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How Domestic Responsibilities Affect Physician Mothers
This study examines the association between increased domestic workload and career dissatisfaction for physicians who are mothers, comparing those in proceduralist vs nonproceduralist roles. In a survey of 1712 attending physician-mothers from the Physician Moms Group, Lyu and colleagues identified factors associated with career dissatisfaction. For those in proceduralist positions, self-reported higher levels of domestic responsibility were associated with career dissatisfaction.
Continuing Medical Education
Enoxaparin Dosage Adequacy After Colorectal Surgery
Venous thromboembolism is a source of morbidity and mortality in patients undergoing colorectal surgery. Pannucci and colleagues enrolled 116 patients undergoing colorectal surgery at the University of Utah; each received a 40-mg dose of enoxaparin once daily. The study examined anti–Factor Xa levels, a marker of the extent of anticoagulation, and found that 2 of every 3 patients (67.9%) had insufficient anticoagulation with a 40-mg, once-daily dose of enoxaparin. This nonrandomized trial calls into question the current, one-size-fits-all mentality for enoxaparin dosing.
Enhanced Recovery After Surgery and Colorectal Surgery Outcome
The Enhanced Recovery After Surgery protocols have been associated with improvement in outcomes. In this multicenter prospective cohort study, 2084 consecutive patients scheduled for elective colorectal surgery were recruited from 80 centers in Spain over a 2-month period, with follow-up for 1 month. The authors found that increased adherence to the Enhanced Recovery After Surgery protocols appeared to be associated with a decrease in postoperative complications.
Clinical Education & Review
Guidelines for Perioperative Care in Cardiac Surgery
The Enhanced Recovery After Surgery protocols are associated with reductions in overall complications and length of stay. Engelman and colleagues performed a systematic review of the cardiac surgical literature and selected and graded the evidence for 22 expert consensus–driven recommendations for optimal perioperative care of patients undergoing cardiac surgery.
Chemotherapy for Unresectable Colorectal Liver Metastases
Hepatic disease control and conversion to resectability are important considerations in patients with initially unresectable colorectal liver metastasis who have liver-dominant disease. This narrative review discusses the biological rationale for hepatic arterial infusion chemotherapy, evidence for conversion to resectability using hepatic arterial infusion chemotherapy and systemic chemotherapy, and morbidity and toxic effect profiles of hepatic arterial infusion chemotherapy.
JAMA Surgery. JAMA Surg. 2019;154(8):681. doi:10.1001/jamasurg.2018.3827
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