Research Spotlight

Garmon, E. H., E. M. Stock, A. C. Arroliga and J. D. Bean-Lijewski (2017). “Effects of training on resident physician emergency airway management skills.” Can J Anaesth 64(7): 777-779.

Full text of this article.

Emergency airway management is necessary when patients develop acute cardiopulmonary failure. Early intubation prevents hypoxemia from a poor bag-mask seal, but multiple intubation attempts increase the risk of complications.1, 2, 3 The Canadian Airway Focus Group summarizes the adverse effects associated with multiple intubation attempts in Table 3 of their 2013 publication on difficult tracheal intubation in the unconscious patient.4 Highly trained residents in supervised intensive care settings have previously been studied. 1, 2, 3

Garofalo, R., E. Ceccarelli, A. Castagna, V. Calvisi, B. Flanagin, M. Conti and S. G. Krishnan (2017). “Open capsular and ligament reconstruction with semitendinosus hamstring autograft successfully controls superior and posterior translation for type v acromioclavicular joint dislocation.” Knee Surg Sports Traumatol Arthrosc 25(7): 1989-1994.

Full text of this article.

PURPOSE: Appropriate surgical management for type V complete acromioclavicular (AC) joint dislocation remains controversial. The purpose of this paper is to retrospectively report the clinical and radiographic outcomes of an open surgical technique consisting for AC joint ligamentous and capsular reconstruction using autologous hamstring tendon grafts and semi-permanent sutures. METHODS: Between January 2005 and December 2011, 32 consecutive patients with symptomatic type V complete AC joint dislocation underwent surgical treatment using the same technique. The median time from injury to surgery was 45 days (range 24-90). The average median postoperative clinical and radiographic follow-up time was 30 months (range 24-33). Clinical outcomes measures included the ASES score, the visual analog score (VAS), and subjective patient satisfaction score. Minimum follow-up was 2 years. RESULTS: ASES score increased from a median of 38.2 +/- 6.2 preoperative to 92.1 +/- 4.7 postoperatively (p

Elwir, S. and R. S. Rahimi (2017). “Hepatic encephalopathy: An update on the pathophysiology and therapeutic options.” J Clin Transl Hepatol 5(2): 142-151.

Full text of this article.

Hepatic encephalopathy is a spectrum of reversible neuropsychiatric abnormalities, seen in patients with liver dysfunction and/or portosystemic shunting. One of the most debilitating complications of cirrhosis, encephalopathy affects 30-45% of cirrhotics. In addition to significantly affecting the lives of patients and their caregivers, it is also associated with increased morbidity and mortality as well as significant utilization of health care resources. In this paper, we provide an overview on the pathophysiology, diagnosis, management and newer therapies of hepatic encephalopathy.

Cowey, C. L., L. Mahnke, J. Espirito, C. Helwig, D. Oksen and M. Bharmal (2017). “Real-world treatment outcomes in patients with metastatic merkel cell carcinoma treated with chemotherapy in the USA.” Future Oncol: 2017 Jun [Epub ahead of print].

Full text of this article.

AIM: This retrospective study of patients in the USA with metastatic Merkel cell carcinoma (mMCC) aimed to assess patient responses to second-line and later (2L+) and first-line (1L) chemotherapy. PATIENTS & METHODS: Out of 686 patients with MCC identified in The US Oncology Network, 20 and 67 patients with mMCC qualified for the 2L+ and 1L study, respectively; the primary analysis population was restricted to immunocompetent patients. RESULTS: In the 2L+ primary analysis population, objective response rate (ORR) was 28.6%, median duration of response (DOR) was 1.7 months and median progression-free survival was 2.2 months. In the 1L primary analysis population, ORR was 29.4%, median DOR was 6.7 months and median progression-free survival was 4.6 months. CONCLUSION: The low ORR and brief DOR underscore the need for novel therapies.

Keller, D. S., I. Tantchou, J. R. Flores-Gonzalez and D. P. Geisler (2017). “Predicting delayed discharge in a multimodal enhanced recovery pathway.” Am J Surg: 2017 Jun [Epub ahead of print].

Full text of this article.

BACKGROUND: Despite advances with Enhanced Recovery Pathways(ERP), some patients have unexpected prolonged lengths of stay(LOS). Our goal was to identify the patient and procedural variables associated with delayed discharge despite an established ERP. METHODS: A divisional database was reviewed for minimally invasive colorectal resections with a multimodal ERP(8/1/13-7/31/15). Patients were stratified into ERP success or failure based on length of stay >/=5 days. Logistic regression modeling identified variables predictive of ERP failure. RESULTS: 274 patients were included- 229 successes and 45 failures. Groups were similar in demographics. Failures had higher rates of preoperative anxiety(p = 0.0352), chronic pain(p = 0.0040), prior abdominal surgery(p = 0.0313), and chemoradiation(p = 0.0301). Intraoperatively, failures had higher conversion rates(13.3% vs. 1.7%, p = 0.0002), transfusions(p = 0.0032), and longer operative times(219.8 vs. 183.5min,p = 0.0099). Total costs for failures were higher than successes($22,127 vs. $13,030,p = 0.0182). Variables independently associated with failure were anxiety(OR 2.28, p = 0.0389), chronic pain(OR 10.03, p = 0.0045), and intraoperative conversion(OR 8.02, p = 0.0043). CONCLUSIONS: Identifiable factors are associated with delayed discharge in colorectal surgery. By prospectively preparing for patient factors and changing practice to address procedural factors and ERP adherence, postoperative outcomes could be improved.