Does defensive medicine change the behaviors of vascular surgeons? a qualitative review

Although in literature few successful claims have been shown in comparison with other medical specialties such as gynaecology and orthopaedics, vascular surgery is included among high-risk specialties. The high-risk of receiving medical claims may lead vascular surgeons to practice defensive medicine, as is normal in several other areas of clinical practice. No studies are available to our knowledge of the incidence of defensive medicine in the field of vascular surgery. Taking into consideration the scarce amount of information, the authors provide a critical discussion regarding the application of defensive medicine behaviour among vascular surgeon

Surgeon Speaks-Paul J. DiMuzio, MD, FACS

“Patients with extensive acute deep vein thrombosis (DVT) of the legs provide an excellent example of why effective medical-surgical collaboration is so important. “These patients typically benefit from emergency catheter-directed thrombolysis, an endovascular procedure performed by vascular surgeons. Subsequent medical management is directed toward preventing re-thrombosis and preventing the long-term complications of DVT. At the Jefferson Vascular Center, vascular medicine specialists initiate and transition that care, as well as provide long-term management of blood thinners and other medical measures. “Across vascular diseases and conditions, Jefferson’s vascular medicine specialists provide many outpatient services. In addition to the excellent care they afford, this collaboration allows the surgeons to focus on complex surgical and endovascular procedures.” Paul J. DiMuzio, MD, FACS William M. Measey Professor of Surgery Director, Division of Vascular and Endovascular Surger

Hemolytic Anemia soon after Replacement of Ascending Aorta for acute Aortic Dissection

A 61-year-old female underwent replacement of the ascending aorta for Type A aortic dissection, then gradually developed severe hemolytic anemia over 1 month. The cause of hemolysis was found to be mechanical damage of red blood cells caused by an inverted felt strip at the proximal anastomosis. A reoperation for resection of the felt and repair of the proximal anastomosis successfully resolved the problem. Here, we report a rare case of hemolytic anemia at the site of an inverted felt strip that occurred after replacement of the ascending aorta

Mechanisms of vascular smooth muscle contraction and the basis for pharmacologic treatment of smooth muscle disorders

The smooth muscle cell directly drives the contraction of the vascular wall and hence regulates the size of the blood vessel lumen. We review here the current understanding of the molecular mechanisms by which agonists, therapeutics, and diseases regulate contractility of the vascular smooth muscle cell and we place this within the context of whole body function. We also discuss the implications for personalized medicine and highlight specific potential target molecules that may provide opportunities for the future development of new therapeutics to regulate vascular function.Accepted manuscrip

The compelling arguments for the need of medical vascular physicians in Europe

<b></b> The burden of vascular diseases is growing worldwide, as the population ages, prompting a call to action not only in terms of awareness but also and most urgently in recognizing the need for vascular physicians, also called angiologists. Vascular medicine views the vascular system (arteries, veins, and lymphatics) as a whole, unique, and independent entity requiring specialized competencies. Vascular physicians offer a holistic and comprehensive approach to vascular patients including provision of interventional procedures, management of a heterogeneous group of multi-morbid and frail patients affected by multi-vessel diseases, and connecting different specialists in a multidisciplinary effort. Vascular medicine practise varies across European countries. While it is a firmly accepted medical speciality in many European countries it is not formally recognized by the European Union limiting adoption in the other countries. The lack of vascular physicians likely accounts for inequality of care of vascular patients as compared for example to patients with heart disease and might contribute to adverse outcomes and healthcare costs associated with vascular diseases. To move forward in the struggle to provide efficient care for multimorbid poly-vascular patients, it is essential to establish vascular medicine programs in Europe and worldwide. Important steps to achieve this goal include improving public awareness of vascular diseases, attain formal recognition by the EU of angiology/vascular medicine as a medical specialty, creating specialized treatment guidelines, and to harmonize vascular care in Europe

Grand Rounds Panel Discussion: Blood Thinners Peri-Operatively: What to do?

PANELISTS Mathew DeCaro, MD: Associate Professor of Cardiology, Director of the Coronary Cardiac Unit, Cardiology fellowship program director John Doherty, MD: Professor of Cardiology Gregary Markefka, MD: Associate Professor of Cardiology, Associate Director of the Coronary Cardiac Unit, Cardiology fellowship assistant program director Geno Merli, MD: Professor of Vascular Medicine, Co-director of Jefferson Vascular Center Srikanth Nagalla, MD, MS: Associate Professor of Medicine, Director, Clinical Hematology Eric Schwenk, MD: Assistant Professor of Anesthesiology, Director of orthopedic anesthesia Barry Ziring, MD: Clinical Associate Professor of Internal Medicine / Primary Care, Director of the division of Internal Medicin

Development of mathematical models of environmental physiology

Selected articles concerned with mathematical or simulation models of human thermoregulation are presented. The articles presented include: (1) development and use of simulation models in medicine, (2) model of cardio-vascular adjustments during exercise, (3) effective temperature scale based on simple model of human physiological regulatory response, (4) behavioral approach to thermoregulatory set point during exercise, and (5) importance of skin temperature in sweat regulation

Collaboration is Key to Treating Complex Vascular Diseases and Conditions

As one of the highest-volume vascular practices on the East Coast, the Jefferson Vascular Center (JVC) brings together the physicians, surgeons and pharmacists needed to deliver coordinated, convenient patient care. The JVC’s integrated, multi-disciplinary approach is extremely effective in diagnosing, treating and monitoring vascular diseases (diseases of blood vessels) and thrombotic (bloodclotting) disorders – including complex arterial and vein thrombosis, peripheral artery disease, lymphedema, postthrombotic syndromes, chronic venous insufficiency, varicose veins, vasculitis and congenital vascular conditions. Launched in 2009, the JVC is led by Co-Directors Paul J. DiMuzio, MD, FACS, the William M. Measey Professor of Surgery and Director of the Division of Vascular and Endovascular Surgery, Geno Merli, MD, Senior Associate Chief Medical Officer of Thomas Jefferson University Hospital (TJUH), and Laurence Needleman, MD, Associate Professor of Radiology and Director of the Division of Abdominal Imaging. Dr. Merli has long been a nationally recognized expert in deep vein thrombosis (DVT), a potentially deadly blood clot in the leg. Housed on the sixth floor of the Gibbon Building at 11th and Chestnut Streets, the JVC recently completed a renovation that tripled its footprint and brought the angioplasty center, staffed by an interventional cardiologist, in close proximity. JVC faculty members also care for patients at Methodist Hospital and in Northeast Philadelphia, serving a total of about 1,500 patients annually. As a medical specialty, vascular medicine is relatively new. Jefferson’s Taki Galanis, MD, received Board certification in vascular medicine by being sponsored and mentored into the specialty. More recently, physicians have been able to pursue fellowship training. One such specialist is Luis H. Eraso, MD, who joined Jefferson in June 2011 after completing three years of fellowship training at the Cardiovascular Division of the Hospital of the University of Pennsylvania. Dr. Eraso, who received Jefferson’s Marjorie A. Bowman, MD, ’76 Early Career Investigator Award for Primary Care Research for his work on novel biomarkers of peripheral arterial disease, emphasizes the value of an integrated, multi-disciplinary center. “Other programs offer treatment for problems affecting the arterial, venous and lymphatic circulatory systems, but very few do so in one physical location,” he says. “The Jefferson Vascular Center brings together medical, surgical and pharmacy specialists, which offers benefits to patients and improvement in care coordination and delivery.” Vascular medicine physicians also manage the vascular wound care program, an integral part of the JVC which provides advanced vascular wound services, such as multilayer compression and absorbent dressing (MCAD) therapy, outpatient surgical debridement, application of bioengineered skin grafts and substitutes, and/or use of hyperbaric oxygen therapy. Additionally, some of the certified vascular medicine physicians are involved in the interpretation of vascular ultrasound studies performed at the JVC vascular laboratory. Equally important, Dr. Eraso says, are the roles of Walter Kraft, MD, who is board certified in both internal medicine and clinical pharmacology, and Lynda Thomson, PharmD, who joins the vascular medicine physicians in staffing the Jefferson Anticoagulation and Thrombosis Service (JATS). JATS is a busy inpatient and outpatient consult service dedicated to coordinating the transition of care as patients with complex vascular conditions move back into community-based primary care. JATS also provides guidance in the medical management of venous thromboembolic disease in special populations, including pregnant patients. Working closely with Maternal-Fetal Medicine, Jefferson’s high-risk obstetrics team, the medical and pharmacy staff at the JVC helps to manage anticoagulation therapy throughout their pregnancy. “Our multi-disciplinary approach helps prevent overlap in care—ensuring that two specialties within the same system aren’t dealing with the same disease in different ways,” he concludes. “Here, multiple specialists practice side by side. We consult with each other and collaborate in real time, which enables us to provide a more seamless experience and support better outcomes for our patients.” For more information about the JVC, please visit Jefferson.edu/JV