2024 Moving Beyond Teamwork in the Operating Room to Facilitating Mutual Professional Respect
Psychological safety enables the interpersonal risk-taking necessary for providing safer patient care in the operating room (OR). Limited studies look at psychological safety in the OR from the perspectives of each highly specialized team member. Therefore, we investigated each member’s perspective on the factors that influence psychological safety in the OR. Interviews were conducted with operative team members of a level 1 trauma center in central Texas. The interviews were transcribed, de-identified, and coded by two investigators independently, and thematic analysis was performed. Responses were collected from 21 participants representing all surgical team roles (attending surgeons, attending anesthesiologists, circulating nurses, nurse anesthetists, scrub techs, and residents). Circulating nurse responses were redacted for confidentiality (n = 1). Six major themes influencing psychological safety in the OR were identified. Psychological safety is essential to better, safer patient care. Establishing a climate of mutual respect and suspended judgment in an OR safe for learning will lay the foundation for achieving psychological safety in the OR. Team exercises in building rapport and mutual understanding are important starting points.
Category
  • BUMC Proceedings
Format
  • Journal
Credits
  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2
  • 1.00 AMA PRA Category 1 Credit
  • 1.00 Attendance
2024 Monkeypox: Another Pandemic in the Making
Monkeypox is a zoonotic disease caused by the monkeypox virus, which is a member of the Poxviridae family of viruses. It is transmitted through direct or indirect contact with fluid secretions. Initial symptoms include fever, chills, headache, and malaise, followed by a maculopapular rash that starts on the face and progresses centrifugally. Polymerase chain reaction is the preferred laboratory test for the diagnosis, and management is mostly supportive. The clinical presentation of monkeypox is quite similar to that of another member of the Poxviridae family: smallpox, which wreaked havoc in the 20th century, before being eradicated with the help of the vaccinia virus vaccine in 1977. This vaccine protects not only against smallpox but also monkeypox; therefore, when use of this vaccine was discontinued, monkeypox had a new susceptible population to infect and way to proliferate and evolve. Initially the disease spread in Africa, but now the more evolved monkeypox is quickly spreading to other countries. On July 23, 2022, the World Health Organization declared this multicountry outbreak a public health emergency of international concern. Given its mutating ability and high transmissibility, we need to quickly devise measures to control this virus before it turns into a pandemic.
Category
  • BUMC Proceedings
Format
  • Journal
Credits
  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2
  • 1.00 AMA PRA Category 1 Credit
  • 1.00 Attendance
2024 Updates on Enhanced Recovery after Surgery protocols for plastic surgery of the breast and future directions
Perioperative pain control is an important component of any plastic surgery practice. Due to the incorporation of Enhanced Recovery after Surgery (ERAS) protocols, reported pain level, opioid consumption, and hospital length of stay numbers have decreased significantly. This article provides an up-to-date review of current ERAS protocols in use, reviews individual aspects of ERAS protocols, and discusses future directions for the continual improvement of ERAS protocols and control of postoperative pain.
Category
  • BUMC Proceedings
Format
  • Journal
Credits
  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2
  • 1.00 AMA PRA Category 1 Credit
  • 1.00 Attendance
2024 The potential impact of computed tomography coronary calcium score screening on patients with dyslipidemia
Coronary artery calcium (CAC) scoring helps determine whether patients with known coronary artery disease (CAD) should initiate medical management by predicting future cardiac event risk. CAC scoring is underutilized because many insurance companies consider it experimental. This study aims to determine whether CAC screening of patients at risk for CAD can decrease the risk of myocardial infarction and improve survival.
Category
  • BUMC Proceedings
Format
  • Journal
Credits
  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2
  • 1.00 AMA PRA Category 1 Credit
  • 1.00 Attendance
2024 Management dilemmas in restarting anticoagulation after gastrointestinal bleeding
Systemic anticoagulants are widely prescribed to prevent and treat thromboembolism, among other indications. A common com-plication of using these agents is gastrointestinal bleeding. While early resumption of anticoagulants after the bleeding has resolved can increase the risk of rebleeding, delayed resumption puts the patient at increased risk of thromboembolic events and mortality. There is limited data on this topic to guide clinicians on resuming anticoagulation after hospitalization for gastrointestinal bleeding and to educate patients regarding the subsequent risks of recurrent gastrointestinal bleeding, thromboembolism, and mortality. The optimal time to resume anticoagulation is also unknown. This review summarizes the existing literature and available data on the commonly encountered dilemma of restarting anticoagulation therapy after hospitalization for gastrointestinal bleeding.
Category
  • BUMC Proceedings
Format
  • Journal
Credits
  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2
  • 1.00 AMA PRA Category 1 Credit
  • 1.00 Attendance
2024 A Concerning Trend in Geriatric Pharmacy Merits Evidence-Based Intervention
The effects of polypharmacy on geriatric populations are an emerging concern that merits more exploration. The primary goal of this review was to evaluate the current body of knowledge on polypharmacy and explore the preventive and corrective measures to avoid negative outcomes. Even if a medication has an appropriate indication, polypharmacy in the geriatric population is associated with an increased risk of drug-drug or drug-condition interactions. Recent efforts to prevent polypharmacy include the development of interprofessional teams in clinics dedicated to medication review and reconciliation, deprescription plans aimed to safely discontinue potentially inappropriate medications, and inpatient screening tools that provide prescribing recommendations. In conclusion, polypharmacy affects a high percentage of the geriatric population. Current efforts to address and prevent polypharmacy are ongoing but have not been widely adopted.
Category
  • BUMC Proceedings
Format
  • Journal
Credits
  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2
  • 1.00 AMA PRA Category 1 Credit
  • 1.00 Attendance
2024 Optimal Cardiovascular Medical Therapy: Current Guidelines and New Developments
Coronary artery disease is a leading cause of mortality worldwide, and patients with obstructive coronary artery disease require optimal cardiovascular medical therapy along with lifestyle modification for secondary prevention of future cardiac events. Optimal medical therapy includes antiplatelet agents, high-intensity statins, beta-blockers, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, aldosterone antagonists, and calcium channel blockers. There are differences in the medical therapy guidelines of the American Heart Association/American College of Cardiology and the European Society of Cardiology. In addition, there are emerging medical therapies that may be added to future guidelines with additional cardiovascular outcome benefits.
Category
  • BUMC Proceedings
Format
  • Journal
Credits
  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2
  • 1.00 AMA PRA Category 1 Credit
  • 1.00 Attendance
2024 Dietary Supplements and Bleeding
An estimated one third of United States adults use herbal supplements, often without reporting use to their physicians. These supplements can potentially alter bleeding and coagulation during surgery, and when used concomitantly with anticoagulants. Our objective is to provide a comprehensive review of the evidence of bleeding risks of the most popular herbal and dietary supplements. A PubMed search and review of the literature was performed. We found that garlic and hawthorn supplementation are strongly associated with surgical bleeding independent of anticoagulants; cordyceps sinensis, echinacea, and aloe vera are loosely associated with surgical bleeding independent of anticoagulants. In patients on anticoagulants, ginkgo biloba, chondroitin-glucosamine, melatonin, turmeric, bilberry, chamomile, fenugreek, milk thistle, and peppermint are associated with bleeding risk; no evidence was found for bleeding with these supplements independent of anticoagulants. Fish oil, ginseng, and saw palmetto are not associated with bleeding. Evidence for overall bleeding risk associated with St. John’s Wort, ginger, ginkgo biloba, or cranberry supplementation is conflicting. In conclusion, physicians must be aware of the potential anticoagulant effects of these supplements. It is imperative to report dietary and herbal supplement usage to physicians and is best to discontinue non-essential supplement use 2 weeks prior to surgery.
Category
  • BUMC Proceedings
Format
  • Journal
Credits
  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2
  • 1.00 AMA PRA Category 1 Credit
  • 1.00 Attendance
2024 The efficacy and safety of botulinum toxin epicardial fat injection to prevent postoperative atrial fibrillation in patients undergoing cardiac surgery: a meta-analysis of randomized controlled trials
Postoperative atrial fibrillation (POAF) is prevalent in about 30% to 60% of patients undergoing cardiac surgery, leading to worse outcomes. Botulinum toxin type A (BTX) epicardial injection has been proposed to prevent POAF by impairing cholinergic signaling.
Category
  • BUMC Proceedings
Format
  • Journal
Credits
  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2
  • 1.00 American Board of Surgery (ABS) Accredited CME
  • 1.00 AMA PRA Category 1 Credit
  • 1.00 Attendance
2024 The effect of polycystic ovarian syndrome on fibrocystic breast changes in postmenopausal women
AbstractFibrocystic breast changes (FCCs) are benign lesions thought to be caused by an increased estrogen-to-progesterone ratio. One of the most common endocrinopathies that increases this ratio is polycystic ovarian syndrome (PCOS).
Category
  • BUMC Proceedings
Format
  • Journal
Credits
  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2
  • 1.00 American Board of Surgery (ABS) Accredited CME
  • 1.00 AMA PRA Category 1 Credit
  • 1.00 Attendance