Neonatal Cholestasis: Updates on Diagnostics, Therapeutics, and Prevention

NeoReviews ◽  
2021 ◽  
Vol 22 (12) ◽  
pp. e819-e836
Author(s):  
Amy G. Feldman ◽  
Ronald J. Sokol
Keyword(s):  
Liver Disease ◽  
Biliary Atresia ◽  
Young Infant ◽  
Management Strategies ◽  
Bloodstream Infections ◽  
Cost Effective ◽  
Central Line ◽  
Primary Indication ◽  
Effective Diagnosis ◽  
Made In

Cholestatic jaundice is a common presenting feature of hepatobiliary and/or metabolic dysfunction in the newborn and young infant. Timely detection of cholestasis, followed by rapid step-wise evaluation to determine the etiology, is crucial to identify those causes that are amenable to medical or surgical intervention and to optimize outcomes for all infants. In the past 2 decades, genetic etiologies have been elucidated for many cholestatic diseases, and next-generation sequencing, whole-exome sequencing, and whole-genome sequencing now allow for relatively rapid and cost-effective diagnosis of conditions not previously identifiable via standard blood tests and/or liver biopsy. Advances have also been made in our understanding of risk factors for parenteral nutrition–associated cholestasis/liver disease. New lipid emulsion formulations, coupled with preventive measures to decrease central line–associated bloodstream infections, have resulted in lower rates of cholestasis and liver disease in infants and children receiving long-term parental nutrition. Unfortunately, little progress has been made in determining the exact cause of biliary atresia. The median age at the time of the hepatoportoenterostomy procedure is still greater than 60 days; consequently, biliary atresia remains the primary indication for pediatric liver transplantation. Several emerging therapies may reduce the bile acid load to the liver and improve outcomes in some neonatal cholestatic disorders. The goal of this article is to review the etiologies, diagnostic algorithms, and current and future management strategies for infants with cholestasis.

scholarly journals Evolution of proteomic biomarker for chronic liver disease Promise into reality

2018 ◽  
Vol 7 (1) ◽  
Author(s):  
Krishna Sumanth Nallagangula ◽  
KN Shashidhar ◽  
V Lakshmaiah ◽  
  Muninarayana
Keyword(s):  
Liver Disease ◽  
Chronic Liver Disease ◽  
Cost Effective ◽  
Chronic Liver ◽  
Protein Domain ◽  
Potential Cost ◽  
Protein Biomarker ◽  
Assay Optimization ◽  
Proteomic Approach ◽  
Effective Diagnosis

Liver is the vital organ for synthesis of proteins whose concentration in blood reflects liver dysfunction. Variations in protein domain can generate clinically significant biomarkers. Biomarker pipeline includes discovery of candidates, qualification, verification, assay optimization, and validation. Advances in proteomic approach can discover protein biomarker candidates based on “up-or-down” regulation or fold change in expression which is correlated with disease state. Despite numerous biomarker candidates been discovered, only few are useful in clinical practice which indicates the need for well-established validation regimen. Hence, the main purpose of this review is to understand the protein biomarker development and pitfalls. Companion diagnostics provide insights into potential cost-effective diagnosis for chronic liver disease.

Achieving Near-Zero and Zero: Who Said Interventions and Controls Don't Matter?

2013 ◽  
Vol 18 (3) ◽  
pp. 157-163 ◽  
Author(s):  
Donna Matocha
Keyword(s):  
Evidence Based Practice ◽  
Bloodstream Infections ◽  
Cost Effective ◽  
Central Line ◽  
Evidence Based ◽  
Product Selection ◽  
Process Improvements ◽  
Crucial Part ◽  
Simple Average ◽  
Central Line Bundle

AbstractBackground: Implementation of the Institute for Healthcare Improvement's Central Line Bundle in 2005 did not result in attainment of 0 central line-associated bloodstream infections (CLABSIs).Purpose: To establish process improvements to eliminate CLABSIs.Methods: Infection Prevention and Intravenous Therapy Departments at our institution formed a collaborative partnership in 2008 to eliminate CLABSIs. Staff education, daily surveillance, and implementing evidence-based practice into policies, protocols, and product selection were utilized. A study designed to capture and track multiple interventions from the beginning versus time was implemented.Results: There were a total of 7 CLABSIs over 5 years, which trended down by year from 3 to 2 to 1 to 1 to 0. The average annual CLABSI rate of infections per 1,000 catheter line days declined from 1.068 to 0.849 to 0.508 to 0.449 to 0.000. The full 3-year simple average from 2009 to 2011, after all of the key interventions were phased-in, was 0.3048.Conclusions: Collaboration and commitment played a role in implementing changes. Empowering staff through education that increases knowledge, understanding, and skills improves patient safety and patient outcomes. Process changes and practice protocols supported by evidence-based practice along with efficacious products played a crucial part in getting to 0 CLABSIs. Layered kits with products placed in the correct order of use can increase aseptic technique compliance. Prompt identification of individual CLABSI episodes with prompt intervention to the specific individuals involved has been shown to be cost-effective and can be implemented in most hospitals.

Limnological characteristics, community metabolism and management strategies of a coastal sinkhole in Cuba (Cenote Jennifer)

2020 ◽  
Vol 56 ◽  
pp. 24
Author(s):  
Roberto González-De Zayas ◽  
Liosban Lantigua Ponce de León ◽  
Liezel Guerra Rodríguez ◽  
Felipe Matos Pupo ◽  
Leslie Hernández-Fernández
Keyword(s):  
Hydrogen Sulfide ◽  
Primary Productivity ◽  
Major Ions ◽  
Saline Water ◽  
Management Strategies ◽  
Tourist Destination ◽  
Community Metabolism ◽  
Morphological Studies ◽  
Made In ◽  
Limnological Parameters

The Cenote Jennifer is an important and unique aquatic sinkhole in Cayo Coco (Jardines del Rey Tourist Destination) that has brackish to saline water. Two samplings were made in 1998 and 2009, and 4 metabolism community experiments in 2009. Some limnological parameters were measured in both samplings (temperature, salinity, pH, dissolved oxygen major ions, hydrogen sulfide, nutrients and others). Community metabolism was measured through incubated oxygen concentration in clear and dark oxygen bottles. Results showed that the sinkhole limnology depends on rainfall and light incidence year, with some stratification episodes, due to halocline or oxycline presence, rather than thermocline. The sinkhole water was oligotrophic (total nitrogen of 41.5 ± 22.2 μmol l−1 and total phosphorus of 0.3 ± 0.2 μmol l−1) and with low productivity (gross primary productivity of 63.0 mg C m−2 d−1). Anoxia and hypoxia were present at the bottom with higher levels of hydrogen sulfide, lower pH and restricted influence of the adjacent sea (2 km away). To protect the Cenote Jennifer, tourist exploitation should be avoided and more resources to ecological and morphological studies should be allocated, and eventually use this aquatic system only for specialized diving. For conservation purposes, illegal garbage disposal in the surrounding forest should end.

1226: SIMPLY ZERO: MAINTAINING THE REDUCTION OF CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTIONS IN THE ICU

2018 ◽  
Vol 46 (1) ◽  
pp. 596-596
Author(s):  
Elise Kumar ◽  
Paul Yodice ◽  
Rezai Fariborz ◽  
Kaitlin Kumar ◽  
Kristin Fless ◽  
...  
Keyword(s):  
Bloodstream Infections ◽  
Central Line

Value Analysis of Central Line Simulation-Based Education

2021 ◽  
pp. 000313482110111
Author(s):  
Nicholas J. Iglesias ◽  
Taylor P. Williams ◽  
Clifford L. Snyder ◽  
Christian Sommerhalder ◽  
Alexander Perez
Keyword(s):  
Financial Burden ◽  
Bloodstream Infections ◽  
Central Line ◽  
Complication Rates ◽  
Qualitative Synthesis ◽  
Reporting Standard ◽  
Value Analysis ◽  
Learner Analysis ◽  
Simulation Based ◽  
Value Propositions

Background Central line-associated bloodstream infections (CLABSIs) are preventable complications that pose a significant health risk to patients and place a financial burden on hospitals. Central line simulation-based education (SBE) efforts vary widely in the literature. The aim of this study was to perform a value analysis of published central line SBE and develop a refined method of studying central line SBE. Methods A database search of PubMed Central and Cumulative Index to Nursing and Allied Health Literature (CINAHL) was performed for articles mentioning “Cost and CLABSI,” “Cost and Central line Associated Bloodstream Infections,” and “Cost and Central Line” in their abstract and article body. Articles chosen for qualitative synthesis mentioned “simulation” in their abstract and article body and were analyzed based on the following criteria: infection rate before vs. after SBE, cost of simulation, SBE design including simulator model used, and learner analysis. Results Of 215 articles identified, 23 were analyzed, 10 (43.48%) discussed cost of central line simulation with varying criteria for cost reporting, 8 (34.8%) numerically discussed central line complication rates (7 CLABSIs and 1 pneumothorax), and only 3 (13%) discussed both (Figure). Only 1 addressed the true cost of simulation (including space rental, equipment startup costs, and faculty salary) and its longitudinal effect on CLABSIs. Conclusion Current literature on central line SBE efforts lacks value propositions. Due to the lack of value-based data in the area of central line SBE, the authors propose a cost reporting standard for use by future studies reporting central line SBE costs.

An evaluation of a shoulder rehabilitation class in a UK hospital following evidence-based modifications

2021 ◽  
pp. 1-8
Author(s):  
Emily Kell ◽  
John A. Hammond ◽  
Sophie Andrews ◽  
Christina Germeni ◽  
Helen Hingston ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Shoulder Pain ◽  
Management Strategies ◽  
Cost Effective ◽  
Rehabilitation Programme ◽  
Patient Specific ◽  
Satisfaction Survey ◽  
Evidence Based ◽  
Patient Satisfaction Survey ◽  
Significant Difference

OBJECTIVES: Shoulder pain is a common musculoskeletal disorder, which carries a high cost to healthcare systems. Exercise is a common conservative management strategy for a range of shoulder conditions and can reduce shoulder pain and improve function. Exercise classes that integrate education and self-management strategies have been shown to be cost-effective, offer psycho-social benefits and promote self-efficacy. This study aimed to examine the effectiveness of an 8-week educational and exercise-based shoulder rehabilitation programme following the introduction of evidence-based modifications. METHODS: A retrospective evaluation of a shoulder rehabilitation programme at X Trust was conducted, comparing existing anonymised Shoulder Pain and Disability Index (SPADI) and Patient-Specific Functional Scale (PSFS) scores from two cohorts of class participants from 2017-18 and 2018-19 that were previously collected by the physiotherapy team. Data from the two cohorts were analysed separately, and in comparison, to assess class efficacy. Descriptive data were also analysed from a patient satisfaction survey from the 2018-19 cohort. RESULTS: A total of 47 patients completed the 8-week shoulder rehabilitation programme during the period of data collection (2018-2019). The 2018-19 cohort showed significant improvements in SPADI (p 0.001) and PSFS scores (p 0.001). No significant difference was found between the improvements seen in the 2017-18 cohort and the 2018-19 cohort. 96% of the 31 respondents who completed the patient satisfaction survey felt the class helped to achieve their goals. CONCLUSION: A group-based shoulder rehabilitation class, which included loaded exercises and patient education, led to improvements in pain, disability and function for patients with rotator cuff related shoulder pain (RCRSP) in this outpatient setting, but anticipated additional benefits based on evidence were not observed.

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