Publications Update # 14
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 !!
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.
David Cibula
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
Despite believing that #LACC is not the definitive trial and knowing the current data, don't you think that type of statement shouldn't be part of @ESGO_society guideline? Look the level of evidence. @IJGConline @SGO_org @pedroramirezMD @RParejaGineOnco @leitaomd @br_gynoncgroup pic.twitter.com/usvJSI01p1
— Glauco Baiocchi (@glaucobaiocchi) May 4, 2023
Concern # 2 - Frozen section of sentinel LND
These just came out. Got some concerns. Recommending frozen section for SLN should not be a "strongly recommended" thing. @RParejaGineOnco @pedroramirezMD https://t.co/gJpgYyQZHi
— Mario M. Leitao, Jr (@leitaomd) May 1, 2023
Radiation Oncology
This study could be a game changer for patients receiving radiation for vulvar cancer.
Yana KostIn 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.
Ladin A Yurteri-KaplanEmily LinTatiana CatanzariteCorrect 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
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