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Journal and News Scan
April 4, 2019
Submitted by: Wei-Guo Ma
Colorado becomes the second state (after Rhode Island) to require hospitals and ambulatory surgical centers to implement a surgical smoke evacuation system that prevents human exposure to surgical smoke. Effective May 1, 2021, all planned procedures in Colorado which are likely to generate surgical smoke must be conducted in facilities with policies and equipment in place to prevent human exposure to the smoke. According to the estimates of AORN, each year 500,000 healthcare workers, including surgeons, nurses, anesthesiologists, and other staff in the operating room, are exposed to laser or electrosurgical smoke, which can lead to serious and life-threatening respiratory diseases.
April 4, 2019
Submitted by: Wei-Guo Ma
In this review, biomedical informatics experts explain what machine learning is with illustrative examples, and they discuss how machine learning can help the work of clinicians including diagnosis, treatment, prognosis, optimizing clinician workflow, and expanding the availability of clinical expertise. The major challenges and vulnerabilities of machine learning are also expounded.
April 4, 2019
Submitted by: Claire Vernon
Gu and colleagues developed a surgeon-specific quality monitoring system using a structured database of information derived from electronic health records. Additionally, they used a mobile-based system to provide feedback to surgeons on risk-adjusted mortality, risk-adjusted complications, and other quality measures. The authors report on both the development of the system and the quality measures of top, middle, and bottom performing surgeons, with differences observed only for the rate of internal mammary artery use, the risk-adjusted postoperative length of stay, and risk-adjusted hospitalization cost. They conclude that the system allowed surgeons to compare their own surgical quality with that of their colleagues and identify priorities for improvement.
April 3, 2019
Submitted by: Tom C. Nguyen
In light of the recent Centers for Medicare and Medicaid Services recommendation for transcatheter aortic valve replacement (TAVR) volumes, this study looked at 113,662 TAVRs from the TVT registry from 2015 to 2017 and found that 30-day mortality was higher at low-volume TAVR hospitals or low-volume operators.
Intraoperative Conversion During Video-Assisted Thoracoscopy Does Not Constitute a Treatment Failure
April 3, 2019
Submitted by: Claire Vernon
Intraoperative conversion may be necessary during video-assisted thoracoscopic surgery (VATS) for lung cancer. In this study on 610 patients, Fourdrain and colleagues observed that conversion during a VATS procedure was not associated with worse outcomes than undergoing an up-front thoracotomy. The authors conclude that thoracoscopic access should be preferred to thoracotomy, since conversion is not disadvantageous.
Attrition of the Cardiothoracic Surgeon-Scientist: Definition of the Problem and Remedial Strategies
April 3, 2019
Submitted by: Wei-Guo Ma
Surgeon-scientists have been instrumental in many breakthroughs that have improved the lives of millions of patients. However, despite the many rewards that a career as a surgeon-scientist offers, the number of surgeons pursuing such a path has been steadily declining.
In this thoughtful editorial, Dr Ikonomidis and other cardiothoracic leaders explore the root causes for this decline and possible solutions for keeping a surgeon-scientist activity.
April 2, 2019
Submitted by: Wei-Guo Ma
Although computed tomography is the most used imaging technique in the diagnosis of acute aortic syndrome, echocardiography offers complementary information for diagnosis and management in the emergency room, operting rooom, and catheter lab. In this review, Evangelista and associates explore the current role of echocardiography in the diagnosis and management of patients with acute aortic syndrome based on its advantages and limitations.
April 1, 2019
Submitted by: Wei-Guo Ma
Researchers from the University of Nottingham studied 502,628 adults aged 40 to 69 years whose health information was logged in the UK Biobank between 2006 and 2010. Using demographic data and taking into account biometric, clinical, and lifestyle factors, the authors developed predictive mortality models using deep learning, random forest, and Cox regression.
Death occurred in 14,418 adults (2.9%) over a total follow-up time of 3,508,454 person-years, and mortality data was corroborated with national records. The age- and gender-based Cox model was the least predictive, with an area under the curve (AUC) of 0.689, followed by the multivariate Cox regression model, which improved discrimination by 6.2% for an AUC of 0.751. The application of machine-learning algorithms further improved discrimination by 3.2% using the random forest model (AUC = 0.783; 95% confidence interval (CI), 0.776 - 0.791) and 3.9% using deep learning model (AUC = 0.790; 95% CI, 0.783 - 0.797). The two machine-learning algorithms improved discrimination by 9.4% and 10.1% respectively from a simple age and gender Cox regression model.
This work suggest machine learning significantly improved accuracy of prediction of premature all-cause mortality in this middle-aged population, compared to standard methods. This study illustrates the value of machine learning for risk prediction within a traditional epidemiological study design.
April 1, 2019
Submitted by: Aristotle Protopapas
A robust meta-analysis of randomized controlled trials on stem cell therapies for refractory angina, offering some encouragement.
March 31, 2019
Submitted by: Wei-Guo Ma
In this state-of-the-art review review, the authors summarize current knowledge of anatomic, structural, metabolic, functional, and hemodynamic characteristics of the right ventricle (RV) in both health and disease. Highlights of this review are:
- Anatomically and functionally different from the left ventricle, the RV plays an increasingly recognized role in determining both symptoms and outcomes in multiple conditions.
- The normal RV is coupled to the low-pressure, high-compliance pulmonary circulation to ensure transfer of blood to the pulmonary arteries in an energy-efficient fashion. RV adaptation to disease is determined by the degree of pressure overload, volume overload, and alterations in intrinsic contractility. These 3 situations have distinct clinical course and therapeutic approach although they commonly coexist in various degrees.
- Advances promise to enhance our understanding of the mechanisms of RV adaptation or maladaptation to pathologic conditions. These include refinements in the evaluation of RV anatomy, myoarchitecture, ultrastructure, metabolism, perfusion, function, and degree of coupling to the pulmonary circulation. Such evaluation can be performed invasively but increasingly is accomplished through noninvasive imaging.