We live in a complex system. Complex systems are those that are intrinsically difficult to model due to interactions between their parts or between a given system and its environment. Their reaction to a given input is unpredictable. The capacity of a complex system to absorb hits and disturbances and still retain basic function and structure is called resilience. Non-resilient systems destabilize and mutate to new, most frequently, less desirable states1. The coronavirus disease (Covid-19), the pandemic disease caused by the SARS-CoV-2 virus, demonstrates how susceptible our complex systems are, when the disturbance cannot be controlled rapidly and effectively.
When research is the subject, you have certainly heard the words “translational research” or “from bench to bedside”.
What do these words mean?
The topic might seem a contradiction, how can it be possible to engage in intense sport with an operated heart? It is possible, but not for everyone and not in each case. The topic is complex and requires a differentiated approach. The major components of the equation are the following:
- Nature of the disease
- Functional condition of the heart
- Response of the heart and of the whole cardiovascular system to the operation
- Presence of any residual or other disease with particular relevance to intense sport
- Attitude of the patient and his/her family
- Sports history of the patient
Our surgical technique for cannulation of the right axillary artery and fully percutaneous TEE-guided cannulation of the right atrium in minimally invasive valve surgery is presented with a video in the CTSNet. Our data point towards a better cerebral protection with this technique.
I very well remember my first experiences as a medical student in the operating room. I was ordered to stand in a corner with my back to the wall (just as the surgeon ordered), almost motionless because of the staff’s worry that I might touch and contaminate something sterile. I could only listen to the surgeon describing what he was doing. That was a humiliating experience and I was close to abandoning my goal of becoming a surgeon.
Quality of medical and surgical care is a profoundly felt need of every patient, of every involved family. Although based on slightly different motivations, the same is requested by those who pay for the care. Therefore, the interest in defining and measuring the quality of provided care is high. This is, however, a highly complex endeavor. It requires in-depth knowledge, differentiation, multiple perspectives and expert judgment.
How can we define “quality of care”?
The Institute of Medicine (IOM) of the US National Academy of Sciences defines it as “the degree to which health services for individuals and population increase the likelihood of desired health outcomes and are consistent with current professional knowledge.”
Traditionally, technical skills in surgery are taught by the “apprentice model”: trainee surgeons learn under supervision in the operating room, by performing portions of or complete real operations on real patients.
This is one of the biggest emergencies in heart surgery, or, dare I say, of medicine in general. From a subjective wellbeing, a sudden sharp and excruciating pain in the chest makes the person reach out for medical help. As soon as the patient arrives to the ER, a diagnostic protocol for acute chest pain is carried out. Once acute myocardial infarction is ruled out, the patient must undergo a CT scan to either exclude or confirm acute aortic dissection.
On June 10th 2017, the formal graduation ceremony held at the TMEC Walter amphitheater at Harvard Medical School and the Certficate of Completion marked the end of a highly demanding yet interesting one-year training named GCSRT (Global Clinical Scholar Research Training). The study of key subjects in clinical research (biostatistics, epidemiology, ethics) was much deeper and thorough than expected. Side subjects such as self- and team management, as well as mentorship and leadership, were also integral part of the course.
This post is a tribute to the families of our patients. To all families of all patients we care for. My thoughts especially go to the families whose relatives had a bad outcome, experienced a severe complication or who sadly did not survive surgery.