scholarly journals 774 Paediatric Appendicitis Score (PAS): A Local Trial of a Risk Prediction Pathway

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Darwich ◽  
J Lim ◽  
A Malik ◽  
S Paul ◽  
K Verma
Keyword(s):  
Inflammatory Markers ◽  
Iliac Fossa ◽  
Clinical Signs ◽  
National Average ◽  
Second Phase ◽  
Prospective Analysis ◽  
Final Phase ◽  
Negative Appendicectomy ◽  
Appendicitis Score ◽  
Surgical Presentation

Abstract Aim Right iliac fossa (RIF) pain remains the commonest acute general surgical presentation in children. Our centre had been an outlier compared with the national average in terms of negative appendicectomy rates. Thus, we designed and implemented a local pathway for risk stratification and management of children with RIF pain. Method The first phase was a retrospective analysis of all appendicectomies performed between April 2018 and March 2019, in children aged five to seventeen years old. Pre-operative inflammatory markers, clinical signs, and histology findings were analysed. Second phase involved designing a pathway utilizing Paediatric Appendicitis Score (PAS), a ten-point scoring system when assessing children with RIF pain. The final phase was a prospective analysis of appendicectomy results performed between August and November 2019, after implementing PAS pathway. Results 92 cases were recruited in the first phase (mean age 12.3). 22 cases were analysed in the final phase after implementing PAS pathway (mean age 10.9). Our negative appendicectomy rates had reduced from 25% to 15.4%. In addition, we found that 96% of positive appendicectomies had either raised inflammatory markers (WCC or CRP), raised PAS (Score of ≥ 4), or both. Conclusions There is noticeable difference in our negative appendicectomy rates since the introduction of PAS pathway. A diagnosis of appendicitis in a child with normal inflammatory markers and PAS score seemed unlikely. Our goal is to continue utilizing the PAS pathway in our department in order to reduce unnecessary surgeries in children.

scholarly journals EP.FRI.101 Paediatric Appendicitis Score (PAS): A local trial of a risk prediction pathway

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Jie Lim ◽  
Ayman Darwich ◽  
Saati Paul ◽  
Afaq Malik ◽  
Keshav Verma
Keyword(s):  
Inflammatory Markers ◽  
Iliac Fossa ◽  
Clinical Signs ◽  
National Average ◽  
Second Phase ◽  
Prospective Analysis ◽  
Final Phase ◽  
Negative Appendicectomy ◽  
Appendicitis Score ◽  
Surgical Presentation

Abstract Introduction Right iliac fossa (RIF) pain remains the commonest acute general surgical presentation in children. Our centre had been an outlier compared with the national average in terms of negative appendicectomy rates. Thus, we designed and implemented a local pathway for risk stratification and management of children with RIF pain. Methods The first phase was a retrospective analysis of all appendicectomies performed between April 2018 and March 2019, in children aged five to seventeen years old. Pre-operative inflammatory markers, clinical signs, and histology findings were analyzed. Second phase involved designing a pathway utilizing Paediatric Appendicitis Score (PAS), a ten-point scoring system when assessing children with RIF pain. The final phase was a prospective analysis of appendicectomy results performed between August and November 2019, after implementing PAS pathway. Results 92 cases were recruited in the first phase (mean age 12.3). 22 cases were analyzed in the final phase after implementing PAS pathway (mean age 10.9).  Our negative appendicectomy rates had reduced from 25% to 15.4%. In addition, we found that 96% of positive appendicectomies had either raised inflammatory markers (WCC or CRP), raised PAS (Score of ≥ 4), or both.  Conclusion There is noticeable difference in our negative appendicectomy rates since the introduction of PAS pathway. A diagnosis of appendicitis in a child with normal inflammatory markers and PAS score seemed unlikely. Our goal is to continue utilizing the PAS pathway in our department in order to reduce unnecessary surgeries in children.

Listening for the “Still Small Voice” of Mendelssohn’s Domestic Elijah

2015 ◽  
Vol 32 (1) ◽  
pp. 40-77
Author(s):  
Peter Mercer-Taylor
Keyword(s):  
Second Phase ◽  
Divine Presence ◽  
Final Phase ◽  
Public And Private ◽  
The Public ◽  
The Third ◽  
Interpretive Approach ◽  
Will To Live ◽  
Three Phases

The notion that there might be autobiographical, or personally confessional, registers at work in Mendelssohn’s 1846 Elijah has long been established, with three interpretive approaches prevailing: the first, famously advanced by Prince Albert, compares Mendelssohn’s own artistic achievements with Elijah’s prophetic ones; the second, in Eric Werner’s dramatic formulation, discerns in the aria “It is enough” a confession of Mendelssohn’s own “weakening will to live”; the third portrays Elijah as a testimonial on Mendelssohn’s relationship to the Judaism of his birth and/or to the Christianity of his youth and adulthood. This article explores a fourth, essentially untested, interpretive approach: the possibility that Mendelssohn crafts from Elijah’s story a heartfelt affirmation of domesticity, an expression of his growing fascination with retiring to a quiet existence in the bosom of his family. The argument unfolds in three phases. In the first, the focus is on that climactic passage in Elijah’s Second Part in which God is revealed to the prophet in the “still small voice.” The turn from divine absence to divine presence is articulated through two clear and powerful recollections of music that Elijah had sung in the oratorio’s First Part, a move that has the potential to reconfigure our evaluation of his role in the public and private spheres in those earlier passages. The second phase turns to Elijah’s own brief sojourn into the domestic realm, the widow’s scene, paying particular attention to the motivations that may have underlain the substantial revisions to the scene that took place between the Birmingham premiere and the London premiere the following year. The final phase explores the possibility that the widow and her son, the “surrogate family” in the oratorio, do not disappear after the widow’s scene, but linger on as “para-characters” with crucial roles in the unfolding drama.

scholarly journals A clinical staging proposal of the disease course over time in non-severe patients with coronavirus disease 2019

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yiting Lin ◽  
Yiqun Wu ◽  
Ping Zhong ◽  
Bingbo Hou ◽  
Jielan Liu ◽  
...  
Keyword(s):  
Inflammatory Markers ◽  
Clinical Signs ◽  
Clinical Staging ◽  
Disease Course ◽  
Prodromal Phase ◽  
The Third ◽  
Convalescent Phase ◽  
Secondary Damage ◽  
Remission Phase ◽  
Over Time

AbstractInformation on the clinical staging of coronavirus disease 2019 (COVID-19) is still limited. This study aimed to propose a clinical staging proposal of the disease course in non-severe patients with COVID-19. In this retrospective study, 108 non-severe patients with COVID-19 were grouped according to the duration from symptoms onset to hospital admission: ≤ 1 week, > 1 to 2 weeks, > 2 to 3 weeks, > 3 to 5 weeks, respectively. The dynamic changes of clinical signs were profiled across the four groups. A clinical staging proposal of the disease course over time was proposed from the perspective of the interaction between the virus and host. The prodromal phase, characterized by pneumonia, significant lymphopenia, and slightly elevated inflammatory markers, occurred in the first week after symptoms onset. In the second week, all the hematological and inflammatory markers were at the peak or bottom. Meanwhile, progressive pneumonia as well as the secondary damage of other organs (e.g. cardiac damage, coagulopathy, etc.) was significant during this period, making the disease progress into the apparent manifestation phase. In the third week, the improvement of the majority of clinical signs accompanied by a relatively high degree of inflammatory response defined the remission phase. After 3 weeks, patients were in the convalescent phase, in which all the indicators were maintained at a relatively normal level. We concluded that the disease course over time in non-severe patients with COVID-19 could be divided into four phases: the prodromal phase (in the first week), the apparent manifestation phase (in the second week), the remission phase (in the third week), and the convalescent phase (after 3 weeks), respectively. In clinical practice, tailored therapies should be considered seriously in different stages of the disease course.

EP.FRI.479 Clinical accuracy of u/sound combined with inflammatory markers in Acute Appendicitis

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Nadia Gulnaz ◽  
Sadia Tasleem ◽  
Farooq Abdullah
Keyword(s):  
Acute Appendicitis ◽  
Clinical Diagnosis ◽  
Inflammatory Markers ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Negative Appendectomy ◽  
Care Hospital ◽  
Clinical Accuracy ◽  
Negative Appendicectomy ◽  
Sensitivity Specificity

Abstract Traditionally acute appendicitis has been a clinical diagnosis based on patients' history and physical examination, but the accuracy of clinical diagnosis ranges from 70-95%. Pre-operative diagnosis of acute appendicitis still remains an enigmatic challenge, because no single test alone can reduce the rate of negative appendectomy. Hence some authors have recommended a combination of two or more investigations to increase accuracy and therefore the use of imaging is gaining support. The objective of the study was to determine the clinical accuracy of ultrasound, combined with inflammatory markers such as CRP, WBC, and neutrophilia keeping histopathology as the gold standard. Methods The study was conducted in a Tertiary care hospital in Peshawar from September 2014 to March 2015 on 250 patients who were clinically diagnosed with acute appendicitis. All these patients underwent u/sound scanning in addition to blood tests. Findings In this study, WBC had the highest sensitivity (77.68%) followed by neutrophil% (69.96%), CRP(67.10%), and U/Sound (62.96%) respectively. While U/Sound had the highest specificity (70.59%) followed by CRP and TLC (64.71% each) and neutrophil% (58.82%) respectively. When all the four tests were combined the sensitivity, specificity, (99.17% and 98.45%) increased significantly. When all four tests were negative, appendicitis could be safely ruled out. Conclusion Acute appendicitis is very unlikely and surgery can be safely deferred in these patients when all tests are negative thereby reducing the negative appendicectomy rates. 

scholarly journals assignFAST: An Autosuggest based tool for FAST Subject Assignment

2014 ◽  
Vol 33 (1) ◽  
pp. 34 ◽  
Author(s):  
Rick Bennett ◽  
Edward T. O'Neill ◽  
Kerre Kammerer
Keyword(s):  
Single Step ◽  
Second Phase ◽  
Final Phase ◽  
Santa Barbara ◽  
Authority Control ◽  
Alternate Form ◽  
Research Activities ◽  
Authority File ◽  
Three Phase ◽  
Subject Assignment

<p><em>Subject assignment is really a three-phase task. The first phase is intellectual—reviewing the material and determining its topic. The second phase is more mechanical, identifying the correct subject heading(s).  The final phase is retyping or cutting and pasting the heading(s) into the cataloging interface along with any diacritics, and potentially correcting formatting and subfield coding. If authority control is available in the interface, some of these tasks may be automated or partially automated.</em></p> <p><em>A cataloger with a reasonable knowledge of </em><a href="http://www.oclc.org/research/activities/fast.html"><em>FAST</em></a><a href="#_edn1">[i]</a>,<a href="#_edn2">[ii]</a><em> or even </em><a href="http://www.loc.gov/catdir/cpso/lcc.html"><em>LCSH</em></a><a href="#_edn3">[iii]</a><em> can quickly get to the proper heading, but usually needs to confirm the final details—was it plural? Am I thinking of an alternate form? Is it inverted? Etc. This often requires consulting the full authority file interface. assignFAST is a Web service that consolidates the entire second phase of the manual process of subject assignment for FAST subjects into a single step based on autosuggest technology.</em></p> <div><br /> <hr size="1" /><div><p><a href="#_ednref1">[i]</a> Chan, Lois Mai and Edward T. O'Neill.  <em>FAST: Faceted Application of Subject Terminology, Prnciples and Applications</em> Libraries Unlimited, Santa Barbara, 2010.<br /> <a href="http://lu.com/showbook.cfm?isbn=9781591587224">http://lu.com/showbook.cfm?isbn=9781591587224</a>.</p></div> <div><p><a href="#_ednref2">[ii]</a> OCLC Research Activities associated with FAST are summarized at  <a href="http://www.oclc.org/research/activities/fast/default.htm">http://www.oclc.org/research/activities/fast/</a></p></div> <div><p><a href="#_ednref3">[iii]</a> Chan, Lois M. <em>Library of Congress Subject Headings : Principles and Application: Principles and Application</em>. Westport, Conn: Libraries Unlimited, 2005.</p></div></div>

scholarly journals Application of multi-based quality function deployment (QFD) model to improve halal meat industry

2019 ◽  
Vol 10 (1) ◽  
pp. 97-124 ◽  
Author(s):  
Iwan Vanany ◽  
Ghoffar Albab Maarif ◽  
Jan Mei Soon
Keyword(s):  
Food Production ◽  
Quality Function Deployment ◽  
Food Industry ◽  
Raw Material ◽  
Second Phase ◽  
Processing Plant ◽  
Final Phase ◽  
Quality Function ◽  
Content Type ◽  
Halal Food

PurposeHalal food market has grown significantly over the years. As consumers are becoming more aware of the significance of halal food products and certification, food industries will benefit from a model that controls and assures halal food production. Quality function deployment (QFD) is a tool to support product design and improve food quality systems. Thus, the purpose of this study is to propose a multi-phased QFD model to identify key processes and prioritise programmes to improve halal food production.Design/methodology/approachThe matrix in the first phase was designed using the halal assurance system (HAS) requirements and the set of production process. The relationships between HAS requirements and a set of halal critical factors [i.e. raw material (chicken), workers, procedures and documentation, equipment and premises] were established in the second phase. In the final phase, potential problems and improvement programmes arising under each critical halal phase were identified. The QFD model was developed and applied in a chicken processing plant in Indonesia.FindingsIn Matrix 1, slaughtering, meat processing and meat delivery were identified as the key process, whilst equipment, procedures and documentation and workers were determined as the most critical halal factors in Matrix 2. The final phase of the QFD approach assisted the chicken processing plant in reducing potential issues by identifying key improvement programmes. The prioritisation of improvement programmes also supports the company in decision-making and allocating their resources accordingly.Practical implicationsThe multi-phased QFD model can be designed and adapted to specific food industry. It can be used to assure halal food production and inform food industry which area to prioritise and to allocate resources accordingly. The improvement of halal food production will assist food companies to target and access international markets.Originality/valueThis study proposed a new multi-phased QFD model that can be used as a halal food assurance and prioritisation tool by the food industry. This model will benefit food industry intending to implement halal assurance scheme in their process, halal auditors and policymakers.

scholarly journals Diagnostic Role of Pediatric Appendicitis Score (PAS) in Appendicitis of Children

2016 ◽  
Vol 6 (1) ◽  
pp. 16-19
Author(s):  
Susankar Kumar Mondal ◽  
AKM Zahid Hossain ◽  
Mizanur Rahman ◽  
Gazi Zahirul Hasan ◽  
Kaniz Hasina ◽  
...  
Keyword(s):  
Predictive Value ◽  
Age Group ◽  
Good Tool ◽  
Suspected Appendicitis ◽  
Diagnostic Role ◽  
Group 5 ◽  
Negative Appendicectomy ◽  
Sensitivity Specificity ◽  
Appendicitis Score

Appendicitis is one of the most common causes of acute abdominal pain in pediatrics and is the most common indication for emergency abdominal surgery in childhood. The diagnosis of pediatric appendicitis remains challenging. To evaluate the role of pediatric appendicitis score (PAS) in the diagnosis of appendicitis of children.Methods: In this study, 200 suspected appendicitis patients attended in four private hospitals in old Dhaka city over a period of about 34 months from January 2011 to May 2014 were selected as study subjects. Patient age, sex and each of the eight PAS components were collected. Children who had PAS less than six were discharged and contacted by telephone upto 1 month to verify final outcome. Rest of the children with PAS equal or more than 6 were underwent appendectomy.Results: Two hundred patients were assessed in this study. Out of them 67 (33.5%) children had appendicitis and 76 (38.0%) children had PAS equal or more than 6. In appendicitis children, maximum (85.3%) children were in age group 10- 16 years and 10 (14.7%) patients were in age group 5-9 years.Male (73.5%) were predominant than female (26.5%) in appendicitis children. Migration of pain, nausea and anorexia were in 43 (63.2%), 45 (66.2%) and 48 (70.6%) appendicitis children respectively. Fever, cough/percussion tenderness and tenderness in RLQ were in 37 (54.4%), 52 (76.5%) and 59 (86.8%) appendicitis children respectively. Leukocytosis andneutophilia were present in 42 (61.8%) and 46 (67.6%) appendicitis children respectively. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy rate of PAS were 80.6%, 83.5%, 71.1%, 89.5% and 82.5% respectively.Conclusion: Paediatric Appendicitis Score is a good tool but not good enough for diagnosis of paediatirc appedicitis. It cannot be recommended for diagnosis of paediatric appendicitis because its negative appendicectomy rate as well as wrongly discharged rate is high.J. Paediatr. Surg. Bangladesh 6(1): 16-19, 2015 (Jan)

scholarly journals Pediatric appendicitis score in the diagnosis of childhood appendicitis: a validation study

2017 ◽  
Vol 4 (6) ◽  
pp. 2196 ◽  
Author(s):  
Kambalabettu Zohara Parveen ◽  
K. Shreedhara Avabratha ◽  
Kishan Shetty
Keyword(s):  
Biopsy Specimen ◽  
Laboratory Tests ◽  
Iliac Fossa ◽  
Diagnostic Value ◽  
College Hospital ◽  
Medical College ◽  
Right Iliac Fossa Pain ◽  
Laboratory Investigations ◽  
A Prospective Study ◽  
Appendicitis Score

Background: Pediatric appendicitis score (PAS) is a scoring system which includes symptoms, physical examination and laboratory tests in children suspected to have appendicitis. The objectives of this study were to analyze the diagnostic value of Paediatric Appendicitis Score and to aid early diagnosis of appendicitis.Methods: A prospective study was done in a Medical College hospital, in Mangalore in children aged between 4-16 years, admitted during study period June to December 2016, with right Iliac fossa pain, suspected to have appendicitis. Data from the children including demographic details, clinical features, laboratory investigations and ultrasound done were recorded in proformas after consent from parents. The PAS score was applied to them. If PAS was between 4-6, PAS scoring was repeated after 6 hours. Investigations done were noted. If child was taken up for surgery, histopathology report of the biopsy specimen was collected. The decision to operate or manage conservatively was taken up by the treating pediatric surgeon. PAS score was compared with ultrasound and biopsy report.Results: Sixty children were included in the study. Anorexia, emesis, migration pain, cough tenderness and leukocytosis were the features most consistently seen in appendicitis. Initial PAS were comparable to the repeat scores. Ultrasound showed presence of appendicitis in 88.3% of the children. Ultrasound showed appendicitis in all children with PAS ≥7. Twenty-six children out of 60 underwent surgery. Out of 20 children with PAS ≥7.15 (75%) were taken up for surgery and biopsy showed appendicitis. Biopsy was done in 26 children, of whom 58.1% had PAS ≥ 7. These findings were statistically significant. Conclusions: Paediatric appendicitis score is a valuable tool in diagnosing childhood appendicitis.

scholarly journals Idiopathic Omental Infarction Mimic Acute Appendicitis: A Case Report

2020 ◽  
pp. 1-3
Author(s):  
Hamad Almakinzy ◽  
Bandar Idress ◽  
Hamad Almakinzy
Keyword(s):  
Case Report ◽  
Acute Appendicitis ◽  
Acute Abdomen ◽  
Inflammatory Markers ◽  
Iliac Fossa ◽  
Young Patients ◽  
Acute Onset ◽  
First Case ◽  
Laparoscopy Surgery ◽  
The Right

Idiopathic Omental Infarct (IOI) is a rare cause of an acute abdomen that arises from an interruption of blood supply to the omentum. Since first case was described by Elitelin 1899, more than 300 cases have been published [1]. It can mimic serious surgical pathology. It occurs in <1% of appendicitis cases [2]. It’s challenge to diagnose, as features may mimic acute appendicitis and therefore in young patients, may only be discovered intra-operative. Here, we present a case of omental infarct in 26-year-old gentleman with no significant medical or surgical background who present with acute onset of right iliac fossa (RIF) pain. Examination revealed tenderness over the right iliac fossa and was having localized rebound. His inflammatory markers were high. He was successfully treated with laparoscopy surgery and he was subsequently discharged the following day.

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