On this episode we are joined by Dr. Gretchen Schwarze, Associate Professor of Vascular Surgery at the University of Wisconsin in Madison.  Dr. Schwarze is an expert in surgical decision making, informed consent, advance directives, and end-of-life care, and in this episode we pick her brain for practical tips on how to talk to patients about surgery and end of life decisions.  Tune in to hear Dr. Schwarze’s 7 Habits for Highly Effective Surgery Communication, created just for Behind the Knife.   1.     Be clear about the goal 2.     Stay away from anatomy and physiology 3.     Remember the downsides of surgery are more than just complications 4.     Help patients to anticipate and prepare 5.     Ask people about their hopes and fears 6.     Make a recommendation and show your work 7.     Attend to emotion The Patient Preferences Project: https://patientpreferences.org/

On this episode we talk about an extremely important topic - end of life care and decision making.  We are lucky to be joined by Dr. Gretchen Schwarze, Associate Professor of Vascular Surgery at the University of Wisconsin in Madison.  Dr. Schwarze is the creator of the Best Case Worst Case tool, an incredibly useful resource.  The Best Case Worse Case tool helps improve communication between older patients and their surgeons so that patients can avoid unwanted treatment and make decisions that align with their values, preferences, and goals.  As most of our listeners know, these conversations are not easy.  Tune in and learn how to do better.   Whiteboard video: https://www.youtube.com/watch?v=FnS3K44sbu0 The Patient Preferences Project: https://patientpreferences.org/ Managing Uncertainty — Harnessing the Power of Scenario Planning: https://www.nejm.org/doi/full/10.1056/NEJMp1704149

Description: Pancreatic adenocarcinoma is a highly lethal cancer with a dismal long-term prognosis requiring complex multidisciplinary planning in order to optimize outcomes. In this episode from the Hepato-Pancreato-Biliary team at Behind the Knife, we discuss a patient presenting with a borderline resectable pancreatic head mass.  Learning Objectives: In this episode, we review risk factors for pancreatic adenocarcinoma, key steps of the diagnostic work-up and pre-operative planning, and definitions of resectable, borderline resectable, and unresectable tumors. The history of chemotherapy for pancreatic cancer is briefly reviewed, highlighting the importance of multi-agent regimens and role of neoadjuvant therapy. Finally, we highlight the critical steps of the Whipple procedure. Hosts: Timothy Vreeland, MD, FACS (@vreelant) is an Assistant Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center Daniel Nelson, DO, FACS (@usarmydoc24) is an Associate Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at William Beaumont Army Medical Center Connor Chick, MD (@connor_chick) is a PGY-4 General Surgery resident at Brooke Army Medical Center Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a PGY-3 General Surgery resident at Brooke Army Medical Center Links to Papers Referenced in this Episode Treatment sequencing for resectable pancreatic cancer: influence of early metastases and surgical complications on multimodality therapy completion and survival J Gastrointest Surg. 2014 Jan;18(1):16-24 https://pubmed.ncbi.nlm.nih.gov/24241967/  Preoperative biliary drainage for cancer of the head of the pancreas N Engl J Med. 2010 Jan 14;362(2):129-37 https://pubmed.ncbi.nlm.nih.gov/20071702/ 1423 pancreaticoduodenectomies for pancreatic cancer: A single-institution experience J Gastrointest Surg. 2006 Nov;10(9):1199-210; discussion 1210-1. https://pubmed.ncbi.nlm.nih.gov/17114007/  Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: the CONKO-001 randomized trial JAMA. 2013 Oct 9;310(14):1473-81.  https://pubmed.ncbi.nlm.nih.gov/24104372/ Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial Lancet. 2017 Mar 11;389(10073):1011-1024 https://pubmed.ncbi.nlm.nih.gov/28129987/ FOLFIRINOX or Gemcitabine as Adjuvant Therapy for Pancreatic Cancer N Engl J Med. 2018 Dec 20;379:2395-2406 https://www.nejm.org/doi/full/10.1056/NEJMoa1809775  Surgical Outcome Results From SWOG S1505: A Randomized Clinical Trial of mFOLFIRINOX Versus Gemcitabine/Nab-paclitaxel for Perioperative Treatment of Resectable Pancreatic Ductal Adenocarcinoma Ann Surg. 2020 Sep 1;272(3):481-486.doi: 10.1097/SLA.0000000000004155 https://pubmed.ncbi.nlm.nih.gov/32740235/ ASCO Guidelines Potentially Curable Pancreatic Adenocarcinoma https://www.asco.org/research-guidelines/quality-guidelines/guidelines/gastrointestinal-cancer#/12146 NCCN Guidelines Pancreatic Adenocarcinoma https://www.nccn.org/guidelines/nccn-guidelines/guidelines-detail?category=1&id=1455

Today we have a very special guest on Behind the Knife- Dr Michael D’Angelica. He discusses surgical oncology with his HPB focus along with colorectal liver metastases. The episode digs in deeper on the origin of hepatic artery infusion pump, its surgical technique and common complications and much more. Enjoy! https://jamanetwork.com/journals/jamasurgery/article-abstract/2735967

Clinical Challenges in Trauma Surgery: Penetrating Cardiac Trauma A patient presents with a stab wound to the THE BOX.  What do you do?  X-ray?  FAST?  Heal with steel?  In this episode, the BTK trauma team discusses your options and gives you a few pro tips along the way. Join Drs. Haut, Feinman, and Sigmon for a high-yield clinical challenge. Hosts: Elliott Haut, MD, PhD, a senior, nationally recognized name in trauma and acute care surgery at Johns Hopkins University. Dr. Haut is a past president of The Eastern Association for the Surgery of Trauma (EAST). Marcie Feinman, MD, MEHP, the current program director of General Surgery Residency at Sinai Hospital of Baltimore and editorial board member of SCORE.  She received her Masters in Education in the Health Professions from Johns Hopkins. David Sigmon, MD, MMEd, a PGY-5 resident at the University of Illinois at Chicago who plans on going into trauma surgery.  He did two years of research in surgical education at the University of Pennsylvania where he also received his Master’s in Medical Education. Papers: Inaba K, Chouliaras K, Zakaluzny S, et al. FAST ultrasound examination as a predictor of outcomes after resuscitative thoracotomy: a prospective evaluation. Ann Surg. 2015;262(3):512-518; discussion 516-518.  https://pubmed.ncbi.nlm.nih.gov/26258320/ Teeter W, Haase D. Updates in traumatic cardiac arrest. Emerg Med Clin North Am. 2020;38(4):891-901. https://pubmed.ncbi.nlm.nih.gov/32981624/ Israr S, Cook AD, Chapple KM, et al. Pulseless electrical activity following traumatic cardiac arrest: Sign of life or death? Injury. 2019;50(9):1507 1510. https://pubmed.ncbi.nlm.nih.gov/31147/183/

The podcast discusses carotid artery stenosis and its management, including diagnosis, imaging, and surgical options. They focus on Transcarotid Artery Revascularization (TCAR), a new technique. The hosts also mention seminal papers in carotid artery stenosis. Each chapter explores different aspects of the evaluation and treatment, emphasizing the importance of cardiovascular risk factors, statin medication regimen, and patient selection.

“If you could go back to your very first day of intern year and tell yourself one thing, what would it be?"   In this episode, AlleaBelle Gongola joins Scott Steele, Kevin Kniery, and Patrick Georgoff to discuss this very question. Tune in to hear wise answers from previous BTK episodes and fill up on inspiration as we head into a new academic year.  

Go to greenchef.com/90surgery with code "90surgery" to get 90 dollars off some fantastic meals and help support Behind The Knife. Host: Kevin Kniery Guests: Alexis Lauria and Alec Kersey

Go to greenchef.com/90surgery with code "90surgery" to get 90 dollars off some fantastic meals and help support Behind The Knife.  Host: Kevin Kniery Guest Hosts: Alexis Lauria and Alec Kersey For more details on vascular trauma discussion check previous episodes with Dr. Rasmussen. 

Go to HelloFresh.com/Surgery12 to get up to 12 free meals and support Behind The Knife. Host: Kevin Kniery Guest Hosts: Alexis Lauria and Alec Kersey Check our YouTube tutorial on REBOA https://bit.ly/3uSxLXb For more in detail vascular trauma discussions check out our previous episodes with Dr. Todd Rasmussen.