scholarly journals 473 A Review of The Risk Stratification Models Used in The Management of Oncological Hepato-Pancreato-Biliary Surgical Patients

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Coombs ◽  
C Jordan ◽  
S Hussain ◽  
O Ghandour
Keyword(s):  
Decision Aids ◽  
Scoring Systems ◽  
Prognostic Scores ◽  
Clinical Implementation ◽  
Diverse Range ◽  
Ovid Medline ◽  
Current Trends ◽  
Patient Groups ◽  
Evidenced Based ◽  
User Friendly

Abstract Introduction Oncological scoring systems in surgery are used as evidence-based decision aids to best support management through assessing prognosis, effectiveness and recurrence. Currently, the use of scoring systems in the hepato-pancreato-biliary (HPB) subspecialty is limited as concerns over precision and applicability prevent widespread clinical implementation. The aim of the review is to discuss clinically useful oncological scoring systems for the surgical management of HPB patients. Method Primary articles of validated novel and established scoring systems were searched over a 25-year period using PubMed, Cochrane and Ovid Medline. Results This review discusses 9 clinically useful scoring systems in cancers of the liver (CLIP, BCLC, ALBI Grade, RETREAT, Fong et al.), pancreas (Genc et al., mGPS) and biliary tract (TMHSS, MEGNA). CLIP and BCLC are extensively validated prognostic tools, with BCLC clinically endorsed by guidelines. Conversely, patient and treatment stratification is limited in CLIP and BCLC respectively - ALBI works to improve patient stratification. RETREAT, Fong et al. and Genc et al. scores predict recurrence following surgery, however these scores require further validation in heterogenous patient groups. mGPS and MEGNA are simple prognostic scores, but also require further validation in varied patient cohorts. TMHSS is user-friendly, however is limited at discriminating treatment for the middle patient group. Conclusion A diverse range of HPB surgical scoring systems may facilitate evidenced-based treatment decisions and improve management. Future scoring systems need to be developed on heterogenous patient cohorts with improved stratification, with current trends towards implementing machine learning and genetics to improve outcome prediction.

scholarly journals An Overview of Guillain-Barré Syndrome

2019 ◽  
pp. 42-46
Author(s):  
Sanad Esmail
Keyword(s):  
High Risk Patient ◽  
Scoring Systems ◽  
Clinical Severity ◽  
Guillain Barre Syndrome ◽  
Diverse Range ◽  
Patient Morbidity ◽  
Guillain Barré Syndrome ◽  
Patient Groups ◽  
Guillain Barré ◽  
Prognostic Scoring Systems

Guillain-Barré Syndrome (GBS) is an acute, autoimmune polyradiculoneuropathy that carries great patient morbidity, and significant mortality, worldwide. The manifestations are highly heterogeneous at the clinical, electrophysiological and biochemical levels, which means that it is better to conceptualise GBS as a spectrum of disorders rather than a singular one. Despite the diverse range of presentations, the management of GBS is relatively stereotyped, albeit guided by the level of clinical severity. Treatment is largely restricted to general supportive measures, Intravenous Immunoglobulin (IVIG) and Plasma Exchange (PLEX), with no current role for oral or intravenous corticosteroids in clinical practice. Several validated prognostic-scoring systems, which can predict the probability of long-term residual disability, may assist in targeting intensive therapies to high-risk patient groups. The aim of this article is to provide a practical overview of GBS, with particular emphasis on the clinical presentation, investigation and management of this important spectrum of neurological conditions.

scholarly journals An interactive application for malaria elimination transmission and costing in the Asia-Pacific

2019 ◽  
Vol 4 ◽  
pp. 61 ◽  
Author(s):  
Olivier J. Celhay ◽  
Sheetal Prakash Silal ◽  
Richard James Maude ◽  
Chris Erwin Gran Mercado ◽  
Rima Shretta ◽  
...  
Keyword(s):  
Malaria Elimination ◽  
Complex Model ◽  
Asia Pacific ◽  
Great Effort ◽  
Dissemination Strategy ◽  
Diverse Range ◽  
Interactive Application ◽  
Scientific Results ◽  
Widespread Access ◽  
User Friendly

Leaders in the Asia-Pacific have endorsed an ambitious target to eliminate malaria in the region by 2030. The emergence and spread of artemisinin drug resistance in the Greater Mekong Subregion makes elimination urgent and strategic for the global goal of malaria eradication. Mathematical modelling is a useful tool for assessing and comparing different elimination strategies and scenarios to inform policymakers. Mathematical models are especially relevant in this context because of the wide heterogeneity of regional, country and local settings, which means that different strategies are needed to eliminate malaria. However, models and their predictions can be seen as highly technical, limiting their use for decision making. Simplified applications of models are needed to allow policy makers to benefit from these valuable tools. This paper describes a method for communicating complex model results with a user-friendly and intuitive framework. Using open-source technologies, we designed and developed an interactive application to disseminate the modelling results for malaria elimination. The design was iteratively improved while the application was being piloted and extensively tested by a diverse range of researchers and decision makers. This application allows several target audiences to explore, navigate and visualise complex datasets and models generated in the context of malaria elimination. It allows widespread access, use of and interpretation of models, generated at great effort and expense as well as enabling them to remain relevant for a longer period of time. It has long been acknowledged that scientific results need to be repackaged for larger audiences. We demonstrate that modellers can include applications as part of the dissemination strategy of their findings. We highlight that there is a need for additional research in order to provide guidelines and direction for designing and developing effective applications for disseminating models.

Time Changes In Predictive Power Of MDS Prognostic Scores – Effects On Revised Scores Such As The IPSS-R, Impact Of Age

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1544-1544 ◽  
Author(s):  
Michael Pfeilstöcker ◽  
Heinz Tüchler ◽  
Julie Schanz ◽  
Guillermo Sanz ◽  
Guillermo Garcia Manero ◽  
...  
Keyword(s):  
Lower Risk ◽  
Prognostic Value ◽  
Conflicts Of Interest ◽  
Scoring Systems ◽  
Prognostic Scores ◽  
Risk Category ◽  
Prognostic Scoring Systems ◽  
Prognostic Power ◽  
Risk Categories ◽  
Over Time

Abstract Introduction New, refined prognostic scoring systems have been established for MDS. Most scores assess prognosis at time of diagnosis assuming stable prediction over time. Earlier studies have shown moderate loss of prognostic power over time in scores using clinical parameters whereas cytogenetic scores maintained prognostic power, scores including comorbidity had shown gain of prognostic power (Pfeilstöcker et al, 2012). The aim of this multicenter retrospective study was to assess the relative stability of the newly developed scoring systems over time, to compare and explain observed time-related losses of prognostic power, and to discuss their clinical implications. Methods This study is based on 7212 untreated (no disease modifying treatment) MDS patients from multiple institutional databases of the IWG-PM, which generated the IPSS-R (Greenberg et al, 2012). Patient characteristics were well comparable with other populations: median age 71 years, male gender 60 %, median overall survival 3.8 years (range 3.7-4.0), median time to AML transformation not reached with 25% of patients transforming to AML after 6.8 years. Patients were diagnosed and classified by FAB and WHO; cytogenetics were classified by original IPSS subtypes and by the recently refined proposal integrated into the IPSS-R (Schanz et al, 2012). The following scores were analysed for their stability over time: IPSS, IPSS-R, WPSS variants, cytogenetic scores, age, performance status and other differentiating features of the IPSS-R. Time variations were described by the Cox-zph-test, and by applying Dxy, a measure of concordance, for censored data at separate observation periods. Results In line with previous observations, loss of prognostic power occurred over time after diagnosis in all scoring systems. While for the entire population the risk between adjacent IPSS-R risk categories differs by ∼80%, for patients observed at least 1 year the increase is ∼66%, and for those observed 4 years it is only ∼25%. The IPSS-R and particularly its age-including version (the IPSS-RA) retained the highest prognostic values compared to all other scoring systems at all time points. Dxy for IPSS-R: at diagnosis 0.43, 1 year 0.35, 2 years 0.27, 4 years 0.14. Including age, as in the IPSS-RA, was associated with less loss of prognostic power over time: Dxy at diagnosis 0.46, 1 year 0.38, 2 years 0.31, 4 years 0.22. For the IPSS and WPSS (available for the latter in only 33% cases), these values were: 0.37, 0.30, 0.22, 0.11 and 0.44, 0.36, 0.29, 0.18 respectively. Considering risk categories, the risk remained fairly constant over time for the lower risk categories in every analyzed scoring system, while the risks in the higher risk categories were especially high in the second half of the first year after diagnosis, diminishing thereafter, thus reducing the prognostic value of these categories over time. To determine whether statistical weights optimized for each time period would alter these results, time-specific weights were applied, which did not demonstrate substantially different prognostic values from the basic model analysis. Particularly good retention of prognostic power was found in the lower risk categories over time. The lesser retention of prognostic power in the higher risk categories appeared related to loss of a larger portion of these patients over time due to their deaths or being censored by their beginning treatment. For the IPSS-R intermediate risk category patients, the prognosis for survival approached the “high” category ∼3 years after diagnosis, while it remained intermediate regarding their risk of AML transformation. Conclusions These data demonstrate that a degree of attrition of prognostic value occurred over time from diagnosis for all of the assessed MDS prognostic scoring systems. The IPSS-R, particularly the age-inclusive IPSS-RA, best retained such prognostic capability over time for the untreated patients analyzed. Disclosures: No relevant conflicts of interest to declare.

Scoring Systems For Predicting Outcome Of Chronic Myeloid Leukemia In Adults Are Poorly Informative In Pediatric Patients Treated With Imatinib

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2725-2725 ◽  
Author(s):  
Meinolf Suttorp ◽  
Ingmar Glauche ◽  
David Gurrea Salas ◽  
Josephine Tabea Tauer ◽  
Christina Nowasz ◽  
...  
Keyword(s):  
Chronic Myeloid Leukemia ◽  
Treatment Response ◽  
Myeloid Leukemia ◽  
Pediatric Patients ◽  
Scoring Systems ◽  
Prognostic Scores ◽  
Sokal Score ◽  
Eutos Score ◽  
Risk Categorization ◽  
Risk Categories

Abstract Introduction Imatinib (IM) front-line treatment impressively improved survival of children with chronic myeloid leukemia (CML). In contrast to adult CML, specific scoring systems predicting the treatment response in individual pediatric patients (pts) are still lacking. Here we analyzed a cohort of pediatric pts with CML applying the established prognostic scores for adults in a comparative fashion. We question the value of four scoring systems (Sokal-, Sokal young-, Hasford-, Eutos-Score) especially with regard to grouping individual children differently or homogeneously into a defined risk category. In addition, we analyzed which scoring system would classify most specifically the prognosis of pediatric CML with regard to early molecular response (MR) on IM. Methods A total of 90 pts (male/female: 57/33; median age: 11.6 yrs, range: 1-18) with CML-CP enrolled in the prospective trial CML-PAED-II were included in this analysis. Registry data were collected on standardized forms filled in by the treating physicians. On this basis the Eutos-, Sokal- and Hasford-Scores were calculated using internet resources of the ELN (www.leukemia-net.org/content/leukemias/cml/cml_score), whereas the Sokal young Score (Sy) – a score described specifically for adolescents and younger adults (Sokal JE, Blood 1985;66:1352) – was manually calculated. Pts were grouped using the original three risk categories (low=LR, intermediate=IR, high=HR) or two categories, respectively, for the Eutos-Score (LR or HR). Evaluation of therapeutic response was performed by assessing the MR by measurement of the transcript ratio BCR-ABL1/ABL1 in blood specimen sent to the central reference laboratory at month 3 after start of IM treatment. Measurements were expressed according to the International Scale. Results By Sokal-Score 59/90 pts were classified as LR, 20/90 pts as IR and 11/90 pts as HR. By Hasford Score 57/90 pts were classified as LR, 25/90 pts as IR, and 8/90 pts as HR. By Eutos Score 73/90 pts were classified as LR and 17/90 pts as HR. As the hematocrit value was not collected systematically at diagnosis, this necessary parameter for calculating the Sy-Score was applicable only in 46/90 pts and thus 44/46 pts were classified as LR, 2/46 as IR, and 0/46 as HR. Comparing results of individual pts only 25/46 pts (54%) were categorized homogeneously as LR by applying all 4 scoring systems, while 54/90 pts (60%) were classified as LR if Sy-Score was excluded. Thus, the remaining 21/46 pts (46%) were grouped heterogeneously by applying each of the 4 prognostic scores, and correspondingly 33/90 pts (37%) were classified heterogeneously within different risk categories by the Eutos, Hasford and Sokal Score. Only 3 pts were categorized homogenously as HR by each of the Sokal, Hasford, and Eutos Score and by applying all 4 scoring systems no patient was concordantly classified as HR. When comparing only the Sokal-Score to the Sy-Score, discordant results were obtained in 19/46 (41%) pts. BCR-ABL1/ABL1 transcript ratio could be analyzed quantitatively in 72/90 pts at month 3 after treatment initiation. In this cohort we identified 46/72 good responders (ratio BCR-ABL1/ABL1 <10%) and 26/72 poor responders (ratio >10%). Although the Eutos-score performed best in in a logistic regression analysis with an Odds Ratio OR=3.02 to predict an unfavorable course of IM-treated CML in the HR group, the discrimination did not reach statistical significance (p=0.08). However, by reducing the cut-off point for the Eutos Score from 87 to 64 an OR=4.8 with p=0.004 was achieved, thus indicating that a refined risk categorization appears beneficial. Conclusion Comparing risk categorization by all four scores in individual pediatric pts, results may vary considerably. Keeping in mind that the number of pts analyzed is still small, especially applying the Sy-Score seems not to provide benefit in this cohort with a median age of only 11 years. Contrasting results in adults, in this pediatric cohort the Sokal- and Hasford-Scores did not predict a poor IM treatment response at month 3 while the Eutos Score achieved borderline significance. Thus, there is an urgent need for the development of a more specific pediatric risk score. Disclosures: No relevant conflicts of interest to declare.

GATA2 Expression Level in Chronic Myeloid Leukemia (CML) Patients Correlates with Their Prognostic Scores and Is Associated with Disease Stage at Diagnosis

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 2768-2768
Author(s):  
Philippe Guardiola ◽  
Corentin Orvain ◽  
Nick C.P. Cross ◽  
Martine Gardembas ◽  
Marc Spentchian ◽  
...  
Keyword(s):  
Gene Expression ◽  
Transcription Factor ◽  
Platelet Count ◽  
Peripheral Blood ◽  
Research Funding ◽  
Scoring Systems ◽  
Gene Expression Dataset ◽  
Expression Level ◽  
Prognostic Scores ◽  
Eutos Score

Abstract The Sokal, Hasford and EUTOS scoring systems have been successively proposed to predict the outcome of CML patients in chronic phase (CP-CML), both in terms of disease response and survival. The EUTOS score, which is the only one developed for patients treated with tyrosine kinase inhibitors, considers 2 risk groups based on spleen size and peripheral blood basophil percentage. No clear link has been identified between the covariates used to calculate those scores and CML molecular pathophysiology. To better delineate the molecular mechanisms underlying those scoring systems, a gene expression profiling study was performed on 48 CP-CML patients included in the Novartis ENEST1st study, for whom good quality peripheral blood total RNA was available at diagnosis. First, patients with low-risk (n=21) and high-risk (n=12) Sokal scores were compared, leading to identify 13 genes differentially expressed between those groups (q<.05). GATA2, which encodes a critical hematopoietic transcription factor, was among the 10 genes significantly overexpressed in high Sokal score CP-CMLs. Robust regression analyses confirmed that GATA2 expression level was correlated to the 3 prognostic scores, when considering those as continuous covariates (R2=.39, p<10-4 [Sokal]; R2=.16, p=.007 [Hasford]; R2=.16, p=.007 [EUTOS]). Among the covariates used to calculate those scores, platelet count (R2=.35, p<10-4), basophil (R2=.22, p=.0012), eosinophil (R2=.14, p=.01) and peripheral blood blast (R2=.13, p=.017) percentages were correlated to GATA2 expression level. Using a quantitative RT-PCR assay, GATA2 expression was subsequently assessed on an independent set of 80 CP-CML patients followed at Angers University Hospital from 2005 to 2014 (Sokal low, n=32; int, n=30; high, n=18 of which 7 EUTOS high). This validation set confirmed that GATA2 expression level was significantly correlated to the 3 prognostic scores (R2=.31, p<10-4 [Sokal]; R2=.28, p<10-4 [EUTOS]; R2=.11, p=.003 [Hasford]). Among the covariates used in those scores, basophil percentage (R2=.44, p<10-4), platelet count (R2=.31, p<10-4) and peripheral blood blast percentage (R2=.22, p<10-4) were significantly correlated to GATA2 expression level in this second cohort. The ENEST1st gene expression dataset and a linear regression approach were then used to better define the role of GATA2 in CP-CMLs. This analysis identified 12 genes significantly correlated to GATA2 in terms of expression levels (q<10-5). Half of those - CPA3, FCER1A, ENPP3, HDC, IL1RL1, SLC45A3 - were basophil-related genes. Interestingly, in normal umbilical cord blood-derived myelopoiesis, the expressions of GATA2, CPA3, FCER1A, and HDC were significantly correlated and coexpressed in common myeloid progenitors (CMP), granulocyte/monocyte progenitors (GMP) and megakaryocyte/erythroid progenitors (MEP) (GEO Microarray, GSE24759). Transcription factor ChIP-Seq data from the ENCODE project confirmed that, in K562 cell line, among the 12 genes identified above, GCSAML, EPAS1, FCER1A, HDC, IL1RL1, MGAT3, RDH11 and SLC45A3 were direct GATA2 targets. To extend this analysis, the gene expression dataset from Radich et al study (Proc Natl Acad Sci USA 2006;103:2794-9 - GEO Microarray, GSE4170), based on 108 peripheral blood samples from patients with CP-CML (n=57), accelerated phase (AP)-CML (n=17) or blastic crisis (BC)-CML (n=22 myeloid BC, n=12 B-cell lymphoblastic BC) were reanalyzed, and confirmed that GATA2 expression level was significantly correlated to the one of the basophil-related genes FCER1A, HDC and SLC45A3 in CP-CMLs. It also showed that GATA2 expression level significantly increased from CP-CMLs to myeloid BC-CMLs, whereas it was expressed at the lowest levels in lymphoblastic BC-CMLs. Similar results were observed when analyzing the dataset from Cramer-Morales et al study (Blood 2013;122:1293-304 - GEO Microarray, GSE47927), in which GATA2 was expressed at significantly higher levels in the hematopoietic stem cell, multipotent progenitors, CMP, GMP, and MEP compartments in myeloid BC-CMLs, when compared to the same compartment in AP-CMLs, CP-CMLs or in healthy volunteers. Therefore, GATA2 is a key gene affecting the outcome of CP-CMLs and the evolution into myeloid BC-CMLs. GATA2 is associated with a basophil-related gene expression signature that might explain the prognostic influence of the basophil percentage within the EUTOS score. Disclosures Gardembas: Novartis: Speakers Bureau. Spentchian:Novartis: Research Funding. Giles:Novartis: Consultancy, Honoraria, Research Funding. Hochhaus:Pfizer: Honoraria, Research Funding; ARIAD: Honoraria, Research Funding; Bristol-Myers Squibb: Honoraria, Research Funding; Novartis: Honoraria, Research Funding. Radich:Gilliad: Consultancy; Incyte: Consultancy; Novartis: Consultancy, Research Funding; Ariad: Consultancy. Rousselot:Pfizer: Consultancy; BMS: Consultancy, Speakers Bureau; Novartis: Speakers Bureau.

scholarly journals Point-of-care ultrasonography (POCUS) in hemophilia A: a commentary on current status and its potential role for improving prophylaxis management in severe hemophilia A

2017 ◽  
Vol 8 (4) ◽  
pp. 153-156 ◽  
Author(s):  
Suchitra S. Acharya ◽  
Brittny Rule ◽  
Omar McMillan ◽  
Thomas J. Humphries
Keyword(s):  
Hemophilia A ◽  
Point Of Care ◽  
Scoring Systems ◽  
Current Status ◽  
Recurrent Bleeding ◽  
Severe Hemophilia ◽  
Transitional Age ◽  
Point Of Care Ultrasonography ◽  
User Friendly

In patients with severe hemophilia A, recurrent bleeding into joints results in increased morbidity and reduced quality of life. Prophylaxis using replacement factor products, especially when initiated early, has established benefits in terms of reducing joint bleeds and preserving joint function. Poor adherence to prophylactic regimens is a common cause for breakthrough bleeds and resultant arthropathy. Improving prophylaxis management, especially in the transitional age group, is a challenge. Here, we discuss the current status of ultrasonography (US) in hemophilia A, challenges in its wider implementation, and the potential for use of point-of-care US (POCUS) as an adjunct in the routine management of patients with hemophilia following prophylaxis regimens. Using POCUS, in which US is performed by trained hematologists and nonphysician operators (rather than comprehensive US performed by imaging specialists), specific clinical questions can be addressed in a time-efficient, user-friendly manner to promote adherence to prophylaxis and guide or modify treatment approaches. This review also discusses barriers to acceptance of POCUS as a part of routine management of patients with hemophilia, including questions related to its diagnostic accuracy, dependence on trained operators, agreement on appropriate scoring systems, and potential usefulness in patient management.

scholarly journals Consistency Test between Scoring Systems for Predicting Outcomes of Chronic Myeloid Leukemia in a Saudi Population Treated with Imatinib

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Haneen R. Banjar ◽  
Enaam Alsobhi
Keyword(s):  
Chronic Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Quantitative Polymerase Chain Reaction ◽  
Hematological Parameters ◽  
Prognostic Score ◽  
Scoring Systems ◽  
Transcript Level ◽  
Prognostic Scores ◽  
Molecular Response ◽  
Risk Categories

Inconsistency in prognostic scores occurs where two different risk categories are applied to the same chronic myeloid leukemia (CML) patient. This study evaluated common scoring systems for identifying risk groups based on patients’ molecular responses to select the best prognostic score when conflict prognoses are obtained from patient profiles. We analyzed 104 patients diagnosed with CML and treated at King Abdulaziz Medical City, Saudi Arabia, who were monitored for major molecular response (achieving a BCR-ABL1 transcript level equal to or less than 0.1%) by Real-Time Quantitative Polymerase Chain Reaction (RQ-PCR), and their risk profiles were identified using Sokal, Hasford, EUTOS, and ELTS scores based on the patients’ clinical and hematological parameters at diagnosis. Our results found that the Hasford score outperformed other scores in identifying risk categories for conflict groups, with an accuracy of 63%.

scholarly journals EP-1403: Tolerance level assessment for different patient groups during clinical implementation of in vivo dosimetry

2015 ◽  
Vol 115 ◽  
pp. S757
Author(s):  
L.R. Rutonjski ◽  
B.P. Borislava Petrovic ◽  
M.B. Milutin Baucal ◽  
M.T. Milan Teodorovic ◽  
O.C. Ozren Cudic ◽  
...  
Keyword(s):  
In Vivo Dosimetry ◽  
Clinical Implementation ◽  
Tolerance Level ◽  
Patient Groups

scholarly journals Shared decision-making in food allergy management

2020 ◽  
Vol 2 (1) ◽  
pp. 124-127
Author(s):  
Meera Patrawala ◽  
Gerald Lee ◽  
Brian Vickery
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Food Allergy ◽  
Shared Decision Making ◽  
Health Care Providers ◽  
Decision Aids ◽  
Shared Decision ◽  
Care Providers ◽  
Patient Centered ◽  
Evidenced Based

Historically, the role of the health-care provider in medical practice has been primarily paternalistic by offering information, compassion, and decisive views with regard to medical decisions. This approach would exclude patients in the decision-making process. In a shift toward more patient-centered care, health-care providers are routinely encouraged to practice shared decision making (SDM). SDM uses evidence-based information about the options, elicitation of patient preferences, and decision support based on the patient’s needs with the use of decision aids or counseling. Although there are well-known benefits of SDM, including improvements in psychological, clinical, and health-care system domains providers have found it challenging to apply SDM in everyday clinical practice. In allergy, we have a unique role in the treatment of children and adults, and SDM should be applied appropriately when engaging with these specific groups. There are many situations in which there is not a clear best option (food allergy testing, food introduction and challenges, and immunotherapy). Therefore, decision aids specific to our field, coupled with evidenced-based information that ultimately leads to a decision that reflects the patient’s values will make for a vital skill in practice. In this article, we defined SDM, the benefits and barriers to SDM, unique situations in SDM, and approach to SDM in food allergy.

scholarly journals An Update on Alcoholic Steatohepatitis

2015 ◽  
Vol 3 (1) ◽  
pp. 54-59
Author(s):  
Bickram Pradhan ◽  
Lubina Arjyal ◽  
Shatdal Chaudhary
Keyword(s):  
Alcoholic Hepatitis ◽  
Elevated Serum ◽  
Early Death ◽  
Scoring Systems ◽  
Prognostic Scores ◽  
Prognostic Models ◽  
Impaired Liver Function ◽  
Impaired Liver ◽  
Short Term Mortality ◽  
End Stage

Alcoholic steato hepatitis (ASH) is an acute hepatic manifestation occurring from heavy alcohol ingestion. It is associated with liver failure, hepatorenal syndrome, severe sepsis and increased mortality. Patients with severe ASH have reported short-term mortality of up to 40%-50%. Although approximately 20% of alcoholics undergoing liver biopsy reveal histological features of alcoholic hepatites (AH) only a minority progress to severe alcoholic hepatitis (AH) with markedly elevated serum liver enzymes, jaundice and impaired liver function. Prognostic scores include the Maddrey's discriminant function, the model of end-stage liver disease, the Glasgow Alcoholic Hepatitis score, and the ABIC score. The response to corticosteroid therapy can be assessed using the Lille model. Severe ASH at risk of early death should be identified by one of the available prognostic scoring systems before considering specific therapies. Corticosteroids are the mainstay of treatment for severe ASH. When corticosteroids are contraindicated, Pentoxifylline may be alternatively used. This review article aims to discuss the clinical features, diagnosis, prognostic models, and treatment of ASH.Journal of Universal College of Medical Sciences Vol. 3, No. 1, 2015: 54-59

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