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Avoiding Overtreatment of Women ≥70 With Early-Stage Breast Cancer: A Provider-Level Deimplementation Strategy.
J Surg Res
April 2023
Department of Surgery, University of Michigan, Ann Arbor, Michigan. Electronic address:
Introduction: National guidelines recommend against routine axillary staging with sentinel lymph node biopsy (SLNB) and adjuvant radiotherapy (RT) in women ≥70 y with early-stage, hormone receptor-positive, HER2-negative breast cancer and clinically negative axilla; however, these practices remain common.
Methods: We conducted a prospective pilot study from August 2021 to 2022 using an intervention targeting breast surgeons and radiation oncologists in Michigan that aimed to reduce SLNB and RT in eligible patients. The intervention consisted of (1) a geriatric assessment, (2) an assessment of the patient's medical maximizing-minimizing preferences, and (3) a tailored script with counterpoints to reasons patients commonly seek SLNB or RT.
Neurosurgeon Wilder Penfield (1891-1976) envisioned hospital architecture as a powerful medical tool. Focusing on two key interiors in the 1934 Montreal Neurological Institute (MNI)-the operating room and the foyer-this article engages newly accessible textual and material evidence to show Penfield's intense involvement in the design of the building. A unique, tri-level surgical room, with a sophisticated setup for photography, made the MNI's surgery interactive.
View Article and Find Full Text PDFDoes intracranial pressure management hurt more than it helps in traumatic brain injury?
Trauma Surg Acute Care Open
January 2018
R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Maryland, USA.
Unlabelled: Traumatic brain injury (TBI) is the leading cause of death after traumatic injury. Raised intracranial pressure (ICP) is particularly associated with poor TBI outcomes, prompting clinicians to monitor this parameter, using it to guide therapies aimed at reducing pressures. Despite this approach being recommended by several bodies such as the Brain Trauma Foundation and the American College of Surgeons, the evidence demonstrating that ICP-guided therapy improves outcome is limited.
View Article and Find Full Text PDFPoint-Counterpoint: The Use of Neuromonitoring in Lateral Transpsoas Surgery.
Spine (Phila Pa 1976)
April 2016
*Department of Orthopedic Surgery, Stanford University Hospital and Clinics, Redwood City, CA †Keck Medicine, University of Southern California, Los Angeles, CA.
Study Design: Expert opinion.
Objective: The objective of this study is to debate the requirement for intraoperative neuromonitoring in 90° lateral transpsoas spine surgery (lateral lumbar interbody fusion [LLIF]) in a point-counterpoint style with an argument made for each side followed by a brief rebuttal of each. Dr.
For breast cancer patients, the role of the axillary lymph node dissection (ALND) in the management of clinically node negative breast cancer patient has shifted from routine, to selective, to increasingly rare. With the publication of the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial results, some are ready to announce the time of death of this procedure. However, many questions remain regarding the design and statistical interpretation of the study, the treatments the patients actually received, and its applicability in clinical practice in light of other studies concerning regional management.
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