This document discusses diverticular disease and provides information on incidence, definitions, pathogenesis, epidemiology, clinical manifestations, evaluation, differential diagnosis, and management, including both non-operative and surgical treatment options. Diverticular disease is increasingly common, affecting over 50% of people over age 80. It is associated with low-fiber diets and risks like smoking. Clinical manifestations range from acute diverticulitis to chronic complications. Treatment depends on severity and includes antibiotics, percutaneous drainage, or surgery.
Bladder cancer is a disease of urinary bladder in which cells grow abnormally and have the potential to spread to other parts of the body. This is one of four parts of presentations on Bladder cancer. Please do go through the rest of the presentations too.
Globally, over 600,000 new cases and 300,000 deaths were estimated for cervical cancer in 2020 .
Third most common gynecological cancer in Palestine.
Palestine has a higher age-standardized mortality rate than other countries in the region
Bladder Cancer Diagnostic-Initial Team ProjectSagar Desai
A mini-project to find biomarkers for bladder cancer diagnosis. We narrowed down our list of viable candidates down to three that could be used in combination to provide sensitivity and specificity values greater than 94%. Furthermore, we calculated long-term monitoring and payor costs as well as potential profit.
Bladder cancer is a disease of urinary bladder in which cells grow abnormally and have the potential to spread to other parts of the body. This is one of four parts of presentations on Bladder cancer. Please do go through the rest of the presentations too.
Globally, over 600,000 new cases and 300,000 deaths were estimated for cervical cancer in 2020 .
Third most common gynecological cancer in Palestine.
Palestine has a higher age-standardized mortality rate than other countries in the region
Bladder Cancer Diagnostic-Initial Team ProjectSagar Desai
A mini-project to find biomarkers for bladder cancer diagnosis. We narrowed down our list of viable candidates down to three that could be used in combination to provide sensitivity and specificity values greater than 94%. Furthermore, we calculated long-term monitoring and payor costs as well as potential profit.
Tumors of kidney and Bladder by Sunil Kumar Dahasunil kumar daha
Please find the power point on Tumors of kidney and Bladder. I tried present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
2. Incidence
Increasing
• 5% at turn of the century
• 50% by 1975
• 5% by age 40 and 80% by age 80
1.5 – 2 million office visits
300,000-450,000 Admissions
1.5 million days of inpatient care
$1.8 BILLION of direct medical costs
3. • The most common location for a carcinoid tumor is ______.
• the appendix!
• If a mass is found in the appendix, what are the odds that it is a
carcinoid?
• ~80% of all appendiceal masses are carcinoids
• Small bowel carcinoids are much more aggressive than their
appendiceal and rectal counterparts
• If you encounter a carcinoid in the small bowel, what are the odds
that there is 2nd lesion?
• 30-40%
• If you suspect a carcinoid lesion on CT, what tests can help make
the diagnosis?
• Urinary 5-HIAA
• Chromogrannin A
4. Incidence
10-20% with Diverticula develop diverticulitis
10-20% of those with diverticulitis are admitted and treated
1% of those admitted will be treated operatively
Most patients admitted are treated non operatively
5. Definitions and Pathogenesis
Diverticulum – Thin wall outpouching of mucosa and
serosa but no muscularis – FALSE diverticulum
Diverticulosis – Prescense of diverticula
• Pathogensis: Altered Bowel motility = increased intraluminal pressures –
highest in the sigmoid colon
• Vasa recta penetrate the circular muscle layer
Diverticulitis
• Inflammation and focal necrosis
• Micro or macroscopic perforation of
a diverticulum
6. • Arise from the ____________.
• Interstitial cells of cajal (pacemaker cell of GI)
• 50% gastric, 25% small bowel, 25% colon/rectal
• 95% of GIST tumors have a mutation of the ________ gene.
• C-kit or CD117
• C-kit is a __________.
• Tyrosine Kinase receptor
• _________ is used as a specific chemotherapeutic agent against this
tyrosine kinase receptor.
• Gleevac or Imatinib
• What is a tyrosine kinase receptor that has been implicated in breast
cancer?
• Her2 neu
• What drug targets this receptor?
• Trastuzumab
• What is the most significant and dangerous side effect?
• “Trastuzumab trashes the heart:” CHF can occur
• Surgery for GIST can be aggressive:
• En bloc resection if necessary
• Need to take nodes?
• Only if palpable, GIST largely spreads hematogenously & locally
7. Epidemiology
Diet
• High red meat and low fiber diets
• Fiber may be protective - increases stool
water, decreases transit time
JAMA article 2008
- DIVERTICULITIS IS NOTASSOCIATED with
NUTS, CORN, and POPCORN CONSUMPTION
8. Epidemiology
• Higher in older patients
• Younger men – Fistulas
• Older men – Bleed
• Younger women – Perforate
• Older Women – Stricture
• Women tend to present 5 years later than men
10. • Following resection of single <1 cm adenoma
• 5 years postpolypectomy
• If first colonoscopy is normal, resume average-risk recommendations
• Following resection of ≥1 cm or high-risk adenoma
• 3 years postpolypectomy
• Repeat colonoscopy in 3 years; if normal, return to average-risk
recommendations
• Following curative resection for colorectal cancer
• Within 1 year postoperatively
• Repeat in 3 years, then every 5 years
• Inflammatory bowel disease
• Within 8 years of diagnosis
• Survey for dysplasia every 1–2 years
•Personal history risk
•Initiate surveillance
•Interval
11. Clinical Manifestations
Acute
• Uncomplicated – No abscess (surrounding
inflammation)
• Complicated - abscess formation, perforation,
fistula, and bleeding
Fevers, leukocytosis, LLQ abdominal pain,
tachycardia, and hypotension
Dysuria, pneumaturia, and fecaluria
16. • External Radiation
• Start day 1
• 5days/week x 5 weeks
• Systemic Chemotherapy (often is 5-fu)
• Start day 1 x 4days
• Repeat @ day 28
• Mitomycin C
• Give day 1
20. Outpatient Non-operative
• Reliable, compliant, not sick, can tolerated PO,
available support.
• Oral antibiotics for 10 to 14 days.
• Gram-negative rods and anaerobes (particularly E.
coli and B. fragilis)
• Quinolone with metronidazole, amoxicillin-
clavulanate, or trimethoprim-sulfamethoxazole with
metronidazole
21. Inpatient Non-Operative
• Empiric broad-spectrum intravenous antibiotics.
• Percutaneous drainage of any abscess >3cm.
• Small abscesses can be treated with abx
• Ampicillin-sulbactam OR piperacillin-tazobactam OR
ticarcillin-clavulanate
• Third generation cephalosporin such as ceftriaxone
PLUS metronidazole
Usually better in 24-48 hours, No fevers, No abdominal
pain, Tolerate PO
Failure = continued pain, repeat CT after 4-7 days with
worse
28. Surgical Treatment
INDICATIONS ≠ NOT NUMBER
OF EPISODES
Routine elective resection based
on age is no longer recommended
Individualized based on risk factors
29. Surgical Indications Continued
Failure of abscess to respond to non-
operative treatment
• Medical Treatment
• Percutaneous drainage
Perforation/Sepsis
Obstruction
31. Types of Procedures
Historically: Staged Procedure – Colostomy --> Resection -->
Anastomosis
• Resection with Colostomy Formation --> Hartmann
procedure
• 35-45% of patients never have the colostomy reversed
• Resection with anastomosis
with or without a diverting
loop ileostomy
• Laparoscopic Lavage?
32. • Already have an elevated WBC
• Can’t scan them…
• US
• MRI
• Gravid uterus may displace the
appendix
• Acute appendicitis: 10% risk of fetal
loss
• Ruptured appendicitis: 30% fetal loss
• Be more aggressive in pregnant
patients with appendicitis
• Laparoscopy is tolerated well in
pregnancy
• Ruptured appendicitis isn’t
• Accept a higher negative
appendectomy rate in pregnant
women
33. Extent of Resection
Proximally – Entire sigmoid to NORMAL SUPPLE BOWEL
Distally – Proximal Rectum (Splaying of the teania )
37. • Less surgery for diverticulitis
• Most patients can be treated on an outpatient basis
• Age is no longer a factor when deciding to operate
• Current Guidelines state recurrence does not warrant
elective resection
• Nuts and Seeds are OK!!!
• The first episode is typically the worst
When do I operate
Persistent symptoms, aka smoldering diverticulitis,
failure of medical management while inpatient, fistula,
obstruction, stricture.
Conclusions