Surgery Improves Patient-Reported Outcomes in Patients with Intestinal and Pancreatic NETs: A Prospective Analysis.

BACKGROUND: Incorporation of patient-reported outcomes such as health-related quality of life has become increasingly important in the management of chronic diseases such as cancer. In this prospective study, we examined the effect of surgical resection on quality of life in patients with intestinal and pancreatic neuroendocrine tumors (NETs). METHODS: Thirty-two patients underwent NET resection at our institution from January 2020 to January 2022. All patients completed the 12-item short-form quality-of-life survey prior to surgery, as well as at the 3-, 6-, and 12-month postoperative time points. The presence and severity of specific carcinoid syndrome symptoms (diarrhea, flushing, and abdominal pain) were also recorded during pre- and postoperative appointments. RESULTS: Patients experienced significant increases in both mental and physical health after surgery. Mental health scores significantly increased at all three time points (baseline: 51.33; 3-month: 53.17, p = 0.02; 6-month: 57.20, p < 0.001; 12-month: 57.34, p = 0.002), and physical health scores increased at 6 and 12 months (baseline: 50.39; 6-month: 53.16, p = 0.04; 12-month: 55.02, p = 0.003). Younger patients benefited more in terms of physical health, while older patients had more significant increases in mental health. Patients with metastatic disease, larger primary tumors, and those receiving medical therapy had lower baseline quality-of-life scores and greater improvements after surgery. The vast majority of patients in this study also experienced alleviation of carcinoid syndrome symptoms. CONCLUSIONS: In addition to prolonging survival, resection of intestinal and pancreatic NETs leads to significantly improved patient-reported quality of life.

How hospital-based health care providers perceive clinical librarian services: a qualitative review protocol.

OBJECTIVE: The objective of the review is to evaluate how health care providers working in hospitals perceive clinical librarian services. INTRODUCTION: Clinical librarianship programs existed as early as 1971; however, there is a lack of evidence on their effectiveness in impacting health care outcomes. Studies report primarily on programs supporting medicine, although these programs also support other health care providers. In order to affect outcomes, particularly those focused on patient-centered, evidence-based care, clinical librarians need insight into how hospital health care providers perceive clinical librarian services. INCLUSION CRITERIA: The review will consider studies that include any health care provider who works within a hospital, including surgical, clinical, and inpatient units. Studies that focus on qualitative data about clinical librarian services, published from 1971 onward, will be eligible for inclusion. METHODS: The primary databases to be searched are PubMed, CINAHL, Embase, PsycINFO, Library Literature & Information Science, LISTA (Library, Information Science & Technology Abstracts), and Web of Science. Studies will be selected based on their assessment against the inclusion criteria by two independent reviewers. Eligible studies will be critically appraised for methodological quality. Data will be extracted using a standardized tool, and findings pooled and synthesized using a meta-aggregation approach.

The ACA Medicaid Expansion Waiver in the Keystone State: Do the Medically Uninsured "Got a Friend in Pennsylvania"?

Medicaid is fundamental to near universal health insurance coverage under the 2010 Affordable Care Act (ACA). Its goal of broadening the program to all households with income at or below 138 percent of the federal poverty level was thwarted in 2012 by a Supreme Court decision that allowed the states to choose whether or not they would join. This essay seeks to assess the status of Pennsylvania with regard to the Medicaid expansion controversy. It briefly describes the Keystone State's existing Medicaid program and the potential impact of the ACA on its growth. It then discusses Governor Tom Corbett's market-based alternative and what he achieved in his deliberations with the Obama administration. The article also discusses some of the financial considerations facing Pennsylvania policy makers in the expansion decision, the role of three of the more influential lobby groups, and the problematic situation of the medically uninsured population.

A cell number-counting factor regulates levels of a novel protein, SslA, as part of a group size regulation mechanism in Dictyostelium.

Developing Dictyostelium cells form aggregation streams that break into groups of approximately 2 x 10(4) cells. The breakup and subsequent group size are regulated by a secreted multisubunit counting factor (CF). To elucidate how CF regulates group size, we isolated second-site suppressors of smlA(-), a transformant that forms small groups due to oversecretion of CF. smlA(-) sslA1(CR11) cells form roughly wild-type-size groups due to an insertion in the beginning of the coding region of sslA1, one of two highly similar genes encoding a novel protein. The insertion increases levels of SslA. In wild-type cells, the sslA1(CR11) mutation forms abnormally large groups. Reducing SslA levels by antisense causes the formation of smaller groups. The sslA(CR11) mutation does not affect the extracellular accumulation of CF activity or the CF components countin and CF50, suggesting that SslA does not regulate CF secretion. However, CF represses levels of SslA. Wild-type cells starved in the presence of smlA(-) cells, recombinant countin, or recombinant CF50 form smaller groups, whereas sslA1(CR11) cells appear to be insensitive to the presence of smlA(-) cells, countin, or CF50, suggesting that the sslA1(CR11) insertion affects CF signal transduction. We previously found that CF reduces intracellular glucose levels. sslA(CR11) does not significantly affect glucose levels, while glucose increases SslA levels. Together, the data suggest that SslA is a novel protein involved in part of a signal transduction pathway regulating group size.