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Journal and News Scan

Source: The Telegraph
Author(s): Laura Donnelly

An interesting article from a popular UK newspaper, reflecting perhaps the views of members of government and public in confining UK medical graduates to largely low-paid work for five years after graduation, on the socialist principle that the public has paid for their education (they pay quite a lot themselves as well, and end up in debt).

We experienced similar expansion of compulsory government low-paid work (extension of preregistration internship) in the Republic of South Africa after 1994. 

The figure of 230 000 pounds as an average cost is probably demagogic, as no calculation source is being offered. It would be interesting to attempt a robust calculation of the cost of thoracic (cardiothoracic) specialist training.

The concept may come to a surprise to our North American colleagues, as the European socialist health concepts may have not penetrated the New World outside the British Commonwealth.

The United Kingdom has been facing a multilevel exodus of doctors since the beginning of the century, when a progressive deterioration in job satisfaction in the NHS started. It remains baffling how, in the face of loss of a highly qualified workforce, various governments have not attempted any improvement in work terms and conditions of doctors. The NHS salaries have particularly dropped for clinical staff since.

Source: News from around the web.
Author(s): Claire Vernon

Patient Care

China and Cambodia will work together on a program to provide free heart surgery to 100 Cambodian children with congenital heart disease.

Quadruple bypass surgery was the inspiration a Singapore man needed to turn his lifestyle heart-healthy. Now he has run the Singapore Marathon.

A balloon sampling device that can be swallowed and then retrieved might provide an easier test for Barrett’s esophagus.


Drugs and Devices

The US Food and Drug Administration has expanded approval of the lung cancer drug afatinib to patients whose tumors show any of five EGFR mutations.

Brazil marked its first implantations of the transcatheter pulmonary valve called the Venus P-Valve, which is made by Chinese company Venus Medtech, Inc. The valve is under clinical trial investigation in Europe and the US.


Research, Trials, and Funding

Researchers in Japan have 3D-printed artificial tracheas without scaffolds using spheroids composed of multiple cell types, which they have transplanted into rats.

Merck announced that its anti-PD-L1 therapy, pembrolizumab met its primary endpoints of longer overall and progression-free survival when given in combination with pemetrexed and chemotherapy for non-small cell lung cancer.

Source: New England Journal of Medicine
Author(s): Mitesh S. Patel, Kevin G. Volpp, and David A. Asch

The authors describe a clinical unit developed at their institution designed to implement "nudges" to help improve health care delivery, primarily through the EMR.   "Nudges" have been used to shape other  behaviors, such as offering opt-out (rather than opt-in) for organ donor status to encourage increased organ donation.  The concept was described by Nobel prize winner Richard Thaler.

Source: JAMA Surgery
Author(s): Asanthi Ratnasekera, Paula Ferrada

The authors summarize the rationale and utility of point of care ultrasonography for identifying factors associated with hypotension or hypoxia in a deteriorating surgical patient, including hypovolemia, LV dysfunction, PE, pleural fluid, ascites, etc.  Their claim is that a variety of other diagnostic measures are less accurate, and that a single ultrasonographic exam of the abdomen, lung, pleura, and heart in a single study is efficient, useful, and can be performed in any location.   

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Miguel Sousa-Uva, Stuart J Head, Milan Milojevic, Jean-Philippe Collet, Giovanni Landoni, Manuel Castella, Joel Dunning, Tómas Gudbjartsson, Nick J Linker, Elena Sandoval, Matthias Thielmann, Anders Jeppsson, Ulf Landmesser

The new EACTS Guidelines on perioperative medication in adult cardiac surgery address antithrombotic management, atrial fibrillation, renin–angiotensin–aldosterone system inhibitors, beta-blockers, dyslipidaemia, ulcer prevention and steroids, antibiotic prophylaxis, anaesthesia and postoperative analgesia, and blood glucose management.

Source: JACC: Cardiovascular Interventions
Author(s): Norihiko Kamioka, John Wells, Patricia Keegan, Stamatios Lerakis, Jose Binongo, Frank Corrigan, Jose Condado, Ateet Patel, Jessica Forcillo, Leslie Ogburn, Andy Dong, Hope Caughron, Amy Simone, Bradley Leshnower, Chandan Devireddy, Kreton Mavromatis, Robert Guyton, James Stewart, Vinod Thourani, Peter C. Block and Vasilis Babaliaros

In this study with 663 TAVI patients, the authors investigated the predictors for next day discharge (NDD). After excluding cases that did not have a minimalist transfemoral approach, 150 patients had NDD and 210 patients had non-NDD.

Predictors of NDD include male sex, lower creatinine, absence of atrial fibrillation and younger age. When compared to uncomplicated cases with longer hospital stay, NDD patients had similar 30-day and even superior one-year clinical outcomes.

Source: Journal of Visualized Surgery
Author(s): Omar Matthieu Sarsam, Joel Dunning, Bruno Pochulu, Jean-Marc Baste

In this video-based article, Sarsam and colleagues demonstrate the use of continuous barbed sutures in four robotic procedures, two wedge bronchoplasties and two sleeve bronchoplasties.

Source: The Annals of Thoracic Surgery
Author(s): Kimberly A. Holst, Joseph A. Dearani, Sameh Said, Roxann B. Pike, Heidi M. Connolly, Bryan C. Cannon, Kristen L. Sessions, Megan M. O'Byrne, Patrick W. O’Leary

Holst and colleagues present their experience with cone repair of the tricuspid valve for Ebstein’s anomaly in 235 patients over eight years. They conclude that cone repair is safe and effectively reduces tricuspid regurgitation, which might allow for right ventricular remodeling. The procedure remains a challenge to master, however, due to the rarity of the disease and the highly variable anatomy.

Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): Kezhong Chen, Wei Chen, Jianqiao Cai, Fan Yang, Feng Lou, Xun Wang, Jingbo Zhang, Mingyu Zhao, Jay Zhang, Jun Wang

The authors studied survival in patients with multiple lung cancers and their associated genetic mutations.  There was 90% discordance in driver mutations beween cancers in individual patients that was associated with favorable survival.  The two patients in whom condordance was present suffered recurrent cancer.

Source: JAMA Cardiology
Author(s): Rudolf A. de Boer, Matthew Nayor, Christopher R. deFilippi, Danielle Enserro, Vijeta Bhambhani, Jorge R. Kizer, Michael J. Blaha, Frank P. Brouwers, Mary Cushman, Joao A. C. Lima, Hossein Bahrami, Pim van der Harst, Thomas J. Wang, Ron T. Gansevoort, Caroline S. Fox, Hanna K Gaggin, Willem J. Kop, Kiang Liu, Ramachandran S. Vasan, Bruce M. Psaty, Douglas S. Lee, Hans L. Hillege, Traci M. Bartz, Emelia J. Benjamin, Cheeling Chan, Matthew Allison, Julius M. Gardin, James L. Januzzi Jr, Sanjiv J. Shah, Daniel Levy, David M. Herrington, Martin G. Larson, Wiek H. van Gilst, John S. Gottdiener, Alain G. Bertoni, Jennifer E. Ho

Using a group of nearly 23,000 individuals in four community-based longitudinal cohorts, the authors studied those who developed heart failure (HF) with either preserved (633) or reduced (841) ejection fraction (EF).  HF with reduced EF was more strongly associated with natriuretic peptide, troponin, and C-reactive protein than was HF with preserved EF.