Connect with us

Uncategorized

Sylvester study shows that new protocols enable many patients to safely return home just one day after lung cancer surgery

MIAMI, FLORIDA (Sept. 18, 2023) – Thoracic surgeons and researchers at Sylvester Comprehensive Cancer Center at the University of Miami Miller School…

Published

on

MIAMI, FLORIDA (Sept. 18, 2023) – Thoracic surgeons and researchers at Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine found that increasing numbers of patients undergoing cancer-removal lung surgery by “anatomic lung resections” – lobectomies or segmentectomies – are able to go home safely and without complications one day after the operation, thanks to growing rates of robot-assisted surgeries and improvements in patient-centered care protocols.

Credit: Photo by Sylvester

MIAMI, FLORIDA (Sept. 18, 2023) – Thoracic surgeons and researchers at Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine found that increasing numbers of patients undergoing cancer-removal lung surgery by “anatomic lung resections” – lobectomies or segmentectomies – are able to go home safely and without complications one day after the operation, thanks to growing rates of robot-assisted surgeries and improvements in patient-centered care protocols.

However, the research team found, patients of lower socioeconomic status were considerably less likely than others to be discharged on postoperative Day 1 (POD1).

“We believe this is the first study to explore the impact of socioeconomic factors on POD1 discharge in this patient population,” said Dao Nguyen, M.D., Sylvester Thoracic Cancers Group Co-Lead,  and senior author of an article in the Sept. 14, 2023, issue of the Journal of Thoracic and Cardiovascular Surgery Open.

“We found that economic deprivation severely affects the ability to be discharged home the day following surgery, an observation that provides future direction for research and the development of improved care strategies and interventions,” added Nguyen, who treats and studies lung and other cancers. The retrospective study of medical records of 750 patients over a 10-year period was launched to document the effects and progress of postoperative care protocols initiated by lung cancer surgeons at Sylvester.

The guidelines, similar to those at other institutions, are called enhanced recovery after thoracic surgery, or ERATS, protocols. The first ERATS initiative was introduced in February 2018, with an optimized version implemented in January 2020. This study focused on findings from 279 patients whose treatment took place during the latest protocol period.

“Patients in the optimized ERATS group had significantly shorter hospital stays, more ‘lung-sparing’ procedures, and lower incidence of complications. Up to 30% of our patients undergoing robotic surgery and having the advantage of our latest ERATS version were discharged home on POD1. This is a significant difference from the less than 5% rate of POD1 discharge prior to the implementation of the optimized ERATS in January 2020,” Nguyen said, adding that ERATS implementation has been associated with a significant reduction of postoperative acute pain and the need for in-hospital opioid medication.

Postoperative Day 1 discharge was a byproduct, not a stated goal, of ERATS, the authors note. The protocol’s emphasis on an enhanced recovery period – in particular, effective opioid-sparing pain control and reduction of complications – brought about accelerated discharges, include those on POD1.

The study was based on the experience of thoracic surgeons, Nguyen and article co-author Nestor Villamizar, M.D. They had seen that POD1 discharge was possible and safe for patients undergoing other chest operations before extending the expedited discharge practice to the lung cancer surgery population.

According to the authors, critical factors making next-day discharge possible are: expedited drain removal, better opioid-sparing pain control, preoperative counseling to discuss realistic postop expectations and home care arrangements, and regular, follow-up phone calls by nurse practitioners to encourage patients and monitor their progress.

Despite the growing number of next-day discharges, Nguyen and colleagues said they saw a 71% decrease in POD1 discharges in patients of lower socioeconomic status, a finding that demands further study. As part of their work, they also analyzed numerous factors contributing to and detracting from POD1 discharge.

“We were able to identify a variety of factors that can be mitigated to facilitate POD1 discharge, and we have instituted strategies to address them,” Nguyen said.

Authors: Nguyen is senior and corresponding author. Daniel Gross, M.D., is first author. In addition to Villamizar, co-authors include: Ahmed Alnajar, M.D., Luis Miguel Cotamo, and Michael Sarris-Michopoulos.

Funding and potential conflicts of interest: The authors declare no conflicts of interest. The authors discuss the off-label use of liposomal bupivacaine (LipoB) (Exparel, Pacira Pharmaceuticals Inc, Parsippany, New Jersey) for intercostal nerve block, used with institutional approval.

Article Title: “Postoperative day 1 discharge following robotic thoracoscopic pulmonary anatomic resections in the era of enhanced recovery protocol: A single-institution experience”

DOI: https://doi.org/10.1016/j.xjon.2023.08.006

# # #


Read More

Continue Reading

Uncategorized

I Say We’re Setting Up For A Major Bottom

It’s almost impossible to call market tops and market bottoms using basic technical analysis tools like price and volume. Don’t get me wrong, that combination…

Published

on

It's almost impossible to call market tops and market bottoms using basic technical analysis tools like price and volume. Don't get me wrong, that combination is my favorite during trend-following periods. But trying to spot bearish reversals is difficult when price action keeps riding higher and higher. The same is true in trying to spot bullish reversals when prices keep moving lower and lower. Maybe that seems unconventional to hard-core technicians, but I believe it's the reality. Too many folks say "when this line crosses that line, then this will happen". To me, that's following technical analysis and wearing blinders. Just my two cents.

I use technical price action to confirm what other signals are suggesting. We get plenty of signals on a regular basis - some short-term in nature, others long-term - if we're only willing to listen. While I've been bullish since June 2022, I do recognize short-term warning signals that tell us that risks of remaining long have increased substantially. In mid-July, I turned very cautious short-term and discussed those signals in a "Your Daily 5" episode that aired on July 19th. Let me pull up an S&P 500 chart, so you can see where U.S. equities stood when I fired this warning shot:

There were several reasons for the stock market bulls to hit quicksand. Tesla (TSLA), a Wall Street darling and a favorite stock of mine, suggested a possible 20% drop. That call aired the day of TSLA's top and TSLA fell closer to 30% in less than one month. These signals work and help us to manage risk! As I always say, they do NOT guarantee future price action, but they make us aware of increasing risk and that's how you invest more successfully. Since that July top, I've encouraged our EB members to tread very cautiously, whatever that means to each individual member. To some, it's being in cash. To others, it might simply mean to avoid leverage on the long side. But this cautious period is coming to an end.

If you want to see what was discussed on July 19th and why I felt the stock market was in short-term trouble, check out the Your Daily 5 recording on YouTube!

I absolutely LOVE when my signals take the opposite view of the masses. And now that everyone believes we're resuming the prior bear market, my signals are saying HOGWASH. Could we continue to proceed lower? Sure. There are never any guarantees with the stock market. But I see signs that suggest shorting is a VERY HIGH RISK strategy, with those risks growing every day. I'm discussing one major reason why in our FREE EB Digest newsletter that will be published early Monday morning, before the stock market opens. If you're not already an EB Digest subscriber, it's 100% free with no credit card required. Simply CLICK HERE and enter your name and email address. I'll discuss Reason #1 to turn bullish tomorrow morning. And I'll also focus on other reasons to be thinking bullish thoughts when I publish the EB Digest on Wednesday and Friday. Don't wait until it's too late. Check them out NOW!

Happy trading!

Tom

Read More

Continue Reading

Uncategorized

Highlights from My Week’s Reading

Natalię Dowzicky, “How Florida Beat California to High-Speed Rail,” Reason, September 20, 2023.
Excerpt:
Not only is Brightline the first privately…

Published

on

Natalię Dowzicky, “How Florida Beat California to High-Speed Rail,” Reason, September 20, 2023.

Excerpt:

Not only is Brightline the first privately funded intercity rail line in the U.S., but it’s also the fastest train in the country outside of the northeast corridor. Topping out at 125 mph in Florida, it will travel from Miami to Orlando in about three hours. For comparison, the Amtrak in the area takes about six and a half hours to complete that same trip.

Mike Reininger, CEO of Brightline, told Reason that passenger rail makes commercial sense under specific conditions, such as the case in Florida, where it connects two populous, tourist-friendly cities that are about 250 miles apart. At that distance, Reininger says, “It is too far to drive and too short to fly. You can approximate the time of flying significantly, improve the time of driving, and you can offer it at a price point that makes it an economic proposition.”

Not surprisingly, though, Brightline has become a subsidy sucker.

Romina Boccia, “Social Security Benefits are Growing Too Fast,” Cato at Liberty, September 21, 2023.

Excerpt:

When a Social Security‐​eligible worker’s benefits are first calculated, this worker’s past wages are indexed to bring them to the same level as today’s earnings. This is called wage indexing and is based on the growth in average wages in the economy. When the Social Security Administration (SSA) first indexes a worker’s lifetime covered earnings, it does so using the SSA’s Average Wage Index (AWI). The AWI includes all wages that are subject to federal income tax, including wages in excess of the taxable Social Security maximum payroll tax threshold.

Wage indexing gives retirees a benefit amount that reflects the increase in the standard of living over their working careers—even if they didn’t earn commensurate wages. It’s like giving workers retroactive credit for improvements in the economy, including for wage improvements among the highest income earners.

Definitely worth reading carefully.

Christopher Wilcox, “Truck This: Why I’m Leaving the Long-Haul Industry,” American Institute for Economic Research, September 21, 2023.

Excerpt:

More recently, environmental regulations requiring manufacturers to reduce emissions gave us the diesel particulate filter (DPF), an exhaust treatment system that replaces a standard muffler. While there is no current federal mandate requiring a DPF, the filters are required by the 2008 California Statewide Truck and Bus Rule, which has incentivized many nationwide fleets to adopt them. The problem with DPFs is the filter system clogs. A lot.

When DPFs go down, trucks roll to a stop. Truckers report having to have a DPF serviced as often as every 5,000 miles, which means lots of lost productivity and stranded cargo. I’ve had four breakdowns over the past two years, and three were due to my DPF. A tow truck driver I spoke to on one of those occasions told me half of his business comes from malfunctioning DPFs. Repairs are a specialized affair, and replacements can cost up to $2,000. When my truck isn’t moving, I’m not earning. And these regulators have required that my truck stand still far too often.

Of course California is in the forefront of regulation.

Fiona Harrigan, “Biden Administration Announces New Measures to Get Migrants to Work,” Reason, September 21 2023.

Excerpt:

Yesterday, the Biden administration announced new actions to help get recent immigrants to work, including offering almost half a million Venezuelans a status that will let them live and work in the U.S. legally for the next 18 months. The new measures come at a critical time, as labor shortages persist and cities struggle to provide for newcomers.

Certain Venezuelan migrants are eligible for temporary protected status (TPS), a designation offered to migrants who can’t safely return to their home countries due to armed conflict, environmental disaster, or another temporary safety hazard. Venezuela was first designated for TPS in 2021 due to a severe political and economic crisis perpetuated by Nicolás Maduro’s regime. Under that designation, Venezuelans who came to the U.S. before March 2021 qualified for protection; now, the status will apply to Venezuelans who arrived before the end of July this year. There are currently 16 countries designated for TPS.

If I understand the program correctly, it sounds good: let them work instead of forcing taxpayers to subsidize their living expenses. It’s win-win-win for immigrants, employers and consumers, and taxpayers.

James Herndon, “Keep the Washington Consensus,” Law & Liberty, September 21, 2023.

Excerpt:

Despite those deliberate omissions, synergies still allowed the Consensus to exceed the sum of its parts. Opening up foreign direct investment eased privatization. Privatization enabled balanced budgets. Balanced budgets limited inflation, which encouraged foreign direct investment. The common denominators were respect and restraint: leaders had to trust that firms and citizens knew better than the bureaucrats how best to allocate their own labor and resources. That’s why the Consensus’ first beneficiary was always likely to be the poor. After all, funding for primary education and basic healthcare does far more to reduce poverty than subsidies for diesel fuel and national airlines.

In short, Williamson promoted policies that enabled sustainable growth in developing countries with respect for their autonomy and an emphasis on raising prospects for the least fortunate. The Left never forgave him.

It’s the nicest treatment of the Washington Consensus that I’ve read. Lots of good nuggets.

 

(0 COMMENTS)

Read More

Continue Reading

Uncategorized

Miss Universe denies link with recently unveiled coin project

The Miss Universe Organization said that there is no Miss Universe cryptocurrency or blockchain offering involved with the Miss Universe or Miss Universe…

Published

on

The Miss Universe Organization said that there is no Miss Universe cryptocurrency or blockchain offering involved with the Miss Universe or Miss Universe Philippines.

The Miss Universe Organization has denied any association with the Miss Universe Coin project announced at the Philippine Blockchain Week (PBW) event held earlier this month. PBW said that they are in contact with all involved parties and will post an update soon.

Earlier this month, a project called Miss Universe Coin was announced at PBW. Donald Lim, the founder of the organization managing the PBW, said during the event that the PBW will “launch the Miss Universe Coin.” However, weeks after the announcement, the official organization behind Miss Universe has denied any association with the coin project and called it a fraud. 

Official announcement published on the Miss Universe Facebook page. Source: Facebook

On Sept. 22, the Miss Universe official Facebook page announced that the Miss Universe Organization and JKN Global Group, the company behind the pageant, are not associated with the coin project that was unveiled at the PBW event. According to the organization, it will be pursuing “all legal options with regards to this infringement.” 

“There is currently no Miss Universe cryptocurrency or blockchain offering, and these products are in no way involved with the voting or selection process for Miss Universe or the Miss Universe Philippines pageants,” they wrote.

Related: JPEX hikes withdrawal fee to almost $1K after Hong Kong watchdog warning

In a statement sent to Cointelegraph, a representative from the Miss Universe Organization claimed that the Miss Universe Coin is a "fraud," and they expect it to be further announced in other events across the globe. “We suspect that people may be planning to mention this at upcoming blockchain conferences in Dubai and Singapore. If you see it there, please do not cover, it's a fraud,” they said.

In a statement on X (formerly Twitter), PBW said that they are currently in contact with all of the parties involved and will announce an update as soon as possible. Cointelegraph reached out to the Philippine Blockchain Week but did not get an immediate response.

Magazine: Chinese billionaire’s $1B fraud charges, Kwon’s $11M bet, Zhu Su and Islam: Asia Express

Read More

Continue Reading

Trending