we don't have what's happening then in the long term. And yes, Sean shows us about this one child who comes up and is able to flex it. But there are also cases in social media who are talking about the fact that they're on gabapentin. And when is this terrible nerve pain going to disappear?
I say cryoablation is not ready for prime time, uh, and just because you can't do it doesn't really justify us. I'm arguing for a trial, randomized controlled trial, as well as a registry so that we can track right Doctor Red results.
Insurance companies require some metric (abnormal pectus index plus evidence of cardiac dysfunction or abnormality) to approve coverage; providing multiple indices (Haller, correction, depression) plus cardiac dysfunction evidence has been effective in reversing denials.
Pectus - Preoperative Assessment - Radiology and Cardiac Evaluation
▶Ep 4 · 2:48
clinicalPectus excavatum repair is arguably the most painful operation that could be done in a child.↗
▶Ep 4 · 2:48
quotearguably what is the most painful operation that could be done in a child↗
▶Ep 4 · 2:48
clinicalThe Cincinnati Children's approach is selective in identifying patients who will benefit from surgery and emphasizes helping patients and parents deal with pain and discomfort, minimizing workup risks (ionizing radiation), and mitigating chronic pain and substance abuse risk.↗
▶Ep 4 · 31:08
guidelineInsurance companies require some metric (abnormal pectus index plus evidence of cardiac dysfunction or abnormality) to approve coverage; providing multiple indices (Haller, correction, depression) plus cardiac dysfunction evidence has been effective in reversing denials.↗
▶Ep 4 · 42:03
host_summaryDr. Park in Korea, who performs the largest number of pectus repairs worldwide, argues that age 3 and older is safe for repair, and earlier is better.↗
▶Ep 4 · 42:31
clinicalWhen operating on younger patients, bars need to be shorter (not extending to mid-axillary line) to avoid impeding chest wall growth.↗
▶Ep 4 · 43:01
host_summaryOvercorrection from excavatum to carinatum can occur if repair is done too early, particularly in patients with connective tissue disorders (reported by Hopkins group).↗
▶Ep 4 · 43:35
host_summaryDr. Park reports seeing fewer asymmetric pectus patients because he corrects them when they're younger, suggesting early correction may prevent asymmetry development.↗
Pectus - Preoperative Assessment - Radiology and Cardiac Evaluation
▶Ep 8 · 2:48
quotearguably what is the most painful operation that could be done in a child↗
▶Ep 8 · 2:48
clinicalPectus excavatum repair is arguably the most painful operation that could be done in a child.↗
▶Ep 8 · 2:48
clinicalThe Cincinnati Children's approach is selective in identifying patients who will benefit from surgery and emphasizes helping patients and parents deal with pain and discomfort, minimizing workup risks (ionizing radiation), and mitigating chronic pain and substance abuse risk.↗
▶Ep 8 · 2:48
clinicalPectus excavatum repair is arguably the most painful operation that could be done in a child.↗
▶Ep 8 · 2:48
quotearguably what is the most painful operation that could be done in a child↗
▶Ep 8 · 2:48
clinicalThe Cincinnati Children's approach is selective in identifying patients who will benefit from surgery and emphasizes helping patients and parents deal with pain and discomfort, minimizing workup risks (ionizing radiation), and mitigating chronic pain and substance abuse risk.↗
▶Ep 8 · 31:08
guidelineInsurance companies require some metric (abnormal pectus index plus evidence of cardiac dysfunction or abnormality) to approve coverage; providing multiple indices (Haller, correction, depression) plus cardiac dysfunction evidence has been effective in reversing denials.↗
▶Ep 8 · 31:08
guidelineInsurance companies require some metric (abnormal pectus index plus evidence of cardiac dysfunction or abnormality) to approve coverage; providing multiple indices (Haller, correction, depression) plus cardiac dysfunction evidence has been effective in reversing denials.↗
▶Ep 8 · 42:03
opinionDr. Park in Korea, who performs the largest number of pectus repairs worldwide, argues that age 3 and older is safe for repair, and earlier is better.↗
▶Ep 8 · 42:03
host_summaryDr. Park in Korea, who performs the largest number of pectus repairs worldwide, argues that age 3 and older is safe for repair, and earlier is better.↗
▶Ep 8 · 42:31
clinicalWhen operating on younger patients, bars need to be shorter (not extending to mid-axillary line) to avoid impeding chest wall growth.↗
▶Ep 8 · 42:31
clinicalWhen operating on younger patients, bars need to be shorter (not extending to mid-axillary line) to avoid impeding chest wall growth.↗
▶Ep 8 · 43:01
clinicalOvercorrection from excavatum to carinatum can occur if repair is done too early, particularly in patients with connective tissue disorders (reported by Hopkins group).↗
▶Ep 8 · 43:01
host_summaryOvercorrection from excavatum to carinatum can occur if repair is done too early, particularly in patients with connective tissue disorders (reported by Hopkins group).↗
▶Ep 8 · 43:35
host_summaryDr. Park reports seeing fewer asymmetric pectus patients because he corrects them when they're younger, suggesting early correction may prevent asymmetry development.↗
▶Ep 8 · 43:35
opinionDr. Park reports seeing fewer asymmetric pectus patients because he corrects them when they're younger, suggesting early correction may prevent asymmetry development.↗
Update Course Rewind 2021 - Updates in Pectus
▶Ep 23 · 9:50
quoteI come to this perspective from really an article by Jerome Grootman in the New Yorker, that then led me to a book, which I would argue everybody who's doing innovation in this space ought to read↗
▶Ep 23 · 10:00
guidelineMedical devices and implants are not required to undergo clinical trials before market introduction, unlike drugs↗
▶Ep 23 · 12:30
quotewe don't have what's happening then in the long term. And yes, Sean shows us about this one child who comes up and is able to flex it. But there are also cases in social media who are talking about the fact that they're on gabapentin. And when is this terrible nerve pain going to disappear?↗
▶Ep 23 · 14:10
guidelineCryotherapy device received FDA approval via 510k predicate pathway based on similarity to 1976 device, not clinical trial data↗
▶Ep 23 · 17:00
quoteI challenge anybody on this panel to tell me that they're not long term consequences. And what are we going to do about that?↗
▶Ep 23 · 27:43
clinicalWith erector spinae catheters, hospital stay is two days, opioid requirements reduced both in-hospital and post-discharge↗
▶Ep 23 · 28:10
clinicalErector spinae catheters stay in for five days total, with family removing them at home on day three after discharge↗
APSA - Is same day discharge possible following the Nuss repair for pectus excavatum - R. Luke Rettig
▶Ep 24 · 4:37
quotejust because it can be done, uh, should it be done?↗
▶Ep 24 · 4:42
quoteI personally don't feel that cryoablation is ready for prime time.↗
▶Ep 24 · 4:48
quotewe really don't know what the long-term consequences of this.↗
▶Ep 24 · 4:53
guidelineMedical devices typically are not subjected to the same rigorous, robust trials that drugs are↗
▶Ep 24 · 5:24
clinicalMany adverse consequences for medical devices are either underreported or not reported, as suggested by Kaiser Health News↗
▶Ep 24 · 5:41
opinionLong-term consequences of cryoablation are unknown, particularly for children↗
▶Ep 24 · 5:52
opinionThere is concern about chronic neuropathic pain as a consequence of cryoablation↗
▶Ep 24 · 6:16
quoteI say cryoablation is not ready for prime time, uh, and just because you can't do it doesn't really justify us. I'm arguing for a trial, randomized controlled trial, as well as a registry so that we can track right Doctor Red results.↗
Update Course Rewind: Pectus Excavatum 2021
▶Ep 25 · 3:01
quoteI agree with Sean. It works. I mean, it is great, one day.↗
▶Ep 25 · 3:04
clinicalThere are no long-term studies on cryoanalgesia outcomes↗
guidelineMedical devices and implants are not required to undergo clinical trials before market introduction, unlike drugs↗
▶Ep 25 · 3:24
quoteUnlike drugs, medical devices and implants are not, are not required to undergo clinical trials before they're introduced into the market.↗
▶Ep 25 · 4:09
clinicalErector spinal catheters are placed by the pain team with ultrasound guidance and are juxtaposed to but not in the vertebral space↗
▶Ep 25 · 4:19
clinicalWith erector spinal catheters, hospital stay is 2 days, catheters stay in for 5 days total, and are removed by family on day 3 at home↗
▶Ep 25 · 4:33
clinicalErector spinal catheters reduced opioid requirements both in hospital and after discharge↗
▶Ep 25 · 8:40
clinicalSternal elevator allows entry and exit at the same interspace↗
Update Course Rewind: Pectus Excavatum 2021
▶Ep 26 · 3:01
quoteI agree with Sean. It works. I mean, it is great, one day. Yeah, no. So, um, what I'm concerned about is, is that there are no long-term studies.↗
▶Ep 26 · 3:04
clinicalThere are no long-term studies on cryoanalgesia outcomes↗
▶Ep 26 · 3:24
quoteUnlike drugs, medical devices and implants are not, are not required to undergo clinical trials before they're introduced into the market.↗
▶Ep 26 · 3:24
guidelineMedical devices and implants are not required to undergo clinical trials before market introduction, unlike drugs↗
▶Ep 26 · 4:09
clinicalErector spinal catheters are placed by the pain team with ultrasound guidance and are juxtaposed to but not in the vertebral space↗
▶Ep 26 · 4:19
clinicalWith erector spinal catheters, hospital stay is 2 days, catheters stay in for 5 days total and are removed by family on day 3 at home↗
▶Ep 26 · 4:33
clinicalErector spinal catheters reduce opioid requirements both in hospital and after discharge↗
▶Ep 26 · 8:40
clinicalUsing sternal elevator allows passage in and out at the same interspace without guesswork↗
guidelineMedical devices and implants are not required to undergo clinical trials before market introduction, unlike drugs↗
▶Ep 1 · 3:24
quoteUnlike drugs, medical devices and implants are not, are not required to undergo clinical trials before they're introduced into the market.↗
▶Ep 1 · 4:09
clinicalErector spinal catheters are placed by the pain team with ultrasound guidance and are juxtaposed to but not in the vertebral space↗
▶Ep 1 · 4:19
clinicalWith erector spinal catheters, hospital stay is 2 days, catheters stay in for 5 days total, and are removed by family on day 3 at home↗
▶Ep 1 · 4:33
clinicalErector spinal catheters reduced opioid requirements both in hospital and after discharge↗
▶Ep 1 · 8:40
clinicalSternal elevator allows entry and exit at the same interspace↗
Update Course Rewind: Pectus Excavatum 2021
▶Ep 2 · 3:01
quoteI agree with Sean. It works. I mean, it is great, one day. Yeah, no. So, um, what I'm concerned about is, is that there are no long-term studies.↗
▶Ep 2 · 3:04
clinicalThere are no long-term studies on cryoanalgesia outcomes↗
▶Ep 2 · 3:24
quoteUnlike drugs, medical devices and implants are not, are not required to undergo clinical trials before they're introduced into the market.↗
▶Ep 2 · 3:24
guidelineMedical devices and implants are not required to undergo clinical trials before market introduction, unlike drugs↗
▶Ep 2 · 4:09
clinicalErector spinal catheters are placed by the pain team with ultrasound guidance and are juxtaposed to but not in the vertebral space↗
▶Ep 2 · 4:19
clinicalWith erector spinal catheters, hospital stay is 2 days, catheters stay in for 5 days total and are removed by family on day 3 at home↗
▶Ep 2 · 4:33
clinicalErector spinal catheters reduce opioid requirements both in hospital and after discharge↗
▶Ep 2 · 8:40
clinicalUsing sternal elevator allows passage in and out at the same interspace without guesswork↗
