Journal of Pediatric Surgery Article Review: January 2022 - APSA Issue
With Dr. Casey Kelleher & Dr. Gail Besner & Dr. Shahzad Jaharifar · hosted by Dr. Rod Gerardo & Dr. Todd Ponsky
Chapter 1 of 4 · Fundamentals
Episode intro
Introduction to January 2022 APSA Issue Review
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What the experts said
Casey Kelleher is a pediatric surgeon at Mass General for Children in Boston and chair of the APSA Publications Committee
Surgeons have historically been incentivized based on work RVUs, which is important for clinical productivity but does not take advantage of other strengths surgeons have
The concept of academic RVUs was first described approximately 12-13 years ago but did not include how to incentivize people for academic work
Nationwide Children's Hospital implemented a point-based academic RVU system where people accumulate points based on number of publications, presentations, and other academic pursuits
The Nationwide system kept work RVUs as part of the incentivization plan along with other achievable goals
In Akron under Bob Perry, the bonus structure required the entire group to reach a certain RVU threshold for everyone to receive 50% of their bonus, eliminating competition for cases
The Akron system required each surgeon to have a project and bonus was partially determined by project performance, requiring value addition beyond clinical work
Shahzad Jaharifar is a pediatric surgeon and assistant clinical professor at BC Children's Hospital in Vancouver, Canada
At Saint Justine Hospital, gastroschisis treatment differed from other institutions by having very low silo use, with nearly every patient having an attempt at immediate bedside sutureless closure
At other institutions where the fellows trained, the majority of gastroschisis patients were placed in silos and serially reduced until ultimate closure
A gastroschisis protocol had been developed at Saint Justine several years before the study period
Approximately 75% of gastroschisis babies can be closed immediately, whether in the OR pre-protocol with fascial closure or at bedside post-protocol
With silo management, parents look at their newborn's intestines through a silo for 5-6 days and cannot hold their baby until the silo is completely reduced
With immediate closure, even if intubated, babies can be extubated and held within 48 hours, or held immediately if managed without intubation
After implementing the academic RVU system, Nationwide had an increase in presentations and peer-reviewed publications
External federal research funding at Nationwide increased from $750,000 to $5.7 million, representing a 7.7-fold increase
Sarah Stokes is a PGY-6 general surgery resident at University of California, Davis
Prior studies on placental mesenchymal stem cells for in utero myelomeningocele repair involved two separate surgeries: one to create the defect and one to repair it
In the current study, a single operation was performed at approximately 100 days gestational age where the myelomeningocele defect was created and repaired simultaneously with PMSCs placed directly on the spinal cord
Placental mesenchymal stromal cells did not persist in placentas, uteri, or lambs at 3 months post-treatment
There was no histological evidence of abnormal growth or tumor development in the ovine model at 3 months
Human trials using placental mesenchymal stromal cells for myelomeningocele repair have been initiated with the first two patients enrolled