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Medical Rounds

Crystal Aguh

Surgery: Something to Smile About

For people with one-side facial paralysis, Kofi Boahene and his colleagues have been able to achieve a "true smile" by modifying a muscle transplant operation.

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At the Bench: Tarnished Treasures?

A method currently used by thousands of laboratories across the country to preserve tissue could render samples useless over time for a common test to assess gene activity, according to a new study by Johns Hopkins researchers.

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Pediatric Surgery: Promising Alternatives to Whole-Liver Transplants

A new Johns Hopkins study of patient and graft survival trends for pediatric liver transplant recipients between 2002 and 2015 shows that outcomes for alternatives to whole-liver transplantation have improved significantly.

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Technology: Learning by Osmosis

The brainchild of two Johns Hopkins medical students, which started as a side project to help them study for an anatomy class, has grown into a company with more than 175,000 registered users and 425,000 YouTube subscribers.

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At the Bench: Unraveling Pulmonary Hypertension

Johns Hopkins investigators say they have made a leap forward in understanding the underlying biology behind pulmonary hypertension, a dangerous type of high blood pressure in lungs that ultimately leads to right heart failure and death.

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"Nobody went into medicine to sit in a team room at a bank of computers, endlessly clicking through templated notes, interrupted to triage pages."

"Nobody went into medicine to sit in a team room at a bank of computers, endlessly clicking through templated notes, interrupted to triage pages. We chose medicine so we could build relationships with people while sorting out their stories, using our observations to make sense of their ailments, and formulate plans to help patients feel better."

Timothy Niessen, assistant professor of medicine, part of a Johns Hopkins team that created a curriculum for the Osler Medical Housestaff Training Program called Advancing Bedside Cardiopulmonary Examination Skills (ACE). Complementing ACE is a midweek session in which an experienced clinician joins residents to model physical exam techniques and bedside interactions. The impetus for both: growing concern that physical exam skills have begun to erode as residents spend more time updating the electronic medical record and looking at scans, and less time at the bedside with patients.

"Our study found that the same knee operation shown to have no benefit in treating degenerative disease in multiple trials is now one of the most common orthopaedic procedures in older Americans."

—Surgeon Martin Makary, lead author of a study reported in JAMA Surgery. The study noted that arthroscopic partial meniscectomy accounted for an estimated two-thirds of all orthopaedic knee arthroscopy procedures in older patients in 2016. But multiple clinical trials, Makary says, have shown that compared with regular exercise and physical therapy, the procedure provides no additional benefit in older patients with meniscal tears linked to aging and everyday wear and tear.

Sparing patients the unnecessary operation has tremendous implications for reducing the burden of health care use, for rehabilitation, and for complications related to surgery, including opioid-related complications, since most patients are prescribed opioids after the procedure, Makary notes.