Behind The Knife: The Surgery Podcast Behind The Knife: The Surgery Podcast

VTE prophylaxis is more than just some squeezy leg socks and a one-size fits all dose of enoxaparin!  Ever wonder how VTE prophylaxis is similar to constipation?  Have you or a loved one been hurt by a hospital administrator telling you that VTE is a never event?  Come with us, and our special guest Dr. Bryan Cotton, on this journey to the frontier of research attempting to debunk this myth and improve patient care by reducing VTE rates in trauma patients.  

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

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

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

- Brandon Parker, DO, Assistant Professor of Surgery, 5 years in practice
University of Miami/Jackson Memorial Hospital/Ryder Trauma Center
@BrandonParkerDO (X/twitter)

- Bryan Cotton, MD, MPH, FACS, Professor of Surgery, 20 years in practice
 University of Texas Health Science Center at Houston/Red Duke Trauma Institute at Memorial Herman Hospital
@bryanacotton1 (X/twitter)

Learning Objectives:

- Describe the rationale for the addition of aspirin to chemoprophylactic regimens for VTE

-  Identify appropriate screening systems for trauma patients at high risk for VTE

-  Describe the rationale for monitoring anti factor Xa levels in the trauma population receiving VTE chemoprophylaxis

- List the major conclusions of the two studies discussed regarding the addition of aspirin to VTE chemoprophylaxis regimens in trauma patients, and the change in antithrombin activity levels over time in relation to enoxaparin responsiveness in polytrauma patients

Quick Hits:

1.     On adjusted analysis, the standard VTE PPX plus aspirin group had a lower OR of developing VTE, though limitations of this study highlight need for future prospective work
2.     Trauma patients often suffer from decreased activity of antithrombin 3, which may mediate the relatively higher rates of VTE in this population.
3.     Trauma patients who went on to develop VTE were more likely to not achieve satisfactory anti Xa levels, with a VTE rate of 30% in the never-responder group, the group for which Xa levels were never higher than 0.2
4.     Ex vivo supplementation of antithrombin seems to improve enoxaparin responsiveness.  Remember, enoxaparin and heparin are HELPING AT3, not the other way around

References

1.     Lammers D, Scerbo M, Davidson A, et al. Addition of aspirin to venous thromboembolism chemoprophylaxis safely decreases venous thromboembolism rates in trauma patients. Trauma Surg Acute Care Open. 2023;8(1):e001140. doi:10.1136/tsaco-2023-001140
https://pubmed.ncbi.nlm.nih.gov/37936904/

2.     Vincent LE, Talanker MM, Butler DD, et al. Association of Changes in Antithrombin Activity Over Time With Responsiveness to Enoxaparin Prophylaxis and Risk of Trauma-Related Venous Thromboembolism. JAMA Surg. 2022;157(8):713-721. doi:10.1001/jamasurg.2022.2214
https://pubmed.ncbi.nlm.nih.gov/35731524/

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Most surgeons know about malpractice lawsuits, but did you know that residents and even medical students can be involved in them? Join us for a discussion of what happens when patients sue their treatment teams -- and what happens when those teams involve trainees.

Host: Nina Clark, MD, MS

Guests:
Cindy Hamra, JD, MA is an associate dean in the GME Office at the University of Washington School of Medicine, where she leads the operational, administrative and finance functions.  UW School of Medicine is sponsors clinical training for over 1600 medical and dental residents in fellows in over 200 programs.  UW Medicine, through the School of Medicine, is the largest sponsor of GME programs in the five-state WWAMI region (Washington, Wyoming, Alaska, Montana and Idaho).

Lisa Hammel, JD is the senior director of clinical risk management for UW medicine. Prior to that, she spent over 20 years as a defense attorney primarily working in medical malpractice and professional liability defense. 

References:
American College of Surgeons: https://www.facs.org/for-medical-professionals/news-publications/journals/rise/articles/litigation-overview/ 

AMA: https://www.ama-assn.org/medical-residents/residency-life/resident-medical-liability-lawsuits-why-and-how-often-they-happen

JAMA Surgery: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5833625/ & https://jamanetwork.com/journals/jamasurgery/article-abstract/2670456

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Join Drs. Scott Steele and Dan Scheese as they engage in an in-depth conversation with Dr. Michael Valente about the intricate world of appendiceal masses, including carcinoid, adenocarcinoma, and mucinous neoplasms. Despite the complexity of the subject, this episode skillfully deconstructs the topic through the analysis of three distinct cases, illuminating the latest terminology, diagnostic approaches, and management strategies. 

Hosts: 
Scott Steele, MD (@ScottRSteeleMD)
Dan Scheese, MD (@DanScheese13)

Guest:
Michael Valente, MD (@DrMikeValente) is an Associate Professor of Surgery at the Cleveland Clinic and Program Director of the colon and rectal residency program. Dr. Valente's specialty and research interests include cancer of the appendix, peritoneum, colon, rectum and anus, cytoreductive surgery/HIPEC, complex re-operative surgery, inflammatory bowel disease, advanced endoscopic techniques, laparoscopic and minimally invasive colorectal surgery, and surgical education. Dr. Valente has published numerous peer-reviewed journal articles and book chapters and has presented his research interests both nationally and internationally.

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M&M - we all do it, but what is its purpose? Join Jason and Nina as they talk to two experts about why we present at all, and what we can do to better reach the educational and quality improvement goals of morbidity and mortality conference.

Hosts: Jason Bingham, Nina Clark

Panelists



Keith Lillemoe, MD
Chief of Surgery, Massachusetts General Hospital
Professor of Surgery at the Harvard Medical School



Luise Pernar, MD, MHPE
Bariatric Surgeon
Associate Professor of Surgery, Boston University Chobanian and Avedisian School of Medicine





References
https://jamanetwork.com/journals/jamasurgery/article-abstract/2810740
https://pubmed.ncbi.nlm.nih.gov/26649585/

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

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

It’s that time of year (again!)- when medical students- both US and International- are preparing their residency applications. This year, we have been focusing on the special challenges International Medical Graduates face when applying to US surgical residency positions. In our previous episode, we discussed how residents can make their applications stand out to program directors. Today, we will explore the unique challenges, experiences, and the future of IMGs with special guest Dr. Hasan Alam. 

Guests:
Hasan Alam, MD- Chair of the Department of Surgery and Professor of Surgery (Trauma and Critical Care) and Cell and Developmental Biology- Northwestern University 

Previous DOMINATE the Match Episodes: 
Episode 2- “Choose Me” (Personal Statements and Letters of Recommendations)
https://behindtheknife.org/podcast/dominate-the-match-episode-2-choose-me/

Episode 3- “The Interview”
https://behindtheknife.org/podcast/dominate-the-match-episode-3-the-interview/

Episode 4- “Rank and Match”
https://behindtheknife.org/podcast/dominate-the-match-episode-4-rank-and-match/

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

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

It’s that time of year (again!)- when medical students- both US and International- are preparing their residency applications. In this episode, we will focus on the special challenges International Medical Graduates face when applying to US surgical residency positions and discuss tips and tricks for making IMG residency applicants standout to program directors in the US. 

Guests:
David Hughes, MD- Clinical Associate Professor of Endocrine Surgery and General Surgery Residency Program Director- University of Michigan
Krishnan Raghavendran, MBBS- Professor of Acute Care Surgery and Critical Care- University of Michigan

Link to video: 
You can watch Dr. Hughes’s full presentation here: https://youtu.be/iQ0CzH7xHwE

Previous DOMINATE the Match Episodes: 

Episode 2- “Choose Me” (Personal Statements and Letters of Recommendations)
https://behindtheknife.org/podcast/dominate-the-match-episode-2-choose-me/

Episode 3- “The Interview”
https://behindtheknife.org/podcast/dominate-the-match-episode-3-the-interview/

Episode 4- “Rank and Match”
https://behindtheknife.org/podcast/dominate-the-match-episode-4-rank-and-match/

Residency Program Lists: 
- FREIDA Residency and Fellowship Database: https://freida.ama-assn.org/
- Doximity: https://www.doximity.com/residency/?utm_campaign=marketing_resnav_competitor_broad_20210520&utm_source=google&utm_medium=cpc&gclid=CjwKCAjwt52mBhB5EiwA05YKo1J47BLAtTPtsJBmVvXGP2pDXLLqgDIwM0pgkSYjoBhFUOO1ktXDYRoC2bkQAvD_BwE

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

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