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Journal and News Scan
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.