Impact of qualitative endoscopic ultrasonography on fatty pancreas at a referral medical center

IntroductionIdiopathic acute pancreatitis (IAP) remains a dilemma for physicians as it is uncertain whether patients with IAP may actually have an occult aetiology. It is unclear to what extent additional diagnostic modalities such as endoscopic ultrasonography (EUS) are warranted after a first episode of IAP in order to uncover this aetiology. Failure to timely determine treatable aetiologies delays appropriate treatment and might subsequently cause recurrence of acute pancreatitis. Therefore, the aim of the Pancreatitis of Idiopathic origin: Clinical added value of endoscopic UltraSonography (PICUS) Study is to determine the value of routine EUS in determining the aetiology of pancreatitis in patients with a first episode of IAP.Methods and analysisPICUS is designed as a multicentre prospective cohort study of 106 patients with a first episode of IAP after complete standard diagnostic work-up, in whom a diagnostic EUS will be performed. Standard diagnostic work-up will include a complete personal and family history, laboratory tests including serum alanine aminotransferase, calcium and triglyceride levels and imaging by transabdominal ultrasound, magnetic resonance imaging or magnetic resonance cholangiopancreaticography after clinical recovery from the acute pancreatitis episode. The primary outcome measure is detection of aetiology by EUS. Secondary outcome measures include pancreatitis recurrence rate, severity of recurrent pancreatitis, readmission, additional interventions, complications, length of hospital stay, quality of life, mortality and costs, during a follow-up period of 12 months.Ethics and disseminationPICUS is conducted according to the Declaration of Helsinki and Guideline for Good Clinical Practice. Five medical ethics review committees assessed PICUS (Medical Ethics Review Committee of Academic Medical Center, University Medical Center Utrecht, Radboud University Medical Center, Erasmus Medical Center and Maastricht University Medical Center). The results will be submitted for publication in an international peer-reviewed journal.Trial registration numberNetherlands Trial Registry (NL7066). Prospectively registered.

Download Full-text

A Novel Clinical Score Predicting the Presence of Fatty Pancreas

Journal of Clinical Medicine ◽

10.3390/jcm10245843 ◽

2021 ◽

Vol 10 (24) ◽

pp. 5843

Author(s):

Tawfik Khoury ◽

Amir Mari ◽

Wisam Sbeit

Keyword(s):

Fatty Liver ◽

Predictive Value ◽

Medical Center ◽

Univariate Analysis ◽

Clinical Score ◽

Multivariate Regression Analysis ◽

Cross Sectional ◽

Diagnostic Score ◽

Disease States ◽

Fatty Pancreas

Background: Fatty pancreas (FP) has become an increasingly encountered entity in recent years. Several studies have shown an association with several disease states. Aims: we aimed to generate a simple non-invasive scoring model to predict the presence of FP. Method: We performed a retrospective cross-sectional analysis at Galilee Medical Center. Inclusion criteria included patients who underwent endoscopic ultrasound (EUS) for hepatobiliary indications and who had either hyperechogenic pancreas consistent with FP or no sonographic evidence of fatty pancreas. Results: We included 569 patients. Among them, 78 patients had FP by EUS and 491 patients did not have FP. On univariate analysis, obesity (odds ratio (OR) 5.11, p < 0.0001), hyperlipidemia (OR 2.86, p = 0.0005), smoking (OR 2.02, p = 0.04), hypertension (OR 2.58, p = 0.0001) and fatty liver (OR 5.94, p < 0.0001) were predictive of FP. On multivariate analysis, obesity (OR 4.02, p < 0.0001), hyperlipidemia (OR 2.22, p = 0.01) and fatty liver (OR 4.80, p < 0.0001) remained significantly associated with FP. We developed a diagnostic score which included three parameters that were significant on multivariate regression analysis, with assignment of weights for each variable according to the OR estimate. A low cut-off score of ≤1 was associated with a negative predictive value (NPV) of 98.1% for FP, whereas a high cut-off score of ≥2 was associated with a positive predictive value (PPV) of 35–56%. Conclusion: We recommend incorporating this simple score as an aid to identify individuals with FP.

Download Full-text

Health resource utilization and multidisciplinary impact of endoscopic ultrasonography in a tertiary referral medical center

Therapeutic Advances in Gastroenterology ◽

10.1177/1756283x13479686 ◽

2013 ◽

Vol 6 (3) ◽

pp. 199-203

Author(s):

Jamie B. Sodikoff ◽

Sagar S. Garud ◽

Steven A. Keilin ◽

Sheila J. Bharmal ◽

Melinda M. Lewis ◽

...

Keyword(s):

Resource Utilization ◽

Endoscopic Ultrasonography ◽

Medical Center ◽

Health Resource ◽

Tertiary Referral ◽

Health Resource Utilization

Download Full-text

Medicaid & Medicare: D.C. Appellate Court Denies Claim for Medicare Reimbursement of GME Cost

The Journal of Law Medicine & Ethics ◽

10.1017/s1073110500012997 ◽

1999 ◽

Vol 27 (2) ◽

pp. 205-205

Author(s):

choeffel Amy

Keyword(s):

Medical Center ◽

Federal District ◽

Federal Court ◽

University Of Pennsylvania ◽

District Court ◽

Appellate Court ◽

Court Of Appeals ◽

Department Of Health ◽

Administrative Proceedings ◽

Summary Judgment

The U.S. Court of Appeals for the District of Columbia upheld, in Presbyterian Medical Center of the University of Pennsylvania Health System v. Shalala, 170 F.3d 1146 (D.C. Cir. 1999), a federal district court ruling granting summary judgment to the Department of Health and Human Services (DHHS) in a case in which Presbyterian Medical Center (PMC) challenged Medicare's requirement of contemporaneous documentation of $828,000 in graduate medical education (GME) expenses prior to increasing reimbursement amounts. DHHS Secretary Donna Shalala denied PMC's request for reimbursement for increased GME costs. The appellants then brought suit in federal court challenging the legality of an interpretative rule that requires requested increases in reimbursement to be supported by contemporaneous documentation. PMC also alleged that an error was made in the administrative proceedings to prejudice its claims because Aetna, the hospital's fiscal intermediary, failed to provide the hospital with a written report explaining why it was denied the GME reimbursement.

Download Full-text