Readmission following pancreatectomy: what can be improved?

AbstractBackgroundReadmissions after pancreatectomy, largely for the management of complications, may also occur as a result of failure to thrive or for diagnostic endeavours. Potential mechanisms to reduce readmission rates may be elucidated by assessing the adequacy of the initial disposition and the real necessity for readmission.MethodsUsing previously identified categories of readmission following pancreatectomy, details of reasons for and results of readmissions were scrutinized using a root cause analysis approach.ResultsOf 658 patients subjected to pancreatectomy between 2001 and 2010, 121 (18%) were readmitted within 30 days. The clinical course in 30% of readmitted patients was found to deviate from the pathway assumed on the initial admission. Patients were readmitted at a median of 9 days (range: 1–30 days) after initial discharge and had a median readmission length of stay of 7 days (mode = 4). Postoperative complications accounted for most readmissions (n = 77, 64%); 17 patients (14%) were readmitted for failure to thrive and 16 (13%) for diagnostics. Root cause analysis detailed subtextual reasons for readmission, including, for example, the initiation of new medications that could potentially have been ordered in an outpatient setting.ConclusionsMore than one quarter of readmissions after pancreatectomy occurred in the setting of failure to thrive or for diagnostic evaluation alone. Root cause analysis revealed potentially avoidable readmissions. The development of a system for stratifying patients at risk for readmission or the failure of the initial disposition, along with an alternative means of efficiently evaluating patients in an outpatient setting, could limit unnecessary readmissions and resource utilization

Eps15R is required for bone morphogenetic protein signalling and differentially compartmentalizes with Smad proteins

Transforming growth factor β superfamily members signal through Smad transcription factors. Bone morphogenetic proteins (BMPs) act via Smads 1, 5 and 8 and TGF-βs signal through Smads 2 and 3. The endocytic adaptor protein Eps15R, or ‘epidermal growth factor (EGF) receptor pathway substrate 15-related protein’ is a component of EGF signal transduction, mediating internalization of the EGF receptor. We show that it interacts with Smad proteins, is required for BMP signalling in animal caps and stimulates Smad1 transcriptional activity. This function resides in the Asp-Pro-Phe motif-enriched ‘DPF domain’ of Eps15R, which activates transcription and antagonizes Smad2 signalling. In living cells, Eps15R segregates into spatially distinct regions with different Smads, indicating an unrecognized level of Smad compartmentalization

Sarcoid-like reaction in a patient recovering from coronavirus disease 19 pneumonia

As coronavirus disease 2019 (COVID-19) cases continue to increase, so do the reported extrapulmonary manifestations of this disease. To date, described dermatologic manifestations of COVID-19 include pernio-like acral nodules, dengue fever–like petechiae, vesiculobullous eruptions, pityriasis rosea and viral-like exanthems, retiform purpura, and livedo reticularis.1 We describe a patient with new-onset, biopsy confirmed sarcoid-like reaction in the setting of COVID-19 pneumonia and postulate a role for this immunologic reaction in hastening disease recovery

The Lantern Vol. 67, No. 1, Fall 1999

• I Write Poetry • So Many Poems Start This Way... • Mantra 99 for A. Joe • Indecision • Last Night • My Body Cut Off at the Back • Brittany Sestina • The Hearth • To Jane • Attention • Chemistry • Recombination • Buried • Going Home • Bound for Happiness • Stumble • Punk Rock • Ghost Spray and a Slingshot • Distant Voices • Beyond the Gear Shift • Damn It • Poppy Hands • Waist Deep • The Lie • Paying Your Dueshttps://digitalcommons.ursinus.edu/lantern/1155/thumbnail.jp

Something in the atmosphere? Michael Chekhov, Deirdre Hurst Du Prey, and a web of practices between acting and dance

This article contextualises principles of Chekhov’s technique within convergent developments in dance by bringing into focus the interesting web of connections between Chekhov’s female colleagues — specifically his associate Deirdre Hurst Du Prey — and key pioneers in the field of dance and dance-mime, including Mary Wigman, Isadora Duncan, Martha Graham and Margaret Barr. Their cross-connections broaden our view on the canon of embodied theatre practice, and also open up reflection on how overlaps between acting- and dance principles may be useful for contemporary embodied theatre practice and its efforts to work across these currently (in the Western conservatoire context) quite segregated disciplines

Barriers and facilitators of effective self-management in asthma: systematic review and thematic synthesis of patient and healthcare professional views

Self-management is an established, effective approach to controlling asthma, recommended in guidelines. However, promotion, uptake and use among patients and health-care professionals remain low. Many barriers and facilitators to effective self-management have 25 been reported, and views and beliefs of patients and health care professionals have been explored in qualitative studies. We conducted a systematic review and thematic synthesis of qualitative research into self-management in patients, carers and health care professionals regarding self-management of asthma, to identify perceived barriers and facilitators associated with reduced effectiveness of asthma self-management interventions. Electronic databases and guidelines were searched systematically for qualitative literature that explored factors relevant to facilitators and barriers to uptake, adherence, or outcomes of self-management in patients with asthma. Thematic synthesis of the 56 included studies identified 11 themes: 1) partnership between patient and health care professional; 2) issues around medication; 3) education about asthma and its management; 4) health beliefs; 5) self-management interventions; 6) co-morbidities 7) mood disorders and anxiety; 8) social support; 9) non-pharmacological methods; 10) access to healthcare; 11) professional factors. From this, perceived barriers and facilitators were identified at the level of individuals with asthma (and carers), and health-care professionals. Future work addressing the concerns and beliefs of adults, adolescents and children (and carers) with asthma, effective communication and partnership, tailored support and education (including for ethnic minorities and at risk groups), and telehealthcare may improve how self-management is recommended by professionals and used by patients. Ultimately, this may achieve better outcomes for people with asthma

"There's nothing I can't do – I just put my mind to anything and I can do it": a qualitative analysis of how children with chronic disease and their parents account for and manage physical activity

The results of this study suggest that for these children and young people, having a chronic disease was not perceived as a barrier to participation in organised sport and recreational activities. They were physically active and perceived themselves to be no different from their peers. Their positive beliefs were shared by their parents and the level of participation described was enabled by the high level of parental support and background planning involved in managing their child's health care needs

Tracing the city - parkour training, play and the practice of collaborative learning

The article examines how parkour training is constructed and transmitted amongst localised peer groups known as ‘traceurs’. It concentrates on training practices that develop as a result of peer interaction in open, public spaces rather than formal training sessions that take place within a gym or as part of a regulated coaching programme. Drawing on extended interview material from a range of parkour practitioners with varying levels of experience and expertise, the article investigates the traceur's perspective on group training and how this relates to cognition and processes of learning. Using traceurs' own reflections the research will identify how physical obstacles, mental challenges, fear and risk are handled through repeated actions that then result in deeply embedded somatic responses to the built environment. The repertoire of moves that is shared between traceurs offers a patterned way of learning that, in turn, provides a route to embodied knowing. The research demonstrates how group training sessions in parkour can be conceived as collaborative learning and how that relates to theories of social learning (Bandura 1977, Lave 2009, Wenger 1998). The article argues that the efficacy of play as an approach to training provides a vehicle for active learning that chimes with the utilitarian aspect of parkour practice where to know and overcome obstacles represents the knowing and attainment of freedom