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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…

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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

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One city held a mass passport-getting event

A New Orleans congressman organized a way for people to apply for their passports en masse.

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While the number of Americans who do not have a passport has dropped steadily from more than 80% in 1990 to just over 50% now, a lack of knowledge around passport requirements still keeps a significant portion of the population away from international travel.

Over the four years that passed since the start of covid-19, passport offices have also been dealing with significant backlog due to the high numbers of people who were looking to get a passport post-pandemic. 

Related: Here is why it is (still) taking forever to get a passport

To deal with these concurrent issues, the U.S. State Department recently held a mass passport-getting event in the city of New Orleans. Called the "Passport Acceptance Event," the gathering was held at a local auditorium and invited residents of Louisiana’s 2nd Congressional District to complete a passport application on-site with the help of staff and government workers.

A passport case shows the seal featured on American passports.

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'Come apply for your passport, no appointment is required'

"Hey #LA02," Rep. Troy A. Carter Sr. (D-LA), whose office co-hosted the event alongside the city of New Orleans, wrote to his followers on Instagram  (META) . "My office is providing passport services at our #PassportAcceptance event. Come apply for your passport, no appointment is required."

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The event was held on March 14 from 10 a.m. to 1 p.m. While it was designed for those who are already eligible for U.S. citizenship rather than as a way to help non-citizens with immigration questions, it helped those completing the application for the first time fill out forms and make sure they have the photographs and identity documents they need. The passport offices in New Orleans where one would normally have to bring already-completed forms have also been dealing with lines and would require one to book spots weeks in advance.

These are the countries with the highest-ranking passports in 2024

According to Carter Sr.'s communications team, those who submitted their passport application at the event also received expedited processing of two to three weeks (according to the State Department's website, times for regular processing are currently six to eight weeks).

While Carter Sr.'s office has not released the numbers of people who applied for a passport on March 14, photos from the event show that many took advantage of the opportunity to apply for a passport in a group setting and get expedited processing.

Every couple of months, a new ranking agency puts together a list of the most and least powerful passports in the world based on factors such as visa-free travel and opportunities for cross-border business.

In January, global citizenship and financial advisory firm Arton Capital identified United Arab Emirates as having the most powerful passport in 2024. While the United States topped the list of one such ranking in 2014, worsening relations with a number of countries as well as stricter immigration rules even as other countries have taken strides to create opportunities for investors and digital nomads caused the American passport to slip in recent years.

A UAE passport grants holders visa-free or visa-on-arrival access to 180 of the world’s 198 countries (this calculation includes disputed territories such as Kosovo and Western Sahara) while Americans currently have the same access to 151 countries.

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Fast-food chain closes restaurants after Chapter 11 bankruptcy

Several major fast-food chains recently have struggled to keep restaurants open.

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Competition in the fast-food space has been brutal as operators deal with inflation, consumers who are worried about the economy and their jobs and, in recent months, the falling cost of eating at home. 

Add in that many fast-food chains took on more debt during the covid pandemic and that labor costs are rising, and you have a perfect storm of problems. 

It's a situation where Restaurant Brands International (QSR) has suffered as much as any company.  

Related: Wendy's menu drops a fan favorite item, adds something new

Three major Burger King franchise operators filed for bankruptcy in 2023, and the chain saw hundreds of stores close. It also saw multiple Popeyes franchisees move into bankruptcy, with dozens of locations closing.

RBI also stepped in and purchased one of its key franchisees.

"Carrols is the largest Burger King franchisee in the United States today, operating 1,022 Burger King restaurants in 23 states that generated approximately $1.8 billion of system sales during the 12 months ended Sept. 30, 2023," RBI said in a news release. Carrols also owns and operates 60 Popeyes restaurants in six states." 

The multichain company made the move after two of its large franchisees, Premier Kings and Meridian, saw multiple locations not purchased when they reached auction after Chapter 11 bankruptcy filings. In that case, RBI bought select locations but allowed others to close.

Burger King lost hundreds of restaurants in 2023.

Image source: Chen Jianli/Xinhua via Getty

Another fast-food chain faces bankruptcy problems

Bojangles may not be as big a name as Burger King or Popeye's, but it's a popular chain with more than 800 restaurants in eight states.

"Bojangles is a Carolina-born restaurant chain specializing in craveable Southern chicken, biscuits and tea made fresh daily from real recipes, and with a friendly smile," the chain says on its website. "Founded in 1977 as a single location in Charlotte, our beloved brand continues to grow nationwide."

Like RBI, Bojangles uses a franchise model, which makes it dependent on the financial health of its operators. The company ultimately saw all its Maryland locations close due to the financial situation of one of its franchisees.

Unlike. RBI, Bojangles is not public — it was taken private by Durational Capital Management LP and Jordan Co. in 2018 — which means the company does not disclose its financial information to the public. 

That makes it hard to know whether overall softness for the brand contributed to the chain seeing its five Maryland locations after a Chapter 11 bankruptcy filing.

Bojangles has a messy bankruptcy situation

Even though the locations still appear on the Bojangles website, they have been shuttered since late 2023. The locations were operated by Salim Kakakhail and Yavir Akbar Durranni. The partners operated under a variety of LLCs, including ABS Network, according to local news channel WUSA9

The station reported that the owners face a state investigation over complaints of wage theft and fraudulent W2s. In November Durranni and ABS Network filed for bankruptcy in New Jersey, WUSA9 reported.

"Not only do former employees say these men owe them money, WUSA9 learned the former owners owe the state, too, and have over $69,000 in back property taxes."

Former employees also say that the restaurant would regularly purchase fried chicken from Popeyes and Safeway when it ran out in their stores, the station reported. 

Bojangles sent the station a comment on the situation.

"The franchisee is no longer in the Bojangles system," the company said. "However, it is important to note in your coverage that franchisees are independent business owners who are licensed to operate a brand but have autonomy over many aspects of their business, including hiring employees and payroll responsibilities."

Kakakhail and Durranni did not respond to multiple requests for comment from WUSA9.

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Industrial Production Increased 0.1% in February

From the Fed: Industrial Production and Capacity Utilization
Industrial production edged up 0.1 percent in February after declining 0.5 percent in January. In February, the output of manufacturing rose 0.8 percent and the index for mining climbed 2.2 p…

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From the Fed: Industrial Production and Capacity Utilization
Industrial production edged up 0.1 percent in February after declining 0.5 percent in January. In February, the output of manufacturing rose 0.8 percent and the index for mining climbed 2.2 percent. Both gains partly reflected recoveries from weather-related declines in January. The index for utilities fell 7.5 percent in February because of warmer-than-typical temperatures. At 102.3 percent of its 2017 average, total industrial production in February was 0.2 percent below its year-earlier level. Capacity utilization for the industrial sector remained at 78.3 percent in February, a rate that is 1.3 percentage points below its long-run (1972–2023) average.
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Click on graph for larger image.

This graph shows Capacity Utilization. This series is up from the record low set in April 2020, and above the level in February 2020 (pre-pandemic).

Capacity utilization at 78.3% is 1.3% below the average from 1972 to 2022.  This was below consensus expectations.

Note: y-axis doesn't start at zero to better show the change.


Industrial Production The second graph shows industrial production since 1967.

Industrial production increased to 102.3. This is above the pre-pandemic level.

Industrial production was above consensus expectations.

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