Nancy Ascher

• Professor at University of California, San Francisco

A decision to withdraw life-sustaining treatment (WLST) is derived by a conclusion that further treatment will not enable a patient to survive or will not produce a functional outcome with acceptable quality of life that the patient and the treating team regard as beneficial. Although many hospitalized patients die under such circumstances, control...

A decision to withdraw life-sustaining treatment (WLST) is derived by a conclusion that further treatment will not enable a patient to survive or will not produce a functional outcome with acceptable quality of life that the patient and the treating team regard as beneficial. Although many hospitalized patients die under such circumstances, control...

Importance Physician well-being is a critical component of sustainable health care. There are few data on the effects of multilevel well-being programs nor a clear understanding of where and how to target resources. Objective To inform the design of future well-being interventions by exploring individual and workplace factors associated with surgi...

Objective: To determine the effects of ESRT (an iteratively adapted and tailored MBI) on perceived stress, executive cognitive function, psychosocial well-being (ie, burnout, mindfulness), and pro-inflammatory gene expression in surgical (ESRT-1) and mixed specialty (ESRT-2) PGY-1 volunteers. Summary of background and data: Tailored MBIs have pr...

Background: Burnout and distress are widespread issues in surgical training. While effective interventions are slowly coming to light, little has been published regarding the sustainable implementation of such interventions, including the critical need to identify barriers and enablers. Methods: Enhanced Stress Resilience Training (ESRT), a mind...

Importance Mindfulness meditation training has been shown to be feasible in surgical trainees, but affective, cognitive, and performance benefits seen in other high-stress populations have yet to be evaluated. Objective To explore potential benefits to stress, cognition, and performance in postgraduate year 1 (PGY-1) surgery residents receiving mo...

Importance Among surgical trainees, burnout and distress are prevalent, but mindfulness has been shown to decrease the risk of depression, suicidal ideation, burnout, and overwhelming stress. In other high-stress populations, formal mindfulness training has been shown to improve mental health, yet this approach has not been tried in surgery. Objec...

Since 2012, the Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) has required transplant centers to record the citizenship and residency status of patients undergoing transplantation in the United States. This policy replaced the 5% threshold of the non-US citizen/non-U.S. residents (NC/NR) undergoing org...

Background: Burnout among physicians affects mental health, performance and patient outcomes. Surgery residency is a high-risk time for burnout. We examined burnout and the psychological characteristics that may contribute to burnout vulnerability and resilience in a group of surgical trainees. Study design: An online survey was distributed in S...

We are writing in opposition to the proposed Global Kidney Exchange that would solicit living donors from economically underdeveloped countries such as Mexico, the Philippines, Kenya, India and Ethiopia (1). The experience of representatives from countries such as India and Mexico reported at the Vatican Pontifical Academy of Sciences Summit on the...

The Transplantation Society (TTS) was the first professional transplantation organisation to respond to the practice of using organs from executed prisoners for transplantation more than a decade ago [1]. TTS has been instrumental in working with the World Health Organization (WHO) and the World Health Assembly to develop guidelines for governments...

The purpose of this study was to assess first-year medical students' implicit perceptions of surgeons, focusing on the roles of gender and demeanor (communal = supportive, associated with women; agentic = assertive, associated with men). Survey study. Each survey had 1 of 8 possible scenarios; all began with a short description of a surgeon who was...

Optimizing the surgeon-nurse relationship to improve interprofessional communication is increasingly recognized as an essential component of patient care. The increasing number of women surgeons has altered the surgeon-nurse dynamic, which has traditionally been a male-female relationship. In particular, this shift has raised the issue of whether i...

Background: Perceptions underlie bias and drive behavior. This study assessed female surgeons' implicit perceptions of surgeons, with a focus on the roles of sex and demeanor (communal = supportive, associated with women; agentic = assertive, associated with men). Methods: Electronic surveys were administered via the Association of Women Surgeon...

Background Perceptions underlie bias and drive behavior. This study assessed female surgeons’ implicit perceptions of surgeons, with a focus on the roles of gender and demeanor (communal=supportive, associated with women; agentic=assertive, associated with men). Methods Electronic surveys were administered via the Association of Women Surgeons ema...

As more women become surgeons, knowledge of patient perceptions is necessary to educate this new pool of surgeons on how to maximize patient trust and foster the optimal surgeon-patient relationship. Patients in a general medicine clinic in San Francisco were surveyed. Study respondents read one of the eight short scenarios that differed by surgeon...

Living donor liver transplantation (LDLT), originally used in children with left lateral segment grafts, has been expanded to adults who require larger grafts to support liver function. Most adult LDLT procedures have been performed with right lobe grafts, and this means a significant risk of morbidity for the donors. To minimize the donor risk for...

Despite the growing need for organ donation among Asian Americans, studies suggest that they are reluctant to donate. To examine the association of attitudes and knowledge about organ donation and transplantation with willingness to donate and willingness to engage in family discussion about organ donation among Asian American adolescents. A cross-...

Despite the importance of preclerkship experiences, surgical education has essentially remained confined to the third-year operating room experience. According to experience-based learning theory, the acquisition of new clinical knowledge is a dynamic process of social enculturation and professional identity development that requires active partici...

Overall, the liver transplant experience at UCSF has been a highly successful one. The program has made major contributions to the advancement of liver transplantation as a field. The UCSF has pushed the envelope in, at times, including recipients that were thought to have absolute contraindications for liver transplantation. The program is a tribu...

Early introduction to surgical skills may serve several valuable purposes; medical students will acquire skills that will reduce their anxiety in approaching clerkships and improve the quality of patient care, and they will possibly become interested in surgery as a career. We designed an elective called "OR assist" for first and second year medica...

Preliminary studies suggest preemptive anti-HCV therapy in liver transplant recipients may enhance the rates of viral clearance, but the applicability and tolerability of preemptive therapy has not been evaluated in a contemporary cohort. In this randomized study, the safety and tolerability of preemptive standard (IFN) or pegylated (peg-IFN) inter...

Although prolonged composite tissue allograft (CTA) survival is achievable in animals using immunosuppressive drugs, long-term immunosuppression of CTAs in the clinical setting may be unacceptable for most patients. The purpose of this study was to develop a model for reliable CTA tolerance induction in the adult rat across a major MHC mismatch wit...

The natural history and predictors of HCV-related disease severity post-transplantation are uncertain. The aims of this study were to define the natural history of post-transplantation HCV infection by assessing the rate of fibrosis progression, to determine if the post-transplantation natural history differs from that observed pre-transplantation,...

Although prolonged composite tissue allograft (CTA) survival is achievable in animals using immunosuppressive drugs, long-term immunosuppression of CTAs in the clinical setting would be unacceptable for most patients. The purpose of this study was to develop a model for reliable CTA tolerance induction in the adult rat across a strongly antigenic M...

Background. To prevent the central role played by complement activation in the hyperacute rejection of pig organs transplanted into primates, pigs transgenic for human decay-accelerating factor (HDAF) have recently been produced. The data presented here extend previous immunohistochemical findings by documenting the immunological characterization a...

This is a discussion of transplant surgery fellowship training issues that pertain to educational quality guidelines of fellowship programs, the number of fellows being trained, and the individual's fate in securing transplant surgery positions after training. In 1995, the Council of the American Society of Transplant Surgeons (ASTS) revised the ac...

Background. The transjugular intrahepatic portosystemic shunt (TIPS) is an important treatment for complications of portal hypertension. As some authors have suggested that TIPS may facilitate liver transplantation technically, the objective of this study was to determine the impact of TIPS on the liver transplant operation and its outcome. Methods...

Recombinant adenovirus vectors are efficient at transferring genes into somatic tissues but are limited for use in clinical gene therapy by immunologic factors that result in the rapid loss of gene expression and inhibit secondary gene transfer. This study demonstrates that systemic coadministration of recombinant adenovirus with soluble CTLA4lg, w...

Liver granulomas have long been known to pose diagnostic problems for pathologists; however, their prevalence and associated etiologic factors have not been studied in liver transplant patients. We reviewed 3632 liver biopsy specimens from 563 patients at two institutions and identified 42 patients with posttransplant granulomas. A possible or prob...

The shortage of liver grafts results in the fact that 8% of potential recipients die before receiving a graft. Liver graft division has therefore been proposed to maximize the current available liver graft pool. However, the question of benefit or additional risk for the recipients that this technique might carry remains unanswered. The European Sp...

Posttransplantation lymphoproliferative disorder (PTLD) is a well-described complication of the systemic immunosuppression required for successful organ transplantation. Lesions of PTLD often occur in the region of the head and neck and require otolaryngologic evaluations. Although the majority of reported cases of PTLD are associated with cyclospo...

The waiting list for liver transplantation has more than doubled between 1988 and 1992, yet the number of liver transplantations during the same period increased by only 79%. This discrepancy is due to the limited availability of donors. The modest increase in donor pool is caused entirely by donors > or = 40 years of age, a trend likely to continu...

The shortage of organs for transplantation is especially severe for the critically ill newborn infant, for whom donors of the appropriate size are particularly scarce. One way to overcome this problem is to use animals in lieu of human as organ donors. The major limitation to using animals for this purpose is the susceptibility of animal organs to...

Fulminant hepatic failure (FHF) is defined by the appearance of severe liver injury with hepatic encephalopathy in a previously healthy person. There are an estimated 2,000 cases of FHF in the United States yearly, representing 0.1% of all deaths and, perhaps, 6% of liverrelated deaths. The causes of FHF are many, the chief ones in the United State...

The aims of this pilot study were to evaluate the safety and efficacy of interferon-alpha 2b for treatment of hepatitis C virus infection in liver transplant recipients, to monitor changes in hepatitis C virus RNA levels with treatment and to determine pretreatment parameters predictive of a complete response. Eighteen patients with documented hepa...

Although surgical proficiency is essential to the immediate outcome of transplantation, long-term success depends upon how adequately the transplantation recipient is managed. Immunosuppression, the most critical aspect of after care, is subject to wide variation. In January 1990, a survey was sent to the directors of all transplant programs in the...

To examine whether unknown viruses or autoimmune processes contribute to the development of cryptogenic liver disease, we studied 48 patients undergoing liver transplantation who had non-A, non-B cirrhosis; non-blood-borne cirrhosis of unknown etiology; or autoimmune cirrhosis. After the diagnosis of hepatitis C virus infection was established by t...

In Japan, the presence of a large regenerative nodule within a cirrhotic liver, referred to as a macroregenerative nodule or adenomatous hyperplasia, is thought to play a role in the pathogenesis of hepatocellular carcinoma. These lesions, however, have received little attention outside of Japan. We examined 110 sequentially explanted cirrhotic liv...

In this study we examined multiple serial liver biopsy specimens from liver transplant recipients to determine the pathological features of hepatitis C virus-induced hepatitis. Hepatitis C virus infections acquired after transplantation and previous infections that recurred in patients after transplantation were confirmed by the results of the poly...

Cerebral edema and intracranial hypertension, commonly present in fulminant hepatic failure, may lead to brainstem herniation and limit the survival of comatose patients awaiting liver transplantation before a donor organ becomes available. Also, they are likely responsible for postoperative neurological morbidity and mortality. Although intracrani...

Objectives. —To estimate the potential supply of organ donors and to measure the efficiency of organ procurement efforts in the United States.

Intragraft cytokine and T cell receptor gene expression was analyzed in rejecting renal allografts by polymerase chain reaction (PCR). Message for IL-1[beta], IL-6, and TNF-[alpha] was detected in nephrectomy tissue with pathological evidence of acute or chronic rejection. Similarly, mRNA for both IL-6 and TNF-[alpha] was present in renal biopsies...

We report the first two cases of apparent azathioprine hepatotoxicity occurring after liver transplantation. The two patients exhibited jaundice, elevated serum transaminase activities and histopathological features of sinusoidal congestion and centrilobular hepatocellular degeneration 17 and 61 days after transplantation. After withdrawal of azath...

A new flow cytometric method (FCM) for detection of soluble interleukin 2 receptor (sIL-2R) in serum was established. Using this method, results from one to forty samples can be obtained in less than 2 hr as compared with 5 hr in an ELISA. Comparing over 300 sera samples tested by both methods, we found the FCM to be as specific and sensitive as th...

Hereditary tyrosinemia type I presents with either acute hepatic failure in the neonatal period or later in infancy with progressive liver dysfunction secondary to cirrhosis. The inevitably fatal outcome in those children with the chronic form has been transformed with the advent of liver transplantation. Native livers from five children who receiv...

Three patients with hereditary tyrosinemia type I were examined before and after liver transplantation to assess the role of extrahepatic tissues in the biochemical disorders of this disease. Before transplantation the three patients excreted excessive amounts of succinylacetoacetate (SAA), succinylacetone (SA), tyrosyl acidic compounds, and 5-amin...