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Background Thromboelastography has called into question the coagulopathy seen following partial hepatectomy. However the coagulation profile in cirrhotic livers has not been studied. Our objective was to determine the coagulation profile following partial hepatectomy in normal and cirrhotic livers. Methods Patients undergoing liver resection were prospectively enrolled in the study. The prothrombin time and international normalized ratio, as well as the thromboelastogram, were obtained preoperatively, post-operatively, and on post-operative days 1, 3, and 5. Results 22 noncirrhotic and 11 cirrhotic patients undergoing liver resection were enrolled. Postoperatively the thromboelastogram demonstrated a hypercoagulable profile in 64%, 33%, 39% and 36% of patients on post-operative days 0, 1, 3 and 5 respectively. There was no difference between patients with cirrhosis and those without underlying liver disease. Conclusion Patients appear to have a similar coagulation profile after liver resection regardless of underlying cirrhosis with many having a hypercoagulable profile.

Every year, most businesses experience a cyber attack of some sort. Despite the fact that these attacks can interrupt business operations, many organisations lack an effective business continuity response. While some organisations do have cyber security and incident response functions in place, they focus more on mitigating the attack itself than on ensuring business operations can continue in the interim. To understand why it is important to integrate cyber security into the business continuity plan, business continuity planners must first be familiar with the common cyber threats organisations face as well as the far-reaching impact of data breaches. Then, they must address the root causes of the breakdown between business continuity and cyber security: the lack of a security culture, boardroom support and a coordinated response. Practical steps for integrating cyber security into the business continuity response include starting a conversation with those responsible for cyber security, determining the appropriate response to cyber incidents, assessing the organisation's recovery needs and testing the response strategy. Ideally, however, organisations should prevent attacks altogether. As employees are often the primary point of failure in cyber security preparedness, organisations should improve their cyber security posture by investing in education and awareness from the top down.

In hepato-pancreato-biliary (HPB) surgery higher volumes are associated with improved outcomes; however, there are limitations to regionalization. Here we report our experience establishing multidisciplinary HPB program at a university-affiliated community hospital.This is a retrospective review of patients who underwent HPB surgery between 2015 and 2017. Chief residents' HPB case logs were collected.61 pancreatic resections and 62 hepatic resections were performed. The morbidity, 30-day mortality and median length of stay following pancreatic resections were 27%, 1.5%, and 8 days, respectively. The morbidity, 90-day mortality, and median length of stay following hepatic resections were 24%, 3%, and 7 days, respectively. The median pancreatic and liver case volumes for graduating chief residents increased from 7 to 8 to 16 and 16, respectively (p 0.05), after the establishment of a HPB program. Participation in multidisciplinary care (p = 0.08) and clinical trial enrollment increased.Our study demonstrates short-term outcomes comparable to high volume centers. Development of a HPB program had a positive impact on resident operative experience, increased multidisciplinary care and increased clinical trial enrollment.