Surgery
Audio Summaries

Self-Directed vs Clinician-Delivered Cognitive Behavioral Therapy for Chronic Pain: A Randomized Clinical Trial

The authors aimed to compare the effectiveness of self-directed cognitive behavioral therapy for chronic pain (CBT-CP) with asynchronous feedback to clinician-delivered CBT-CP in patients with chronic musculoskeletal pain. The study found that self-directed CBT-CP significantly reduced pain interference and improved secondary outcomes at 4 months, with benefits sustained at 12 months, suggesting it may be a more accessible alternative to traditional clinician-delivered therapy.

Ethical Implications of the Slow Code: A Systematic Review of Ethics of Slow Codes in U.S. Hospitals

The authors investigate the ethical implications of "slow codes" in U.S. hospitals, where clinicians perform resuscitation efforts without full commitment, often in response to patient or family requests despite the futility of such interventions. Their systematic review of 34 studies reveals a significant divide among physicians regarding the permissibility of slow codes, with most ethics literature deeming them impermissible due to concerns about deception, patient autonomy, and moral distress. The findings underscore the need for improved communication and ethical guidance in navigating end-of-life care decisions.

Non-invasive removal of the Smart tracheal occlusion device for fetal congenital diaphragmatic hernia: a single-arm, open-label, phase 1 study

This study aimed to evaluate the effectiveness and safety of a novel non-invasive tracheal occlusion device (Smart-TO) for treating congenital diaphragmatic hernia (CDH) in fetuses, which eliminates the need for a second intervention to restore airway patency. The results demonstrated a 100% deflation rate of the device using magnetic resonance imaging, with all infants having the balloon successfully expelled from their airways at birth, indicating a significant advancement in fetal surgery for CDH. Overall, the findings suggest that the Smart-TO device is effective and safe for use in this clinical context.

Non-Operative Treatment of Pectus Carinatum: Fifteen Years of Outcomes and Predictors from a National Paediatric Service

This study investigates the long-term outcomes of non-surgical bracing for pectus carinatum in patients under 20 years old, aiming to identify factors that predict successful correction. The authors found that wear-time adherence, chest wall flexibility, and patient motivation were significant predictors of treatment success, with 34.8% of patients achieving full resolution. The findings emphasize the importance of monitoring adherence and engaging patients in bracing programs to enhance treatment outcomes.

Combined bladder-kidney transplantation: first-in-human feasibility trial

The authors investigate the feasibility and safety of combined bladder-kidney transplantation as a novel treatment for patients with terminal bladder dysfunction and end-stage kidney disease. The first-in-human trial demonstrated successful surgical outcomes, with the patient maintaining good renal and bladder function, sensation, and continence beyond six months post-transplantation, suggesting this approach may be a viable option for select patients requiring immunosuppression.

Preventable Pediatric Trauma Transfers in a Rural State

The authors aimed to evaluate the prevalence and predictors of potentially preventable transfers (PTs) among pediatric trauma patients in a rural state. Their study found that 25% of trauma transfers were classified as PTs, primarily characterized by lower injury severity scores, suggesting that enhanced pre-transfer triage, potentially through telemedicine consultations, could reduce unnecessary transfers.

Assessment of Postoperative Outcomes of LAT-HSL in the Treatment of Unilateral Inguinal Hernia in Boys: A Multicenter Prospective Randomized Controlled Study

The authors aimed to compare the efficacy, safety, and economic outcomes of Laparoscope-Assisted Trans-scrotal Hernia Sac ligation (LAT-HSL) versus traditional laparoscopic hernia needle extraperitoneal high ligation (LH) in treating unilateral indirect inguinal hernia in boys aged 1-3 years. Their findings indicate that both procedures have comparable short-term safety and efficacy, with LAT-HSL offering advantages such as shorter pneumoperitoneum duration and lower intraoperative hypocapnia risk, as well as reduced medical costs in specific settings.

The UCL-Lancet Commission on Migration and Health: review of the state of progress

The authors review the progress made since the UCL-Lancet Commission on Migration and Health's 2018 publication, highlighting the urgent need for improved health care access for refugees and migrants amid rising global migration trends and the impacts of the COVID-19 pandemic. They emphasize the importance of incorporating health considerations into migration policies, establishing monitoring systems, and addressing the health consequences of climate change. Ultimately, the authors call for strong leadership and accountability to enhance the health outcomes and rights of people on the move.

Bispecific Antibody Ivonescimab Added to Chemotherapy in EGFR-Variant Non-Small Cell Lung Cancer: The HARMONi-A Randomized Clinical Trial

The study aimed to determine whether adding the bispecific antibody ivonescimab to chemotherapy improves overall survival in patients with EGFR-variant non-small cell lung cancer (NSCLC) who have progressed after prior EGFR tyrosine kinase inhibitor therapy. Results showed that ivonescimab combined with chemotherapy significantly increased median overall survival to 16.8 months compared to 14.1 months with chemotherapy alone, indicating a clinically meaningful benefit despite a higher incidence of treatment-emergent adverse events.

Prone Positioning in Infants With Acute Bronchiolitis: The PROPOSITIS Randomized Clinical Trial

The authors aimed to determine whether prone positioning in infants with moderate to severe acute bronchiolitis receiving high-flow nasal cannula (HFNC) support could reduce the need for escalation to noninvasive or invasive ventilation. In a multicenter randomized trial involving 451 infants, they found no significant difference in the escalation of care between those in the prone position and those in the supine position. The study suggests that while prone positioning did not show a definitive benefit, further research is needed due to the wide confidence interval around the results.