The American surgeon
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The American surgeon · Jun 2020
US Rural Surgeon Responses to the COVID-19 Pandemic: Leadership in a Time of Crisis.
Nine surgeons from rural and remote communities in the United States share early experiences preparing for the COVID-19 pandemic. Relating experiences remarkably different from health care providers in urban areas in America most affected by the first stages of the outbreak, they tell the challenges of organizing resources in facilities already struggling with poverty-stricken communities far from established health care resources and supplies. From Alaska to Appalachia and the Navajo Nation to the rural midwest, they show the leadership and professionalism that exemplify rural surgery.
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The American surgeon · May 2020
Meta AnalysisMeta-analysis on the Effect of Pasireotide for Prevention of Postoperative Pancreatic Fistula.
A randomized controlled trial (RCT) of routine administration of pasireotide demonstrated decreased incidence of clinically significant postoperative pancreatic fistula (POPF). Recent studies have not replicated these results. A meta-analysis was performed to evaluate its efficacy in this setting. ⋯ Routine administration of pasireotide did not decrease POPF rates for all pancreatectomies, but was associated with lower rates for PD and decreased readmission rates. Further prospective, randomized studies are warranted.
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The American surgeon · Mar 2020
Comparative StudyPredictors of Change in Code Status from Time of Admission to Death in Critically Ill Surgical Patients.
Racial and gender disparities in end-of-life decision-making practices have not been well described in surgical patients. We performed an eight-year retrospective analysis of surgical patients within the Cerner Acute Physiology and Chronic Health Evaluation Outcomes database. ICU patients with documented admission code status, and death or ICU discharge code status, respectively, were included. ⋯ Before ICU discharge, blacks and other minorities had a 0.56 odds of changing from full code status when compared with whites (95% CI: 0.40-0.79, P < 0.001 vs 95% CI: 0.36-0.87, P = 0.01, respectively). Women were more likely to be discharged or die after a change in code status from full code (odds ratio 1.27, 95% CI: 1.06-1.07, P < 0.001; odds ratio 1.39, 95% CI: 1.09-1.79, P = 0.009). Men and minorities are more likely to be discharged from the ICU or die with a full code status designation.