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Tag: Surgery

  • ENRICH Trial Findings Debuts at the 2023 American Association of Neurological Surgeons Annual Scientific Meeting

    ENRICH Trial Findings Debuts at the 2023 American Association of Neurological Surgeons Annual Scientific Meeting

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    Newswise — The latest science and trial results were unveiled during the 2023 American Association of Neurological Surgeons (AANS) Annual Scientific Meeting in Los Angeles. The late-breaking abstract “Efficacy and Safety of Early Minimally Invasive Removal of Intracerebral Hemorrhage (ENRICH): a Multicenter Randomized Adaptive Trial,” was showcased Saturday, April 22.

    The abstract was authored by Gustavo Pradilla, Jonathan J. Ratcliff, Alex J. Hall, Benjamin R. Saville, Jason W. Allen, Michael Frankel, David W. Wright, Daniel L. Barrow, and for the ENRICH Investigators.

    Supratentorial intracerebral hemorrhage (ICH) accounts for 10-15% of all strokes and results in significant morbidity and mortality. The ENRICH Trial evaluated a Minimally Invasive trans-sulcal, Parafascicular Surgery (MIPS) approach. Between December 1, 2016, and August 24, 2022, eligible patients were randomized to either MM or MIPS at 37 centers in the United States. At the second interim analysis (175 enrolled), a pre-specified stopping criterion was met for the ABG location resulting in a study adaptation. Per design, the ABG location was halted and all subsequent participants were enrolled (enriched) meeting lobar location criteria. The trial randomized 300 participants, with 92 (30.7%) in the ABG location and 198 (69.3%) in the lobar location. There were no observed baseline differences between groups for age, ICH volume, GCS or NIHSS.

    Overall mortality at 6 months was 21.3% (22.7% in the MM group and 20.7% in the MIPS group). In the MIPS group, median extent of hematoma evacuation was 87.7% with a median end-of-treatment volume (EOTV) of 7.2mL. Goal EOTV <15mL was reached in 72.7%. An mRS at 6 months was obtained in 286 participants (95.3%): 139 in the MM group (40 ABG and 99 lobar) and 147 in the MIPS group (47 ABG and 100 Lobar).

    The Bayesian primary analysis compared the mean UWmRS at 6 months between treatment groups, with an estimated mean UWmRS of 0.376 for the control and 0.456 for the MIPS group, with a difference of 0.0793. The Bayesian posterior probability of superiority of the intervention was 0.9762, which exceeded the pre-specified 0.975 threshold to claim superiority of MIPS versus MM. The observed difference in mean UWmRS was -0.0488 in the ABG location, 0.1386 in the lobar location. Differences greater than 0 correspond to improved outcomes in the treatment group.

    This is the first clinical trial to demonstrate the functional benefit of surgical clot evacuation among participants with supratentorial ICH presenting within 24 hours of LKN. MIPS was deemed safe, resulted in substantial clot evacuation and improved the UWmRS at 6 months relative to standard management. The overall benefit of MIPS appears to be from the strong positive effect observed for participants with lobar ICH.

     

    About the 2023 AANS Annual Scientific Meeting:

    From April 21-24, 2023, in in Los Angeles, California, neurosurgeons, neurosurgical residents, medical students, neuroscience nurses, clinical specialists, physician assistants, allied health professionals and other medical professionals will join together for the 2023 AANS Annual Scientific Meeting. The annual meeting is the largest gathering of neurosurgeons in the nation, with an emphasis on the field’s latest research and technological advances. The scientific presentations scheduled for the 2023 event represent cutting-edge examples of the incredible developments taking place within the field of neurosurgery.

     

    About the AANS:

    Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 13,000 members worldwide. The AANS promotes the highest quality of patient care and advances the specialty of neurological surgery. Fellows of the AANS are board-certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons of Canada or the Mexican Council of Neurological Surgery, A.C. Neurosurgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the spinal column, spinal cord, brain, nervous system and peripheral nerves.

     

     For more information, visit www.AANS.org.

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  • Peripheral Nerve Blocks in Total Joint Arthroplasty May Provide the Best Reduction in Complications in Older Patients With Fewer Comorbidities

    Peripheral Nerve Blocks in Total Joint Arthroplasty May Provide the Best Reduction in Complications in Older Patients With Fewer Comorbidities

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    Newswise — Hollywood, Florida, April 22, 2023 — In a study conducted at Hospital for Special Surgery (HSS), researchers found that the use of peripheral nerve blocks in total knee and total hip arthroplasty were associated with a consistent reduction in risk for postoperative complications in patients with a lower comorbidity burden. In particular, the most consistent reduction in risk of complications and use of hospital resources was in older patients with no comorbidity burden. These findings were presented at the 2023 Spring American Society of Regional Anesthesia and Pain Medicine (ASRA) Annual Meeting and were acknowledged as one of the President’s Choice Abstracts.1

    “The utility of interventions in a general population of patients might be difficult to show, but might differ by subgroups, with certain patients deriving benefit when others do not,” said Stavros G. Memtsoudis, MD, PhD MBA FCCP, an anesthesiologist at HSS and lead author of the study. “In this study, we tried to identify which subgroups might benefit most from peripheral nerve blocks in terms of a reduction in complications after joint arthroplasty.”

    These findings demonstrate that comorbidities may be a factor with a greater effect on complication risk than other factors, such as age, and that peripheral nerve blocks alone may not be sufficient to consistently influence outcomes in patients with comorbidities.

    These findings may also demonstrate that there may be a specific optimal baseline patient population for whom peripheral nerve blocks have the greatest impact on improving surgical outcomes: patients who are older but do not have many comorbidities. This study could help clinicians determine which surgical patients may benefit most from peripheral nerve blocks and which candidates may need additional measures to improve their outcomes.

    Many total joint arthroplasty (TJA) patients are at risk for poorly controlled pain and complications. The number of these surgeries performed increases each year, underscoring the importance of finding solutions. To find out how uniformly peripheral nerve blocks can improve perioperative outcomes and pain relief in TJA patients, the researchers conducted a population-based analysis using data from TJA surgeries in the United States from January 2006 to December 2019.

    Patients were divided into nine groups based on age and number of comorbidities. Age was broken down as follows: Young (Y) = younger than 65 years; Middle (M) = 65 to 75 years; and Old (O) = older than 75 years. Comorbidities were categorized as: no pre-existing comorbidity (Group 1); 1 or 2 comorbidities (Group 2); and 3 or more comorbidities (Group 3). This led to a breakdown of nine groups total: Y1, Y2, Y3, M1, M2, M3, O1, O2, and O3.

    The sample included more than 2.8 million TJA cases performed in 887 hospitals. Of those, 15.5% received a peripheral nerve block. The overall rate of peripheral nerve blocks increased from 9.5% in 2006 to 18.9% in 2019. Peripheral nerve blocks were used least often in young patients with more than 3 comorbidities (13.9%) and used most often in middle-aged patients with no comorbidities (16.3%). Peripheral nerve blocks were associated with a significant reduction in the odds of respiratory complication, acute renal failure, delirium, ICU admission, high opioid consumption during hospitalization, and prolonged length of stay.

    The results showed reduced odds of respiratory complications for the O1 and Y2 groups, reduced odds of acute renal failure in the Y1, O1, and M2 groups, and reduced odds of delirium in O1. The risk for ICU admission was reduced in those who received peripheral nerve blocks in all ages with no comorbidities, as well as in the Y2 and O2 groups, compared with those who did not receive a peripheral nerve block. Peripheral nerve blocks also reduced the odds of a prolonged length of stay in the Y1, M1, Y2, M2, and Y3 groups. Odds of high opioid use in patients who received a peripheral nerve block versus no peripheral nerve block were significantly reduced in all groups except for Y3 and O3.

    “While peripheral nerve blocks might have the advantage of providing superior pain control versus systemic modalities as well as reducing opioid consumption, a reduction in complications might be expected in those without comorbidities,” Dr. Memtsoudis said. “However, given that peripheral nerve blocks still provide better pain control and reduce opioid use, all patients should be considered for peripheral nerve blocks.”

    “Older patients without major comorbidities might represent a subgroup in which the beneficial effects of peripheral nerve blocks are most likely to be expected,” he noted. “This might be the case because major comorbidities are a bigger determinant of complications, with peripheral nerve blocks being less likely to be able to exert a substantial effect.”

    Future research should include further examination of the benefits of peripheral nerve blocks. “Many questions remain unanswered, including quantification of attributable risk reduction of peripheral nerve blocks and which peripheral nerve blocks provide the biggest effect,” Dr. Memtsoudis concluded.

     

    References

    1. Haoyan Zhong MPA, Marko Popovic BS, Jashvant Poeran MD PhD, Crispiana Cozowicz MD, Alex Illescas MPH, Jiabin Liu MD PhD, Stavros G Memtsoudis MD PhD MBA FCCP. “Does the impact of peripheral nerve blocks vary by age and comorbidity subgroups? A nationwide population based study.” Presented at: 48th Annual Regional Anesthesiology and Acute Pain Medicine Meeting of the American Society of Regional Anesthesia and Pain Medicine (ASRA), April 20-22, 2023; Hollywood, FL.

     

    About HSS

    HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the 13th consecutive year), No. 3 in rheumatology by U.S. News & World Report (2022-2023), and the best pediatric orthopedic hospital in NY, NJ and CT by U.S. News & World Report “Best Children’s Hospitals” list (2022-2023). In a survey of medical professionals in more than 20 countries by Newsweek, HSS is ranked world #1 in orthopedics for a third consecutive year (2023). Founded in 1863, the Hospital has the lowest complication and readmission rates in the nation for orthopedics, and among the lowest infection rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center five consecutive times. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Innovation Institute works to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 145 countries. The institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. www.hss.edu.

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  • Dame Edna creator Barry Humphries dies in Sydney at 89

    Dame Edna creator Barry Humphries dies in Sydney at 89

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    CANBERRA, Australia — Tony Award-winning comedian Barry Humphries, internationally renowned for his garish stage persona Dame Edna Everage, a condescending and imperfectly-veiled snob whose evolving character has delighted audiences over seven decades, has died. He was 89.

    His death in the Sydney hospital, where he spent several days with complications following hip surgery, was confirmed by his family.

    “He was completely himself until the very end, never losing his brilliant mind, his unique wit and generosity of spirit,” a family statement said.

    ”With over 70 years on the stage, he was an entertainer to his core, touring up until the last year of his life and planning more shows that will sadly never be,” they added.

    Humphries had lived in London for decades and returned to native Australia in December for Christmas.

    He told The Sydney Morning Herald newspaper last month that his physiotherapy had been “agony” following his fall and hip replacement.

    “It was the most ridiculous thing, like all domestic incidents are. I was reaching for a book, my foot got caught on a rug or something, and down I went,” Humphries said of his fall.

    Humphries has remained an active entertainer, touring Britain last year with his one-man show “The Man Behind the Mask.”

    The character of Dame Edna began as a dowdy Mrs. Norm Everage, who first took to the stage in Humphries’ hometown of Melbourne in the mid-1950s. She reflected a postwar suburban inertia and cultural blandness that Humphries found stifling.

    Edna is one of Humphries’ several enduring characters. The next most famous is Sir Les Patterson, an ever-drunk, disheveled and lecherous Australian cultural attache.

    Patterson reflected a perception of Australia as a Western cultural wasteland that drove Humphries along with many leading Australian intellectuals to London.

    Humphries, a law school dropout, found major success as an actor, writer and entertainer in Britain in the 1970s, but the United States was an ambition that he found stubbornly elusive.

    A high point in the United States was a Tony Award in 2000 for his Broadway show “Dame Edna: The Royal Tour.”

    Australian Prime Minister Anthony Albanese paid tribute to the celebrated comedian.

    “For 89 years, Barry Humphries entertained us through a galaxy of personas, from Dame Edna to Sandy Stone,” Albanese tweeted, referring to the melancholic and rambling Stone, one of Humphries most enduring characters. “But the brightest star in that galaxy was always Barry. A great wit, satirist, writer and an absolute one-of-kind, he was both gifted and a gift.”

    British comedian Ricky Gervais tweeted: “Farewell, Barry Humphries, you comedy genius.”

    Piers Morgan, British television personality, also paid tribute. “One of the funniest people I’ve ever met,” Morgan tweeted.

    “A wondrously intelligent, entertaining, daring, provocative, mischievous comedy Genius,” Morgan added.

    Married four times, he is survived by his wife Lizzie Spender, four children and 10 grandchildren.

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  • Metabolic liver disease best treated with surgery

    Metabolic liver disease best treated with surgery

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    Newswise — Metabolic (bariatric) surgery is more effective than medications and lifestyle interventions for the treatment of advanced non-alcoholic fatty liver disease.

    A new paper, published today in The Lancet by King’s College London and the Catholic University of Rome, is the first to compare three active treatments of non-alcoholic Steatohepatitis (NASH) and to specifically investigate the effectiveness of metabolic surgery (weight loss surgery) in a randomised clinical trial.

    Non-Alcoholic Fatty Liver Disease (NAFLD) is the most common cause of chronic liver disease, globally affecting 55% of people with type 2 diabetes and 75% of those with obesity. Non-alcoholic steatohepatitis (NASH) is the progressive form of the disease and is characterised by liver cell injury and inflammation, which induce liver fibrosis (scarring of the tissue). Left untreated, it can lead to liver failure and liver cancer, and is one of the leading causes of liver transplant in the western world. NASH also increases risk of cardiovascular disease and overall mortality in patients with obesity or type 2 diabetes.  NAFLD/NASH currently affects 12% of adults in the UK; in the USA it is estimated that the condition will affect 27 million people by 2030.

    The multi-centre randomised trial was conducted in Italy. The trial compared the efficacy of bariatric and metabolic surgery versus lifestyle modifications and best current medical care in 288 patients. 

    Pre- and post-operative liver biopsies showed that surgery was more effective in inducing complete reversal of inflammation and cell damage in the liver – the core characteristics of NASH – without worsening of liver fibrosis after 1 year from surgery. The probability of achieving reversal of NASH was 3–5 times higher with metabolic surgery than with medical care. Surgery was also more effective at achieving improvement of at least one stage of liver fibrosis, another pre-specified endpoint of the trial. The two surgical procedures appeared to equally improve NASH.

    Researchers say the ability of surgery to control and even improve fibrosis associated with NASH is of special clinical relevance as fibrosis is the main predictor of liver complications and poor cardiovascular outcomes and death in patients with NASH.

    Professor Geltrude Mingrone, first author of the report, Professor of Medicine at the Catholic University of Rome and a Professor of Diabetes and Nutrition at King’s College London said: “The results of our study support the use of metabolic surgery as a treatment of NASH, a condition for long considered orphan of effective therapies”.

    Professor Francesco Rubino, a senior co-investigator and Chair of Bariatric and Metabolic Surgery at King’s College London and consultant surgeon at King’s College Hospital  said: “The presence of NASH predicts a significant risk of complications and mortality in people with severe obesity and type 2 diabetes. The results of this study provide a compelling case for prioritisation of metabolic surgery in this patient population”.

    Compared to conventional medical treatment, surgery also resulted in better overall health benefits. While both surgical procedures seemed to equally improve NASH, the gastric bypass group was more effective than sleeve gastrectomy at improving type 2 diabetes and reducing other cardiovascular risk factors associated with NAFLD/NASH.

    ENDS

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  • Democratic congressman has surgery to remove cancerous tumor in his tonsil | CNN Politics

    Democratic congressman has surgery to remove cancerous tumor in his tonsil | CNN Politics

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    CNN
     — 

    Democratic Rep. Dan Kildee of Michigan had surgery Monday to remove a small cancerous tumor in his tonsil, his office said.

    Kildee, who announced last month that he’d been diagnosed with squamous cell carcinoma, will stay at George Washington University Hospital “for the next several days as part of the normal recovery process,” his chief of staff, Mitchell Rivard, said in a statement, adding that he’d continue his recovery at home later in the week.

    Kildee will miss House votes while he recovers. “During this time, the Congressman will be submitting written statements for the record to the House Clerk for any missed recorded votes, to keep his constituents updated on his positions,” Rivard said.

    In announcing his diagnosis, Kildee said he’d scheduled what he had thought would be a “preventative scan for a swollen lymph node.” Following additional testing, however, he received his diagnosis. “Thankfully, I caught it very early,” he said.

    “The prognosis after surgery and treatment is excellent,” Kildee said at the time. “I am going to get through this. I’m going to beat cancer.”

    First elected to congress in 2012, Kildee currently represents Michigan’s 8th Congressional District and is co-chair of the Democratic Steering and Policy Committee.

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  • NHK media: Japan police say they’ve arrested suspect who appears to have thrown explosive at port where PM was to speak

    NHK media: Japan police say they’ve arrested suspect who appears to have thrown explosive at port where PM was to speak

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    NHK media: Japan police say they’ve arrested suspect who appears to have thrown explosive at port where PM was to speak

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  • Missouri to restrict transgender care for minors, adults

    Missouri to restrict transgender care for minors, adults

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    COLUMBIA. Mo. — Missouri’s attorney general announced new restrictions Thursday on transgender care for adults in addition to minors in a move that is believed to be a first nationally and has advocacy groups threatening to sue.

    Attorney General Andrew Bailey announced plans to restrict transgender health care weeks ago, when protesters rallied at the Capitol to urge lawmakers to pass a law banning puberty blockers, hormones and surgeries for children. But the discussion was focused on minors, not adults.

    Missouri Attorney General spokeswoman Madeline Sieren clarified in a statement later in the day that adults also would be covered.

    “We have serious concerns about how children are being treated throughout the state, but we believe everyone is entitled to evidence-based medicine and adequate mental health care,” Sieren said.

    The rule, which incudes a required 18 months of therapy before receiving gender-affirming health care, is set to take effect April 27 and expire next February.

    The ACLU and Lambda Legal said in a joint statement that they would “take any necessary legal action” and urged those affected to call.

    “The Attorney General’s so-called emergency rule is based on distorted, misleading, and debunked claims and ignores the overwhelming body of scientific and medical evidence supporting this care,” the statement said.

    Robert Fischer, the spokesman for the LGBT rights groups PROMO, said he was not aware of similar restrictions elsewhere.

    “He’s essentially attacking the entire trans community at this point,” Fischer said of Bailey. “It’s no longer just about children.”

    The National Center for Transgender Equality called the order “deeply wrong” in a tweet, adding that “trans people of all ages across the state of Missouri deserve access to health care.”

    The restrictions are in response to a former employee’s allegations of mistreatment at a transgender youth clinic in St. Louis run by Washington University. Bailey is investigating the center.

    “My office is stepping up to protect children throughout the state while we investigate the allegations and how they are harming children,” Bailey said in a statement.

    University spokespeople didn’t immediately respond to phone or email messages from The Associated Press seeking comment.

    Moving forward, doctors who provide gender-affirming health care must first provide them a lengthy list of potential negative side effects and information warning against those treatments, according to a copy of the rule released Thursday.

    Health care providers will need to ensure “any psychiatric symptoms from existing mental health comorbidities of the patient have been treated and resolved” before providing gender-affirming treatments under the new rule. Physicians also must screen patients for social media addiction, autism and signs of “social contagion with respect to the patient’s gender identity.”

    The FDA approved puberty blockers 30 years ago to treat children with precocious puberty — a condition that causes sexual development to begin much earlier than usual. Sex hormones — synthetic forms of estrogen and testosterone — were approved decades ago to treat hormone disorders or as birth control pills.

    The FDA has not approved the medications specifically to treat gender-questioning youth, but they have been used for many years for that purpose “off label,” a common and accepted practice for many medical conditions. Doctors who treat transgender patients say those decades of use are proof the treatments are not experimental.

    Critics have raise concerns about children changing their minds. Yet the evidence suggests detransitioning is not as common as opponents of transgender medical treatment for youth contend, though few studies exist and they have their weaknesses.

    Bailey’s rule was released the same day Missouri’s Republican-led House voted to ban access to transgender-related health care for minors.

    The House voted 103-52 along mostly party lines in favor of the ban, although the bill’s passage seems uncertain in the Senate.

    The House proposal is stricter than what was passed by the GOP-led Senate, where Democrats have more influence through the use of stall tactics.

    Senators compromised to exempt care for minors whose treatment is already underway. The Senate bill also would expire after four years.

    The House version includes no exceptions for current treatments and would remain in effect indefinitely.

    Republican Senate leaders said it’s unlikely that the House version will make it through the Senate.

    “We’ve already passed legislation on this issue out of the Senate,” Senate President Pro Tem Caleb Rowden said. “We would expect the House to appreciate how hard and difficult it was and to take up our bill and pass it.”

    Both the House and Senate proposals would ban inmates and prisoners from accessing gender-affirming surgeries and would end coverage of any gender-affirming treatments for Missouri patients on Medicaid, the federal health insurance program.

    The Human Rights Campaign have condemned the legislation in a statement, describing gender-affirming care as medically necessary.

    At least 13 states have now enacted laws restricting or banning gender-affirming care for minors: Alabama, Arkansas, Arizona, Georgia, Idaho, Indiana, Iowa, Kentucky, Mississippi, Tennessee, Utah, South Dakota and West Virginia. Bills are awaiingt action from governors in Kansas, Montana and North Dakota. Federal judges have blocked enforcement of laws in Alabama and Arkansas, and nearly two dozen states are considering bills this year to restrict or ban care.

    House debate on the bill became emotional as some Democrats argued the ban on health care will hurt transgender children.

    “You are erasing my grandchild,” said St. Louis Democratic Rep. Barbara Phifer, whose grandson is transgender.

    Republican sponsor Rep. Brad Hudson, of Cape Fair, criticized Democrats for threatening to end political partnerships and friendships with Republicans over the bill.

    Hudson said his bill “seeks to protect kids” and that it’s unfair that Democrats are describing it as hateful towards transgender children.

    “A yes vote is a vote to protect kids from sex-change drugs and surgeries,” Hudson said.

    ——

    Associated Press writer David A. Lieb contributed to this report from Jefferson City, Missouri.

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  • The 2023 American Association of Neurological Surgeons Annual Scientific Meeting Features Never-Before-Presented Research

    The 2023 American Association of Neurological Surgeons Annual Scientific Meeting Features Never-Before-Presented Research

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    Newswise — The American Association of Neurological Surgeons (AANS) Annual Meeting will be the first ever to showcase the late-breaking abstract “Decompressive Craniectomy vs Craniotomy for Traumatic Acute Subdural Hematoma” Sunday, April 23, at 9:10 am-9:18 am, during Plenary Session ll.

    Traumatic acute subdural hematomas frequently require surgical evacuation via a craniotomy or decompressive craniectomy. Craniectomy may prevent intracranial hypertension, but it is unclear if it is associated with better outcomes. The authors conducted a trial to compare the two techniques. Methods used and the results of the study will be debuted during this special Late-Breaking Abstract presentation.

    The abstract, authored by Peter J. Hutchinson, Hadie Adams, Midhun Mohan, Bhagavatula I. Devi, Christopher Uff, Shumaila Hasan, Harry Mee, Mark H. Wilson, Deepak K. Gupta, Diederik Bulters, Ardalan Zolnourian, Catherine J. McMahon, Matthew G. Stovell, Yahia Z. Al-Tamimi, Manoj K. Tewari, Manjul Tripathi, Simon Thomson, Edoardo Viaroli, Antonio Belli, Andrew T. King, Adel E. Helmy, Ivan S. Timofeev, Sarah Pyne, Dhaval P. Shukla, Dhananjaya I. Bhat, Andrew R. Maas, Franco Servadei, Geoffrey T. Manley, Garry Barton, Carole Turner, David K. Menon, Barbara Gregson and Angelos G. Kolias, for the British Neurosurgical Trainee

    Research Collaborative, NIHR Global Health Research Group on Acquired Brain and Spine Injury and RESCUE-ASDH Trial Collaborators, will be presented by Peter Hutchinson, MD,  Professor of Neurosurgery, NIHR Senior Investigator and Head of the Division of Academic Neurosurgery at the University of Cambridge. He is the director of clinical research at the Royal College of Surgeons of England.

    The Plenary Session ll will begin at 8:30 am and continue until 12:30 pm. In addition to the latest science, the Sunday session will feature inspirational lectures, prestigious award presentations, the Incoming President’s Address and Lunch and Learn seminars.

     

    About the 2023 AANS Annual Scientific Meeting:

    From April 21-24, 2023, in in Los Angeles, California, neurosurgeons, neurosurgical residents, medical students, neuroscience nurses, clinical specialists, physician assistants, allied health professionals and other medical professionals will join together for the 2023 AANS Annual Scientific Meeting. The annual meeting is the largest gathering of neurosurgeons in the nation, with an emphasis on the field’s latest research and technological advances. The scientific presentations scheduled for the 2023 event represent cutting-edge examples of the incredible developments taking place within the field of neurosurgery.

     

    About the AANS:

    Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 13,000 members worldwide. The AANS promotes the highest quality of patient care and advances the specialty of neurological surgery. Fellows of the AANS are board-certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons of Canada or the Mexican Council of Neurological Surgery, A.C. Neurosurgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the spinal column, spinal cord, brain, nervous system and peripheral nerves.

     

     For more information, visit www.AANS.org.

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  • Sen. Blumenthal will undergo ‘routine surgery’ after fracturing femur during parade | CNN Politics

    Sen. Blumenthal will undergo ‘routine surgery’ after fracturing femur during parade | CNN Politics

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    CNN
     — 

    Democratic Sen. Richard Blumenthal will undergo “routine surgery” on Sunday after he fractured his femur at a University of Connecticut men’s basketball victory parade.

    Connecticut’s senior senator said in a post on Twitter that the fracture happened during the team’s parade Saturday in honor of their NCAA championship win last week.

    “I did indeed fracture my femur after a fellow parade goer tripped & fell on me during the parade today,” Blumenthal said. “Routine surgery tomorrow just to make sure everything heals properly. I expect a full recovery!”

    Blumenthal was replying to Sen. Chris Murphy, a fellow Connecticut Democrat who was also at the parade and tweeted that his colleague “FINISHED THE PARADE” after breaking his femur. “Most Dick Blumenthal thing ever,” Murphy said.

    The 77-year-old Blumenthal won a third Senate term last fall. First elected in 2010, he previously served five terms as Connecticut’s attorney general.

    The Senate is set to reconvene April 17. The Democratic Caucus’s narrow 51-49 advantage in the chamber means any absence could affect key votes. Democratic Sen. John Fetterman was recently discharged from a hospital where he was being treated for depression and expects to return when the Senate reconvenes.

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  • Grand Canyon delays opening of North Rim due to snowfall

    Grand Canyon delays opening of North Rim due to snowfall

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    Officials at Grand Canyon National Park are delaying the opening of the North Rim to visitors for the 2023 season

    NORTH RIM, Ariz. — The public will have to wait a little longer to visit the North Rim at Grand Canyon National Park this year.

    Like other parts of the West, northern Arizona received an abundance of snow over the winter, and park officials say pushing back the opening from mid-May to June 2 will give them more time to plow the main state road that leads to the rim and allow staff to reopen visitor facilities.

    “We appreciate the patience and cooperation of our neighbors and visitors with this delay as our partners and park staff work to open the North Rim roads, trails and facilities safely,” Superintendent Ed Keable said in a statement Friday.

    According to park officials, the North Rim has received more than 250 inches (6.35 meters) of accumulated snowfall since October. That marks what is believed to be the second-snowiest on record for the North Rim since 1925, although there are some years of missing data during that time period.

    Photos shared by the park showed impassable areas and snow up to the eves of one of the entrances at Grand Canyon Lodge.

    The snow depth recorded on Bright Angel Point in March totaled a record 92 inches (2.34 meters). The weather station near the point is situated at an elevation of 8,339 feet (2.54 kilometers).

    The North Rim typically receives an average of 126 inches (3.2 meters) of snow each year.

    Park officials said the visitor station, backcountry information center and the bookstore will reopen June 2 and daily ranger-led programs will resume. Grand Canyon Lodge North Rim operations also are expected to reopen on that date, while the North Rim Campground will reopen June 9.

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  • Roger Goodell, Commissioner, National Football League, Joins the American Association of Neurological Surgeons for a Fireside Chat at the 2023 AANS Annual Scientific Meeting

    Roger Goodell, Commissioner, National Football League, Joins the American Association of Neurological Surgeons for a Fireside Chat at the 2023 AANS Annual Scientific Meeting

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    Newswise — The American Association of Neurological Surgeons (AANS) announced that the 2023 AANS Annual Scientific Meeting will feature an exclusive Fireside Chat with Roger Goodell, Commissioner, National Football League.

    Goodell will join a prestigious group of professionals during the Opening Session of the meeting Friday, April 21, to discuss “Concussion in Sports: What Every Neurosurgeon Should Know.”

    The Fireside Chat will feature Allen K. Sills, MD, FAANS, Chief Medical Officer, National Football League and Margot Putukian, MD, Chief Medical Officer, Major League Soccer. The chat will be moderated by Ann Stroink, MD, FAANS, AANS President, and Dr. Sills.

    Roger Goodell became the eighth chief executive of the National Football League after a 24-year history with the league, holding numerous football and business operations roles prior to being elected commissioner. Commissioner Goodell’s priorities have focused on improving all aspects of the game for fans, players and the clubs. Under Commissioner Goodell’s leadership, the NFL has focused on improvements to player health and safety, benefits for retired players, the league’s personal conduct policy, diversity in hiring practices, stadium development, fan experience, international development, officiating and rules changes, among others. These enhancements have increased the quality, safety and enjoyment of the game.

    The 2023 AANS Annual Scientific Meeting takes place April 21 – 24 in Los Angeles where innovative speakers and community sessions examine new literature, controversies and technology in a focused setting to connect, collaborate and generate new ideas.

     

    About the 2023 AANS Annual Scientific Meeting:

    From April 21-24, 2023, in in Los Angeles, California, neurosurgeons, neurosurgical residents, medical students, neuroscience nurses, clinical specialists, physician assistants, allied health professionals and other medical professionals will join together for the 2023 AANS Annual Scientific Meeting. The annual meeting is the largest gathering of neurosurgeons in the nation, with an emphasis on the field’s latest research and technological advances. The scientific presentations scheduled for the 2023 event represent cutting-edge examples of the incredible developments taking place within the field of neurosurgery.

    For more information, visit www.aans.org/Meetings.

     

    About the AANS:

    Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 13,000 members worldwide. The AANS promotes the highest quality of patient care and advances the specialty of neurological surgery. Fellows of the AANS are board-certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons of Canada or the Mexican Council of Neurological Surgery, A.C. Neurosurgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the spinal column, spinal cord, brain, nervous system and peripheral nerves.

     

     For more information, visit www.AANS.org.

     

     

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  • Indiana and Idaho enact bans on gender-affirming care for transgender youth | CNN Politics

    Indiana and Idaho enact bans on gender-affirming care for transgender youth | CNN Politics

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    CNN
     — 

    Indiana Republican Gov. Eric Holcomb signed a bill Wednesday to ban gender affirming care for minors in the state, following a growing trend of GOP-led states restricting transgender youth’s access to such treatments after Idaho enacted similar legislation earlier in the week.

    “Permanent gender-changing surgeries with lifelong impacts and medically prescribed preparation for such a transition should occur as an adult, not as a minor,” Holcomb said in a statement upon signing Senate Bill 480 into law.

    The legislation, which takes effect July 1, states that physicians or practitioners who provide minors with such care, including puberty blocking medication, hormone therapy and surgery intended to help transition genders, will be subject to discipline by their regulatory board.

    Transgender youths’ access to gender-affirming care – medically necessary, evidence-based care that uses a multidisciplinary approach to help a person transition from the gender they were designated at birth to the gender by which they want to be known – has become a flashpoint in red states across the country.

    Some Republicans have expressed concern over long-term outcomes and whether children should be able to make such consequential decisions, even with parental consent. But major medical associations say that gender-affirming care is clinically appropriate for children and adults with gender dysphoria – a psychological distress that may result when a person’s gender identity and sex assigned at birth do not align, according to the American Psychiatric Association.

    Indiana’s new legislation was met with immediate backlash by LGBTQ advocates.

    The American Civil Liberties Union and local ACLU of Indiana sued the state Wednesday on behalf of four transgender youth and their families, as well as a doctor and healthcare clinic, alleging the new law violates their constitutional rights.

    “Gender-affirming care is life-saving care for our clients,” Ken Falk, legal director of the ACLU of Indiana, said in a statement. “No child should be cut off from the medical care they need or denied their fundamental right to be themselves — but this law would do both.”

    Holcomb’s signing of SB 480 came a day after Idaho Republican Gov. Brad Little enacted similar legislation.

    Under the Idaho law, which takes effect on January 1, 2024, physicians or practitioners who provide gender affirming care, including puberty blocking medications as well as surgeries, could face a $5,000 fine and a felony charge.

    “In signing this bill, I recognize our society plays a role in protecting minors from surgeries or treatments that can irreversibly damage their healthy bodies. However, as policymakers we should take great caution whenever we consider allowing the government to interfere with loving parents and their decisions about what is best for their children,” Little said in a statement to lawmakers.

    Following Little’s signing of the bill, the ACLU of Idaho said it planned to challenge the law.

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  • Hackensack Meridian Hackensack University Medical Center Performs 1,000th Single-Port Robotic Procedure – More Than Any Other Hospital in the Country

    Hackensack Meridian Hackensack University Medical Center Performs 1,000th Single-Port Robotic Procedure – More Than Any Other Hospital in the Country

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    Newswise — Surgeons at Hackensack Meridian Hackensack University Medical Center performed their 1,000th Single-Port Robotic surgery with the da Vinci single port (SP) system on March 23.

    Hackensack University Medical Center, a center for excellence in advanced robotic surgery, was the first and only hospital in New Jersey to have access to this groundbreaking technology in 2018 and is now the first hospital in the country to perform the most procedures with it. 

    “Performing 1,000 Single-Port Robotic procedures is a tremendous accomplishment for our entire team and for our patients,” says Michael D. Stifleman, MD, director of Robotic Surgery at Hackensack Meridian Health Network. “The more procedures we perform with this state-of-the-art technology, the greater the benefit for our patients as it further minimizes the trauma associated with surgery while enhancing precision and control compared to traditional techniques.”

    The da Vinci SP technology’s revolutionary design involves a single arm that delivers three multi-jointed instruments and camera, making it an innovative, dynamic instrument for narrow, deep spaces. A single, one inch incision helps surgeons perform complex procedures in the most  minimally invasive way, resulting in less pain and fewer complications, especially with urologic procedures, including prostate cancer; kidney cancer; head and neck cancers; and advanced urinary tract reconstruction surgery. Click here to learn more about the future of single-port surgery in an episode of “Operation: Reimagine Surgery,” a Freethink original series produced in partnership with Intuitive, which created the world’s first commercially available robotic surgery system in the 1990s.

    “Surgeons at Hackensack University Medical Center performed New Jersey’s first robotic surgery more than 20 years ago,” says Mark D. Sparta, FACHE, President & Chief Hospital Executive of Hackensack University Medical Center and President, North Region, Hackensack Meridian Health. “Our academic medical center now has the largest and most experienced robotic surgery program in the state and one of the busiest in the nation.”

    Experience matters as close to  25% of the nation’s single-port robotic procedures are completed at Hackensack University Medical Center by renowned surgeons including  Chan W. Park, M.D., head and neck oncology surgeon; Brian E. Benson, M.D., interim chair of Otolaryngology; and  Mutahar Ahmed, M.D., director of the Urologic Bladder Cancer Program; and Dr. Michael Stifelman, who is also professor and chair of Urology at Hackensack Meridian School of Medicine.

    “Single-port robotic surgery places Hackensack University Medical Center’s urology program on the world stage with surgeons visiting us from the most prestigious medical centers nationally and internationally to see how we do it here in Hackensack,” says Dr. Ahmed. “Hackensack University Medical Center is focused on bringing the most advanced technologies and the most experienced surgeons together to constantly improve patient outcomes. The single-port technology is transformative and enables our surgeons to perform the most complex surgeries in the hardest to reach places, through just one small incision.”

    Mutahar Ahmed, M.D., director of the Urologic Bladder Cancer Program using the Single-Port Robot

    ABOUT HACKENSACK UNIVERSITY MEDICAL CENTER

    Hackensack University Medical Center, a 803-bed nonprofit teaching and research hospital, was Bergen County’s first hospital founded in 1888. It was also the first hospital in New Jersey and second in the nation to become a Magnet®-recognized hospital for nursing excellence, receiving its sixth consecutive designation from the American Nurses Credentialing Center. The academic flagship of the Hackensack Meridian Health network, Hackensack University Medical Center is Nationally-Ranked by U.S. News & World Report 2022-2023 in four specialties, more than any other hospital in New Jersey. The hospital is home to the state’s only nationally-ranked Urology and Neurology & Neurosurgery programs, as well as the best Cardiology & Heart Surgery program. It also offers patients nationally-ranked Orthopedic care and one of the state’s premier Cancer Centers (John Theurer Cancer Center at Hackensack University Medical Center). Hackensack University Medical Center also ranked as High-Performing in conditions such as Acute Kidney Failure, Heart Attack (AMI), Heart Failure, Pneumonia, chronic obstructive pulmonary disease (COPD), Diabetes and Stroke. As well as High Performing in procedures like Aortic Valve Surgery, Heart Bypass Surgery (CABG), Colon Cancer Surgery, Lung Cancer Surgery, Prostate Cancer Surgery, Hip Replacement and Knee Replacement. This award-winning care is provided on a campus that is home to facilities such as the Heart & Vascular Hospital; and the Sarkis and Siran Gabrellian Women’s and Children’s Pavilion, which houses the Donna A. Sanzari Women’s Hospital and the Joseph M. Sanzari Children’s Hospital, ranked #1 in the state and top 20 in the Mid-Atlantic Region in the U.S. News & World Report’s 2022-23 Best Children’s Hospital Report. Additionally, the children’s nephrology program ranks in the top 50 in the United States. Hackensack University Medical Center is also home to the Deirdre Imus Environmental Health Center and is listed on the Green Guide’s list of Top 10 Green Hospitals in the U.S. Our comprehensive clinical research portfolio includes studies focused on precision medicine, translational medicine, immunotherapy, cell therapy, and vaccine development. The hospital has embarked on the largest healthcare expansion project ever approved by the state: Construction of the Helena Theurer Pavilion, a 530,000-sq.-ft., nine-story building, which began in 2019. A $714.2 million endeavor, the pavilion is one the largest healthcare capital projects in New Jersey and will house 24 state-of-the-art operating rooms with intraoperative MRI capability, 50 ICU beds, and 175 medical/surgical beds including a 50 room Musculoskeletal Institute. 

    ABOUT HACKENSACK MERIDIAN HEALTH

    Hackensack Meridian Health is a leading not-for-profit health care organization that is the largest, most comprehensive and truly integrated health care network in New Jersey, offering a complete range of medical services, innovative research and life-enhancing care. The network has 18 hospitals and more than 500 patient care locations, which include ambulatory care centers, surgery centers, home health services, long-term care and assisted living communities, ambulance services, lifesaving air medical transportation, rehabilitation centers, urgent care centers, physician practice locations, and a fitness and wellness center. With more than 35,000 team members and 7,000 physicians, Hackensack Meridian Health is a distinguished leader in health care philanthropy and committed to the health and well-being of communities throughout New Jersey. The network’s notable distinctions include having more U.S. News-ranked hospitals than any other health system in New Jersey, as ranked by U.S. News & World Report, 2022-23. Hackensack University Medical Center is nationally-ranked by U.S. News & World Report in four specialties, more than any other hospital in New Jersey. Joseph M. Sanzari Children’s Hospital at Hackensack University Medical Center, and K. Hovnanian Children’s Hospital at Jersey Shore University Medical Center, are ranked #1 in the state and top 20 in the Mid-Atlantic Region by U.S. News & World Report’s 2022-23 Best Children’s Hospital Report. Additionally, their combined nephrology program ranks in the top 50 in the United States. To learn more, visit www.hackensackmeridianhealth.org.

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  • Imaging brain connections can predict improvements in obsessive-compulsive disorder patients after deep brain stimulation

    Imaging brain connections can predict improvements in obsessive-compulsive disorder patients after deep brain stimulation

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    Newswise — Deep brain stimulation (DBS) is a promising therapy for treatment-resistant obsessive-compulsive disorder (OCD). A first-of-its-kind collaborative study led by researchers at Texas Children’s Hospital, Baylor College of Medicine, and Brigham & Women’s Hospital has found that mapping neural connections in the brains of OCD patients offers key insights that explain the observed improvements in their clinical outcomes after DBS. The study was published in Biological Psychiatry.

    Neuropsychiatric disorders such as obsessive-compulsive disorder are a result of dysfunction across broad neural networks and typically involve brain domains responsible for cognitive and higher-order decision-making such as the prefrontal cortex.

    “The goal of neuromodulatory therapies like DBS is to restore the functional balance within these networks. Since the extent of functional dysfunction in these networks varies between individuals, it is important to customize DBS surgery for each patient. To do that reliably, we first need to precisely map the neural connections involved in the specific condition and then understand how these connections are affected by DBS,” said co-corresponding author Dr. Sameer Sheth, professor in the department of neurosurgery at Baylor College of Medicine, director of the Cain Foundation Labs, and principal investigator at the Jan and Dan Duncan Neurological Research Institute (Duncan NRI) at Texas Children’s Hospital.

    In 2020, a seminal study by Dr. Andreas Horn and his team at Brigham & Women’s Hospital identified an ‘OCD response tract’ – a white matter circuit that precisely mapped the specific fiber bundles and brain regions whose modulation by DBS could improve clinical outcomes in OCD patients. The present study is the first one to conduct blind testing of the OCD response tract model with the goal of developing a predictive ‘connectomic’ model.

    Connectomic imaging strategies such as white matter tractography – a three-dimensional magnetic resonance imaging (MRI) technique that maps the location and direction of white matter bundles and their constituent fibers within the brain – are becoming increasingly reliable methods to identify these networks that inform surgeons where to implant DBS electrodes in the brain of the patient during surgery. Here, Sheth and colleagues used this approach to rank and conduct ‘blind’ comparison of clinical outcomes in ten OCD patients who had undergone a specific DBS procedure six months prior to the study.

    DBS programming was performed by Dr. Wayne Goodman, Chair of the department of psychiatry at Baylor College, and patient outcomes were periodically assessed by Dr. Eric Storch, Vice Chair of psychology, for changes in the severity of their OCD and mood symptoms.

    Then the Brigham & Women’s Hospital (BWH) team led by Dr. Andreas Horn analyzed the imaging data and provided rank predictions based solely on the neuroimaging data and stimulation parameters. This team was not involved in DBS planning or programming and did not have prior knowledge of clinical outcomes. The outcomes predicted by the BWH team closely matched the actual clinical outcomes that the Baylor team observed in these patients.

    “To our knowledge, this is the first example of such a collaborative ‘blinded’ team effort by two research centers to validate DBS therapy for a brain tract proposed on the basis of retrospective data,” co-corresponding author, Dr. Horn added. “This is also a big step in the continued optimization and improving the efficacy of DBS procedures that target this brain tract to treat OCD, even as efforts are underway to make this therapy more widely available to patients. Finally, this two-center ‘blinded’ approach could serve as a model for validating and optimizing DBS therapies for other neurological conditions in the future.”

    Others involved in the study were Ron Gadot, Ningfei Li, Ben Shofty, Michelle Avendano-Ortega, Sarah McKay, Kelly Bijanki, Megan Robinson, Garrett Banks, and Nicole Provenza. They are affiliated with one or more of the following institutions: Baylor College of Medicine, Charité – Universitätsmedizin Berlin, Germany; University of Utah, and Brigham and Women’s Hospital. This research was funded by the National Institutes for Health and the McNair Foundation.

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    Texas Children’s Hospital

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  • Vatican: Pope Francis goes to hospital for scheduled tests

    Vatican: Pope Francis goes to hospital for scheduled tests

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    The Vatican says Pope Francis has gone to a Rome hospital for some scheduled tests

    VATICAN CITY — Pope Francis went to a Rome hospital on Wednesday for some previously scheduled tests, slipping out of the Vatican after his general audience and before the busy start of Holy Week this Sunday.

    The Vatican provided no details, including how long the 86-year-old pope would remain at the Gemelli hospital where he had intestinal surgery in 2021. But a statement from spokesman Matteo Bruni suggested Francis could remain at least overnight, since he only arrived in the afternoon.

    “The Holy Father has been at Gemelli since this afternoon for some previously scheduled checkups,” read the one-line statement.

    Francis is due to celebrate Palm Sunday this weekend, which begins a busy series of ceremonies at the Vatican the following week: Holy Thursday, Good Friday, the Easter Vigil and finally Easter Sunday on April 9.

    The pope spent 10 days at the Gemelli hospital in July 2021 following surgery for an intestinal narrowing. He had 33 centimeters (13 inches) of his colon removed.

    He said soon after that he had recovered fully and could eat normally. But in a Jan. 24 interview with The Associated Press, Francis said the diverticulosis, or bulges in his intestinal wall, had “returned.”

    Francis has also been using a wheelchair for over a year for strained ligaments in his right knee, and then a small fracture in his knee. He has said the injury is healing, and he has been walking more with a cane of late.

    He has said he resisted having surgery for the knee problems because he didn’t respond well to the general anesthesia during the 2021 intestinal surgery.

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  • Alabama police officer killed, another wounded in shooting

    Alabama police officer killed, another wounded in shooting

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    HUNTSVILLE, Ala. — An Alabama police officer has died and another was critically wounded after being shot by a man who was captured after barricading himself inside an apartment, authorities said.

    A woman called 911 on Tuesday afternoon and reported that she had been shot, Huntsville Deputy Police Chief Michael Johnson told news outlets. Officers arriving at the scene found the shooting victim, whose injuries were not life-threatening. The suspect fired at the two officers, hitting them both, and barricaded himself inside an apartment.

    The officers were transported to a hospital, where one died from his injuries and the other underwent emergency surgery and was in critical condition, city officials said in a news release.

    The suspect was apprehended a little more than an hour later and transported to the hospital with non-life-threatening injuries, the city said.

    “This is a devastating loss for our department, the Huntsville community and the state of Alabama,” Huntsville Police Chief Kirk Giles said in a statement. “As we grieve with our fallen officer’s family, we have another officer fighting for his life. Please keep all our officers and the entire department in your prayers.”

    The department did not immediately release the name of the officer killed but Alabama Attorney General Steve Marshall identified him as Officer Garrett Crumby, a three-year veteran of the Huntsville Police Department who previously served for eight years with the Tuscaloosa Police Department.

    Marshall said the two officers were ambushed by an armed suspect when they arrived at the scene.

    Jail records show that Juan Robert Laws, 24, was arrested by the Alabama Law Enforcement Agency and booked into the Madison County Jail on a charge of capital murder of a law enforcement officer. He was being held without bond.

    “Tonight, our State grieves the death of another member of the law enforcement community— one who, when called upon, ran toward danger in aide of a female victim,” Marshall said in a statement.

    Officers huddled in prayer outside the hospital where the officer was taken and later surrounding the hearse that was called to transport his body for autopsy.

    “This is a painful night for the city of Huntsville and for our police family,” Huntsville Mayor Tommy Battle said. “We are heartbroken. Words cannot express our loss. We have been overwhelmed by the show of love and support from our community, and we stand united with our police officers and their families in this tragic moment.”

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  • How one state beat national surgery opioid trends

    How one state beat national surgery opioid trends

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    Newswise — A statewide effort to treat the pain of surgery patients without increasing their risk of long-term dependence on opioids has paid off in Michigan, a study shows.

    In less than two years, the effort led to a 56% reduction in the amount of opioids patients received after having six different common operations, and a 26% drop in the chance that they would still be filling opioid prescriptions months after their surgical pain should have eased.

    Both of those drops beat national trends for similar patients, according to the new study published in Annals of Surgery by a team from Michigan Medicine, the University of Michigan’s academic medical center.

    Michigan patients having certain operations – for instance, to remove part of their colon – saw the biggest drops over the study period in how many opioids they received after their operations. They also had the biggest drop in risk of developing persistent opioid use, which the researchers define as filling opioid prescriptions for months or years after surgery, when their initial surgery-related prescription was intended for short-term use.

    The Michigan effort used prescribing guidelines based on real-world evidence about how many opioid doses surgery patients actually need to ease their pain, compared with what they were prescribed.

    Importantly, the guidelines don’t leave patients in pain. In fact, past research showed that surgery patients receiving smaller opioid prescriptions had similar pain outcomes and were just as satisfied with their pain care.

    “Tens of millions of people have operations in the U.S. every year, and most of them go home with a prescription for an opioid painkiller. Although they are meant for short-term use during recovery from surgery, unfortunately, some patients keep filling opioid prescriptions for months or years after surgery, which raises their risk of opioid use disorder, overdose, and death,” said Ryan Howard, M.D., M.S., the resident in the U-M Department of Surgery who led the new analysis. “Reducing those trends is a key part of addressing our national opioid problems.”

    A statewide team effort

    The achievement was driven by the Opioid Prescribing Engagement Network and the Michigan Surgical Quality Collaborative – both based at U-M – and by surgical team leaders at 70 hospitals across the state that take part in MSQC and have implemented OPEN guidelines.

    “Our study shows how voluntary prescribing guidelines, and involvement of surgical teams in choosing evidence-based pain care options, can really make a difference,” said senior author Chad Brummett, M.D., co-director of OPEN and director of pain research at Michigan Medicine’s Department of Anesthesiology. “Fewer opioids prescribed and dispensed means lower risk not only of persistent use, but also of risks to others in the household from unused opioid medication.”

    Helping patients get leftover opioids out of their homes and disposed of safely is another key goal of the opioid prescribing engagement network. They offer several free programs to Michigan organizations including free medication disposal pouches, permanent disposal boxes and medication take back event planning materials.

    Making Michigan the safest place for surgery

    The team showed that declines in Michigan – where these guidelines were implemented – outpaced the nation, and other Midwest states, by comparing records from tens of thousands of patients who had the six types of operations in Michigan and those who had them in other states.

    Their analysis spans almost four years before the prescribing guidelines were deployed statewide, and nearly two years afterward, from 2013 to mid-2019.

    They focused on patients covered by traditional Medicare, who had not filled an opioid prescription for a year before their operation, and who had not had a second operation in the six months after their index operation.

    The study focuses on nearly 25,000 Michigan patients and more than 118,600 non-Michigan patients who had minimally invasive gallbladder removal or appendix removal, minor or major hernia repairs, removal of part of the colon (colectomy), or hysterectomy.

    Those six types of operations were the first ones that focused on when developing and implementing prescribing guidelines based on opioid prescription fills and surveys of patients undergoing surgery. They were first published in October 2017, and have been added to ever since with guidelines for other types of surgical and dental procedures. The opioid prescribing engagement network recently published its first pediatric surgery prescribing guidelines.

    The 70 hospitals across Michigan where the guidelines were deployed account for the majority of surgical care in the state. The non-Michigan patients were a 20% sample of all traditional Medicare patients who had the same operations in the same timeframe.

    The researchers looked for signs of new persistent use of opioids, which means a patient filled an opioid prescription immediately after surgery, and then also filled at least one more opioid prescription in the three months after surgery, and another up to six months after surgery. They also looked at the total amount of opioids that patients received in the six months after their operation.

    Because opioid prescribing in general was trending downward in the mid-2010s, the researchers looked at differences between Michigan and national trends to see if there was any difference.

    Michigan outperforms the nation

    Michigan patients had a larger decrease in the rate of new persistent opioid use than their non-Michigan counterparts, with the two drops differing by about half a percentage point.

    This was driven especially by a 2.76 percentage-point reduction among those having colon surgery, and smaller but significant reductions among those having gallbladder and minor hernia operations. Patients having other operations had either no difference between Michigan and the rest of the nation, or a slight increase in Michigan for appendectomy.

    On the whole, Michigan surgical patients saw a faster drop in the size of the opioid prescriptions they filled, compared with those in other states having the same operations in the same time period.

    The difference was nearly 56 mg of opioids by the end of the study period, with significant drops in all types of surgery except laparoscopic appendectomy. Michigan patients started at about 200 mg morphine equivalents, and dropped to 89 mg morphine on average, while non-Michigan patients started at 218 mg morphine and dropped to 154 mg morphine.

    The size of dispensed opioid prescriptions to Michigan surgical patients was actually already lower than national surgical opioid prescribing before the guidelines, though persistent opioid use after surgery was higher in Michigan at 3.4% compared with 2.7%.

    When the researchers excluded cancer patients, or patients with substance issues, Michigan still outperformed the rest of the country in decreasing persistent use and reducing the size of prescriptions dispensed to patients.

    Michigan’s colon surgery patients had the biggest drop in both the amount of opioids they received and their chance of developing persistent use.

    The researchers also did additional comparisons of Michigan with a group of Midwestern states, and with Indiana and Wisconsin, as well as doing analyses that excluded cancer patients and patients who had previously been diagnosed with a substance use disorder. In all these cases, Michigan performed better than the nation.

    Both MSQC and OPEN receive funding from Blue Cross Blue Shield of Michigan. The opioid prescribing engagement network also has received funding from the Michigan Department of Health and Human Services and National Institutes of Health, as well as support from the U-M Institute for Healthcare Policy and Innovation.

    In addition to Howard and Brummett, the study’s authors are Andrew Ryan, Ph.D., formerly of the U-M School of Public Health, Hsou Mei Hu, Ph.D., M.B.A., of OPEN; Craig S. Brown, M.D., M.S., of Surgery; and OPEN co-directors Jennifer Waljee, M.D., M.P.H., M.S., Mark Bicket, M.D., Ph.D. and Michael Englesbe, M.D. Many of the authors are members of IHPI and the Center for Healthcare Outcomes and Policy.

    Paper cited: “Evidence-Based Opioid Prescribing Guidelines and New Persistent Opioid Use After Surgery,” Annals of Surgery. DOI: 10.1097/SLA.0000000000005792

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  • Judge denies defense bid to prevent release of Otieno’s body

    Judge denies defense bid to prevent release of Otieno’s body

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    RICHMOND, Va. — A Virginia judge has denied a request from attorneys for one of seven sheriff’s deputies charged in the death of a mental patient to prevent the man’s body from being released until they decide whether they will seek an independent autopsy.

    Dinwiddie Circuit Court Joseph Teefey Jr. ruled Wednesday that defense attorneys could instead ask for an independent examiner to be present during the autopsy currently being performed by the state medical examiner’s office.

    Irvo Otieno died on March 6 while he was being admitted to Central State Hospital. Dinwiddie Commonwealth’s Attorney Ann Cabell Baskervill has said that Otieno was suffocated to death, but an autopsy has not been completed. Video released this week shows the deputies and hospital employees pinning the 28-year-old Black man to the floor for more than 10 minutes.

    Defense attorneys have said that the deputies and hospital employees were trying to restrain Otieno after he became combative during the transfer process from a Henrico jail to the hospital.

    Otieno’s family said he had longstanding mental health struggles and was brutally mistreated at the hospital and in jail. He was initially taken to a Richmond-area hospital by police for psychiatric care on March 3. But after authorities said he became combative, he was charged with three counts of assaulting a law enforcement officer and transferred to the jail. His family says he was denied access to needed medication during his time there.

    In their motion, attorneys for Sgt. Kaiyell Sanders of the Henrico County Sheriff’s Office asked that Otieno’s body be preserved as physical evidence. They said it would be “highly unlikely” that they would ask for a second autopsy, but because the cause of death “will be an essential element” of the state’s case against Sanders, their request to preserve Otieno’s body is “imminently reasonable.”

    “Without an order from this Honorable Court ordering the preservation of the physical evidence, namely the body of Irvo N. Otieno, the Defendant will be unjustly deprived of his ability to inspect the physical evidence through an independent autopsy,” Sanders’ attorney, W. Edward Riley IV, wrote in the motion.

    Riley did not immediately return a call Thursday seeking comment on the judge’s denial of the request.

    WRIC-TV reports that during a bond hearing in court Wednesday, Sanders’ attorneys said the state medical examiner informed them it could be up to 12 weeks before the autopsy report is released.

    Mark Krudys, an attorney for Otieno’s family, did not respond to an email seeking comment on the defense request.

    In denying the motion, Teefey said the defense request was “speculative in nature,” WRIC reported.

    “We’re not talking about a T-shirt or a vial of blood,” Teefey said. “We’re talking about the dignity of a human body.”

    A total of 10 people have been charged in the case. All have been granted bond and have pre-trial hearings scheduled in court in April and May.

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  • Nebraska trans health bill advances, despite filibuster vow

    Nebraska trans health bill advances, despite filibuster vow

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    LINCOLN, Neb. — The Nebraska Legislature voted Thursday to advance a contentious bill that would ban gender-affirming care for minors, despite threats from two lawmakers that they would filibuster the rest of the session.

    The vote came on the third day of debate, in which lawmakers angrily accused one another of hypocrisy and a lack of collegiality. With the bill’s advancement, Omaha Sens. Megan Hunt and Machaela Cavanaugh have promised to filibuster every bill that comes before lawmakers for the rest of the 90-day session.

    Hunt took to the floor of the Legislature on Wednesday to confess that the debate is deeply personal for her, because her teenage son is transgender. She called the bill an affront to her as a parent and called out by name lawmakers she would hold accountable if they vote to advance it.

    “If this bill passes, all your bills are on the chopping block, and the bridge is burned,” she said. “I’m not doing anything for you. Because this is fake. this has nothing to do with real life. this is all of you playing government.”

    The proposal had caused tumult in the legislative session long before debate began on it earlier this week. It was cited as the genesis of a nearly three-week, uninterrupted filibuster carried by Cavanaugh, who followed through on her vow in late February to filibuster every bill before the Legislature — even those she supported — declaring she would “burn the session to the ground over this bill.”

    She stuck with it until an agreement was reached late last week to push the bill to the front of the debate queue. Instead of trying to eat time to keep the bill from getting to the floor, Cavanaugh decided she wanted a vote to put on the record which lawmakers would “legislate hate against children.”

    The Nebraska bill, along with another that would ban trans people from using bathrooms and locker rooms or playing on sports teams that don’t align with the sex listed on their birth certificates, are among roughly 150 bills targeting transgender people that have been introduced in state legislatures this year.

    Introduced by Republican Sen. Kathleen Kauth, a freshman lawmaker, the bill would outlaw gender-affirming therapies such as hormone treatments, puberty blockers and gender reassignment surgery for those 18 and younger. The purpose of the bill, she has said, is to protect youth from undertaking gender-affirming treatments they might later regret as adults, citing research that says adolescents’ brains aren’t fully developed.

    The bill will have to survive two more rounds of debate to pass in the unique one-house, officially nonpartisan Legislature. Republican Gov. Jim Pillen has said he will sign the bill into law if it reaches his desk.

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  • Remoção de ambos os ovários em mulheres mais jovens associada ao aumento do risco da Doença de Parkinson

    Remoção de ambos os ovários em mulheres mais jovens associada ao aumento do risco da Doença de Parkinson

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    Newswise — ROCHESTER, Minnesota — A remoção cirúrgica de ambos os ovários está associada a um risco aumentado de Doença de Parkinson e parkinsonismo em mulheres com menos de 43 anos, conforme relatam os pesquisadores da Mayo Clinic na revista médica JAMA Network Open. 

    Usando dados de registros de saúde do Rochester Epidemiology Project, o estudo incluiu 2.750 mulheres que foram submetidas a cirurgia para remover ambos os ovários (um procedimento chamado ooforectomia bilateral) e 2.749 que não passaram pela cirurgia. As razões para a cirurgia foram uma condição benigna (não cancerosa), como endometriose, cisto ou outro motivo, incluindo a cirurgia preventiva do câncer. Os pesquisadores descobriram que para cada 48 mulheres com menos de 43 anos no momento da cirurgia, uma mulher adicional desenvolveu a Doença de Parkinson em comparação com mulheres da mesma idade que não tiveram os ovários removidos. 

    A Doença de Parkinson é um distúrbio progressivo que afeta o sistema nervoso e as partes do corpo controladas pelos nervos. Os tremores são comuns, mas o distúrbio também pode causar rigidez ou lentidão dos movimentos. Os sintomas muitas vezes são acompanhados por demência, distúrbios do sono e problemas intestinais e da bexiga. Parkinsonismo é um termo geral para lentidão dos movimentos, juntamente com rigidez, tremores ou perda de equilíbrio.

    A Doença de Parkinson se manifesta comumente quase duas vezes mais em homens do que em mulheres na população em geral, sugerindo que fatores de sexo ou gênero desempenham um papel no seu desenvolvimento. Para as mulheres, os ovários são a principal fonte do hormônio estrogênio. A remoção cirúrgica dos ovários de uma mulher pode ser recomendada devido ao câncer, mutações genéticas e outras condições. Quando os ovários de uma mulher são removidos cirurgicamente antes que ela entre na menopausa, essa fonte de estrogênio e outros hormônios é perdida e a remoção causa uma disfunção endócrina abrupta.

    As descobertas confirmam um estudo de 2008 que sugeriu que a falta de estrogênio causada pela remoção de ambos os ovários em mulheres mais jovens pode estar associada a um risco aumentado da Doença de Parkinson e do parkinsonismo. Os resultados comprovam as diretrizes atuais de que a remoção de ambos os ovários não deve ser realizada para prevenir o câncer de ovário em mulheres com risco médio de câncer, diz o Dr. Walter Rocca, neurologista e epidemiologista da Mayo Clinic e investigador principal do estudo.

    Para mulheres que carregam uma variante genética de alto risco para câncer de ovário, a remoção do ovário antes da menopausa pode ser indicada, mas as mulheres devem receber terapia de estrogênio após a cirurgia até os 50 ou 51 anos, idade aproximada da menopausa espontânea, diz ele. 

    “Hoje em dia, não é recomendado o uso de terapia com estrogênio para a prevenção de demência ou parkinsonismo após a menopausa espontânea para mulheres com idade entre 46 e 55 anos”, diz o Dr. Rocca. “Mas este estudo e estudos anteriores sugerem que a terapia com estrogênio é importante em mulheres cujos ovários foram removidos cirurgicamente antes dos 46 anos. Mulheres que passaram pela menopausa induzida cirurgicamente antes dos 40 anos são particularmente vulneráveis.”

    A pesquisa foi financiada em parte pelo National Institute on Aging (Instituto Nacional do Envelhecimento) dos National Institutes of Health.  Uma lista completa de autores e afiliações pode ser encontrada no artigo de pesquisa. 

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    Sobre a Mayo Clinic 
    A Mayo Clinic é uma organização sem fins lucrativos comprometida com a inovação na prática clínica, educação e pesquisa, fornecendo compaixão, conhecimento e respostas para todos que precisam de cura. Visite a Rede de Notícias da Mayo Clinic para obter outras notícias da Mayo Clinic. 

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