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Pandanaboyana S, Knoph CS, Olesen SS, Jones M, Lucocq J, Samanta J, Talukdar R, Capurso G, de‐Madaria E, Yadav D, Siriwardena AK, Windsor J, Drewes AM, Nayar M. Opioid analgesia and severity of acute pancreatitis: An international multicentre cohort study on pain management in acute pancreatitis. United European Gastroenterol J 2024; 12:326-338. [PMID: 38439202 PMCID: PMC11017759 DOI: 10.1002/ueg2.12542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/05/2023] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND The effect of analgesic modalities on short-term outcomes in acute pancreatitis remains unknown. However, preclinical models have raised safety concerns regarding opioid use in patients with acute pancreatitis. OBJECTIVE This study aimed to assess the association between analgesics, particularly opioids, and severity and mortality in hospitalised patients with acute pancreatitis. METHODS This prospective multicentre cohort study recruited consecutive patients admitted with a first episode of acute pancreatitis between April 1 and 30 June 2022, with a 1-month follow-up. Data on aetiology, clinical course, and analgesic treatment were collected. The primary outcome was the association between opioid analgesia and acute pancreatitis severity, which was analysed using univariate and multivariate analyses. RESULTS Among a total of 1768 patients, included from 118 centres across 27 countries, 1036 (59%) had opioids administered on admission day, and 167 (9%) received opioids after admission day. On univariate analysis, moderately severe or severe acute pancreatitis was associated with male sex, Asian ethnicity, alcohol aetiology, comorbidity, predicted severe acute pancreatitis, higher pain scores, longer pain duration and opioid treatment (all p < 0.001). On multivariate analysis, comorbidity, alcohol aetiology, longer pain duration and higher pain scores increased the risk of moderately severe or severe acute pancreatitis (all p < 0.001). Furthermore, opioids administered after admission day (but not on admission day) doubled the risk of moderately severe or severe disease (OR 2.07 (95% CI, 1.29-3.33); p = 0.003). Opioid treatment for 6 days or more was an independent risk factor for moderately severe or severe acute pancreatitis (OR 3.21 (95% CI, 2.16-4.79; p < 0.001). On univariate analysis, longer opioid duration was associated with mortality. CONCLUSION Opioid treatment increased the risk of more severe acute pancreatitis only when administered after admission day or for 6 days or more. Future randomised studies should re-evaluate whether opioids might be safe in acute pancreatitis.
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Affiliation(s)
- Sanjay Pandanaboyana
- HPB and Transplant UnitFreeman HospitalNewcastle Upon TyneUK
- Population Health Sciences InstituteNewcastle UniversityNewcastle Upon TyneUK
| | - Cecilie Siggaard Knoph
- Centre for Pancreatic Diseases, Department of Gastroenterology & HepatologyAalborg University HospitalAalborgDenmark
- Department of Clinical MedicineAalborg UniversityAalborgDenmark
| | - Søren Schou Olesen
- Centre for Pancreatic Diseases, Department of Gastroenterology & HepatologyAalborg University HospitalAalborgDenmark
- Department of Clinical MedicineAalborg UniversityAalborgDenmark
| | - Michael Jones
- HPB and Transplant UnitFreeman HospitalNewcastle Upon TyneUK
| | - James Lucocq
- Department of HPB SurgeryRoyal Infirmary of EdinburghEdinburghUK
| | - Jayanta Samanta
- Department of GastroenterologyPost Graduate Institute of Medical Education and ResearchChandigarhIndia
| | | | - Gabriele Capurso
- Pancreatico‐Biliary Endoscopy DivisionVita‐Salute San Raffaele UniversityMilanItaly
| | - Enrique de‐Madaria
- Gastroenterology DepartmentDr. Balmis General University HospitalAlicanteSpain
| | - Dhiraj Yadav
- Division of Gastroenterology & HepatologyUniversity of Pittsburgh Medical CentrePittsburghPennsylvaniaUSA
| | | | - John Windsor
- Surgical and Translational Research CentreUniversity of AucklandAucklandNew Zealand
| | - Asbjørn Mohr Drewes
- Centre for Pancreatic Diseases, Department of Gastroenterology & HepatologyAalborg University HospitalAalborgDenmark
- Department of Clinical MedicineAalborg UniversityAalborgDenmark
| | - Manu Nayar
- HPB and Transplant UnitFreeman HospitalNewcastle Upon TyneUK
- Population Health Sciences InstituteNewcastle UniversityNewcastle Upon TyneUK
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Morreau M, Cheah E, Thakur S, Hong J, Hickey A, Phillips A, Windsor J. Luminal Delivery of Pectin-Modified Oxygen Microbubbles Mitigates Rodent Experimental Intestinal Ischemia. J Surg Res 2024; 296:603-611. [PMID: 38350299 DOI: 10.1016/j.jss.2024.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/12/2024] [Accepted: 01/18/2024] [Indexed: 02/15/2024]
Abstract
INTRODUCTION Ischemic gut injury is common in the intensive care unit, impairs gut barrier function, and contributes to multiorgan dysfunction. One novel intervention to mitigate ischemic gut injury is the direct luminal delivery of oxygen microbubbles (OMB). Formulations of OMB can be modified to control the rate of oxygen delivery. This project examined whether luminal delivery of pectin-modified OMB (OMBp5) can reduce ischemic gut injury in a rodent model. METHODS The OMBp5 formulation was adapted to improve delivery of oxygen along the length of small intestine. Adult Sprague-Dawley rats (n = 24) were randomly allocated to three groups: sham-surgery (SS), intestinal ischemia (II), and intestinal ischemia plus luminal delivery of OMBp5 (II + O). Ischemia-reperfusion injury was induced by superior mesenteric artery occlusion for 45 min followed by reperfusion for 30 min. Outcome data included macroscopic score of mucosal injury, the histological score of gut injury, and plasma biomarkers of intestinal injury. RESULTS Macroscopic, microscopic data, and intestinal injury biomarker results demonstrated minimal intestinal damage in the SS group and constant damage in the II group. II + O group had a significantly improved macroscopic score throughout the gut mucosa (P = 0.04) than the II. The mean histological score of gut injury for the II + O group was significantly improved on the II group (P ≤ 0.01) in the proximal intestine only, within 30 cm of delivery. No differences were observed in plasma biomarkers of intestinal injury following OMBp5 treatment. CONCLUSIONS This proof-of-concept study has demonstrated that luminal OMBp5 decreases ischemic injury to the proximal small intestine. There is a need to improve oxygen delivery over the full length of the intestine. These findings support further studies with clinically relevant end points, such as systemic inflammation and vital organ dysfunction.
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Affiliation(s)
- Mathew Morreau
- Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
| | - Ernest Cheah
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Sachin Thakur
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jiwon Hong
- Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Applied Surgery and Metabolism Laboratory, School of Biological Science, Faculty of Sciences, University of Auckland, Auckland, New Zealand
| | - Anthony Hickey
- Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Applied Surgery and Metabolism Laboratory, School of Biological Science, Faculty of Sciences, University of Auckland, Auckland, New Zealand
| | - Anthony Phillips
- Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Applied Surgery and Metabolism Laboratory, School of Biological Science, Faculty of Sciences, University of Auckland, Auckland, New Zealand
| | - John Windsor
- Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; HBP/Upper GI Unit, Department of General Surgery, Auckland City Hospital, Te Whatu Ora Te Toka Tumai, Auckland, New Zealand
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Law B, Windsor J, Connor S, Koea J, Srinivasa S. Best supportive care in advanced pancreas cancer: a systematic review to define a patient-care bundle. ANZ J Surg 2024. [PMID: 38366699 DOI: 10.1111/ans.18906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 01/17/2024] [Accepted: 01/29/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND The majority of patients with pancreatic adenocarcinoma (PDAC) have advanced disease at presentation, preventing treatment with curative intent. Management of these patients is often provided by surgical teams for whom there are a lack of widely accepted strategies for care. The aim of this study was to conduct a systematic review to identify key issues in patients with advanced PDAC and integrate the evidence to form a care bundle checklist for use in surgical clinics. METHODS A systematic review of the literature was performed regarding best supportive care for advanced PDAC according to the PRISMA guidelines. Interventions pertaining to supportive care were included whilst preventative and curative treatments were excluded. A narrative review was planned. RESULTS Forty-four studies were assessed and four themes were developed: (i) Pain is an undertreated symptom, requiring escalating analgesics and sometimes invasive modalities. (ii) Health-related quality of life necessitates optimisation by involving family, carers and multi-disciplinary teams. (iii) Malnutrition and weight loss can be mitigated with early assessment, replacement therapies and resistance exercise. (iv) Biliary and duodenal obstruction can often be relieved by endoscopic/radiological interventions with surgery rarely required. CONCLUSION This is the first systematic review to evaluate the different types of interventions utilized during best supportive care in patients with advanced PDAC. It provides a comprehensive care bundle for surgeons that informs management of the common issues experienced by patients within a multidisciplinary environment.
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Affiliation(s)
- Bena Law
- The Department of Surgery, North Shore Hospital, Private Bag 93503, Auckland, New Zealand
- The Department of Surgery, University of Auckland, Auckland, New Zealand
| | - John Windsor
- The Department of Surgery, University of Auckland, Auckland, New Zealand
- Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Saxon Connor
- The Department of Surgery, Christchurch Hospital, Private Bag 4710, Christchurch, New Zealand
| | - Jonathan Koea
- The Department of Surgery, North Shore Hospital, Private Bag 93503, Auckland, New Zealand
- The Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Sanket Srinivasa
- The Department of Surgery, North Shore Hospital, Private Bag 93503, Auckland, New Zealand
- The Department of Surgery, University of Auckland, Auckland, New Zealand
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Xu W, Liu G, Varghese C, Wells C, Smith N, Windsor J, Gaborit L, Goh S, Basam A, Elhadi M, Soh RT, Saeed U, Abdulwahed E, Farrell M, Wright D, Martin J, Pockney P, Xu W, Basam A, Goh S, Li J, Shah J, Waraich A, Gaborit L, Pathak U, Hilder A, Elhadi M, Jabur A, Kalyanasundaram K, Ohis C, Ong CF, Park M, Siribaddana V, Raubenheimer K, Vu J, Wells C, Liu G, Ferguson L, Xu W, Varghese C, Pockney P, Atherton K, Dawson A, Martin J, Banerjee A, Dudi-Venkata N, Lightfoot N, Ludbrook I, Peters L, Sara R, Watson D, Wright D, Adeyeye A, Alvarez-Lozada LA, Atici SD, Buhavac M, Calini G, Elhadi M, Ioannidis O, Tepe MD, Nath U, Uzair A, Yang W, Zaidi F, Singh S, Abdullah B, Palacios DSG, Ragab A, Ahmed A, Raubenheimer K, Daudu D, Goh S, Benyani SV, Karthikeyan N, Mansour LT, Seow W, Tasi Z, Jabur A, Pathak U, Park M, Abdelmelek DE, Boussahel IFZ, Kaabache O, Lemdaoui N, Nebbar O, Rais M, Abdoun M, Kouicem AT, Bouaoud S, Bouchenak K, Saada H, Ouyahia A, Messai W, Choong ZS, Ting C, Larkin M, Fong PJ, Soh I, Grandi AD, Iftikhar H, Sinha A, Kapoor D, Chlebicka T, Singer D, Goddard K, Matthews L, Lin R, Chambers J, Chan J, Macnab B, Barker J, Mckenzie M, Ferguson N, Juwaheer G, Muralidharan V, Gill S, Sung N, Patel R, Walters C, Nguyen K, Liu D, Cabalag C, Lee J, Leow SHA, Ng SL, Ashraf H, Mulder F, Loo J, Proud D, Wong S, Zhou Y, Soh QR, Chye D, Stevens S, Tang P, Kritharides S, Dong J, Morice O, Huang D, Hardidge A, Amarasekara M, Kink A, Bolton D, Rawal A, Singh J, Heard M, Hassan Y, Naqeeb A, Cobden A, Prinsloo D, Quadros D, Gunn E, Kim HJ, Ekwebelam J, Shanahan J, Alkazali M, Hoosenally M, Nara N, Nguyen P, Barker S, Hilder A, Hui A, Karmakar A, Wang B, Goonawardena J, Cheung KT, Chan N, Natarajan R, Cade R, Jin R, Sengupta S, Snider R, Morisetty H, Weeda L, Sun P, Chilaka L, Cover J, Gunasekara ADSA, Senthilrajan R, Alwahaib A, Limmer A, Zamanbandhon B, Jaffry K, Shen Y, Chua A, Syed S, Saha S, Glynatsis J, Aitchison L, Lagana B, Crossman M, Watson D, Dawson A, Fong B, Harrison E, Horsburgh E, Glynatsis J, Khoo M, Mishra K, Hewton L, Mesecke A, Tu H, Tun T, Wong J, Ong E, Law TN, Landy A, Leano A, Li A, Soni A, Dowdle B, Pilgrim C, Abeysirigunawardana D, Jeyarajan DR, Patel D, Mckinnon K, Gould M, Gilmore P, Geng R, Loughnan R, Norton-Smith S, Nyame S, Tan S, Yoon SW, Wang Y, Zhang Y, Wang Z, Mare H, Withanage I, Khattar M, Toft A, Sivasuthan G, Zhao H, Addley J, O'brien L, Raza M, Bindra R, Sharma S, Cornwell C, Patil A, Cheung A, Lown A, Dawson A, Blassey A, Ochigbo B, Cheng F, Fatima A, Zhang E, Kocatekin H, Roth C, Brewster D, Kwok K, Chen P, Laura S, Tynan D, Latif E, Lun E, Honore E, Ziergiebel F, Blake J, Chandiok K, Bird K, Ngothanh L, Lee M, El-Masry M, Hamer P, Palaniappan RR, Mcgee R, Huang S, Zhang S, Hariharan S, Silva YD, Lee C, Fotheringham P, Incoll I, Cordingley T, Cheng F, Brown M, Kang L, Wijayaratne R, Moore P, Qian G, Elgindy Y, Carnuccio E, Rae H, Shehata M, Liu M, Lockwood B, Bockxmeer JV, Alsoudani A, Swan D, Hsieh J, Orchard-Hall F, Tay KYJ, Mehra R, Gebeh A, Bailey A, Brown G, Colaco A, Gopal H, Boyley J, Changati V, Fletcher J, Khandelwal T, House C, O'neil C, Jaarsma E, Ly V, Balogh Z, Shui A, Sathasivam V, Legge-Wilkinson H, Wong KH, Chen A, Tran A, Rehfisch P, Wang G, Nguyen J, Peker J, Gallert K, Komesaroff M, Namburi M, Goldfinch E, Muchabaiwa R, Jangam A, Taylor I, Nusem I, Park JH(D, Gundara J, Heigan R, Tran T, Mackay T, Butterworth Y, Sadauskas T, Tung M, Ellepola H, Gan C, Fong H, Das A, Naicker L, Hauptman S, Kamath A, Yew A, Parange A, Kim K, Kharwadkar S, Gamage T, Vance L, Seldon A, Ghaly M, Phan V, Chauhan K, Bassam A, Vollenhoven B, Jaffry K, Mandhan K, Sritharan M, Sakthivel M, Evans N, Robinson S, Sivakumar S, Marrison L, Jollow D, Joshi K, Tao S, Shrestha P, Nukala SK, Hodgson R, Crotty A, Esho A, Harris A, Surkitt A, Bland L, Mcleod B, Yin C, Keng C, Greenwood E, Yuan G, Haege E, Wu H, Xiao H, Pozzi I, Fu J, Ross JS, Gentle J, Gan K, Chang K, Sun K, Singh M, Xie M, Mccabe N, Slavec M, Clarnette N, Niknami B, Zou P, Flintoft S, Jayatilleke S, Sok R, Tan S, Wadhwa S, Swansson W, Abulafia D, Blundell J, Sweetapple A, Solar CD, Martin C, Bell D, Fernando I, Chang J, Vanzuylekom K, Zuylekom KV, Zuylekom KV, Hobbs K, Liang R, Jabur A, Tarmidi J, Ugool M, Beatson N, Bowman S, Moin S, Tan WPJ, Chidambaram S, Gan SW, Wang P, Naicker L, Kim K, Wang NQ, Kwan YX, Patil C, Joshi D, Kamath A, Hanan A, Sheriff A, Duffield J, Naiker L, Smitham P, Neo EL, Chua M, Prasad S, Nagaratnam A, Sammour T, Lin Y, Lee C, Hopping E, Jangra M, Das A, Lin K, Bunjo Z, Raubenheimer K, Yunos MHM, Yeung KL, Phu R, Betts A, Just B, Gera S, Leeson H, Jamieson J, Wang K, Luu E, Innes M, Vu J, Hong J, Dzator S, Flame A, Jiang V, Kwok J, Lawrence A, Meads K, Pearce L, Sarangadasa P, Shaw H, Yu V, Crostella ;E, Wong J, Bobba S, Muller M, Hau YCH, Wilson T, Markovic A, Green J, Forbes C, Burrows E, Hou L, O'sullivan C, Foo J, Greig H, Collins AJ, Chandler C, Heaney E, Gross H, Morgan M, Loder R, Rajesh K, Ananthapadmanabhan S, Razmi A, Vong C, Pothukuchi P, Theophilus M, Sriranjan R, Kaur S, Kanczuk M, Groot JD, Corrigan A, Li D, Badri D, Ciranni D, Needi ET, Clanfield M, Copertino N, Rumble W, Vanguardia MK, Lew C, Dennaoui R, Shah J, Kong J, Koh I, Zeng R, Baziotis-Kalfas K, Denby H, Li A, Tran W, Singh A, Lin O, Chau M, Donaldson O, Min C(S, Ballah S, Tsui SCT, Yong N, Standish L, Tan S, Fujihara A, Davies L, Odisho R, Ravi A, Collins J, Chandra P, Abdelmeguid R, Singh G, Feierdaiweisi X, Seneviratne D, Srivastava S, Yao M, Teng C, Chowdhury N, Vidanagama S, Lin C, Sampatha-Waduge T, Wang E, Yodkitydomying C, Koh I, Silverii J, Lam A, Zeng R, Solanki K, Franks A, Edwards L, Atilhan R, Nandurkar R, Wells O, Vanguardia K, King D, Edwards E, Edwards L, Tran Q, Chau M, Min S, Rauf A, Fu Y, Haximolla H, Shang M, Segaran S, Wang S, Sivakumar G, Sandhu JK, Mishra N, Hauptman S, Chua A, Chene D, Maddern G, Shaw H, Wang Q, Pang S, Lu C, Fung J, Cyr K, Lu K, How MZ, Hu N, Anderson P, Jakanovski P, Youssef A, Tang H, Keenan R, Chan A, Canny M, Tahir F, Egerton J, Yeung J, Chan J, Tiffany L, Bei M, Raj M, Williams P, Nagpal S, Outhred T, Krawitz R, Choi CCM, Younus K, Giurgius M, Kirk R, Pegorer AG, Tang-Ieam P, Ward J, Wijetunga A, Zhang C, Nahm C, Wang C, Golja D, Jenkins G, Qian H, Luong J, Nguyen K, Suttor S, Lai S, Ma V, Chen Y, Yu HH, Lee A, Barbaro A, Mcguinness C, Maddern G, Young S, Lim YF, Trotta G, Chao P, Ding G, Fang C, Lu A, Wagaarachchi P, Cornwell C, Gojnich A, Stewart P, Dong I, Wong K, Burruso L, Hogan L, Mcorist N, Singh R, Jeyamohan R, Hou Z, Lai W, Taylor E, Palacios DSG, Pantoja MAN, Nanez DMB, Hernandez GOP, Jimenez Ramirez LJ, Mohamed M, El-Taher AK, Elewa A, Soliman MA, Diab M, Ali R, Ahmed A, Galal A, Elkhodary A, Alaa A, Faisal A, Badawy A, Eldomiaty D, Sayed MA, Rasslan E, Ramadan M, Fares GE, Altabbaa H, Emad H, Alboridy M, Mongy M, Albarhomy O, Selim O, Rafaei R, Atta R, Altaweel A, Sherif Y, Elghoul Y, Tarek Y, Sabry AA, Moustafa A, AbouHiekal O, Shaqran OA, Haggag Z, Abbas AM, Temerik AR, Atef D, Mahmoud A, Saad MM, Ragab M, Mahmoud AO, Hussien A, Abdelbaky M, Muhammad I, Morad A, Ali A, Hussien A, Shipa A, Aboulfotouh A, Abdelaal AM, Hashem AM, Youssef AA, Morsi A, Ebrahim A, Sayed AM, Kamel AM, Elmaghrabey A, Elgharib AM, Abdelrahman A, Ali A, Abdelnaeam S, Emam A, el-mola AG, Shaban A, Shaltout AS, Nabil B, Barsoum F, Mostafa E, Abdelbaset D, Salah D, Othman D, Othman S, Khairallah NS, Hassan SA, Morsi S, Azer A, Abdelsamed EA, Ahmed R, Ibrahim I, AbdElbaset E, Hamoda E, Monib F, Harb F, Maher H, Ahmed H, Mohammed H, Hana K, Ayoub K, Henes K, Shamshoon K, Soliman K, Hassanein M, Abdelhamid MM, Mahdy M, Khalil M, Ali M, Khalifa M, Amary M, Suliman ME, Abdallah MM, Nasr MSA, Elia M, Adly M, Roshdy M, Ramadan MF, Shahat MA, Abdelnasser MK, Zaed M, Al-Quossi M, Zarzour MA, Hares MM, Abdelfatah MA, Abughanima M, Abdeljaber M, Saber M, Amin MK, Abbas M, Haroon O, Khalil O, Talaat O, Elnagar R, Soliman R, Aboelela R, Salah S, Abdelgawad S, Mohammed T, Hussien TA, Sobhy G, Sayed Y, Silem YOR, Dawood A, Hemaida T, Ahmed R, Kamaleldin A, Zakaria A, Salah M, Salem E, Rashed OFAA, Halawa M, Elfeki H, Mosaad A, Shaaban A, Abdelsalam H, Sakr A, Sanad A, Elsawy A, Maged BM, Hegazy D, Abdelmaksoud M, Laymon M, Taman M, Moawad ER, AboElfarh HE, Elkenawi K, Osama M, Sadek M, Elghazy MA, Attia M, Nader M, Shalaby M, Attiya O, Gaarour OS, Zaghloul A, Mikhail P, Badr K, Soltan H, Donia M, Gaafar M, Abdelwahab K, Sallam A, Eid A, Yousri M, Hamdy O, Al-Touny A, Alshawadfy A, Hamdy A, Ellilly A, Mahdy A, El-Sakka A, Hendawy H, Salah A, Raslan B, Teema E, Albayadi E, Nasser E, Mohamed H, Mahmoud M, Elsaied M, Taha O, Dahshan S, Al-Touny S, Karrar A, Khairy A, Farag A, Deafallah A, Ads AM, Alomar R, AbuShawareb I, Saeed A, Mashaal A, Ads AM, Ghanem S, Elghamry A, Nada EA, Noureldin YA, Fouda MF, Shaheen N, Allam S, Mazrou I, Shehab AF, Kussaili W, Korkolis D, Fradelos E, Sarafi A, Machairas N, Giannakopoulos KS, Stavratis F, Korovesis G, Tsourouflis G, Keramida MD, Kydonakis N, Kykalos S, Syllaios A, Dorovinis P, Schizas D, Ioannidis O, Malliora A, Anestiadou E, Zapsalis K, Kontidis F, Loutzidou L, Ouzounidis N, Bitsianis S, Symeonidis S, Skalidou S, Ioannidis O, Valaroutsou OM, Dagklis T, Arvanitaki A, Mamopoulos A, Athanasiadis A, Kopatsaris S, Kalogiannidis I, Tsakiridis I, Kapetanios G, Papanikolaou E, Tsakiridis N, Zachomitros F, Larentzakis A, Gyftopoulos A, Albanopoulos K, Champipis A, Yiannakopoulos C, Vrakopoulou GZ, Saliaris K, Lathouras K, Skoufias S, Doulami G, Bareka M, Arnaoutoglou E, Angelis F, Angeslis F, Hantes M, Ntalouka M, Al-Juaifari MA, Alwash M, Maala R, Zwain YA, Saleh SA, Khorsheed M, Pesce A, Feo CV, Bernabei M, Petrarulo F, Fabbri N, Labriola R, Barbara SJ, Bosi S, Romano A, Canavese A, Catalioto C, Isopi C, Larotonda C, Dajti G, Rottoli M, Russo IS, Cardelli S, Castagnini F, Traina F, Guizzardi G, Giuzzardi G, Gorgone M, Maestri M, Cianci P, Conversano I, Restini E, Gattulli D, Grillea G, Varesano M, Calini G, Andriani A, Gattesco D, Terrosu G, Zambon M, Cerinic PM, Moretti L, Muschitiello D, Polo S, Bresadola V, Wardeh SA, Al-Baw M, Alhaleeq S, Al-Issawi S, Alsaify E, Banihani F, Massadeh N, Massadeh N, Al-issawi D, Elyan B, Al-Shami Q, Alomari Y, Khamees A, Al-Tahayneh SA, Alsheik A, Sawaftah K, Sarhan O, Alkhatib AA, Alzghoul B, Saleh A, Yaghmour J, Shahin M, Maali M, Alatefi D, Al-Smirat H, Hezam A, Alathameen N, Kaddah AA, Al Hammoud A, Ayasrah S, Abuuqteish H, Al-Mwajeh T, Makableh R, Bataineh S, Shabaneh A, Alnatsheh W, Aldeges M, Hamad H, Shehahda S, Khassawneh D, Alzyoud O, Alrosan R, Awad H, Khaldoon T, Shannaq R, hamoud MA, fadalah BA, Al-Hazaimeh M, Khraise W, Alnajjar L, Alnajjar M, Al-Omary S, Ababneh A, Albashaireh A, Khadrawi M, Aljamal M, Athamneh T, Muqbel RA, Al-jammal M, Masarrat A, Al-zawaydeh A, Taha I, Qattawi T, Smadi R, Alhaleem A, Alboon M, Hazaymeh O, Karasneh L, Al-Haek S, Almahroush M, Alfrijat T, Elporgay A, Shanag H, Agilla H, Alameen H, Bensalem M, Altair M, Ghemmied M, Alarabi R, Alhudhairy S, Gweder R, Alzarroug A, Alabed E, Elreaid F, Elkharaz OA, Elreaid FF, Albatni SS, Elmehdawi H, Gahwagi M, Mohamed A, Alfrjani T, Khafifi K, Rasheed A, Akwaisah A, Bushaala H, Elfadli M, Moftah M, Algabbasi S, Esaiti S, Elfallah S, Alharam A, Alariby F, Isweesi M, Eldarat TA, Dabas AA, Alkaseek A, Abodina AM, Alqaarh A, Bakeer HB, Alhaddad HS, Aboudlal H, Alsaih S, Abubaker N, Abdelrahim N, Alzarga A, Omar B, Faris F, Alhadad Q, Abufanas A, Badi H, Benismai I, Obeid H, Abdalei A, Abdulrahman A, Swalem A, Alzarouq E, Safar A, Shagroun E, Hashem B, Elrishi F, Abdulali F, Ahmed H, Eltaib I, Elzoubia J, Albarki A, Mugassabi HE, Abushaala F, Abuzaho A, Juha N, Egzait R, Shetwan S, Lemhaishi A, Matoug F, Abdulwahed E, Askar A, Ashur AB, Bezweek A, Altughar B, Emhimmed D, Elferis D, Elgherwi L, Soula E, Gidiem D, Grada M, Derwish K, Alameen M, Algatanesh N, Elkheshebi A, Ghmagh R, Barka S, Ahmeed S, Aljamal S, Alragig Z, Addalla M, Atia A, Kharim A, Mahmoud F, Binnawara M, Alshareea E, Alsori M, Alshawesh A, Alrifae GMH, Ashour A, Abozid A, Alflite AOS, Mohamed A, Arebi J, Alagelli F, Gineeb HY, Ghmagh R, Omar RMB, Alaqoubi R, Mohammed S, Bensalem SH, Elgadi T, Sami W, Bariun Y, Alhashimi AMA, Abdulla DA, Rhuma H, Enaami H, Alboueishi AA, Alkchr HBHMAA, Albakosh BA, Hasan NB, Alsari N, Aldreawi M, Abushanab K, Yahya R, Samalavicius N, Eismontas V, Jurgaitis J, Aliosin O, Nutautiene V, Zakaria AD, Pillai AKSK, Vadioaloo DK, Daud MAM, Soh JY, Zakaria MZ, Rusli SM, Ashar NAK, Ahmad ZA, Ramlee AA, Alsagoff SNASAL, Sofian AA, Jamil MBHM, Abdullah B, Noorman MF, Abidin MFZ, Isahak MI, Adnan SNN, Noor ZHM, Alvarez-Lozada LA, Garza AQ, Leal AA, Reyes BAF, Guerra EVO, Garza FJA, Mey HEA, Isais JAR, Zertuche JTG, García PLG, Sánchez LAH, Mercado MPF, Sierra OAV, Morales PER, Fuentes SO, Martínez VMP, Guerra-Juárez YA, Flores-González AK, Singh S, Hadi A, Woodbridge C, Thornton-Hume D, Forsythe J, Dharmaratne I, Pai V, Windsor J, Zargar K, Waldin L, Winthrop L, Alvarez M, Huang M, Kumove M, Simonetti M, Chand N, Goldsmith O, Guo O, Monk P, Zhou K, Penneru SH, Prasad S, Ren S, Hill T, Mistry V, Sun S, Pereira A, Mclaughlin S, Stokes A, Sathiyaseelan A, Rossaak J, Lim J, Brooke K, Quinlan L, Pottier M, Podder N, Jinu P, Ramphal S, Vermeulen W, Jeffery F, Busaidi ISA, Divinagracia J, Ju W, Liu Y, Glyn T, Thompson N, Graziadei V, Canton J, Furey J, Choi H, Coomber G, Divekar T, English T, Gernhoefer E, Healy T, Chou J, Parajuli D, Reed C, Studd R, Lin A, Wells C, Xu C, Hadi A, Maccormick A, Park H, Rathnayake A, Williams B, Chan A, Smith C, Casciola F, Bhikha J, Luo J, Yi K, Singhal M, George R, Luo R, Frost T, Hakak F, George A, Carlos A, Ho A, Mcrae C, Lescheid J, Soek J, Pham A, Clair SS, Yee SA, Lim J, Wu CY, Kim T, Chua AQ, Harmston C, Boyes H, Cook H, Struthers J, Radovanovich J, Quek N, Fearnley-Fitzgerald C, Wright D, Ghandi K, Matheson N, McGuinness MJ, Chen B, Douglas RI, Richter K, Soliman NB, Bolam SM, Vimalan V, Currie W, Cuthbert M, Ross P, Nicholson A, Garton B, Agnew E, Conlon N, Waaka N, Kejriwal R, Nguyen S, Leung E, Ratnayake M, Smith Q, Joseph N, Yue B, Fraser C, Lam C, Figgitt E, Liu G, Tan K, You HS, Zheng H, Luo J, Sharp J, Khanna K, Simiona L, Luo M, Ratnayake M, Wong P, Luu R, Paul R, Nair S, Asadyari-Lupo S, Hung W, Ying G, Ho J, Wu A, Walsh E, Lee J, Liu J, Yao S, Nosseir O, Dang J, Young S, Zyul'korneeva S, Boyd T, Ho J, Wu A, Yao S, Kirfi AM, Ningi AB, Garba MA, Salihu MB, Ukwuoma OE, Ibrahim A, Sajo IM, Aminu MB, Usman LH, Lanre ON, Shuaibu IS, Yusuf S, Ismail T, Umar GI, Adeyeye A, Afeikhena E, Nnaji FC, Agu JO, Maxwell TP, Motajo OO, Ifoto O, Okon SAI, Makama JG, Mohammed-Durosinlorun AA, Aminu B, Onwuhafua PI, Mohammed C, Abdulrasheed L, Adze JA, Suleiman KR, Airede LR, Taingson MC, Bature SB, Kache SA, Ogbonna UO, Fufore MB, Iya A, Ajulo AA, Mahmud A, Yahya BS, Onimisi-Yusuf F, Isaac H, Jawa T, Joseph F, Kala B, Bakari MA, Ngwan DW, umar A, Filikus AL, Wycliff D, Okunlola A, Abiola O, Adeniyi A, Adeyemo O, Awoyinka B, Babalola O, Bakare A, Buari T, Okunlola C, Adeleye G, Salawu A, Abiyere H, Ogidi A, Orewole T, Abdullahi HI, Akaba G, Achem A, Bassey AO, Ayogu E, Sulaiman B, Isah DA, Akpamgbo CN, Asudo F, Adewole N, Oguche O, Ejembi P, Sani SA, Andrew PC, Isah A, Eniola B, Songden Z, Agida T, Atim T, Mohammed TO, Raji HO, Ibiyemi F, Salawu H, Fasiku O, Solagbade RS, Shiru MM, Ibraheem GH, Oruade J, Ezeoke G, Chawla T, Aziz AB, Marium A, Waheed AA, Aamir FB, Qureshi F, Ather MH, Ali IFM, Tahir I, Akbar MG, Ukrani RD, Raja S, Virani SS, Noordin S, Rehman SU, Golani S, Aamir SR, Mufarrih SM, Waqar U, Taufiq M, Ammar AS, Ejaz A, Sarwar A, Khalid AU, Khattak S, Imran A, Khalid OB, Kaleem U, Muneer U, Kashaf Y, Zafar F, Zaheer A, Ali M, Shafaat A, Qazi A, Tariq AI, Aslam MN, Ali S, Atiq T, Wasim T, Babar D, Zain A, Ibtisam M, Ahmed U, Aqeel STB, Muhib M, Abbal MA, Khan NA, Javed I, Alkaraja L, Amro D, Manasrah G, Hammouri I, Hilail IA, Zalloum J, Alamlih L, Nasereddin M, Rajabi M, Shalalfeh S, Natsheh Z, Elessi K, Jayyab MA, Astal M, Al-Dahdouh M, Salameh AE, Ayyad A, Dawod N, Alsaid H, Matar I, Hassan M, Bakeer M, Malasah M, Abuhashem S, Salem M, Lunca S, Dimofte MG, Morarasu S, Musina AM, Roata CE, Velenciuc N, Butyrskii A, Bozhko M, Ametov A, Chowdhury S, Bagazi D, Domenech J, Rosello-Añon A, Monis A, Chiappe C, Cuneo B, Clemente-Navarro P, Febre J, Sanz-Romera J, Lopez-Vega M, Miranda I, Valverde-Vazquez R, Garcia S, Sanguesa MJ, Balciscueta Z, Ruiz E, Marco E, Talavera E, Farre J, Bacariza L, Duart M, Ureña V, Carre X, Hamid HKS, Abd-Albain MA, Galal-Eldin S, Sarih M, Adam E, Ismail S, Azhari M, Hassan T, Salaheldein M, Abdalla Z, Ahmed W, Alhassan M, Mohamed A, Suliman HMA, Eltayeb MOM, Ahmed RAA, Babekir EMA, Khairy MAT, Mukhtar MMA, Ali RAH, Al-Shambaty YBA, Yousif FI, Mohammed HMH, Osher L, Osher L, Abdelbast M, Yassin M, Moawia N, Abdalsadeg R, Husein A, Elhassan B, Abdelbagi AY, Adam MA, Ali EM, Mohammed IAB, Mohamed M, Abdulaziz M, Akasha M, Hassan M, Hilal N, Mohamed NAA, Abubaker N, Mohammed O, Mohamed S, Osman W, Mustafa F, Salih AA, Ali D, Almakki DMA, Mohamed HE, Elmubark A, Hassan M, Alnour A, Elaagib A, Abdelrahman A, Abdelkhalig M, Eldaim KN, Babiker A, Ahmed E, Ali M, Hussain E, Wedatalla M, Ahmed A, Hamza AA, Mohammed M, Osman O, Ibrahim R, Ahmed R, Ahmed R, Yasir R, Awadallah S, Mohmmed S, Hassan S, Shaban W, Hussein A, Rafea R, Abdalla A, Ahmed A, Mohamed K, Mohammed M, Altahir M, Adam M, Mohamed O, Abdullah W, Fadlalmola H, Abdalla AY, Omer AA, Mustafa AA, Elhadi REH, Banaga EEA, Osman F, Abdalla MGA, Taha HAM, Abdalmahmoud NE, Nafie RH, Jamal S, Ahmed S, Ali RA, Aladna A, Aljoumaa A, Nawfal H, Jamali S, Khouja F, Niazi A, Al Rawashdeh T, Kechiche N, Gara M, Nasr M, Baccar M, Benamor O, Chakroun S, Sanli AN, Yildiz A, Demirkiran MA, Atadag YB, Tandogan YI, Ozkan E, Ozer Y, Ozkan E, Oncel MM, Kalkan S, Gover T, Manoglu B, Oksak I, Kurt I, Rifaioglu K, Sokmen S, Bisgin T, Yildirim Y, Keskin AY, Dogan T, Sahin Bİ, Aydin C, Benek DE, Tiras HN, Arslangilay M, Aslangilay M, Yaytokgil M, Capar MA, Yazgan Y, Bektas S, Alagoz AC, Dagsali AE, Izgis A, Uzel K, Soytas M, Cakir N, Askin AE, Azboy I, Sabuncu K, Aslan M, Sahin M, Oncel M, Okkabaz N, Sivrikaya RK, Saylar A, Saylar A, Yasar M, Erginoz E, Bozkir HO, Zengin K, Ozcelik MF, Uludag SS, Ozdemir Z, Sibic O, Telci H, Bozkurt MA, Kara Y, Tepe MD, Gündoğdu A, Akın B, Pehlivan D, Guner A, Baysallar D, Yıldız B, Cepe H, Reis ME, Yuzgec AN, Kıralı N, Kodalak TA, Ulusahin M, Selim K, Kale A, Gecici ME, Ozbilen M, Düzyol Z, Gemici A, Korkmaz E, Şen E, Taşcı ME, Camkıran E, Elieyioğlu G, Kayabaş İ, Uprak TK, Aral C, Saraçoğlu A, Uğurlu MÜ, Baltacı ZH, Akkaya EN, Fergar C, Tabak EZ, Kocyigit GZ, Kayilioglu I, Polat S, Çolak E, Kara ME, Candan M, Uyanık MS, Sarı AC, Ulkucu A, Certel AT, Dindar A, Durdu B, Bayram C, Kaya E, Akdere H, Cakcak IE, Yavuz I, Omur M, Ajredini M, Aydoğdu EO, Şenödeyici E, Koksoy UC, Kazbek BK, Korkmaz DS, Yavuz D, Yilmaz H, Cetınkaya ZS, Durmus E, Tuzuner F, Hokelekli F, Mutlu M, Akbuz SO, Kus ZC, Kus ZC, Farrell M, Craig-Lucas A, Painter M, Titan A, Narayan A, Fariyike B, Knowlton L, Yue T, Benham E, Nimeri A, Werenski H, Kaiser N, Reinke C. Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries. Br J Surg 2024; 111:znad421. [PMID: 38207169 PMCID: PMC10783642 DOI: 10.1093/bjs/znad421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/29/2023] [Accepted: 12/05/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures. METHODS This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge. RESULTS The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (β coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not. CONCLUSION Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely.
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Tan GSQ, Morton JI, Wood S, Trevaskis NL, Magliano DJ, Windsor J, Shaw JE, Ilomäki J. COX2 inhibitor use and type 2 diabetes treatment intensification: A registry-based cohort study. Diabetes Res Clin Pract 2024; 207:111082. [PMID: 38160735 DOI: 10.1016/j.diabres.2023.111082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 12/22/2023] [Accepted: 12/25/2023] [Indexed: 01/03/2024]
Abstract
AIM This study examined the association between cyclooxygenase-2 inhibitor (COX2i) use and diabetes progression in people with type 2 diabetes. METHODS We conducted a nation-wide cohort study using an Australian diabetes registry linked to medication dispensing data. We assessed time to diabetes treatment intensification among new users of COX2i compared to mild opioids. Inverse probability of treatment-weighted Cox regression models were used to adjust for age, sex, time since diabetes diagnosis, comorbidities, and socio-economic disadvantage. We conducted several sensitivity analyses, including per-protocol analyses and comparing use of any NSAID to mild opioids. RESULTS There were 8,071 new users of COX2i and 7,623 of mild opioids with 4,168 diabetes treatment intensifications over a median follow-up of 1.6 years. Use of COX2i was associated with decreased risk of treatment intensification when compared to mild opioids (HR 0.91, 95 %CI 0.85-0.96). The results were not significant in the per-protocol analyses. Use of any NSAID was associated with a lower risk of treatment intensification compared to mild opioids (HR 0.90, 95 %CI 0.85-0.96). CONCLUSIONS Treatment with COX2i may be associated with a modest decreased risk of diabetes treatment intensification compared to mild opioids. Future clinical studies are required to confirm whether COX2 inhibition has clinically significant benefits for glycaemic control.
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Affiliation(s)
- George S Q Tan
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
| | - Jedidiah I Morton
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Stephen Wood
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Natalie L Trevaskis
- Drug Delivery, Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Faculty of Pharmacy and Pharmaceutical, Sciences, Monash University, Melbourne, Victoria, Australia
| | - Dianna J Magliano
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - John Windsor
- Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia.
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Landers A, Cahill C, McCall P, Kaw A, Brown H, McKenzie C, Agar M, Yenson V, Clarke K, Windsor J. Recruitment of participants with pancreatic cancer to a mixed media study for optimal recruitment in an Australasian survey of pancreatic enzyme replacement. BMJ Open 2023; 13:e076242. [PMID: 38035745 PMCID: PMC10689358 DOI: 10.1136/bmjopen-2023-076242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 11/08/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Pancreatic cancer is relatively rare and aggressive, with digestion and malabsorption issues often leading to significant weight loss. Recruitment of people with this malignancy into studies can be challenging, and innovative methods need to be explored to improve recruitment rates. AIM To describe a mixed media methodology and the outcomes used to recruit patients to participate in a binational survey. METHODS The details of the mixed media method used to identify and recruit people with pancreatic cancer are described. This method was used to investigate pancreatic enzyme replacement therapy use in people with pancreatic cancer across Australia and Aotearoa New Zealand. RESULTS The mixed media approach was successful in reaching 334 participants from a range of ethnicities and regions. Results showed that social media platforms were notably more efficient and cost-effective than radio and newspaper but required additional expertise, including graphic design and media strategy knowledge. CONCLUSIONS Social media is an effective and efficient method of recruiting people with pancreatic cancer to a national survey. Studies using media to recruit patients may need to include team members with a range of skills.
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Affiliation(s)
- Amanda Landers
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Charlotte Cahill
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Poppy McCall
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Anu Kaw
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Helen Brown
- Nurse Maude Hospice and Community Palliative Care, Christchurch, New Zealand
| | - Clare McKenzie
- Nurse Maude Hospice and Community Palliative Care, Christchurch, New Zealand
| | - Meera Agar
- IMPACCT Centre, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Vanessa Yenson
- IMPACCT Centre, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Kate Clarke
- Te Whatu Ora Health New Zealand, Wellington, New Zealand
| | - John Windsor
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Li JN, Mu D, Zheng SC, Tian W, Wu ZY, Meng J, Wang RF, Zheng TL, Zhang YL, Windsor J, Lu GT, Wu D. Machine learning improves prediction of severity and outcomes of acute pancreatitis: a prospective multi-center cohort study. Sci China Life Sci 2023; 66:1934-1937. [PMID: 37209250 DOI: 10.1007/s11427-022-2333-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/21/2023] [Indexed: 05/22/2023]
Affiliation(s)
- Jia-Ning Li
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Dong Mu
- Department of Gastroenterology, General Hospital of Western Theater Command, Chengdu, 610083, China
| | - Shi-Cheng Zheng
- Department of Gastroenterology, West China Longquan Hospital Sichuan University, Chengdu, 610100, China
| | - Wei Tian
- Department of Gastroenterology, Fangshan Liangxiang Hospital of Beijing, Beijing, 102400, China
| | - Zuo-Yan Wu
- Department of Gastroenterology, The Sixth Hospital of Beijing, Beijing, 100048, China
| | - Jie Meng
- Department of Gastroenterology, Affiliated Hospital of Hebei University, Baoding, 071030, China
| | - Rui-Feng Wang
- Department of Gastroenterology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Tian-Lei Zheng
- Artificial Intelligence Unit, Department of Medical Equipment Management, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221004, China
| | - Yue-Lun Zhang
- Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - John Windsor
- Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, Auckland, 1142, New Zealand
| | - Guo-Tao Lu
- Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, 225003, China.
| | - Dong Wu
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
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Adisa A, Bahrami-Hessari M, Bhangu A, George C, Ghosh D, Glasbey J, Haque P, Ingabire JCA, Kamarajah SK, Kudrna L, Ledda V, Li E, Lillywhite R, Mittal R, Nepogodiev D, Ntirenganya F, Picciochi M, Simões JFF, Booth L, Elliot R, Kennerton AS, Pettigrove KL, Pinney L, Richard H, Tottman R, Wheatstone P, Wolfenden JWD, Smith A, Sayed AE, Goswami AG, Malik A, Mclean AL, Hassan A, Nazimi AJ, Aladna A, Abdelgawad A, Saed A, Abdelmageed A, Ghannam A, Mahmoud A, Alvi A, Ismail A, Adesunkanmi A, Ebrahim A, Al-Mallah A, Alqallaf A, Durrani A, Gabr A, Kirfi AM, Altaf A, Almutairi A, Sabbagh AJ, Ajiya A, Haddud A, Alnsour AAM, Singh A, Mittal A, Semple A, Adeniran A, Negussie A, Oladimeji A, Muhammad AB, Yassin A, Gungor A, Tarsitano A, Soibiharry A, Dyas A, Frankel A, Peckham-Cooper A, Truss A, Issaka A, Ads AM, Aderogba AA, Adeyeye A, Ademuyiwa A, Sleem A, Papa A, Cordova A, Appiah-Kubi A, Meead A, Nacion AJD, Michael A, Forneris AA, Duro A, Gonzalez AR, Altouny A, Ghazal A, Khalifa A, Ozair A, Quzli A, Haddad A, Othman AF, Yahaya AS, Elsherbiny A, Nazer A, Tarek A, Abu-Zaid A, Al-Nusairi A, Azab A, Elagili A, Elkazaz A, Kedwany A, Nuhu AM, Sakr A, Shehta A, Shirazi A, Mohamed AMI, Sherif AE, Awad AK, Abbas AM, Abdelrahman AS, Ammar AS, Azzam AY, Ciftci AB, Dural AC, Sanli AN, Rahy-Martín AC, Tantri AR, Khan A, Al-Touny A, Tariq A, Gmati A, Costas-Chavarri A, Auerkari A, Landaluce-Olavarria A, Puri A, Radhakrishnan A, Ubom AE, Pradhan A, Turna A, Adepiti A, Kuriyama A, Kassam AF, Hassouneh A, El-Hussuna A, Habeebullah A, Ads AM, Mousli A, Biloslavo A, Hoang A, Kirk A, Santini A, Melero AV, Calvache AJN, Baduell A, Chan A, Abrate A, Balduzzi A, Sánchez AC, Navarrete-Peón A, Porcu A, Brolese A, Barranquero AG, Saibene AM, Adam AA, Vagge A, Maquilón AJ, Leon-Andrino A, Sekulić A, Trifunovski A, Mako A, Bedada AG, Broglia A, Coppola A, Giani A, Grandi A, Iacomino A, Moro A, D’amico A, Malagnino A, Tang A, Doyle A, Alfieri A, Haynes A, Wilkins A, Baldwin A, Heriot A, Laird A, Lazarides A, O'connor A, Trulson A, Rokohl AC, Caziuc A, Triantafyllou A, Anesi A, Nikova A, Andrianakis A, Charalabopoulos A, Tsolakidis A, Chirca A, Arnaud AP, Narvaez-Rojas AR, Kavalakat A, Spina A, Recordare A, Annicchiarico A, Conti A, Mohammed AD, Kocataş A, Almhimid A, Arnaout A, Fahmy A, Mangi A, Modabber A, Ulas AB, Mohamedahmed AYY, Frontali A, Moynihan A, Yunus A, Ahmad A, Kent AJ, Khamees A, Ugwu AO, Turan A, Mohammed AAK, Navarro-Barrios A, Yebes A, De Sousa ÁFL, Moreno A, Sethi A, Dawson AC, Othman AAA, Kaur A, Wolde A, Antonelli A, Scifo A, Alhamad A, Davis A, Alderazi A, Harky A, Mohammed-Durosinlorun A, Seguya A, Okhakhu A, Chamakhi A, Sebai A, Souadka A, Asla A, Agrawal A, Persad A, Gupta A, Elgazar A, Kulkarni A, Coates A, Bellés AC, Hadzibegovic AD, Jotic A, Kowark A, Martins A, Pineda AM, Peral A, Gollarte AS, Senent-Boza A, Camarena AIA, Castaño-Leon AM, Bravo AMM, Moro AMG, Musina AM, Tapia-Herrero AM, Kothari A, Gupta A, Raja A, Aljaiuossi A, Taha A, Majbar AM, Prodromidou A, Kanatas A, Gupte A, Zakaria AD, Balla A, Barberis A, Bondurri A, Bottari A, Costantino A, Figus A, Lauretta A, Mingoli A, Romanzi A, Sagnotta A, Scacchi A, Picchetto A, Valadez AEC, Luzzi AP, Älgå A, Fontalis A, Hecker A, Demetriades AK, Serban AM, Văcărașu AB, Cokan A, Isaza-Restrepo A, Beamish A, Schache A, Stevenson A, Yiu A, Cockbain AJ, Litvin A, Abad-Motos A, Becerra A, Ramos ÁC, Chiaradia A, Dell A, Romano A, Pascale A, Marra AA, Dimas A, Kolias A, Cerovac A, Koneru A, Tidjane A, Agbeko AE, Bajaj A, Gosain A, Allan A, Carreras-Castañer A, D'amore A, Dare A, Maffioli A, Palepa A, Paspala A, Konney A, Gatta AND, Ezanno AC, Yiallourou A, Kinnair A, Rayner A, Scafa AK, Bowan AB, Veglia A, Russo A, Maniaci A, Castaldi A, Gil-Moreno A, Maffuz-Aziz A, Meola A, Nenna A, Ferrer AP, Bonilla AR, Ramos-De La Medina A, Infante AR, Santoro A, Laganà AS, Bateman A, Michael ALR, Abozid A, Seidu AS, Lowery A, Tantraworasin A, Rasheed A, Picciariello A, Isik A, Saif A, Anjum A, Ioannidis A, Abeldaño A, Hussain A, Nathan A, Bedzhanyan A, Perfecto A, De Virgilio A, Galvan A, Sablotzki A, Böttcher A, Pellacani A, Gatti A, Ibrahimli A, Menon A, Sahni A, Mwenda AS, Choudhry A, Jayawardane A, Gupta A, Ramasamy A, Mitul AR, Bawa A, Nugur A, Rammohan A, Sachdeva A, Mehraj A, Yildirim A, Alqaseer A, Radwan A, Sallam A, Syllaios A, Tampakis A, Alwael A, Samara A, Eroglu A, Rahman A, Ulkucu A, Zaránd A, Dulskas A, Tawiah A, Zani A, Vas A, Lukosiute-Urboniene A, Adamu A, Aujayeb A, Malik AA, İplikçi A, Mahmud A, Cil AP, Makanjuola A, Akwaisah A, Galandarova A, Saracoglu A, Regan A, Barlas AM, Alhassan BAB, Mostafa B, Hamida BB, Torun BC, Abdullah B, Balagobi B, Banky B, Singh B, Alegbeleye B, Yigit B, Hajjaj BN, Burgos-Blasco B, Seeliger B, Alayande B, Alhazmi B, Enodien B, Torre B, Pérez BG, Tamayo BV, De Andrés-Asenjo B, Quintana-Villamandos B, Girgin B, Barmayehvar B, Beisenov B, Creavin B, Dunne B, Marson B, Waterson B, Martin B, Zucker B, Wong BNX, Ozmen BB, Hammond B, Mbwele B, Núñez B, Dhondt B, Gafsi B, Mcleish B, Lieske B, Tailor B, La Pira B, Picardi B, Zampogna B, Casagranda B, Festa BM, Panda B, Kirmani B, Sulaiman B, Gurung B, Zacharia B, Bette B, Ayana B, Nikolovska B, Vilaró BC, De Vega Sánchez B, Hameed BZ, Diaconescu B, Kovacevic B, Bumber B, Sakakushev B, Tadic B, Malek B, Alrayes B, Thomas B, Gális B, Gallagher B, Knowles B, Cunningham B, Daley B, Mishra B, Ashford B, Pirozzi BM, Berselli B, Martinez-Leo B, Sensi B, Nardo B, Celik B, Giray B, Abud B, Almiqlash B, Pramesh CS, Taskiran C, De Campos Prado CA, Cipolla C, Kumar C, English C, Riccetti C, Vanni C, Brasset C, Downey C, Duffy C, Chwat C, Cutmore C, Sars C, Ratto C, Pacilio CA, De La Infiesta García C, Moreno CG, Magalhães C, Prada C, Zapata CS, Senni C, Flumignan CDQ, Martinez-Perez C, Duarte CL, Garcia CSR, Anderson C, Hing C, Cullinane C, Cina C, Zabkiewicz C, Sohrabi C, Guldogan CE, Ciubotaru C, Desai C, Raut C, Demetriou C, Handford C, Okpani C, Paranjape C, Koh C, Khatri C, Parmar C, Mok CW, Caricato C, Marafante C, Echieh CP, Tan CY, Ong CS, Conso C, Jardinez C, Konrads C, Warner C, Makwe CC, Henein C, Fleming C, Roland CL, Maurus C, Nitschke C, Mittermair C, Mallmann C, Andro C, Harmston C, Kuppler C, Lotz C, Nahm C, Rowe C, Ryalino C, Wallis C, Millward CP, Anthoulakis C, Apostolou C, Chouliaras C, Kalfountzos C, Kaselas C, Vosinakis C, Okereke C, Chean CS, Barlow C, Tatar C, Clancy C, Forde C, Sharpin C, Mccarthy C, Nestor C, Warden C, Ávila CC, Massaguer C, Fang CEH, Martins CP, Guerci C, Mauriello C, Holzmeister C, Miller C, Weber C, Wiesinger CG, Kenington C, Noel C, Sue-Chue-Lam C, Adumah C, Neary C, Sen C, Fitzgerald C, Ezeme C, Nastos C, Mesina C, Bombardini C, Torregrosa C, Valdespino CP, Don CP, Wickramasinghe D, Milanesi D, Armijos D, Asiimwe D, Beswick D, Clerc D, Cox D, Doherty D, Martínez DF, Lechuga DG, Gero D, Gil-Sala D, Lindegger D, Reim D, Shaerf D, Shmukler D, Branzan D, Filipescu D, Rega D, Bernardi D, Bissacco D, Fusario D, Morezzi D, Sabella D, Zimak DM, Vinci D, Sale D, Khan DZ, Thereska D, Andreotti D, Tartaglia D, Abdulai DR, Mukherjee D, Verdi D, Idowu D, John D, Johnson D, Moro-Valdezate D, Naumann D, Omar D, Proud D, Roberts D, Guzmán DS, Watson D, Bergkvist DJ, Lumenta DB, Ferrari D, Rizzo D, Degarege D, Castillo DFC, Douglas D, Wright D, Nanjiani D, Bratus D, Altun D, Sievers D, Vaysburg D, Katechia D, Ghosh D, Azize DA, Rodrigues D, Pachajoa DAP, Hayne D, Mutter D, Raimondo D, Eskinazi D, Sasia D, Corallino D, Muduly D, Grewal D, Hadzhiev D, Peristeri D, Pournaras D, Raptis DA, Angelou D, Haidopoulos D, Magouliotis D, Moris D, Schizas D, Symeonidis D, Tsironis D, Korkolis D, Tatsis D, Thekkinkattil D, Bulian DR, Pandey D, Vatansever D, Parker D, Wiedemann D, Borselle D, Pedini D, Schweitzer D, Venskutonis D, Otokwala J, Adamu KM, Pk P, Garod M, Ellafi AAD, Zivkovic D, Jelovac D, Wijeysundera D, Mcpherson D, Ryan É, Ugwu E, Baidoo EI, Shaddad E, Memişoğlu E, Naranjo EPL, Brodkin E, Segalini E, Viglietta E, Hendriks E, Bonci EA, Sá-Marta E, Ortega EN, Gomez EGL, Joviliano EE, Clune E, Horwell E, Mains E, Vasarhelyi E, Caruana EJ, Nevins EJ, Yenli EMTA, Baili E, Lostoridis E, Morgan E, Shiban E, Latif E, Tampaki EC, Ezenwa E, Irune E, Borg E, Eisa E, Gialamas E, Parvez E, Theophilidou E, Toma EA, Arnaoutoglou E, Samadov E, Kantor E, Ulman EA, Colak E, Cassinotti E, Bannone E, Sarjanoja E, Yates E, Vincent E, Lun EWY, Cerovac E, Dif ES, Alkhalifa E, Daketsey E, Fayad EA, Sheikh E, Pontecorvi E, Cammarata E, La Corte E, Rausa E, Odai ED, Guasch E, Cano-Trigueros E, Uldry E, Ros EP, Matthews E, Donmez EE, Giorgakis E, Kapetanakis E, Stamatakis E, Bua E, Schneck E, Nachelleh EA, Ofori EO, Akin E, Gönüllü E, Kirkan EF, Çelik E, Wong E, Capozzi E, Pinotti E, Colás-Ruiz E, González E, Fekaj E, Ohazurike E, Kebede E, Erginöz E, Duran EES, Scott E, Aytac E, Albanese E, Castro EJ, Albayadi E, Kriem E, Siddig E, Otify E, El Tayeb EEABH, Hong EH, Saguil E, Belzile E, Tuyishime E, Panieri E, Martínez EG, Myriokefalitaki E, Wong EG, Samara E, Agbeno EK, Drozdov E, Tokidis E, Shah FA, Barra F, Carbone F, Ferreli F, Marino F, Martinelli F, D'acapito F, Masciello F, Bàmbina F, Issa F, Salameh FT, Kethy F, Mahmood F, Gareb F, Idrees F, Karimian F, Ashraf F, Haji F, Inayat F, Begum F, Nabil F, Rosa F, Haider F, Parray F, Calculli F, Ferracci F, Saraceno F, Coppola F, Coccolini F, Fusini F, Migliorelli F, Pecoraro F, Alconchel F, Coimbra FJF, Trivik-Barrientos F, Naegele F, Almarshad F, Agresta F, Fleming F, Mendoza-Moreno F, Brzeszczyński F, Carannante F, Wu F, Aljanadi F, Hayati F, Campo F, Sorbi F, Milana F, Takeda FR, Shekleton F, Gessler F, Recker F, Grama F, Cherbanyk F, Faponle F, Angelis F, Calabretto F, Gaino F, Toia F, Bianco F, Bussu F, Cammarata F, Castagnini F, Colombo F, Ferrara F, Fleres F, Guerrera F, Litta F, Mongelli F, Pata F, Roscio F, Mulita F, Ardura F, Tejero-Pintor FJ, Calvo FJR, Escobedo FJB, Camacho FJB, Odicino F, Schmitt F, Bloemers F, Hölzle F, Gyamfi FE, Messner F, Koh F, Cáceres F, Smolle-Juettner FM, Herman F, Ayeni F, Djedovic G, De Oliveira GP, Rodrigues G, Wagner G, Bellio G, Giarratano G, Capolupo GT, Budd G, Marom G, Poillucci G, Thiruchandran G, Nicholson G, Groot G, Hoey G, Bass GA, Sachdev G, Agarwal G, Aggarwal G, Cormio G, Mazzarella G, Perrone G, Osterhoff G, Singer G, Dejeu G, Fowler G, Garas G, Gradinariu G, Theodoropoulos G, Tzimas G, Babis G, Wong GKC, Cross GWV, Micha G, Chrysovitsiotis G, Koukoulis G, Peros G, Tsoulfas G, Kapetanios G, Karagiannidis G, Verras GI, Ekwen G, Perrotta G, Petruzzi G, Bertelli G, Calini G, Fiacchini G, Pirola GM, Dolci G, Mendiola G, Baiocchi GL, Palini GM, Prucher GM, D'andrea G, Maggiore G, Cassese G, Franceschini G, Pellino G, Saponaro G, Pattacini GC, Pantuso G, Iannella G, Bonsaana GB, Lever G, Brachini G, Giraudo G, Lisi G, Russo GI, Aprea G, Pascale G, Tomasicchio G, Sandri GBL, Armatura G, Turri G, Zaccaria G, Barugola G, Lantone G, Gasparini G, Iacob G, Sozzi G, Zancana G, Mercante G, Bianco G, Brisinda G, Consorti G, Currò G, Giannaccare G, Palomba G, Pascarella G, Rotunno G, Spriano G, Vizzielli G, Cucinella G, Sica G, Campisi G, Baiocchi G, Guerra GR, Pacheco GMF, Atis G, Augustin G, Šantak G, Chauhan GS, Branagan G, Harris G, Stewart GD, Padmore G, Kocher GJ, Di Franco G, De Jesus Labrador Hernandez G, Christodoulidis G, Neal-Smith G, Yim G, Piozzi GN, Claret G, Yanowsky-Reyes G, Dhaity GD, Cakmak GK, Mohamed G, Kucuk GO, Ancans G, Banipal GS, De Bacco Marangon G, Laporte G, Martinez-Mier G, Recinos G, V GMM, Benshetrit G, Vijgen G, Pickett G, Rodriguez HA, Shiwani H, Derilo H, Awad H, El Assaad H, Raji HO, Hardgrave H, Karakullukcu HK, Abdussalam HO, Mustafa H, Parwaiz H, Khan H, Arbab H, Naga H, Salem H, Ulgur HS, Perez-Chrzanowska H, Greenlee H, Javanmard-Emamghissi H, Lederhuber H, Osman H, Adamou H, Majid HJ, Van Goor H, Spiers HVM, Manesh HF, Mushtaq H, Aljaaly H, Hasan HB, Ahmed HTA, Martinez-Said H, Aguado HJ, Consani H, Chaplin H, Mohan H, Van Vliet H, Lohse HAS, Shah H, Claireaux H, Lule H, Juara H, Abozied H, Bayo HL, Alibrahim H, Kroon HM, Ulman H, Khan H, Yonekura H, Abou-Taleb H, Wong HYF, Carpenter H, Majd HS, Zenha H, Mayer HF, Elghadban H, Abdou H, Elfeki H, Yusefi H, Gomez-Fernandez H, Horsfall HL, Meleiro H, Sungurtekin H, Junior HFL, Moloo H, Bayhan H, Şevi̇k H, Embarek H, Hamid HKS, Pradeep IHDS, Donkin I, Ateca IV, Jafarov I, Salisu I, Abdalaal I, Garzali IU, Sall I, Adebara I, Aghadi I, Ugwu I, Zapardiel I, Reis I, Nwafor I, Fakhradiyev I, Surya IU, Robo I, Njokanma I, Iannone I, Khan I, Correia I, Königsrainer I, Seiwerth I, Linero IB, Kadiri I, Florian IA, Tzima I, Akrida I, Baloyiannis I, Gerogiannis I, Katsaros I, Tsakiridis I, Valioulis I, Negoi I, Yadev I, De Haro Jorge I, Vázquez IO, Dajti I, Russo IS, Afzal I, Wasserman I, Chukwu I, Gracia I, Oliver IM, Hughes I, Mondi I, Ncogoza I, Bsisu I, Rashid I, Balasubramanian I, Omar I, Dominguez-Rosado I, Smati I, Vokshi I, Al-Badawi IA, Saleh IA, Pilkington I, Kirac I, Trostchansky I, Gawron IM, Trebol J, Martellucci J, Andreuccetti J, Abou-Khalil J, Shah J, Manickavasagam J, De Alarcón JR, Mihanovic J, O'riordan J, Archer J, Ashcroft J, Blair J, Hamill J, Munthali J, Park J, Parry J, Ryan J, Tomlinson J, Wheeler J, Wilkins J, Balogun JA, Hodgetts JM, Vatish J, Žatecký J, Dziakova J, Martin J, Beatty JW, Stijns J, Faiz J, Ripollés-Melchor J, Mata J, Vásquez JAG, Mitra JK, Tuech JJ, Mvukiyehe JP, Fallah JM, Díaz JT, Vishnoi JR, Van Den Eynde J, Rickard J, Rolinger J, Kaplowitz J, Meyer J, Reid J, Rossaak J, Smelt J, Thomas JJ, Reyes JAS, Davies J, Luc J, Alonso JAM, Hajiioannou J, Querney J, Van Acker J, Pu JJ, Cama J, Simoes J, Cozens J, Barbosa-Breda J, Ribeiro J, De Haro J, Nigh J, Bowen J, Pollok JM, Strotmann JJ, Doerner J, Edwards J, Green J, Massoud J, Mcgrath J, Squiers J, Street J, Windsor J, Santoshi JA, Meara JG, Abebrese JT, Reilly JJ, Zabaleta J, Phillips J, Herron J, Horsnell J, Dawson J, Sheen J, Kauppila JH, Konsten J, Raurich-Leandro J, Romera JS, Nuñez J, Gass JM, Blanco J, Calvache JA, Iturralde JLF, D’addino JL, Hermosa JMG, Guillen JRO, Beristain-Hernandez JL, Sole-Sedeno JM, Vives JMM, Attwood J, Furey J, Hadaya J, Mckay J, Meilak J, Natale J, Shalhoub J, Jung J, Arthur J, Kealey J, Wright J, Moreau J, Miskovic J, Juloski J, Bauset JCC, Segura-Sampedro JJ, Cisneros JRT, Gomez-Rosado JC, Arneja J, Heider J, Fernández JD, Plata-Bello J, Villanueva J, Olaogun J, Hing JX, Košir JA, Daruwalla J, Yeung J, Wormald J, Seyi-Olajide J, Rani J, Wong KY, Hristova K, Kajal K, Algarni K, Theivendran K, Futaba K, Elsayem K, Kapur K, Bailey K, El-Boghdadly K, Ataya K, Lacorbiniere K, Shah K, Tellez KSM, Szyluk K, Rangasamy K, Iyengar K, Szabómihályová K, Atkinson K, Camargo-Parra K, Galliard K, Dickson K, Singh K, Qader K, Hasan K, Spellar K, Feeney K, Ajenifuja K, Oh KE, Okunade K, Adanu K, Bateman K, Saracoglu K, Ho KW, Enwerem K, Mishra K, Verhoeff K, Bensoltane K, Larabi K, Hamdan KH, Nadi K, Fozo K, Abdelwahab K, Al-Sayaghi K, Dajani K, Algahtany K, Abdel-Galil K, Ahmed K, Bajunaid K, Bhatti K, Sofi K, Abdulsalam K, Tamoos K, Dzhumabaev K, Samo KA, Purich K, Madhvani K, Qin KR, Underwood K, Senanayake KJ, Augestad KM, Sigamoney K, Apostolou K, Bouchagier K, Bouliaris K, Bramis K, Gousias K, Lasithiotakis K, Paraskevopoulos K, Perivoliotis K, Roditis K, Stamatis K, Stroumpoulis K, Paraskevas KI, Govindarajan KK, Šimko K, Olson KA, Khobragade K, Seah KM, Kishore K, Ayad K, Papavasiliou K, Angelou K, Paniagua LC, Czako L, Ching LVK, Rai L, Gupta L, Ismail L, Mbodi L, Dasanayake L, Schröder L, Baiyewu LA, Fortuna L, Fernandez LG, Vivancos LG, Jack L, Keçi L, Lavalle L, Leonard L, Shelmerdine L, Vaassen L, Hasan L, Lazarou L, Tzelves L, Matos L, Siragusa L, Licari L, Lima LS, Solaini L, Lichman L, Moral LT, Cabeza L, Kaplan L, Valeanu L, Kaman L, Karout L, Pieteris L, Chan L, Grüßer L, Zamora L, Catarzi L, Rampersad L, Anyanwu LJ, Cheung LK, Rodríguez LV, Andreani L, Cobianchi L, Petagna L, Howse L, Gonzalez LE, Bains L, Vohra L, Ansaloni L, Bertolaccini L, Ferrario L, Orecchia L, Tirloni L, Zanin L, Morelli L, Scaravilli L, Locatello LG, García LD, Vida L, Carbone L, Heindl LM, Bonavina L, Conti L, Marano L, Verre L, Conte LE, Boccalatte L, Tellez LGS, Loureiro L, Sánchez-Guillén L, Tallon-Aguilar L, Nakano L, Alvarez-Lozada LA, Gonzalez LAS, Flórez LJG, Capitan-Morales LC, Kowalski LP, Widmer LW, Harper L, Render L, Wheldon L, Abdur-Rahman L, Doğan L, Prusty L, Katsiaras L, Gourbault L, Siddiqui MT, Saleh M, Karthigeyan M, Rodriguez M, Chowdhury M, Nagappa M, Sultania M, Bashir M, Alam M, Elshahawy MAM, Elfiky M, Loubani M, Marei M, Mewafy M, Alali M, Nassar MA, Alobied M, Bilfaqirah M, Ahmad M, Rius M, Manangi M, Dornseifer MD, Tripathi M, S M, Sokolov M, Pigeolet M, Alonso MD, Losada M, Carretero MM, Tousidonis M, Cotovio MD, Wijeyaratne M, Boira MA, Franza M, Albdour M, Alkhatieb M, Déserts MDD, Niewiera M, Vallve-Bernal M, Kavanagh MM, Migliore M, Calabrò M, Martino MD, Reicher M, Baia M, Caricato M, Clementi M, De Zuanni M, Fiore M, Giacometti M, Inama M, Maestri M, Materazzo M, Sparavigna M, Pascale MM, Nemeth M, Serra M, Fahim MMF, Soucheiron MC, Papadoliopoulou M, Wittmann M, Sotiropoulou M, García-Conde M, Ranucci MC, Amo MDAD, Boedo MJM, Velázquez MJM, Pissaridou MK, Petersen ML, Sacras ML, Modolo MM, Caubet MM, Di Nuzzo MM, Ntalouka MP, Menna MP, Aguilera-Arevalo ML, Rela M, Capuano M, Hollyman M, Olivos M, Sacdalan MD, Raphael MC, Takkenberg M, Bortul M, Cabrera M, Castaño M, D'oria M, Giuffrida M, Laborde MM, Rodriguez-Lopez M, Trejo-Avila M, Papa MV, Ghobrial M, Kryzauskas M, Anwer M, Cheetham M, Davies M, Higgins M, Siboe M, Tarle M, Velten M, Wurm M, Süleyman M, Bauer M, O’dwyer M, Caretto M, De La Rosa-Estadella M, Fragoso M, Serra ML, Merayo M, Golet MR, Martínez-Sánchez MI, Domingo MMA, Gosselink M, Batstone M, Reichert M, Salö M, Soljic M, Zambon M, Angeles MA, Abdulkhaleq M, Abdelkarim M, Alsefri M, Iwasaki M, Shiota M, Veroux M, Molina-Corbacho M, Frasson M, Serenari M, De Pastena M, Desio M, Risaliti M, Rottoli M, Bence M, Chan M, Watson M, Wiles M, Boisson M, Berselli M, Capobianco M, Di Bartolomeo M, Fehervari M, Pacilli M, Romano M, Zizzo M, Domanin M, Montuori M, Podda M, Zago M, Dzogbefia M, Frountzas M, Thaw MH, Al-Juaifari M, Gharat M, Mohamed M, Hannan MJ, Venketeswaran M, Chisthi M, Dessalegn M, Kaplan M, Çakıcı MÇ, Ulutaş ME, Hassan M, Elsadek M, Mengesha MG, Gómez ME, Elbadawy MA, Pitcher M, Tanal M, Tokocin M, Ergenç M, Çelik MN, Bareka M, Pekcici MR, Cappuccio M, Dasa M, Dewan M, El Boghdady M, Ezeanochie M, Greenhalgh M, Jenkinson M, Kelly M, Spartalis M, Zyskowski M, Racine M, De Cillia M, Chu MJJ, Mallmann MR, Zhu MZL, Klimovskij M, Vailas M, Kisielewski M, Adamina M, Campanelli M, Carvello M, Ammendola M, Manigrasso M, Scopelliti M, White M, Collins ML, Chevallay M, Borges MF, Mayo-Yáñez M, Melo MR, Ruiz-Marín M, Eiras MAF, Cunha MF, Pertea M, Slavchev M, Davidescu M, Prieto M, Agapov M, Gahwagi M, Prats MC, Rudic M, Verbic MS, Kostusiak M, Stoleriu MG, Lucas MA, Barone M, Ahmad M, Alemu MAA, Fatima M, Ida M, Sahu M, Muhaisen M, Salem M, Emara MM, Oludara M, Sotudeh M, Kassab MB, Abdelkhalek M, Alsori M, Anwar M, El-Kassas M, Elbahnasawy M, Eldabaa M, Rabie M, Hassanin MA, Thaha MA, Ali MSM, Alhamid M, Almoshantaf MB, Keramati MR, Bafaquh M, Abuzaid M, Al-Shehari M, Alharthi M, Alkahlan M, Alwash M, Alyousef M, Amir M, Basendowah M, Deputy M, Jibreel M, Alam MS, Alsharif M, Issahalq MD, Omer MEA, Abubakar MK, Draman MR, Elnour MAE, Eltayeb M, Castillo MN, Jawad M, Raut M, Ghalleb M, Katsura M, Lebe M, Abbas M, Abdelrahman M, Shalaby M, Farhan-Alanie M, Farooq M, Musadaq M, Arshad M, Anjum MA, Usman M, Chaudhary MA, Raza MA, Karim MFSA, Chaudhary MH, Janjua MH, Khokhar MI, Malik MIK, Pirzada MT, Younis MU, Elhadi M, Suer MS, Ergenç M, Binnawara M, Emmanuel M, Abbasi M, Naimzada MD, Kulimbet M, Kusunoki M, Eugene M, Chauhan M, Shokor MA, Aljiffry M, Kalın M, Kurawa M, Dincer MB, Tolani MA, Soytas M, Yakubu M, Usman MI, Aremu M, Paranyak M, Talat N, Kausar N, Dudi-Venkata N, Bazzi N, Hasan NB, Van Wyk NN, Shaban N, Almgla N, Kandevani NY, Alzerwi N, Alvarez N, Motas N, Rincón NAR, Blencowe N, Simon N, Aghtarafi N, Ghuman NK, Sharma N, Wijekoon N, Kumar N, Hassan N, Onyemaechi N, Prijović N, Özçay N, Goel N, Segaren N, Sharma N, Kalyva N, Palacios NM, Alonso NFP, Onyeagwara N, Petrucciani N, Daddi N, Lightfoot N, Power N, Segaren N, Starr N, Dreger NM, Cillara N, Colucci N, Eardley N, Tartaglia N, Zanini N, Bacalbasa N, Campuzano N, Mouawad N, Federico NSP, Tamini N, Mariani NM, Beasley N, Adu-Aryee NA, Burlov N, Dimitrokallis N, Gouvas N, Machairas N, Memos N, Thomakos N, Tsakiridis N, Schizas N, Börner N, Theochari N, Al-Saadi N, Glass N, Horesh N, R NE, Gahlot N, Ismail N, Aljirdabi N, Maria NUH, Trabulsi N, Akeel N, Borges N, Moda N, Redondo NV, Nyarko OO, Ginghina O, Enciu O, Okere O, Ekwunife OH, Quadri O, Ogundoyin O, Tucker O, Mateo-Sierra O, Azzis O, Ojewuyi O, Habeeb O, Idowu O, Elebute O, Agboola O, Ladipo-Ajayi O, Oyinloye O, Adebola O, Ekor O, Ogundoyin O, Salamanca O, Vergara-Fernandez O, Wafi O, Aladawi O, Bahassan OM, Tammo Ö, Ozkan OF, Williams OM, Salami O, Akinajo O, Sakhov O, Gallo O, Sole OM, Milella O, Alser O, Bettar OA, Alomar O, Osman OS, Aisuodionoe-Shadrach O, Basnayake O, Bozbiyik O, Hodges O, Ojo O, Yanık Ö, Mutlu ÖPZ, Kazan O, Calavia P, García PR, Urriza PV, Lopez PR, Christidis P, Dorovinis P, Kokoropoulos P, Mourmouris P, Papatheodorou P, Garg PK, Patel P, Vassiliu P, Campennì P, De Nardi P, Bernante P, Ubiali P, Baroffio P, Pizzini P, Sapienza P, Myrelid P, Chatzikomnitsa P, Tsiantoula P, Gada P, Avella P, Cianci P, Romero P, Méndez PS, Pazmiño PAF, Coughlin P, Kirchweger P, Pessaux P, Maguire PJ, Petrone P, Cullis P, Köglberger P, Marriott P, Nankivell P, Santos-Costa P, Martins PN, Panahi P, Botelho P, Teixeira P, Escobar P, Vázquez PJG, Gribnev P, Nolte P, Agbonrofo P, Bobak P, Choong P, Elbe P, Hutchinson P, Labib P, Paal P, Pockney P, Reemst P, Szatmary P, Vaughan-Shaw PG, Alexander P, Pucher P, Stather P, Foessleitner P, Winnand P, Zehnder P, Kruse P, Matos PAW, Lapolla P, Cicerchia PM, Solli P, Di Lascio P, Zarif P, Champagne PO, Anoldo P, Bertoglio P, Fransvea P, Familiari P, Lombardi PM, Stogowski PT, Bruzzaniti P, Tripathi P, D'sa P, Salunke P, Shah PA, Punjabi PPP, Christodoulou P, Hamdan Q, Tawalbeh R, Gadelkareem R, Awad R, Callcut R, Clegg R, Choron R, Payne R, Gefen R, Costea R, Drasovean R, Mirica RM, Ravindra R, Fajardo RT, Nunes RL, Aspide R, Lombardi R, Vidya R, Elboraei R, Saaid R, Ghodke R, Gupta R, Sharma RD, Lunevicius R, Kalayarasan R, Mohan R, Singh R, Sivaprakasam R, Seenivasagam RK, Rajendram R, Radulescu RB, Goicea R, Seshadri RA, Sarı R, Nataraja R, Aslam R, Abdelemam R, Shrestha R, Bharathan R, Pellini R, Guevara R, Agarwal R, Vissapragada R, Alharmi RA, Sayyed R, Browning R, Critchley R, Mallick R, Alarabi R, Beron RI, Függer R, Othman R, Saad R, Amores RR, Colombari RC, Radivojević RC, Patrone R, Novysedlák R, Palacios Huatuco RM, Baertschiger R, Liang R, Luckwell R, Escrevente R, Rezende RF, Cruz RP, Lenzi R, Rosati R, Donovan R, Egan R, Morris R, Page R, Seglenieks R, Unsworth R, Wilkin R, Skipworth RJ, Davies RJ, Bezirci R, Talwar R, Azami R, Bohmer R, Crichton R, Fruscio R, Hooker R, Jach R, Parker R, Pillerstorff R, Sinnerton R, Stabler R, O'connell RM, Ragozzino R, Tutino R, Angelico R, Cammarata R, Colasanti R, Macchiavello R, Peltrini R, Pirrello R, Vaschetti R, Pires RE, Papalia R, Arrangoiz R, Hompes R, Mittal R, Salah R, Pinto R, Flumignan R, Callan R, Cuthbert R, Dennis R, Scaramuzzo R, Macías RM, Sánchez R, Ogu R, Ramely R, Sgarzani R, Ramli R, Hillier R, Thumbadoo R, Ooi R, Abdus-Salam R, Masri R, Hodgson R, Mathew R, Wade R, D'archi S, Khan S, Ngaserin S, Kale S, Hassan S, Merghani S, Benamar S, Muhammad S, Badran S, Elsahli S, Heta S, Hammouche S, Baeesa S, Paiella S, Eldeen STEHT, Arkani S, Mittal S, Hirji S, Tebha S, Emile S, Dbouk S, Bandyopadhyay SK, Muhammad S, Olori S, Asirifi SA, Hailu S, Ling S, Newman S, Ross S, Wanjara S, Kumar S, Seneviratne S, Tamburello S, Suarez SB, Ingallinella S, Irshaidat S, Konswa S, Mambrilla S, Nasser S, Parini S, Pitoni S, Ornaghi S, Rodrigues SC, Abdelmohsen S, Aitken S, Tian S, Badiani S, Ahmad S, Swed S, Muthu S, Lakpriya S, Alzahrani S, Mikalauskas S, Lasrado S, Satoskar S, Bawa S, Altiner S, Garcia S, Stevens S, Demir S, Ken-Amoah S, Tranca S, Ziemann S, Awad S, Atici SD, Subramaniam S, Erel S, Jiang S, Efetov S, Efremov S, Katorkin S, Valladares SC, Contreras SM, Meriç S, Zenger S, Safi S, Leventoğlu S, Elsalhawy S, Shaikh S, Sheik S, Islam S, Shamim S, Waqar SH, Ahmad S, Farid S, Seraj SS, Sundarraju S, Karandikar S, Sambhwani S, Chopra S, Chowdhury S, Laura S, Ahmed S, Wason S, Tan SJH, Fraser S, Williams S, Ghozy S, Abdelmawgoud S, Shehata S, Sharma S, Ahmed S, Al-Touny SA, Ramzanali S, Nah SA, Jansen S, Rajan S, Dindyal S, Amin S, Ahmad S, Shoukrie SIM, Karar S, Patkar S, Abdulsalam S, Lin S, Hegde S, Fiorelli S, Quaresima S, Redondo SV, Palmisano S, Ruggiero S, Balogun S, Cais S, Cole S, Federer S, Le Roux S, Ippoliti S, Meneghini S, Viola S, Manfredelli S, Novello S, Gananadha S, Mesli SN, Kale S, Tani SI, Malik S, Anastasiadou S, Boligo S, Esposito S, Valanci S, Xenaki S, Pejkova S, Bandyopadhyay S, Trungu S, Basu S, Alkhatib S, Pérez-Bertólez S, Flores SL, Donoghue S, Lunca S, Orsoo S, Potamianos S, Devarakonda S, Suresh S, Croghan SM, Turi S, Capella S, Lucchini S, Magnone S, Salizzoni S, Scabini S, Scaringi S, Cioffi SPB, Seyfried S, Degener S, Potten S, Taha-Mehlitz S, Ali S, Angamuthu S, Mcaleer S, Knight SR, White S, Mantziari S, Kykalos S, Goh SK, Chowdhury SP, Ibrahim S, Elzwai S, Bansal S, Tripathy S, Amrayev S, Anwar SL, Banerjee S, Thakar S, Saeed S, Venkatappa SK, Das S, Techapongsatorn S, Dube SK, Lee S, González-Suárez S, Henriques S, Konjevoda S, Gisbertz S, Bravo SL, Mannan S, Bukhari SI, Zafar SN, Batista S, Chin SL, Arif T, Lawal TA, Aktokmakyan TV, Osborn T, Szakmany T, Sztipits T, Triantafyllou T, Valadez TAC, Singh T, Khaliq T, Patel T, Fadalla T, Jichi T, Sammour T, Al-Shaiji T, Naggs T, Barišić T, Nikolouzakis T, Bisgin T, Perra T, Uprak TK, Dagklis T, Liakakos T, Sidiropoulos T, Adjeso TJK, Dölker T, Oung T, Aherne T, Diehl T, Pinkney T, Raymond T, Rhomberg T, Schmitz-Rixen T, Madhuri TK, Lohmann TK, Yeoh T, Zaimis T, Bright T, Vilz TO, Glowka TR, Board T, Hardcastle T, Cohnert T, Mahečić TT, William TG, Klatte T, Abbott T, Watcyn-Jones T, Mendes T, Kulis T, Sečan T, Campagnaro T, Frisoni T, Simoncini T, Violante T, Safranovs TJ, Risteski T, Pang T, Akinyemi T, Yotsov T, Laeke T, Kochiyama T, Sholadoye TT, Alekberli T, Ezomike U, Giustizieri U, Grossi U, Köksoy ÜC, Bork U, Kisser U, Ronellenfitsch U, Saeed U, Bracale U, Jayarajah U, Rauf UHA, Bumbasirevic U, Ferrer UMJ, Ahmed U, Bello UM, Jogiat U, Sadia U, Galandarov V, Narayanan V, Calu V, Bianchi V, Ciniero V, Tonini V, Silvestri V, Vijay V, Dewan V, Lohsiriwat V, Thuduvage V, Mousafeiris V, Dragisic V, Sasireka V, Santric V, Kusuma VRM, Kolli VS, Alonso V, De Simone V, Picotti V, Martínez VM, Panduro-Correa V, Kakotkin V, Angulo VP, Turrado-Rodriguez V, Krishnamoorthy V, Ban VS, Shah V, Maiola V, Giordano V, La Vaccara V, Lizzi V, Papagni V, Schiavone V, Satchithanantham V, Garcia-Virto V, Jimenez V, Kumar V, Shelat V, Bhat V, Sodhai V, Graziadei V, Kutuzov V, Stoyanov V, Oktseloglou V, Flis V, Elhassan WAF, Yang W, Soon WC, Tashkandi W, Al-Khyatt W, Mabood W, Bijou W, Wijenayake W, D W, Krawczyk W, Atkins W, Bolton W, White W, Ceelen W, Vagena X, Gozal Y, Baba YI, Subramani Y, Jansen Y, Mittal Y, Kara Y, Zwain Y, Noureldin Y, Alawneh Y, Aydin Y, Lam YH, Tang Y, Lim Y, Dean Y, Tanas Y, Su YX, Fujimoto Y, Altinel Y, Frolova Y, Oshodi Y, Fadel ZT, Zahid Z, Elahi Z, Djama Z, Zaheen Z, Jawad Z, Demetrashvili Z, Gebremeskel Z, Gudisa Z, Alyami Z, Garoufalia Z, Li Z, Zimak Z, Radin Z, Balogh ZJ. Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries. Br J Surg 2023; 110:804-817. [PMID: 37079880 PMCID: PMC10364528 DOI: 10.1093/bjs/znad092] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. METHODS This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low-middle-income countries. RESULTS In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of 'single-use' consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low-middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. CONCLUSION This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high- and low-middle-income countries.
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Study Management Group, Varghese C, McGuinness M, Wells CI, Elliott BM, Gunawardene A, Edwards M, Expert Advisory Group, Vohra R, Griffiths EA, Connor S, Poole GH, Windsor JA, Wright D, Harmston C, Collaborating Authors, Wang JHS, Windsor J, Chen E, Ghate K, Lal S, Lekamalage B, Ratnayake M, Bansal A, Windsor J, von Keisenberg S, Hemachandran A, Singhal M, Joseph N, Bhat S, Rossaak J, Carson D, Dubey N, Pan M, Ferguson L, Watt I, Choi J, Mclauchlan J, Connor S, Nicholas E, Al-Busaidi I, Wood D, Haran C, Lin A, Fagan P, Bathgate A, Patel S, Mak J, Espiner E, Poole G, Hassan S, Javed Z, Randall M, Clough S, Cook W, Clark S, Finlayson C, Poole G, Bahl P, Singh S, Lin C, Wang C, Kittaka R, Morreau M, Ing A, Logan S, Guest S, Sutherland K, Lewis A, Roberts J, Watson B, Tietjens J, Teague R, Su'a B, Modi A, Modi V, Williams Y, Morreau J, Khoo C, Desmond B, Young M, Christmas R, Holm T, Harmston C, Long K, Garton B, Niki kau, Barber L, Amer M, Haddow J, Amer M, Fearnley-Fitzgerald C, Suresh K, Zeng E, Young-Gough A, Skeet J, El-Haddawi F, Alvarez M, Nguyen S, King J, Crichton J, Welsh F, Edwards M, Tan J, Luo J, Banker K, Field X, Allan P, Rennie S, Ratnayake CB, Srinivasa S, Gloria Kim JH, Bradley S, Singh N, Kang G, Xu W, Srinivasa S, Cook H, Mistry V, Dabla K, de Oca AM, Yoganandarajah V, Lill M, Lu J, Bonnet LA, Uiyapat T. Variation in the practice of cholecystectomy for benign biliary disease in Aotearoa New Zealand: a population-based cohort study. HPB (Oxford) 2023:S1365-182X(23)00128-4. [PMID: 37198069 DOI: 10.1016/j.hpb.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 03/26/2023] [Accepted: 04/18/2023] [Indexed: 05/19/2023]
Abstract
INTRODUCTION Cholecystectomy for benign biliary disease is common and its delivery should be standardised. However, the current practice of cholecystectomy in Aotearoa New Zealand is unknown. METHODS A prospective, national cohort study of consecutive patients having cholecystectomy for benign biliary disease was performed between August and October 2021 with 30-day follow-up, through STRATA, a student- and trainee-led collaborative. RESULTS Data were collected for 1171 patients from 16 centres. 651 (55.6%) had an acute operation at index admission, 304 (26.0%) had delayed cholecystectomy following a previous admission, and 216 (18.4%) had an elective operation with no preceding acute admissions. The median adjusted rate of index cholecystectomy (as a proportion of index and delayed cholecystectomy) was 71.9% (range 27.2%-87.3%). The median adjusted rate of elective cholecystectomy (as proportion of all cholecystectomies) was 20.8% (range 6.7%-35.4%). Variations across centres were significant (p < 0.001) and inadequately explained by patient, operative, or hospital-factors (index cholecystectomy model R2 = 25.8, elective cholecystectomy model R2 = 50.6). CONCLUSIONS Notable variation in the rates of index and elective cholecystectomy exists in Aotearoa New Zealand not attributable to patient, operative or hospital factors alone. National quality improvement efforts to standardise availability of cholecystectomy are needed.
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Woodhouse B, Barreto SG, Soreide K, Stavrou GA, Teh C, Pitt H, Di Martino M, Herman P, Lopez-Lopez V, Berrevoet F, Talamonti M, Mikhnevich M, Khatkov I, Webber L, Kaldarov A, Windsor J, Costa Filho OP, Koea J, Soreide K, Teh C, Stavrou GA, Pitt H, Di Martino M, Herman P, Lopez-Lopez V, Barreto SG, Berrevoet F, Teh C, Talamonti M, Mikhnevich M, Di Martino M, Soreide K, Khatkov I, Webber L, Kaldarov A, Pitt H, Windsor J, Costa Filho OP, Stavrou GA, Teh C, Pitt H, Di Martino M, Stavrou GA, Lopez-Lopez V, Stavrou GA, Barreto SG, Di Martino M, Lopez-Lopez V, Koea J. A core set of quality performance indicators for HPB procedures: a global consensus for hepatectomy, pancreatectomy, and complex biliary surgery. HPB (Oxford) 2023:S1365-182X(23)00126-0. [PMID: 37198070 DOI: 10.1016/j.hpb.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 03/10/2023] [Accepted: 04/18/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Surgery for hepatopancreaticobiliary (HPB) conditions is performed worldwide. This investigation aimed to develop a set of globally accepted procedural quality performance indicators (QPI) for HPB surgical procedures. METHODS A systematic literature review generated a dataset of published QPI for hepatectomy, pancreatectomy, complex biliary surgery and cholecystectomy. Using a modified Delphi process, three rounds were conducted with working groups composed of self-nominating members of the International Hepatopancreaticobiliary Association (IHPBA). The final set of QPI was circulated to the full membership of the IHPBA for review. RESULTS Seven "core" indicators were agreed for hepatectomy, pancreatectomy, and complex biliary surgery (availability of specific services on site, a specialised surgical team with at least two certified HPB surgeons, a satisfactory institutional case volume, synoptic pathology reporting, undertaking of unplanned reintervention procedures within 90 days, the incidence of post-procedure bile leak and Clavien-Dindo grade ≥III complications and 90-day post-procedural mortality). Three further procedure specific QPI were proposed for pancreatectomy, six for hepatectomy and complex biliary surgery. Nine procedure-specific QPIs were proposed for cholecystectomy. The final set of proposed indicators were reviewed and approved by 102 IHPBA members from 34 countries. CONCLUSIONS This work presents a core set of internationally agreed QPI for HPB surgery.
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Affiliation(s)
- Braden Woodhouse
- Department of Oncology, The University of Auckland, Auckland, New Zealand
| | - Savio G Barreto
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Kjetil Soreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Gregor A Stavrou
- Department of General, Visceral and Thoracic Surgery, Surgical Oncology, Klinikum Saarbrücken, Saarbrücken, Germany
| | - Catherine Teh
- Department of Surgery, National Kidney and Transplant Institute, and Department of Surgery, Makati Medical Center and Department of Surgery, St Luke's Medical Center, Metro Manila, Philippines
| | - Henry Pitt
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Jersey, USA
| | - Marcello Di Martino
- Division of Hepatobiliary and Liver Transplantation Surgery, Department of Transplantation Surgery, A.O.R.N. Cardarelli, Napoli, Italy
| | - Paulo Herman
- Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Victor Lopez-Lopez
- Clinic and University Virgen de la Arrixaca Hospital, IMIB-Arrixaca, Murcia, Spain
| | - Frederik Berrevoet
- Department for General and HPB Surgery and Liver Transplantation, University Hospital, Ghent, Belgium
| | - Mark Talamonti
- University of Chicago Pritzker School of Medicine, Chicago, USA
| | | | - Igor Khatkov
- Moscow Clinical Scientific Centre, Moscow, Russia
| | | | - Ayrat Kaldarov
- Vishnevsky Centre of Surgery, Ministry of Health, Russia, Moscow, Russian Federation
| | - John Windsor
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Omero P Costa Filho
- Universidade Luterana do Brasil and Hospital Militar de Área de Porto Alegre and Hospital de Clinicas de Porto Alegre, Brazil
| | - Jonathan Koea
- Department of Surgery, The University of Auckland, Auckland, New Zealand.
| | - Kjetil Soreide
- Universidade Luterana do Brasil and Hospital Militar de Área de Porto Alegre and Hospital de Clinicas de Porto Alegre, Brazil; Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway; College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Catherine Teh
- Department of Surgery, National Kidney and Transplant Institute, Metro Manila, Philippines; Department of Surgery, Makati Medical Center, Metro Manila, Philippines; Department of Surgery, St Luke's Medical Center, Metro Manila, Philippines
| | - Gregor A Stavrou
- Department of General, Visceral and Thoracic Surgery, Surgical Oncology, Klinikum Saarbrücken, Saarbrücken, Germany
| | - Henry Pitt
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Jersey, United States of America
| | - Marcello Di Martino
- Division of Hepatobiliary and Liver Transplantation Surgery, Department of Transplantation Surgery, A.O.R.N. Cardarelli, Napoli, Italy
| | - Paulo Herman
- Hospital Das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Victor Lopez-Lopez
- Clinic and University Virgen de La Arrixaca Hospital, IMIB-Arrixaca, Murcia, Spain
| | - Savio G Barreto
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Frederik Berrevoet
- Department for General and HPB Surgery and Liver Transplantation, University Hospital, Ghent, Belgium
| | - Catherine Teh
- Department of Surgery, National Kidney and Transplant Institute, Philippines; Department of Surgery, Makati Medical Center, Philippines; Department of Surgery, St Luke's Medical Center, Metro Manila, Philippines
| | - Mark Talamonti
- University of Chicago Pritzker School of Medicine, Chicago, United States of America
| | | | - Marcello Di Martino
- Division of Hepatobiliary and Liver Transplantation Surgery, Department of Transplantation Surgery, A.O.R.N. Cardarelli, Napoli, Italy
| | - Kjetil Soreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Igor Khatkov
- Moscow Clinical Scientific Centre, Moscow, Russia
| | | | - Ayrat Kaldarov
- Vishnevsky Centre of Surgery, Ministry of Health, Russia, Moscow, Russian Federation
| | - Henry Pitt
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Jersey, United States of America
| | - John Windsor
- The Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Omero P Costa Filho
- Universidade Luterana Do Brazil, Brazil; Hospital Militar de Área de Porto Alegre, Brazil; Hospital de Clinicas de Porto Alegre, Brazil
| | - Gregor A Stavrou
- Department of General, Visceral and Thoracic Surgery, Surgical Oncology, Klinikum Saarbrücken, Saarbrücken, Germany
| | - Catherine Teh
- Department of Surgery, National Kidney and Transplant Institute, Philippines; Department of Surgery, Makati Medical Center, Philippines; Department of Surgery, St Luke's Medical Center, Metro Manila, Philippines
| | - Henry Pitt
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Jersey, United States of America
| | - Marcello Di Martino
- Division of Hepatobiliary and Liver Transplantation Surgery, Department of Transplantation Surgery, A.O.R.N. Cardarelli, Napoli, Italy
| | - Gregor A Stavrou
- Department of General, Visceral and Thoracic Surgery, Surgical Oncology, Klinikum Saarbrücken, Saarbrücken, Germany
| | - Victor Lopez-Lopez
- Clinic and University Virgen de La Arrixaca Hospital, IMIB-Arrixaca, Murcia, Spain
| | - Gregor A Stavrou
- Department of General, Visceral and Thoracic Surgery, Surgical Oncology, Klinikum Saarbrücken, Saarbrücken, Germany
| | - Savio G Barreto
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Marcello Di Martino
- Division of Hepatobiliary and Liver Transplantation Surgery, Department of Transplantation Surgery, A.O.R.N. Cardarelli, Napoli, Italy
| | - Victor Lopez-Lopez
- Clinic and University Virgen de La Arrixaca Hospital, IMIB-Arrixaca, Murcia, Spain
| | - Jonathan Koea
- The Department of Surgery, The University of Auckland, Auckland, New Zealand
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Ke L, Mao W, Shao F, Zhou J, Xu M, Chen T, Liu Y, Tong Z, Windsor J, Ma P, Li W. Association between pretreatment lymphocyte count and efficacy of immune-enhancing therapy in acute necrotising pancreatitis: a post-hoc analysis of the multicentre, randomised, placebo-controlled TRACE trial. EClinicalMedicine 2023; 58:101915. [PMID: 37007743 PMCID: PMC10050769 DOI: 10.1016/j.eclinm.2023.101915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 04/04/2023] Open
Abstract
Background Immune-enhancing thymosin alpha 1 (Tα1) therapy may reduce infected pancreatic necrosis (IPN) in acute necrotising pancreatitis (ANP). However, the efficacy might be impacted by lymphocyte count due to the pharmacological action of Tα1. In this post-hoc analysis, we tested the hypothesis that pre-treatment absolute lymphocyte count (ALC) determines whether patients with ANP benefit from Tα1 therapy. Methods A post-hoc analysis of data from a multicentre, double-blind, randomised, placebo-controlled trial testing the efficacy of Tα1 therapy in patients with predicted severe ANP was performed. Patients from 16 hospitals of China were randomised to receive a subcutaneous injection of Tα1 1.6 mg every 12 h for the frst 7 days and 1.6 mg once a day for the following 7 days or a matching placebo during the same period. Patients who discontinued the Tα1 regimen prematurely were excluded. Three subgroup analyses were conducted using the baseline ALC (at randomisation), and the group allocation was maintained as intention-to-treat. The primary outcome was the incidence of IPN 90 days after randomisation. The fitted logistic regression model was applied to identify the range of baseline ALC where Tα1 therapy could exert a maximum effect. The original trial is registered with ClinicalTrials.gov, NCT02473406. Findings Between March 18, 2017, and December 10, 2020, a total of 508 patients were randomised in the original trial, and 502 were involved in this analysis, with 248 in the Tα1 group and 254 in the placebo group. Across the three subgroups, there was a uniform trend toward more significant treatment effects in patients with higher baseline ALC. Within the subgroup of patients with baseline ALC≥0.8 × 10ˆ9/L (n = 290), the Tα1 therapy significantly reduced the risk of IPN (covariate adjusted risk difference, -0.12; 95% CI, -0.21,-0.02; p = 0.015). Patients with baseline ALC between 0.79 and 2.00 × 10ˆ9/L benefited most from the Tα1 therapy in reducing IPN (n = 263). Interpretation This post-hoc analysis found that the efficacy of immune-enhancing Tα1 therapy on the incidence of IPN may be associated with pretreatment lymphocyte count in patients with acute necrotising pancreatitis. Funding National Natural Science Foundation of China.
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Affiliation(s)
- Lu Ke
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
- Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, 210010, Jiangsu, China
- National Institute of Healthcare Data Science, Nanjing University, Nanjing, 210010, Jiangsu, China
| | - Wenjian Mao
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
- Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, 210010, Jiangsu, China
| | - Fang Shao
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, 211166, Jiangsu, China
| | - Jing Zhou
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
- Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, 210010, Jiangsu, China
| | - Minyi Xu
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, 211166, Jiangsu, China
| | - Tao Chen
- Department of Public Health, Policy and Systems, Institute of Population Health, The University of Liverpool, Liverpool, UK
| | - Yuxiu Liu
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
- Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, 210010, Jiangsu, China
- National Institute of Healthcare Data Science, Nanjing University, Nanjing, 210010, Jiangsu, China
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, 211166, Jiangsu, China
| | - Zhihui Tong
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
- Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, 210010, Jiangsu, China
- National Institute of Healthcare Data Science, Nanjing University, Nanjing, 210010, Jiangsu, China
- Corresponding author. Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, Jiangsu Province, 210002, China.
| | - John Windsor
- Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Penglin Ma
- Department of Critical Care Medicine, Guiqian International General Hospital, Guiyang, 550004, Guizhou, China
- Corresponding author. Department of Critical Care Medicine, Guiqian International General Hospital, Guiyang, Guizhou Province, 550004, China.
| | - Weiqin Li
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
- Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, 210010, Jiangsu, China
- National Institute of Healthcare Data Science, Nanjing University, Nanjing, 210010, Jiangsu, China
- Corresponding author. Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, Jiangsu Province, 210002, China.
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Sharifi N, Ma C, Seow C, Quan J, Hracs L, Caplan L, Markovinović A, Herauf M, Windsor J, Coward S, Buie M, Gorospe J, Panaccione R, Kaplan G. A195 DURABILITY OF SEROLOGICAL RESPONSES AFTER SECOND, THIRD AND FOURTH DOSE OF SARS-COV-2 VACCINATION IN INFLAMMATORY BOWEL DISEASE: A PROSPECTIVE COHORT STUDY. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991316 DOI: 10.1093/jcag/gwac036.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Adequate serological responses following two-dose regimens and additional doses of SARS-CoV-2 vaccination have been demonstrated for the vast majority of those with IBD. However, antibody levels following 2nd, 3rd, and 4th dose SARS-CoV-2 vaccination may decrease over time in the IBD population. Purpose We assessed the durability of serological responses to 2nd, 3rd, and 4th dose SARS-CoV-2 vaccination over time in a cohort of IBD patients. Method Adults with IBD who received at least one dose of a SARS-CoV-2 vaccine (n=559) were evaluated for serological response to the spike protein of SARS-CoV-2 using the Abbott IgG II Quant assay with a seroconversion threshold of ≥ 50 AU/mL. The geometric mean titer (GMT) with 95% confidence intervals (CI) were calculated and stratified by weeks (1–8, 8–16, 16–24, 24+ weeks) after each vaccine dose. We compared stratified GMTs with Mann–Whitney U tests using a significance level of 0.05. Result(s) Our cohort (n=559) comprised the following patient characteristics: 82.8% were 18–65 years-old (n = 463), 53.1% were female (n =297), and 71.6% had Crohn’s disease (n =400). IBD medications were classified in the following mutually exclusive groups: No immunosuppressives 10.5% (n = 59), anti-TNF monotherapy 35.8% (n = 200), immunomodulatory monotherapy 2.1% (n =12 ), vedolizumab 11.8% (n =66 ), ustekinumab 20.4% (n =114 ), tofacitinib 1.2% (n =7 ), combination therapy 15.9% (n = 89), and prednisone 2.1% (n =12). For vaccine type, 85.6% and 82.3% had Pfizer for 3rd and 4th dose, respectively, while the remainder had Moderna. Seroconversion rates 1–8 weeks after 3rd and 4th dose were both 99.9%. Figure 1 compares GMTs with 95% CI by weeks after each vaccine dose. GMTs are highest 1–8 weeks after 2nd dose (4053 AU/mL; 95% CI: 3468, 4737 AU/mL; n=337), 3rd dose (12116 AU/mL; 10413, 14098 AU/mL; n=256), and 4th dose (14337 AU/mL; 10429, 19710 AU/mL; n=67). Subsequently, antibody levels decay from 1–8 weeks to 8–16 weeks (p<0.001) for 2nd dose (mean difference: –2224 AU/mL), 3rd dose (mean difference: –7526 AU/mL), and 4th dose (mean difference: –9715 AU/mL). Compared to 16–24 weeks after 2nd dose, antibody levels 24+ weeks after were similar (GMTs: 795 AU/mL vs. 1043 AU/mL, p=0.52). For third dose, antibody levels 8–16 weeks and 16–24 weeks after vaccination were similar (4590 AU/mL vs. 4073 AU/mL, p=0.73) along with 16–24 weeks compared to 24+ weeks after vaccination (4073 AU/mL vs. 5876 AU/mL, p=0.18). Image ![]()
Conclusion(s) Within 1–8 weeks after each dose of vaccine, serological responses spikes with each subsequent dose yielding a higher GMT. While antibody levels decay 8–16 weeks after each dose, similar GMT levels beyond 16 weeks may indicate durability of antibody levels over a longer duration of time. Disclosure of Interest None Declared
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Affiliation(s)
- N Sharifi
- Department of Medicine, University of Calgary, Calgary, Canada
| | - C Ma
- Department of Medicine, University of Calgary, Calgary, Canada
| | - C Seow
- Department of Medicine, University of Calgary, Calgary, Canada
| | - J Quan
- Department of Medicine, University of Calgary, Calgary, Canada
| | - L Hracs
- Department of Medicine, University of Calgary, Calgary, Canada
| | - L Caplan
- Department of Medicine, University of Calgary, Calgary, Canada
| | - A Markovinović
- Department of Medicine, University of Calgary, Calgary, Canada
| | - M Herauf
- Department of Medicine, University of Calgary, Calgary, Canada
| | - J Windsor
- Department of Medicine, University of Calgary, Calgary, Canada
| | - S Coward
- Department of Medicine, University of Calgary, Calgary, Canada
| | - M Buie
- Department of Medicine, University of Calgary, Calgary, Canada
| | - J Gorospe
- Department of Medicine, University of Calgary, Calgary, Canada
| | - R Panaccione
- Department of Medicine, University of Calgary, Calgary, Canada
| | - G Kaplan
- Department of Medicine, University of Calgary, Calgary, Canada
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13
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Al-Leswas D, Baxter N, Lim WB, Robertson F, Ratnayake B, Samanta J, Capurso G, de-Madaria E, Drewes AM, Windsor J, Pandanaboyana S. The safety and efficacy of epidural anaesthesia in acute pancreatitis: a systematic review and meta-analysis. HPB (Oxford) 2023; 25:162-171. [PMID: 36593161 DOI: 10.1016/j.hpb.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/02/2022] [Accepted: 12/09/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Acute pancreatitis (AP) has variable clinical courses. This systematic review and meta-analysis aimed to determine the safety, efficacy, and impact of epidural anaesthesia (EA) use in AP. METHODS The PubMed, EMBASE, SCOPUS and Cochrane library databases were systematically searched between 1980 and 2022 using the PRISMA guidelines, to identify observational and comparative studies reporting on EA in AP. The meta-analysis was performed in R Foundation for Statistical Computing using the meta R Package for Meta-Analysis. RESULTS A total of 9 studies with 2006 patients of which 726 (36%) patients had EA were included. All studies demonstrated high safety and feasibility of EA in AP with no reported major local or neurological complications. One randomised controlled trial demonstrated an improvement in pain severity using a 0-10 visual analogue scale (VAS) at the outset (1.6 in EA vs 3.5 in non-EA, P = 0.02) and on day 10 (0.2 in EA vs 2.33 in non-EA, P = 0.034). There was also improvement in pancreatic perfusion with EA measured with computerised tomography 13 (43%) in EA vs 2 (7%) in non-EA, P = 0.003. The need for ventilatory support and overall mortality was lower in EA patients 40 (19%) vs 285 (24%) P = 0.025 (OR: 0.49, 95% CI: 0.28-0.84) and 16 (7%) vs 214 (20%), P = 0.050 (OR: 0.39, 95% CI: 0.15-1.00), respectively. CONCLUSION EA is infrequently used for pain management in AP and yet the available evidence suggests that it is safe and effective in reducing pain severity, improving pancreatic perfusion, and decreasing mortality.
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Affiliation(s)
- Dhya Al-Leswas
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Nesta Baxter
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Wei B Lim
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Francis Robertson
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, UK
| | | | - Jayanta Samanta
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Gabriele Capurso
- Pancreatico-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy
| | - Enrique de-Madaria
- Gastroenterology Department, Dr. Balmis General University Hospital; Department of Clinical Medicine, Miguel Hernández University; ISABIAL, Alicante, Spain
| | - Asbjørn M Drewes
- Department of Gastroenterology, Centre for Pancreatic Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - John Windsor
- HBP/Upper GI Unit, Auckland City Hospital, Auckland, New Zealand; Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Sanjay Pandanaboyana
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, UK; Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK.
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14
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Mao W, Li K, Zhou J, Chen M, Ye B, Li G, Singh V, Buxbaum J, Fu X, Tong Z, Liu Y, Windsor J, Li W, Ke L. Prediction of infected pancreatic necrosis in acute necrotizing pancreatitis by the modified pancreatitis activity scoring system. United European Gastroenterol J 2022; 11:69-78. [PMID: 36579414 PMCID: PMC9892470 DOI: 10.1002/ueg2.12353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/12/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Infected pancreatic necrosis (IPN) is a significant complication of acute necrotizing pancreatitis (ANP). Early identification of patients at high risk of IPN would enable appropriate treatment, but there is a lack of valid tools. This study aimed to assess the performance of the Pancreatitis Activity Scoring System (PASS) and its modifications (by removing or reducing the weight of opioid usage) in predicting IPN in a cohort of predicted severe ANP patients. METHODS Data was prospectively collected in the TRACE trial (2017-2020) involving 16 sites across China. The predictive performance of PASS, modified PASS (mPASS), and conventional indices were assessed by the area under the receiver operating characteristic curve (AUC), Hosmer-Lemeshow Ĉ-test, Brier score, and Fagan's nomogram. Multivariate logistic regression analysis (MLRA) was used to define the relationship between the best-performing PASS/mPASS model and IPN. RESULTS A total of 508 subjects were enrolled (median age, 43 years; 62.8% males) in the original trial, and 122 developed IPN (24%) within 90 days after randomization. Compared with non-IPN patients, the scores of PASS and its modified models were significantly higher in the IPN patients (all p < 0.001). Among the PASS and its modifications, mPASS-4 had the largest AUC, the lowest Brier score, and good calibration. The mPASS-4 model demonstrated an AUC of 0.752 in predicting IPN (the optimal cut-off for the mPASS-4 was 292.5) and outperformed the conventional indices. The MLRA results showed that mPASS-4 >292.5 was an independent risk factor of IPN (OR: 3.6, 95% CI: 2.1-6.3). CONCLUSION The PASS and its modifications during the first week of ANP onset predict the development of IPN, with mPASS-4 performing best. The mPASS-4 model simplifies the original PASS, increasing the likelihood of clinical implementation.
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Affiliation(s)
- Wenjian Mao
- Department of Critical Care MedicineJinling HospitalNanjing Medical UniversityNanjingJiangsuChina,Department of Critical Care MedicineJinling HospitalMedical College of Nanjing UniversityNanjingJiangsuChina,National Institute of Healthcare Data ScienceNanjing UniversityNanjingJiangsuChina
| | - Kang Li
- Department of Critical Care MedicineThe Affiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Jing Zhou
- Department of Critical Care MedicineJinling HospitalNanjing Medical UniversityNanjingJiangsuChina,Department of Critical Care MedicineJinling HospitalMedical College of Nanjing UniversityNanjingJiangsuChina,National Institute of Healthcare Data ScienceNanjing UniversityNanjingJiangsuChina
| | - Miao Chen
- Department of Critical Care MedicineThe Affiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Bo Ye
- Department of Critical Care MedicineJinling HospitalNanjing Medical UniversityNanjingJiangsuChina,Department of Critical Care MedicineJinling HospitalMedical College of Nanjing UniversityNanjingJiangsuChina,National Institute of Healthcare Data ScienceNanjing UniversityNanjingJiangsuChina
| | - Gang Li
- Department of Critical Care MedicineJinling HospitalNanjing Medical UniversityNanjingJiangsuChina,Department of Critical Care MedicineJinling HospitalMedical College of Nanjing UniversityNanjingJiangsuChina,National Institute of Healthcare Data ScienceNanjing UniversityNanjingJiangsuChina
| | - Vikesh Singh
- Pancreatitis CentreDivision of GastroenterologyJohns Hopkins Medical InstitutionsBaltimoreMarylandUSA
| | - James Buxbaum
- Department of MedicineDivision of GastroenterologyKeck School of Medicine of the University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Xiaoyun Fu
- Department of Critical Care MedicineThe Affiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Zhihui Tong
- Department of Critical Care MedicineJinling HospitalNanjing Medical UniversityNanjingJiangsuChina,Department of Critical Care MedicineJinling HospitalMedical College of Nanjing UniversityNanjingJiangsuChina,National Institute of Healthcare Data ScienceNanjing UniversityNanjingJiangsuChina
| | - Yuxiu Liu
- Department of Critical Care MedicineJinling HospitalNanjing Medical UniversityNanjingJiangsuChina,Department of Critical Care MedicineJinling HospitalMedical College of Nanjing UniversityNanjingJiangsuChina,Department of Medical StatisticsJinling HospitalMedical School of Nanjing UniversityNanjingJiangsuChina
| | - John Windsor
- Surgical and Translational Research CentreFaculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
| | - Weiqin Li
- Department of Critical Care MedicineJinling HospitalNanjing Medical UniversityNanjingJiangsuChina,Department of Critical Care MedicineJinling HospitalMedical College of Nanjing UniversityNanjingJiangsuChina,National Institute of Healthcare Data ScienceNanjing UniversityNanjingJiangsuChina
| | - Lu Ke
- Department of Critical Care MedicineJinling HospitalNanjing Medical UniversityNanjingJiangsuChina,Department of Critical Care MedicineJinling HospitalMedical College of Nanjing UniversityNanjingJiangsuChina,National Institute of Healthcare Data ScienceNanjing UniversityNanjingJiangsuChina
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Jahedi H, Ramachandran A, Windsor J, Knowlton N, Blenkiron C, Print CG. Clinically Relevant Biology of Hyaluronic Acid in the Desmoplastic Stroma of Pancreatic Ductal Adenocarcinoma. Pancreas 2022; 51:1092-1104. [PMID: 37078930 DOI: 10.1097/mpa.0000000000002154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
ABSTRACT Pancreatic ductal adenocarcinoma (PDAC) is notorious for its poor outcome. The presence of a dense desmoplastic stroma is a hallmark of this malignancy, and abundant hyaluronic acid (HA) within this stroma is a common feature of PDAC. At the end of 2019, an HA-targeting drug, after initial promise, failed phase 3 clinical trials in PDAC. This failure in the face of such strong evidence for biological importance forces us to turn back to the research and seek a better understanding of HA biology in PDAC. Therefore, in this review, we reexamine what is known about HA biology, the methods used to detect and quantify HA, and the ability of the biological models in which HA has been investigated to recapitulate an HA-rich desmoplastic tumor stroma. The role of HA in PDAC relies on its complex interplay with a range of HA-associated molecules, which have not been as extensively investigated as HA itself. Therefore, using large genomic data sets, we cataloged the abundance and activity in PDAC of molecules that modulate HA synthesis, degradation, protein interactions, and receptor binding. Based on their association with clinical characteristics and individual patient outcomes, we suggest a small number of HA-associated molecules that warrant further investigation as biomarkers and drug targets.
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Affiliation(s)
- Hossein Jahedi
- From the Departments of Molecular Medicine and Pathology
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Yang F, Huang Y, Li T, Fu Y, Sun C, Xu Y, Windsor J, Fu D. Prevalence and outcomes of acute pancreatitis in COVID-19: a meta-analysis. Gut 2022; 71:1451-1453. [PMID: 34670809 DOI: 10.1136/gutjnl-2021-325941] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 10/09/2021] [Indexed: 01/19/2023]
Affiliation(s)
- Feng Yang
- Department of Pancreatic Surgery, Huashan Hospital Fudan University, Shanghai, Shanghai, China
| | - Yuting Huang
- Department of Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, Maryland, USA
| | - Tian Li
- Department of Medicine, SUNY Downstate Health and Science University, New York City, New York, USA
| | - Yunting Fu
- Health Sciences and Human Services Library, University of Maryland, Baltimore, Baltimore, Maryland, USA
| | - Chenyu Sun
- Internal Medicine, AMITA Health Saint Joseph Hospital Chicago, Chicago, Illinois, USA
| | - Yecheng Xu
- Department of Pancreatic Surgery, Huashan Hospital Fudan University, Shanghai, Shanghai, China
| | - John Windsor
- Surgical and Translational Research Centre, The University of Auckland, Auckland, New Zealand
| | - Deliang Fu
- Department of Pancreatic Surgery, Huashan Hospital Fudan University, Shanghai, Shanghai, China
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Robertson R, Russell K, Pandanaboyana S, Wu D, Windsor J. Postoperative nutritional support after pancreaticoduodenectomy in adults. Hippokratia 2022. [DOI: 10.1002/14651858.cd014792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Rachel Robertson
- Department of General Surgery; Whangarei Hospital, Northland District Health Board; Whangarei New Zealand
| | - Kylie Russell
- Nutrition and Dietetics; Auckland District Health Board; Auckland New Zealand
- Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
| | - Sanjay Pandanaboyana
- HPB and Liver Transplant Surgery; Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust; Newcastle upon Tyne UK
| | - Dong Wu
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases; Peking Union Medical College Hospital, Chinese Academy of Medical Sciences; Beijing China
| | - John Windsor
- Surgical and Translational Research Centre, Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
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Ke L, Zhou J, Mao W, Chen T, Zhu Y, Pan X, Mei H, Singh V, Buxbaum J, Doig G, He C, Gu W, Lu W, Tu S, Ni H, Zhang G, Zhao X, Sun J, Chen W, Song J, Shao M, Tu J, Xia L, He W, Zhu Q, Li K, Yao H, Wu J, Fu L, Jiang W, Zhang H, Lin J, Li B, Tong Z, Windsor J, Liu Y, Li W. Immune enhancement in patients with predicted severe acute necrotising pancreatitis: a multicentre double-blind randomised controlled trial. Intensive Care Med 2022; 48:899-909. [PMID: 35713670 PMCID: PMC9205279 DOI: 10.1007/s00134-022-06745-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/16/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Infected pancreatic necrosis (IPN) is a highly morbid complication of acute necrotising pancreatitis (ANP). Since there is evidence of early-onset immunosuppression in acute pancreatitis, immune enhancement may be a therapeutic option. This trial aimed to evaluate whether early immune-enhancing Thymosin alpha 1 (Tα1) treatment reduces the incidence of IPN in patients with predicted severe ANP. METHODS We conducted a multicentre, double-blind, randomised, placebo-controlled trial involving ANP patients with an Acute Physiology and Chronic Health Evaluation II (APACHE II) score ≥ 8 and a computed tomography (CT) severity score ≥ 5 admitted within 7 days of the advent of symptoms. Enrolled patients were assigned to receive a subcutaneous injection of Tα1 1.6 mg every 12 h for the first 7 days and 1.6 mg once a day for the subsequent 7 days or matching placebos (normal saline). The primary outcome was the development of IPN during the index admission. RESULTS A total of 508 patients were randomised, of whom 254 were assigned to receive Tα1 and 254 placebo. The vast majority of the participants required admission to the intensive care unit (ICU) (479/508, 94.3%). During the index admission, 40/254(15.7%) patients in the Tα1 group developed IPN compared with 46/254 patients (18.1%) in the placebo group (difference -2.4% [95% CI - 7.4 to 5.1%]; p = 0.48). The results were similar across four predefined subgroups. There was no difference in other major complications, including new-onset organ failure (10.6% vs. 15%), bleeding (6.3% vs. 3.5%), and gastrointestinal fistula (2% vs. 2.4%). CONCLUSION The immune-enhancing Tα1 treatment of patients with predicted severe ANP did not reduce the incidence of IPN during the index admission.
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Affiliation(s)
- Lu Ke
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, 210000 Jiangsu China ,National Institute of Healthcare Data Science, Nanjing University, Nanjing, 210010 Jiangsu China
| | - Jing Zhou
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, 210000 Jiangsu China ,Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, 210010 Jiangsu China
| | - Wenjian Mao
- Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, 210010 Jiangsu China
| | - Tao Chen
- Department of Public Health, Policy and Systems, Institute of Population Health, Whelan Building, Quadrangle, The University of Liverpool, Liverpool, L69 3GB UK
| | - Yin Zhu
- Pancreatic Disease Centre, Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006 Jiangxi China
| | - Xinting Pan
- Department of Emergency Intensive Care Unit, The Affiliated Hospital of Qingdao University, Qingdao, 266000 Shandong China
| | - Hong Mei
- Department of Critical Care Medicine, The Affiliated Hospital of Zunyi Medical University, Zunyi, 536000 Guizhou China
| | - Vikesh Singh
- Pancreatitis Centre, Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD USA
| | - James Buxbaum
- Division of Gastroenterology, Department of Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, USA
| | - Gordon Doig
- Northern Clinical School, Royal, North Shore Hospital, University of Sydney, Sydney, Australia
| | - Chengjian He
- Department of Critical Care Medicine, the Affiliated Nanhua Hospital, University of South China, Hengyang, 421002 Hunan China
| | - Weili Gu
- Department of Critical Care Medicine, Affiliated Hospital 2 of Nantong University, Nantong, 226000 Jiangsu China
| | - Weihua Lu
- Department of Intensive Care Unit, The First Affiliated Hospital of Wannan Medical College, Wuhu, 241001 Anhui China
| | - Shumin Tu
- Department of Emergency Medicine, Shangqiu First People’s Hospital, Shangqiu, 476000 Henan China
| | - Haibin Ni
- Department of Emergency Medicine, Jiangsu Provincial Hospital of Integrated Chinese and Western Medicine, Nanjing, 210010 Jiangsu China
| | - Guoxiu Zhang
- Department of Emergency Medicine, The First Affiliated Hospital and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, 471003 Henan China
| | - Xiangyang Zhao
- Department of Intensive Care Unit, Qilu Hospital of Shandong University, Qingdao, 266000 Shandong China
| | - Junli Sun
- Department of Intensive Care Unit, Luoyang Central Hospital, Zhengzhou University, Luoyang, 471100 Henan China
| | - Weiwei Chen
- Department of Gastroenterology, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu China
| | - Jingchun Song
- Department of Critical Care Medicine, 94Th Hospital of PLA, Nanchang, 330006 Jiangxi China
| | - Min Shao
- Department of Intensive Care Unit, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022 Anhui China
| | - Jianfeng Tu
- Department of Emergency Medicine, Zhejiang Provincial People’s Hospital, Hangzhou, 310014 Zhejiang China
| | - Liang Xia
- Pancreatic Disease Centre, Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006 Jiangxi China
| | - Wenhua He
- Pancreatic Disease Centre, Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006 Jiangxi China
| | - Qingyun Zhu
- Department of Emergency Intensive Care Unit, The Affiliated Hospital of Qingdao University, Qingdao, 266000 Shandong China
| | - Kang Li
- Department of Critical Care Medicine, The Affiliated Hospital of Zunyi Medical University, Zunyi, 536000 Guizhou China
| | - Hongyi Yao
- Department of Critical Care Medicine, the Affiliated Nanhua Hospital, University of South China, Hengyang, 421002 Hunan China
| | - Jingyi Wu
- Department of Intensive Care Unit, The First Affiliated Hospital of Wannan Medical College, Wuhu, 241001 Anhui China
| | - Long Fu
- Department of Emergency Medicine, Shangqiu First People’s Hospital, Shangqiu, 476000 Henan China
| | - Wendi Jiang
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, 210000 Jiangsu China
| | - He Zhang
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Southeast University, Nanjing, 210002 Jiangsu China
| | - Jiajia Lin
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, 210000 Jiangsu China
| | - Baiqiang Li
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, 210000 Jiangsu China
| | - Zhihui Tong
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, 210000 Jiangsu China
| | - John Windsor
- Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, 1142 New Zealand
| | - Yuxiu Liu
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, 210000 Jiangsu China ,Department of Medical Statistics, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002 Jiangsu China
| | - Weiqin Li
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, 210000 Jiangsu China ,Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, 210010 Jiangsu China ,National Institute of Healthcare Data Science, Nanjing University, Nanjing, 210010 Jiangsu China
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Thavanesan N, White S, Lee S, Ratnayake B, Leeds J, Nayar M, Sharp L, Siriwardena A, Drewes A, Capurso G, de Madaria E, Windsor J, Pandanaboyana S. P-P08 Towards effective analgesia in acute pancreatitis: a systematic review of randomised controlled trials. Br J Surg 2021. [DOI: 10.1093/bjs/znab430.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
The optimal analgesic strategy for patients with acute pancreatitis (AP) remains unknown. The present systematic review and meta-analysis aims to compare the efficacy of several analgesic modalities trialled in AP.
Methods
A systematic search of PubMed, MEDLINE and EMBASE was conducted up until June 2021, according to PRISMA Guidelines to identify all randomised control trials (RCTs) comparing analgesic modalities in AP. The primary outcome measure was improvement in pain scores as reported on visual analogue scale (VAS) on day 0, day 1 and day 2.
Results
Twelve RCTs were identified including 542 patients. Seven trial drugs were compared: opiates, non-steroidal anti-inflammatories (NSAIDs), placebo, local anaesthetic, epidural, paracetamol and metamizole. A weighted single-arm effects estimate showed global improvement in VAS across all modalities from baseline to day 2. On visual inspection, epidural analgesia appears to provide the greatest improvement in pain scores within the first 24hrs, however at 48hrs it was comparable to opiates. Within the first 24hrs, NSAIDs offered similar pain-relief to opiates, while placebo also showed equivalence to other modalities but then plateaued. Local anaesthetics demonstrated least overall efficacy. VAS scores for opiate and non-opiate analgesics were comparable at baseline and day 1. The identified RCTs demonstrated significant heterogeneity in pain-relief reporting with relatively small datasets per study.
Conclusions
Given the incidence of AP there is remarkable paucity of level 1 evidence to guide pain management. Epidural administration is most effective analgesic modality within the first 24hrs of AP. NSAIDs are an effective opiate sparing alternative during the first 24hrs.
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Affiliation(s)
- Navamayooran Thavanesan
- Department of Gastrointestinal Surgery, Salisbury Hospital Foundation Trust, Salisbury, United Kingdom
| | - Sophie White
- Department of General Surgery, Royal Hampshire County Hospital, Winchester, United Kingdom
| | - Shiela Lee
- Department of General Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Bathiya Ratnayake
- Surgical and Translational Research Centre, University of Auckland, Auckland, New Zealand
| | - John Leeds
- Department of Gastroenterology, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Manu Nayar
- Department of Gastroenterology, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ajith Siriwardena
- Department of Hepatobiliary Surgery, Manchester Royal Infirmary, Manchester, United Kingdom
- University of Manchester, Manchester, United Kingdom
- European-African Hepato-Pancreatico-Biliary Association, Glasgow, United Kingdom
| | - Asbørn Drewes
- Gastroenterology and Hepatology clinical institute, Aalborg University Hospital, Aalborg, Denmark
| | - Gabriele Capurso
- Pancreas Translational and Clinical Research centre, San Raffaele Scientific Institute, Milan, Italy
| | - Enrique de Madaria
- Digestive System Service, General University Hospital of Alicante, Alicante, Spain
| | - John Windsor
- Surgical and Translational Research Centre, University of Auckland, Auckland, New Zealand
- Department of Hepatopancreaticobiliary surgery, Auckland City Hospital, Auckland, New Zealand
| | - Sanjay Pandanaboyana
- Department of Hepatopancreaticobiliary surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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20
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Thompson B, Philcox S, Devereaux B, Metz A, Croagh D, Windsor J, Davaris A, Gupta S, Barlow J, Rhee J, Tagkalidis P, Zimet A, Sharma A, Manocha R, Neale RE. A decision support tool for the detection of pancreatic cancer in general practice: A modified Delphi consensus. Pancreatology 2021; 21:1476-1481. [PMID: 34483054 DOI: 10.1016/j.pan.2021.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/12/2021] [Accepted: 08/17/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES Diagnosis of pancreatic cancer is often delayed, contributing to patient and family distress and leading to worse survival. We aimed to develop a decision support tool to support primary care providers to identify patients that should undergo investigations for pancreatic cancer, and to recommend initial diagnostic pathways. METHODS A modified Delphi process, including a series of three surveys, was undertaken to ascertain clinical expert opinion on which combinations of signs, symptoms and risk factors should be included in a tool for the early identification of pancreatic cancer. A group of clinical specialists finalised the development of the tool during a focus group meeting. RESULTS The tool presents individual or combinations of signs, symptoms, and risk factors in three tiers which direct the urgency of investigation. Tier 1 includes 5 clinical presentation and risk factors clusters that indicate the need for urgent investigation of the pancreas. A further five clusters are included as Tier 2 aiming to elimate other causes and reduce the time to investigating the pancreas. Tier 3 includes a list of non-specific signs, symptoms and risk factors that indicate the need to consider pancreatic cancer as a potential diagnosis, but without specific recommendations for investigation. CONCLUSIONS Prospective validation studies are now required prior to implementation in the primary care setting. Implementation into primary care practice and as an educational resource may facilitate rapid diagnosis and improve outcomes such as distress and survival.
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Affiliation(s)
- B Thompson
- Department of Population Health, QIMR Berghofer Medical Research Institute, Queensland, Australia.
| | - S Philcox
- Gastroenterology Department, John Hunter Hosptial, New South Wales, Australia
| | - B Devereaux
- The Gastroenterology and Hepatology Department, Royal Brisbane and Women's Hospital, Queensland, Australia; School of Clinical Medicine, University of Queensland, Queensland, Australia
| | - A Metz
- Gastroenterology and Hepatology, Royal Melbourne Hospital, Victoria, Australia
| | - D Croagh
- Department of Surgery (School of Clinical Sciences at Monash Health), Monash University, Victoria, Australia
| | - J Windsor
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - A Davaris
- Royal Australian College of General Practitioners, Australia
| | - S Gupta
- Sydney Adventist Hospital, Sydney, New South Wales, Australia
| | - J Barlow
- Bankstown Family Medical Practice, Sydney, Australia
| | - J Rhee
- Royal Australian College of General Practitioners, Australia; General Practice Academic Unit, Graduate Medicine, University of Wollongong, New South Wales, Australia
| | - P Tagkalidis
- Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - A Zimet
- Epworth Hospital, Victoria, Australia
| | - A Sharma
- School of Clinical Medicine, University of Queensland, Queensland, Australia
| | - R Manocha
- HealthEd, Melbourne, Victoria, Australia
| | - R E Neale
- Department of Population Health, QIMR Berghofer Medical Research Institute, Queensland, Australia; School of Public Health, University of Queensland, Queensland, Australia
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21
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Wu D, Bai X, Lee P, Yang Y, Windsor J, Qian J. A systematic review of NSAIDs treatment for acute pancreatitis in animal studies and clinical trials. Clin Res Hepatol Gastroenterol 2021; 44S:100002. [PMID: 33602483 DOI: 10.1016/j.clirex.2019.100002] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/08/2019] [Accepted: 08/26/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently given to patients with acute pancreatitis (AP) for controlling pain, but their efficacy in treating AP, particularly in reducing systemic complications, remains unclear. AIM The aim of our study was to evaluate the efficacy of NSAIDs in treating AP and its systematic complications. METHODS Two independent reviewers screened articles from MEDLINE, Embase and Cochrane and scored the quality of each study according to the CAMARADES 10-item quality checklist or the Jadad scale. Five endpoints were chosen to evaluate the effect of NSAIDs in animal studies: amylase and lipase levels, proinflammatory cytokines, oxidative damage, histopathological changes, and mortality rate. Meanwhile, in clinical studies, endpoints, such as proinflammatory cytokines, pain relief, systematic complications, mortality, and adverse events were used. RESULTS A total of 36 studies out of 17,845 were identified and included. Of these 36 studies, only 5 were clinical trials involving 580 patients, and the remaining 31 were animal studies with 1623 rats or mice. 24 studies focused on the treatment of AP with NSAIDs and 12 on AP-associated systematic complications. Both preclinical and clinical studies showed that NSAIDs may have beneficial effects against AP-related injuries. 9 of the 14 preclinical studies stated that NSAIDs reduced the serum amylase level significantly, and 6 of 7 showed that NSAIDs lowered the lipase level markedly. 17 experimental studies all demonstrated that NSAIDs reduced the inflammation. Histopathological examinations indicated that NSAIDs significantly improved the histopathological damages. Similarly, clinical evidence showed that NSAIDs are effective in suppressing proinflammatory cytokines, relieving pain, ameliorating systematic complications and reducing mortality. In the included 5 clinical studies, serious adverse events associated with NSAIDs were rarely reported. CONCLUSION This systematic review shows that NSAIDs are a potential treatment for AP-related injuries based on the current preclinical and clinical evidences.
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Affiliation(s)
- Dong Wu
- Department of Gastroenterology, Translational Medicine Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Xiaoyin Bai
- Department of Gastroenterology, Translational Medicine Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Peter Lee
- Division of Gastroenterology, Department of Medicine, Hospital of the University of Pennsylvania, PA, USA
| | - Yingyun Yang
- Department of Gastroenterology, Translational Medicine Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - John Windsor
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Park Road, Auckland, New Zealand
| | - Jiaming Qian
- Department of Gastroenterology, Translational Medicine Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
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22
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Ye B, Huang M, Chen T, Doig G, Wu B, Chen M, Tu S, Chen X, Yang M, Zhang G, Li Q, Pan X, Zhao L, Xia H, Chen Y, Ke L, Tong Z, Bellomo R, Windsor J, Li W. The Impact of Normal Saline or Balanced Crystalloid on Plasma Chloride Concentration and Acute Kidney Injury in Patients With Predicted Severe Acute Pancreatitis: Protocol of a Phase II, Multicenter, Stepped-Wedge, Cluster-Randomized, Controlled Trial. Front Med (Lausanne) 2021; 8:731955. [PMID: 34671619 PMCID: PMC8521113 DOI: 10.3389/fmed.2021.731955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/07/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction/aim: The supraphysiologic chloride concentration of normal saline may contribute to acute kidney injury (AKI). Balanced crystalloids can decrease chloride concentration and AKI in critically ill patients. We aim to test the hypothesis that, in patients with predicted severe acute pancreatitis (pSAP), compared with saline, fluid therapy with balanced crystalloids will decrease plasma chloride concentration. Methods/Design: This is a multicenter, stepped-wedge, cluster-randomized, controlled trial. All eligible patients presenting to the 11 participating sites across China during the study period will be recruited. All sites will use saline for the first month and sequentially change to balanced crystalloids at the pre-determined and randomly allocated time point. The primary endpoint is the plasma chloride concentration on day 3 of enrollment. Secondary endpoints will include major adverse kidney events on hospital discharge or day 30 (MAKE 30) and free and alive days to day 30 for intensive care admission, invasive ventilation, vasopressors, and renal replacement therapy. Additional endpoints include daily serum chloride and sequential organ failure assessment (SOFA) score over the first seven days of enrollment. Discussion: This study will provide data to define the impact of normal saline vs. balanced crystalloids on plasma chloride concentration and clinical outcomes in pSAP patients. It will also provide the necessary data to power future large-scale randomized trials relating to fluid therapy. Ethics and Dissemination: This study was approved by the ethics committee of Jinling Hospital, Nanjing University (2020NZKY-015-01) and all the participating sites. The results of this trial will be disseminated in peer-reviewed journals and at scientific conferences. Trial registration: The trial has been registered at the Chinese Clinical Trials Registry (ChiCTR2100044432).
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Affiliation(s)
- Bo Ye
- Department of Critical Care Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Mingfeng Huang
- Department of Critical Care Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Tao Chen
- Global Health Trials Unit, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Gordon Doig
- Northern Clinical School, Royal, North Shore Hospital, University of Sydney, Sydney, NSW, Australia
| | - Bin Wu
- Department of General Intensive Care Unit, The Third Hospital of Xiamen City, Xiamen, China
| | - Mingzhi Chen
- Department of Critical Care Medicine, Jinjiang Hospital of Traditional Chinese Medicine, Jinjiang, China
| | - Shumin Tu
- Department of Emergency, The First Hospital of Shangqiu City, Shangqiu, China
| | - Xiaomei Chen
- Department of Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Mei Yang
- Department of Intensive Care Unit, The Qujing NO.1 People's Hospital, Qujing, China
| | - Guoxiu Zhang
- Department of Emergency Intensive Care Unit, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China
| | - Qiang Li
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xinting Pan
- Department of Emergency Intensive Care Unit, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lijuan Zhao
- Department of Emergency Intensive Care Unit, First People's Hospital of Yunnan Province, Kunming, China
| | - Honghai Xia
- Department of Emergency, The First Affiliated Hospital of the University of Science and Technology of China, Hefei, China
| | - Yan Chen
- National Institute of Healthcare Data Science at Nanjing University, Nanjing, China
| | - Lu Ke
- Department of Critical Care Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.,National Institute of Healthcare Data Science at Nanjing University, Nanjing, China
| | - Zhihui Tong
- Department of Critical Care Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Rinaldo Bellomo
- Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia.,Australian and New Zealand Research Center, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.,Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - John Windsor
- Surgical And Translational Research Center, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Weiqin Li
- Department of Critical Care Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.,National Institute of Healthcare Data Science at Nanjing University, Nanjing, China
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23
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Chong E, Ratnayake B, Lee S, French JJ, Wilson C, Roberts KJ, Loveday BPT, Manas D, Windsor J, White S, Pandanaboyana S. Systematic review and meta-analysis of risk factors of postoperative pancreatic fistula after distal pancreatectomy in the era of 2016 International Study Group pancreatic fistula definition. HPB (Oxford) 2021; 23:1139-1151. [PMID: 33820687 DOI: 10.1016/j.hpb.2021.02.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Risk factors for the development of clinically relevant POPF (CR-POPF) following distal pancreatectomy (DP) need clarification particularly following the 2016 International Study Group of Pancreatic Fistula (ISGPF) definition. METHODS A systemic search of MEDLINE, Pubmed, Scopus, and EMBASE were conducted using the PRISMA framework. Studies were evaluated for risk factors for the development CR-POPF after DP using the 2016 ISGPF definition. Further subgroup analysis was undertaken on studies ≥10 patients in exposed and non-exposed subgroups. RESULTS Forty-three studies with 8864 patients were included in the meta-analysis. The weighted rate of CR-POPF was 20.4% (95%-CI: 17.7-23.4%). Smoking (OR 1.29, 95%-CI: 1.08-1.53, p = 0.02) and open DP (OR 1.43, 95%-CI: 1.02-2.01, p = 0.04) were found to be significant risk factors of CR-POPF. Diabetes (OR 0.81, 95%-CI: 0.68-0.95, p = 0.02) was a significant protective factor against CR-POPF. Substantial heterogeneity was observed in the comparisons of pancreatic texture and body mass index. Seventeen risk factors achieved significance in a univariate or multivariate comparison as reported by individual studies in the narrative synthesis, however, they remain difficult to interpret as statistically significant comparisons were not uniform. CONCLUSION This meta-analysis found smoking and open DP to be risk factors and diabetes to be protective factor of CR-POPF in the era of 2016 ISGPF definition.
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Affiliation(s)
- Eric Chong
- Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Bathiya Ratnayake
- Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Shiela Lee
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Newcastle Upon Tyne, Tyne and Wear, United Kingdom
| | - Jeremy J French
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Newcastle Upon Tyne, Tyne and Wear, United Kingdom
| | - Colin Wilson
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Newcastle Upon Tyne, Tyne and Wear, United Kingdom
| | - Keith J Roberts
- Department of Hepatobiliary and Pancreatic Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Benjamin P T Loveday
- Hepatobiliary and Upper Gastrointestinal Unit, Royal Melbourne Hospital, Victoria, Australia; Department of Surgical Oncology, Peter MacCallum Cancer Centre, Victoria, Australia
| | - Derek Manas
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Newcastle Upon Tyne, Tyne and Wear, United Kingdom
| | - John Windsor
- Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Steve White
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Newcastle Upon Tyne, Tyne and Wear, United Kingdom
| | - Sanjay Pandanaboyana
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Newcastle Upon Tyne, Tyne and Wear, United Kingdom; Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom.
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Xiong Y, Zhao Y, Han X, Chen G, Windsor J, Wu D, Qian J. Clinical characteristics and outcome of tumor-associated acute pancreatitis: a single-center cohort study. Ann Transl Med 2021; 9:639. [PMID: 33987337 PMCID: PMC8106109 DOI: 10.21037/atm-20-7196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background What features should alert clinicians to suspect underlying tumors in patients with acute pancreatitis (AP) was largely unknown. This study aimed to assess the clinical characteristics and outcome in patients with tumor-associated AP. Methods Patients who presented with AP and were diagnosed with tumor after admission were included according to the inclusion and exclusion criteria and followed up by hospital notes, telephone, WeChat and/or e-mail. The clinical characteristics and outcome were analyzed with multivariable logistic regression and were compared with AP patients without tumor. Results Out of a cohort of 1,792 AP patients we identified 103 who had a neoplastic etiology. The 103 patients had a median age of 57 (range, 13-81) and 65 were males. AP was mild in 92 patients, moderately severe in 7 and severe in 4. The three most common tumors included pancreatic cancer (PC) (40), periampullary carcinoma (PAC) (25), and neoplastic pancreatic cysts (NPC) (22). The following ranked features were predictive of a tumor etiology: dilation of main pancreatic duct (MPD) (OR 417.83, 95% CI: 80.40-2,171.42), vascular invasion (OR 82.04, 95% CI: 6.05-1,113.14), mild AP (8.29, 95% CI: 1.98-34.73), and anemia (OR 5.73, 95% CI: 2.02-16.26). The median survival period of AP patients with PC, PAC, and NPC was 10.0 (7.0-23.5), 21.0 (5.0-37.0), and 35.0 (30.0-96.0) months, respectively. Conclusions Mild AP patients with dilation of MPD, vascular invasion, and anemia were more frequently suggested a tumor etiology. Thus, clinical vigilance is needed for timely detection of tumor-associated pancreatitis with these characteristics.
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Affiliation(s)
- Yangyang Xiong
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yi Zhao
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xianlin Han
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Guorong Chen
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - John Windsor
- Surgical and Translational Research Center, Faculty of Medical and Health Sciences, The University of Auckland, Park Road, Auckland, New Zealand
| | - Dong Wu
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.,Clinical Epidemiology Unit, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jiaming Qian
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Knight SR, Shaw CA, Pius R, Drake TM, Norman L, Ademuyiwa AO, Adisa AO, Aguilera ML, Al-Saqqa SW, Al-Slaibi I, Bhangu A, Biccard BM, Brocklehurst P, Costas-Chavarri A, Chu K, Dare A, Elhadi M, Fairfield CJ, Fitzgerald JE, Ghosh D, Glasbey J, van Berge Henegouwen MI, Ingabire JA, Kingham TP, Lapitan MC, Lawani I, Lieske B, Lilford R, Martin J, McLean KA, Moore R, Morton D, Nepogodiev D, Ntirenganya F, Pata F, Pinkney T, Qureshi AU, Ramos-De la Medina A, Riad A, Salem HK, Simões J, Spence R, Smart N, Tabiri S, Thomas H, Weiser TG, West M, Whitaker J, Harrison EM, Gjata A, Modolo MM, King S, Chan E, Nahar SN, Waterman A, Vervoort D, Lawani I, Bedada AG, De Azevedo B, Figueiredo AG, Sokolov M, Barendegere V, Ekwen G, Agarwal A, Dare A, Liu Q, Camilo Correa J, Malemo KL, Bake J, Mihanovic J, Kuncarová K, Orhalmi J, Salem H, Teras J, Kechagias A, Arnaud AP, Lindert J, Tabiri S, Kalles V, Aguilera-Arevalo ML, Recinos G, Baranyai Z, Kumar B, Neelamraju Lakshmi H, Zachariah SK, Alexander P, Kumar Venkatappa S, Pramesh C, Amandito R, Fleming C, Ansaloni L, Pata F, Pellino G, Altibi AM, Nour I, Hamdun I, Elhadi M, Ghellai AM, Venskutonis D, Poskus T, Zilinskas J, Whitaker J, Malemia P, Tew YY, Borg E, Ellul S, Ramos-De la Medina A, Wafqui FZ, Borowski DW, van Dalen AS, Wells C, Adamou H, Ademuyiwa A, Adisa A, Søreide K, Qureshi AU, Al-Slaibi I, Al Saqqa S, Alser O, Tahboub H, Segovia Lohse HA, Shu Yip S, Lapitan MC, Major P, Simões J, Sampaio Soares A, Bratu MR, Litvin A, Vardanyan A, Allen Ingabire JC, Costas-Chavarri A, Gudal A, Albati N, Juloski J, Lieske B, Rems M, Rayne S, Van Straten S, Moodley Y, Chu K, Moore R, Ortega Vázquez I, Ruiz-Tovar J, Senanayake KJ, Thalgaspitiya SPB, Omer OA, Homeida A, Cengiz Y, Clerc D, Alshaar M, Bouaziz H, Altinel Y, Doe M, Freigofer M, Teasdale E, Kabariti R, Clements JM, Knight SR, Ashfaq A, Azodo I, Wagner G, Trostchansky I, Maimbo M, Linyama D, Nina H, Zeko A, Fermani CG, Modolo MM, Villalobos S, Carballo F, Farina P, Guckenheimer S, Dickfos M, Ajmera A, Chong C, Gourlay R, Hussaini S, Lee YJ, Majid A, Martin P, Miles R, Morris OJ, Phua J, Ridley W, Saluja T, Tan RR, Teh J, Wells A, Arora B, Dollie Q, Ho D, Ma Y, Perera OM, Truong A, Dawson AC, Lim B, Pahalawatta U, Phan J, Woon-Shoo-Tong XMS, Yeoh A, Charman L, Drane A, Laura S, Lo CCW, Mozes A, Poon R, Tan HH, Wall E, Chopra P, De Giovanni J, Dhital B, Draganic B, Duller A, Gani J, Goh YK, Jeong JY, McManus B, Nagappan P, Pockney P, Rugendyke A, Sarrami M, Smith S, Wills V, Wong HV, Ye G, Zhang G, Brooker E, Feng D, Lau B, Ngai C, Birks S, Gyorki D, Otero de Pablos J, Abbosh A, Gillespie C, Mahmoud A, Kwan B, Lawson J, Warwick A, Bingham J, Cockbain AJ, Dudi-Venkata NN, Ellaby-Hall J, Finlay B, Humphries E, Pisaniello J, Pisaniello M, Salih S, Sammour T, Abd Wahab HH, De Silva A, Hayward N, Iyer K, Maddern G, Prevost GA, Annapureddy N, Settipalli KP, Yeo J, Hempenstall L, Pham L, Purcell S, Talavera C, Vaska AI, Chaggar G, Chrapko P, Cocco A, Coulter-Nile SMCJ, Ctercteko G, French J, Gong H, Gosselink M, Jegathees T, Jin I, Kalachov M, Kiefhaber K, Lee K, Luong J, Phan S, Pleass H, Veale K, Zeng Z, Au A, DeBiasio A, Deng I, Myooran J, Nair A, Stewart P, Stift A, Unger LW, Wimmer K, Ahmed N, Hasan S, Rahman S, O'Shea M, Padmore G, Peters A, Perduca P, Pulcina G, Tinton N, Buxant F, Dabin E, Garofalo G, Dossou F, Lawani I, Gnangnon FHR, Imorou Souaibou Y, Bedada AG, Motlaleselelo P, Tlhomelang O, Lima Buarque I, Mendonça Ataíde Gomes G, Vieira Barros A, Batashki I, Damianov N, Stoyanov V, Dardanov D, Maslyankov S, Petkov P, Sokolov M, Todorov G, Zhivkov E, Akisheva A, Castilla Moreno MA, Genov G, Ilieva I, Ivanov T, Karamanliev M, Khan A, Mitkov E, Yotsov T, Atanasov B, Belev N, Slavchev M, Nsengiyumva C, Jones E, Stock S, Ekwen G, Kyota S, Brown J, Mabanza K. T, Nigo Samuel L, Otuneme C, Prosper N, Umenze F, Boutros M, Caminsky N, Dumitra S, Garfinkle R, Morency D, Salama E, Banks A, Ferri L, He H, Katz A, Liberman AS, Meterissian S, Pang A, Parvez E, Agarwal A, Dare A, Hameed U, Osman F, Sequeira S, Coburn N, Dare A, Jaffer A, Karanicolas P, Mosseler M, Musselman R, Liu X, Yip CW, Garces-Otero JS, Guzman C, Sierra S, Uribe Valencia A, Cabrera Rivera PA, Camelo S, Gonzalez A, González-Orozco A, Mosquera Paz MS, Perez Rivera CJ, Gonzalez F, Isaza-Restrepo A, Nino- Torres L, Arias Madrid N, Mendoza Arango MC, Sierra S, Bake J, Tsandiraki J, Jemendžic D, Kocman B, Šuman O, Canic R, Jurišic D, Karakas I, Krizanovic Rupcic A, Pitlovic V, Samardžic J, Kopljar M, Bacic I, Domini E, Karlo R, Mihanovic J, Miljanic D, Simic A, Ahmed M, Al Nassrallah M, Altaf R, Amjad T, Eltoum R, Haidar H, Hassan A, Khalil O, Qasem M, Ramesh R, Sajith G, Wisal M, Žatecký J, Bujda M, Jirankova K, Paclik A, Abdallah A, Abdulgawad Almogy M, Ayman El-sawy E, ElFayoumy AM, Elghareeb N, Esmat NA, Fadel A, Habater A, Hamdy H, Hefni A, Kamal M, Mohamed Abobakr N, Sayed A, Shaker N, Taha E, Tharwat H, Zakaria O, Abdelmotaleb I, Al-Dhufri A, Al-Himyari HS, El sheikh E, Eldmaty A, Elkhalawy A, M.Elkhashen A, Magdy K, Mostafa S, Sadia HD, Saleh MM, Samir D, Yahia Mohamed Ali M, A. Nassar M, Abdelhady S, Abdelrazek A, Abdelsalam I, El-Sawy A, Essam E, Gadelkarim M, Ghaly K, Hassabalnaby M, Masarani R, Mohamed Shaaban N, Sabry A, Salem M, Soliman NA, Zahran D, Abou El.soud MR, Badr ET, Borham H, Elmeslemany N, Elsayed M, Elsherif F, Eslam S, Gaber G, Ibrahim S, Kamh Y, Mahmoud A, Mohamed SG, Morshedy E, Omar C, Salem Soliman F, Abdelkawy S, Abdelmohsen N, Abdelshakour M, Dahy A, Gamal N, Gamal M, Hasan A, Hetta H, Mousa N, Omar M, Rabie S, Saad M, Saleh B, Sayed Mohamed M, Shawqi M, Abdelhady Mousa H, Alnoury M, Elbealawy M, Elshafey A, Essam Ibrahim El Desouki Muhammad Ahmed M, Ghonaim M, Hgag F, Ibrahim M, Morsy M, Reda Loaloa M, Refaat A, Samir H, Shahien F, Sobhy M, Sroor F, Abdellatif E, Adel M, Afifi AA, Afifi E, Antaky M, Dawoud A, El Zoghby N, El-remaily A, Elzanfaly AA, Gadallah A, Gamal FA, Hashem O, Medhat Youssef S, Muhammad Attyah A, Munir M, Shazly O, Taha E, Wilson K, Adel S, Ali A, Eid E, Elhelow E, Elmahdy M, Elshatby B, Hossam el-din Zakaria A, Hossny A, Ibrahim E, M.Yonis A, Metwalli M, Yousry B, Zid E, A Yacoub M, Abdelhakim A, Abouelsoad N, Alkhatib M, Ashraf A, Ashraf A, Elazab Y, Elfanty M, Elkabir O, Elsayed M, Elshimy A, Elsobky H, Eskander J, Gad A, Hamsho W, Khaled Abdelwahed N, Magdy M, Moharam D, Osama A, Ramadan S, Roum R, Sayed T, Shehada T, Zidan AM, Abbas K, Ali A, Attia M, Balata M, El Nakeeb A, Elewaily MIE, Elfallal A, Elfeki H, Elkhadragy A, Emile S, Ezzat H, Hosni H, Mansour I, Omar W, Othman G, Sadek K, Shalaby M, Shehab-Eldeen N, Anas khalifa R, Badr H, Eldeep M, Eldeep A, Eldoseuky mohammed A, Khallaf S, Magdy Hegazy E, Mahmoud R, Mikhail P, Morsi M, Mowafy S, Raafat D, Safy A, Sera M, Sera AS, AbdAllah MSM, Abdelkader M, Abdou AO, Ahmed A, Gaafar S, Ibrahim negm F, Lapic M, Maher A, Mahmoud H, Mostafa A, Samir M, Samy F, Semeda N, Shalaby HI, El-taweel A, Galal Elnagar A, Hemidan AG, Hussein M, Kandil A, Moawad M, Nasser Hamamah AA, Soliman M, Abdelkhalek M, Abdelmaksoud Tawakel N, Abdelwahed AM, Abdou A, Atallah K, Elsherbeny MY, Emara E, Hamdy M, Hamdy O, Haron A, Ismail S, Metwally IH, Mohamed Hamed Elgaml N, Nassar A, Refky B, Sadek M, Saleh M, Yunes A, Zakaria M, Zuhdy M, Fayed N, Mohammed MMH, Kütner S, Melnik P, Seire I, Teras J, Ümarik T, Ainoa E, Eerola V, Koppatz H, Koskenvuo L, Sallinen V, Takala S, Katunin J, Kechagias A, Turunen A, Christou N, Mathonnet M, Lavoue V, Nyangoh Timoh K, Soulabaille L, Lesourd R, Merdrignac A, Sulpice L, André B, Chantalat E, Vaysse C, Dousset B, Gaujoux S, Martin G, Clonda O, Juodis D, Kienle K, Mravik A, Palmer S, Szabadhegyi G, Agbeko AE, Gyabaah S, Gyamfi FE, Naabo N, Owusu senior A, Yorke J, Owusu F, Abantanga F, Anyomih TTK, Muntaka AJM, Owusu Abem E, Sheriff M, Tabiri S, Wondoh PM, Balalis D, Korkolis D, Gkiokas G, Pantiora E, Theodosopoulos T, Ioannidis A, Konstantinidis K, Konstantinidou S, Machairas N, Paspala A, Prodromidou A, Chouliaras C, Papadopoulos K, Baloyiannis I, Mamaloudis I, Tzovaras G, Akrida I, Argentou MI, Germanos S, Iliopoulos E, Maroulis I, Skroubis G, Theofanis G, Chatzakis C, Ioannidis O, Loutzidou L, Kalles V, Karathanasis P, Michalopoulos N, Theodoropoulos C, Theodorou D, Triantafyllou T, Garoufalia Z, Hasemaki N, Kontos M, Kouraklis G, Kykalos S, Liakakos T, Mpaili E, Papalampros A, Schizas D, Syllaios A, Tampaki EC, Tsimpoukelis A, Antonopoulou MI, Deskou E, Manatakis DK, Papageorgiou D, Zoulamoglou M, Anthoulakis C, Margaritis M, Nikoloudis N, Campo V, Ceballos A, Flores MA, Giron W, Ko D, Martinez G, Recinos G, Rivera Lara V, Rueda N, Sanchez A, Tejeda Garrido JCG, Aguilera-Arevalo ML, Alvarez Rivera AE, Bamaca Ixcajoc EB, Barreda Zelaya LE, Chacòn-Herrera P, Corea Ruiz LM, Echeverria-Davila G, Garcia M, García D, Gutiérrez Mayen EF, José N, Mazariegos N, Méndez D, Paniagua Espinoza M, Baranyai Z, Bardos D, Benke M, Illes K, Kokas BA, Szabó R, Appukuttan A, Asok A, D.k V, Malik K, Ravishankaran P, Tapkire R, Moorthy G, Abraham J, Muthuvel R, Alapatt J, Kattepur A, Pareekutty N, Garod M, Harris C, Wanniang C, Gupta A, Nehra D, Parshad S, Acharya R, Badwe R, Bhandare M, Jain U, Kirti K, Nair N, Shrikhande S, Thakkar P, Anandan P, C S A, Holenarasipur Narasannaiah A, Jagarlamudi T, Kumar Venkatappa S, M R R, Manangi M, Raghavendra A, Rao KS, S V, Sajjan V, Shenoy A, Shivashankar Chikkanayakanahalli S, Tharanath K, V S, Adidharma P, Agarwal R, Amandito R, Anggita Gultom P, Arifin GR, Billy M, Elfizri Z, Fahira A, Felicia D, Gunardi TH, Johanna N, Nugrahadi NR, Panigoro SS, Rahmayanti S, Sihotang RC, Brata SY, Winoto H, Barati N, Karami M, Khorshidi H, Naderifar H, Abdulla MA, Coleman M, Doherty RJ, Hannon R, Murphy B, Stakelum A, Winter D, Aljohmani L, Farnan R, Seldon Y, Tan T, Varghese S, Alherz M, Ather M, Bajilan M, Graziadei V, Pilkington I, Quidwai O, Ridgway P, Shiwani H, Tahir AAR, Blunnie E, Burke D, Kennedy N, Macdonagh K, O'Neill M, Rooney S, Falco G, Ferrari G, Mele S, Nita GE, Ugoletti L, Zizzo M, Confalonieri G, Pesenti G, Tagliabue F, Baronio G, Ongaro D, Pata G, Compagnoni B, Salvadori R, Taglietti L, D'Alessandro N, Di Lascio P, Pascale G, Bortolasi L, Campagnaro T, Carlini M, Lisi G, Lombardi D, Pedrazzani C, Spoletini D, Turri G, Violi P, Altomare DF, Aquilino F, Musa N, Papagni V, Picciariello A, Vincenti L, Andreotti D, Occhionorelli S, Tondo M, Basso SMM, Cirelli R, Maino MEM, Piozzi GN, Picone E, Scaramuzzo R, Sinibaldi G, Amendola A, Anastasio L, Bucci L, Caruso E, Castaldi A, Di Maso S, Dinuzzi VP, Esposito G, Gaudiello M, Giglio MC, Greco PA, Luglio G, Manfreda A, Marra E, Mastella F, Pagano G, Peltrini R, Pepe V, Sacco M, Sollazzo V, Spiezio G, Cianchetti E, Menduni N, Carvello MM, Di Candido F, Spinelli A, Corsi F, Sorrentino L, Marino F, Asti ELG, Bonavina L, Rausa E, Asta M, Belli A, Bianco F, Cervone C, Delrio P, Falato A, Fares Bucci A, Guarino R, Pace U, Rega D, De Luca E, Gallo G, Sammarco G, Sena G, Vescio G, Santandrea L, Ugolini G, Zattoni D, Chetta N, Logrieco G, Vanella S, Garulli G, Zanini N, Bondurri A, Cammarata F, Colombo F, Foschi D, Lamperti GMB, Maffioli A, Sampietro GM, Yakushkina A, Zaffaroni G, Ansaloni L, Cicuttin E, Sibilla MG, Impellizzeri H, Inama M, Moretto G, Mochet S, Ponte E, Usai A, Mancini S, Sagnotta A, Solinas L, Bolzonaro E, Tamini N, Curletti G, Galleano R, Malerba M, Campanella S, Cocorullo G, Colli F, De Marco P, Falco N, Fontana T, Kamdem Mambou LJ, La Brocca A, Licari L, Randisi B, Rizzo G, Rotolo G, Salamone G, Tutino R, Venturelli P, Malabarba S, Sgrò A, Vella I, Cirillo B, Crocetti D, De Toma G, Lapolla P, Mingoli A, Sapienza P, Belvedere A, Bianchini S, Binetti M, Birindelli A, Tonini V, Podda M, Pulighe F, De Rosa M, Bono L, Borghi F, Geretto P, Giuffrida MC, Lauro C, Marano A, Pellegrino L, Salusso P, Sasia D, Campanelli M, Realis Luc A, Trompetto M, Cardia R, Cillara N, Giordano AN, Costanzo A, Giovilli MA, Turati L, Canonico S, Pellino G, Sciaudone G, Selvaggi F, Selvaggi L, Albsoul N, AlBsoul A, Alkhatib AA, Alsallaq O, Amarin JZ, Ayoub R, Bsisu I, El Muhtaseb MS, Jabaiti M, Melhem J, Nour I, Qwaider YZ, Salameh MH, Suleihat A, Suradi HH, Alammarin M, Aljaafreh A, Bani hani M, Bani hani Z, Bani Hani F, Fahmawee T, Hamouri S, Katanani C, Tawalbeh R, Tawalbeh T, Zawahrah H, Abou Chaar MK, Abusalem L, Al-Masri M, Al-Najjar H, Barghuthi L, Ahmed Z, Maulana A, Ngotho O, Kamau C, Stanley Mwenda A, Bosire F, Mwachiro E, Parker R, Simel I, Sylvester K, Althini AAM, Elbarouni S, Elbeshina AE, Gwea A, Malek A, Masoud Farag WA, Abdalei A, Abdel Malik AB, Abo-khammash A, Abuhlaiga M, Adnan N, Albaggar M, Alfitory A, Aljanfi A, Almuzghi F, Altumei Z, Alzabti F, Ashoushan H, Assalhi M, Azzubia J, Bnhameida S, Delhen M, Elshafei H, Elteir H, Esbaga F, Gobbi AA, Hamouda F, Hilan H, Ismail R, Jebran F, Kasbour M, Maderi G, Mohammad S, Mohammed B, Murtadi H, Mustafa H, Rajab M, Trenba S, Wafaa M, Al Sagheir E, Almigheerbi A, Alzahaf A, Bahroun SG, Ben Dallah N, Elshaibani M, Eswaye H, Karar M, Omar S, Younes E, Younes M, Zreeg D, Abujamra S, Ashour F, Elgammudi M, Omar F. Aljadidi W, Saddouh E, Sharif R, Alabuzidi A, Alwerfally A, Aribi S, Bibas F, Elfaituri T, Elhajjaji Y, Khaled A, Khalil W, Layas T, Soula E, Tarek A, Abu hallalah MFK, Abujamra S, Ahmed HA, Alsharef T, Ben Saoud AA, El Gharmoul T, Elhadi A, Elrais S, Shebani A, Zarti H, Zeiton A, Ambrazevicius M, Kaselis N, Stakyte M, Aliosin O, Cizauskaite A, Dailidenas S, Eismontas V, Kybransiene M, Nutautiene V, Samalavicius N, Simcikas D, Slepavicius A, Tamosiunas A, Ubartas N, Zeromskas P, Bradulskis S, Dainius E, Juocas J, Kubiliute E, Kutkevicius J, Opolskis A, Parseliunas A, Subocius A, Venskutonis D, Virbickaite E, Zuikyte D, Bogusevicius A, Buzaite K, Cepuliene D, Cesleviciene I, Cesna V, Gribauskaite J, Ignatavicius P, Jokubauskas M, Liugailaite M, Margelis E, Mazelyte R, Pankratjevaite L, Pažusis M, Rackeviciute A, Saladyte J, Škimelyte M, Šlenfuktas V, Sudeikyte M, Tamelis A, Vanagas T, Žumbakys Ž, Atkociunas A, Dulskas A, Kuliavas J, Birutis J, Paškevicius S, Šatkauskas M, Danys D, Jakubauskas M, Jakubauskiene L, Kryzauskas M, Lipnickas V, Makunaite G, Rasoaherinomenjanahary F, Rasolofonarivo H, Samison LH, Banda B, Malemia P, Msosa V, Ahmad Izzuddin AI, Das A, Gan YY, Shong Sheng T, Siaw JY, Ab Rahim MF, Abang Jamari DZH, Che Husin N, Kamarulzaman MY, Lim YP, Mohamed Kamil NA, Mohd Hassan MR, Mohd Sahid S, Mustafa J, Ng EHB, Wan Khazim WK, Chang Ern N, Lingeshan P, Sulaiman SE, Ang SE, Bin Mohamad Sithik MN, Cheong YJ, Deva Tata M, Jia Xian L, Kadravello A, Koh IE, Ng LY, Ng We Yong YJ, Palayan K, Sam CX, Siow Jin P, Tan Ern Hwei J, Tang Y, Ter AZ, Wong MPK, Zakaria AD, Zakaria Z, Henry F, Kalaiselvan T, Abd Karim MFS, Abdul Aziz MR, Abdul Aziz N, Khong TL, Lau PC, Lim HC, Roslani AC, Seak JCK, Wong SW, Wong LF, Yeen Chin L, Anyanwu MC, Borg E, Busuttil Z, Calleja T, Chircop KL, Cutajar R, Dimech AM, Ellul S, Galea J, Gascon Perai K, Gatt R, Kelman L, Micallef E, Nwolu F, Sammut K, Thompson J, Warwicker S, Zammit M, Cordera F, Cruz González E, Sánchez-García J, Barbosa Camacho FJ, Barrera López FJ, Zuloaga Fernandez del Valle CJ, Acosta E, González Espinoza IR, Moreno P, Cortes-Flores AO, Fuentes Orozco C, Gonzalez Ojeda A, Corro Díaz González S, Martinez L, Ramos-De la Medina A, Mosqueda Amador B, Novoa A, Olazo Espejo DA, Jimenez A, Lopez Rosales F, Vanoye EG, Garcia Gonzalez LA, Miranda-Ackerman RC, Solano-Genesta M, Alvarez-Cano A, Romero-Garza HH, Medina-Franco H, Mejía-Fernández L, Salgado-Nesme N, Vergara-Fernandez O, Gutiérrez-Mota GM, Hernandez Vera FX, Llantada Lopez A, Morgan Villela G, Ramirez Padilla FDJ, Tapia Marin W, Martínez Maldonado M, Sánchez Suárez R, Troche JM, Benyaiche C, Outani O, Amine S, Benkabbou A, Majbar AM, Mohsine R, Rafik A, Oung T, Tin MM, Borowski DW, Plarre P, Borowski DW, Plarre P, Alberga A, Sluiter N, Tuynman J, Blok R, Cömert D, Hompes R, Kalff M, Stellingwerf ME, Tanis P, van Berge Henegouwen M, van Praag EM, Wisselink D, Gerhards M, Lopes Cardozo J, Westerduin E, de Jonge J, van Geloven A, van Schilt K, den Boer F, Stoots S, Vlek S, Adams J, Al-Busaidi IS, Budd G, Choi SI, Chu MJJ, Ganugapati A, McKinstry L, Pascoe R, Richards S, Rosser K, Stevenson A, White R, Farik S, Kwun J, Murad A, Cowan S, Hall T, Hayton M, Malam Sani L, Oumarou Garba S, Adamou H, Amadou Magagi I, Habou O, Aliyu H, Daniyan M, Sholadoye TT, Abdullahi L, Anyanwu LJ, Mohammad Mohammad A, Muhammad AB, Sheshe AA, Suleiman I, Adesina A, Awolowo A, Onuoha C, Salami O, Taiwo O, Taiwo A, Kache S, Makama JG, Sale D, Abiola O, Ajao A, Ajiboye A, Etonyeaku A, Olaogun J, Adebanjo A, Adesanya O, Afolayan MO, Balogun O, Makanjuola A, Nwokocha S, Ojewola RW, Olajide TO, Aderounmu A, Adesunkanmi AR, Adisa A, Agbakwuru A, Akeem Aderogba A, Alatise OI, Arowolo O, Lawal O, Mohammed T, Ndegbu C, Olasehinde O, Wuraola F, Akinkuolie A, Etonyeaku A, Mosanya A, Ayandipo O, Elemile P, Lawal TA, Ali SANI S, Garba S, Hauwa SANI R, Olori S, Onyebuashi H, Umoke I, Adenuga A, Adeyeye A, Habeeb O, Lawal B, Nasir A, Aahlin EK, Kjønås D, Myrseth E, Abbasy J, Alvi A, Saleem O, Afzal A, Nazir A, Farooq M, Liaqat A, Naqi SA, Raza A, Sarfraz M, Sarwar M, Banglani M, Munir A, Sehrish R, Ayub B, Sayyed R, Altaf A, Ayub S, Qureshi AU, Saeed K, Syed B, Akbar SA, Anwer AW, Khan RN, Khan AI, Khattak S, Mohtasham S, Parvaiz MA, Syed AA, Ansari AB, Shahzad N, Khaliq T, Rashid I, Waqar SH, Abu Al-saleem H, Abu Alqumboz A, Alqadi M, Amro A, Assa R, Awesat E, Ayyad R, Hammad M, Haymony A, Hijazi B, Hmeidat B, Lahaseh R, Qawasmi A, Rajabi A, Shehada M, Shkokani S, Yaghi Y, Yaghi N, AlZohour M, Farid M, Habes YM, Juba W, Nubani Y, Rabee A, Sa'deh M, Abed S, Al basos I, Alswerki M, Ashour D, Awad I, Diab S, El Jamassi A, El-Kahlout S, Elhout S, Hajjaj ANK, Hasanain D, Nabil hajjaj B, Obaid M, Saikaly E, Salhi A, Al-Tammam H, Almasri M, Baniowda M, Beshtawi D, Horoub A, Misk R, Mohammad B, Qasrawi R, Sholi T, Abu-Nimeh S, Abu-srour A, Abukhalaf SA, Adawi S, Alsalameh B, Ayesh K, Elqadi M, Hammouri A, Karim Mustafa F, Marzouqa N, Melhem S, Miqdad D, Mohamad B, Rawhi M, Abu Ahammala AB, Abu Ataya A, Abu Jayyab I, Al-Shwaikh S, Alagha O, Alasttal M, Awadallah H, Elblbessy M, Fares J, Jarbou A, Mahfouz I, Albahnasawi MA, Abo mahadi A, Abuelhatal H, Abuelqomboz A, Almoqayyad A, Alwali A, Balaawi R, Hamouda M, Humeid M, Jedyan A, Mahmoud Abu hamam T, Matar G, Salem A, Samra T, Shaheen N, Shihada K, A.Nemer A, Abu Al Amrain M, Abu Alamrain A, Abu Jamie N, Abu-Rous MR, Alfarra N, AlTaweel M, Alwhaidi N, Hamed R, Saqqa B, Shaheen A, Aljaber D, Aljaberi L, Alwaheidi M, Jawaada A, Khaldi H, Qahoush R, Qari J, Saadeh R, Salim A, Yacoub A, Abbas A, Abu shua`ib R, Abu Zainah B, AbuSirrees M, Babaa B, Barhoush O, Belal qadomi A, Daraghmeh L, Haji R, Khatatbeh A, Khatib L, Qarariah S, Quzmar Y, Safadi K, Salameh R, Hassan M, Herzallah S, Massad L, Nazzal A, Nazzal R, Escobar D, Machain V GM, Rodriguez Gonzalez A, Chachaima Mar JE, Chinchihualpa Paredes NO, Cuba V, Lopez W, Niquen Jimenez MM, Sanchez Bartra NA, Sapallanay Ojeda O, Sequeiros D, Toscano Pacheco A, Vergara M, Abarca S, Alcorta R, Borda-Luque G, Eusebio Zegarra IE, Luján López C, Marrufo M, Mogrovejo C, Nomura A, Rodríguez Angeles Y, Vidal Meza MR, Zavala G, Castillo Arrascue JN, Hidrogo Cabrera JC, Larrea vera JJM, Osorio M, Ylatoma Díaz EA, Fontanilla MA, Fuentes JR, Salazar AL, Dominguez G, Lopez MP, Macalindong S, Onglao MA, Ramirez A, Sacdalan MD, Tampo MM, Uy GL, Mangahas J, Yabut K, Cañete JP, Cansana BE, Castro EJ, Lipana MK, Roxas MF, Zara VJ, Chrol M, Franczak P, Orlowski M, Budzynski P, Budzynski A, Bury P, Czerwinska A, Dworak J, Dziedzic J, Kisielewski M, Kulawik J, Lasek A, Major P, Malczak P, Migaczewski M, Pedziwiatr M, Pisarska M, Radkowiak D, Rubinkiewicz M, Rzepa A, Skoczylas T, Stanek M, Truszkiewicz K, Wierdak M, Winiarski M, Zarzycki P, Zub-Pokrowiecka A, Kowalewski P, Roszkowski R, Waledziak M, Tomé M, Patrocinio S, Guerreiro I, Almeida F, de Sousa X, Monteiro N, Costa Santos MT, de Oliveira D, Lopes Serra M, Morgado D, Neves C, Oliveira AC, Pimentel A, Silva S, Carvalho M, Carvalho L, Magalhães J, Matos L, Monteiro T, Ramos C, Santos V, Barbosa J, Costa-Maia J, Devezas V, Fareleira A, Fernandes C, Gonçalves D, Mora H, Morais M, Silva de Sousa F, Catarino Santos S, Logrado A, Tojal A, Amorim E, Cunha MF, Fazenda A, Melo Neves JP, Sampaio da Nóvoa Gomes Miguel II, Veiga D, Azevedo J, Cardoso Louro H, Leite M, Azevedo J, Bairos Menezes M, Gama B, Brito D, Cruz Martins MC, Graça e Magalhães A, Longras AC, Lourenço R, Matos D, Castro L, Policarpo F, Romano J, Leite M, Monteiro C, Pinto D, Duarte M, Fortuna Martins S, Oliveira M, Galvão D, Martins L, Silva A, Taranu V, Vieira B, Neves J, Oliveira S, Ribeiro H, Cinza M, Felix R, Machado A, Oliveira J, Patrício J, Pedroso de Lima R, Pereira M, Rocha Melo M, Velez C, Abreu da Silva A, Claro M, Costa Santos D, Ferreira A, Capote H, Rosado D, Taré F, Nogueira O, Ângelo M, Baiao JM, Guimarães A, Marques J, Nico Albano M, Silva M, Valente da Costa A, Vieira Caroço T, Almeida Braga S, Capunge I, Fragoso M, Guimarães J, Pinto B, Ribeiro J, Angel M, Fialho G, Guerrero M, Campos Costa F, Cardoso D, Cardoso V, Alves M, Estalagem I, Louro T, Marques C, Martelo R, Morgado M, Canotilho R, Correia AM, Martins P, Peyroteo M, Gomes J, Monteiro R, Romano M, Alves DM, Peixoto R, Quintela C, Jervis MJ, Melo D, Pacheco A, Paixão V, Pedro V, Pimenta J, Pimenta de Castro J, Rocha A, Beuran M, Bratu MR, Ciubotaru C, Diaconescu B, Hostiuc S, Negoi I, Stoica B, NA NA, Anokhin E, Kuznetsov G, Oganezov G, Paramzin F, Romanova E, Rutkovskii V, Rutkovskii V, Shushval M, Zabiyaka M, Dzhumabaev K, Ivanov V, Mamedli Z, Achkasov S, Balkarov A, Nabiev E, Nagudov M, Rybakov E, Saifutdinova K, Sushkov O, Vardanyan A, Costas-Chavarri A, Joseph L, Ndayishimiye I, Allen Ingabire JC, Faustin N, Mutabazi AZ, Mvukiyehe JP, Nsengimana VJ, Uwakunda C, Abbas MM, Akeel N, Aljiffry M, Awaji K, Farsi A, Jamjoum G, Khoja A, Maghrabi A, Malibary N, Nassif M, Saleem A, Sultan A, Tashkandi W, Tashkandi H, Trabulsi N, Ba MB, Diallo AC, Ndong A, Cuk V, Jankovic U, Juloski J, Koh SZ, Koh F, Lee KC, Lee KY, Lee S, Leong WQ, Lieske B, Lui SA, Prakash P, Grosek J, Norcic G, Tomazic A, Fitchat N, Jaich R, Wineberg D, Koto MZ, Baiocchi D, Clarke D, Steenkamp CJ, Van Straten S, Bannister S, Boutall A, Chinnery G, Coccia A, Dell A, Karjiker P, Kloppers C, Loxton N, Mabogoane T, Malherbe F, Panieri E, Rayamajhi S, Spence R, van Wyngaard T, Warden C, Madiba TE, Moodley Y, Pillay N, Brooks S, Kruger C, Van Der Merwe LH, Gool F, Kariem M, Bougard H, Chu K, Kariem N, Noor F, Pillay R, Steynfaardt L, González González L, Marín Santos JM, Martín-Borregón P, Martínez Caballero J, Nevado García C, Rodriguez Fraga P, De Castro Parga G, Fernández Veiga MP, Garrido López L, Infante Pino H, Lages Cal I, López Otero M, Nogueira Sixto M, Paniagua García Señorans M, Rodríguez Fernández L, Ruano Poblador A, Rufo Crespo E, Sanchez-Santos R, Vigorita V, Alonso Batanero E, Asnel D, Cifrian Canales I, Contreras Saiz E, De Santiago Alvarez I, Díaz Vico T, Fernandez Arias S, Fernández Martínez D, García Bernardo C, García Flórez LJ, Garcia Gutierrez C, García Munar M, Márquez Zorrilla Molina CA, Merayo M, Michi Campos JL, Moreno Gijon M, Otero-Diez JL, Rodicio Miravalles JL, Solar-Garcia L, Suárez Sánchez A, Truan N, Alejandre Villalobos C, Caballero Díaz Y, Jimenez M, Montesdeoca D, Navarro-Sánchez A, Vega V, Beltrán de Heredia J, Gómez Z, Jezieniecki C, Legido Morán AP, Montes-Manrique M, Rodriguez-Lopez M, Ruiz Soriano M, Trujillo Díaz J, Vazquez Fernandez A, Argudo N, Pera M, Torrent Jansà L, García Domínguez M, Goded I, Roldón Golet M, Talal El-Abur I, Utrilla Fornals A, Zambrana Campos V, Aguilar Martinez MDM, Bosch M, García-Catalá L, Sánchez-Guillén L, Artigau E, Gomez Romeu N, Julià Bergkvist D, Espina Perez B, Morató O, Olona C, Diéguez B, Forero-Torres A, Losada M, Gomez-Abril S, Gonzálvez P, Martinez R, Navarro Martínez S, Payá-Llorente C, Pérez Rubio Á, Santarrufina Martinez S, Sebastián Tomás JC, Trullenque Juan R, Gegúndez Simón A, Maté P, Prieto-Nieto MI, Rubio-Perez I, Urbieta A, Vicario Bravo M, Abelló D, Frasson M, Garcia-Granero A, Abad Gurumeta A, Abad-Motos A, Lucena-de Pablo E, Nozal B, Ripollés-Melchor J, Salvachúa R, Ferrero E, Garcia-Sancho Tellez L, Ortega Vázquez I, Picardo AL, Rojo López JA, Zorrilla Matilla LP, Cagigas Fernandez C, Castanedo Bezanilla S, Estevez Tesouro J, Fernandez-Diaz MJ, García Cardo J, Gomez Ruiz M, Gonzalez-Tolaretxipi E, Jimeno Fraile J, Poch C, Rodriguez-Aguirre M, Troche Pesqueira N, Trugeda-Carrera MS, de la Torre J, Blanco-Colino R, Espin-Basany E, Espinosa-Bravo M, Morales Comas C, Reyes Afonso E, Rivero Déniz J, Siso Raber C, Verdaguer Tremolosa M, Chandrasinghe P, Kumarage S, Wijekoon Arachchilage N, Senanayake KJ, Abdalla Ahmed Elkamel A, A. Adam M, Saleh M, Blomme N, Thorell A, Wogensen F, Älgå A, Ansarei D, Celebioglu F, Heinius G, Nigard L, Pieniowski E, Ahlqvist S, Björklund I, Cengiz Y, Frånberg A, Håkansson M, Adamo K, Franklin O, Sund M, Wiberg R, Andersson Y, Chabok A, Nikberg M, Kugelberg A, Canonica C, Christoforidis D, Fasolini F, Gaffuri P, Giuliani M, Meani F, Popeskou SG, Pozza S, Wandschneider W, Peterer L, Widmer LW, Zimmermann B, Bakoleas P, Chanousi I, Charalampidou L, Grochola LF, Heid F, Ntaoulas S, Outos M, Peros G, Podolska-Skoczek H, Reinisch KB, Zielasek C, Clerc D, Demartines N, Gilgien J, Kefleyesus A, St-Amour P, Toussaint A, Alhimyar M, Alsaid B, Alyafi A, Alkhaledi A, Kouz B, Omarain A, Al-Sabbagh Y, Alkhatib H, Sara S, Alhaj A, Danial A, Kadoura L, Maa Albared S, Monawar Y, Nahas L, Abd B, Saad A, Wakkaf H, Bouaziz H, Bouzaiene H, Ghalleb M, Akaydin E, Akbaba AC, Atakul O, Baltaci E, Besli S, Burgu G, Cenal U, de Muijnck C, Demirkaya HC, Dogruoz A, Gezer ZI, Gündogdu Y, Kara M, Korkmaz HK, Kurtoglu GK, Ozben V, Ozmen BB, Pektas AM, Sel EK, Yenidünya N, Bengur FB, Oral BM, Yozgatli TK, Abdullayev S, Gunes ME, Sahbaz NA, Banaz T, Kargici K, Kuyumcu OF, Yanikoglu E, Yesilsancak M, Yilmaz D, Aktas MK, Rencuzogullari A, Isik A, Leventoglu S, Yalçinkaya A, Yüksel O, Kalayci MU, Kara Y, Sarici IS, Akin A, Alemdag GN, Arslan E, Baki BE, Bodur MS, Calik A, Candas Altinbas B, Cihanyurdu I, Erkul O, Gül B, Guner A, Köse B, Semiz A, Sevim S, Tayar S, Tomas K, Tüfek OY, Türkyilmaz S, Ulusahin M, Usta A, Yildirim R, Güler SA, Tatar OC, Varol E, Kirimtay B, Uysal M, Yildiz A, Kose E, Ciftci AB, Çolak E, Eraslan H, Kucuk GO, Yemez K, Lule H, Bienfait M, Lule H, Bua E, Doe M, Okalany N, Birindelli A, Basarab M, Bielosludtsev O, Freigofer M, Kolhanova K, Perepelytsia K, Romanukha K, Savenkov D, Siryi S, Tereshchenko M, Viacheslav N, Volovetskyi A, Kebkalo A, Tryliskyy Y, Tyselskiy V, Bruce E, Chow BL, Iddles E, McGuckin S, Newall N, Ramsay G, Sharma P, Stewart C, Wong J, Badran A, Bath M, Belais F, Butt E, Joshi K, Kapur M, Shaw M, Townson A, Williams CYK, Gray T, Greig R, Husain M, Murray E, Mustafa A, Asif A, Gokul A, Shah M, Akitikori MT, Charalabopoulos A, Davidson S, McNally S, Rupani S, Juma F, Mills SC, Muirhead L, Sellars K, Walsh U, Warren O, Chambers A, Hunt R, Teasdale E, Boyce S, Cornwall H, Tol I, Argyriou EO, Eardley N, Povey M, Aithie JMS, Irfan A, McGuigan MC, Starr R, Warren CR, Archibald J, Kirby G, Kisyov I, Khoo CK, Lee R, Photiou D, Davis R, Prasad U, Yang PZ, Bird J, Leung E, Summerour V, Currow C, Kiam J, Tan GJS, Muthusami A, Pegba-Otemolu I, Urbonas T, Nunoo-Mensah J, Smolskas E, Boddy A, Gravante G, Hunter D, Andrew D, Koh A, Thompson A, Adams L, Clements HA, De Silva K, Ekpete O, Haque S, Henderson S, Ibrahim B, Jayasinghe T, Livie J, Mailley K, Nair G, Tan D, Baggaley C, Dawidziuk A, Szyszka B, Barter C, Gandhi N, Hassell K, Hitchin S, Kelsall J, Nagy E, Nessa A, Whisker L, Yanni F, Ali M, Arora D, Hediwattege S, Kumarasinghe N, Rathore M, Tennakoon A, Ali Ahmad SM, Bajomo O, Nadira F, Celentano V, Bhangu A, Glasbey J, Griffiths E, Karri RS, Mak JKC, Nepogodiev D, Pipe M, Bhatti MI, Rabie M, Boyle C, Hamilton D, Mihuna A, Ng JCK, Nicholson G, Oliwa A, Pearson R, Rose A, Yong SQ, Boereboom C, Hanna M, Walter C, Greensmith TS, Mitchell R, Monaghan E, Crawford J, Moug S, Blackwell J, Boyd-Carson H, Herrod P, Al-Allaf O, Beattie M, Bullock C, Burman S, Clark G, Flamey N, Flannery O, Harding A, Kodiatt B, Lawday S, Mahapatra S, Mukundu Nagesh N, Ng M, Rye D, Yoong A, Clark L, Deans C, Edirisooriya M, Fairfield CJ, Harrison EM, Carrington EV, Wong TLE, Yusuf B, Chamberlain C, Duke K, Kmiotek E, Botes A, Condie N, Schrire T, Shah R, Thomas-Jones I, Yates C, Anthony N, Matthews E, Sahnan K, Tankel J, Tucker S, Winter Beatty J, Ziprin P, Duggan W, Kantartzi A, Sridhar S, Khaw RA, Srivastava P, Underwood C, Alves do Canto Brum H, Chopra S, Davis L, Hughes R, Tulley J, Alberts J, Athisayaraj T, Olugbemi M, Ahmad K, Chan C, Chapman G, Fleming H, Fox B, Grewar J, Hulse K, Rutherford D, Sinead M, Smith S, Speake D, Vaughan-Shaw PG, Christodoulides N, Kudhail S, Welch M, Husaini SM, Lambracos S, Anyanwu C, Suresh R, Thomas JS, Gleeson E, Platoff R, Saif A, Enumah Z, Etchill E, Gabre-Kidan A, Bernstein M, Carrano FM, Connors J, Lynn P, Melis M, Newman E, Foster DS, Perrone K, Titan A, Weiser TG, Ahmad S, Bafford ACM, Dal Molin M, Hanna N, Zafar SN, Hemmila M, Napolitano L, Wong JJ, Chandler J, Wood L, Wren S, Ottesen T, You L, Yu K, Arciénega Yañez MDP, Ferreira Fernandes M, González D, Cubas S, González MC, Zubiaurre V, Demolin R, Giroff N, Sciuto P, Campos M, Rodríguez Cantera G, Wagner G, Deepika G, Maimbo M, Simuchimba E, Bulaya A, Chibuye C, Chirengendure B, Kabale MR, Kabongo K, Linyama D, Munthali J, Mweso O, Pikiti F, Otieno J, Chan E, Lai LT, Blackman B, Richards S, Subramaniam S, Karim R, Kok N, Lee YD, Ali S, Sinha A, Corrigan R, Barnes N, Wong F, Dennis G, Jedamzik J, Phillips E, Piette W, Van hentenryck M, Koco H, Lawani S, Kassa MW, Santos Bezerra T, Gribnev P, Dimitrov D, Krastev P, Oum S, Bonghaseh DT, Al Farsi M, Alsharqawi N, Agarwal A, Acevedo V, Castillo Barbosa AC, Giron F, Leon Rodriguez JP, Kucan D, Rosko D, Barsic N, Župan D, Hegazi A, Truncíková V, Fryba V, Mohamed M, Sultan A, Nagi A, Rashad Temerik A, Elshawy ME, Mahmoud MI, Omar S, Anwar M, Rageh T, Elmokadem A, Gaballa K, Teppo S, Turunen A, Pengermä P, Ballouhey Q, Bergeat D, Weyl A, Hain E, Gyedu A, Yenli E, Osei-Poku D, Rompou VA, Zoikas A, Gaitanidis A, Koukis G, Perivoliotis K, Tavlas P, Galanos-Demiris K, Zografos G, Karavokyros I, Xanthopoulou G, Iordanidou E, Ayau F, Garcia A, Damján P, Wason D, B L A, Rangganata E, Kamath P, O'Connor DB, Pinto M, Perrone F, Tropeano FP, Troilo F, Bossi D, Scala D, Pulitanò L, Carella M, Pietrabissa A, Gori A, Giraudo G, De Simone V, Russo AA, Braccio B, Al-Taher R, Athamneh S, Parker A, Sawiee A, Kattia A, Salem M, Tababa O, Shaeeb Z, Syminas V, Jurgaitis J, Damuleviciene G, Svagzdys S, Poskus T, Razafimanjato NNM, Chieng Loo L, Tiong IC, Wan Muhmad WF, Vijeyan H, Li Ying T, Grech G, Arrangoiz R, Jimenez Ley VB, Arizpe D, Jimenez Ley VB, Lagunes Lara E, Castro López EV, Eaazim J, Gordinou de Gouberville M, Bastiaenen V, Rottier S, Nahab F, Ji MY, Seyoji M, Nwachukwu C, Emeghara O, Muhammed SE, Idowu A, Sowemimo O, Ogundoyin O, Akande O, Lott A, Nadeem M, Laghari AA, Loya A, Mushtaq H, Abdullah MT, Abuhilal B, Atawneh M, Hamdan H, Alhabil B, Srour A, Mousa I, Da Silva Medina L, Sacdalan MD, Lapitan MC, Sacdalan MD, Sacdalan MD, Bartosiak K, Ferreira P, Francisco V, Lemos R, Frutuoso L, Fernandes S, Fonseca T, Pereira J, Rachadell J, Torre A, Madeira Martins F, Carvalho AC, Rodrigues Ferreira J, Ribeiro da Silva B, Devesa H, Vieira A, Mónica I, Amaro M, Sousa D, Reia M, Louro J, Martins A, Dominguez J, Santos I, Freitas Oliveira NM, Pereira JC, Silva-Vaz P, Freire L, Escrevente R, Negoita VM, Shakhmatov D, Nezerwa Y, Radulovic R, Moore R, Obery G, Viljoen F, Mendes T, Suarez A, Moncada E, Fernandez-Hevia M, Curtis Martínez C, Gil Garcia JM, González Zunzarren M, Idris T, Eklöv K, Grahn O, Amin L, Blomqvist M, Ajani C, Kraus R, Seeger N, Willemin M, Rayya F, Ayash M, Msouti R, Kannas I, Abazid E, Esper A, Slim S, Kavcar AS, Aytac E, Dural AC, Ilker A, Eray IC, Kurnaz E, Altiner S, Tepe MD, Sahin C, Savli E, Innocent A, Babirye L, Diachenko A, Hordoskiy V, Curry H, Chau CYC, Robertson H, Mahmoud A, Lennon H, Loi L, Kirkham E, McCann C, Watts D, Gurung B, Wilson M, Tribedi T, Garofalo E, Zahra B, MacDonald S, Daniels I, Ng N, Khosla S, Olivier J, Yue SYP, Suresh G, Wellington J, Lorejo E, Mossaad M, Tryliskyy Y, Crutcher M, Alimi M, Baiu I, Abdou H, Conway A, Peck C, Wagner G, Perdomo Perez MA, Trostchansky I, Zulu S, Nakazwe M, Knight SR, Drake TM, Nepogodiev D, Fitzgerald JE, Ademuyiwa A, Alexander P, Ingabire JA, Al-Saqqa SW, Biccard BM, Borda-Luque G, Borowski DW, Burger S, Chu K, Clarke D, Costas-Chavarri A, Davies J, Donaldson R, Ede C, Garden OJ, Ghosh D, Glasbey J, Kingham TP, Salem HK, Anyomih TTK, Koto MZ, Lapitan MC, Lawani I, Lesetedi C, Aguilera-Arevalo ML, Mabedi C, Maimbo M, Magill L, Makinde Alakaloko F, Makupe A, Martin J, Ramos-De la Medina A, Monahan M, Moore R, Msosa V, Mulira S, Mutabazi AZ, Muller E, Musowoyo J, Adisa AO, Olory-Togbe JL, Pius R, Qureshi AU, Rayne S, Roberts T, Sacdalan MD, Shaw CA, Smart N, Smith M, Spence R, Van Straten S, Tabiri S, Tayler V, Weiser TG, Windsor J, Yorke J, Yepez R, Lilford R, Morton D, Bhangu A, Sundar S, Harrison EM, Runigamugabo E, Verjee A, Chen J, Daya L, El Aroussi N, Farina V, Gnintedeme Olivier T, Gonzales Nacarino M, Hammani A, Honjo S, Jacobs R, Kimura H, Litvin A, Nkoronko M, Nour I, Oscullo Yepez JJ, Pagano G, Pata F, Pin Hung W, Raj A, Romani Pozo A, Rommaneh M, Sassamela Fabiano SC, Shiroma Gago CM, Shu Yip S, Srinivas A, Sung CY, Tai A, Valle Aranda YC, Venturini S, Vervoort D, Wilguens Lartigue J. Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries. Lancet 2021; 397:387-397. [PMID: 33485461 PMCID: PMC7846817 DOI: 10.1016/s0140-6736(21)00001-5] [Citation(s) in RCA: 104] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/02/2020] [Accepted: 12/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. METHODS This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. FINDINGS Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70-8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39-8·80) and upper-middle-income countries (2·06, 1·11-3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26-11·59) and upper-middle-income countries (3·89, 2·08-7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. INTERPRETATION Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. FUNDING National Institute for Health Research Global Health Research Unit.
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Qu C, Zhang H, Chen T, Zhu Y, Feng Q, Guo F, Liu Z, Cao L, Yang J, Li G, Ye B, Zhou J, Ke L, Tong Z, Windsor J, Li W. Early on-demand drainage versus standard management among acute necrotizing pancreatitis patients complicated by persistent organ failure: The protocol for an open-label multi-center randomized controlled trial. Pancreatology 2020; 20:1268-1274. [PMID: 32868182 DOI: 10.1016/j.pan.2020.08.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/16/2020] [Accepted: 08/18/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION/AIM Pancreatic necrosis occurs in a quarter of patients with acute pancreatitis, many of whom form an acute necrotic collection (ANC). The current standard treatment is to defer percutaneous catheter drainage (PCD) until the latter becomes "walled off," which takes approximately four weeks. The majority of patients that develop persistent organ failure (POF), the primary determinant of mortality, do so within four weeks. To defer PCD until after four weeks may result in a worse outcome because of a missed opportunity to treat early infection and thereby reduce the severity and/or duration of POF. This study is aimed to compare the clinical outcome of the current standard approach with early on-demand PCD in acute necrotizing pancreatitis (ANP) patients with ANC and POF. METHODS/DESIGN This is an open-label, multi-center, parallel, randomized, controlled trial. All patients with ANP who develop POF during the first week of onset will be screened for eligibility. In total, 120 study subjects will be randomized to either early on-demand PCD or standard care. Patients assigned to the former will receive PCD when they show signs of decompensation like new-onset OF, aggravation of pre-existent OF, and persistent OF for more than a week. The primary composite endpoint is major complication and/or death. Patients will be followed until discharge or death with an additional follow-up 90 days after randomization. DISCUSSION This study challenges the standard 4-week delay before PCD and will answer the question whether early on-demand PCD is associated with a lower incidence of major complications and/or death.
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Affiliation(s)
- Cheng Qu
- Center of Severe Acute Pancreatitis (CSAP), Department of Critical Care Medicine, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - He Zhang
- Center of Severe Acute Pancreatitis (CSAP), Department of Critical Care Medicine, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Tao Chen
- Tropical Clinical Trials Unit, Department of Clinical Sciences, Liverpool School of Tropical Medicine. Liverpool, L3 5QA, UK
| | - Yin Zhu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Quanxing Feng
- Xijing Hospital of Digestive Diseases, The Fourth Military Medical University,, Xi'an, China
| | - Feng Guo
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhiyong Liu
- Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Longxiang Cao
- Center of Severe Acute Pancreatitis (CSAP), Department of Critical Care Medicine, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Jie Yang
- Center of Severe Acute Pancreatitis (CSAP), Department of Critical Care Medicine, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Gang Li
- Center of Severe Acute Pancreatitis (CSAP), Department of Critical Care Medicine, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Bo Ye
- Center of Severe Acute Pancreatitis (CSAP), Department of Critical Care Medicine, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Jing Zhou
- Center of Severe Acute Pancreatitis (CSAP), Department of Critical Care Medicine, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Lu Ke
- Center of Severe Acute Pancreatitis (CSAP), Department of Critical Care Medicine, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China.
| | - Zhihui Tong
- Center of Severe Acute Pancreatitis (CSAP), Department of Critical Care Medicine, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China.
| | - John Windsor
- HBP/Upper GI Unit, Department of General Surgery, Auckland City Hospital, Auckland, New Zealand; Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Weiqin Li
- Center of Severe Acute Pancreatitis (CSAP), Department of Critical Care Medicine, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
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Collins H, Beban G, Windsor J, Ram R, Orr D, Evennett N, Loveday B. Safety and Utility of Liver Biopsy During Bariatric Surgery in the New Zealand Setting. Obes Surg 2020; 30:313-318. [PMID: 31482482 DOI: 10.1007/s11695-019-04161-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Asymptomatic liver disease is common in bariatric patients and can be diagnosed with intraoperative biopsy. This study aimed to establish the risk-benefit profile of routine liver biopsy, prevalence of clinically significant liver disease, relationship between liver pathology and body mass index, and compare outcomes between ethnic groups. METHODS This retrospective cohort study included all patients who had index bariatric surgery at Auckland City Hospital between 2009 and 2016. Diagnosis of liver disease was based on intraoperative biopsy histology. Outcomes included safety (biopsy-related complication) and utility (liver pathology meeting criteria for referral). Liver pathology and referral rates were compared between ethnic groups. RESULTS Of 335 bariatric surgery patients, 234 (70%) underwent intraoperative liver biopsy. There were no biopsy-related complications. Histological findings were as follows: normal 25/234 (11%), non-alcoholic fatty liver disease (NAFLD) 207/234 (88%), and other pathological findings in 35/234 (15%). Histological finding meeting referral criteria was present in 22/234 (9%). Of these, 12/22 (55%) were referred. Number needed to biopsy to identify histology meeting referral criteria: n = 11. Māori had a similar NAFLD rate to non-Māori [51/56 versus 156/178, p = 0.48]. Pasifika patients had a higher rate than non-Pasifika [39/40 versus 168/194, p = 0.049]. Māori and Pasifika patients had similar referral rates to non-Māori and non-Pasifika [2/3 versus 5/9, p = 0.73; 2/2 versus 5/10, p = 0.19]. CONCLUSIONS Intraoperative liver biopsy during bariatric surgery is safe and identified liver disease in 89%, with 9% meeting referral criteria. Pasifika patients have a higher rate of NAFLD than non-Pasifika.
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Affiliation(s)
- Hannah Collins
- Auckland City Hospital, 2 Park Road, Auckland, 1023, New Zealand.
| | - Grant Beban
- Auckland City Hospital, 2 Park Road, Auckland, 1023, New Zealand
| | | | - Rishi Ram
- Auckland City Hospital, 2 Park Road, Auckland, 1023, New Zealand
| | - David Orr
- Auckland City Hospital, 2 Park Road, Auckland, 1023, New Zealand
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Siriwardena AK, Windsor J, Zyromski N, Marchegiani G, Radenkovic D, Morgan C, Passas I, Olah A, Conlon KC, Smith M, Busch O, Baltatzis M, Besselink MG, Vollmer C, Castillo CFD, Friess H, Garcea G, Burmeister S, Hackert T, Lillemoe KD, Schulick R, Shrikhande SV, Smith A, Gianotti L, Falconi M, Adams D, Adham M, Andersson R, Del Chiaro M, Devar J, Jegatheeswaran S, van Santvoort H, Khatkov I, Izbicki J, Büchler M, Neoptolemos JP, Bassi C, Dervenis C. Standards for reporting on surgery for chronic pancreatitis: a report from the International Study Group for Pancreatic Surgery (ISGPS). Surgery 2020; 168:101-105. [PMID: 32183994 DOI: 10.1016/j.surg.2020.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/23/2020] [Accepted: 02/02/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The International Study Group for Pancreatic Surgery provides globally accepted definitions for reporting of complications after pancreatic surgery. This International Study Group for Pancreatic Surgery project aims to provide a standardized framework for reporting of the results of operative treatment for chronic pancreatitis. METHODS An International Study Group for Pancreatic Surgery project circulation list was created with pre-existing and new members and including gastroenterologists in addition to surgeons. A computerized search of the literature was undertaken for articles reporting the operative treatment of chronic pancreatitis. The results of the literature search were presented at the first face-to-face meeting of this International Study Group for Pancreatic Surgery project group. A document outlining proposed reporting standards was produced by discussion during an initial meeting of the International Study Group for Pancreatic Surgery. An electronic questionnaire was then sent to all current members of the International Study Group for Pancreatic Surgery. Responses were collated and further discussed at international meetings in North America, Europe, and at the International Association of Pancreatology World Congress in 2019. A final consensus document was produced by integration of multiple iterations. RESULTS The International Study Group for Pancreatic Surgery consensus standards for reporting of surgery in chronic pancreatitis recommends 4 core domains and the necessary variables needed for reporting of results: clinical baseline before operation; the morphology of the diseased gland; a new, standardized, operative terminology; and a minimum outcome dataset. The 4 domains combine to give a comprehensive framework for reports. CONCLUSION Adoption of the 4 domains of the International Study Group for Pancreatic Surgery reporting standards for surgery for chronic pancreatitis will facilitate comparison of results between centers and help to improve the care for patients with this debilitating disease.
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Affiliation(s)
- Ajith K Siriwardena
- Department of Surgery, Regional Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, United Kingdom.
| | - John Windsor
- Department of Surgery, University of Auckland, New Zealand
| | - Nicholas Zyromski
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Giovanni Marchegiani
- Clinic for Digestive Surgery, Pancreas Institute, Verona University Hospital, Italy
| | - Dejan Radenkovic
- Department of Surgery, Clinical Center of Serbia and School of Medicine, University of Belgrade, Serbia
| | - Catherine Morgan
- Department of Surgical Oncology, Medical University of South Carolina, Charleston, SC
| | - Ioannis Passas
- Department of Surgery, Metropolitan Hospital, Athens, Greece
| | - Attila Olah
- Department of Surgery, Petz Aladar Hospital, Gyor, Hungary
| | - Kevin C Conlon
- Hepato-Pancreatico-Biliary Unit, Department of General Surgery, Trinity College Dublin, Tallaght Hospital, Ireland
| | - Martin Smith
- Department of Surgery, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Olivier Busch
- Department of Surgery, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - Minas Baltatzis
- Department of Surgery, Regional Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, United Kingdom
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - Charles Vollmer
- Department of Surgery, Penn Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Helmut Friess
- Department of Hepato-Pancreato-Biliary Surgery, Klinikum rechts der Isar, Technische Universitat Munchen, Germany
| | - Giuseppe Garcea
- Department of Surgery, University Hospitals of Leicester, United Kingdom
| | - Sean Burmeister
- Department of General, Visceral, and Transplantation Surgery, University of Cape Town Health Sciences Faculty and Surgical Gastroenterology Unit Groote Schuur Hospital, South Africa
| | - Thilo Hackert
- Department of Surgery, University of Heidelberg, Germany
| | - Keith D Lillemoe
- Department of Surgery, Massachusetts General Hospital and the Harvard Medical School, Boston, MA
| | - Richard Schulick
- Department of GI and HPB Surgical Oncology, University of Colorado School of Medicine, Aurora, CO
| | | | - Andrew Smith
- Department of Surgery, St James University Hospital, Leeds, United Kingdom
| | - Luca Gianotti
- Pancreatic Surgery Unit, School of Medicine and Surgery, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Massimo Falconi
- Digestive Surgery Department, San Raffaele Scientific Institute, 'Vita-Salute' University, Milan, Italy
| | - David Adams
- Department of Surgical Oncology, Medical University of South Carolina, Charleston, SC
| | | | - Roland Andersson
- Dept of Hepato-Pancreato-Biliary Surgery, Clinical Sciences Lund, Lund University, Sweden
| | - Marco Del Chiaro
- Department of GI and HPB Surgical Oncology, University of Colorado School of Medicine, Aurora, CO
| | - John Devar
- Department of Surgery, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | | | | | - Igor Khatkov
- Moscow Clinical Scientific Center, Moscow University of Medicine and Dentistry, Russian Federation
| | - Jakob Izbicki
- University Medical Center Hamburg-Eppendorf, Germany
| | - Markus Büchler
- Department of Surgery, University of Heidelberg, Germany
| | | | - Claudio Bassi
- Clinic for Digestive Surgery, Pancreas Institute, Verona University Hospital, Italy
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Kempeneers MA, Issa Y, Ali UA, Baron RD, Besselink MG, Büchler M, Erkan M, Fernandez-Del Castillo C, Isaji S, Izbicki J, Kleeff J, Laukkarinen J, Sheel ARG, Shimosegawa T, Whitcomb DC, Windsor J, Miao Y, Neoptolemos J, Boermeester MA. International consensus guidelines for surgery and the timing of intervention in chronic pancreatitis. Pancreatology 2020; 20:149-157. [PMID: 31870802 DOI: 10.1016/j.pan.2019.12.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 12/03/2019] [Accepted: 12/11/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND/OBJECTIVES Chronic pancreatitis (CP) is a complex inflammatory disease with pain as the predominant symptom. Pain relief can be achieved using invasive interventions such as endoscopy and surgery. This paper is part of the international consensus guidelines on CP and presents the consensus guideline for surgery and timing of intervention in CP. METHODS An international working group with 15 experts on CP surgery from the major pancreas societies (IAP, APA, JPS, and EPC) evaluated 20 statements generated from evidence on 5 questions deemed to be the most clinically relevant in CP. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to evaluate the level of evidence available for each statement. To determine the level of agreement, the working group voted on the 20 statements for strength of agreement, using a nine-point Likert scale in order to calculate Cronbach's alpha reliability coefficient. RESULTS Strong consensus was obtained for the following statements: Surgery in CP is indicated as treatment of intractable pain and local complications of adjacent organs, and in case of suspicion of malignant (cystic) lesion; Early surgery is favored over surgery in a more advanced stage of disease to achieve optimal long-term pain relief; In patients with an enlarged pancreatic head, a combined drainage and resection procedure, such as the Frey, Beger, and Berne procedure, may be the treatment of choice; Pancreaticoduodenectomy is the most suitable surgical option for patients with groove pancreatitis; The risk of pancreatic carcinoma in patients with CP is too low (2% in 10 year) to recommend active screening or prophylactic surgery; Patients with hereditary CP have such a high risk of pancreatic cancer that prophylactic resection can be considered (lifetime risk of 40-55%). Weak agreement for procedure choice in patients with dilated duct and normal size pancreatic head: both the extended lateral pancreaticojejunostomy and Frey procedure seems to provide equivalent pain control in patients. CONCLUSIONS This international expert consensus guideline provides evidenced-based statements concerning key aspects in surgery and timing of intervention in CP. It is meant to guide clinical practitioners and surgeons in the treatment of patients with CP.
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Affiliation(s)
- M A Kempeneers
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Y Issa
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - U Ahmed Ali
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, the Netherlands; Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - R D Baron
- Department of Surgery, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - M G Besselink
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - M Büchler
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany
| | - M Erkan
- Department of Surgery, Koc University, Istanbul, Turkey
| | | | - S Isaji
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Japan
| | - J Izbicki
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Germany
| | - J Kleeff
- Department of Visceral, Vascular, and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Germany
| | - J Laukkarinen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Faculty of Medicine and Health Technology, Tampere University, Finland
| | - A R G Sheel
- Institute of Translational Medicine, University of Liverpool, United Kingdom
| | - T Shimosegawa
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan
| | - D C Whitcomb
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh and UPMC, PA, USA
| | - J Windsor
- HBP/Upper GI Unit, Auckland City Hospital/Department of Surgery, University of Auckland, New Zealand
| | - Y Miao
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, China
| | - J Neoptolemos
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany
| | - M A Boermeester
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, the Netherlands.
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Shi N, Liu T, de la Iglesia-Garcia D, Deng L, Jin T, Lan L, Zhu P, Hu W, Zhou Z, Singh V, Dominguez-Munoz JE, Windsor J, Huang W, Xia Q, Sutton R. Duration of organ failure impacts mortality in acute pancreatitis. Gut 2020; 69:604-605. [PMID: 31233394 PMCID: PMC7034341 DOI: 10.1136/gutjnl-2019-318241] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 01/18/2019] [Accepted: 01/22/2019] [Indexed: 02/05/2023]
Affiliation(s)
- Na Shi
- Department and Laboratory of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Tingting Liu
- Department and Laboratory of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China,Liverpool Pancreatitis Study Group, Royal Liverpool University Hospital and Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | | | - Lihui Deng
- Department and Laboratory of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Jin
- Department and Laboratory of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Lan Lan
- West China Biomedical Big Data Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Ping Zhu
- Department and Laboratory of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Weiming Hu
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zongguang Zhou
- Institute of Digestive Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Vikesh Singh
- Pancreatitis Centre, Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, USA
| | | | - John Windsor
- Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Wei Huang
- Department and Laboratory of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China,Liverpool Pancreatitis Study Group, Royal Liverpool University Hospital and Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Qing Xia
- Department and Laboratory of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Robert Sutton
- Liverpool Pancreatitis Study Group, Royal Liverpool University Hospital and Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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Windsor J, Garrod T, Tan L, Talley NJ, Churchill J, Farmer E, Smith JA. Progress towards a sustainable clinical academic training pathway. ANZ J Surg 2019; 88:952-953. [PMID: 30276997 DOI: 10.1111/ans.14706] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/16/2018] [Accepted: 04/24/2018] [Indexed: 11/28/2022]
Affiliation(s)
- John Windsor
- Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Tamsin Garrod
- Section of Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Lorwai Tan
- Section of Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Nicholas J Talley
- Royal Australasian College of Physicians, Sydney, New South Wales, Australia.,The University of Newcastle, Newcastle, New South Wales, Australia
| | - James Churchill
- Department of Surgery, Austin Health, Australian Medical Association Council of Doctors-in-Training, Canberra, Australian Capital Territory, Australia
| | - Elizabeth Farmer
- Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Julian A Smith
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
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Drewes AM, Kempeneers MA, Andersen DK, Arendt-Nielsen L, Besselink MG, Boermeester MA, Bouwense S, Bruno M, Freeman M, Gress TM, van Hooft JE, Morlion B, Olesen SS, van Santvoort H, Singh V, Windsor J. Controversies on the endoscopic and surgical management of pain in patients with chronic pancreatitis: pros and cons! Gut 2019; 68:1343-1351. [PMID: 31129569 PMCID: PMC6691929 DOI: 10.1136/gutjnl-2019-318742] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/01/2019] [Accepted: 05/07/2019] [Indexed: 01/09/2023]
Affiliation(s)
- Asbjørn Mohr Drewes
- Centre for Pancreatic Diseases, Department of Gastroenterology, Aalborg University Hospital & Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Marinus A Kempeneers
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Dana K Andersen
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Lars Arendt-Nielsen
- Center for Sensory-Motor Interactions (SMI), Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Marc G Besselink
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marja A Boermeester
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Stefan Bouwense
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marco Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Martin Freeman
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnessota Medical School, Minneapolis, Minnesota, USA
| | - Thomas M Gress
- Department of Gastroenterology, Philipps University & University Hospital of Marburg, Marburg, Germany
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Bart Morlion
- The Leuven Centre for Algology & Pain Management, University Hospitals Leuven, Leuven, Belgium
| | - Søren Schou Olesen
- Centre for Pancreatic Diseases, Department of Gastroenterology, Aalborg University Hospital & Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Hjalmar van Santvoort
- Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands,Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Vikesh Singh
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - John Windsor
- Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Windsor J, Ramanarasiah T, Burke M, Mitchell J. EP-1297 Heart of the Matter: A study of 112 left breast cancer patients treated with DIBH. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31717-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ke L, Mao W, Zhou J, Ye B, Li G, Zhang J, Wang P, Tong Z, Windsor J, Li W. Stent-Assisted Percutaneous Endoscopic Necrosectomy for Infected Pancreatic Necrosis: Technical Report and a Pilot Study. World J Surg 2019; 43:1121-1128. [PMID: 30569220 DOI: 10.1007/s00268-018-04878-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIMS A variety of minimally invasive techniques have been proposed to replace open surgery for the treatment of infected pancreatic necrosis (IPN). In this study, we evaluate the feasibility and safety of the stent-assisted percutaneous endoscopic necrosectomy (SAPEN) procedure. METHODS Data were collected on all patients who underwent the SAPEN procedure between October 2017 and March 2018. The demographic and clinical characteristics of the study patients were analyzed. A composite primary endpoint of major complications and/or death was used. Three different cases were selected to illustrate different technical aspects of the SAPEN procedure. RESULTS The placement of a percutaneous stent was successful in all of the 23 patients (17 males, six females). IPN was successfully managed in 16/23 (70%) patients, with the need for open surgery in seven patients (30%), with a median of two (range 1-5) SAPEN procedures. No significant procedure-related complications occurred. Overall 11/23 (48%) patients had a major complication and/or death. CONCLUSIONS In conclusion, the SAPEN procedure was effective in treating IPN without adding extra procedural risk. The role and benefits of the SAPEN procedure now need to be demonstrated in larger controlled study.
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Affiliation(s)
- Lu Ke
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, 210002, Nanjing Province, China
| | - Wenjian Mao
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, 210002, Nanjing Province, China
- Department of General Surgery, Jinling Clinical Medical College of Southern Medical University, No. 305 Zhongshan East Road, Nanjing, China
| | - Jing Zhou
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, 210002, Nanjing Province, China
| | - Bo Ye
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, 210002, Nanjing Province, China
| | - Gang Li
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, 210002, Nanjing Province, China
| | - Jingzhu Zhang
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, 210002, Nanjing Province, China
| | - Peng Wang
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, 210002, Nanjing Province, China
- Department of General Surgery, Jinling Clinical Medical College of Southern Medical University, No. 305 Zhongshan East Road, Nanjing, China
| | - Zhihui Tong
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, 210002, Nanjing Province, China.
| | - John Windsor
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Weiqin Li
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, 210002, Nanjing Province, China.
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Yao L, Cheng C, Yang X, Han C, Du D, Liu T, Chvanov M, Windsor J, Sutton R, Huang W, Xia Q. Ethyl pyruvate and analogs as potential treatments for acute pancreatitis: A review of in vitro and in vivo studies. Pancreatology 2019; 19:209-216. [PMID: 30611702 DOI: 10.1016/j.pan.2018.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 12/10/2018] [Accepted: 12/15/2018] [Indexed: 02/05/2023]
Abstract
Ethyl pyruvate (EP) has been shown to improve outcomes from multiple organ dysfunction syndrome (MODS) in experimental animal models of critical illness. This review aimed to summarise in vitro and in vivo effects of EP analogs on acute pancreatitis (AP) with the objective of proposing medicinal chemistry modifications of EP for future research. In vitro studies showed that both sodium pyruvate and EP significantly reduced pancreatic acinar necrotic cell death pathway activation induced by multiple pancreatic toxins. In vivo studies using different murine AP models showed that EP (usually at a dose of 40 mg/kg every 6 h) consistently reduced pain, markers of pancreatic injury, systemic inflammation and MODS. There was also a significant increase in survival rate, even when EP was administered 12 h after disease induction (compared with untreated groups or those treated with Ringer's lactate solution). Experimental studies suggest that EP and analogs are promising drug candidates for treating AP. EP or analogs can undergo medicinal chemistry modifications to improve its stability and deliverability. EP or analogs could be evaluated as a supplement to intravenous fluid therapy in AP.
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Affiliation(s)
- Linbo Yao
- Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Chunru Cheng
- School of Chemistry and Pharmaceutical Engineering, Institute of Pharmaceutical Engineering Technology and Application, Key Laboratory of Green Chemistry of Sichuan Institute of Higher Education, Sichuan University of Science and Engineering, Zigong 643000, China
| | - Xinmin Yang
- Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Chenxia Han
- Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Dan Du
- West China-Washington Mitochondria and Metabolism Centre, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Tingting Liu
- Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Michael Chvanov
- Department of Cellular and Molecular Physiology, Institute of Translational Medicine, University of Liverpool, Liverpool L69 3BX, UK
| | - John Windsor
- Centre for Surgical and Translational Research, Faculty of Medical and Health Sciences, University of Auckland, Auckland 92019, New Zealand
| | - Robert Sutton
- Liverpool Pancreatitis Study Group, Royal Liverpool University Hospital, Institute of Translational Medicine, University of Liverpool, Liverpool L69 3GE, UK
| | - Wei Huang
- Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu 610041, China.
| | - Qing Xia
- Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu 610041, China.
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Whitcomb DC, Shimosegawa T, Chari ST, Forsmark CE, Frulloni L, Pramod G, Hegyi P, Hirooka Y, Irisawa A, Ishikawa T, Isaji S, Lerch MM, Levy P, Masamune A, Wilcox CM, Windsor J, Yadav D, Sheel A, Neoptolemos JP. International consensus statements on early chronic Pancreatitis. Recommendations from the working group for the international consensus guidelines for chronic pancreatitis in collaboration with The International Association of Pancreatology, American Pancreatic Association, Japan Pancreas Society, PancreasFest Working Group and European Pancreatic Club. Pancreatology 2018; 18:516-527. [PMID: 29793839 PMCID: PMC6748871 DOI: 10.1016/j.pan.2018.05.008] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 05/14/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Chronic pancreatitis (CP) is a progressive inflammatory disorder currently diagnosed by morphologic features. In contrast, an accurate diagnosis of Early CP is not possible using imaging criteria alone. If this were possible and early treatment instituted, the later, irreversible features and complications of CP could possibly be prevented. METHOD An international working group supported by four major pancreas societies (IAP, APA, JPS, and EPC) and a PancreasFest working group sought to develop a consensus definition and diagnostic criteria for Early CP. Ten statements (S1-10) concerning Early CP were used to gauge consensus on the Early CP concept using anonymous voting with a 9 point Likert scale. Consensus required an alpha ≥0.80. RESULTS No consensus statement could be developed for a definition of Early-CP or diagnostic criteria. There was consensus on 5 statements: (S2) The word "Early" in early chronic pancreatitis is used to describe disease state, not disease duration. (S4) Early CP defines a stage of CP with preserved pancreatic function and potentially reversible features. (S8) Genetic variants are important risk factors for Early CP and can add specificity to the likely etiology, but they are neither necessary nor sufficient to make a diagnosis. (S9) Environmental risk factors can provide evidence to support the diagnosis of Early CP, but are neither necessary nor sufficient to make a diagnosis. (S10) The differential diagnosis for Early CP includes other disorders with morphological and functional features that overlap with CP. CONCLUSIONS Morphology based diagnosis of Early CP is not possible without additional information. New approaches to the accurate diagnosis of Early CP will require a mechanistic definition that considers risk factors, biomarkers, clinical context and new models of disease. Such a definition will require prospective validation.
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Affiliation(s)
- David C Whitcomb
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA. USA,Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA, USA,Corresponding Author: David C Whitcomb MD PhD, University of Pittsburgh, Gastroenterology, Room 401.4, 3708 Fifth Ave, Pittsburgh PA 15213 412 578 9515; Fax 412 578-9537,
| | | | - Suresh T Chari
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN. USA
| | - Christopher E. Forsmark
- Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainsville, FL USA
| | - Luca Frulloni
- Gastroenterology Unit, Department of Medicine and the Pancreas Institute, University of Verona, Verona, Italy
| | - Garg Pramod
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Peter Hegyi
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary and MTA-SZTE Translational Gastroenterology Research Group, Szeged, Hungary
| | - Yoshiki Hirooka
- Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University, Mibu, Tochigi, JAPAN
| | - Takuya Ishikawa
- Department of Gastroenterology, Nagoya University Hospital, Nagoya, Japan
| | - Shuiji Isaji
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University, Tsu, Japan
| | - Markus M. Lerch
- Division of Gastroenterology and Endocrinology, Ernst-Moritz-Arndt Universität Greifswald, Greifswald, Germany
| | - Philippe Levy
- Service de pancréatologie, Pôle des Maladies de l’Appareil Digestif, DHU UNITY, Centre de référence des maladies rares du pancréas (PAncreatic RAre DISeases), Centre de référence européen des tumeurs neuroendocrines digestives et pancréatiques, Hôpital Beaujon, Faculté Denis Diderot, APHP, Clichy, France
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Charles M. Wilcox
- Division of Gastroenterology & Hepatology, University of Alabama Birmingham, Birmingham, AL, USA
| | - John Windsor
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Dhiraj Yadav
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA. USA
| | - Andrea Sheel
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, L69 3GE, UK
| | - John P Neoptolemos
- Department of General, Visceral and Transplantaion Surgery University of Heidelberg, Heidelberg, Germany
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Windsor J, Garrod T, Talley NJ, Tebbutt C, Churchill J, Farmer E, Baur L, Smith JA. The clinical academic workforce in Australia and New Zealand: report on the second binational summit to implement a sustainable training pathway. Intern Med J 2017; 47:394-399. [PMID: 28401723 DOI: 10.1111/imj.13356] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 11/23/2016] [Accepted: 11/26/2016] [Indexed: 01/14/2023]
Abstract
There has been a decline in the proportion of clinical academics compared with full-time clinicians, since 2004. A Working Party was established to help develop and implement a model for the training of clinical academics. After a highly successful first summit in 2014 that summarised the challenges faced by clinical academics in Australia and New Zealand, a second summit was convened late in 2015 to report on progress and to identify key areas for further action. The second summit provided survey results that identified the varied training pathways currently offered to clinical academics and the institutions willing to be involved in developing improved pathways. A literature review also described the contributions that clinical academics make to the health sector and the challenges faced by this workforce sector. Current training pathways created for clinical academics by Australasian institutions were presented as examples of what can be done. The perspectives of government and research organisations presented at the summit helped define how key stakeholders can contribute. Following the summit, there was a strong commitment to continue to work towards developing a sustainable and defined training pathway for clinical academics. The need for a coordinated and integrated approach was highlighted. Some key objectives were agreed upon for the next phase, including identifying and engaging key advocates within government and leading institutions; publishing and profiling the contributions of successful clinical academics to healthcare outcomes; defining the stages of a clinical academic training pathway; and establishing a mentoring programme for training clinical academics.
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Affiliation(s)
- John Windsor
- Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Tamsin Garrod
- Section of Academic Surgery, Royal Australasian College of Surgeons, North Adelaide, South Australia, Australia
| | - Nicholas J Talley
- The Royal Australasian College of Physicians, University of Newcastle, Newcastle, New South Wales, Australia.,Faculty of Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Carmel Tebbutt
- Medical Deans Australia and New Zealand, Sydney, New South Wales, Australia
| | - James Churchill
- Australian Medical Association Council of Doctors in Training, Barton, Australian Capital Territory, Australia
| | - Elizabeth Farmer
- University of Wollongong, Wollongong, New South Wales, Australia
| | - Louise Baur
- Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Newcastle, New South Wales, Australia
| | - Julian A Smith
- Department of Surgery, Monash Medical Centre, Monash University, Melbourne, Victoria, Australia
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Koschwanez H, Robinson H, Beban G, MacCormick A, Hill A, Windsor J, Booth R, Jüllig M, Broadbent E. Randomized clinical trial of expressive writing on wound healing following bariatric surgery. Health Psychol 2017; 36:630-640. [PMID: 28383927 DOI: 10.1037/hea0000494] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Writing emotionally about upsetting life events (expressive writing) has been shown to speed healing of punch-biopsy wounds compared to writing objectively about daily activities. We aimed to investigate whether a presurgical expressive writing intervention could improve surgical wound healing. METHOD Seventy-six patients undergoing elective laparoscopic bariatric surgery were randomized either to write emotionally about traumatic life events (expressive writing) or to write objectively about how they spent their time (daily activities writing) for 20 min a day for 3 consecutive days beginning 2 weeks prior to surgery. A wound drain was inserted into a laparoscopic port site and wound fluid analyzed for proinflammatory cytokines collected over 24 hr postoperatively. Expanded polytetrafluoroethylene tubes were inserted into separate laparoscopic port sites during surgery and removed after 14 days. Tubes were analyzed for hydroxyproline deposition (the primary outcome), a major component of collagen and marker of healing. Fifty-four patients completed the study. RESULTS Patients who wrote about daily activities had significantly more hydroxyproline than did expressive writing patients, t(34) = -2.43, p = .020, 95% confidence interval [-4.61, -0.41], and higher tumor necrosis factor-alpha, t(29) = -2.42, p = .022, 95% confidence interval [-0.42, -0.04]. Perceived stress significantly reduced in both groups after surgery. CONCLUSIONS Expressive writing prior to bariatric surgery was not effective at increasing hydroxyproline at the wound site 14 days after surgery. However, writing about daily activities did predict such an increase. Future research needs to replicate these findings and investigate generalizability to other surgical groups. (PsycINFO Database Record
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Affiliation(s)
- Heidi Koschwanez
- Department of Psychological Medicine, The University of Auckland
| | - Hayley Robinson
- Department of Psychological Medicine, The University of Auckland
| | - Grant Beban
- Department of General Surgery, Auckland City Hospital
| | | | - Andrew Hill
- Department of Surgery, The University of Auckland
| | - John Windsor
- Department of Surgery, The University of Auckland
| | - Roger Booth
- Department of Molecular Medicine and Pathology, The University of Auckland
| | - Mia Jüllig
- Auckland Science Analytical Services, The University of Auckland
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Windsor J, Searle J, Hanney R, Chapman A, Grigg M, Choong P, Mackay A, Smithers BM, Churchill JA, Carney S, Smith JA, Wainer Z, Talley NJ, Gladman MA. Building a sustainable clinical academic workforce to meet the future healthcare needs of Australia and New Zealand: report from the first summit meeting. Intern Med J 2016; 45:965-71. [PMID: 26332622 DOI: 10.1111/imj.12854] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 06/04/2015] [Indexed: 11/27/2022]
Abstract
The delivery of healthcare that meets the requirements for quality, safety and cost-effectiveness relies on a well-trained medical workforce, including clinical academics whose career includes a specific commitment to research, education and/or leadership. In 2011, the Medical Deans of Australia and New Zealand published a review on the clinical academic workforce and recommended the development of an integrated training pathway for clinical academics. A bi-national Summit on Clinical Academic Training was recently convened to bring together all relevant stakeholders to determine how best to do this. An important part understood the lessons learnt from the UK experience after 10 years since the introduction of an integrated training pathway. The outcome of the summit was to endorse strongly the recommendations of the medical deans. A steering committee has been established to identify further stakeholders, solicit more information from stakeholder organisations, convene a follow-up summit meeting in late 2015, recruit pilot host institutions and engage the government and future funders.
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Affiliation(s)
- J Windsor
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - J Searle
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - R Hanney
- Department of Surgery, University of Sydney, Sydney, New South Wales, Australia
| | - A Chapman
- New South Wales Office, Royal Australasian College of Surgeons, Sydney, New South Wales, Australia
| | - M Grigg
- Melbourne Office, Royal Australasian College of Surgeons, Melbourne, Victoria, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - P Choong
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - A Mackay
- Australian Academy of Health and Medical Sciences, Melbourne, Victoria, Australia
| | - B M Smithers
- Discipline of Surgery, University of Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - J A Churchill
- Australian Medical Association Council of Doctors-in-Training, Melbourne, Victoria, Australia.,Austin Health, Melbourne, Victoria, Australia
| | - S Carney
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - J A Smith
- Department of Surgery, Monash Medical Centre, Monash University, Melbourne, Victoria, Australia
| | - Z Wainer
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - N J Talley
- The Royal Australasian College of Physicians, Sydney, New South Wales, Australia.,University of Newcastle, Newcastle, New South Wales, Australia
| | - M A Gladman
- Academic Colorectal Unit, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Smith RC, Smith SF, Wilson J, Pearce C, Wray N, Vo R, Chen J, Ooi CY, Oliver M, Katz T, Turner R, Nikfarjam M, Rayner C, Horowitz M, Holtmann G, Talley N, Windsor J, Pirola R, Neale R. Summary and recommendations from the Australasian guidelines for the management of pancreatic exocrine insufficiency. Pancreatology 2016; 16:164-80. [PMID: 26775768 DOI: 10.1016/j.pan.2015.12.006] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 12/01/2015] [Accepted: 12/10/2015] [Indexed: 02/06/2023]
Abstract
AIM Because of increasing awareness of variations in the use of pancreatic exocrine replacement therapy, the Australasian Pancreatic Club decided it was timely to re-review the literature and create new Australasian guidelines for the management of pancreatic exocrine insufficiency (PEI). METHODS A working party of expert clinicians was convened and initially determined that by dividing the types of presentation into three categories for the likelihood of PEI (definite, possible and unlikely) they were able to consider the difficulties of diagnosing PEI and relate these to the value of treatment for each diagnostic category. RESULTS AND CONCLUSIONS Recent studies confirm that patients with chronic pancreatitis receive similar benefit from pancreatic exocrine replacement therapy (PERT) to that established in children with cystic fibrosis. Severe acute pancreatitis is frequently followed by PEI and PERT should be considered for these patients because of their nutritional requirements. Evidence is also becoming stronger for the benefits of PERT in patients with unresectable pancreatic cancer. However there is as yet no clear guide to help identify those patients in the 'unlikely' PEI group who would benefit from PERT. For example, patients with coeliac disease, diabetes mellitus, irritable bowel syndrome and weight loss in the elderly may occasionally be given a trial of PERT, but determining its effectiveness will be difficult. The starting dose of PERT should be from 25,000-40,000 IU lipase taken with food. This may need to be titrated up and there may be a need for proton pump inhibitors in some patients to improve efficacy.
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Affiliation(s)
| | - Ross C Smith
- Department of Surgery, University of Sydney, NSW, Australia; Australasian Pancreatic Club, Australia.
| | | | | | - Callum Pearce
- Institute for Immunology and Infectious Diseases, Murdoch University, WA, Australia; Fremantle Hospital, WA, Australia
| | - Nick Wray
- Nutrition & Dietetics, School of Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Ruth Vo
- Liverpool Hospital, University of NSW, Australia
| | - John Chen
- South Australian Liver Transplant & HPB Unit, RAH & Flinders Medical Centre, SA, Australia
| | - Chee Y Ooi
- School of Women's and Children's Health, Dept. of Medicine, University of NSW, Australia; Department of Gastroenterology, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Mark Oliver
- Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Parkville, VIC, Australia
| | - Tamarah Katz
- Sydney Children's Hospital, Randwick, NSW, Australia
| | - Richard Turner
- Hobart Clinical School and Dept. Surgery, University of Tasmania, Australia
| | - Mehrdad Nikfarjam
- Dept. Surgery, University of Melbourne, VIC, Australia; Australasian Pancreatic Club, Australia
| | - Christopher Rayner
- School of Medicine, University of Adelaide, SA, Australia; Centre for Digestive Diseases, Royal Adelaide Hospital, SA, Australia
| | - Michael Horowitz
- Endocrine and Metabolic Unit, University of Adelaide and Royal Adelaide Hospital, SA, Australia
| | - Gerald Holtmann
- Faculty of Medicine and Biomedical Sciences, University of Queensland, Australia; Translational Research Institute, Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Qld, Australia
| | - Nick Talley
- Faculty of Health and Medicine, University of Newcastle, NSW, Australia; Royal Australasian College of Physicians, Australia
| | - John Windsor
- Dept. of Surgery, University of Auckland, New Zealand
| | - Ron Pirola
- Faculty of Medicine, SW Sydney Clinical School, University of NSW, Australia
| | - Rachel Neale
- Cancer Control Laboratory, Queensland Institute of Medical Research, Qld, Australia
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Anderson MA, Akshintala V, Albers KM, Amann ST, Belfer I, Brand R, Chari S, Cote G, Davis BM, Frulloni L, Gelrud A, Guda N, Humar A, Liddle RA, Slivka A, Gupta RS, Szigethy E, Talluri J, Wassef W, Wilcox CM, Windsor J, Yadav D, Whitcomb DC. Mechanism, assessment and management of pain in chronic pancreatitis: Recommendations of a multidisciplinary study group. Pancreatology 2016; 16:83-94. [PMID: 26620965 PMCID: PMC4761301 DOI: 10.1016/j.pan.2015.10.015] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 10/29/2015] [Accepted: 10/31/2015] [Indexed: 12/11/2022]
Abstract
DESCRIPTION Pain in patients with chronic pancreatitis (CP) remains the primary clinical complaint and source of poor quality of life. However, clear guidance on evaluation and treatment is lacking. METHODS Pancreatic Pain working groups reviewed information on pain mechanisms, clinical pain assessment and pain treatment in CP. Levels of evidence were assigned using the Oxford system, and consensus was based on GRADE. A consensus meeting was held during PancreasFest 2012 with substantial post-meeting discussion, debate, and manuscript refinement. RESULTS Twelve discussion questions and proposed guidance statements were presented. Conference participates concluded: Disease Mechanism: Pain etiology is multifactorial, but data are lacking to effectively link symptoms with pathologic feature and molecular subtypes. Assessment of Pain: Pain should be assessed at each clinical visit, but evidence to support an optimal approach to assessing pain character, frequency and severity is lacking. MANAGEMENT There was general agreement on the roles for endoscopic and surgical therapies, but less agreement on optimal patient selection for medical, psychological, endoscopic, surgical and other therapies. CONCLUSIONS Progress is occurring in pain biology and treatment options, but pain in patients with CP remains a major problem that is inadequately understood, measured and managed. The growing body of information needs to be translated into more effective clinical care.
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Affiliation(s)
| | | | - Kathryn M Albers
- Department of Neurobiology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Inna Belfer
- Department of Anesthesiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Randall Brand
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Suresh Chari
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Greg Cote
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Brian M Davis
- Department of Neurobiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Luca Frulloni
- Department of Medicine, University of Verona, Verona, Italy
| | - Andres Gelrud
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Nalini Guda
- Department of Gastroenterology, Aurora St. Luke's Medical Center, Milwaukee, WI, USA
| | - Abhinav Humar
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Adam Slivka
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Eva Szigethy
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jyothsna Talluri
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Wahid Wassef
- Department of Medicine, University of Massachusetts, Worcester, MA, USA
| | - C Mel Wilcox
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - John Windsor
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Dhiraj Yadav
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - David C Whitcomb
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Cell Biology & Molecular Physiology, University of Pittsburgh, Pittsburgh, PA, USA; Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA, USA.
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Affiliation(s)
| | - Sherry Ryan
- University of North Texas, Denton, Texas 76201
| | - Gina Harden
- Stephen F. Austin State University, Nacogdoches, Texas 75962
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Brown P, Panattoni L, Cameron L, Knox S, Ashton T, Tenbensel T, Windsor J. Hospital sector choice and support for public hospital care in New Zealand: Results from a labeled discrete choice survey. J Health Econ 2015; 43:118-127. [PMID: 26232651 DOI: 10.1016/j.jhealeco.2015.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 05/26/2015] [Accepted: 06/19/2015] [Indexed: 06/04/2023]
Abstract
This study uses a discrete choice experiment (DCE) to measure patients' preferences for public and private hospital care in New Zealand. A labeled DCE was administered to 583 members of the general public, with the choice between a public and private hospital for a non-urgent surgery. The results suggest that cost of surgery, waiting times for surgery, option to select a surgeon, convenience, and conditions of the hospital ward are important considerations for patients. The most important determinant of hospital choice was whether it was a public or private hospital, with respondents far more likely to choose a public hospital than a private hospital. The results have implications for government policy toward using private hospitals to clear waiting lists in public hospitals, with these results suggesting the public might not be indifferent to policies that treat private hospitals as substitutes for public hospitals.
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Affiliation(s)
- Paul Brown
- University of California, Merced, CA, United States.
| | - Laura Panattoni
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, United States
| | | | - Stephanie Knox
- Centre for Health Economics Research and Evaluation, University of Technology, Sydney, Australia
| | - Toni Ashton
- University of Auckland, Auckland, New Zealand
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Abstract
BACKGROUND The need for an early determination of resectability and before an irreversible step is taken during pancreatoduodenectomy promoted the development of an 'artery first approach' (AFA). The aim of this study was to review the current evidence related to this approach, with particular reference to margins and survival. METHODS An electronic search was performed in MEDLINE, EMBASE and PubMed databases from 1960 to 2015 using both subject headings (MeSH) and truncated word searches to identify all published related articles to this topic. RESULTS Six different AFAs have been published. Four studies evaluated the impact of AFA on perioperative outcomes and survival. Three studies showed no difference in the perioperative outcomes, margin status, lymph node yield and survival while one study showed improved margin status and survival comparing AFA with standard resection. CONCLUSION The current evidence regarding the benefits of AFA in relation to decreasing margin positivity or increasing survival is sparse. Further larger studies and randomized controlled trails are needed to ascertain the benefits of AFA.
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Affiliation(s)
- Sanjay Pandanaboyana
- HBP/Upper GI Unit, Department of General Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Richard Bell
- Department of Hepatobiliary and Pancreatic Surgery, St James Hospital, Leeds, UK
| | - John Windsor
- HBP/Upper GI Unit, Department of General Surgery, Auckland City Hospital, Auckland, New Zealand
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Bellin MD, Freeman ML, Gelrud A, Slivka A, Clavel A, Humar A, Schwarzenberg SJ, Lowe ME, Rickels MR, Whitcomb DC, Matthews JB, Amann S, Andersen DK, Anderson MA, Baillie J, Block G, Brand R, Chari S, Cook M, Cote GA, Dunn T, Frulloni L, Greer JB, Hollingsworth MA, Kim KM, Larson A, Lerch MM, Lin T, Muniraj T, Robertson RP, Sclair S, Singh S, Stopczynski R, Toledo FGS, Wilcox CM, Windsor J, Yadav D. Total pancreatectomy and islet autotransplantation in chronic pancreatitis: recommendations from PancreasFest. Pancreatology 2014; 14:27-35. [PMID: 24555976 PMCID: PMC4058640 DOI: 10.1016/j.pan.2013.10.009] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 10/23/2013] [Accepted: 10/25/2013] [Indexed: 12/11/2022]
Abstract
DESCRIPTION Total pancreatectomy with islet autotransplantation (TPIAT) is a surgical procedure used to treat severe complications of chronic pancreatitis or very high risk of pancreatic cancer while reducing the risk of severe diabetes mellitus. However, clear guidance on indications, contraindications, evaluation, timing, and follow-up are lacking. METHODS A working group reviewed the medical, psychological, and surgical options and supporting literature related to TPIAT for a consensus meeting during PancreasFest. RESULTS Five major areas requiring clinical evaluation and management were addressed: These included: 1) indications for TPIAT; 2) contraindications for TPIAT; 3) optimal timing of the procedure; 4) need for a multi-disciplinary team and the roles of the members; 5) life-long management issues following TPIAP including diabetes monitoring and nutrition evaluation. CONCLUSIONS TPIAT is an effective method of managing the disabling complications of chronic pancreatitis and risk of pancreatic cancer in very high risk patients. Careful evaluation and long-term management of candidate patients by qualified multidisciplinary teams is required. Multiple recommendations for further research were also identified.
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Affiliation(s)
- Melena D. Bellin
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Martin L. Freeman
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Andres Gelrud
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Adam Slivka
- Department of Medicine, University of Pittsburgh, Pennsylvania, USA
| | - Alfred Clavel
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Abhinav Humar
- Department of Surgery, University of Pittsburgh, Pennsylvania, USA
| | | | - Mark E. Lowe
- Department of Pediatrics, University of Pittsburgh, Pennsylvania, USA,Children’s Hospital of Pittsburgh, Pennsylvania, USA
| | - Michael R. Rickels
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David C Whitcomb
- Department of Medicine, University of Pittsburgh, Pennsylvania, USA
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van den Heever M, Mittal A, Haydock M, Windsor J. The use of intelligent database systems in acute pancreatitis--a systematic review. Pancreatology 2013; 14:9-16. [PMID: 24555973 DOI: 10.1016/j.pan.2013.11.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 10/15/2013] [Accepted: 11/18/2013] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Acute pancreatitis (AP) is a complex disease with multiple aetiological factors, wide ranging severity, and multiple challenges to effective triage and management. Databases, data mining and machine learning algorithms (MLAs), including artificial neural networks (ANNs), may assist by storing and interpreting data from multiple sources, potentially improving clinical decision-making. AIMS 1) Identify database technologies used to store AP data, 2) collate and categorise variables stored in AP databases, 3) identify the MLA technologies, including ANNs, used to analyse AP data, and 4) identify clinical and non-clinical benefits and obstacles in establishing a national or international AP database. METHODS Comprehensive systematic search of online reference databases. The predetermined inclusion criteria were all papers discussing 1) databases, 2) data mining or 3) MLAs, pertaining to AP, independently assessed by two reviewers with conflicts resolved by a third author. RESULTS Forty-three papers were included. Three data mining technologies and five ANN methodologies were reported in the literature. There were 187 collected variables identified. ANNs increase accuracy of severity prediction, one study showed ANNs had a sensitivity of 0.89 and specificity of 0.96 six hours after admission--compare APACHE II (cutoff score ≥8) with 0.80 and 0.85 respectively. Problems with databases were incomplete data, lack of clinical data, diagnostic reliability and missing clinical data. CONCLUSION This is the first systematic review examining the use of databases, MLAs and ANNs in the management of AP. The clinical benefits these technologies have over current systems and other advantages to adopting them are identified.
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Affiliation(s)
| | - Anubhav Mittal
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Matthew Haydock
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - John Windsor
- Department of Surgery, University of Auckland, Auckland, New Zealand.
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Phang K, Bowman M, Phillips A, Windsor J. Review of thoracic duct anatomical variations and clinical implications. Clin Anat 2013; 27:637-44. [DOI: 10.1002/ca.22337] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Revised: 09/30/2013] [Accepted: 09/30/2013] [Indexed: 11/06/2022]
Affiliation(s)
- K. Phang
- Department of Surgery; School of Medicine; Faculty of Medical and Health Sciences; University of Auckland; Auckland New Zealand
| | - M. Bowman
- Department of Surgery; School of Medicine; Faculty of Medical and Health Sciences; University of Auckland; Auckland New Zealand
| | - A. Phillips
- Department of Surgery; School of Medicine; Faculty of Medical and Health Sciences; University of Auckland; Auckland New Zealand
- School of Biological Science; University of Auckland; Auckland New Zealand
| | - J. Windsor
- Department of Surgery; School of Medicine; Faculty of Medical and Health Sciences; University of Auckland; Auckland New Zealand
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Wang TKM, Oh T, Windsor J, Ramanathan T. Facilitating synchronous operations with video-assisted thoracoscopic lobectomy. Ann Thorac Surg 2013; 96:1912. [PMID: 24182498 DOI: 10.1016/j.athoracsur.2013.05.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 03/28/2013] [Accepted: 05/14/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Tom Kai Ming Wang
- Green Lane Cardiothoracic Surgical Unit, Auckland City Hospital, 2 Grafton Rd, Grafton, Auckland 1023, New Zealand.
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Ashton T, Brown P, Sopina E, Cameron L, Tenbensel T, Windsor J. Sources of satisfaction and dissatisfaction among specialists within the public and private health sectors. N Z Med J 2013; 126:9-19. [PMID: 24157987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM As in many countries, medical and surgical specialists in New Zealand have the opportunity of working in the public sector, the private sector or both. This study aimed to explore the level and sources of satisfaction and dissatisfaction of specialists in New Zealand with working in the two sectors. Such information can assist workforce planning, management and policy and may inform the wider debate about the relationship between the two sectors. METHOD A postal survey was conducted of 1983 registered specialists throughout New Zealand. Respondents were asked to assess 14 sources of satisfaction and 9 sources of dissatisfaction according to a 5-point Likert scale. Means and standard deviations were calculated for the total sample, and for procedural and non-procedural specialties. Differences between the means of each source of satisfaction and dissatisfaction were also calculated. RESULTS Completed surveys were received from 943 specialists (47% response rate). Overall mean levels of satisfaction were higher in the private sector than the public sector while levels of dissatisfaction were lower. While the public system is valued for its opportunities for further education and professional development, key sources of dissatisfaction are workload pressures, mentally demanding work and managerial interference. In the private sector specialists value the opportunity to work independently and apply their own ideas in the workplace. CONCLUSION Sources of job satisfaction and dissatisfaction amongst specialists are different for the public and private sectors. Allowing specialists more freedom to work independently and to apply their own ideas in the workplace may enhance recruitment and retention of specialists in the public health system.
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Affiliation(s)
- Toni Ashton
- School of Population Health, University of Auckland, 261 Morrin Road, Auckland 1142, New Zealand.
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