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Real-world evidence of long-term survival and healthcare resource use in patients with hepatic encephalopathy receiving rifaximin-α treatment: a retrospective observational extension study with long-term follow-up (IMPRESS II) 接受利福昔明-α治疗的肝性脑病患者长期生存和医疗资源使用的真实证据:一项长期随访的回顾性观察性扩展研究(IMPRESS II)
IF 2.6 Q2 Medicine Pub Date : 2024-01-01 DOI: 10.1136/flgastro-2022-102221corr1
BMJ Publishing Group Ltd
Aspinall RJ, Hudson M, Ryder SD, et al . Real-world evidence of long-term survival and healthcare resource use in patients with hepatic encephalopathy receiving rifaximin-α treatment: a retrospective observational extension study with long-term follow-up (IMPRESS II). …
Aspinall RJ, Hudson M, Ryder SD, et al .接受利福昔明-α治疗的肝性脑病患者长期生存和医疗资源使用的现实证据:一项长期随访的回顾性观察性扩展研究(IMPRESS II)。...
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引用次数: 0
UpFront 前方
IF 2.6 Q2 Medicine Pub Date : 2024-01-01 DOI: 10.1136/flgastro-2023-102603
R Mark Beattie
Diverticular disease is common, affecting 70% of the western population by the age of 80. In this issue Williams and colleagues provide a comprehensive overview discussing pathophysiology, classification and management. The incidence is rapidly increasing in younger age groups. Complications include acute diverticulitis, abscess, bleeding and perforation—most complications occur during the primary episode. Chronic symptoms are common and present a significant healthcare burden. The pathophysiology is complex with diet a significant contributory factor—nicely summarised in figure 1. Disease can be asymptomatic or symptomatic and then uncomplicated or complicated with complicated diverticulitis further categorised by the Hinchey and modified Hinchey classifications (figure 2) which guide treatment. The authors discuss preventative and treatment strategies (figure 3) including diet, lifestyle, probiotics and antibiotics (not always indicated) with endoscopic clipping and surgical intervention indicated in a proportion of cases. The review is authoritative, practical and up to date and as such essential reading. (See page 50). Alcohol-related hepatitis is the most florid presentation of alcohol-related liver disease and carries a high short-term and long-term mortality rate. In this issue Shearer and colleagues …
憩室疾病很常见,80 岁以上的西方人中有 70% 都患有这种疾病。在本期杂志中,威廉姆斯及其同事对该病的病理生理学、分类和治疗进行了全面概述。年轻群体的发病率正在迅速上升。并发症包括急性憩室炎、脓肿、出血和穿孔--大多数并发症发生在原发期。慢性症状很常见,给医疗保健带来了沉重负担。病理生理学非常复杂,饮食是一个重要的诱因--如图 1 所示。疾病可以是无症状或有症状的,也可以是无并发症或并发症并发症憩室炎,还可以根据指导治疗的 Hinchey 和改良 Hinchey 分类法进一步分类(图 2)。作者讨论了预防和治疗策略(图 3),包括饮食、生活方式、益生菌和抗生素(并不总是适用),部分病例适用内镜下剪切和手术干预。该综述具有权威性、实用性和时效性,因此是必读书。(见第 50 页)。酒精相关性肝炎是酒精相关性肝病最常见的表现形式,短期和长期死亡率都很高。在本期杂志中,Shearer 及其同事 ...
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引用次数: 0
Creation of an institutional preoperative checklist to support clinical risk assessment in patients with ulcerative colitis (UC) considering ileoanal pouch surgery 创建机构术前核对表,支持对考虑进行回肠肛门袋手术的溃疡性结肠炎(UC)患者进行临床风险评估
IF 2.6 Q2 Medicine Pub Date : 2023-12-16 DOI: 10.1136/flgastro-2023-102503
Bruno Augusto Alves Martins, Amira Shamsiddinova, Manal Mubarak Alquaimi, Guy Worley, Phil Tozer, Kapil Sahnan, Zarah Perry-Woodford, Ailsa Hart, Naila Arebi, Manmeet Matharoo, Janindra Warusavitarne, Omar Faiz
Background Total proctocolectomy with ileal pouch–anal anastomosis (IPAA) is the most established restorative operative approach for patients with ulcerative colitis. It has associated morbidity and the potential for major repercussions on quality of life. As such, patient selection is crucial to its success. The main aim of this paper is to present an institutional preoperative checklist to support clinical risk assessment and patient selection in those considering IPAA. Methods A literature review was performed to identify the risk factors associated with surgical complications, decreased functional outcomes/quality of life, and pouch failure after IPAA. Based on this, a preliminary checklist was devised and modified through an iterative process. This was then evaluated by a consensus group comprising the pouch multidisciplinary team (MDT) core members. Results The final preoperative checklist includes assessment for risk factors such as gender, advanced age, obesity, comorbidities, sphincteric impairment, Crohn’s disease and pelvic radiation therapy. In addition, essential steps in the decision-making process, such as pouch nurse counselling and discussion regarding surgical alternatives, are also included. The last step of the checklist is discussion at a dedicated pouch-MDT. Discussion A preoperative checklist may support clinicians with the selection of patients that are suitable for pouch surgery. It also serves as a useful tool to inform the discussion of cases at the MDT meeting. No data are available.
背景 全直肠结肠切除术与回肠袋-肛门吻合术(IPAA)是治疗溃疡性结肠炎患者最成熟的修复手术方法。它具有相关的发病率和对生活质量造成重大影响的可能性。因此,患者的选择对其成功与否至关重要。本文的主要目的是介绍一份机构术前检查表,以支持临床风险评估和考虑 IPAA 的患者选择。方法 通过文献综述,确定与手术并发症、功能效果/生活质量下降以及 IPAA 术后胃袋失败相关的风险因素。在此基础上,设计了一个初步的检查表,并通过反复过程进行了修改。随后,由胃袋多学科团队(MDT)核心成员组成的共识小组对该清单进行了评估。结果 最终的术前清单包括对性别、高龄、肥胖、合并症、括约肌损伤、克罗恩病和盆腔放疗等风险因素的评估。此外,决策过程中的重要步骤也包括在内,例如肠袋护士咨询和关于手术替代方案的讨论。核对表的最后一步是在专门的 Pouch-MDT 上进行讨论。讨论 术前核对表可以帮助临床医生选择适合进行胃袋手术的患者。它还可以作为一种有用的工具,为在 MDT 会议上讨论病例提供信息。暂无数据。
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引用次数: 0
Guideline review: EASL clinical practice guidelines on the management of liver diseases in pregnancy 指南回顾:EASL 妊娠期肝病管理临床实践指南
IF 2.6 Q2 Medicine Pub Date : 2023-12-12 DOI: 10.1136/flgastro-2023-102550
Ann J Archer, Jennifer Phillips, Robbie Adamson, Francesca Neuberger, Christy Burden, Kushala WM Abeysekera, Andrew J Portal
The recently published European Association for the Study of the Liver (EASL) clinical practice guideline (CPG) on the management of liver diseases in pregnancy encompasses the management of gestational liver diseases as well as acute and chronic liver disease occurring coincidentally in pregnancy. This review will address the latter, given the broad scope of the CPG and the comprehensive Frontline Gastroenterology curriculum review of gestational liver disease.
最近出版的欧洲肝脏研究协会(EASL)妊娠期肝病管理临床实践指南(CPG)涵盖了妊娠期肝病以及妊娠期偶发的急性和慢性肝病的管理。鉴于 CPG 的广泛范围以及《消化内科前线》课程对妊娠期肝病的全面回顾,本综述将讨论后者。
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引用次数: 0
Colonoscopic cancer detection rate: a new performance measure – is it FIT for purpose? 结肠镜癌症检出率:新的绩效衡量标准--是否符合目的?
IF 2.6 Q2 Medicine Pub Date : 2023-12-09 DOI: 10.1136/flgastro-2023-102555
Khalid Bashir, Iosif Beintaris, Linda Sharp, Julia Newton, Katherine Elliott, Jon Rees, Peter Rogers, Matt Rutter
Introduction Gastrointestinal symptoms correlate poorly with cancer diagnosis. A faecal immunochemical test (FIT) result of ≥10 µg has high sensitivity and negative predictive value for colorectal cancer (CRC) detection. An FIT-based diagnostic pathway may lead to more effective resource utilisation. We aimed to use National Endoscopy Database (NED) data to create a new colonoscopy performance measure, cancer detection rate (CDR) to assess the appropriate identification of target populations for colonoscopy; then to use CDR to assess the impact of implementing an FIT-based referral pathway locally. Methods NED data were analysed to compare local diagnostic colonoscopic CDR in 2019 (prepathway revision) and 2021 (postpathway revision), benchmarked against overall national CDR for the same time frames. Results 1, 123, 624 NED diagnostic colonoscopies were analysed. Locally, there was a significant increase in CDR between 2019 and 2021, from 3.01% (2.45%–3.47%) to 4.32% (3.69%–4.95%), p=0.003. The CDR increase was due to both a 10% increase in the number of CRCs detected and a 25% reduction in the number of diagnostic colonoscopies performed. Nationally, there was a smaller, but significant, increase in CDR from 2.02% (1.99%–2.07%) to 2.33% (2.29%–2.37%), p<0.001. The rate of increase in CDR% between 2019 and 2021 was significantly different locally compared with nationally. Conclusion Our study indicates that the introduction of a robustly vetted FIT-based algorithm to determine whether diagnostic colonoscopy is required, is effective in increasing the colonoscopic CDR. Moreover, CDR appears to be a meaningful performance metric that can be automatically calculated through NED, enabling monitoring of the quality of referral and vetting pathways. All data relevant to the study are included in the article or uploaded as online supplemental information.
导言 胃肠道症状与癌症诊断的相关性很低。粪便免疫化学检验(FIT)结果≥10 µg对大肠癌(CRC)的检测具有较高的灵敏度和阴性预测值。基于粪便免疫化学检验的诊断路径可提高资源利用效率。我们旨在利用国家内镜数据库(NED)数据创建一个新的结肠镜检查绩效指标--癌症检出率(CDR),以评估结肠镜检查目标人群的适当识别;然后利用CDR评估在当地实施基于FIT的转诊途径的影响。方法 对 NED 数据进行分析,比较 2019 年(路径修订前)和 2021 年(路径修订后)的地方结肠镜诊断 CDR,并与相同时间段内的全国总体 CDR 进行比较。结果 分析了 1 123 624 例非急诊结肠镜诊断。从本地来看,2019 年至 2021 年的 CDR 有了显著增长,从 3.01% (2.45%-3.47%) 增长到 4.32% (3.69%-4.95%),P=0.003。CDR增加的原因是检测出的CRC数量增加了10%,而进行的诊断性结肠镜检查数量减少了25%。在全国范围内,CDR 的增幅较小,但也很显著,从 2.02% (1.99%-2.07%) 增至 2.33% (2.29%-2.37%),P<0.001。2019 年至 2021 年期间,当地 CDR% 的增长率与全国相比有显著差异。结论 我们的研究表明,采用经过严格审核的基于 FIT 的算法来确定是否需要进行诊断性结肠镜检查,能有效提高结肠镜检查 CDR。此外,CDR 似乎是一个有意义的绩效指标,可以通过 NED 自动计算,从而监控转诊和审核路径的质量。该研究的所有相关数据均包含在文章中或作为在线补充信息上传。
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引用次数: 0
FIT negative clinic as a safety net for low-risk patients with colorectal cancer: impact on endoscopy and radiology utilisation–a retrospective cohort study FIT 阴性门诊作为低风险结直肠癌患者的安全网:对内镜检查和放射科利用率的影响--一项回顾性队列研究
IF 2.6 Q2 Medicine Pub Date : 2023-12-09 DOI: 10.1136/flgastro-2023-102515
Gaurav B Nigam, Laween Meran, Ishita Bhatnagar, Sarah Evans, Reem Malik, Nicole Cianci, Julia Pakpoor, Charis Manganis, Brian Shine, Tim James, Brian D Nicholson, James E East, Rebecca M Palmer
Background Faecal immunochemical testing (FIT) is recommended by the National Institute for Health and Care Excellence to triage symptomatic primary care patients who have unexplained symptoms but do not meet the criteria for a suspected lower gastrointestinal cancer pathway. During the COVID-19 pandemic, FIT was used to triage patients referred with urgent 2-week wait (2ww) cancer referrals instead of a direct-to-test strategy. FIT-negative patients were assessed and safety netted in a FIT negative clinic. Methods We reviewed case notes for 622 patients referred on a 2ww pathway and seen in a FIT negative clinic between June 2020 and April 2021 in a tertiary care hospital. We collected information on demographics, indication for referral, dates for referral, clinic visit, investigations and long-term outcomes. Results The average age of the patients was 71.5 years with 54% female, and a median follow-up of 2.5 years. Indications for referrals included: anaemia (11%), iron deficiency (24%), weight loss (9%), bleeding per rectum (5%) and change in bowel habits (61%). Of the cases, 28% (95% CI 24% to 31%) had endoscopic (15%, 95% CI 12% to 18%) and/or radiological (20%, 95% CI 17% to 23%) investigations requested after clinic review, and among those investigated, malignancy rate was 1.7%, with rectosigmoid neuroendocrine tumour, oesophageal cancer and lung adenocarcinoma. Conclusion A FIT negative clinic provides a safety net for patients with unexplained symptoms but low risk of colorectal cancer. These real-world data demonstrate significantly reduced demand on endoscopy and radiology services for FIT-negative patients referred via the 2ww pathway. Data are available upon reasonable request.
背景 国家健康与护理优化研究所(National Institute for Health and Care Excellence)建议使用粪便免疫化学检验(FIT)对有不明症状但不符合疑似下消化道癌症路径标准的无症状初级保健患者进行分流。在 COVID-19 大流行期间,FIT 被用于对紧急转诊的 2 周等待(2ww)癌症患者进行分流,而不是采用直接检测策略。对 FIT 阴性患者进行评估,并在 FIT 阴性诊所进行安全防护。方法 我们回顾了一家三甲医院在 2020 年 6 月至 2021 年 4 月期间通过 2 周等待途径转诊并在 FIT 阴性门诊就诊的 622 名患者的病例记录。我们收集了有关人口统计学、转诊指征、转诊日期、门诊就诊、检查和长期结果的信息。结果 患者平均年龄为 71.5 岁,54% 为女性,中位随访时间为 2.5 年。转诊原因包括:贫血(11%)、缺铁(24%)、体重减轻(9%)、直肠出血(5%)和排便习惯改变(61%)。在这些病例中,28%(95% CI 24% 至 31%)在门诊复查后要求进行内窥镜检查(15%,95% CI 12% 至 18%)和/或放射学检查(20%,95% CI 17% 至 23%),其中恶性肿瘤的发生率为 1.7%,包括直肠乙状结肠神经内分泌肿瘤、食道癌和肺腺癌。结论 FIT 阴性诊所为症状不明但罹患结直肠癌风险较低的患者提供了一个安全网。这些实际数据表明,通过 2ww 途径转诊的 FIT 阴性患者对内镜检查和放射科服务的需求明显减少。如有合理要求,可提供相关数据。
{"title":"FIT negative clinic as a safety net for low-risk patients with colorectal cancer: impact on endoscopy and radiology utilisation–a retrospective cohort study","authors":"Gaurav B Nigam, Laween Meran, Ishita Bhatnagar, Sarah Evans, Reem Malik, Nicole Cianci, Julia Pakpoor, Charis Manganis, Brian Shine, Tim James, Brian D Nicholson, James E East, Rebecca M Palmer","doi":"10.1136/flgastro-2023-102515","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102515","url":null,"abstract":"Background Faecal immunochemical testing (FIT) is recommended by the National Institute for Health and Care Excellence to triage symptomatic primary care patients who have unexplained symptoms but do not meet the criteria for a suspected lower gastrointestinal cancer pathway. During the COVID-19 pandemic, FIT was used to triage patients referred with urgent 2-week wait (2ww) cancer referrals instead of a direct-to-test strategy. FIT-negative patients were assessed and safety netted in a FIT negative clinic. Methods We reviewed case notes for 622 patients referred on a 2ww pathway and seen in a FIT negative clinic between June 2020 and April 2021 in a tertiary care hospital. We collected information on demographics, indication for referral, dates for referral, clinic visit, investigations and long-term outcomes. Results The average age of the patients was 71.5 years with 54% female, and a median follow-up of 2.5 years. Indications for referrals included: anaemia (11%), iron deficiency (24%), weight loss (9%), bleeding per rectum (5%) and change in bowel habits (61%). Of the cases, 28% (95% CI 24% to 31%) had endoscopic (15%, 95% CI 12% to 18%) and/or radiological (20%, 95% CI 17% to 23%) investigations requested after clinic review, and among those investigated, malignancy rate was 1.7%, with rectosigmoid neuroendocrine tumour, oesophageal cancer and lung adenocarcinoma. Conclusion A FIT negative clinic provides a safety net for patients with unexplained symptoms but low risk of colorectal cancer. These real-world data demonstrate significantly reduced demand on endoscopy and radiology services for FIT-negative patients referred via the 2ww pathway. Data are available upon reasonable request.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2023-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138561032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Outcome of long-term biliary stenting for stones in the 2010s: beware the cholecystectomised! 2010年代长期胆道支架置入术治疗结石的结果:小心胆囊切除!
IF 2.6 Q2 Medicine Pub Date : 2023-11-29 DOI: 10.1136/flgastro-2023-102461
Jamal Ahmed, Priyanka Prakash, Gney Mehta, Tessa M Davies, Yin Yin Lim, Nicholas D Cross, Marek Alexander Czajkowski, Miles Clifford Allison
Objective Endoscopic retrograde cholangiopancreatography (ERCP) is the mainstay of management for most patients with common bile duct stones (CBDS). Duct clearance at initial ERCP may not be achieved in a third of patients, many of whom may be elderly with multiple comorbidities rendering them at potentially high risk for further procedures. We aimed to quantify the rate of biliary sequelae and mortality among a large cohort undergoing a single ERCP with sphincterotomy and stent insertion without having undergone complete ductal clearance (permanent stent insertion, PSI), and to examine factors that may predispose to adverse outcomes. Design/method Outcomes of all ERCPs undertaken on the intact papilla between February 2010 and January 2020 were distilled to identify a cohort who had undergone PSI for initially irretrievable CBDS. These were subjected to retrospective follow-up until the development of biliary sequelae, death or survival into 2023. Results There were 2175 index ERCPs for CBDS, of whom 114 met the PSI criteria. Eleven did not survive their index hospitalisation, leaving 103 for follow-up. Of these, 25 (24%) developed late biliary sequelae, 19 (18%) required at least one further ERCP and 8 (8%) died from biliary sequelae. Adverse outcomes were found to be more common among those who had undergone cholecystectomy prior to ERCP, and those with periampullary diverticula. Conclusions Long-term biliary stenting following sphincterotomy remains a valid option for selected patients with initially irretrievable bile duct stones who could be at high risk from repeat procedures. Data are available upon reasonable request.
目的内镜逆行胆管造影(ERCP)是治疗胆总管结石(CBDS)的主要方法。三分之一的患者在初始ERCP时可能无法获得导管清除,其中许多患者可能是患有多种合并症的老年人,这使得他们在进一步手术时具有潜在的高风险。我们的目的是量化在没有进行完全导管清除(永久性支架置入,PSI)的情况下,接受单次ERCP合并括约肌切开术和支架置入的大队列患者的胆道后遗症和死亡率,并检查可能导致不良结果的因素。设计/方法对2010年2月至2020年1月期间在完整乳头上进行的所有ercp的结果进行分析,以确定一组因最初不可恢复性CBDS而接受PSI的患者。这些患者将接受回顾性随访,直到出现胆道后遗症、死亡或存活至2023年。结果CBDS有2175个ercp指标,其中114个符合PSI标准。11名患者未能在第一次住院治疗中存活,103名患者需要随访。其中,25例(24%)发展为晚期胆道后遗症,19例(18%)需要至少一次ERCP治疗,8例(8%)死于胆道后遗症。不良结果在ERCP前接受胆囊切除术的患者和壶腹周围憩室患者中更为常见。结论:对于最初无法治愈的胆管结石患者,重复手术的风险较高,括约肌切开术后长期胆管支架置入术仍然是一种有效的选择。如有合理要求,可提供资料。
{"title":"Outcome of long-term biliary stenting for stones in the 2010s: beware the cholecystectomised!","authors":"Jamal Ahmed, Priyanka Prakash, Gney Mehta, Tessa M Davies, Yin Yin Lim, Nicholas D Cross, Marek Alexander Czajkowski, Miles Clifford Allison","doi":"10.1136/flgastro-2023-102461","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102461","url":null,"abstract":"Objective Endoscopic retrograde cholangiopancreatography (ERCP) is the mainstay of management for most patients with common bile duct stones (CBDS). Duct clearance at initial ERCP may not be achieved in a third of patients, many of whom may be elderly with multiple comorbidities rendering them at potentially high risk for further procedures. We aimed to quantify the rate of biliary sequelae and mortality among a large cohort undergoing a single ERCP with sphincterotomy and stent insertion without having undergone complete ductal clearance (permanent stent insertion, PSI), and to examine factors that may predispose to adverse outcomes. Design/method Outcomes of all ERCPs undertaken on the intact papilla between February 2010 and January 2020 were distilled to identify a cohort who had undergone PSI for initially irretrievable CBDS. These were subjected to retrospective follow-up until the development of biliary sequelae, death or survival into 2023. Results There were 2175 index ERCPs for CBDS, of whom 114 met the PSI criteria. Eleven did not survive their index hospitalisation, leaving 103 for follow-up. Of these, 25 (24%) developed late biliary sequelae, 19 (18%) required at least one further ERCP and 8 (8%) died from biliary sequelae. Adverse outcomes were found to be more common among those who had undergone cholecystectomy prior to ERCP, and those with periampullary diverticula. Conclusions Long-term biliary stenting following sphincterotomy remains a valid option for selected patients with initially irretrievable bile duct stones who could be at high risk from repeat procedures. Data are available upon reasonable request.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138520427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Infection control and environmental sustainability: focus on practice 感染控制和环境可持续性:注重实践
IF 2.6 Q2 Medicine Pub Date : 2023-11-23 DOI: 10.1136/flgastro-2023-102475
Helen Griffiths
Endoscopy is known to be a high generator of waste in healthcare. It also poses an infection risk to patients, both from their own endogenous flora and from exogenous micro-organisms. Increases in infection, as seen during the pandemic, result in increased use of single-use equipment, personal protective equipment, packaging and harmful chemicals. With the significant risk of a further pandemic within the next 5 years, both climate change and the risk of infections should be considered as health emergencies, as they create a revolving door scenario. This article reviews some of the endoscopic and non-endoscopic infection risks and practical ways in which we can improve our environmental footprint while maintaining infection prevention and control.
内窥镜检查被认为是医疗保健中产生大量废物的原因。它也对患者造成感染风险,既来自患者自身的内源性菌群,也来自外源性微生物。如大流行期间所见,感染的增加导致一次性设备、个人防护设备、包装和有害化学品的使用增加。由于未来5年内有进一步大流行的重大风险,气候变化和感染风险都应被视为突发卫生事件,因为它们造成了一种旋转门情景。本文综述了一些内窥镜和非内窥镜感染风险,以及我们在保持感染预防和控制的同时改善环境足迹的实用方法。
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引用次数: 0
Nutritional assessment of patients with cirrhosis in the South West requires improvement: results of the Evaluation of NutRItion in CirrHosis (ENRICH) Study 西南地区肝硬化患者的营养评估需要改进:肝硬化营养评估(ENRICH)研究结果
IF 2.6 Q2 Medicine Pub Date : 2023-11-22 DOI: 10.1136/flgastro-2023-102566
Keith Pohl, Ashwin Dhanda
Malnutrition is a concern for all inpatients; however, those with cirrhosis are particularly at risk. Current guidelines recommend standardised nutritional assessment of all inpatients with advanced chronic liver disease (eg, Malnutrition Universal Screening Tool (MUST)) followed by specialist dietician review within 24 hours to commence nutritional support.1 Such nutritional optimisation has been shown to improve symptoms, quality of life, morbidity and mortality.2 Severn and Peninsula Research in Gastroenterology is a trainee research network. The Evaluation of NutRItion in CirrHosis is a trainee-led retrospective regional service evaluation of dietetic provision to inpatients with cirrhosis in the South West of England against current guidelines from the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver.1 3 The aim was to evaluate the nutritional management of inpatients with cirrhosis to inform improvements in current services. The objectives were to determine the proportion of inpatients receiving nutritional assessment, referral to dietetics and/or the proportion appropriately commenced on nutritional support. Data was collected from admissions in …
营养不良是所有住院病人都关心的问题;然而,肝硬化患者的风险尤其大。目前的指南建议对所有晚期慢性肝病住院患者进行标准化的营养评估(例如,营养不良普遍筛查工具(MUST)),然后在24小时内进行专家营养师审查,以开始营养支持这种营养优化已被证明可以改善症状、生活质量、发病率和死亡率塞文和半岛胃肠病学研究是一个实习研究网络。肝硬化营养评估是一项由实习生主导的回顾性区域服务评估,根据美国肝病研究协会和欧洲肝脏研究协会的现行指南,对英格兰西南部肝硬化住院患者的饮食提供进行评估。目的是评估肝硬化住院患者的营养管理,以改善当前的服务。目的是确定接受营养评估的住院患者的比例,转介到营养学和/或适当开始营养支持的比例。数据收集自……
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引用次数: 0
Challenges of developing a green gastroenterology evidence base and how trainee research networks can fill the gaps 发展绿色胃肠病学证据基础的挑战以及实习生研究网络如何填补空白
IF 2.6 Q2 Medicine Pub Date : 2023-11-22 DOI: 10.1136/flgastro-2023-102497
Oliver Tavabie, Jennifer Clough, Jonathan King, Victoria Nicholas, Aditi Kumar
Trainee research networks are a collaborative effort to enable high-quality multicentre audits or research that is more widely accessible to trainees. Such networks lead, design and deliver research at a far higher scale than could be achieved locally and are carried out solely by trainees. There is an increasing focus on delivering research that is not only environmentally sustainable but also focuses on areas that can reduce the carbon footprint of service provision in gastroenterology and hepatology. In this manuscript, we performed a scoping review to understand the current evidence base of the impact of gastroenterology and hepatology services on the environment as well as exploring any association between pollution and climate change with gastrointestinal and liver disease. We further discuss the barriers that researchers face in delivering environmentally sustainable research, the limitation in clinical guidelines related to practicing environmentally sustainable gastroenterology and hepatology and how the trainee research networks are ideally placed to initiate change by developing, disseminating and implementing best practice in ‘green Gastroenterology’.
学员研究网络是一项协作努力,使学员能够更广泛地获得高质量的多中心审计或研究。这样的网络领导、设计和提供的研究规模远远超过了在当地可以实现的规模,而且完全由学员进行。人们越来越关注提供的研究不仅是环境可持续的,而且还关注可以减少胃肠病学和肝病学服务提供的碳足迹的领域。在这篇文章中,我们进行了一项范围综述,以了解目前胃肠病学和肝病学服务对环境影响的证据基础,并探索污染和气候变化与胃肠和肝脏疾病之间的关系。我们进一步讨论了研究人员在提供环境可持续研究方面面临的障碍,与实践环境可持续胃肠病学和肝病学相关的临床指南的局限性,以及实习生研究网络如何通过发展,传播和实施“绿色胃肠病学”的最佳实践来发起变革。
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引用次数: 0
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