Surgeon Opinions on Use of Epidural Steroids in Treatment of Lumbar Disk Disease: Results of an Online Survey

“Standard of care” can vary along regional and specialty lines; it is common to discover that a local “standard” can be different somewhere else. Opinions may differ between pain management specialists, primary care physicians, and spine surgeons with regard to use of conservative treatment modalities. Opinion within a given group of practitioners, however, should converge. Local differences between hospitals may exist, but conferences, professional journals, and national boards for certification are mechanisms that should act to maintain homogeneity within a professional group. It could be expected that commonly utilized treatment approaches within a well defined group of sub-specialists should converge. One of the more common non-surgical options for herniated lumbar spinal discs is epidural steroid injections (ESIs). Patients may be referred to pain management centers for lumbar ESIs by their primary care physician or perhaps after consultation with a surgical specialist. We sought to assess the opinion of practicing spine surgeons with regard to timing and use of lumbar ESIs as a part of a conservative treatment approach to both lumbar disk herniations (HNP) and lumbar degenerative disk disease (DDD)

Implementation of a Residency Twitter Account to Provide Curricular Enrichment

Background The Problem With the goals of improving patient safety and resident well-being, the ACGME’s 2011 revision of duty-hour requirements included a 16-hour limit on continuous duty hours for postgraduate year 1 (PGY-1) trainees, increased supervision for junior trainees, as well as mandated rest periods between duty hours.1 These rules place limitations on the ability of trainees to attend scheduled educational activities during standard work hours; a recent study showed a decrease in resident availability for teaching conferences compared with the 2003 duty hour regulations.2 Residency training programs must develop alternative avenues for education and encouraging inquiry outside of traditional methods. A Modern Solution Social networking sites, such as Twitter, represent a promising opportunity for residency programs to foster collaborative learning and educational engagement both inside and outside of the hospital. After surveying our residents’ methods of obtaining medical knowledge, the chief medical residents at Thomas Jefferson University Hospital created a shared Twitter account entitled “@JeffIMChiefs” with the goals of disseminating clinical pearls from our daily conferences and inspiring continued learning by providing links to relevant research and review articles

Underutilization of Statins and Aspirin Following Coronary Artery Bypass Graft Surgery

Introduction Coronary artery bypass graft (CABG) surgery continues to be an important procedure for the treatment of coronary artery disease. However, clinically significant stenoses and complete bypass graft occlusion rates remain high, especially among saphenous vein grafts1. This is associated with significant morbidity and mortality. Both statin medications and aspirin have been shown in numerous clinical trials to play an important role in the medical management of coronary artery disease following CABG surgery. As per the ACC/AHA guidelines, both statin medications and aspirin have class I indications to support their use indefinitely following CABG, unless contraindication exists2. Long term studies evaluating statin and aspirin usage rates following CABG procedures are lacking. Purpose The goal of this study was to assess the usage rates of statins and aspirin in post-CABG patients undergoing coronary angiograms. Further analysis was done to assess the clinical and laboratory differences among the populations based on medication usage group