2024 Resistant gastroenteropancreatic neuroendocrine tumors: a definition and guideline to medical and surgical management
Gastroenteropancreatic neuroendocrine tumors (NETs), also historically known as carcinoids, are tumors derived of hormone-secreting enteroendocrine cells. Carcinoids may be found in the esophagus, stomach, small intestine, appendix, colon, rectum, or pancreas. The biologic behavior of carcinoids differs based on their location, with gastric and appendiceal NETs among the least aggressive and small intestinal and pancreatic NETs among the most aggressive. Ultimately, however, biologic behavior is most heavily influenced by tumor grade. The incidence of NETs has increased by 6.4 times over the past 40 years. Surgery remains the mainstay for management of most carcinoids. Medical management, however, is a useful adjunct and/or definitive therapy in patients with symptomatic functional carcinoids, in patients with unresectable or incompletely resected carcinoids, in some cases of recurrent carcinoid, and in postoperative patients to prevent recurrence. Functional tumors with persistent symptoms or progressive metastatic carcinoids despite therapy are called “resistant” tumors. In patients with unresectable disease and/or carcinoid syndrome, an array of medical therapies is available, mainly including somatostatin analogues, molecular-targeted therapy, and peptide receptor radionuclide therapy. Active research is ongoing to identify additional targeted therapies for patients with resistant carcinoids.
Category
- BUMC Proceedings
Format
- Journal
Credits
- 1.00 American Board of Surgery (ABS) Accredited CME
- 1.00 AMA PRA Category 1 Credit™
- 1.00 Attendance
Cost $25.00
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
Cost $25.00
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
Cost $25.00
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
Cost $25.00
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
Cost $25.00
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
Cost $25.00
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
Cost $25.00
2024 Clinician Corner - A rare cause of hypokalemia
AbstractHypokalemia is a common electrolyte derangement seen in the inpatient setting, often with multiple plausible explanations.
Category
- BUMC Proceedings
Format
- Journal
Credits
- 1.00 AMA PRA Category 1 Credit™
- 1.00 Attendance
Cost $25.00
2024 Clinician Corner - Enterohemorrhagic Escherichia Coli: Trigger for Small Vessel Vasculitis
AbstractWe describe the case of a 19-year-old woman who presented with abdominal pain, vomiting, and a palpable purpuric rash. The patient subsequently developed dysentery and was found to have an infection from Shiga toxin–producing Escherichia coli.
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
Cost $25.00
2024 Clinician Corner - VEXAS syndrome unveiled: a multidimensional journey from clinical presentation to management
AbstractAn 83-year-old man with a history of monoclonal gammopathy of unknown significance, macrocytic anemia, and cytopenias presented with hemorrhagic bullae on his left hand, alongside intermittent fevers and joint pain.
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
Cost $25.00