Pancreatic exocrine insufficiency after non-pancreatic upper gastrointestinal surgery: meta-analysis.

BACKGROUND: Untreated pancreatic exocrine insufficiency (PEI) results in substantial patient harm. Upper gastrointestinal surgery (bariatric metabolic surgery and oesophagogastric resection) affects the delicate physiology of pancreatic exocrine function and may result in PEI. The aim of this study was to assimilate the literature on incidence, diagnosis, and management of PEI after bariatric metabolic surgery and oesophagogastric resection. METHODS: A systematic review of PubMed, MEDLINE, and Embase databases identified studies investigating PEI after non-pancreatic upper gastrointestinal surgery. Meta-analyses were undertaken for incidence of PEI and benefit of pancreatic enzyme replacement therapy. RESULTS: Among 1620 patients from 24 studies included in quantitative synthesis, 36.0% developed PEI. The incidence of PEI was 23.0 and 50.4% after bariatric metabolic surgery and oesophagogastric resection respectively. Notably, the incidence of PEI was 44% after biliopancreatic diversion with duodenal switch and 66.2% after total gastrectomy. The most common diagnostic test used was faecal elastase 1 (15 of 31 studies), with less than 200 µg/g being diagnostic of PEI. A total of 11 studies considered the management of pancreatic exocrine insufficiency, with 78.6% of patients responding positively to pancreatic enzyme replacement when it was prescribed. CONCLUSION: PEI is common after non-pancreatic upper gastrointestinal surgery and patients may benefit from enzyme replacement therapy.

Pancreatic exocrine insufficiency occurs when enzymes from the pancreas are unable to help digest food. Pancreatic exocrine insufficiency is known to cause disruptive symptoms after gastrointestinal surgery. Although such symptoms are well known after pancreatic surgery, after other gastrointestinal operations, including bariatric metabolic surgery and oesophagogastric cancer resection, pancreatic exocrine insufficiency is often overlooked as a cause of both symptoms and poor nutrition. This study looked at, and combined, all the current evidence on the rate of pancreatic exocrine insufficiency after these operations, the way it is diagnosed, and how it is treated. Pancreatic exocrine insufficiency may be more common than previously thought after bariatric metabolic surgery or oesophagogastric surgery, and clinicians working with these patients should have a low threshold for starting treatment.

What is known about clinician researcher careers in allied health? A scoping review of the last decade.

PURPOSE: Although the benefits of clinician researchers for health services are now more clearly recognised, their career development is not well understood. Hence, the purpose of this paper, a scoping review, is to determine what has been discussed in the literature about career opportunities for allied health (AH) clinician researchers in health services. DESIGN/METHODOLOGY/APPROACH: A structured literature search was completed in December 2020 for literature published 2010-2020 in English. A total of 2,171 unique abstracts were found and screened by two reviewers and 206 articles progressed to full text screening. FINDINGS: Forty-six studies were ultimately included; however, only two of these had aims directly related to AH clinician researcher careers, with the remainder containing only incidental data on this topic. Over half (56.5%) of the included studies were conducted in Australia, with a variety of AH professions represented. In terms of research design, 52.2% used cross-sectional survey designs, while case studies and qualitative research designs were also common. Key observations were that varying terminology and definitions were used, and there was little information about the inclusion of research in clinical positions or opportunities for formal clinical researcher positions in health services. There was some evidence to support that there are limited career opportunities after PhD completion, and that current career pathways are insufficient. There was conflicting evidence on whether engagement in research is beneficial for clinical career progression. ORIGINALITY/VALUE: This review highlights a lack of research on this topic and outlines future directions to better support career pathways for AH clinician researchers.

Draft Genome Sequences of Cefepime-Resistant and -Susceptible Escherichia coli Strains and Imipenem-Resistant and -Susceptible Pseudomonas aeruginosa Strains.

Draft genome sequences of Escherichia coli and Pseudomonas aeruginosa strains collected from clinical infections were used to determine the prevalence of newly emerging antibiotic resistance genes in Maine. Comparisons between cefepime-resistant and -susceptible E. coli strains and imipenem-resistant and -susceptible P. aeruginosa strains are being conducted.

The high impact actions for nursing and midwifery 8: ready to go--no delays.

In recent years, discharge initiatives that aim to free up hospital beds have become commonplace. However, new systems, such as bed management, have left many nurses feeling disengaged from the management of patient admission and discharge. They feel pressurised into speeding up discharge by the increasing focus on bed capacity and patient turnover, which can make them feel distanced from their primary role of caring for patients. Although new roles and initiatives can be valuable, changing the way nurses engage with discharge is key. Ensuring that the process is nurse led will lead to a faster discharge and less frustration for patients who are waiting to go home. This article, the last in our series on the high impact actions for nursing and midwifery, looks at how nursing staff can respond to the issue of discharge planning.

The high impact actions for nursing and midwifery 6: where to die when the time comes.

Around half of the 500,000 deaths in England each year occur in acute hospitals, while around half of all complaints made to acute trusts relate to an aspect of end of life care. Howaver, research suggest that 40% of people who die in hospital have no medical need to be there, and that 55% of people with cancer would prefer to die at home while only around 25% do so. When people die in hospital despite having a preference to die at home and no medical reason to be in hospital, it causes unnecessary distress to patients and their familes, and is costly to the NHS. This article, the seventh in our series on the high impact actions for nursing and midwifery, looks at how nurses can help to improve end of life care.

The high impact actions for nursing and midwifery 4: your skin matters.

Pressure ulcers can occur in any patient but are most commonn in high risk groups such as: older people; those who are obese, malnourished orwith continence problems; people with certain skin types; andthose with certain underlying conditions. Pressure ulcers increase morbidityand mortality, and represent a significant proportion of NHS expenditure, yet the vast majority are avoidable. This article, the fifth in our series on the high impact actions for nursing and midwifery, looks at how nurses can prevent pressure ulcers in their patients.

The high impact actions for nursing and midwifery 5: protection from infection.

Four out of every five urinary tract infections can be traced to indwellng catheters. If the number of these infections is to be reduced significantly, nurses need to implement best practice for catheter care, and only catheterise patients when absolutely necessary.

The high impact actions for nursing and midwifery. 7: Promoting normal birth.

There is significant variation in rates of Caesarean section between maternity units. Higher rates appear to be associated with older mothers and women from certain ethnic groups. However, taking these and other demographic factors into account does not explain the differences between trusts. This eighth article in this series on the high impact actions for nursing and midwifery looks at how midwives and nurses can help to avoid unnecessary Caesarean sections.

How nurses can implement the high impact actions to improve quality and cost effectiveness.

In November 2009 the NHS Institute for Innovation and Improvement published a list of eight high impact actions for nursing and midwifery and stated that, if implemented across the NHS, the actions could save over pounds 9 bn a year while improving the quality of care. The NHS Institute has now published a selection of case studies from different settings demonstrating successful initiatives relating to each action and a range of other supporting material. This article, the first in a Nursing Times series summarising the main information on how the high impact actions can be achieved, sets the context for the initiative. Subsequent articles will discuss the individual actions and offer practical information on implementation.

The high impact actions for nursing and midwifery. 3: Staying safe, preventing falls.

The National Patient Safety Agency reported 152,000 falls in England and Wales in acute hospitals in 2009, 26,000 in mental health trusts and 28,000 in community hospitals. The number of falls is due to rise in line with increasing numbers of older and frail people who have more complex health needs. Many of these falls are preventable; the challenge for the NHS is to improve patient safety while protecting independence patients' rights to make informed choices.

The high impact actions for nursing and midwifery 1: keeping nourished--getting better.

Approximately one in four patients in NIIS hospitals are either malnourished or at risk of malnurition and as much as 70% of malnutrition in acute hospital admission is unrecognised and unmanaged. Although most of those who are malnourished live in the community, malnutrition and dehydration are key challenges for NHS organisations. Well hydrated and nourished patients get better more quickly, have a shorter length of stay and a more positive experience of care. Ensuring patients receive all of the nutrients they need is vital to the delivery of good care. This article, the second in our series on the high impact actions for nursing and midwifery, looks at how nurses can reduce malnutrition in their patients.

The high impact actions for nursing and midwifery 2: fit and well to care.

Each year in the health service in England, 10.3 million working days are lost to sickness absence (Chartered Institute of Personnel and Development, 2009). This is the equivalent of 4.5% of the current workforce, or 45,000 whole time equivalent nurses. This article, the third in our series on the high impact a actions for nursing and midwifery, looks at how ward managers and team leaders can provide support and information to improve nurses' health and wellbeing.