scholarly journals Recent advances in understanding and managing acute pancreatitis

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 959 ◽  
Author(s):  
Amar Mandalia ◽  
Erik-Jan Wamsteker ◽  
Matthew J. DiMagno
Keyword(s):  
Acute Pancreatitis ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Biliary Pancreatitis ◽  
Treatment Interventions ◽  
Local Complication ◽  
Acute Biliary Pancreatitis

This review highlights advances made in recent years in the diagnosis and management of acute pancreatitis (AP). We focus on epidemiological, clinical, and management aspects of AP. Additionally, we discuss the role of using risk stratification tools to guide clinical decision making. The majority of patients suffer from mild AP, and only a subset develop moderately severe AP, defined as a pancreatic local complication, or severe AP, defined as persistent organ failure. In mild AP, management typically involves diagnostic evaluation and supportive care resulting usually in a short hospital length of stay (LOS). In severe AP, a multidisciplinary approach is warranted to minimize morbidity and mortality over the course of a protracted hospital LOS. Based on evidence from guideline recommendations, we discuss five treatment interventions, including intravenous fluid resuscitation, feeding, prophylactic antibiotics, probiotics, and timing of endoscopic retrograde cholangiopancreatography (ERCP) in acute biliary pancreatitis. This review also highlights the importance of preventive interventions to reduce hospital readmission or prevent pancreatitis, including alcohol and smoking cessation, same-admission cholecystectomy for acute biliary pancreatitis, and chemoprevention and fluid administration for post-ERCP pancreatitis. Our review aims to consolidate guideline recommendations and high-quality studies published in recent years to guide the management of AP and highlight areas in need of research.

scholarly journals Recent advances in understanding and managing acute pancreatitis

F1000Research ◽  
2019 ◽  
Vol 7 ◽  
pp. 959 ◽  
Author(s):  
Amar Mandalia ◽  
Erik-Jan Wamsteker ◽  
Matthew J. DiMagno
Keyword(s):  
Acute Pancreatitis ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Biliary Pancreatitis ◽  
Treatment Interventions ◽  
Local Complication ◽  
Acute Biliary Pancreatitis

This review highlights advances made in recent years in the diagnosis and management of acute pancreatitis (AP). We focus on epidemiological, clinical, and management aspects of AP. Additionally, we discuss the role of using risk stratification tools to guide clinical decision making. The majority of patients suffer from mild AP, and only a subset develop moderately severe AP, defined as a pancreatic local complication, or severe AP, defined as persistent organ failure. In mild AP, management typically involves diagnostic evaluation and supportive care resulting usually in a short hospital length of stay (LOS). In severe AP, a multidisciplinary approach is warranted to minimize morbidity and mortality over the course of a protracted hospital LOS. Based on evidence from guideline recommendations, we discuss five treatment interventions, including intravenous fluid resuscitation, feeding, prophylactic antibiotics, probiotics, and timing of endoscopic retrograde cholangiopancreatography (ERCP) in acute biliary pancreatitis. This review also highlights the importance of preventive interventions to reduce hospital readmission or prevent pancreatitis, including alcohol and smoking cessation, same-admission cholecystectomy for acute biliary pancreatitis, and chemoprevention and fluid administration for post-ERCP pancreatitis. Our review aims to consolidate guideline recommendations and high-quality studies published in recent years to guide the management of AP and highlight areas in need of research.

scholarly journals Using daily monitoring of psychiatric symptoms to evaluate hospital length of stay

BJPsych Open ◽  
2016 ◽  
Vol 2 (6) ◽  
pp. 341-345 ◽  
Author(s):  
Andrew C. Page ◽  
Nadia K. Cunningham ◽  
Geoffrey R. Hooke
Keyword(s):  
Hospital Stay ◽  
Clinical Decision Making ◽  
Psychiatric Symptoms ◽  
Clinical Decision ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Significant Treatment ◽  
Daily Monitoring ◽  
Additional Information ◽  
Clinically Significant

BackgroundRoutine symptom monitoring and feedback improves out-patient outcomes, but the feasibility of its use to inform decisions about discharge from in-patient care has not been explored.AimsTo examine the potential value to clinical decision-making of monitoring symptoms during psychiatric in-patient hospitalisation.MethodA total of 1102 in-patients in a private psychiatric hospital, primarily with affective and neurotic disorders, rated daily distress levels throughout their hospital stay. The trajectories of patients who had, and had not, met a criterion of clinically significant improvement were examined.ResultsTwo-thirds of patients (n=604) met the clinically significant improvement criterion at discharge, and three-quarters (n=867) met the criterion earlier during their hospital stay. After meeting the criterion, the majority (73.2%) showed stable symptoms across the remainder of their hospital stay, and both classes showed substantially lower symptoms than at admission.ConclusionsMonitoring of progress towards this criterion provides additional information regarding significant treatment response that could inform clinical decisions around discharge readiness.

scholarly journals Can soluble urokinase plasminogen receptor predict outcomes after cardiac surgery?

2020 ◽  
Author(s):  
Chase T Schultz-Swarthfigure ◽  
Philip McCall ◽  
Robert Docking ◽  
Helen F Galley ◽  
Benjamin Shelley
Keyword(s):  
Cardiac Surgery ◽  
Hospital Stay ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Enzyme Linked Immunosorbent Assay ◽  
Urokinase Plasminogen Activator Receptor ◽  
Prolonged Ventilation ◽  
Prolonged Hospital

Abstract OBJECTIVES Soluble urokinase plasminogen activator receptor (suPAR) is a biomarker that has been implicated in several cardiac pathologies and has been shown to be elevated in critically ill populations. We measured plasma suPAR in a cohort of cardiac surgical patients to evaluate its ability to predict prolonged intensive care unit (ICU) and hospital length of stay and development of complications following surgery. We compared suPAR against EuroSCORE II and C-reactive protein (CRP). METHODS Ninety patients undergoing cardiac surgery were recruited with samples taken preoperatively and on postoperative days 1, 2 and 3. suPAR was measured using enzyme-linked immunosorbent assay. Area under the receiver operator curve (AUROC) was used to test predictive capability of suPAR. Comparison was made with EuroSCORE II and CRP. RESULTS suPAR increased over time (P < 0.001) with higher levels in patients requiring prolonged ICU and hospital stay, and prolonged ventilation (P < 0.05). suPAR was predictive for prolonged ICU and hospital stay, and prolonged ventilation at all time points (AUROC 0.66–0.74). Interestingly, this association was also observed preoperatively, with preoperative suPAR predicting prolonged ICU (AUROC 0.66), and hospital stay (AUROC 0.67) and prolonged ventilation (AUROC 0.74). The predictive value of preoperative suPAR compared favourably to EuroSCORE II and CRP. CONCLUSIONS suPAR increases following cardiac surgery and levels are higher in those who require prolonged ICU stay, prolonged hospital stay and prolonged ventilation. Preoperative suPAR compares favourably to EuroSCORE II and CRP in the prediction of these outcomes. suPAR could be a useful biomarker in predicting outcome following cardiac surgery, helping inform clinical decision-making. Clinical registration West of Scotland Research Ethics Committee Reference: 12/WS/0179 (AM01).

scholarly journals Surgical and Transcatheter Pulmonary Valve Replacement: A Single Institution Comparison

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Emily Barron ◽  
John W. Brown ◽  
Mark W. Turrentine ◽  
Mark Hoyer ◽  
Mark H. Rodefeld ◽  
...  
Keyword(s):  
Valve Replacement ◽  
Clinical Decision Making ◽  
Pulmonary Valve ◽  
Clinical Decision ◽  
Stent Migration ◽  
Pulmonary Valve Replacement ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Valve Dysfunction

Background and Hypothesis: Pulmonary valve replacement (PVR) is one of the most commonly performed procedures for patients with congenital heart disease. Transcatheter-based PVR (TPVR) approaches have emerged as alternatives to surgical pulmonary valve replacement (SPVR), but few studies have directly compared clinical outcomes between the two interventions. Further characterization of performance between the two valve procedures may inform clinical decision-making.  Project Methods: Using institutional databases, we identified patients aged ≥ 9 years who underwent either a TPVR or SPVR at Riley Hospital for Children between January 2009 and June 2020. Exclusions were made for previous endocarditis diagnosis, <1 year follow-up, and concomitant left heart procedures. Valve dysfunction was defined as ≥ moderate regurgitation or gradient ≥ 40 mmHg.  Results: 94 (TPVR, n=52; SPVR, n=42) patients met inclusion criteria. Average follow-up for SPVR and TPVR patients was 5.1(2.0,6.7) and 2.9(1.6,4.8) years, respectively (p=0.007). The SPVR cohort was younger, had lower BMI, and underwent more prior sternotomies. Hospital length of stay was shorter after TPVR (1.0 day vs. 5.0 days, p<0.001). Despite being younger, BSA-indexed valve size was larger in the SPVR cohort (14.7 mm/m2 vs 12.9 mm/m2, p<0.001). Short-term mortality (0% vs 2%, p=0.36), endocarditis (0% vs 6%, p=0.11), and reintervention (12% vs 8%, p=0.49) did not differ between groups. Intermediate-term valve dysfunction/failure was greater in SPVR patients (29% vs 12%, p=0.04) with time to dysfunction 809(421,1565) and 1184(181,1627) days for SPVR and TPVR, respectively. Valve implantation failure due to pre-stent migration occurred in 4% of TPVR cases; one required surgical intervention.   Conclusion and Potential Impact: In patients undergoing PVR at our institution, rates of mortality and infective endocarditis are similar between interventions. Intermediate-term valve dysfunction/failure was greater in SPVR cohort, but length of follow-up was significantly longer in these patients. Reintervention rates were similar between procedures. 

scholarly journals Predictors of prolonged hospital stay in HIV-positive patients presenting to the emergency department

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249706
Author(s):  
Abdullah E. Laher ◽  
Fathima Paruk ◽  
Guy A. Richards ◽  
Willem D. F. Venter
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Hiv Positive ◽  
Cross Sectional ◽  
Prolonged Hospitalization ◽  
Prolonged Hospital

Background Prolonged hospitalization places a significant burden on healthcare resources. Compared to the general population, hospital length of stay (LOS) is generally longer in HIV-positive patients. We identified predictors of prolonged hospital length of stay (LOS) in HIV-positive patients presenting to an emergency department (ED). Methods In this cross-sectional study, HIV-positive patients presenting to the Charlotte Maxeke Johannesburg Academic Hospital adult ED were prospectively enrolled between 07 July 2017 and 18 October 2018. Data was subjected to univariate and multivariate logistic regression to determine parameters associated with a higher likelihood of prolonged hospital LOS, defined as ≥7 days. Results Among the 1224 participants that were enrolled, the median (IQR) LOS was 4.6 (2.6–8.2) days, while the mean (SD) LOS was 6.9 (8.2) days. On multivariate analysis of the data, hemoglobin <11 g/dL (OR 1.37, p = 0.032), Glasgow coma scale (GCS) <15 (OR 1.80, p = 0.001), creatinine >120 μmol/L (OR 1.85, p = 0.000), cryptococcal meningitis (OR 2.45, p = 0.015) and bacterial meningitis (OR 4.83, p = 0.002) were significantly associated with a higher likelihood of LOS ≥7 days, while bacterial pneumonia (OR 0.35, p = 0.000) and acute gastroenteritis (OR 0.40, p = 0.025) were significantly associated with a lower likelihood of LOS ≥7 days. Conclusion Various clinical and laboratory parameters are useful in predicting prolonged hospitalization among HIV-positive patients presenting to the ED. These parameters may be useful in guiding clinical decision making and directing the allocation of resources.

scholarly journals In-depth blood proteome profiling analysis revealed distinct functional characteristics of plasma proteins between severe and non-severe COVID-19 patients

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Joonho Park ◽  
Hyeyoon Kim ◽  
So Yeon Kim ◽  
Yeonjae Kim ◽  
Jee-Soo Lee ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Clinical Decision ◽  
Good Prognosis ◽  
Severe Illness ◽  
Proteome Profiling ◽  
T Cell Suppression ◽  
Cell Suppression ◽  
Profiling Analysis ◽  
Necrosis Factor

AbstractThe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected over forty million patients worldwide. Although most coronavirus disease 2019 (COVID-19) patients have a good prognosis, some develop severe illness. Markers that define disease severity or predict clinical outcome need to be urgently developed as the mortality rate in critical cases is approximately 61.5%. In the present study, we performed in-depth proteome profiling of undepleted plasma from eight COVID-19 patients. Quantitative proteomic analysis using the BoxCar method revealed that 91 out of 1222 quantified proteins were differentially expressed depending on the severity of COVID-19. Importantly, we found 76 proteins, previously not reported, which could be novel prognostic biomarker candidates. Our plasma proteome signatures captured the host response to SARS-CoV-2 infection, thereby highlighting the role of neutrophil activation, complement activation, platelet function, and T cell suppression as well as proinflammatory factors upstream and downstream of interleukin-6, interleukin-1B, and tumor necrosis factor. Consequently, this study supports the development of blood biomarkers and potential therapeutic targets to aid clinical decision-making and subsequently improve prognosis of COVID-19.

scholarly journals Clinical decision making and research in hepatocellular carcinoma: Pivotal role of imaging techniques

Hepatology ◽  
2011 ◽  
Vol 54 (6) ◽  
pp. 2238-2244 ◽  
Author(s):  
Jordi Bruix ◽  
Maria Reig ◽  
Jordi Rimola ◽  
Alejandro Forner ◽  
Marta Burrel ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Imaging Techniques ◽  
Clinical Decision ◽  
Pivotal Role

Practice Guidelines for the Diagnosis of COVID-19-Associated Pulmonary Aspergillosis in an Intensive Care Setting

2021 ◽  
pp. 088506662110471
Author(s):  
Zia Hashim ◽  
Zafar Neyaz ◽  
Rungmei S.K. Marak ◽  
Alok Nath ◽  
Soniya Nityanand ◽  
...  
Keyword(s):  
Intensive Care ◽  
Practice Guidelines ◽  
Clinical Management ◽  
Care Setting ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Third Wave ◽  
Intensive Care Setting ◽  
Pulmonary Aspergillosis

Coronavirus disease-2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) is a new disease characterized by secondary Aspergillus mold infection in patients with COVID-19. It primarily affects patients with COVID-19 in critical state with acute respiratory distress syndrome, requiring intensive care and mechanical ventilation. CAPA has a higher mortality rate than COVID-19, posing a serious threat to affected individuals. COVID-19 is a potential risk factor for CAPA and has already claimed a massive death toll worldwide since its outbreak in December 2019. Its second wave is currently progressing towards a peak, while the third wave of this devastating pandemic is expected to follow. Therefore, an early and accurate diagnosis of CAPA is of utmost importance for effective clinical management of this highly fatal disease. However, there are no uniform criteria for diagnosing CAPA in an intensive care setting. Therefore, based on a review of existing information and our own experience, we have proposed new criteria in the form of practice guidelines for diagnosing CAPA, focusing on the points relevant for intensivists and pulmonary and critical care physicians. The main highlights of these guidelines include the role of CAPA-appropriate test specimens, clinical risk factors, computed tomography of the thorax, and non-culture-based indirect and direct mycological evidence for diagnosing CAPA in the intensive care unit. These guidelines classify the diagnosis of CAPA into suspected, possible, and probable categories to facilitate clinical decision-making. We hope that these practice guidelines will adequately address the diagnostic challenges of CAPA, providing an easy-to-use and practical algorithm to clinicians for rapid diagnosis and clinical management of the disease.

Sign in / Sign up

Export Citation Format

Share Document