Research Spotlight

Roberts, W. C. (2017). “Cardiology 1919-1941 and cardiology today.” Am J Cardiol 120(6): 1040-1041.

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My father, Stewart Ralph Roberts, MD (1878–1941) ( Figure 1 ), probably the first cardiologist in the South, 1 2 is shown in 1924, the year he was president of the Southern Medical Association. The American Heart Journal , the first cardiology journal in the world, started in 1926, and he was soon on its editorial board. In 1932, the year I was born, he was president of the American Heart Association. In 1937, he had a large acute myocardial infarction (AMI) and was hospitalized at Emory University Hospital, where he was clinical professor of medicine, for 1 month, followed by total bed rest at home for 2 months, then gentle activities at home for 3 months, and then gradually increasing activities outside the home for 6 months…

Squiers, J. J., K. W. Lobdell, J. I. Fann and J. M. DiMaio (2017). “Physician burnout: Are we treating the symptoms instead of the disease?” Ann Thorac Surg 104(4): 1117-1122.

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Despite increasing recognition of physician burnout, its incidence has only increased in recent years, with nearly half of physicians suffering from symptoms of burnout in the most recent surveys. Unfortunately, most burnout research has focused on its profound prevalence rather than seeking to identify the root cause of the burnout epidemic. Health care organizations throughout the United States are implementing committees and support groups in an attempt to reduce burnout among their physicians, but these efforts are typically focused on increasing resilience and wellness among participants rather than combating problematic changes in how medicine is practiced by physicians in the current era. This report provides a brief review of the current literature on the syndrome of burnout, a summary of several institutional approaches to combating burnout, and a call for a shift in the focus of these efforts toward one proposed root cause of burnout.

Althans, A. R., J. T. Brady, D. S. Keller, S. L. Stein, S. R. Steele and M. Times (2017). “Are we catching women in the safety net? Colorectal cancer outcomes by gender at a safety net hospital.” Am J Surg 214(4): 715-720.

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BACKGROUND: Our goal was to evaluate presentation and outcomes for colorectal cancer across gender in a safety net hospital (SNH). METHODS: An institutional Tumor Registry was reviewed for colorectal cancer resections 12/2009-2/2016. Patients were stratified into male and female cohorts. The main outcome measures were stage at presentation and oncologic outcomes across gender. RESULTS: 170 women (48.6%) and 180 men (51.4%) were evaluated; 129 (84.1%) females and 143 (79.4%) males underwent curative resection. There were no significant differences in prior colorectal cancer screening. On presentation, there were similar rates of stage IV disease across genders (p = 0.3). After median follow-up of 26.5 months (female) and 29.9 months (male), there were no significant differences in overall survival, survival by stage, or disease-free survival by gender (all p = 0.7). The local (1.4% females vs. 2.6% males, p = 0.7) and distant recurrence (16.6% females vs. 14.9% males, p = 0.7) were similar across gender. CONCLUSION: With equal access to treatment, there were no significant differences in overall survival, survival by stage, or local or distant recurrence rates by gender. These findings stress the importance of the SNH system, and need for continued support.

Azzalini, L., L. Candilio, P. A. McCullough and A. Colombo (2017). “Current risk of contrast-induced acute kidney injury after coronary angiography and intervention: A reappraisal of the literature.” Can J Cardiol 33(10): 1225-1228.

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Contrast-induced acute kidney injury (CI-AKI) is the acute impairment of renal function further to the intravascular administration of iodinated contrast media, and occurs most frequently after coronary angiography, percutaneous coronary intervention, and contrast-enhanced computed tomography. CI-AKI has been associated with the development of acute renal failure, worsening of chronic kidney disease, requirement for dialysis, prolonged hospital stay, and higher mortality rates and health care costs. Recently, a number of studies suggested that contrast media exposure might not be the causative agent in the occurrence of acute kidney injury, particularly in stable patients who receive small to moderate amounts of contrast media. However, those who undergo coronary angiography and intervention are indeed subject to an increased hazard of CI-AKI, in view of a more significant contrast media exposure as well as the presence of concomitant risk factors. Solid randomized clinical trials are therefore required to identify preventative strategies to reduce the risk of CI-AKI and its complications in these patients.

Kane, J. M., J. W. Brodsky and Y. Daoud (2017). “Radiographic results and return to activity after sesamoidectomy for fracture.” Foot Ankle Int 38(10): 1100-1106.

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BACKGROUND: Limited data are available comparing the results of lateral sesamoidectomy and medial sesamoidectomy for the treatment of fractures recalcitrant to nonoperative treatment interventions. The hypothesis of this study was that sesamoidectomy for either lateral or medial sesamoid fractures would not change radiographic alignment of the first ray given the use of identical reconstruction of the plantar plate, intersesamoid ligament, and plantar ligament complex at the time of surgery. METHODS: This retrospective cohort study compared the outcomes of 46 consecutive patients treated with sesamoidectomy (24 lateral, 22 medial). Patient demographics, mechanisms of injury, and outcomes were recorded. Preoperative, postoperative, and changes in both hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measured. RESULTS: No statistically significant difference could be detected for age ( P = .577), sex ( P = .134), return to activity ( P = 1.000), likelihood to undergo the procedure again ( P = 1.000), orthotic use postoperatively ( P = 1.000), perioperative complications ( P = .497), duration of symptoms ( P = .711), or length of follow-up ( P = .609). While statistically significant changes in preoperative and postoperative alignment were detected for both medial and lateral sesamoidectomy, these changes were not clinically significant. Patients undergoing medial sesamoidectomy had higher preoperative and postoperative HVA and IMA compared with those undergoing lateral sesamoidectomy. Medial sesamoidectomy patients had a net increase in both HVA and IMA, while patients undergoing lateral sesamoidectomy had a net decrease in both HVA and IMA. CONCLUSION: Although statistically significant changes in both HVA and IMA were detected, these values were too small to be considered clinically significant. Patient outcomes did not differ between the 2 groups, and sesamoidectomy was used with low patient morbidity for both medial and lateral sesamoid fractures that failed to respond to nonoperative modalities. These data suggest that the underlying mechanics of the foot may be different in patients who sustain medial and lateral sesamoid stress injury, suggesting a possible etiologic difference between medial and lateral sesamoid injuries.