Goldsby - - Journal of Business Ethics 91 1: Both sides of this argument — that good ethics is good business and that bad ethics is bad business — are explored. The possibility of a moral floor above which ethical behavior is not rewarded is considered, and an economic experiment testing such a proposition is discussed.
Several studies have looked into predictive patterns of occurrence, risk features and associated measures to prevent fistulas. A few recent studies, including conducted meta-analyses, have accumulated updated data. The aim of this review was to present the current knowledge on risk factors and preventive strategies for POPF in a collective synopsis.
Only studies published after were considered to allow for likely reporting according to the International Study Group on Pancreatic Fistula Definition issued that year. The final inclusion of papers to cite and refer was made at the discretion of the authors.
Where several reports exist, we prioritized the most recent or the one with highest evidence level. Case reports, single-center retrospective studies and editorials were excluded. Specific management of POPF is a long and controversial chapter to cover in itself, and as such studies solely dealing with this aspect of POPF were excluded.
Results Of a total of hits in the PubMed literature, we included 49 systematic reviews and meta-analyses,[ 10—58 ] all of which were conducted within the last 5 years — Three of these were Cochrane reviews.
Based on the identified and updated recent literature, we first present and discuss risk estimation of POPF based on surgery and surgical techniques including the type of anastomosis; second, we will discuss pancreas-specific factors including texture and the types of underlying pathology; third, we will discuss biomarkers of risk; further, we will present results from interventions, including use of drains, stents or products; finally, we will discuss the available clinical risk scores and their current role.
For example, pancreatic neuroendocrine tumors PNETs had a higher risk of POPF,[ 77 ] but this was largely attributed to the fact that these types of tumors more frequently underwent atypical resections and enucleations,[ 7778 ] thus posing a different risk for ductal injury.
In distal resections, tail resections appear to have higher risk than more central resections,[ 80 ] and a systematic review demonstrated superiority of stapler closure over suture closure in distal pancreatectomies.
Six meta-analyses [ 4345—4850 ] have investigated the effect of the two most commonly performed anastomotic techniques for creating continuity between the pancreas remnant and the gastrointestinal tract — pancreaticogastrostomy and pancreaticojejunostomy — and their effect on fistula rates, and found significantly different rates of POPF in all six meta-analyses.
The difference in the POPF rates is likely due to the variation in studies included, yet the risk reduction remains similar across studies odds ratio at about 0. The meta-analyses, although conducted and published within the same time-frame five published inone in include different number of trials and patients ranging from 4 to 8 randomized trials; and from to patients includedand also arrive at different conclusions concerning the additional effect on other outcomes, such as biliary fistula rates and intra-abdominal fluid collections.
Despite the slight difference in included material, the superiority of pancreaticogastrostomy appears consistent in all the meta-analyses, as all six studies conclude with an overall reduced risk for POPF.
Notably, a recent small Canadian RCT found no difference between the two techniques, and the trial was stopped early. The most frequently used technique for pancreaticojejunostomy is the end-to-side, duct-to-mucosa anastomosis.
However, these results were not confirmed in two French prospective case—control studies.
The neck of the pancreas is a vascular watershed between the celiac and superior mesenteric arterial systems.
In a prospective, non-randomized study,[ 88 ] the blood supply at the cut surface of the pancreas was evaluated, and if found inadequate, the pancreas was cut back 1.Oct 02, · Risk factors and preventive strategies for post-operative pancreatic fistula after pancreatic surgery: a comprehensive review.
The search period ended as of 3 December to cover the emerging evidence over the last decade, since the presentation of the ISGPS definition in Seiler CM, Rossion I, et al.
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Based on interviews with young female musicians, Stelzer explores the divergent musical biographies of young female instrumentalists ad asks how some of them succeed in making a profession out of their passion and others don’t.
It is also contemplated that images may be sent or distributed to users on a regular basis, based upon a subscription scenario, where users or organizations wishing to use the images may receive periodic updates of images (e.g., monthly) based upon a . Oct 02, · Risk factors and preventive strategies for post-operative pancreatic fistula after pancreatic surgery: a comprehensive review.
The search period ended as of 3 December to cover the emerging evidence over the last decade, since the presentation of the ISGPS definition in Seiler CM, Rossion I, et al. Efficacy of.
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