Publications Update # 14

Publications Update # 14
McDonald's original store at the original Ann Arbor location, 2000 W. Stadium. Photo from 1961 Omega, the Ann Arbor High School yearbook. Photographer: Wystan

Registration for Dr. Merrill's talk end at 5 pm today. Last chance to REGISTER

Non-Medical Article of the Week

This is an amazing summary of all the research on the topic of "Flow". Many of us wonder how some people are more creative than others. As you watch the video and read the attached article, consider the following:

  • Think of the last time you experienced "Flow." What were you doing?
  • Consider your experience in the operating room. Yes, thinking of complications and strategies to avoid them is important - but overthinking and a fixation on outcomes will likely reduce the likelihood of you entering a state of flow during an operation and exhibiting your best performance.
  • FLOW is an antidote to burnout !!
3 science-based strategies to increase your creativity
These three unexpected things can help fuel your creativity: A good mood, some quiet time that’s all your own, and limits. Learn why, from performance expert Steven Kotler.

Want to learn more about Flow?

The flow state of mind, first introduced by psychologist Mihaly Csikszentmihalyi, is characterized by a deep sense of immersion, engagement, and optimal experience in an activity.

In this state, individuals often report feeling that their actions and awareness merge, creating a sense of oneness with the task at hand. The flow state is accompanied by selflessness, where the sense of self and self-consciousness disappears, and timelessness, where past and future dissolve into an eternal present. This state often feels effortless, intrinsically rewarding, and autotelic, meaning the activity is done for its own sake. Paradoxically, individuals in flow experience a heightened sense of control over their situation. Intrinsic motivation is a key component of flow, as the activity itself is enthralling and rewarding.

Flow also requires intense concentration on a limited field of information, allowing for complete absorption in the present moment.

To achieve flow, there must be a balance between the challenge of the task and the individual's skill set, pushing them to stretch but not break. Clear, immediate goals and real-time feedback are essential in maintaining focus and allowing mid-flight adjustments.

Question of the Week

Which of the following accurately describes the mechanism of action of tranexamic acid (TXA) in reducing bleeding?

A) TXA promotes the conversion of plasminogen to plasmin, enhancing fibrinolysis
B) TXA binds to the active site of thrombin, inhibiting the formation of fibrin clots
C) TXA competitively blocks lysine-binding sites of plasminogen and plasmin, stabilizing fibrin clots and reducing fibrinolysis
D) TXA enhances the activity of factor XIII, promoting cross-linking of fibrin polymers

Answer: At the end of the post

Cervical Cancer

ESGO/ESTRO/ESP published their guidelines on the management of cervical cancer.

ESGO/ESTRO/ESP Guidelines for the management of patients with cervical cancer - Update 2023 - PubMed
In 2018, the European Society of Gynecological Oncology (ESGO) jointly with the European Society for Radiotherapy and Oncology (ESTRO) and the European Society of Pathology (ESP) published evidence-based guidelines for the management of patients with cervical cancer. Given the large body of new evid…

However, there has been a lot of criticism of these guidelines on the Twitterverse. Overall, the guidelines do a great job summarizing the treatment of cervical cancer. It is worth your time to read this article.

Concern # 1 - Guidelines recommending consideration for MIS Rad Hyst for tumors < 2 cm

Concern # 2 - Frozen section of sentinel LND

Radiation Oncology

This study could be a game changer for patients receiving radiation for vulvar cancer.

Bacterial Decolonization for Prevention of Radiation Dermatitis: A Randomized Clinical Trial - PubMed Identifier: NCT03883828.

In this study, the intervention arm received a decolonization regimen - intranasal mupirocin ointment to be applied twice daily to the nares + chlorhexidine wash to be used once daily to the body. Standard of care served as the control where these agents were not prescribed. No patient receiving treatment with this regimen developed radiation dermatitis (0/39 patients), while in the standard-of-care arm, 9/39 (23%) developed radiation dermatitis. Although confirmatory trials will be needed, the results of this trial are encouraging. Until now, topical steroids were the mainstay of treatment.

Surgical Ergonomics

In recent months there has been a lot of chatter about surgical ergonomics. Unfortunately for me personally, I wish this discussion had started a few years ago prior to sustaining an injury myself. Nevertheless, I live my life by the advice given by the legendary TV personality Robin Roberts.

Make your mess your message

So here is my advice. Download these articles and read them, please. And make an action plan to mitigate injury. It might save you a lot of time and pain !!

Dr. Andrea Merrill will also briefly discuss this in her upcoming talk on May 10th.

Surgical Ergonomics and Preventing Work-Related Musculoskeletal Disorders - PubMed
Surgical Ergonomics and Preventing Work-Related Musculoskeletal Disorders
Growing pains: strategies for improving ergonomics in minimally invasive gynecologic surgery - PubMed
Considering the serious downstream effects of WMSDs on surgeons, it is imperative to implement strategies for WMSD prevention. Optimal positioning of the surgeons and operative equipment should be routine. Intraoperative breaks and stretching should be incorporated during procedures and between ever…
Ergonomics in gynecologic surgery - PubMed
WMSDs are prevalent among surgeons but have received little attention because of under-reporting of injury and logistical constraints of studying surgical ergonomics. Future research must aim to develop objective surgical ergonomics instruments and guidelines and to correlate ergonomics assessments…

Correct Answer

Tranexamic acid (TXA) is an antifibrinolytic agent that helps to reduce bleeding by inhibiting the breakdown of blood clots. It works by competitively blocking the lysine-binding sites of plasminogen and plasmin, thus preventing their interaction with fibrin. This inhibition of plasminogen activation and plasmin activity results in the stabilization of fibrin clots, thereby reducing fibrinolysis and blood loss.

In the context of trauma and surgery, TXA has been shown to decrease blood loss and the need for blood transfusions effectively. The CRASH-2 trial demonstrated that the administration of TXA in trauma patients with significant hemorrhage led to a reduction in mortality without increasing the risk of vascular occlusive events. Similarly, the WOMAN trial found that early administration of TXA in women with postpartum hemorrhage reduced the risk of death due to bleeding and the need for surgical interventions.

  • CRASH-2 trial collaborators. (2010). Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet, 376(9734), 23-32.
  • WOMAN Trial Collaborators. (2017). Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet, 389(10084), 2105-2116.

Here is a great summary article about TXA

That's all for this week