Comparative Evaluation of Harmless Acute Pancreatitis Score (HAPS) and Bedside Index of Severity in Acute Pancreatitis (BISAP) Scoring System in the Stratification of Prognosis in Acute Pancreatitis

Acute pancreatitis is a common disease in patients presenting to the emergency room in any hospital. The most common causes are alcohol ingestion and gallstone disease. Diagnosis is usually based on clinical findings and elevated serum amylase and lipase levels. Imaging is often not necessary but may be used to confirm the diagnosis or rule out any other pathology or to evaluate for any complications. The majority of patients will have a mild, self-limiting disease but others may develop a severe fulminant course with organ failure. These patients are at high risk of developing complications, morbidity or mortality. Treatment of acute pancreatitis includes supportive treatment with antibiotics, fluids, analgesics and early enteral feeding. Several scores have been developed to predict the course of pancreatitis and help make informed decisions, monitoring and timely intervention. The majority of them are complicated, require extensive and expensive interventions or require time. Harmless acute pancreatitis score (HAPS) is one such score that is easy to calculate and is done at the time of admission, bedside index of severity in acute pancreatitis (BISAP) is another one requiring more parameters. The parameters used to calculate it are easily available and can be done at a majority of healthcare facilities in developing countries. HAPS thus seems to be a good option in aiding doctors in assessing acute pancreatitis. It may be considered as a standard scoring for acute pancreatitis for early and effective management. We have tried to study and compare the superiority of HAPS over BISAP in predicting prognosis in acute pancreatitis.

Improved clinical investigation and evaluation of high-risk medical devices: the rationale and objectives of CORE-MD (Coordinating Research and Evidence for Medical Devices)

In the European Union (EU), the delivery of health services is a national responsibility but there are concerted actions between member states to protect public health. Approval of pharmaceutical products is the responsibility of the European Medicines Agency, while authorising the placing on the market of medical devices is decentralised to independent ‘conformity assessment’ organisations called notified bodies. The first legal basis for an EU system of evaluating medical devices and approving their market access was the Medical Device Directive, from the 1990s. Uncertainties about clinical evidence requirements, among other reasons, led to the EU Medical Device Regulation (2017/745) that has applied since May 2021. It provides general principles for clinical investigations but few methodological details – which challenges responsible authorities to set appropriate balances between regulation and innovation, pre- and post-market studies, and clinical trials and real-world evidence. Scientific experts should advise on methods and standards for assessing and approving new high-risk devices, and safety, efficacy, and transparency of evidence should be paramount. The European Commission recently awarded a Horizon 2020 grant to a consortium led by the European Society of Cardiology and the European Federation of National Associations of Orthopaedics and Traumatology, that will review methodologies of clinical investigations, advise on study designs, and develop recommendations for aggregating clinical data from registries and other real-world sources. The CORE–MD project (Coordinating Research and Evidence for Medical Devices) will run until March 2024. Here, we describe how it may contribute to the development of regulatory science in Europe.

Cite this article: EFORT Open Rev 2021;6:839-849. DOI: 10.1302/2058-5241.6.210081

Measuring peak expiratory flow rate: what the nurse needs to know

Rationale and key points This article provides information on monitoring a patient's peak expiratory flow rate. It explains the rationale for measuring the peak expiratory flow rate, provides guidance for nurses to undertake this investigation and offers advice on how to instruct patients in the use of this technique. » Measuring the peak expiratory flow rate is an inexpensive, straightforward and useful clinical investigation that enables fluctuations in the patient's respiratory effort to be monitored over time. » The peak expiratory flow rate is used for the diagnosis, monitoring and assessment of the severity of respiratory compromise, particularly in patients with asthma. » The nurse can enable significant improvements in patient care by providing patient education on the correct technique, and by accurate assessment and recording of the peak expiratory flow rate. » The nurse should advise the patient on the action required if variation between readings occurs, where the patient is required to monitor their condition at home.

Serological and Pathogenic Analyses of Fowl Adenovirus Serotype 4 (FAdV-4) Strain in Muscovy Ducks

Hydropericardium hepatitis syndrome (HHS) is a lethal disease caused by Fowl adenovirus serotype 4(FAdV-4) that mainly infects 3- to 6-week-old broiler chicks. In 2015, an infectious disease characterized similar symptom to HHS in broilers outbroke in commercial duck flocks in Shandong province. FAdV-4 was isolated from naturally infected ducks and determined by polymerase chain reaction (PCR) amplification and DNA sequence analysis. In order to investigate the effect of FAdV-4 infection on muscovy ducks, we determined and characterized the FAdV-4 Isolate, and assessed its pathogenicity. In this study, HHS was respectively reproduced in 5-week-old muscovy duck by intramuscular injection and intranasal inoculation of allantoic fluid containing FAdV-4, ducks in the negative control group were inoculated with allantoic fluids of healthy duck embryos in the same manner. Clinical symptoms, gross and microscopic lesions, cytokines and antibodies, blood biochemical indices were detected and recorded for 12 days after infection. Typical hydropericardium and hepatitis was observed in experimental muscovy duck in the 3rd day post-inoculation (dpi). FAdV-4 can be replicated in tissues and cause pathological damage, especially in the liver and immune organs. Most of the immune-related cytokines and antibodies levels are up-regulated and then decreased, which may be caused by the initial infection and the normal immune response, later the virus caused the immunosuppression and led to the decrease of levels. To the best of our knowledge, this is the first systematic trial of the pathogenicity of FAdV-4 in muscovy ducks mainly based on the serological test, which will provide new insights into the study of the disease.

X-rays: what the nurse needs to know

Rationale and key points X-ray imaging is a form of electromagnetic radiation that is able to pass through the human body producing an image of the internal structures. X-rays are one of the main investigations for confirming a suspected diagnosis. Developing an understanding of the underlying mechanism and the rationale for requesting an X-ray will increase nurses' understanding of the process and enable improved patient preparation through explanation and reassurance. This article provides an overview of the fundamental principles underlying the process of obtaining an X-ray. » X-ray imaging is a common diagnostic tool that nurses will encounter on a regular basis. » Several factors affect the production of a clear X-ray image, including patient movement. » Radiation safety and avoidance of unnecessary exposure are paramount. » Co-operation and communication by the multidisciplinary team are vital to ensure that X-ray imaging can be requested, performed, interpreted and acted on, and the findings communicated to the patient.

Brain natriuretic peptide: what the nurse needs to know

Rationale and key points Brain natriuretic peptide is a chemical secreted when the heart is under strain. It is sampled by a blood test. This article informs nurses about how brain natriuretic peptide can be used as a diagnostic and prognostic marker for patients with cardiac conditions. » A brain natriuretic peptide level within the normal range in a patient who is not receiving treatment, almost certainly rules out a significant cardiac condition. » An elevated brain natriuretic peptide level suggests an active cardiac condition and further investigations are indicated, usually an electrocardiogram and echocardiogram. » A highly elevated brain natriuretic peptide level is a marker for a more severe prognosis.

Sputum collection and analysis: what the nurse needs to know

Rationale and key points Sputum is the term used to describe mucus that has been expectorated. It consists of secretions and other matter that has been coughed up from the lungs and large airways. This article informs nurses about how and why sputum collection and analysis are undertaken. » Sputum is always considered abnormal, because healthy people swallow bronchial secretions. » Sputum analysis is important, because it enables diagnosis of conditions such as pneumonia, tuberculosis, lung abscess and lung cancer. » The nurse should record the colour, amount and consistency of the sputum collected. They should send the specimen to the laboratory for analysis without delay to ensure accurate results.

Development of Clinical Pharmacology in the Russian Federation

PURPOSE

The article aims to provide the history, organization, and approaches to clinical pharmacology in the Russian Federation.

METHODS

This article is based on major international and Russian documents, along with groundbreaking historical facts and scientific articles related to the development of modern clinical pharmacology the Russian Federation.

FINDINGS

Improving the quality of drug therapy is the main goal of clinical pharmacology in the Russian Federation. Decisions of the World Health Organization, scientific achievements, and the work of well-known scientists among the world community and in the Russian Federation have strongly influenced the development of clinical pharmacology the Russian Federation. Clinical pharmacology in the Russian Federation addresses a wide range of problems; it actively engages in modern scientific research, education; and clinical practice. Clinical pharmacologists participate in studies of new drugs and often have a specific area of expertise.

IMPLICATIONS

The future development of clinical pharmacology in the Russian Federation will be related to improvements in training, refinement of the framework that regulates clinical pharmacologists, and the creation of clinical pharmacology laboratories with modern equipment.

Understanding clinical investigations in children's endocrinology

Children and young people referred to paediatric endocrinology services present with a wide range of illnesses and disorders varying from minor to life-threatening conditions. This article introduces the role of the children's endocrine nurse in caring for children and families undergoing investigations that are frequently undertaken to identify specific problems associated with pituitary, adrenal and thyroid glands. Although children with endocrine problems may be cared for in specialist centres, they may also present, for other health reasons, in secondary and primary care. In schools some children may need teachers to administer emergency medication. There is a high incidence of children diagnosed with growth hormone deficiency and an even higher incidence of congenital hypothyroidism. These children would benefit from health professionals having a broader understanding of their conditions. This article--the third in the endocrinology nursing series--aims to disseminate information and educate colleagues in children's nursing to raise the profile of children with long-term endocrine conditions.