Jeannette Y. Wick, RPh, MBA, FASCP

Laparoscopic colorectal surgery (LCS) using multiple ports has become commonplace in colorectal surgery, offering a safe alternative to open surgery with similar surgical results. In other types of surgery, single-incision laparoscopic surgery (SILS) and natural orifice transluminal endoscopic surgery (NOTES) are growing in popularity.

In the wake of Joan Rivers' untimely death last year, ambulatory surgery centers have come under increased scrutiny. Several recent articles in the literature look at this complicated area of surgical practice.

The incidence and mortality of pancreatic adenocarcinoma, the fourth leading cause of cancer deaths in the United States, are both on the rise. Globally, the disease is responsible for 227,000 deaths annually. Researchers from the National Taiwan University College of Medicine recently published a meta-analysis that demonstrated a dose-response relationship between fasting blood glucose levels and pancreatic cancer risk. They also examined the link between prediabetes and pancreatic cancer risk.

Researchers at the University of Missouri and the National Research Council in Padova, Italy, recently investigated the role that timing of resistance exercise plays in lowering cardiovascular risk. They wondered if the time of day when diabetics exercise could explain the lower-than-expected exercise-derived benefits seen in some diabetics.

Tuberculosis (TB) kills 1.43 million people annually. Effective TB treatment is challenging, due to the mycobacterial cell wall's unusual structure and chemical composition -- the wall repels drugs efficiently and renders many antibiotics ineffective. An article in Science Translational Medicine describes a drug that may have potential to alter host response to TB: the antidiabetic agent metformin.

Surgical management of colon and rectum diseases changes quite quickly. Noting that many changes have been suggested in just the last year, 2 surgeons from the Mayo Clinic in Rochester, Minnesota, assembled a review of the most significant. This paper appears in the January 2015 issue of Current Opinions in Gastroenterology.

Fragmentation -- a lack of care continuity when disparate healthcare professionals provide care without integrated access to clinical information -- is a public health focus. It's a concern for surgeons when patients undergo complex procedures that require lengthy periods of recovery. Fragmentation is especially troubling when patients are elderly.

Surgeons from several leading medical schools in the United States gathered expert witness guidelines among major surgical societies for review. They looked for gaps in the standards to stimulate discussion about areas for improvement. Their review provides an educational look at the surgeon's role in the judicial system.

Diabetic polyneuropathy (DPN) can exist with or without neuropathic pain. Roughly half of patients with types I and II diabetes mellitus (DM) develop DPN. In type 1 DM, patients start to notice symptoms of distal polyneuropathy after many years of chronic prolonged hyperglycemia. It's more aggressive in type 2 DM, and can develop after only a few years of known poor glycemic control and may be present at diagnosis.

Many health care organizations have started to lessen their environmental impact slowly by tackling small problems and making manageable changes. A multidisciplinary team of researchers from across the US carved out one surgical procedure to determine environmental impact. Their assessment of abdominal, vaginal, laparoscopic, and robotic hysterectomy appears ahead of print in the journal Environmental Science and Technology.

In many medical fields, malpractice has driven changes in the way physicians practice medicine. In the surgical field, tracheotomies are often crucial, but are associated with a high risk of morbidity and mortality. A quick look at the results when one enters "tracheotomy" and "lawsuit" into any search engine shows that patients, dissatisfied with myriad aspects of breathing through a tube, often sue after this procedure.

Postextubation dysphagia is a common but often unrecognized problem in critically ill patients who've been intubated for 2 days or more. Its causes include mechanical abrasion, cognitive disturbances, and the residual effects of narcotics and anxiolytic medications.

As many as 15% of diabetics may be misdiagnosed with simple diabetes mellitus (DM) types 1 or 2. But DM presents as more than 50 unique types, and even among correctly diagnosed type 2 patients, 60 predisposing genetic variants exist.

An article published electronically in JAMA Facial and Plastic Surgery discusses what happens when ears have been stretched beyond the body's ability to heal.

Around 10% of elders experience some form of elder abuse (physical, sexual or emotional abuse; neglect, exploitation, or abandonment), and elders who are abused appear to have a high level of comorbidity. Evidence suggests that patients who have experienced elder abuse are at higher risk of cardiovascular-related mortality.

The American Society for Reproductive Medicine (ASRM) published a 2013 guideline addressing the number of embryos to transfer. Its guideline relied on empiric data to individualize patient care while minimizing the risk of high-order multiple births.

Atherosclerotic internal carotid artery disease is a major contributor to ischemic stroke. Surgeons use a combination of carotid artery and brain imaging to determine if patients have symptomatic carotid stenosis. However, there remains widespread disagreement on the threshold, timing, and best technical approach to carotid revascularization in symptomatic patients.

Slightly more than 6.8 million community-dwelling Americans use assistive devices (eg, canes, walkers, crutches) to help them with mobility and, of these, 1.7 million people use wheelchairs or scooter riders. These Americans at risk for unique musculoskeletal problems, especially rotator cuff injuries.

Research has shown that probiotics may help improve insulin resistance, impaired insulin secretion, and metabolic defects associated with type 2 diabetes mellitus.

An article published recently in the journal Diabetes Research and Clinical Practice reviews the mechanisms by which microalbuminuria causes renal and cardiovascular disease. The authors also describe appropriate interventions.

A review in the online version of Gerontology makes it eminently clear that age-related morbidities often follow hormone-regulated homeostasis changes in later life.

A larger study published ahead of print in the New England Journal of Medicine indicated that progesterone's role in treating TBI was questionable.

A new Danish database analysis in the November 2014 issue of Neurology, indicated increased mortality after ischemic stroke in patients taking older non-steroidal anti-inflammatory drugs (NSAIDs) that inhibit COX-2 (e.g. diclofenac, etodolac).

Since 2007, the American College of Surgeons National Surgical Quality Improvement Program database has tracked 30-day surgical outcomes and complications longitudinally.

Exhaustion, depersonalization, and perceived lack of personal accomplishment-these are the signs of burnout, a syndrome that decreases efficacy at work.

Statins effectively lower LDL cholesterol levels in many patients, However, on the individual level, some patients do not respond with the expected 40% to 55% reduction in cholesterol levels. Genetic variation may be the cause.

The Endocrine Society has issued a clinical practice guideline for the diagnosis and treatment of acromegaly, a rare condition usually caused by a non-cancerous, growth hormone-producing pituitary tumor.

Microvascular disease is a concern in patients with diabetes, and follows hyperglycemia-induced endothelial damage or endothelial dysfunction. Diabetic neuropathy is the most prominent microvascular consequence of diabetes, and often, the foot is involved.

Dynamic physical activity and weight-bearing exercise are crucial to good bone health. Can we recreate musculoskeletal loading's anabolic effects in frail individuals who cannot exercise?

The 2013 American College of Cardiology/American Heart Association guideline for management of low-density lipoprotein cholesterol to reduce atherosclerotic cardiovascular disease risk identified adults who could benefit from moderate- to high-intensity statin use.