimodal pain regimens not only reduce opioid consumption, but also improve pain control. On this episode of the BIG T TRAUMA series, we explore a multimodal approach to pain management...and tackle some surgical dogma along the way.

    Hosts:Patrick Georgoff, MD, Trauma Surgeon, Duke University, @georgoffTeddy Puzio, MD, Trauma Surgeon, University of Texas HoustonGabby Hatton, MD, Trauma Surgery fellow, University of Texas Houston References:
    1. Rate and Risk Factors Associated With Prolonged Opioid Use After Surgery: A Systematic Review and Meta-analysis. JAMA Netw Open 2020: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767637
    2. Traumatic injuries and persistent opioid use in the USA: findings from a nationally representative survey. Injury Prevention 2017: https://pubmed.ncbi.nlm.nih.gov/27597400/
    3. Ketamine For Acute Pain After Trauma (KAPT): A Pragmatic, Randomized Clinical Trial. J Trauma 2024:
    https://pubmed.ncbi.nlm.nih.gov/38689402/
    4. EAST PMG: Efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs) for the treatment of acute pain after orthopedic trauma (2023): https://www.east.org/education-resources/practice-management-guidelines/details/efficacy-and-safety-of-nonsteroidal-antiinflammatory-drugs-nsaids-for-the-treatment-of-acute-pain-af
    5. Systematic Review and Meta-Analysis of the Association Between Non-Steroidal Anti-Inflammatory Drugs and Operative Bleeding in the Perioperative Period. JACS 2021:
    https://pubmed.ncbi.nlm.nih.gov/33515678/
    6. Is the use of nonsteroidal anti-inflammatories after bowel anastomosis in trauma safe? J Trauma 2023:
    https://pubmed.ncbi.nlm.nih.gov/36728125/
    7. University of Texas at Houston Multimodal Pain Guideline: https://med.uth.edu/surgery/acute-trauma-pain-multimodal-therapy/
    8. ACS TRAUMA QUALITY PROGRAMS BEST PRACTICES GUIDELINES FOR ACUTE PAIN MANAGEMENT IN TRAUMA PATIENTS: https://www.facs.org/media/exob3dwk/acute_pain_guidelines.pdf

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  • A 70 year old healthy female is referred to you with a 5.7 cm abdominal aortic aneurysm. As an astute clinician you are aware that current guidelines support surgical repair for her AAA. What if there was new data to suggest this patient may not benefit from repair? What would be the optimal size threshold that she would benefit from AAA repair? Tune into this episode of Behind the Knife, where the vascular surgery subspecialty team discusses a paper that challenges current size threshold guidelines for AAA repair.

    Hosts:
    Dr. Bobby Beaulieu is an Assistant Professor of Vascular Surgery at the University of Michigan and the Program Director of the Integrated Vascular Surgery Residency Program as well as the Vascular Surgery Fellowship Program at the University of Michigan.

    Dr. Frank Davis is an Assistant Professor of Vascular Surgery at the University of Michigan

    Dr. Drew Braet is a PGY-5 Integrated Vascular Surgery Resident at the University of Michigan

    Learning Objectives
    - Review the current size threshold guidelines for surgical repair of abdominal aortic aneurysms

    - Understand the limitations of the aforementioned guidelines

    - Understand the methodology, findings, limitations, and clinical applications of the manuscript “Size thresholds for repair of abdominal aortic aneurysms warrant reconsideration.”

    References
    1. Columbo JA, Scali ST, Jacobs BN, et al. Size thresholds for repair of abdominal aortic aneurysms warrant reconsideration. Journal of Vascular Surgery. 2024;79(5):1069-1078.e8. doi:10.1016/j.jvs.2024.01.017
    https://pubmed.ncbi.nlm.nih.gov/38262565/

    2. Chaikof EL, Dalman RL, Eskandari MK, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. Journal of Vascular Surgery. 2018;67(1):2-77.e2. doi:10.1016/j.jvs.2017.10.044
    https://pubmed.ncbi.nlm.nih.gov/29268916/

    3. Wanhainen A, Van Herzeele I, Bastos Goncalves F, et al. Editor’s Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms. European Journal of Vascular and Endovascular Surgery. 2024;67(2):192-331. doi:10.1016/j.ejvs.2023.11.002
    https://pubmed.ncbi.nlm.nih.gov/38307694/

    4. The UK Small Aneurysm Trial Participants, Mortality results for randomised controlled trial of early elective surgery or ultrasonographic surveillance for small abdominal aortic aneurysms. Lancet 1998;352 (9141) 1649- 1655
    https://pubmed.ncbi.nlm.nih.gov/9853436/

    5. Lederle FAWilson SEJohnson GR et al. Aneurysm Detection and Management Veterans Affairs Cooperative Study Group, Immediate repair compared with surveillance of small abdominal aortic aneurysms. N Engl J Med 2002;346 (19) 1437- 1444
    https://pubmed.ncbi.nlm.nih.gov/12000813/

    6. United Kingdom EVAR Trial Investigators; Greenhalgh RM, Brown LC, Powell JT, Thompson SG, Epstein D. Endovascular repair of aortic aneurysm in patients physically ineligible for open repair. N Engl J Med. 2010 May 20;362(20):1872-80. doi: 10.1056/NEJMoa0911056. Epub 2010 Apr 11. PMID: 20382982.
    https://pubmed.ncbi.nlm.nih.gov/20382982/

    7. Lederle FA, Johnson GR, Wilson SE, Ballard DJ, Jordan WD Jr, Blebea J, Littooy FN, Freischlag JA, Bandyk D, Rapp JH, Salam AA; Veterans Affairs Cooperative Study #417 Investigators. Rupture rate of large abdominal aortic aneurysms in patients refusing or unfit for elective repair. JAMA. 2002 Jun 12;287(22):2968-72. doi: 10.1001/jama.287.22.2968. PMID: 12052126.

    8. Lancaster EM, Gologorsky R, Hull MM, Okuhn S, Solomon MD, Avins AL, Adams JL, Chang RW. The natural history of large abdominal aortic aneurysms in patients without timely repair. J Vasc Surg. 2022 Jan;75(1):109-117. doi: 10.1016/j.jvs.2021.07.125. Epub 2021 Jul 26. PMID: 34324972.
    https://pubmed.ncbi.nlm.nih.gov/34324972/

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  • Take a listen into the wild and fascinating world of lung transplantation! One of the biggest challenges for any transplant is organ preservation to provide the best possible recovery and outcome for recipients. That’s especially important for lung transplant, which remains one of the most complex and challenging areas in the field of transplantation. This episode takes a deep dive into the lung transplant landscape and discusses new technologies and innovations that are revolutionizing the field. Jon Williams is joined by Dr. Elliot Wakeam, MD, a thoracic surgeon and lung transplant expert from University of Toronto to discuss the advent of ex-vivo lung perfusion (EVLP) systems and how that and other preservation techniques may impact the future of lung transplantation. Also, Dr. Wakeam provides unique perspectives as faculty from one of the best lung transplant programs in the world.

    If you have any questions or comments, or find the episode interesting and want to learn more, feel free to reach out to us at [email protected]. Dominate the Day!

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