Surgery
Audio Summaries

Proton beam therapy for oropharyngeal cancer (TORPEdO): a phase 3, randomised controlled trial

The authors conducted a phase 3 trial (TORPEdO) to compare the clinical benefits of intensity-modulated proton therapy (IMPT) versus intensity-modulated radiation therapy (IMRT) in patients with locally advanced oropharyngeal squamous cell carcinoma, specifically assessing treatment-related effects on physical function and quality of life. The results indicated that both treatment modalities yielded similar outcomes regarding late physical quality of life, gastrostomy-tube dependence, disease control, and overall survival, suggesting that IMRT remains the standard of care in settings where IMPT is not routinely utilized.

Clinical Criteria for the Definition of Refractory Septic Shock: A Joint Delphi Consensus from the Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM)

The authors aimed to establish a consensus on clinical criteria for defining refractory septic shock to improve diagnosis, management, and research in this severe condition. Through a Delphi process involving critical care experts, they identified 13 key criteria, including markers of organ dysfunction, tissue perfusion indicators, and specific treatment requirements, such as high doses of norepinephrine and the use of critical care ultrasound. This consensus provides a structured framework for recognizing and managing refractory septic shock in clinical practice.

Outcomes from a Longitudinal Palliative Care Curriculum for Medical Students

The authors aimed to evaluate the effectiveness of a longitudinal palliative care curriculum at the University of Pennsylvania's Perelman School of Medicine, focusing on its acceptability, impact on student knowledge and attitudes, and engagement in palliative care opportunities. Through a comprehensive assessment using both qualitative and quantitative methods, the study found that the curriculum successfully met its intended outcomes and provided valuable insights into its broader impacts. This evaluation serves as a model for other medical schools looking to assess similar palliative care educational initiatives.

Primary sclerosing cholangitis

This article investigates the clinical features, pathogenesis, and management challenges of primary sclerosing cholangitis (PSC), a rare chronic liver disease often associated with inflammatory bowel disease. The authors aim to clarify the disease's variable presentation, the role of genetic and environmental factors, including the intestinal microbiome, and the limited treatment options available. The seminar highlights the need for a deeper understanding of PSC to improve patient outcomes and management strategies.

The Inherited Basis of Coronary Artery Disease

The authors investigate the genetic underpinnings of coronary artery disease (CAD) and how these insights can enhance risk prediction, prevention, and treatment strategies. They highlight the significance of both monogenic and polygenic factors in CAD, emphasizing the potential of polygenic risk scores to improve individual risk assessment. Key questions remain about the practical application, cost-effectiveness, and integration of these genetic insights into clinical practice.

Ready for Donation, Not for Death: A Qualitative Study of Families' Experience With Controlled Donation After Circulatory Determination of Death in Intensive Care

This qualitative study investigates the experiences and challenges faced by families of patients undergoing controlled donation after circulatory determination of death (cDCDD). Through in-depth interviews, the authors explore themes related to decision-making, the waiting period before death, and the controlled environment of the dying process, highlighting the need for better support for families during this time. The findings suggest that while families can engage meaningfully in the cDCDD process, proper preparation and emotional support are essential to mitigate distress.

Diagnosis and Management of Resistant Hypertension: A Review

The authors aim to address the diagnosis and management of resistant hypertension, which affects approximately 10% of patients despite treatment. They highlight the importance of excluding factors such as white-coat hypertension and medication nonadherence, and recommend lifestyle modifications, optimized pharmacologic therapy, and interventions like spironolactone and renal denervation to effectively lower blood pressure in these patients.

Effects of a Combined Lifestyle Intervention on Recovery of ICU Survivors: A Randomized Controlled Trial

The authors aimed to evaluate the effects of a combined lifestyle intervention, including exercise and dietary support, on perceived physical functioning (PF) and health-related quality of life (HRQoL) in ICU survivors. The study found that participants in the intervention group experienced a significant improvement in PF scores and increased protein intake compared to the control group, suggesting that such interventions may benefit recovery in this population.

Sepsis and Subsequent Psychiatric Morbidity: A Nationwide Population-Based Matched Cohort Study, 2008-2019

The authors aimed to quantify the risk of developing psychiatric morbidity following community-acquired sepsis and to determine if new chronic diseases mediated this association. Their findings indicate that patients with sepsis experienced a significantly higher incidence of psychiatric events compared to matched controls, with the elevated risk persisting for at least five years. This suggests that sepsis may have lasting effects on mental health, highlighting the need for preventive strategies in this population.

Efficacy and safety of oral semaglutide 14 mg (flexible dose) in early-stage symptomatic Alzheimer's disease (evoke and evoke+): two phase 3, randomised, placebo-controlled trials

The evoke and evoke+ trials aimed to evaluate the efficacy and safety of oral semaglutide (14 mg) in individuals with early-stage symptomatic Alzheimer's disease. The results indicated that semaglutide did not significantly slow clinical progression compared to placebo, and while safety profiles were consistent with other indications, the treatment did not demonstrate the expected benefits in this population.