Digestive diseases and sciences
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There are guidelines for the medical management of cirrhosis and associated quality indicators (QIs), but QIs focusing on standards for palliative aspects of care are needed. ⋯ These QIs are evidence-based process measures of care that may be useful to improve the quality of palliative care. Research is needed to better understand the quality of palliative care provided to patients with cirrhosis.
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Patients with advanced liver disease have a high prevalence of cardiovascular risk factors, but many of them are asymptomatic. Cardiovascular risk stratification prior to liver transplant can be done by dobutamine stress echocardiography, stress myocardial perfusion imaging, cardiac computer tomography, and coronary angiography, but there are no clear recommendations regarding what method should be used and who should be screened. Because of this and because of inherent risk profile in this population, the variations in practice are significant. Careful screening and rigorous management of cardiovascular risk factors are important to ensure optimal cardiovascular outcomes in the immediate post-transplantation period and in the long term as well.
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Review Meta Analysis Comparative Study
Bispectral Index Versus Standard Monitoring in Sedation for Endoscopic Procedures: A Systematic Review and Meta-Analysis.
Bispectral index (BIS ) monitoring has been used as an objective measurement tool for sedation depth and has been proposed as a guidance to reduce the risk of intraprocedural over-sedation. However, the results of several studies evaluating the benefits of BIS monitoring for gastrointestinal endoscopy were not consistent. ⋯ This first meta-analysis showed that BIS monitoring appears to be an effective and safe method for avoiding unnecessary administration of propofol and for providing adequate sedation during endoscopic procedures.
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Review Meta Analysis Comparative Study
Bispectral Index Versus Standard Monitoring in Sedation for Endoscopic Procedures: A Systematic Review and Meta-Analysis.
Bispectral index (BIS ) monitoring has been used as an objective measurement tool for sedation depth and has been proposed as a guidance to reduce the risk of intraprocedural over-sedation. However, the results of several studies evaluating the benefits of BIS monitoring for gastrointestinal endoscopy were not consistent. ⋯ This first meta-analysis showed that BIS monitoring appears to be an effective and safe method for avoiding unnecessary administration of propofol and for providing adequate sedation during endoscopic procedures.
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Diverticulitis is a common condition which carries significant morbidity and socioeconomic burden (McGillicuddy et al in Arch Surg 144:1157-1162, 2009). The surgical management of diverticulitis has undergone significant changes in recent years. This article reviews the role of minimally invasive approach in management of complicated diverticulitis, with a focus on recent concepts and advances. ⋯ Laparoscopic peritoneal lavage has evolved as a good alternative to invasive surgery, yet clear indications for its role in the management of complicated diverticulitis need to be established. Recent evidence suggests that existing guidelines for optimal management of complicated diverticulitis should be updated. Non-resectional radiographic techniques are likely to play a prominent role in the initial treatment of complicated diverticulitis in the near future.