tag:blogger.com,1999:blog-4968787219619380438.post8112332705662604734..comments2023-09-21T04:02:29.457-04:00Comments on Skeptical Scalpel: Reviewing three studies that question dogmaSkeptical Scalpelhttp://www.blogger.com/profile/13206922456661320751noreply@blogger.comBlogger15125tag:blogger.com,1999:blog-4968787219619380438.post-32318878343773980322013-10-19T14:51:29.870-04:002013-10-19T14:51:29.870-04:00I am not directly involved in resident teaching an...I am not directly involved in resident teaching any longer. I agree with you that it's probably too much fluid. A quick look at the Internet shows that the 3:1 ratio is alive and well. That has been dogma for over 40 years. It's not going to disappear quickly.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-73130681491946994122013-10-18T15:23:44.889-04:002013-10-18T15:23:44.889-04:00One of the contributing factors to perioperative o...One of the contributing factors to perioperative over-hydration is the commonly taught idea that crystalloid replacement is 3 x amt of blood loss. The times where I have seen rapid surgical blood loss (accurately measured) and replaced with 3* crystalloid - the patients act overhydrated.<br /><br />A few years ago, an ICU study found that in their population, 1.7 ml of crystalloid has the same central volume effect as 1 ml of colloid. What ratio are current surgical and anesthesiology residents being taught?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-62544852191462675172013-10-18T14:48:14.378-04:002013-10-18T14:48:14.378-04:00u keep it unbelievably realu keep it unbelievably realAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-60960681323458456462013-10-18T13:41:25.949-04:002013-10-18T13:41:25.949-04:00Anon, I appreciate your comments.
I have expresse...Anon, I appreciate your comments.<br /><br />I have expressed similar feelings about the purpose of research here http://skepticalscalpel.blogspot.com/2013/08/what-is-purpose-of-research.html.<br /><br />I agree with you about limiting fluids during and after surgery. It's hard to do when the anesthesiologists are not on the same page too.<br /><br />I had Toradol after my recent surgery. It's good stuff and of course, doesn't cause bleeding.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-41541257363670432812013-10-18T13:07:30.908-04:002013-10-18T13:07:30.908-04:00the point of doing studies is to get more NIH fund...the point of doing studies is to get more NIH funding or to beef up your CV in hopes of landing a chairman job where your surgical productivity can decrease but your pay will increase. Another reason if non academic is to beef up your CV so you can land gigs on the speaking circuit. this is obviously a very cynical and somewhat joking answer.<br />I brought up the bowel prep example because I was always met with frustration as a resident when dealing with certain attendings who would bend surgical dogma to fit their practice styles. Some surgeons speak as if their means of practice is the only way to practice and as a resident you were wrong to think otherwise. common ways of expressing this would involve some stupid remark about white hair and having more of it.<br />another trend I read about that I found interesting and was somewhat enthusiastic about was running patients dry post op and how less tissue edema could lead to lower complications. this ran counter current to surgical dogma of urine output>30cc/hr and at various "journal clubs" was met with all kinds of "this was interesting but study wasn't relevant to my patient....etc."<br />I always try to remain mindful of this frustration and hope to not become the old stubborn surgeon I hated so much as a resident. I strive to be someone dynamic and at least open minded. here's another one for the road ... "no toradol on my patients...it causes bleeding!"Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-1308428344932641362013-10-18T09:37:13.963-04:002013-10-18T09:37:13.963-04:00That's a good question. I read somewhere recen...That's a good question. I read somewhere recently that it takes about 17 years for doctors to change a practice. That's almost an entire generation. It's probably true. Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-41195436563650791022013-10-17T22:17:59.518-04:002013-10-17T22:17:59.518-04:00Question:
If a well-respected meta-analysis says...Question: <br /><br />If a well-respected meta-analysis says an intervention is useless, but most clinicians do it anyways (to not look bad in M&M's), what is the point of doing studies? Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-544796407040483362013-10-16T08:47:04.214-04:002013-10-16T08:47:04.214-04:00Anon, good point. I could never bring myself to om...Anon, good point. I could never bring myself to omit the mechanical prep. Despite the literature on the subject, I think the majority of surgeons in the US still do mechanical preps. It might be that the fear of criticism at M&M conference is a factor.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-91625303626013877512013-10-15T14:51:12.445-04:002013-10-15T14:51:12.445-04:00Cochran review on bowel prep for colon surgery pre...Cochran review on bowel prep for colon surgery pretty old. majority of people in my society still do it. I do it because I don't want to be admonished for not doing by older surgeons at M&M.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-13069554940135021172013-10-14T09:07:44.188-04:002013-10-14T09:07:44.188-04:00Khoi, I agree about the infections. I've blogg...Khoi, I agree about the infections. I've blogged about that before. Thanks for reading and good luck with the job hunt. Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-90812480441945838202013-10-13T18:39:28.342-04:002013-10-13T18:39:28.342-04:00This is a great article. I particularly like the ...This is a great article. I particularly like the JAMA article re: VTE. This plays into the larger, more overarching topic of metric tracking and quality based reimbursement in my mind. Though I'm still only a surgical resident (PGY 5), as I continue my job search and knowing what questions to ask, research on these topics brings important relevant questions as to how hospitals are tracking metrics, and what their plans of action are when quality metrics aren't met. One that bothers me a lot is the looking at surgical site infection. I mean, honestly...should a surgeon get dinged when a Hinchey class IV perforated diverticulitis patient gets a wound infection? I guess it's debatable, but my initial inclination is no. But I'm biased...<br /><br />Thanks for the great blog. Long time reader, first time commenter. Keep up the great work!Khoi Le, M.D.https://www.blogger.com/profile/04393329345218847784noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-36850923534597012312013-10-11T20:52:12.255-04:002013-10-11T20:52:12.255-04:00Ben, you could be right. It would not surprise me....Ben, you could be right. It would not surprise me. Thanks for commenting.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-12676434241551606702013-10-11T20:49:57.575-04:002013-10-11T20:49:57.575-04:00No worries, Skep. The next batch of studies are su...No worries, Skep. The next batch of studies are sure to prove the opposite to be true.Ben Rush MDnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-85817433842632817762013-10-10T17:15:29.767-04:002013-10-10T17:15:29.767-04:00Thanks. I'm feeling better today. Already 2 we...Thanks. I'm feeling better today. Already 2 weeks postop.<br /><br />Yes, more studies like this are needed.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-70209420630191784712013-10-10T17:09:14.627-04:002013-10-10T17:09:14.627-04:00I wish the current MD crew liked questions as much...I wish the current MD crew liked questions as much as you do. Hope the shoulder is better ... and your wife's patience is holding out. :) <br /><br />I find this a really great thing. Wish the medical community did more of it. I can applaud and agree with trying to make things better, seeing if there isn't something that could be improved. <br /><br />Do or do not. Try or try not. Action ... not inaction. Anonymousnoreply@blogger.com