The American journal of gastroenterology
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Am. J. Gastroenterol. · Feb 2010
Comparative StudyComparison of BISAP, Ranson's, APACHE-II, and CTSI scores in predicting organ failure, complications, and mortality in acute pancreatitis.
Identification of patients at risk for severe disease early in the course of acute pancreatitis (AP) is an important step to guiding management and improving outcomes. A new prognostic scoring system, the bedside index for severity in AP (BISAP), has been proposed as an accurate method for early identification of patients at risk for in-hospital mortality. The aim of this study was to compare BISAP (blood urea nitrogen >25 mg/dl, impaired mental status, systemic inflammatory response syndrome (SIRS), age>60 years, and pleural effusions) with the "traditional" multifactorial scoring systems: Ranson's, Acute Physiology and Chronic Health Examination (APACHE)-II, and computed tomography severity index (CTSI) in predicting severity, pancreatic necrosis (PNec), and mortality in a prospective cohort of patients with AP. ⋯ We confirmed that the BISAP score is an accurate means for risk stratification in patients with AP. Its components are clinically relevant and easy to obtain. The prognostic accuracy of BISAP is similar to those of the other scoring systems. We conclude that simple scoring systems may have reached their maximal utility and novel models are needed to further improve predictive accuracy.
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Am. J. Gastroenterol. · Feb 2010
ReviewErrors in the conduct of systematic reviews of pharmacological interventions for irritable bowel syndrome.
Systematic reviews and meta-analyses are integral to evidence-based clinical decision making. Although flawed systematic reviews could compromise optimal decision making, their accuracy has received limited investigation. We assessed conduct of systematic reviews of pharmaceutical interventions for irritable bowel syndrome (IBS). ⋯ We found many errors in both application of eligibility criteria and dichotomous data extraction in the eight meta-analyses studied. Independent verification of systematic reviews and meta-analyses may be required for full confidence in their results.
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Am. J. Gastroenterol. · Feb 2010
Multicenter Study Controlled Clinical TrialDo stool form and frequency correlate with whole-gut and colonic transit? Results from a multicenter study in constipated individuals and healthy controls.
Despite a lack of supportive data, stool form and stool frequency are often used as clinical surrogates for gut transit in constipated patients. The aim of this study was to assess the correlation between stool characteristics (form and frequency) and gut transit in constipated and healthy adults. ⋯ Stool form predicts delayed vs. normal transit in adults. However, only a moderate correlation exists between stool form and measured whole-gut or colonic transit time in constipated adults. In contrast, stool frequency is a poor surrogate for transit, even in those with reduced stool frequency.