11210 research outputs found
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D2 lymphadenectomy for gastric cancer
No full textLymphadenectomy (LND) is a crucial component of the curative surgical treatment of gastric cancer (GC). The LND serves to both accurately stage the disease and offer therapeutic benefits. At the time of curative-intent gastrectomy, D2 LND is the optimal treatment for patients with locally advanced GC due to its survival benefits and acceptable morbidity. Mastery of the technical aspects of LND, especially D2, requires significant training, adequate case volume, and expertise. This review discusses key aspects of D2 LND, including its status as the standard treatment for locally advanced GC, definition and anatomic borders, technical details, and controversial topics such as splenic hilar dissection and omentectomy. The application of indocyanine green (ICG) fluorescence imaging to elucidate the drainage patterns of GC and to facilitate lymph node (LN) identification is briefly reviewed. Finally, GC standardization and centralization, including surgical treatment, are discussed
Rural-urban disparities in treatment and disease-specific survival for patients with intrahepatic cholangiocarcinoma: A retrospective cohort analysis of the 2000 to 2021 SEER database
No full textBackground: Intrahepatic cholangiocarcinoma (ICC) is an aggressive malignancy with very poor survival. Prior research suggests rural-urban disparities on a regional scale. We aimed to elucidate these disparities in treatment and disease-specific survival (DSS) for ICC patients on a national scale using the SEER database.
Methods: The SEER database was queried to identify biopsy-confirmed cases of ICC from 2000 to 2021. Differences in clinicopathologic features and treatment between rural and urban patients were assessed using Chi-square and Fischer\u27s exact tests. Disease-specific survival was compared using Kaplan-Meier and log-rank tests as well as multivariable Cox regressions.
Results: A total of 14,940 ICC patients were identified. Rural patients were less likely than urban patients to receive chemotherapy (789 of 1588 [49.7%] vs. 7112 of 13,352 [53.3%], p = 0.006) and surgical treatment (305 of 1588 [19.2%] vs. 2922 of 13,352 [21.9%], p = 0.013). Rural patients experienced reduced 5- and 10-year DSS rates (7.0% and 4.0%) compared to urban patients (9.0% and 6.0%, p \u3c 0.001). In multivariable analysis, rural residence independently demonstrated a 17% increased risk of disease-specific mortality compared to their urban counterparts (aHR 1.17, 95% CI 1.03-1.32).
Conclusions: This study demonstrates significant rural-urban disparities in ICC treatment and survival throughout the US, independent of other prognostic factors. Further investigation into factors driving these disparities is warranted to improve outcomes for rural ICC patients
Association between glycemic control and adverse outcomes in atrial fibrillation: Evidence from a large real-world cohort
No full textPerspectives on Communicating Information and Shared Decision-Making in Patients Undergoing Transtibial Amputation
No full textPurpose: Patients undergoing lower extremity amputation often desire to take an active part in decision-making. The primary aim of this study was to explore patients’ experiences of the care trajectory and information provided after a new care program was introduced. The secondary aim was to explore patients\u27 perspectives of their involvement and participation in shared decision-making throughout the care process. The care program features new educational material, recommendations for the sagittal surgical technique, and information about a rigid removable dressing, early liner treatment, and a multidisciplinary team follow up three weeks after amputation.
Methods: Fifteen participants who underwent transtibial amputation were included in the study and were interviewed two to three months post-surgery. Purposeful sampling was used, and data were analyzed with content analysis.
Results: Three themes were identified: (1) the emotionally mixed experience of becoming a person with an amputation, (2) the need to be seen during the amputation process, and (3) the importance of being involved in care. Participants wanted to take a more active role in the decision-making process, and our multidisciplinary team follow up was an excellent example of shared decision-making. Printed information was appreciated, but the most crucial aspect was oral communication, given the gravity of the subject. Participants experienced a lack of continuity throughout the care trajectory.
Conclusions: Individualized oral information and interaction with dedicated healthcare professionals are essential for participants undergoing transtibial amputation. Implementing a multidisciplinary team consultation pre-amputation may enhance patient involvement and promote shared decision-making
Current status and future directions of pancreas transplantation: Overcoming the challenges to expand and be successful
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Evaluation of the Adjunctive Effect of Photodynamic Therapy for the Treatment of Residual Periodontal Pockets: A Systematic Review
No full textPurpose: Adjunctive use of photodynamic therapy in combination with scaling and root planing for periodontal maintenance offers an alternative to antibiotic therapy, potentially mitigating the risk of antibiotic resistance and its genotoxic or mutagenic effects. This systematic review analyzed studies, as of January 2023, that included the effects of a single application of photodynamic therapy in residual periodontal pockets with the probing depth and clinical attachment level as the primary and secondary outcomes, respectively.
Methods: PubMed, Scopus, and Web of Science databases, as well as the US National Institutes of Health and WHO Clinical Trials Registry, were searched for eligible studies on January 14, 2023.
Results: Excluding non-English language articles, a total of nine studies examining 286 subjects were considered. Six of the nine studies resulted in decreased probing depth levels. Likewise, six of the nine studies exhibited a positive trend in terms of clinical attachment levels with photodynamic therapy. A limited number of studies revealed significant probing depth levels and clinical attachment levels after photodynamic therapy. The overall risk of bias was high in four studies, four studies showed some concerns regarding the study limitations, and one study had a low risk of bias.
Conclusions: Photodynamic therapy in combination with scaling and root planing may result in modest reductions in residual periodontal pocket depth levels and improvements in clinical attachment levels. The use of PDT in periodontal maintenance can reduce or eliminate the need for periodontal surgery, which may be more invasive and lead to a longer recovery time
Graduating residents\u27 readiness for unsupervised practice
No full textObjective:This study sought to determine whether graduating residents were deemed ready for unsupervised practice for each of the 17 general pediatrics entrustable professional activities (EPAs).
Methods:At the end of the 2021-22, 2022-23, and 2023-24 academic years, the authors collected entrustment-supervision levels assigned by clinical competency committees for graduating residents from pediatric and medicine/pediatrics residency training programs to determine readiness for unsupervised practice at the time of graduation. They did this for each of the general pediatrics EPAs and examined the levels reported to determine the proportion of residents ready for unsupervised practice on each EPA and on all EPAs. They compared rates of readiness by academic year using a mixed-effects logistic regression model.
Results:Across all EPAs, 33 190 total entrustment-supervision levels were reported for 2276 graduating pediatrics residents, and 2607 entrustment-supervision levels were reported for 168 graduating medicine/pediatrics residents. There were no EPAs in which programs reported more than 89% of residents as ready for unsupervised practice at the time of graduation. Only 31.3% of graduating residents with observations on all EPAs (414/1322) were deemed ready for unsupervised practice for all EPAs. Graduating medicine/pediatrics residents were more likely than pediatrics residents to be deemed ready for all EPAs (P = .002). Across study years, the rates of readiness at graduation for all EPAs rose from 18.0% to 38.5% (linear contrast P \u3c .001).
Conclusion:While there are reasons beyond actual resident readiness that may contribute, this study highlights a gap in readiness for unsupervised practice at the time of graduation
