Background
Laparoscopic liver resection is rapidly expanding with more than 9500 cases performed worldwide. While initial series reported non-anatomic resection of benign peripheral hepatic lesions, ...approximately 50–65 % of laparoscopic liver resections are now being done for malignant tumors, primarily hepatocellular carcinoma (HCC) or colorectal cancer liver metastases (mCRC).
Methods
We performed a literature review of published studies evaluating outcomes of major laparoscopic liver resection, defined as three or more Couinaud segments.
Results
Initial fears of adverse oncologic outcomes or tumor seeding have not been demonstrated, and dozens of studies have reported comparable 5-year disease-free and overall survival between laparoscopic and open resection of HCC or mCRC in case-cohort and propensity score-matched analyses. Increased experience has led to laparoscopic anatomic liver resections including laparoscopic major hepatectomy. A steep learning curve of 45–60 cases is evident for laparoscopic hepatic resection.
Conclusion
Laparoscopic major hepatectomy is safe and effective in the treatment of benign and malignant liver tumors when performed in specialized centers with dedicated teams. Comparable to other complex laparoscopic surgeries, laparoscopic major hepatectomy has a learning curve of 45–60 cases.
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EMUNI, FZAB, GEOZS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UL, UM, UPUK, VKSCE, ZAGLJ
Overt hepatic encephalopathy is a generally reversible neurologic complication of cirrhosis. Overt hepatic encephalopathy has been associated with poor hospitalization- and mortality-related ...outcomes, which is important given increasing hepatic encephalopathy-related hospitalizations over time. The aim of this narrative review is to provide an overview of hospital- and mortality-related outcomes in patients with overt hepatic encephalopathy and the pharmacologic therapies that may improve these outcomes. Guideline-recommended prophylaxis with lactulose (first-line therapy) or secondary prophylaxis with rifaximin plus lactulose decreases hospital admissions and mortality rates. Rifaximin or lactulose treatment was beneficial for reducing the hospitalization rate in patients with hepatic encephalopathy compared with no treatment. Further, retrospective studies have shown that rifaximin with or without lactulose was effective for decreasing the number of hepatic encephalopathy episodes, hepatic encephalopathy-related hospitalizations, and duration of hospitalization. Ornithine phenylacetate, an ammonia-reducing agent currently in development, is also being investigated in hospitalized patients with hepatic encephalopathy. Overall, data support that prophylaxis for the prevention of hepatic encephalopathy recurrence improves outcomes in patients with cirrhosis and a history of hepatic encephalopathy.
The COVID-19 pandemic has significantly impacted the diagnosis of breast cancer (BC). With a large Hispanic/Latinx population, early revocation of mask mandates, and lower vaccination rate than many ...other states, this study explores the relationship between COVID-19 and the presentation and diagnosis of BC patients in the unique socio-politico-economic context of Central Texas.
This study is a retrospective review of the Seton Medical Center Austin tumor registry for BC patients from March 1, 2019 to March 2, 2021. We compared demographics, insurance status, clinical and pathologic stage, and time from diagnosis to intervention between “pre-COVID” (March 1, 2019- March 1, 2020) and “post-COVID” (March 2, 2020-March 2, 2021). We utilized descriptive, univariate, and multivariable logistic regression statistics.
There were 781 patients diagnosed with BC, with 113 fewer post-COVID compared to pre-COVID. The proportion of Black patients diagnosed with BC decreased post-COVID compared with pre-COVID (10.1%-4.5%, P = 0.002). When adjusting for other factors, uninsured and underinsured patients had increased odds of presenting with late-stage BC (odds ratio:5.40, P < 0.001). There was also an association between presenting with stage 2 or greater BC and delayed time-to-intervention.
Although fewer women overall were diagnosed with BC post-COVID, the return to baseline diagnoses has yet to be seen. We identified a pandemic-related decrease in BC diagnoses in Black women and increased odds of late-stage cancer among uninsured patients, suggesting a disparate relationship between COVID-19 and health care access and affordability. Outreach and screening efforts should address strategies to engage Black and uninsured patients.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Although the effects of parenting styles have received much consideration in the research literature, less attention has been given to outcomes in emerging adults. Also, regional differences among ...areas of the United States may influence parents to use varying degrees of parenting practices such as affection and discipline. The current study investigated the differences in parenting in two geographically close yet distinct regions of the United States and the associated psychological outcomes in emerging adults. The sample was derived from two datasets: one consisting of participants predominantly from Southern states and one predominantly from Florida. The participants reported on maternal and paternal perceived parenting styles and discipline tactics as well as their own internalizing problems. Most notably, authoritative style of both parents shared a direct relationship with authoritarian style in the Southern sample, whereas this was an inverse relationship in the Florida sample. Maternal authoritarian parenting shared a negative relationship with internalizing symptoms in the Mississippi sample, whereas this relationship was positive in the Florida sample. Additionally, paternal permissive parenting shared a negative relationship with internalizing symptoms in the Florida sample, whereas no relationship was found in the Mississippi sample. For both samples, paternal, not maternal, corporal punishment and maternal, not paternal, psychological aggression were related positively to emerging adult internalizing problems. Overall, it was found that both parenting characteristics as well as associated outcomes differed by region, suggesting the need for increased awareness and sensitivity to these differences.
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DOBA, EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, IZUM, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, ODKLJ, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, SIK, UILJ, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
The present investigation was designed to systematically examine the insanity defense typology proposed by Brown (2018) using a large sample of cases wherein there was support for the insanity ...defense. A total of 187 court‐ordered cases in which an insanity defense was supported were categorized based on the typology. The sample comprised of mostly single, middle‐aged males who had been charged with a felony and diagnosed with a psychotic disorder. About half the sample was ultimately adjudicated not guilty by reason of insanity by the court. About two‐thirds of the cases were categorized into one of the seven insanity defense subtypes using a coding scheme developed by the author of the typology. Inter‐rater agreement occurred 82% of the time. The most frequent subtype was Paranoid Self‐Defense, followed by “But It's Mine” and Paranoid Protection of Others. There were few differences among these subtypes based on demographic, clinical, offense, and outcome variables, except for presence of a primary psychotic disorder and offense type. Implications and ideas for future research are discussed.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, PRFLJ, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
Background Operations requiring biliary-enteric anastomosis are uncommon, and the true incidence of postoperative stricture is unknown. Our goal was to determine the timing, incidence, and management ...of stricture after biliary-enteric anastomosis. Methods We used 5% Medicare claims data (1996–2011) to identify patients ≥66 years who underwent an operation requiring a biliary-enteric anastomosis. A cumulative incidence curve was used to describe timing of stricture diagnosis. The use of imaging and intervention was evaluated. A Cox proportional hazards model was constructed to identify factors associated with stricture. Results A total of 3,374 patients underwent an operation requiring either a hepaticojejunostomy (54.33%; N = 1,833) or choledochojejunostomy (45.67%; N = 1,541); 2-year survival was 57.0%. Overall, 403 (11.9%) patients developed a stricture. The cumulative incidence of stricture was 12.5% at 2 years. Mean time to stricture diagnosis was 16.8 ± 21.6 months (median = 8.5 months); 23% of patients with a stricture required hospitalization for cholangitis ( N = 94). Only 18 (4.5%) patients with a stricture required reoperation. Younger age (hazard ratio 0.98; 95% confidence interval 0.98–0.99) was associated with a decreased likelihood of stricture formation; presence of an endostent (hazard ratio 1.66; 95% confidence interval 1.35–2.04) predicted stricture formation. Conclusion Biliary-enteric anastomotic strictures occur with significant frequency after a biliary-enteric anastomosis. Although many patients are managed nonoperatively, stricture diagnosis remains burdensome.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Adjunct Faculty Voices Roy Fuller, Marie Kendall Brown, Kimberly Smith / Roy Fuller, Marie Kendall Brown, Kimberly Smith
2017, 2023-07-03, 2017-10-31
eBook
As the debate regarding the increasing use of adjunct faculty in higher education continues to swirl, the voices of adjunct faculty themselves are rarely heard. Stories abound regarding the poor ...working conditions in which most adjunct faculty labor, yet many of those that employ adjunct faculty are unaware of how the conditions impact an adjunct's ability to teach effectively. Adjunct Faculty Voices gives a voice to this growing population. It shares the experiences and clear benefits adjuncts gain from having access to professional development opportunities. In spite of a shortage of resources, there are institutions offering development programs that target the pressing needs of this population.The first part of the book features the voices of adjunct faculty who tell their stories of finding professional development and creating or connecting with communities of colleagues for mutual support. These adjunct voices represent a range of disciplinary perspectives, career stages, and institutional types. In the second section, the authors draw upon a benchmarking study of adjunct faculty developing programs, examine specific challenges and highlight successful practices. Institutions can support adjunct faculty through teaching academies and faculty learning communities; mentor programs; conference support; and adjunct faculty liaison positions.Topics discussed include:
Best professional development practices that support and benefit adjunct faculty
Faculty social isolation and community-building opportunities
An overview of changes affecting the academic workforce
An outline of issues and working conditions
Current demographics and types of adjunct faculty
Survey results from adjunct faculty developers
Adjunct faculty narratives featuring their professional development and community experiencesTeaching and Learning centers across the country are responding to the growing adjunct cohort in innovative and efficient ways. Administrators, deans, department cha
Routine preoperative laboratory testing for ambulatory surgery is not recommended.
Patients who underwent elective hernia repair (N = 73,596) were identified from the National Surgical Quality ...Improvement Program (NSQIP) database (2005-2010). Patterns of preoperative testing were examined. Multivariate analyses were used to identify factors associated with testing and postoperative complications.
A total of 46,977 (63.8%) patients underwent testing, with at least one abnormal test recorded in 61.6% of patients. In patients with no NSQIP comorbidities (N = 25,149) and no clear indication for testing, 54% received at least one test. In addition, 15.3% of tested patients underwent laboratory testing the day of the operation. In this group, surgery was done despite abnormal results in 61.6% of same day tests. In multivariate analyses, testing was associated with older age, ASA (American Society of Anesthesiologists) class >1, hypertension, ascites, bleeding disorders, systemic steroids, and laparoscopic procedures. Major complications (reintubation, pulmonary embolus, stroke, renal failure, coma, cardiac arrest, myocardial infarction, septic shock, bleeding, or death) occurred in 0.3% of patients. After adjusting for patient and procedure characteristics, neither testing nor abnormal results were associated with postoperative complications.
Preoperative testing is overused in patients undergoing low-risk, ambulatory surgery. Neither testing nor abnormal results were associated with postoperative outcomes. On the basis of high rates of testing in healthy patients, physician and/or facility preference and not only patient condition currently dictate use. Involvement from surgical societies is necessary to establish guidelines for preoperative testing.
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