P86 PANC Study - Pancreatitis: A National Cohort Study

Introduction Pancreatitis is a common, yet complex, surgical presentation with an incidence of approximately 56 cases per 100,000 people per year in the UK. The management of pancreatitis can vary significantly between different regions, hospitals or clinicians despite a number of national and international guidelines. Historic regional studies in the UK have shown management to be suboptimal with regards to time to diagnosis, higher dependency care or dynamic CT for severe cases and time to definitive treatment of gallstones. Aim We aim to assess current variation in practice in the management of patients diagnosed with early acute pancreatitis. This will identify areas for future research need, and give the groundwork for a potential future model of ambulatory care in a select subgroup of patients. Study design Pancreatitis: A National Cohort Study (PANC Study) is a multicentre, prospective cohort audit which will be conducted through trainee-led research collaboratives in Spring 2021. All patients >18 years, presenting with a diagnosis of acute pancreatitis by modified Atlanta classification, will be included during the 2-month collection period. Data will only be collected for the first 30-days from presentation. The data collected will include patient demographics, admission observations and investigations, aetiology, management and complications and will be anonymised and uploaded onto an online platform for analysis. Conclusions Management of pancreatitis has not been previously assessed nationally in the UK. Obtaining data on population characteristics, management choices and patient outcomes will allow for resource planning so that the service provision reflects local and national population needs.

Audit of oxygen administration to achieve a target oxygen saturation range in acutely unwell medical patients

Purpose of the studyTo evaluate documentation of a target oxygen saturation (SpO2) range and ability to achieve this range in acutely unwell inpatients.Study designIn this single-centre audit, patients with discharge diagnoses of pneumonia, heart failure and exacerbation of asthma or COPD admitted to Wellington Regional Hospital, New Zealand between 1 June 2019 and 31 August 2019 who received oxygen were identified. In those with a documented target SpO2 range, the proportion of SpO2 measurements in the observation chart which were within, above and below range were determined as well as the maximum and minimum SpO2. Regression analysis was performed to determine whether these outcomes were influenced by the prescribed range, high-dependency care or the number of adjustments to oxygen administration.Results268 admissions were screened. Of the 100 eligible admissions who received oxygen, a target SpO2 range was documented in 62. The mean (SD) proportion of SpO2 measurements within range was 56.2 (30.6)%. A hypercapnic target SpO2 range was associated with a higher probability of an SpO2 above range; multivariate OR 5.34 (95% CI 1.65 to 17.3, p=0.006) and a lower probability of an SpO2 below range; multivariate OR 0.25 (95% CI 0.08 to 0.80) p=0.02. The mean (SD) maximum SpO2 was similar in those with a target range of 92%–96% versus a hypercapnic range; 96.2 (3.0)% and 95.2 (3.4)%, respectively.ConclusionsOxygen prescription and delivery in this clinical setting was suboptimal. SpO2 values above the designated range are common, particularly in patients with a hypercapnic target range.

Consideraciones en la estimación de costes de un sistema de atención domiciliaria para la atención de la dependencia en Chile. Considerations in estimating costs of a home care system for dependency care in Chile

El envejecimiento de la población ocurrido en los países ricos se está produciendo ahora en algunos países en vías de desarrollo. En América Latina, todo indica que este proceso se desarrollará más rápido, con peores estados de salud y menos recursos económicos que los de los países que hoy disponen de un sistema de cuidados a la dependencia. Chile es uno de los países latinoamericanos que se acerca más rápidamente a un punto de quiebre que presione la implementación de políticas formales de cuidados. Por ello, es necesario iniciar un proceso de evaluación de costes e impacto de estas posibles políticas. El objetivo de esta investigación fue realizar una estimación de coste de un sistema inicial para el cuidado de personas dependientes en Chile. The ageing population in rich countries is now occurring in some developing countries. In Latin America, everything indicates that this process will develop faster, with worse health states and fewer economic resources than those in countries that now have a dependency care system. Chile is one of the fastest approaching Latin American countries to a breaking point that pushes for formal care policies. Therefore, it is necessary to initiate a process of cost and impact assessment of these possible policies. The objective of this research was to make a cost estimate of an initial system for the care of dependents in Chile.

Incidence of symptomatic, image-confirmed venous thromboembolism following hospitalization for COVID-19 with 90-day follow-up

Although COVID-19 has been reported to be associated with high rates of venous thromboembolism (VTE), the risk of VTE and bleeding after hospitalization for COVID-19 remains unclear, and the optimal hospital VTE prevention strategy is not known. We collected retrospective observational data on thrombosis and bleeding in 303 consecutive adult patients admitted to the hospital for at least 24 hours for COVID-19. Patients presenting with VTE on admission were excluded. Data were collected until 90 days after admission or known death by using medical records and an established national VTE network. Maximal level of care was ward based in 78% of patients, with 22% requiring higher dependency care (12% noninvasive ventilation, 10% invasive ventilation). Almost all patients (97.0%) received standard thromboprophylaxis or were already receiving therapeutic anticoagulation (17.5%). Symptomatic image-confirmed VTE occurred in 5.9% of patients during index hospitalization, and in 7.2% at 90 days after admission (23.9% in patients requiring higher dependency care); half the events were isolated segmental or subsegmental defects on lung imaging. Bleeding occurred in 13 patients (4.3%) during index hospitalization (1.3% had major bleeding). The majority of bleeds occurred in patients on the general ward, and 6 patients were receiving treatment-dose anticoagulation, highlighting the need for caution in intensifying standard thromboprophylaxis strategies. Of 152 patients discharged from the hospital without an indication for anticoagulation, 97% did not receive thromboprophylaxis after discharge, and 3% received 7 days of treatment with low molecular weight heparin after discharge. The rate of symptomatic VTE in this group at 42 days after discharge was 2.6%, highlighting the need for large prospective randomized controlled trials of extended thromboprophylaxis after discharge in COVID-19.

Inserting central lines via the peripheral circulation in neonates

Peripherally inserted central catheters (PICCs) are extensively used in neonatal intensive and high-dependency care settings. These intravenous catheters provide medium to longer-term access to the circulatory system for the delivery of medications, parenteral nutrition and the like. Catheters are available in a variety of bespoke designs and materials, each with their unique characteristics, benefits and limitations. PICCs are frequently inserted in a sterile zone cot-side procedure, one that requires an advanced knowledge base, technical skill and training. This article relates some important practical advice around managing minor complications that can be encountered while using the modified Seldinger technique (MST) to insert neonatal PICCs, which can make this procedure a less stressful experience for both infants and health professionals.

Emergency and high dependency care

Recognition and management of the sick child can generate significant challenges and anxiety for the clinician assessing children presenting with acute medical problems. The shear breadth of differential diagnoses, as well as the pressures of minimizing avoidable hospital admission, can seem daunting. The commonest presentations are detailed in this chapter, with the initial management steps required to stabilization.