In this week's edition
- βοΈ Letter from P'Fella
Females are better surgeons. Evidence says so. - π€ The Sunday Quiz
How do you treat a ganglion? - π¦ Spotlight
Join the waiting list for an updated flashcard system. - πΈ Image of the Week
AI-generated hand swelling. - π£ Tweets of the Week
P'Fella's 3 favourite tweets - π€ Ask P'Fella
Topical timolol for Infantile haemangiomas. - π Articles of the Week
3 hot reads ganglions management.
Deep dive: the best technique for ganglion aspiration? - π Feedback
P'Fella spotlighted ganglion cysts. Do you like this focused format?
ps - P'Fella is trying out a new format, spotlighting one major topic each week. Do you prefer this focused approach?
A Letter from P'Fella
Evidence suggests females are rocking the surgical world.
Hope you're having a fabulous Sunday. I've got a little nugget of info for you that's been buzzing around recently. Have you heard that patients operated on by female surgeons seem to have slightly better outcomes? It's a headline that caught my eye in the New York Times and Guardian newspapers.
Now, before you jump to conclusions, let's unwrap this!
Dive in with me π
So, a couple of interesting studies from Canada and Sweden took a deep dive into over a million patient records. The scoop? Patients treated by female surgeons had fewer complications and needed less follow-up care than those treated by male surgeons.
Why the Difference, Though?
It's not about being better or worse; it's about different approaches:
- Technique & Speed: Female surgeons often take things a tad slower, focusing more on precision.
- Risk-Taking: They tend to stick to the plan, switching techniques mid-surgery less often.
A Glimpse at the Numbers:
Here's a brief overview of the data presented in published articles from Canada and Sweden.
But Hold Up! Some Caveats:
Studies have limits. While we see correlations, they don't mean direct causation. Some factors to consider:
- Complexity: Varying case complexities might play a role.
- Data Gaps: Some missing data and potential misattributions of lead surgeons.
- Scope: Results are region-specific and might not be universally applicable.
- Assumptions: A surgeon's time spent doesn't necessarily equate to precision.
- Shifting Views: The image of the lone surgeon is outdated.
Here's the Real Talk:
This isnβt a competition. It's all about learning from each other. If we can pick up a trick or two from our colleagues, no matter their gender, then why not? At the end of the day, it's about the patient. If they're happy and healthy, then we've done our job. And hey, maybe we can all slow down a bit and see if it makes a difference.
What do you think? Got any insights or stories? Hit reply; I'm all ears!
Cheers and chat soon,
P'Fella β€οΈ
The Sunday Quiz
Best Management of a Ganglion
- Observation: Reassurance with education on change of self-resolution
- Excision: open or arthroscopic
- Aspiration Β± injection (commonly corticosteroids)
Spotlight
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Image of the Week
AI-generated clinical images
Tweets of the Week
Don't forget to follow P'Fella!
Given only this X-ray, can you initially determine the disease the patient is suffering from?#MedTwitter #ortho pic.twitter.com/1CkFcETFal
β Jian Wang, MD, PhD, FCMDA (@OrthoJianWANG) September 8, 2023
Interview Tip:
β Dr. Austin Price | Action Potential Mentoring, LLC (@action_ap) September 8, 2023
Before each interview, google the name of the hospital youβre interviewing at and click βNewsβ at the top of Google.
Stay up to date with the things that are going on in that program / hospital. It makes for good small talk to show youβve thoroughly investigatedβ¦
In progressβ¦.#trauma #unfallchirurgie #medicine #medicalart #medicalillustration #MedTwitter #TraumaTwitter #illustration #procreate #digitalart #anatomy #muscles #bones #pelvis pic.twitter.com/Z0nlPNV9Tr
β Kimberly Ohm (@ohm_kimberly) September 7, 2023
Ask P'Fella
You ask, I'll answer
"Small, isolated, superficial infantile haemangioma in pre-auricular area. 2x5mm. Otherwise well 2 month old. No associated features/concerns re visual/airway/auditory obstruction - purely cosmetic concern. Would topical timolol be indicated? Unclear risk/benefit from NICE 2015 review. Any other relevant evidence?
Thanks
Hey there!
For the 2-month-old with a small infantile hemangioma (IH) in the pre-auricular area, topical timolol might be worth considering. Since its first report of its use in 2010, let's break down what the evidence says:
A recent consensus guideline states:
- "May prescribe topical timolol maleate for thin and/or superficial IHs"
- Evidence is moderate
- 62% clearance... 7% of infants required subsequent systemic Ξ²-blocker
A clinical trial (JAMA, 2021) showed that while topical timolol didn't significantly speed up the resolution of IH, it did improve the color of the lesion. So, even if the hemangioma doesn't disappear faster, it might look better with the treatment. There's some retrospective data suggesting that timolol might be a safe option for treating ulcerated IHs up to about 3 cm in size (Boos, 2013). That said, if an IH does ulcerate, oral propranolol is often the go-to.
We know a lot about infantile hemangiomas. Most of them just shrink on their own. Once parents get that these little growths usually peak in the first few months and then chill out, it often puts them at ease.
Hope that helps!
P'Fella
4 questions submitted in the last 7 days...
Articles of the Week
3 must-read articles, 1 deep-dive! π
3 Must-reads
- What is the best management of ganglions?
Head L et al. Wrist ganglion treatment: systematic review and meta-analysis. J Hand Surg Am. 2015 Mar;40(3):546-53.e8. doi: 10.1016/j.jhsa.2014.12.014. - How often do ganglions self-resolve?
Dias JJ et al. The natural history of untreated dorsal wrist ganglia and patient reported outcome 6 years after intervention. J Hand Surg Eur Vol. 2007 Oct;32(5):502-8. - Splint after ganglion excision?
Wong CR et al. Immobilization of the Wrist After Dorsal Wrist Ganglion Excision: A Systematic Review and Survey of Current Practice. Hand (N Y). 2023 Mar;18(2):254-263..
What's the best way to aspirate a ganglion?
Ever dealt with pesky wrist ganglia? Dive into our latest Journal Club where we compare old-school surgical remedies to an innovative technique using triamcinolone. Discover which method offers a quicker recovery with fewer side effects. Plus, get access to further reading for an even deeper dive
