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Journal and News Scan
Interesting metanalytic review on the effect of binary gender in mammals.
"We were all worried about the availability of ventilators but actually you've got to have enough people to run them." Consultant Cardiothoracic Surgeon, Joel Dunning, decided to do something about it by redeploying as an ICU Nurse for the NHS, setting a great example for all clinicians being asked to consider roles outside of the comfort zone. He discusses his decision and experience as a surgeon-turned-ICU nurse during the COVID-19 pandemic in this Medscape UK interview.
This manuscript by Yamanashi et al retrospectively looks into the outcome of patients with newly classified clinical T4 lung cancer. They report 93 patients who underwent surgical treatment during a 10-year study period. They identified several risk factors and conclude that “surgery should be considered if there is no suspicion of N2 disease and complete resection is technically feasible.”
Modolo et al. present a substudy from the EXCEL trail. They looked into the impact of the SYNTAX score II treatment recommendation for patients with left main disease. Patients who were randomized to PCI treatment against the SYNTAX II CABG recommendation had a four-fold higher mortality compared to patients who underwent CABG in conclusion with the syntax II recommendation.
A prepublication manuscript describing a balanced system for multidimensional decision making about timing of surgery in the COVID era.
The UNOS donor heart allocation system was revised in 2018, giving priority to patients on inpatient mechanical circulatory support (MCS). Patients admitted with heart failure-associated cardiogenic shock were tracked for the frequency of use of mechanical circulatory support before and after implementation of this change. In non-transplant centers, there was no change in the frequency of MCS. In transplant centers, use of MCS increased from 25% to 43%.
Guidance document for the triage of operations for thoracic malignancies produced by the Thoracic Outcomes Research Network. Their recommendations emphasize the importance of shared decision making, transparency and adherence to ethical principals.
Guidance document to assist in decision making and triage of congenital cardiac surgical patients during the COVID-19 pandemic. The article also includes guidance principles on the need and methods to preserve the workforce and emphasizes the need for regional collaboration, use of telecommunication technologies, and the evolving role of the congenital cardiac surgeon in the pandemic.
Guidance Statement from the Canadian Society of Cardiac Surgeons (CSCS) and its Board of Directors on patient assessment and triage, risk reduction, and real-time sharing of expertise and experiences during the COVID-19 pandemic.
Topical review on the epidemic in Britain, with a number of observations that relate to the cardiothoracic surgeons and all healthcare professionals:
-The assertion that the National Health Service in Britain was overrun PRIOR to the pandemic.
-The assertion that acute angina is now being undertreated.
-Perhaps most worryingly, the assumed increase in non-COVID positive deaths in Scotland.
In the light of the government poised to review the lockdown in an attempt to balance the prevention of another viral infestation versus the conceivable grave financial implications here in the UK and worldwide, it is interesting to see their take on the financial toll on patients.