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Tag: Surgery

  • استئصال المبيضين لدى النساء الأصغر سنًا يرتبط بزيادة خطر الإصابة بداء باركنسون  

    استئصال المبيضين لدى النساء الأصغر سنًا يرتبط بزيادة خطر الإصابة بداء باركنسون  

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    Newswise — يرتبط الاستئصال الجراحي للمبيضين بزيادة خطر الإصابة بداء باركنسون والباركنسونية لدى النساء الأصغر من 43 عامًا، بحسب ما نشره باحثو مايو كلينك في مجلةجاما نتورك اوبن.  

    باستخدام بيانات السجل الصحي لمشروع علم الأوبئة في روتشستر، ضمت الدراسة 2,750 امرأة خضعن لجراحة استئصال المبيضين، وهي إجراء طبي يعرف باسم الاستئصال الثنائي للمبيض، و2,749 امرأة لم يخضعن لها. وكان سبب إجراء الجراحة هو وجود حالة مرضية حميدة (غير سرطانية) – مثل: الانتباذ البطاني الرحمي، أو التكيسات، أو غيرها من الحالات – أو للوقاية من السرطان. لقد وجد الباحثون أنه لكل 48 امرأة أجرت الجراحة في عمر أصغر من 43 عامًا، أُصيبت امرأة واحدة بداء باركنسون، مقارنة بالنساء في نفس العمر اللاتي لم يخضعن لاستئصال المبيضين.  

    داء باركنسون هو اضطراب يتفاقم تدريجيًا ويؤثر على الجهاز العصبي وأجزاء الجسم التي تتحكم بها الأعصاب. الرُعاش هو أحد الأعراض الشائعة لهذا الاضطراب، لكنه قد يسبب أيضًا التيبّس وتباطؤ الحركة. وعادة ما يصاحبه الخَرَف، واضطرابات النوم، ومشكلات الأمعاء والمثانة. الباركنسونية هو مصطلح عام يصف تباطؤ الحركة مع التيبّس أو الرُعاش أو فقدان التوازن. 

    يُصاب الرجال بداء باركنسون أكثر من النساء بمقدار الضعفين بين عموم السكان، مما يرجح أن العوامل المتعلقة بجنس الشخص تلعب دورًا في الإصابة. الـمِبيَضان هما المصدر الأساسي لهرمون الإستروجين لدى السيدات. وقد يُوصى بإجراء استئصال جراحي للـمبيضين بسبب السرطان والطفرات الجينية وغيرها من الحالات المرضية. وعندما يُستأصل الـمِبيَضان قبل بلوغ المرأة مرحلة انقطاع الطمث، فإنها بذلك تفقد المصدر الرئيسي لهرمون الإستروجين وغيره من الهرمونات، مما يسبب خللًا وظيفيًا مفاجئًا في الغدد الصماء. 

    تؤكد نتائج هذه الدراسة ما توصلت إليه دراسة أُجريت في 2008 تشير إلى أن نقص الإستروجين الناتج عن استئصال المبيضين لدى النساء الأصغر سنًا قد يرتبط بزيادة خطر الإصابة بداء باركنسون والباركنسونية. تدعم هذه النتائج التوجيهات الحالية بخصوص عدم جواز استئصال المبيضين للوقاية من سرطان المبيضين لدى النساء المعرضات لخطر متوسط للإصابة بالسرطان، بحسب ما أفاد به والتر روكا، دكتور الطب، وطبيب الأعصاب والأوبئة في مايو كلينك والمؤلف الأول لهذه الدراسة. 

    وأضاف: بالنسبة للنساء اللاتي يحملنَ متغيرًا جينيًا مرتفع الخطورة للإصابة بسرطان المبيضين، فقد يُنصح باستئصال المبيضين قبل بلوغ مرحلة انقطاع الطمث، ولكن يجب أن تتلقى تلك النساء علاج بهرمون الإستروجين بعد إجراء الجراحة حتى بلوغ سن 50 أو 51 عامًا، وهو العمر التقريبي لحدوث انقطاع الطمث التلقائي.  

    يقول دكتور روكا: “إلى يومنا هذا، لا يُنصح باستعمال علاج بهرمون الإستروجين للوقاية من الخَرَف أو الباركنسونية بعد انقطاع الطمث التلقائي لدى النساء بين 46 و55 عامًا”. ”لكن تشير هذه الدراسة والدراسات السابقة إلى ضرورة إعطاء علاج بهرمون الإستروجين للنساء دون سن 46 عاما اللاتي خضعن لجراحة استئصال المبيضين. فالنساء الأكثر عرضة للخطر هن من تعرضن لانقطاع الطمث قبل بلوغ 40 عامًا بسبب جراحة استئصال المبيضين”. 

    موَّل المعهد الوطني للشيخوخة (المعاهد الوطنية للصحة) هذه الدراسة بشكل جزئي.  للحصول على القائمة الكاملة للمؤلفين وانتماءاتهم المؤسسية، راجع الورقة البحثية.  

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    نبذة عن مايو كلينك 
    مايو كلينك هي مؤسسة غير ربحية تلتزم بالابتكار في الممارسات السريرية والتعليم والبحث وتوفير التعاطف والخبرة لكل مَن يحتاج إلى الاستشفاء والرد على استفساراته. لمعرفة المزيد من أخبار مايو كلينك، تفضَّل بزيارة شبكة مايو كلينك الإخبارية.  

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    Mayo Clinic

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  • DeRozan scores 49 as Bulls beat Timberwolves in double OT

    DeRozan scores 49 as Bulls beat Timberwolves in double OT

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    CHICAGO — DeMar DeRozan scored a season-high 49 points, Zach LaVine finished with 39 and the Chicago Bulls beat the Minnesota Timberwolves 139-131 in double overtime on Friday night.

    DeRozan and LaVine joined Michael Jordan and Scottie Pippen as the only Bulls duo with 39 points or more in the same game, according to the Elias Sports Bureau. The two Hall of Famers did it against the Indiana Pacers on Feb. 18, 1996, with Jordan going for 44 and Pippen finishing with 40.

    “When we’ve got it rolling like that, it makes everything so much easier not even just to score, just to get everybody else involved,” said DeRozan, who had some trouble seeing after getting hit in the eye.

    Nikola Vucevic added 21 points and 11 rebounds.

    Minnesota All-Star Anthony Edwards left with a sprained right ankle in the first quarter, and the Timberwolves lost for the fourth time in five games.

    Mike Conley led Minnesota with 28 points, nailing a career-high 8 of 12 3-pointers. Rudy Gobert finished with 21 points and 19 rebounds before fouling out in the first OT, and Jaden McDaniels scored 25 points.

    The Bulls led 130-125 in the second OT before Conley hit a 3-pointer. Minnesota’s Naz Reid had a layup rim out, and DeRozan made a turnaround jumper to bump Chicago’s lead to 132-28 with 1:27 remaining.

    Nickeil Alexander-Walker made the second free throw after an airball to pull the Timberwolves within three, but Vucevic brought the Bulls bench to its feet with a thunderous one-handed dunk for a three-point play with just over a minute left.

    Reid drove for a layup to make it a four-point game. But DeRozan made four free throws in the final 36 seconds to help Chicago come away with a wild win.

    EDWARDS INJURED

    Edwards was hurt late in the first quarter when he landed awkwardly after jumping while throwing a pass. He stayed down clutching his ankle before being helped to the back, and coach Chris Finch wasn’t sure how long he’ll be out, though Edwards wasn’t ruling out playing at Toronto on Saturday.

    “I’m gonna see how it feels tomorrow,” he said. “Hopefully I can play.”

    Losing Edwards, who came into the game averaging 25 points and made his first All-Star team this year, would be a big blow for the Timberwolves, particularly with Karl-Anthony Towns appears poised to return from a calf injury that has sidelined him for most of the season. The Timberwolves are trying to avoid the play-in and build some momentum with the regular season winding down.

    “You want to be getting guys healthy and playing at your best, guys in a great rhythm,” Conley said. “Obviously being without KAT and then losing Ant, two of our best players, at such an important time of the season is very tough. This team’s got to be resilient. This is gonna be a great time for us to grow up together and figure it out.”

    FIRST OT

    Conley nailed a 3 to give Minnesota a 121-118 lead in the first overtime. DeRozan tied on a three-point play with just over a minute left, with Gobert fouling out in the process.

    McDaniels then scored to put Minnesota back on top. LaVine drove for a tying layup with 11 seconds remaining after the Timberwolves’ Taurean Prince threw the ball away, and McDaniels missed a pull-up 3 for Minnesota.

    TIP-INS

    Timberwolves: Finch said there are “a lot of dynamics” to Towns’ impending return that the Timberwolves “haven’t really dug into” because there are still some unknowns, such as whether he will be on a minutes restriction. Towns hasn’t played since he strained his right calf against Nov. 28 in a game at Washington. The team announced Wednesday the three-time All-Star is expected to return “in the coming weeks.” “The good thing about KAT is he’s pretty much wired to make the right play, whether it’s passing or shooting,” Finch said.

    Bulls: Coach Billy Donovan wasn’t sure when or even if Lonzo Ball will play again for Chicago, with the point guard set to have yet another surgery on his troublesome left knee. Donovan said Ball will likely undergo a cartilage transplant early next week, though he wasn’t sure which day, and is in for “a long rehab.” The surgery will be the third on the knee in 14 months for Ball, who was ruled out for the season in February.

    UP NEXT

    Timberwolves: Visit Toronto on Saturday.

    Bulls: Host Miami on Saturday.

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    AP NBA: https://apnews.com/hub/nba and https://twitter.com/AP_Sports

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  • HSS Study Shows MISB, a Minimally Invasive Procedure for Treating Bunions, Does Not Affect Flatfoot

    HSS Study Shows MISB, a Minimally Invasive Procedure for Treating Bunions, Does Not Affect Flatfoot

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    Newswise — Existing thought in the orthopedic world is that treating a bunion with the minimally invasive procedure MISB may make a person’s flatfoot worse. A new study by researchers at Hospital for Special Surgery (HSS) in New York City shows that this procedure does not make flatfoot worse in people with asymptomatic flatfoot and may even improve the condition. The findings were presented today at the annual meeting of the American Academy of Orthopaedic Surgeons (AAOS).

    “Because of the way the bunion correction is performed with MISB, there is a thought that it may not help stabilize the foot in the same way that the more extensive, open procedures performed at the midfoot do,” said study senior author Anne Holland Johnson, MD, a foot and ankle surgeon at HSS. “When someone has a flatfoot deformity, which is essentially a fallen arch, the idea is that fixing the bunion through this minimally invasive technique could make the flatfoot worse because we cut the bones closer to the toe. What we found is that it was quite the opposite—that fixing the bunion in a minimally invasive way caused no changes in the overall flatfoot dimensions.”

    “Bunion” is an umbrella term describing a variety of painful deformities at the base of the big toe. In the most common type of bunion, called hallux valgus, the big toe turns inward from its normal position and angles toward the second toe. Hallux valgus often presents with secondary structural deformities such as flatfoot, which can be symptomatic or asymptomatic (causing no symptoms).

    All techniques for treating bunions involve cutting the bones and repositioning them with metal screws. The minimally invasive chevron and akin bunionectomy (MISB) fixes the bunion by cutting the bones through tiny incisions in the skin. “The advantages of doing the surgery through small incisions include minimal to no pain after the surgery; immediate weight bearing, so you can walk normally on the foot; and faster return to day-to-day activities and sports,” said Dr. Johnson.

    The researchers conducted a retrospective study using a patient registry at HSS. In the registry, they identified patients who were over 18 years of age and were diagnosed with a bunion deformity between 2016 and 2021. Of this cohort, patients were included in the study if they underwent a MISB procedure to correct a hallux valgus deformity; reported their outcomes for at least one year and up to two years, as recorded by a patient-reported outcomes tool known as PROMIS; and had x-rays before and three months after surgery, at minimum. Using preoperative x-rays, the team identified individuals who had evidence of flatfoot; using a chart review, they also identified those with an asymptomatic flatfoot. These reviews yielded a study group of 35 patients with asymptomatic flatfoot and 47 patients without flatfoot.

    “We collected PROMIS surveys on all our patients. These are a series of questionnaires that have been validated for use in foot and ankle research and ask the patient about their function, pain, and mental health,” said Rami Mizher, lead author of the study and a research assistant in the Department of Foot and Ankle Surgery at HSS. The researchers found that MISB resulted in similar improvements in the two groups in physical function, pain interference (how often the pain interferes with daily life), pain intensity, and global physical health (overall patient health), as measured by the PROMIS survey. There were no significant preoperative to postoperative changes in PROMIS global mental health and depression measures in either group.

    A chart review showed there was no difference in complications in the two study groups.

    The researchers also examined pre- and post-operative x-rays to clinically assess how well the surgery corrected the bunion deformity and if it changed any of the flatfoot-related measurements. In both groups, there was a similar correction of the bunion deformity. In terms of the flatfoot outcomes, the researchers looked at three different parameters: calcaneal pitch, or the height of the foot arch; Meary’s angle, which measures how much a foot sags; and talonavicular coverage angle, which measures how much the foot turns outward. The first two measures didn’t have any significant changes, while the talonavicular coverage angle improved in the flatfoot group.

    “Our research shows that you can fix the bunion with this comparatively easier procedure and not make the flatfoot worse,” said Dr. Johnson. “It proves that minimally invasive bunion correction is a viable option for patients with flatfoot.”

    Authors: Rami Mizher, BS; Lavan Rajan, BA; Jaeyoung Kim, MD; Syian Srikumar, BS; Elizabeth Cody, MD; Anne Holland Johnson, MD; Scott Ellis, MD (HSS)

    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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    Hospital for Special Surgery

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  • Doctor learns how to walk again after biking accident

    Doctor learns how to walk again after biking accident

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    BYLINE: Valerie Goodwin

    Newswise — Like many during the early stages of the COVID-19 pandemic, Joseph Kolars, M.D., professor of medicine in the Division of Gastroenterology and Hepatology at the University of Michigan and his wife, Candace Kolars would take nice weather days as an opportunity to get outside and be active.

    In December 2020, the Kolars were taking one of their usual bike rides through Gallup Park in Ann Arbor when they noticed a runner had fallen on a slippery bridge. The pair quickly hit their brakes but proceeded to fall off their bikes. While Candace Kolars was unharmed, Joseph Kolars was in a lot of pain and couldn’t stand up.

    After calling 911, EMS arrived to find that not only could Joseph Kolars not stand, but his helmet was cracked. He was quickly whisked away to the University of Michigan Health System Emergency Department for evaluation.

    Joseph Kolars had numerous tests run on both his head and his legs. The results revealed that while his helmet had protected his head, his pelvis and femur absorbed the full brunt of the fall.

    A series of x-rays and CT scans showed that Joseph Kolars’s right femur had broken through the joint capsule, gone up through his pelvis, which shattered in the process. The staff at the ED quickly started trying to control Kolars’ pain while putting him into traction to pull his femur out of his pelvic area.

    “I don’t remember much from the ED, but I do remember them doing everything they could to make me feel comfortable,” said Joseph Kolars. “Everyone who helped me was very efficient.”

    After all the ED tests were run, Jaimo Ahn, M.D., an orthopaedic surgeon at Michigan Medicine, assessed the damage of the injury and started working on a plan of operation for Joseph Kolars.

    While his injury was severe, Ahn was able to quickly identify the injury as a “high energy” acetabular fracture, a type of fracture that has been researched for decades. Within 24 hours of arriving to the ED, Ahn was able to start working with Joseph Kolars on a plan of action for surgery.

    Fixing an injury like this requires a lot of surgical trauma to the body. Almost all surgeries require cutting through muscles and tissues to get to the desired location. The larger the incision, the more trauma, blood loss, risk of infection, and more difficult recovery.

    “Surgery is just controlled trauma to the body,” said Ahn. “The less trauma we can cause, the easier it is for the patient to recover.” 

    Ahn proposed a hybrid procedure that would have a smaller incision and less risk and an easier recovery.

    “Dr. Ahn presented this alternative method with lots of confidence,” said Joseph Kolars. “His confidence in the procedure is what convinced me this was the right choice and that it would pan out well.”

    This procedure used more indirect methods to bring the pieces back together. Pins were used during the procedure to help steady the bones so they could be put back in place and guide the fixation metal to where it needs to go. The plates and screws were left in the pelvis to help hold the bone where it needs to be and steady the area so Joseph Kolars could start walking again during recovery.

    The CT scan that was done before surgery allowed Ahn to see every fracture in full detail down to the millimeter. This allowed for more precise placements of the surgical hardware when it came to the procedure and piecing the pelvic bone back together.

    “Some people would describe fracture care as a mix of carpentry and gardening,” said Ahn. “The carpentry aspect is using a hard material that we need to be able to position and fix into place. We are still working with a living organism and need to make sure there is ample blood flow to support what is being done, that is the gardening.

    Getting back on the bike

    After surgery, Joseph Kolars spent six days in the hospital before being discharged. Even though his wife could not visit due to COVID-related restrictions, she felt kept in the loop about what was going on.

    “Dr. Ahn kept good communication with Candace Kolars and was able to inspire confidence in her that this procedure was the right choice,” said Joseph Kolars. “We were both very impressed with the communication from all the staff. Candace Kolars felt like she was being kept in the loop on everything as if she was there.”

    Candace Kolars would receive regular phone calls and facetimes from Ahn, the staff, and Joseph Kolars himself to be kept up to date with the care that he was receiving.

    Ahn and Joseph Kolars both mentioned that it is not always easy for doctors to be good patients.

    “We have a tendency as doctors to feel like we should be leading the critical treatment decisions,” said Ahn. “Joseph Kolars did a great job of being an engaged patient rather than directing care and that engagement can make a real positive difference.”

    Before being discharged from the hospital, physical therapy and occupational therapy teams created a specialized plan for Joseph Kolars’s recovery at home. Due to the nature of the injury, Joseph Kolars couldn’t ride in a car, so the therapists were sent to his house one to three times per week help with rehabilitation.

    Joseph Kolars was unsure if he would be able to walk again or make a full recovery due to the severity of the injury. Thanks to his care teams, he was able to walk again by April of 2021.  Today, Joseph Kolars and his wife still enjoy riding their bikes for as far as 40 miles.

    “The care I received from everyone during my stay in the hospital and after was phenomenal,” said Joseph Kolars. “I’m extremely grateful for everyone who worked on my case.”

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    Michigan Medicine – University of Michigan

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  • Hospitals Face Challenges When Implementing Enhanced Recovery Programs for Surgery

    Hospitals Face Challenges When Implementing Enhanced Recovery Programs for Surgery

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    Key takeaways

    • Striving to improve patient care: Enhanced recovery programs (ERPs) provide hospitals with patient-centered protocols and standards to improve the safety and quality of care for patients undergoing surgery.
    • Understanding barriers to compliance: Although previous studies have shown substantial improvements when hospitals implement ERPs, some hospitals have reported difficulties successfully implementing these programs.
    • ERPs are not always easily implemented: This study found that out of 151 hospitals that implemented an ERP for colorectal surgery, most of them (85%) had difficulty improving compliance with a national protocol.

    Newswise — CHICAGO: Enhanced recovery programs (ERPs) provide hospitals with the highest-quality resources to improve patient care for surgery, but many hospitals still struggle to successfully implement these programs and may need more structured resources to boost compliance rates, according to findings published in the Journal of the American College of Surgeons (JACS). 

    “Enhanced recovery programs have been instrumental in promoting evidence-based, standardized perioperative care that focuses on engaging patients from the moment it’s decided they will have surgery, all the way to their transition back into the community,” said Elizabeth Wick, MD, FACS, a professor of surgery at the University of California, San Francisco (UCSF) and a study co-author. “While some previous studies have reported substantial improvements when hospitals implement these programs, the goal of this study was to take a deep dive into process compliance and understand how successful these hospitals were at implementing enhanced recovery programs.”

    The research stems from the Improving Surgical Care and Recovery Collaborative (ISCR), a partnership between the American College of Surgeons (ACS), the Agency for Healthcare Research and Quality, and the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality. That collaboration began in 2016 with the goal of helping hospitals implement ERPs, also known as enhanced recovery after surgery, around the country by providing them with centralized support and tools for standardizing patient care — from guidelines on infection control to optimal nutrition. The program ran until 2022 and assisted about 300 hospitals in initiating and spreading ERPs across multiple surgical specialties, according to Dr. Wick.

    “Another principle we try to emphasize through the program is the importance of multidisciplinary or collaborative surgical care with surgeons, anesthesiologists, hospitals, and nurses,” Dr. Wick explained. “All members of the team need to come together to provide the best surgical care for patients and their families.”

    For this study, researchers analyzed data from 151 hospitals enrolled in an ISCR protocol for colorectal surgery to determine if they got better or worse at complying with ERP process measures — and by how much — over an 18-month period. Participating hospitals, which were located throughout the country but were mostly teaching hospitals in urban areas, entered data on process measure compliance and 30-day patient outcomes into a customized registry through the ACS National Surgical Quality Improvement Program® (ACS NSQIP®).

    The researchers looked at six common components of an ERP protocol for colorectal surgery:

    • Oral antibiotics: Did the patient receive oral antibiotics within 24 hours of the operation?
    • Mechanical bowel preparation: Did the patient complete a mechanical bowel preparation (oral medication used to cleanse the large bowel of fecal matter) before the operation?
    • Multimodal pain control: Did the patient use scheduled, nonopioid pain medication in addition to, or in place of, opioid pain medication within 24 hours of the operation?
    • Early mobilization: Was the patient mobile (able to walk and stand) within 24 hours of the operation?
    • Early liquid intake: Did the patient receive liquid within 24 hours of the operation?
    • Early solid intake: Did the patient receive solid food within 48 hours of the operation?

    Looking at changes in process measure compliance from the start of the program to the end, the team divided compliance rate changes into three categories: worsening (<0%), minimal improvement (0-20% change in compliance), and substantial improvement (greater than 20% change in compliance).

    Researchers looked at each of the six process measures separately as an individual opportunity for improvement and looked at a composite measure of all six process measures by the hospital.

    Key findings

    • Out of 151 hospitals studied, only 15% of the hospitals achieved substantial improvements in compliance across the entire protocol.
    • The researchers identified 663 individual opportunities available for improvement; of these opportunities, substantial improvement in compliance only occurred 20% of the time.
    • Process measures that involved simple interventions, such as pain control or oral antibiotics, improved the most by 23% and 16%, respectively. In contrast, early mobilization improved the least, by 2%.
    • On average, the individual components of the ERP were implemented for patients less than 70% of the time across all the hospitals.

    The research focused on a national ERP for colorectal surgery, but the authors note that the results may be generalizable across many surgical specialties.

    “I think these findings suggest that there’s a significant opportunity available to improve compliance with enhanced recovery programs, and in turn, improve patient outcomes, because prior studies have shown that high compliance leads to better outcomes,” said Tejen Shah, MD, a general surgery resident at Ohio State University Wexner Medical Center and lead author of the study.

    Addressing barriers

    Though the study only included data from hospitals that participated in the ISCR collaborative, which could cause selection bias, the trends reflected in the study paint a larger picture of barriers to implementing ERPs, the researchers said. When implementing ERPs, inadequate resources or limited leadership support may hinder progress, for example, or there may be ineffective collaboration and communication among team members.

    In their journal article, the researchers identified the ACS Quality Verification Program™ (ACS QVP) as one program that may offer hospitals a more structured approach to achieving quality improvement measures. The ACS QVP provides hospitals with customized, actionable recommendations on improving surgical quality, such as leadership and safety culture, based on the framework of 12 evidence-based standards vetted by the ACS. The program may help hospitals and providers break down each component of the ERP into manageable items, the researchers noted.

    “The overall structure of the ACS QVP may also be advantageous to hospitals. It really helps surgeons engage with hospital leadership at a very high level,” Dr. Wick said.

    “Lower compliance rates didn’t occur because of a lack of effort. People were passionate about trying to implement the enhanced recovery program. But it was challenging,” she added. “I think this study highlights the fact that we need to collectively figure out how to address those barriers and make this work easier. We have the opportunity to improve prioritization and access to resources, whether it’s project management or expertise in data skills, and then ultimately hold people accountable for doing the work.”

    “This research confirms what we as surgeons know — the work of improvement is challenging. It takes tremendous focus and determination,” Dr. Wick said. “The good news is that the ACS has exceptional expertise in how to improve surgical quality. With more than 17 surgical quality programs, the ACS is a valuable resource for every hospital’s quality journey.”

    Study coauthors are Leandra Knapp, MS; Mark E. Cohen, PhD; Stacy A. Brethauer, MD, MBA, FACS; and Clifford Y. Ko MD, MS, MSHS, FACS. All authors are affiliated with the Division of Research and Optimal Patient Care, the American College of Surgeons, Ohio State University Wexner Medical Center, the University of California, San Francisco (UCSF), or the University of California, Los Angeles (UCLA).

    The study authors have no relevant disclosures to report. This research was supported by funding from the Agency for Healthcare Research and Quality (AHRQ). Ms. Knapp is supported by funding from the U.S. Department of Health and Human Services and is employed by the American College of Surgeons, subcontracted under Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality for Improving Surgical Care and Recovery contract with the AHRQ. Dr. Wick is supported by funding from the National Institutes of Health.

    This research was also presented at the Southern Surgical Association 134th Annual Meeting in Palm Beach, Florida, December 2022. This study is published as an article in press on the JACS website.

    Citation: Shah T, Knapp L, Cohen M, et al. Truth of Colorectal Enhanced Recovery Programs: Process Measure Compliance in 151 Hospitals. Journal of American College of Surgeons. DOI: 10.1097/XCS.0000000000000562.

    # # #

    About the American College of Surgeons 

    The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 84,000 members and is the largest organization of surgeons in the world. “FACS” designates a surgeon is a Fellow of the American College of Surgeons.  

    The Journal of the American College of Surgeons (JACS) is the official scientific journal of ACS. Each month, JACS publishes peer-reviewed original contributions on all aspects of surgery, with the goal of providing its readership the highest quality rapid retrieval of information relevant to surgeons.

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  • Renowned Rutgers Specialist to Receive Prestigious International Award

    Renowned Rutgers Specialist to Receive Prestigious International Award

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    Newswise — Dr. P. Ashley Wackym, professor and founding chair of Rutgers Robert Wood Johnson Medical School’s Department of Otolaryngology–Head and Neck Surgery, has been selected by the Prosper Ménière Society as its 2023 Gold Medal Award recipient. The Gold Medal Award, which has recognized groundbreaking, renowned individuals in the field of neurotology and otolaryngology, is given to a member of the academic community who has furthered the goals of the society through “research excellence, scientific innovation, and far-reaching contributions to the investigation of inner ear disorders.” 

    “Dr. Wackym is a model physician-scientist, known for innovation in otolaryngology and neurotology, who has changed the lives of his patients,” says Amy P. Murtha, MD, dean, Robert Wood Johnson Medical School. “His leadership in the education of our students and residents, and his exceptional skills are most deserving of the Gold Medal Award.”

    “I am truly honored and flattered to have been selected for this award,” says Dr. Wackym, who is also a Chancellor Scholar at Rutgers Biomedical and Health Sciences. “It is humbling to be counted among individuals I hold in great esteem in my field, from my own fellowship mentor, Dr. Brian McCabe, and Dr. Lloyd Minor, the dean of Stanford University School of Medicine, to the man widely considered the ‘Father of Neurotology,’ Dr. William House. It is a privilege to be part of this great community.”

    A member of the Robert Wood Johnson Medical School faculty since 2016, Dr. Wackym was the first neurotologist in the world to perform Gamma Knife radiosurgery and is one of the most experienced cochlear implant, superior semicircular canal dehiscence, and skull base tumor surgeons and neurotologists in the United States.

    In addition to his clinical expertise, Dr. Wackym has broad research interests in the areas of gravitational receptor test device development and in cognitive dysfunction and recovery following surgical repair of third window syndrome. He has published more than 150 peer-reviewed manuscripts, as well as many other works in the field, including serving as senior editor for Ballenger’s Otorhinolaryngology: Head and Neck Surgery, and his research has been supported for more than two decades by the National Institutes of Health and other foundations. He has also served as a senior and neurotology examiner for the American Board of Otolaryngology and on numerous editorial boards of peer-reviewed journals, including Otology & Neurotology, Audiology and Neurotology, Acta Oto-Laryngologica (Stockh), Auris Nasus Larynx, The Journal of International Advanced Otology, and Laryngoscope Investigative Otolaryngology.

    Prior to joining Robert Wood Johnson Medical School, Dr. Wackym served for seven years as the vice president of research for Legacy Health in Portland, Oregon, and for more than a decade prior to that as the John C. Koss Professor and Chair of Otolaryngology and Communication Sciences at the Medical College of Wisconsin. A graduate of the Vanderbilt University School of Medicine, he completed his internship, research fellowship and residency training at the UCLA School of Medicine and a clinical fellowship in neurotology and skull base surgery at the University of Iowa.

    Dr. Wackym will receive the Gold Medal Award at the Prosper Ménière Society’s International Symposium on Inner Ear Disorders, March 11-18, in Austria, where he will also present three sessions, each focused on “third window syndrome”/superior semicircular canal dehiscence.

    Founded in 1981, the Prosper Ménière Society aims to promote the academic dissemination and discussion of basic and clinical research data on Ménière disease and all aspects of inner ear dysfunction, pathophysiology, diagnosis and treatment.

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  • The AANS/CNS Section on Disorders of the Spine and Peripheral Nerves Presents the 2023 Spine Summit

    The AANS/CNS Section on Disorders of the Spine and Peripheral Nerves Presents the 2023 Spine Summit

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    Newswise — The 2023 Spine Summit, presented by the AANS/CNS Section on Disorders of the Spine and Peripheral Nerves, will pack in plenty of intriguing educational opportunities, exciting networking events and thrilling entertainment over the four-day meeting at the Fontainebleau Miami Beach, March 16-19. At the new Spine Summit, keynote speakers, presenters and entertainment will revolve around the theme of “Excellence Requires Change – MVP: Mastery, Vision, Purpose.”

    The 39th Annual Spine Summit, which has preemptively been coined a massive success, has a record-breaking 826 medical registrants to date, a 67% increase from last year. The Spine Summit Exhibit Hall will be packed with 70 diverse exhibitors from established industry giants to nimble startup companies; a healthy 11% increase from the 2022 event. With access to industry experts, neurosurgeons and thought leaders, the floor will serve as the destination to explore advanced technology, attend hot topic presentations and network with colleagues. Throughout the summit, there will be a plethora of learning opportunities including educational courses, special sessions, 357 oral abstract presentations and 254 I-Poster presentations.

    The 2023 Spine Summit kicks off at the Opening Reception Thursday night at the Fontainebleau’s Ocean Lawn where L.A.vation: The World’s Greatest Tribute to U2, sets the backdrop for networking and socializing. Other opportunities to get to know your fellow neurosurgeons include the WINS Reception and the Young Spine Surgeon Reception and Dinner.

    Corresponding with the meeting’s  MVP theme, the Spine Section will celebrate athletic MVPs at its inaugural Sport & Spine Session as pro football Hall of Famer and Super Bowl champion Ronnie Lott of the San Francisco 49ers discusses being an MVP on the gridiron and in life. Lott will take the stage with former teammate and friend, Jeffrey Fuller, who sustained a career-ending spinal cord injury on the field.

    Visionary speakers will kick off every Plenary Session with TEDx-style talks and each will be capped off with an impartial take on the session’s theme by tech leaders. Courses have been revamped, debates and controversies reinvigorated and scientific sessions reimagined.

    In addition to Lott and Fuller, the 2023 Spine Summit will feature inspirational remarks from Michael T. Modic, MD; Michael Brant-Zawadzki, MD, FACR; Sasha Strauss; Liam Duffy and C. Philip O’Carroll, MD.

    Michael T. Modic, MD

    Michael Modic, MD, joined Vanderbilt University Medical Center in 2018 as senior vice president, population health and professor of radiology and radiological sciences. He worked with the population health team integrating clinical activities and establishing and enabling evidence-based clinical standards across diverse network-based ambulatory and inpatient settings. In addition to his administrative efforts, he continued to engage in clinical research and care, committing time to clinical service and the teaching and mentoring of residents, fellows and junior staff as a member of the neuroradiology section.

    Michael Brant-Zawadzki, MD, FACR

    Brant-Zawadzki, MD, FACR, is the senior physician executive at Hoag Hospital and the Ron & Sandi Simon Executive Medical Director Endowed Chair of Hoag’s Pickup Family Neurosciences Institute. In these roles, he facilitates business and strategic relationships with specialist clinicians, and oversees a platform for programmatic care that integrates specialized services with population health. He helps Hoag transform health care strategy, focusing it on specific health conditions using a program-driven, physician-led, multi-disciplinary team approach measured by patient-focused outcomes. He also oversees the Hoag Center for Research and Education.

    Sasha Strauss

    Sasha Strauss shares two decades of experience in brand development, building brands for corporations, philanthropies and universities while working at top advertising, PR, marketing and branding firms worldwide. His unique and proven perspective on how brands are built and communicated laid the foundation for his brand strategy consulting firm, Innovation Protocol. The 10-year-old company has a team of 25, with staff in Los Angeles, San Francisco and New York. His team’s ability to inculcate brand truth is the reason brands like ADP, Amgen, Disney, Google, Notre Dame, PayPal, Nestle and Korn Ferry enlist their consult and keynotes on brand strategy.

    Liam Duffy

    Liam Duffy is a dynamic, high-motor trial lawyer who has significant experience in high-stakes cases. At Yarborough Applegate, Duffy has handled numerous catastrophic injury and wrongful death cases involving issues of workplace safety, over-service of alcohol, product liability, tractor-trailer collisions, premises liability, electric shock and electrocution and more. Liam’s creativeness and forward-thinking approach to trial work has helped his clients achieve numerous seven-figure recoveries, as well as an eight-figure jury verdict in 2019.

    Jeffrey Fuller

    Jeffrey Fuller was recruited to Texas A&M in 1980 and was later drafted by the San Francisco 49ers in 1984 where he played in two Super Bowls and went on to win Super Bowls XIX and XXIII.

    As the result of damage caused to Candlestick Stadium by the 1989 Loma Pierta earthquake, Fuller played his last professional game at Stanford Stadium on October 22, 1989. In the second play of the game, he was partially paralyzed after a helmet-to-helmet hit on New England running back John Stephens.

    Ronnie Lott

    Considered by many to be the greatest defensive back to put on a uniform, Ronnie Lott’s influence reinvented how the position was played, and whose influence can still be seen on the field today. In 14 professional seasons and 192 career games, Lott had 63 interceptions, 1,146 tackles and five touchdowns. He is a 10-time Pro Bowler, made the All-Pro team six times, the All-NFC six times, the All-AFC once and was named to the NFL’s 75th anniversary team in 1994. In 2000, Lott was inducted into the Pro Football Hall of Fame in his first year of eligibility.

    Philip O’Carroll, MD

    Philip O’Carroll, MD, is an expert in mind-body interactions. A native of Ireland and a graduate of University College Dublin Medical School, he completed a three-year residency in internal medicine in Canada, followed by a residency in neurology at Massachusetts General Hospital. Dr. O’Carroll completed a fellowship in neurophysiology at the Mayo Clinic in Rochester, Minnesota. He is a co-founder of the Pickup Family Neurosciences Institute at Hoag Hospital.

     

    The 2023 Spine Summit is being brought to attendees by Adam Kanter, MD, FAANS, AANS/CNS Section on Disorders of the Spine and Peripheral Nerves Chair; Scott Meyer, MD, FAANS, Annual Meeting Chair and Charles Sansur, MD, FAANS, Scientific Program Chair.

    Adam Kanter, MD, FAANS, Section Chair

    Adam Kanter, MD, FAANS, Section chair, graduated with cum laude honors from the University of Massachusetts in Amherst. He performed research for NASA while obtaining a master’s degree at Boston University and then on to medical school at the University of Vermont. He completed neurosurgery residency at the University of Virginia, including a year abroad in Auckland, New Zealand, followed by fellowship training in minimally invasive spine surgery at the University of California, San Francisco. He then joined the University of Pittsburgh Medical Center (UPMC) as director of the minimally invasive spine program. Dr. Kanter launched UPMC’s complex spine fellowship in 2012, was appointed chief of spine in 2014 and performed more than 6,000 operations as he ascended the ranks to tenured professor of neurological surgery. Dr. Kanter has authored more than 150 journal publications, numerous books and chapters, and given more than 200 lectures across the globe.

    After 15 years in Pittsburgh, Dr. Kanter sought new adventures and leadership opportunities, relocating his family and practice to Newport Beach, California, where he joined Hoag Hospital as Associate Executive Medical Director, Pickup Family Neurosciences Institute and Chief of Neurosurgery, Hoag Specialty Clinic.  He is actively obtaining his executive MBA from the University of California, Los Angeles, following which he will assume the executive directorship of the Pickup Family Neurosciences Institute.

    Scott Meyer, MD, FAANS, Annual Meeting Chair

    Scott Meyer, MD, FAANS, Annual Meeting chair, is a top neurosurgeon in New Jersey specializing in degenerative spine disease, minimally invasive spine surgery, cervical disc replacement, spinal deformity (scoliosis), spinal tumors and spinal trauma. In New Jersey, Dr. Meyer has served as chairman and a member of the Spine Technology Committee at Atlantic Health System. He is president of the New Jersey Neurosurgical Society, and also a member of the Executive Board for the New Jersey Spine Society. Dr. Meyer is a member of the Spine Steering Committee at both Morristown Medical Center and Overlook Medical Center.

    Charles Sansur, MD, FAANS, Scientific Program Chair

    Charles Sansur, MD, FAANS, Scientific Program Chair, is a professor and director of spine surgery for the Department of Neurosurgery at the University of Maryland in Baltimore. He is also the current program director and vice-chair of neurosurgery at the University of Maryland. He is a member of the editorial board for the Journal of Neurosurgery, Spine. He has served on the Spine Section Executive Committee since 2010. He holds several patents and is actively engaged in product development in spine surgery. He is frequently invited to teach other spine surgeons throughout the country at various national meetings.

     

    About the 2023 Spine Summit:

    From March 16-19, 2023, in Miami Beach, Florida, neurosurgeons, orthopaedic spine surgeons, spine surgery fellows, as well as residents and advanced practice providers will join for the 2023 Spine Summit for educational advancement, networking opportunities and riveting entertainment. This annual meeting is the

     

    About the AANS/CNS Section on Disorders of the Spine and Peripheral Nerves:

    The AANS/CNS Section on Disorders of the Spine and Peripheral Nerves brings together neurosurgeons, orthopedic spine surgeons, spine surgery fellows, as well as residents and advanced practice providers focused on spinal surgery. The Spine Section advances spine surgeon’s interests, represents them in national advocacy and disseminates science.

     

    For more information, visit www.spinesection.org

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  • Danish queen discharged from hospital after back surgery

    Danish queen discharged from hospital after back surgery

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    Denmark’s Queen Margrethe II, whose half-century reign makes her Europe’s longest-serving monarch, has been discharged from a Copenhagen hospital

    COPENHAGEN, Denmark — Denmark’s Queen Margrethe II, whose half-century reign makes her Europe’s longest-serving monarch, was discharged from a Copenhagen hospital Thursday after undergoing a back operation last week, the palace said.

    Doctors were satisfied with the Feb. 22 operation and the condition of the 82-year-old queen, the royal household said, adding that “awaiting her now is a lengthy physical rehabilitation process, which may extend over the next few months.”

    Earlier the palace had said that the popular queen underwent “extensive back surgery” at the Danish capital’s university hospital after experiencing severe back pains.

    Several official engagements have either been postponed, canceled or are being handled by other members of the royal family.

    The queen’s oldest son, heir to the throne Crown Prince Frederik, and his wife, Crown Princess Mary, are stepping in, as well as the queen’s sister, Princess Benedikte.

    The Danish Constitution gives Margrethe, Denmark’s head of state, no political power, and her duties are ceremonial. She was proclaimed queen on Jan. 15, 1972, following the death of her father.

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  • Tennessee officers’ conduct probed in woman’s death

    Tennessee officers’ conduct probed in woman’s death

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    NASHVILLE, Tenn. — Four Tennessee police officers are being investigated for their treatment of a woman whose pleas for help they repeatedly ignored as they accused her of faking illness after she was discharged from a hospital. The woman was pronounced dead a day later.

    The Knox County District Attorney’s office announced on Monday that it would not press criminal charges after an autopsy determined that 60-year-old Lisa Edwards died of a stroke and that “at no time did law enforcement interaction cause or contribute to Ms. Edwards’ death.”

    That has not stopped public outrage after the Knoxville Police Department released video showing officers accusing Edwards of faking mobility and breathing problems and ignoring her repeated pleas for help.

    In the video released last week, officers struggle for about 25 minutes to move Edwards into a police van and finally a cruiser after being called by Fort Sanders Regional Medical Center on Feb. 5.

    Edwards repeatedly asks for help but is rebuffed by officers and hospital security guards who become frustrated with her inability to step up into the van and tell her she is faking her incapacity.

    Edwards tells them she can’t breathe, she needs help sitting up, and that she’s going to have a stroke. At one point, she tells them, “I’m gonna die.”

    First to arrive at the hospital is Sgt. Brandon Wardlaw. It is 8 a.m. and Edwards is in a hospital wheelchair in the corner of a parking garage. Security guards tell Wardlaw that she has been discharged from the medical center but won’t leave the property and that they need the wheelchair back. Edwards appears somewhat disoriented, asking the officer, “Can you call the preacher for me?”

    When he can’t get Edwards to leave, Wardlaw decides to arrest her for trespassing and calls for a police van, but officers cannot get her inside it. They try several times to lift her but end up leaving her propped half-in, half-out of the van. Eventually she slumps to the ground, where they leave her lying for several minutes.

    Throughout her interaction with police, Edwards repeatedly tells the officers that she can’t breathe and needs help sitting up. Her breathing is heavy and her words are slurred.

    When a man walks into the parking garage, Edwards calls out to him, ”Doctor! Doctor!”

    She asks for her inhaler over and over again, but officers cannot locate it for several minutes. When they finally find it and give it to her, Wardlaw decides she isn’t using it correctly and takes it away again.

    Wardlaw, Officer Adam Barnett, and others repeatedly express their belief that Edwards is faking her mobility and breathing problems.

    “You’ve been medically cleared ma’am. This is not going to work,” Barnett tells her at one point. Later he complains that she is not using her legs “on purpose.”

    “Now you’re starting to piss me off! Get up!” he tells Edwards.

    “This is all an act,” Wardlaw says. “When you get out to jail, you’d better not pull this stunt, ’cause they don’t play around out there.”

    There is an indication in the video that officers may be aware Edwards could be in real distress. When they suggest putting her in the back of the van, the driver balks.

    “She’s saying she can’t breathe. If she falls … and dies, it’s on me,” says Transportation Officer Danny Dugan, who is not a sworn police officer.

    Eventually they call Officer Timothy Distasio, deciding that his cruiser has a lower profile that will make it easier to get her inside. The officers push her in, and leave her lying on her back. At this point she is wheezing heavily. She asks repeatedly for officers to sit her up but they tell her she can sit herself up.

    Video from inside the police car shows Edwards trying to pull herself upright repeatedly, but eventually she slumps out of sight. Several minutes later Distasio performs a traffic stop on another vehicle. When he opens the rear door, Edwards is unresponsive. He calls dispatch for an ambulance, telling them, “I don’t know if she’s faking it or what, but she’s not answering me.”

    Edwards was pronounced dead at the Fort Sanders Regional Medical Center the following day.

    Wardlaw, Barnett, Distasio and Dugan are on paid administrative leave, pending the outcome of the internal investigation into their conduct, according to Knoxville Police spokesman Scott Erland.

    “A lot of us see these terrible videos, and then there are no repercussions for the officers because we are told that it looks terrible but actually is technically lawful and according to policy,” said Alex Vitale, a professor of sociology at Brooklyn College who studies policing. “They never ask the bigger question of why were the police involved in the first place? …. Why are we using police to cover up the failures of our basic health care system?”

    Edwards had flown to Tennessee from Rhode Island on Feb. 4, according to the autopsy report. On the flight, she started experiencing abdominal pain, and was taken to the Blount Memorial Hospital at about 7:45 p.m. There she was disruptive and uncooperative. Her behavior included throwing feces at a nurse.

    She was discharged in stable condition, but she showed up at the Fort Sanders Regional Medical Center at about 1 a.m. on February 5. She was was discharged about six hours later, according to the autopsy.

    Edwards’ daughter-in-law, August Boylan, told television station WATE-TV that Edwards had mobility problems stemming from a stroke in 2019. She also had multiple medical issues, according to the autopsy, including chronic obstructive pulmonary disease.

    Boylan said that her mother-in-law had moved to Rhode Island from Tennessee in 2018, but decided to move back.

    “She was able to make her own decision as far as you know wanting to move back to Tennessee. She had a plan in place. She was discharged from a nursing home that had her helped arrange her flight to fly back to Tennessee. She was going to be living with a friend in Tennessee,” Boylan told the station.

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  • The American Association of Neurological Surgeons Announces Featured Speaker Lineup for the 2023 AANS Annual Scientific Meeting

    The American Association of Neurological Surgeons Announces Featured Speaker Lineup for 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 remarks from Anima Anandkumar, director of machine learning research at NVIDA and Bren Professor at CalTech; Michael Annichine, chief executive officer of the Magee-Womens Research Institute; Will Flanary (aka Dr. Glaucomflecken), ophthalmologist and comedian; Fredric B. Meyer, MD, FAANS, professor of neurosurgery at the Mayo Clinic College of Medicine and Science and Margot Putukian, MD, FACSM, FAMSSM, consultant and chief medical officer with Major League Soccer.

    The four-day weekend meeting will be held at the Los Angeles Convention Center in Los Angeles, California, April 21-24, 2023.

     

    Anima Anandkumar

    Anima Anandkumar offers a combination of leading-edge academic research with equally deep experience in business and practical applications. She is the director of machine learning research at NVIDIA, a Bren professor at Caltech and a former principal scientist at Amazon Web Services. Anandkumar received an Alfred P. Sloan Fellowship, a Microsoft Faculty Fellowship, a Google faculty award and a number of other research and best paper awards. Anandkumar will deliver the Louise Eisenhardt Lecture and speak during the AANS/CNS Section on Women in Neurosurgery (WINS) Breakfast, both on Saturday of the meeting.

     

    Michael Annichine

    Michael Annichine is the chief executive officer of Magee-Womens Research Institute and Foundation (MWRIF), the largest research institute in the US focused on women’s health and reproductive biology. Annichine also leads development campaigns that sustain programs and research within UPMC-Magee-Womens Hospital and MWRIF. Under his leadership, MWRIF has expanded its partnerships with industry, academia and national and local foundations. Annichine will be a panelist Friday evening during the Opening Session discussing Concussion in Sports: What Every Neurosurgeon Should Know.

     

    Will Flanary, MD

    Will Flanary, MD, is an ophthalmologist and comedian who moonlights as “Dr. Glaucomflecken,” a social media personality who creates medical-themed comedy shorts for more than three million viewers. Initially used as an outlet to cope with personal health challenges, Dr. Flanary’s comedy has evolved to incorporate biting satire of the US health care system, academic publishing and interpersonal conflicts pervasive in the medical system. Dr. Flanary will entertain meeting attendees with his witty stand-up comedy Friday night during the Opening Session.

     

    Fredric B. Meyer, MD, FAANS

    Fredric B. Meyer, MD, FAANS, has been a member of the Mayo Clinic staff since 1988 and is a consultant and professor of neurologic surgery. He is the enterprise chair of the Department of Neurologic Surgery at Mayo Clinic and is recognized with the Alfred Uihlein Family Professorship in Neurologic Surgery. Dr. Meyer is currently the Juanita Kious Waugh executive dean of education of the Mayo Clinic College of Medicine and Science and dean of the Mayo Clinic Alix School of Medicine. Dr. Meyer will give the Hunt Wilson Lecture Sunday morning of the meeting.

     

    Margot Putikian, MD, FACSM, FAMSSM

    Margot Putukian, MD, FACSM, FAMSSM, serves as a consultant with Major League Soccer and is their chief medical officer. Dr. Putukian is the former director of athletic medicine and head team physician at Princeton University (2004-2021). Dr. Putukian is a past president of the American Medical Society for Sports Medicine, has served as a team physician for the US Men’s National Lacrosse team and currently serves as a team physician for the US Women’s National Soccer teams. Dr. Putikian will be a panelist Friday evening during the Opening Session discussing Concussion in Sports: What Every Neurosurgeon Should Know.

     

    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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  • Risk of cancer remains high for women over 50 with genetic BRCA1 or BRCA2 mutation

    Risk of cancer remains high for women over 50 with genetic BRCA1 or BRCA2 mutation

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    Newswise — Although genetic mutations in BRCA1 or BRCA2 are associated with a younger onset of breast and ovarian cancer, women with these genetic mutations continue to face a high risk of cancer incidence after age 50, even if they have not been previously diagnosed with cancer. This is according to a new study led by Kelly Metcalfe, a professor at the Lawrence S. Bloomberg Faculty of Nursing.

    The study published recently in the American Cancer Society Journal Cancer, followed over 2000 women between the ages of 50 to 75, from 16 countries, who were aware they had a BRCA mutation and had no previous diagnosis of cancer. The study found that the cumulative risk of these women developing any type of cancer after the age of 50 was 49 percent for those with a BRCA1 mutation and 43 per cent for those with a BRCA2 mutation.  For those in the study cohort who had not undergone a cancer risk-reduction surgery, the risk was even greater at 77 per cent for those with a BRCA1 mutation and 67 per cent for those with a BRCA2 mutation.

    “What is striking about our results is that breast and ovarian cancers were the most frequently observed cancers occurring and that is concerning, considering we know how to reduce the risk of cancer in women who have these genetic risk factors,” says Metcalfe who is also a Senior Scientist at Women’s College Hospital.

    Of the women included in the study only 15 percent underwent a preventative bilateral mastectomy, and 43 percent a bilateral salpingo‐oophorectomy (BSO) – removal of both ovaries and fallopian tubes – before the age of 50. The study found that these women had the lowest risk of any occurrence of cancer at just 9 per cent.

    “Our analysis highlights the effectiveness of these risk reduction surgeries, and emphasizes the need for individuals as well as health care providers, to consider clinical guidelines and recommendations for their cancer risk, including how their genetics might impact them even at a later age,” says Metcalfe.

    She acknowledges that there are some limitations to the study including the fact that in some countries access to risk reduction surgeries may be limited, and knowledge of how often or whether these women received genetic counselling was not assessed.

    “We are not aware of whether the participants in our study received additional counselling about their elevated risk of cancer as they age and we are also unable to determine why some of these women chose to forgo preventative surgery before the age of 50,” says Metcalfe. “However, it is important to point out that screening alone only reduces mortality risk by increasing the chances of detecting the cancer early, it does not reduce the risk of cancer occurring.”

    Understanding the limitations of screening is of particular importance for women with either a BRCA1 or BRCA2 mutation especially in assessing their risk of ovarian cancer, as no good screening method exists to detect the cancer early enough. Metcalfe’s study references the National Comprehensive Cancer Network (NCCN) guidelines where it is recommended that women with a BRCA1 mutation undergo a BSO between ages 35-40 and those with BRCA2 mutation between 40-45.

    Future studies says Metcalfe, will look at exploring women’s decision-making around whether or not to undergo surgery and their own understanding of risk. For now, Metcalfe is hopeful that advances in genetic testing will help make it more accessible to all women who want to know their risk status.

    The Screen Project Canada, housed at Women’s College Hospital, is one example of a consumer-based model of testing where individuals can pay to access genetic testing that allows anyone, regardless of family history, to find out if they carry a BRCA1 or BRCA2 mutation. While it currently operates at a small cost to the patient, Metcalfe believes that lower barriers to genetic testing will not only save lives, but eventually become a mainstay of cancer care in Canada.

    “It has been over 25 years since clinical testing for BRCA1 and BRCA2 began in Canada and the United States, we have come a long way in reducing cancer incidence, but not far enough,” says Metcalfe. “The majority of cancers resulting from these two genes are preventable, we need to be offering women the best chance at a cancer-free life.”

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  • First-of-its-Kind Study Examines the Impact of Cannabis Use on Surgical Patients’ Post-Procedure Healthcare Needs

    First-of-its-Kind Study Examines the Impact of Cannabis Use on Surgical Patients’ Post-Procedure Healthcare Needs

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    BYLINE: Jacqueline Mitchell

    Newswise — BOSTON – As legislation in multiple states eases former restrictions around medical and recreational cannabis in the United States, an increasing proportion of the population reports use of the drug. Between 2016 and 2018, more than 22 percent of Massachusetts residents reported any prior cannabis use for medical or recreational reasons. However, little is known about cannabis use in patients who undergo surgery or interventional procedures, where cannabis use has important additional clinical implications.

    In a new study published in The Lancet’s eClinical Medicine, researchers led by anesthesiologists at Beth Israel Deaconess Medical Center (BIDMC) analyzed de-identified data from patients who underwent non-cardiac surgery in Boston between 2008 and 2020. The scientists found that cannabis users had a higher complexity of co-existing conditions overall, including mood disorders such as depression and substance use disorders. Patients with a diagnosed cannabis use disorder more often required advanced postprocedural healthcare – such as admission to an intensive care unit – compared to non-users. However, patients whose use of cannabis was not classified as a disorder had lower odds of requiring advanced healthcare after surgery compared to patients who never use cannabis.

    “Our analysis revealed that cannabis use is very common and has substantially increased among patients undergoing surgery, reflecting trends in the general population; however, differential effects on postprocedural health care utilization were observed between patients with moderate non-medical cannabis use and patients with a cannabis use disorder,” said corresponding author Maximillian S. Schaefer, Director of the Center for Anesthesia Research Excellence at BIDMC. “We hope our data helps make clinicians aware of how different patterns of cannabis use might represent different patient populations, which in turn translates into distinct perioperative risk profiles.”

    In this hospital registry study, Schaefer and colleagues analyzed de-identified data from 210,639 adult patients undergoing noncardiac surgery at BIDMC between January 2008 and June 2020. Non-medical cannabis use was identified before procedures during routine, structured interviews about past and ongoing habits of drug use, in accordance with the American Society of PeriAnesthesia Nursing recommendations. Patients with cannabis use disorder were identified through diagnostic codes.

    Over the entire study period, the researchers found that more than 16,000 patients, or 7.7 percent, used cannabis prior to surgery, of which 14,045 (87 percent) were identified as non-medical users and 2,166 (13 percent) had a diagnosis of cannabis use disorder. Of all the patients undergoing surgery, a total of 24,516 patients, or 12 percent, required advanced post-procedural healthcare utilization, among which 1,465 patients self-identified as non-medical cannabis users, 418 patients presented with cannabis use disorder and 22,633 patients had no reported ongoing cannabis use.

    Overall, patients who self-identified as cannabis users were on average younger, more often male, and more likely to suffer from depression, anxiety and schizoaffective disorders. Substance use disorders related to alcohol, cocaine, IV drugs, prescription medications and psychedelic drugs were more frequent in patients who used cannabis.

    “As these comorbidities have been associated with increased complications including arrhythmias and sudden cardiac death after anesthesia, a history of cannabis use disorder might serve as an indicator of potentially complicating factor for patients undergoing anesthesia that in turn contribute to the requirement of higher-level healthcare utilization after surgery,” Schaefer said.

    Compared to patients who did not use cannabis, patients with a diagnosis of cannabis use disorder had higher odds of requiring advanced post procedural healthcare utilization. Specifically, a diagnosis of cannabis use disorder was linked with higher odds of a 30-day hospital readmission, compared to patients who did not use cannabis.

    By contrast, patients with reported ongoing non-medical cannabis use had lower odds of advanced post-procedural healthcare unit utilization compared to patients who did not use cannabis. Moreover, such use was linked to shorter hospital length of stay than patients who did not use cannabis. Over the course of the study period, the scientists saw the prevalence of cannabis use rise from 5 percent in 2008 to 14 percent by 2020 and observed higher rates of cannabis use among those undergoing surgery than previous studies reported. While the scientists acknowledge the discrepancy could be the result of regional consumption patterns, they suggest their inclusion of ongoing self-reported non-medical cannabis users based on structured pre-admission interviews paints a more accurate picture than findings that identified patients’ cannabis use on diagnostic codes alone.

    “This cohort represents a distinctively different patient population of more general non-medical users,” said Schaefer. “These differential findings in patients who self-identified as ongoing, non-medical cannabis users without a diagnosis of disorder strongly suggest that future studies need to differentiate these two patient populations. Findings based on the identification of cannabis use from diagnostic codes alone might not be applicable to most mainstream cannabis users.”

    Co-authors included first author Elena Ahrens, Luca J. Wachtendorf, Laetitia S. Chiarella, Sarah Ashrafian, Aiman Suleiman, Tim M. Tartler, Basit A. Azizi, Guangqing Chen, Amnon A. Berge, Denys Shay, Valerie Banner-Goodspeed, Haobo Ma, and Kevin P. Hill, of BIDMC; Bijan Teja, of University of Toronto; and Matthias Eikermann of Albert Einstein College of Medicine.

    This work was supported by an unrestricted, philanthropic grant of Jeff and Judy Buzen. Hill has served as a consultant for Greenwich Biosciences and has received an honorarium from Walters-Klewer as an author. Schaefer received funding for investigator-initiated studies from Merck and Co which do not pertain to this manuscript. Schaefer received honoraria for presentations from Fisher and Paykel healthcare and Mindray medical information international limited period. All other authors declare no competing interests.

     

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  • Not Even Marfan Syndrome Can Curb One Woman’s Energy

    Not Even Marfan Syndrome Can Curb One Woman’s Energy

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    Newswise — LOS ANGELES (Feb. 24, 2023) – Her husband and their five children call Rosa Wernher “the Energizer bunny” because she is always on the go. For decades, not even her genetically inherited Marfan syndrome could keep her off her feet to prevent her from oil painting or from gliding down a ski slope–until it did.

    “I have always been active, almost manic–jumping from one activity to another, chasing my children around to their various activities and never requiring a great deal of sleep,” said Wernher, 53, who lives in Redlands, California. “But as I aged, I started quietly slowing down, needing to rest and sleep just a bit more than usual. I chalked it up to perimenopause, never attributing the new-onset symptoms to my genetic heart condition.”

    Shortly after she turned 51, Wernher decided it was time to check up on her heart. She was referred to Robert Siegel, MD, a Marfan syndrome expert and cardiologist in the Smidt Heart Institute at Cedars-Sinai.   

    After a routine exam and ultrasound imaging of her heart, Siegel discovered that Wernher had an enlarged aorta and a leaking aortic valve. These common complications of Marfan syndrome, which causes abnormalities in connective tissue, can become a life-threatening emergency.

    The aorta, which rises from the heart’s left ventricle–the major chamber that pumps blood out of the heart–is filled with oxygen-rich blood that travels throughout the body. If a tear occurs, blood spills through the inner layer tear and into the middle layers of the aorta, causing them to separate, or dissect. When that happens, it can deprive the body’s organs of vital blood supply.

    “I was told to see a cardiac surgeon, and fast,” said Wernher. “It was really scary to learn that despite my overall good health and energy, I had been a walking time bomb.”  

    Siegel sent Wernher to see Pedro Catarino, MD, director of Aortic Surgery in the Smidt Heart Institute, who confirmed that she had a large aortic root aneurysm and severe aortic valve regurgitation.  

    “A tear or rupture in the aorta is a surgical emergency,” said Catarino. “We do everything we can to avoid patients presenting in this progressive, severe way, and instead, treat them before a life-threatening complication occurs. Rosa was fortunate that her enlarged aorta had not yet reached this critical, life-threatening point.”

    A national leader in aortic surgery, the Smidt Heart Institute recently became an accredited Marfan Center of Excellence, a distinction given by the Marfan Foundation. As one of only 35 accredited medical centers in the nation, the Cedars-Sinai program utilizes a multidisciplinary team of cardiac and vascular surgeons, cardiologists, and radiologists who use advanced imaging techniques to predict patient risk and identify the best surgical options. 

    The medical consensus for Wernher: She was a candidate for a technically complex surgery called a valve-sparing aortic root replacement.

    “During Rosa’s surgery, we kept her aortic valve and reconnected it to a new section of aortic tissue,” said Catarino. “This specialized technique isn’t offered everywhere, and it really requires a team of experts who can deliver it.”

    Wernher’s four-hour surgery was a success. Although it was challenging for her energetic self to lie low after surgery, she gained more zest within six weeks. Now, nearly eight months after surgery, Wernher has already skied Mammoth Mountain and is back to standing on her feet for hours, painting nature scenes of flowers and landscapes.

    She’s also more committed than ever to staying on top of her health.

    “With my kids now grown and out of the house, I’m more vigilant about my own health and wellbeing,” said Wernher. “I’m even trying to relax and slow down a bit and offering myself grace for these changing phases of life. I’m just grateful to be alive.”

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    Cedars-Sinai

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  • UCLA Health tip sheet: Pesticides & Parkinson’s symptoms; Gender-affirming hormones improve mental health; Body composition & cardiovascular disease

    UCLA Health tip sheet: Pesticides & Parkinson’s symptoms; Gender-affirming hormones improve mental health; Body composition & cardiovascular disease

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    UCLA Health Tip Sheet Feb. 21, 2023

    Below is a brief roundup of news and story ideas from the experts at UCLA Health. For more information on these stories or for help on other stories, please contact us at [email protected].

    Body composition, not BMI, may signal risk for cardiovascular disease  Body mass index has long been a measure of a person’s risk of developing cardiovascular disease, but body composition and its role in the disease have not been well studied. In a new study, UCLA researchers predicted higher fat mass would be linked to higher levels of coronary artery calcification (CAC) — a marker of subclinical cardiovascular disease – and higher fat-free mass would be linked to lower levels of CAC. Using computed tomography scans and bioelectrical impedance analysis to study CAC and body composition in 3,129 non‐Hispanic Whites, Blacks, Hispanics, and Chinese patients, the researchers unexpectedly found that higher fat-free mass and, to a lesser extent, higher fat mass were linked to high levels of CAC. The researchers cautioned that bioelectrical impedance analysis could not identify the quality of fat or fat-free mass. Given these findings, the researchers say measuring body composition rather than using BMI to assess obesity may be a better approach to evaluating cardiovascular disease risk. Read the study published Feb. 8, 2023 in the Journal of the American Heart Association.

    Bariatric surgery reduces risks of hospitalization for heart failure Bariatric surgery has been found to reverse the ill effects of diabetes and may be protective against obesity-related cancers. Because obesity rates are on the rise across the globe, UCLA researchers set out to study other health benefits weight loss surgeries confer, in particular the link between the procedures and acute heart failure hospitalizations. After analyzing data from the Nationwide Readmissions Database from 2016 to 2019, the researchers found bariatric surgery was associated with lower odds of being hospitalized with acute heart failure. Among patients hospitalized with acute heart failure, prior bariatric surgery was associated with lower risks of death, prolonged ventilation, and acute renal failure. Beyond the health benefits, those who had undergone surgery stayed one fewer day in the hospital and incurred about $1,200 less in hospital costs compared to age matched cohorts. Read the study in Surgery for Obesity and Related Diseases. 

    Pesticides may also worsen Parkinson’s symptoms: While researchers have consistently found an association between pesticide exposure and higher risk of developing Parkinson’s disease, there has been little study of whether such exposure can accelerate the course of the disease. In a new study of 53 pesticides associated with Parkinson’s onset, researchers led by UCLA assistant professor of neurology Kimberly Paul, PhD, identified 10 pesticides that are associated with faster progression of motor and non-motor symptoms. Furthermore, exposure to six of those pesticides was associated with worsening of multiple endpoints researchers measured. Two pesticides, copper sulfate (pentahydrate) and MCPA (dimethylamine salt), were associated with all three endpoints measured: motor function, cognitive function, and depressive symptoms. Read the study in the journal Science of the Total Environment.

    Repurposing an old drug for a rare disease: A drug used to treat epilepsy, retigabine, may help manage episodic attacks of paralysis in patients with the rare inherited muscle disease Hypokalemic Periodic Paralysis (HypoPP), according to a new study that tested retigabine in genetically engineered mice. There’s a strong need to identify new HypoPP treatments since existing ones only improve symptoms in about half of patients and have considerable side effects. HypoPP is often marked by reduced potassium levels in the blood during episodes of muscle weakness. While it was known that retigabine affects a potassium channel that plays an important role in the heart and brain, the channel wasn’t previously known to exist in skeletal muscle. However, the new study led by Dr. Stephen C. Cannon, chair of the physiology department at the UCLA David Geffen School of Medicine, found that retigabine helps stabilize the membrane potential of skeletal muscle, thereby protecting against attacks of muscle weakness. Read the study, published online Jan. 30, in the journal Brain.

    Women treated with thrombectomy for pulmonary embolism fare worse A new study led by UCLA researchers analyzed the different outcomes in men and women with a pulmonary embolism who are treated by a percutaneous pulmonary artery thrombectomy- a procedure in which a catheter is placed in a patient’s lung to dissolve or remove a blood clot. After analysis of a national cohort of US patients from an inpatient claims-based database, researchers reported that women had higher rates of procedural bleeding, vascular complications, and needed more blood transfusions compared to men. They also found that women had higher in-hospital death rates and were more likely to go a nursing home or an assisted living facility instead of returning home after discharge. Given these disparities in outcomes, study authors are calling for more sex-based research. Read the study in the January 1, 2023 issue of CHEST. 

    A new clue about Parkinson’s progression The transmission of misfolded proteins in the brain is a key mechanism for the progression of various neurodegenerative diseases including Parkinson’s disease and Alzheimer’s disease. Chao Peng, PhD, an assistant professor of neurology, found a novel mechanism that regulates the transmission of one of these pathological proteins, misfolded alpha-synuclein, which leads to disease progression in Parkinson’s. This mechanism is the discovery that many modifications that a cell makes in these proteins alter their ability for transmission in the brain and disease progression. This discovery not only provides critical insights into disease mechanism but also facilitates the development of novel therapy for neurodegenerative diseases. Read the study, published Jan. 23, in Nature Neuroscience.

    Urban heat islands, redlining and kidney stones The persistent rise in kidney stone prevalence in recent decades has prompted much speculation as to the causes. There has been some discussion about the effect of heat on nephrolithiasis. A review of recent data suggests that heat may play a role in stone formation on a large scale and among African-Americans in particular. A new UCLA-led study led by Dr. Kymora B. Scotland states that African-Americans are the race/ancestry group with faster rates of increasing incidence and prevalence of kidney stones. Researchers also found that urban heat islands in the United States have resulted in part from the effects of redlining, a practice of systematic segregation and racism in housing that led to the development of neighborhoods with substantial disparities in environmental conditions. Dr. Scotland and her team hypothesize that the increased temperatures experienced by residents in redlined communities, many of whom are African American may contribute to the 150% increase in the prevalence of kidney stones in African Americans in recent decades. Read the study in the January 1, 2023 issue of Current Opinion in Nephrology and Hypertension.

    Gender-affirming hormones tied to mental health for transgender youth Transgender and nonbinary teens who receive gender-affirming hormones experience improvement in body satisfaction, life satisfaction and less depression and anxiety than before treatment. These findings are according to newly-published research by a four-site prospective, observational study and co-authored by Marco A. Hidalgo, PhD. Dr. Hidalgo is a clinical psychologist and Associate Clinical Professor of Medicine at the David Geffen School of Medicine at UCLA. Read the study published January 19, 2023 in the New England Journal of Medicine.

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  • Immunotherapy After Surgery Provides Significant, Durable Benefit for High-Risk Bladder Patients

    Immunotherapy After Surgery Provides Significant, Durable Benefit for High-Risk Bladder Patients

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    Newswise — New York, NY (February 17, 2023)—Immunotherapy after surgery increased bladder cancer patients’ chance of staying cancer-free compared to patients who received a placebo, according to clinical trial results shared in a late-breaking oral presentation at the American Society of Clinical Oncology (ASCO) 2023 Genitourinary Cancers Symposium in February.

    Matthew Galsky, MD, Co-Director of the Center of Excellence for Bladder Cancer at The Tisch Cancer Institute at Mount Sinai, presented three-year follow-up results from the Phase 3 CheckMate 274 trial. Patients on the trial had urothelial cancer of the bladder or upper urinary tract and had tumor features indicating a high risk for recurrence.

    “Adjuvant nivolumab became a standard of care based on the initial results of CheckMate 274,” Dr. Galsky said. “These results, showing patients’ continued survival three years out, reinforce adjuvant nivolumab as a standard of care for patients with muscle-invasive urothelial cancer of the bladder or upper urinary tract. Normally, patients with this cancer face a high chance of recurrence, especially within the first three years after surgical removal of the bladder or kidney.”

    This new data showed that at approximately three years of follow-up, nivolumab increased these patients’ chance of staying cancer-free after surgery compared to patients who received a placebo. The average length of time before relapse doubled in patients who received nivolumab, which is a monoclonal antibody immune checkpoint inhibitor that harnesses the immune system to fight cancer. For a subset of clinical trial patients who received the immunotherapy, disease-free survival was more than six times that of patients on placebo.

    Among the 699 patients in the trial, half received nivolumab, and the other half received a placebo every two weeks for one year. Adjuvant nivolumab versus placebo was not associated with a detriment to quality of life. This trial was conducted with support from Bristol Myers Squibb, the maker of the immunotherapy, in collaboration with ONO Pharmaceutical Company Ltd.

     

    About the Mount Sinai Health System

    Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 43,000 employees working across eight hospitals, over 400 outpatient practices, nearly 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time — discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it.

    Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment. The Health System includes approximately 7,300 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. We are consistently ranked by U.S. News & World Report‘s Best Hospitals, receiving high “Honor Roll” status, and are highly ranked: No. 1 in Geriatrics and top 20 in Cardiology/Heart Surgery, Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 12 in Ophthalmology. U.S. News & World Report’s “Best Children’s Hospitals” ranks Mount Sinai Kravis Children’s Hospital among the country’s best in several pediatric specialties. The Icahn School of Medicine at Mount Sinai is one of three medical schools that have earned distinction by multiple indicators: It is consistently ranked in the top 20 by U.S. News & World Report‘s “Best Medical Schools,” aligned with a U.S. News & World Report “Honor Roll” Hospital, and top 20 in the nation for National Institutes of Health funding and top 5 in the nation for numerous basic and clinical research areas. Newsweek’s “The World’s Best Smart Hospitals” ranks The Mount Sinai Hospital as No. 1 in New York and in the top five globally, and Mount Sinai Morningside in the top 20 globally.

    For more information, visit https://www.mountsinai.org or find Mount Sinai on Facebook, Twitter and YouTube.

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  • Wisconsin nurse pleads not guilty to amputating man’s foot

    Wisconsin nurse pleads not guilty to amputating man’s foot

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    ELLSWORTH, Wis. — A western Wisconsin nurse accused of amputating a hospice patient’s frostbitten foot without his consent and without doctor’s orders pleaded not guilty Thursday.

    A lawyer for 38-year-old Mary K. Brown, of Durand, Wisconsin, entered pleas of not guilty for her to charges of mayhem, physical abuse of an elderly person and intentionally abusing a patient, causing great bodily harm, WEAU-TV and WQOW-TV reported.

    After she cut off the man’s right foot on May 27, Brown told her colleagues that she wanted to display it at her family’s taxidermy shop with a sign that said: “Wear your boots kids,” according to charges filed in Pierce County.

    The amputation happened May 27, and within about a week the 62-year-old man was dead. A criminal complaint gave no indication the amputation was a factor in his death.

    According to the complaint, the man was admitted to Spring Valley Health and Rehab Center, where Brown worked at the time, after he fell at his home in March. The heat in his home was not turned on, and he suffered frostbite to both feet, leaving the tissue necrotic. His right foot remained attached to his leg by a tendon and roughly 2 inches (5 centimeters) of skin.

    Brown is not allowed to work in any capacity as a caregiver, whether employed or as a volunteer, online court records state. She no longer works at Spring Valley.

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  • Brandon P. Lucke-Wold, MD, Selected as 2024-25 Van Wagenen Fellow

    Brandon P. Lucke-Wold, MD, Selected as 2024-25 Van Wagenen Fellow

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    Newswise — February 13, 2023 (Rolling Meadows, Ill.) – The William P. Van Wagenen Fellowship Selection Committee has announced Brandon P. Lucke-Wold, MD, as the recipient of the 2024-25 William P. Van Wagenen Fellowship.

    Dr. Lucke-Wold, a resident in neurosurgery at the University of Florida in Gainesville, will spend his fellowship year at the Fujita Health University in Japan under the supervision and mentorship of professor Yoko Kato. He will pursue the research topic “Promotion of Aneurysm Healing: Biodegradable Coils with Chemokine Release.”

    “The Van Wagenen Fellowship offers a once-in-a-lifetime opportunity to foster international connections, establish global research across continents and learn unique surgical skill sets and perspectives,” Dr. Lucke-Wold said. “I am honored to have been chosen for this fellowship and am confident that it will be a key catalyst as I launch my career.”

    Shekar N. Kurpad, MD, PhD, FAANS, chair, Van Wagenen Selection Committee and 2001 recipient of the Willliam P. Van Wagenen Fellowship said: “On behalf of the American Association of Neurological Surgeons (AANS) and the Neurosurgery Research & Education Foundation (NREF), we congratulate Dr. Lucke-Wold and welcome him to this select group of neurosurgeons who’ve been awarded this unique and prestigious fellowship.”

    The Van Wagenen Fellowship offers post-residency study in a foreign country for a period of 12 months. The William P. Van Wagenen Fellowship was established by the estate of Dr. Van Wagenen, who was one of the founders and the first president of the Harvey Cushing Society, now the American Association of Neurological Surgeons (AANS). The Van Wagenen Fellowship provides freedom in scientific development without the restrictive limitations usually imposed by many research grants and fellowships.

    For more information on the Van Wagenen Fellowship or other NREF grant programs, contact the NREF at 847.378.0500 or [email protected].

    To support similar research and educational programs, consider a donation to the NREF, www.nref.org/Donate.

     

    ###

     

    About 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 11,000 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. 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.

    About the NREF The Neurosurgery Research & Education Foundation (NREF) is a not-for-profit 501(c)(3) organization created in 1980 by the American Association of Neurological Surgeons (AANS) to support research and education efforts that enhance and confirm the critical role neurosurgeons play in improving lives.

    The NREF is dedicated to providing education to neurosurgeons at all stages of their careers, as well as funding research into new and existing neurosurgical treatments, in order to identify links between best practices and improved outcomes in patient care. Through voluntary public donations, corporate support and donations from allied groups, the NREF supports endeavors that impact the lives of those suffering from epilepsy, stroke, brain tumors, spinal disorders, sports-related head injuries, lower back pain and Parkinson’s disease.

    For more information about NREF, visit www.nref.org.

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  • Q&A: Shania Twain talks rebuilding confidence with new album

    Q&A: Shania Twain talks rebuilding confidence with new album

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    LOS ANGELES — Shania Twain felt the need on her new album to empower herself the same way she has uplifted listeners with hits like “Man! I Feel Like a Woman” and “She’s Not Just a Pretty Face.”

    So she set aside all feelings of self consciousness — appearing braless for the album’s artwork and letting listeners unabashedly hear her surgically repaired voice — on “Queen of Me.” Throughout the album’s 12-tracks, the 57-year-old country pop superstar confronts her physical vulnerabilities with authority in ways meant to uplift fans, and herself.

    Twain’s sixth studio album is her first since having open-throat surgery in 2018 to strengthen her vocal muscles after a long battle with Lyme disease. During the pandemic, the singer said she went into her “writing cave” at home to hone her songwriting skills and penned three albums worth of music with a clear understanding that her powerful vocals might not last forever.

    In a recent interview with The Associated Press, Twain spoke candidly about the album, which is out Friday, regaining her confidence, singing during throat surgery and preparing for her global upcoming tour, which kicks off April 28.

    Remarks have been edited for clarity and brevity.

    ___

    AP: How do you define your new album, “Queen of Me”?

    TWAIN: Self empowerment is about managing your mindset. Controlling your own mood. Your frame of mind. It just turned into “Queen of Me.” I’m my own boss. I’m the boss of me. I have to tell myself how to think. What to think. It became the theme of the whole album. It ended up representing that uplifting mode of myself.

    AP: Before I listened to your album, I was expecting ballads. But it’s a more upbeat experience. What made you choose that route?

    TWAIN: It was all happening in a mode of lifting my own spirit up. I wanted music that was going to make me want to dance. Even some of the songs that are a little more, for example, “Brand New Me” or “Pretty Liar.” Those are songs that would have maybe stayed more in the melancholy vibe more ballady. But because I was really relying on my songwriting during that time to make me feel a positive energy, everything pretty much turned into this more poppy, dancey, beat-driven, upbeat-driven sounding album.”

    AP: You seem liberated on your album cover. Was that your intent?

    TWAIN: That was the entire intention. You know, throw away the bra. I did a lot of nude photography in that session. That’s obviously a partial nude. I wanted to be on a horse. One of the places I feel most liberated is riding a horse. You can fly. It’s very empowering. It’s like you take this unbridled posture to bridle your freedom. It’s like facing a fear, facing something that’s uncomfortable, getting myself out of my comfort zone — especially on a horse. That’s freedom.

    AP: I heard you sang during surgery. Is that true?

    TWAIN: Yes, I had to be awake, so that I could sing and speak. It was horrible. I’m not going to lie. But there was no way around it. It was the only way. The decision to do the surgery was quick for me, but the recovery was quite long and very very painful. They literally had to stretch the larynx, move everything over and put these crutches in there. You’re singing and you speak, so they understand that you have symmetrical closure — which I didn’t have before.

    AP: What’s been your thoughts after the surgery?

    TWAIN: I may not have it forever. Just with age, the effect of it just might not stand up. So I’ve got to take advantage of it now, enjoy it, get out on the stage, make more records, because I’m not sure I would go through it again.

    AP: I’m sure that’s tough to hear. Do you think about when your voice might go again?

    TWAIN: I don’t think about it. I don’t worry about it. I focus on how to manage my voice the way it is now. For example, before the surgery, it was like a two-hour warmup and so much physical therapy. I just couldn’t sustain it. That’s why I decided to have the surgery. The surgery has reduced all of that to about 20 minutes, which is very normal. That’s ideal. But if I’m not singing for even a week or maybe two weeks, it takes me two to three days to get that voice going again. It’s more work than I had to do before, but it’s worth it.

    AP: What was the first sign of your singing confidence?

    TWAIN: The true confidence was three weeks after the surgery. I made a sound and there was resonance. Instant resonance. I’m like, “Oh, my God. I feel it. I feel it working.” It was a small window, but that kind of put the fire under my butt, too, and I said, “All right, no more excuses.” You’ve got this and you’ve got the best technology available. Top notch surgeon. All the physiotherapy education you need. Get out there and do it.

    AP: With your retooled vocals, how are you mentally getting ready for your tour?

    TWAIN: When I now go out on that stage, I am not afraid of the criticism. I’m not going to be perfect. My voice is not what it used to be. I sing differently. There’ll be holes in it. I’m not the same body I used to be. All these things. But I go out there with the confidence that I’m the best I can be and that I’ve worked hard to be my best. I just am not afraid of the criticism. I’m there for the people that are embracing me for who I am. I will get out there and do my best to make everybody happy, as I always do.

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  • Federal agents interview veteran who alleges George Santos took thousands from dying dog’s GoFundMe | CNN Politics

    Federal agents interview veteran who alleges George Santos took thousands from dying dog’s GoFundMe | CNN Politics

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    CNN
     — 

    Federal law enforcement officials are investigating a US Navy veteran’s allegation that Rep. George Santos raised money for a lifesaving surgery for his dying dog only to take off with the money.

    Rich Osthoff, the veteran, told CNN he spoke to a pair of FBI agents on Wednesday about the incident on behalf of the US Attorney’s Office in the Eastern District of New York, which is investigating Santos’ finances. Osthoff said he cooperated with the agents’ requests, including handing over his text message exchanges with Santos.

    CNN has reached Santos’ attorney for comment. Santos did not respond to questions about the matter when asked by reporters on Capitol Hill on Wednesday and a spokesperson for the US attorney’s office for the Eastern District of New York declined to comment.

    Politico first reported the development.

    Osthoff told CNN last month that in 2016 Santos promised to raise funds for his pit bull, Sapphire. Osthoff said at the time he was homeless and living in a tent after losing his job and house.

    Santos set up a GoFundMe which eventually raised around $3,000. A post from the Facebook profile of George Devolder at the time links to a GoFundMe raising surgery funds for the dog.

    Osthoff said Santos became uncooperative when he tried to access the GoFundMe money.

    Santos, a New York Republican, told CNN in January that he had “no clue” what Osthoff was talking about and defended his work with animals.

    Text messages provided to CNN by Osthoff also show his exchanges with Santos in 2016.

    “Hey Anthony, Rich here. I was hoping to hear from you. Just checking whether you made contact with the vet,” Osthoff writes in one text to Santos, who was going by the name Anthony Devolder at the time.

    Santos replies that he “just called” Osthoff and he’s been “jumping through hoops.” He adds, “They are not as flexible as you said they were,” apparently speaking about the vet Osthoff referenced.

    Santos also writes that a vet “had already ruled out the surgery without the ultrasound because based on his experience he thinks it’s very invasive,” but he tells Osthoff he will take the dog to a vet to get an ultrasound “to give you piece of mind.”

    After Osthoff says, “I’m starting to feel liked [SIC] I was mined for my family and friends donations,” Santos tells him that, because his dog is not a candidate for surgery, “the funds are moved to the next animal in need and we will make sure we use of [SIC] resources to keep her comfortable!”

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  • February 2023 Issue of Neurosurgical Focus: “Neurosurgical Management of Psychiatric Disease”

    February 2023 Issue of Neurosurgical Focus: “Neurosurgical Management of Psychiatric Disease”

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    Newswise — Rolling Meadows, IL (February 1, 2023). The February issue of Neurosurgical Focus (Vol. 54, No. 2 [https://thejns.org/focus/view/journals/neurosurg-focus/54/2/neurosurg-focus.54.issue-2.xml]) presents seven articles on the neurosurgical management of psychiatric disease.

    Topic Editors: Sameer A. Sheth, G. Rees Cosgrove, and Nicole C. R. McLaughlin

    Calling attention to the need to reduce the “the ever-narrowing gap between neurosurgery and neuroscience”, the Topic Editors of the February issue of Neurosurgical Focus have selected articles to produce a collection that “features a number of articles detailing the history of psychiatric neurosurgery and provides modern day examples of its continued success.”

    Contents of the February issue: 

    • “Introduction. Neurosurgical neuroscience” by Sameer A. Sheth et al.
    • “The Surgeon, or The Extraction of the Stone of Madness, by Jan Sanders van Hemessen (c 1500–1566)” by Eric J. Chalif
    • “Intracranial subsecond dopamine measurements during a “sure bet or gamble” decision-making task in patients with alcohol use disorder suggest diminished dopaminergic signals about relief” by Brittany Liebenow et al.
    • “Stereotactic electroencephalography in epilepsy patients for mapping of neural circuits related to emotional and psychiatric behaviors: a systematic review” by Christian G. Lopez Ramos et al.
    • “Efficacy of deep brain stimulation for the treatment of anorexia nervosa: a systematic review and network meta-analysis of patient-level data” by Annabelle Shaffer et al.
    • “Novel psychiatric disorders following mild traumatic brain injury: a retrospective multivariable analysis with screening recommendations” by Alexander M. Ballatori et al.
    • “Schizophrenia and neurosurgery: systematic review and theories” by Rajeev R. Dutta et al.
    • “Neurosurgery for psychiatric disorders: reviewing the past and charting the future” by Luke Bauerle et al.

     

    Please join us in reading this month’s issue of Neurosurgical Focus.

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    The global leader for cutting-edge neurosurgery research since 1944, the Journal of Neurosurgery (www.thejns.org) is the official journal of the American Association of Neurological Surgeons (AANS) representing over 12,000 members worldwide (www.AANS.org).

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