bluuebunny/crossref_metadata_2025_split huggingface dataset:
Next steps for student supervision and assessment
Authors: Heath Shaun 
Published: October 2019

Student nurses are the future of the profession. Shaun Heath explains how changes to the Nursing and Midwifery Council's education standards will effect those currently acting as mentors and how all practice nurses can get involved and contribute to student placement experiencesThis article explores the Nursing and Midwifery Council's 2018 education standards and how these will affect the role of general practice nurses in primary care settings. The differing roles found in the standards will be discussed, alongside how primary care and the emerging Primary Care Networks can support learners in general practice through communities of practice.
KONDISI PLANKTON PADA TAMBAK UDANG WINDU (Penaeus monodon FABRICIUS) DENGAN SUBSTRAT BERBEDA
Authors: Hendrajat Erfan Andi , Sahrijanna Andi 
Published: October 2019

Plankton is one of water microorganisms that plays an important role as natural food for fish and shrimp and as an stability indicator of water or aquatic environment.The purpose of this study was to determine the composition and abundance of plankton in tiger shrimp ponds using concrete ponds without substrate, concrete ponds using sand substrate and ponds. Sampling of plankton and water quality was carried out from March to July 2016 at PunagaTakalar Experimental Pond at 6 ponds consisted of concrete ponds without 2 subplot of sand (pond A) and concrete pond with 2 subplate sand subplate (pond B) respectively measuring 1,000 m2 and a 2-square-meter plot of 2,500–3,000 m2 (pond C). The results showed that plankton abundance in pond A ranged from 37–349 individuals/L, pond B ranged from 35–1,399 individuals/L and pond C ranged from 54–999 individuals/L. The most common phytoplankton genera in this study was Oscillatoria while for zooplankton is of Acartia. The diversity of plankton in ponds A, B and C is included in the community of unstable to moderate biota. In general, the diversity of plankton in pond B is included in the community of moderate biota. The plankton uniformity index in pond A, pond B and pond C is generally close to 1 this indicates that the existence of plankton species in the three ponds is relatively even.
PERSPEKTIF GENDER SUKU OSING DI BANYUWANGI DALAM PENILAIAN KEMANFAATAN TANAMAN
Authors: Prasetyo Budi , Chikmawati Tatik , Walujo Eko Baroto , Zuhud Ervizal A.M 
Published: October 2019

The different roles and responsibilities of male and female of the Osing tribe influence the knowledge of the use of plants. The aims of research is to analyze the values of the benefits of plants based on gender perception. The research used a qualitative and quantitative methods. Data collection for the value of plant species utilization were carried out using Pebble Distribution Method (PDM) and analysis used Index of Cultural Significance (ICS). The Osing community recognised 86 plant species that were grouped in to eight beneficial groups. The male in three villages have a better understanding of ethnobotanical knowledge and practice than female on crops as staple foods, medicines, fruits, and firewood, while understanding of ornamental plants are relatively the same for both male and female. Female have a broader and more detailed understanding on vegetables, plant species used as building construction, and traditional rituals. The high PDM value in eight beneficial groups was supported by the high value of each ICS.
3 Comparison of Normal Saline and Plasmalyte in the Management of Acute Pancreatitis
Authors: Iqbal Umair , Makar Michael , Shah Ruchit N. , Berger Andrea , Khara Harshit S. 
Published: October 2019

INTRODUCTION:
Acute pancreatitis (AP) is one of the most common causes of hospitalization in the United States. Intravenous (IV) hydration with normal saline (NS) is the most commonly used fluid for resuscitation. Recent studies have shown better outcomes with use of more pH balanced fluid like ringer's lactate and Plasmalyte (PL). We conducted a retrospective review to evaluate differences in outcomes of AP in patients who received NS compared to PL.

METHODS:
All patients >18 years of age admitted to our hospital with the diagnosis of AP from November 2016 to October 2018. Primary outcomes were persistent SIRS at 48 hours and mortality. Secondary outcomes were readmission within 30 days and length of stay (LOS). Categorical characteristics of NS and PL patients were compared using Pearson's chi-square or Fisher's exact tests and continuous ones were compared using Student's t-tests or Wilcoxon rank-sum tests. Odds ratios (OR) and their 95% confidence intervals (CI) were estimated using a multivariable logistic regression model for 30 days readmission. The model adjusted for age, sex, SIRS at 48 hours, and LOS. A multivariable linear regression model on a natural log transformation of LOS was used to estimate the effect of fluid type on LOS for NS and PL patients. Statistical analysis was conducted using SAS 9.4.

RESULTS:
343 patients met our inclusion criteria. 192 patients received NS and 151 received PL for IV hydration. There were no differences in the baseline demographics including age, sex, BMI and comorbidities as calculated by Charlson comorbidity index. Persistent SIRS at 48 hours was significantly higher in patients who received NS compared to PL (26.8% vs 7.7%; P = <0.0001). LOS was significantly higher in patients who received NS (4.7 days vs 3.7 days, P = 0.0039). 30 days readmission was also significantly higher in NS group (22.8% vs 12.8%; P = 0.0195). Mortality although trended lower in PL group, was not significantly different (7.3% NS group vs 2.6% PL group, P = 0.0556). In multivariable analysis use of PL is associated with lower odds of 30 days readmission [OR = 0.515 (CI: 0.280–0.950); P = 0.0338] and shorter LOS [%decrease = 16.6% (CI: −26.4%, −5.5%); P = 0.0045].

CONCLUSION:
Our study revealed that use of PL in AP is associated with lower rate of persistent SIRS at 48 hours, shorter LOS, and 30 days readmission rate. Larger randomized controlled trials are needed to further strengthen the association of PL for outcomes in AP.
4 Optimizing Inpatient Management of Acute Pancreatitis: A Single Center Quality Improvement Project
Authors: Koul Abhinav , Mills Ashley , Singh Sital , Johl Hershan , Zhang Hao , La Force Jessica , Tejaswi Sooraj 
Published: October 2019

INTRODUCTION:
The management of acute pancreatitis has evolved over the last decade with emphasis on early adequate fluid resuscitation, early nutrition, and cholecystectomy prior to hospital discharge in gallstone pancreatitis. Adherence to these metrics reduces mortality, hospital length of stay (LOS), and overall healthcare utilization. We evaluated our institution's current performance and subsequently devised a strategy to improve adherence to quality metrics.

METHODS:
Patients hospitalized with acute pancreatitis between January, 2017 and October, 2018 were reviewed. Patient demographics, etiology and severity of pancreatitis, rate and type of IV fluid resuscitation, time to initiating nutrition, hospital LOS, ICU LOS, and hospital re-admission rates were examined. An EMR order set for inpatient management of acute pancreatitis was then designed and launched in December, 2018. Follow up data was collected until May, 2019.

RESULTS:
Our baseline data included 240 hospitalizations for acute pancreatitis of varying etiologies (Figure 1) and severity (Figure 2). The average patient age was 54.3 years and the average BMI was 28.3 (Figure 3). The mean hospital LOS was 6 days. ICU care was needed in 17% of cases. Mean ICU LOS was 4 days. The 30-day hospital re-admission rate was 14%. Adequate IV fluid resuscitation was given in only 25% of cases, with 20% receiving Lactated Ringer's (LR) solution. The average time to starting nutrition was 3 days. Cholecystectomy was performed prior to hospital discharge in 87% of mild gallstone pancreatitis cases. After launch, the EMR order set was used in 19 of 70 hospitalizations for acute pancreatitis (usage rate 27%). Among these patients, 79% received adequate fluid resuscitation, with 84% receiving LR. The average time to starting nutrition was 1.4 days. The mean hospital LOS was 4.4 days. No patients required ICU level care.

CONCLUSION:
Our baseline data revealed non-adherence to guideline recommendations of adequate fluid resuscitation with LR and early enteral feeding. By designing a customized EMR order set, we improved adequate fluid resuscitation from 25% to 79%, while reducing time to nutrition from 3 days to 1.4 days. Our average hospital LOS decreased from 6 days to 4.4 days, below the national average of 4.7 days. The advent of our EMR order set for acute pancreatitis has helped standardize management and improve outcomes thus far. Further work is needed to increase EMR order set utilization and continue data collection on patient outcomes.
6 A Novel EUS-Guided Intratumoral Delivery of Submicron Particle Paclitaxel (SPP) for the Treatment of Locally Advanced Pancreatic Cancer (LA-PAC): A Prospective Safety, Tolerability and Preliminary Efficiency Study
Authors: Lo Simon , Hendifar Andrew , Sharma Neil , Othman Mohamed , Mendoza-Ladd Antonio , Verco Shelagh , Verco James , diZerega Gere 
Published: October 2019

INTRODUCTION:
PAC is an aggressive malignancy with a 5-year survival rate of < 8%. LA-PAC poses a particularly difficult therapeutic challenge. The aim of this study is to assess safety and preliminary efficacy of direct injection of submicron paclitaxel particles (SPP), which have been shown to reside at the delivery site for up to at least 100 days in a prior study, for control of PAC disease activity.

METHODS:
LA-PAC subjects were enrolled to receive EUS-guided intratumoral SPP delivery of 6, 10, or 15 mg/mL concentrations, ≤20% of the tumor volume, in a standard “3+3” dose-escalation protocol. The highest dose with an acceptable safety and tolerability profile, 15 mg/mL, is evaluated in the second study phase, which is ongoing, designed to enroll 12 subjects to receive two equal-dose injections 4 weeks apart. All subjects are followed for 6 months (m) to monitor their clinical parameters. Tumor responses are being assessed at 3- and 6 m post-initial injection.

RESULTS:
Seventeen subjects have been enrolled to date, comprising 10 subjects in the dose escalation group and 7 in the second phase. Of the 10 dose escalation subjects, seven have completed the 6 m study; one died just prior to the 6 m visit; 2 withdrew with disease progression. Of the 7 in the second phase, 5 have had both injections; 3 have completed 3m follow-up; 2 have withdrawn due to disease progression. Transient mild/moderate abdominal pain was noted in 4 subjects. Bradycardia, nausea, back pain, bloating, nausea and pancytopenia were also recorded. Acute pancreatitis has not been encountered. Plasma paclitaxel levels were detectable through days 1 and 2 at very low levels, returning to baseline in all but 1 subject by wk 4, supporting slow release of SPP from the delivery site. All but 1 subject had a very low plasma level of ≤10 ng/mL. Plasma CA19-9 was normal or stable in half of the subjects and continued to rise in half during first 3 m of treatment. In one subject the injected tumor appeared cyst-like at time of second injection, without signs of infection, and another subject in the second phase was down-staged at wk 16 and underwent surgical resection.

CONCLUSION:
SPP appears to be safe and tolerable when administered by intratumoral PAC injection at up to 15 mg/mL on two occasions 4-wks apart. One subject was down-staged and has undergone surgical resection. These are encouraging results and warrant further investigation of this novel treatment approach.
11 Risk of Pancreatic Cancer in Patients With a Prior History of Acute Pancreatitis: Meta-Analysis of Cohort Studies
Authors: Gonzalez Zorisadday , Roy Neel P. , Kanth Rajan , Roy Praveen K. 
Published: October 2019

INTRODUCTION:
Several studies have reported increased risk of pancreatic cancer in patients with chronic pancreatitis. However, the risk of pancreatic cancer in patients with a history of acute pancreatitis (AP) is not well known. Several recent epidemiological studies, especially case-control studies, have reported conflicting results. We conducted a meta-analysis of cohort studies to quantify the risk of pancreatic cancer in patients with history of AP.

METHODS:
A detailed search of several databases (Pubmed, Embase, Google Scholar, Cochrane database and CINAHL) and research scientific meetings of gastroenterology and surgical societies was performed for cohort studies examining the risk of pancreatic cancer in patients with a prior history of acute pancreatitis. Data was extracted using a standard form by 2 reviewers. Data regarding study characteristics, patient characteristics, exposures and outcomes and country of study was extracted. Summary odds ratio was calculated using Comprehensive Meta-analysis software. Random effects model was used for computing effect size. Studies without a matched control group were excluded. Heterogeniety and publication bias were assessed. Quality of studies was assessed using the Newscastle-Ottawa scale. There were no language restrictions.

RESULTS:
Five cohort studies met the inclusion criteria. Studies were performed in UK, Sweden, USA and Taiwan. The most common etiology of AP was gall stone pancreatitis in all the studies. Patients with chronic pancreatitis and alcohol related acute pancreatitis were excluded in all studies. All studies had a matched control group and adjusted for confounders. There were 1162 cases of pancreatic cancer in 103958 patients with a prior history of acute pancreatitis. 2042 cases of pancreatic cancer were seen in 1442158 controls. A higher risk of pancreatic cancer was seen among patients with prior history of AP (OR 7.39: 95% CI 5.03–10.88, P < 0.05). Three studies provided data on risk of pancreatic cancer >2 years after diagnosis of AP. The risk of pancreatic cancer was still elevated after >2 years in patients with prior of history of AP (OR 2.31: 1.61 = 3.30, P < 0.05). Heterogeneity was present and the effect size was computed using random effects model.

CONCLUSION:
Patients with a prior history of AP are at an increased risk of pancreatic cancer. Further cohort studies are needed to confirm these findings.
12 Non-Alcoholic Fatty Liver Disease and Risk for Intrahepatic and Extrahepatic Cholangiocarcinoma: Meta-Analysis of Case Control Studies
Authors: Roy Neel P. , Gonzalez Zorisadday , Kanth Rajan , Roy Praveen K. 
Published: October 2019

INTRODUCTION:
The incidence of cholangiocarcinoma is increasing worldwide. Over 8000 cases of both intrahepatic (ICC) and extrahepatic cholangiocarcinoma (ECC) are diagnosed every year in the US. Several recent studies have evaluated the role of non-fatty alcoholic liver disease (NAFLD) as a risk factor for cholangiocarcinoma. We performed a meta-analysis of case-control studies to evaluate the role of NAFLD as a risk factor for intrahepatic and extrahepatic cholangiocarcinoma.

METHODS:
We performed a systematic search of Medline, EMBASE and the Cochrane Library for studies without language restriction for case-control studies evaluating the risk of intra-hepatic and extra-hepatic cholangiocarcinoma in adult patients with NAFLD. We also hand searched grey literature from major gastrointestinal meetings. Standardized forms were used to extract data regarding number of cases of NAFLD and cholangiocarcinoma. Data was extracted by two reviewers independently. Summary odds ratio was calculated using Comprehensive Meta-analysis software. Heterogeneity, quality of studies and publication bias were also assessed. Random effects model was used for calculating the effect size.

RESULTS:
Ten studies met the inclusion criteria. 9 studies reported data on ICC and 5 studies reported data on ECC. Studies were performed in China, Taiwan, Japan, US, Europe and Korea. The period of patient enrollment ranged from 1992 to 2017. The majority of the studies used hospital based controls. The quality of the studies was assessed using Newcastle-Ottawa Scale. NAFLD was associated with a higher risk of ICC (OR 1.78: 95% CI 1.3–2.5, P = 0.001, I2 = 81). On subgroup analysis based on region of study, the increased risk was seen only in the studies reported from the Asian countries (5 studies, OR 1.93; 95% CI, 1.22–3.05, P = 0.005) but not from the Western countries (4 studies, OR 1.58; 95% CI 0.83–3.0, P = 0.17). On pooling all studies, risk of ECC was not increased in patients with NAFLD (OR 1.38; 95% CI 0.67–2.83, P = 0.55, I2 = 95%). However on subgroup analysis, increased risk of ECC was seen in the Western countries (2.42; 95% CI 2.01–2.91, P = 0.0001), but not the Asian countries. No significant publication bias was present.

CONCLUSION:
NAFLD is a risk factor for cholangiocarcinoma. Increased risk of ICC with NAFLD was seen in the Asian countries and ECC in the Western countries. Further studies are needed to confirm these findings.
14 Endoscopic Ultrasound in the Diagnosis and Staging of Pancreatic Cancer: A Comparison With Computer Tomography Imaging
Authors: Moutinho-Ribeiro Pedro , Costa-Moreira Pedro , Morais Rui , Vilas-Boas Filipe , Lopes Susana , Macedo Guilherme 
Published: October 2019

INTRODUCTION:
Computed Tomography (CT) and Endoscopic Ultrasound (EUS) with or without tissue acquisition have been widely used for diagnosing and staging pancreatic adenocarcinoma (PDAC). Previous studies showed conflicting results in the pathologic findings and the role of each modality in diagnosis and staging this disease is still mater of discussion. We aimed to compare CT and EUS in terms of mass detection, mass size, vascular and lymph node involvement and metastatic disease detection according to TNM Classification of Malignant Tumors (8th edition).

METHODS:
We included a consecutive sample of patients proposed for EUS for diagnosis/staging of PDAC in which a CT scan was performed in the same institution (within one-month period) between 2016 and 2018, in a tertiary referral center. Concordance between CT and EUS was assessed using a retrospective chart review and statistical analysis with Cohen's κ.

RESULTS:
We evaluated 44 patients with a median age of 66.9 ± 11.6 years, 52% were male. The median follow-up after EUS was 4 (IQR 0–10) months. All cases were submitted to tissue acquisition, with pathologic confirmation of PDAC in 91% (n = 40). Only 5 patients were submitted to surgical resection. EUS and CT agreed in TNM staging in 41% of the cases. The sub analysis for TNM categories revealed a concordance rate in 66% of the cases for T stage, 75% for N stage and 73% for M stage. In the T-stage, the highest non-concordance rate was found for T4: of the 16 cases with involvement of the celiac axis or the superior mesenteric artery identified in CT, only 7 cases (44%) were classified as T4 in EUS staging. Global Cohen's κ between two imaging methods was low: 0.25 (P < 0.01). However, when applied to each TNM category, we found values of 0.58 (T, P < 0.01), 0.36 (N, P < 0.01) and 0.7 (M, P < 0.01).

CONCLUSION:
Between TNM categories, CT and EUS agreed moderately well in the definition of T stage. Discrepancies between the two modalities were more common in those with T4 (unresectable) disease. EUS, with tissue acquisition, has the unique capacity to provide the definite cytohistological diagnosis. Clinicians should consider the role of both methods for proper diagnosis and staging of PDAC.
18 Characteristics and 30-Day Outcomes of Acute Pancreatitis Admissions According to Etiology: A Nationwide Analysis
Authors: Mulki Ramzi , Shah Rushikesh , Qayed Emad 
Published: October 2019

INTRODUCTION:
Acute pancreatitis (AP) is a frequent cause of hospitalization in the United States. The major etiologies of AP are alcohol, choledocholithiasis, and drug-induced. We aim to describe demographic, clinical, and admission characteristics of AP hospitalizations according to etiology. In addition, we compared in-hospital and 30 day mortality and readmission outcomes among the three major AP subtypes.

METHODS:
We performed a retrospective analysis of the 2016 National Readmission Database. Hospital admissions of adults (>18 years of age) with the primary or secondary discharge diagnosis of AP. Specific ICD-10 codes were used to classify AP into biliary pancreatitis (K851), alcoholic pancreatitis (K852), and drug-induced pancreatitis (K853). Patients with nonspecific AP codes were classified as biliary pancreatitis if they had a concomitant diagnosis of cholelithiasis and as alcoholic AP if they had a diagnosis of alcohol abuse. Non-specific AP admissions were excluded. Characteristics and 30-day outcomes of the three groups were compared using the X-square test for categorical variables and the one-way analysis of variance (ANOVA) for continuous variables.

RESULTS:
A total of 81,382 admissions met the inclusion criteria: 32,459 had biliary AP, 46,438 alcoholic AP, and 2,485 drug-induced AP. Patients with alcoholic AP were more likely to be male (69.1%) and younger (mean age 46.6) compared to the other groups. Patients with biliary AP were more likely to develop cholangitis (1.8%) compared to the other groups (≤0.2%). HIV was more associated with drug-induced pancreatitis (1.4%) compared to the other groups (≤0.4%). Mean length of stay was longest (5.9 days) and mean costs were highest ($15,367) in biliary AP. These were lowest in drug induced AP (4.2 days and $9413, respectively). In-hospital mortality (0.9%) and 30-day mortality (1.3%) was highest in biliary AP compared to the other groups. Thirty day- readmissions were highest in alcoholic AP (14.3%) compared to drug induced AP (11.5%) and biliary AP (10.1%).

CONCLUSION:
In this large, nationally representative patient sample, drug induced AP had the lowest length of stay and costs, while alcoholic AP had the highest 30-day readmission rates (14.3%). Biliary pancreatitis was associated with the highest in-hospital and 30-day mortality. Knowledge of these findings may allow us to design and target future studies to mitigate the high readmission rates in alcoholic pancreatitis, and the complications and mortality in biliary pancreatitis.