PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK

Background Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. Methods All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. Results A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. Conclusion Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions

Investigations into the role of substance P and the NK-1 receptor in an animal model of neuropathic pain

This study investigates the role of substance P and NK-1 receptors in an animal model of neuropathic pain. Unlike naive animals, innocuous peripheral stimulation of neuropathic animals was determined to cause heterosegmental inhibition in the tail-flick test as well as increased plasma extravasation in the paw. These effects were prevented by administration of CP-96,345 before stimulation. Additionally, CP-96,345 or an antisense oligonucleotide against NK-1 receptors significantly alleviated mechanical allodynia in neuropathic animals. Finally, mass spectrum of lumbar spinal cord of neuropathic but not naIve animals showed a significant upregulation of substance P. We conclude that innocuous stimulation of a neuropathic area could trigger activation of NK-1 receptors, presumably due to binding of substance P. Furthermore, this activation of NK-1 receptors could be central to the perception of mechanical allodynia in neuropathic pain. These results justify the investigation of inhibiting the interaction between substance P and the NK-1 receptor for the treatment of drug resistant neuropathies

Primary medication non-adherence after discharge from a general internal medicine service.

Medication non-adherence frequently leads to suboptimal patient outcomes. Primary non-adherence, which occurs when a patient does not fill an initial prescription, is particularly important at the time of hospital discharge because new medications are often being prescribed to treat an illness rather than for prevention.We studied older adults consecutively discharged from a general internal medicine service at a large urban teaching hospital to determine the prevalence of primary non-adherence and identify characteristics associated with primary non-adherence. We reviewed electronic prescriptions, electronic discharge summaries and pharmacy dispensing data from April to August 2010 for drugs listed on the public formulary. Primary non-adherence was defined as failure to fill one or more new prescriptions after hospital discharge. In addition to descriptive analyses, we developed a logistical regression model to identify patient characteristics associated with primary non-adherence.There were 493 patients eligible for inclusion in our study, 232 of whom were prescribed new medications. In total, 66 (28%) exhibited primary non-adherence at 7 days after discharge and 55 (24%) at 30 days after discharge. Examples of medications to which patients were non-adherent included antibiotics, drugs for the management of coronary artery disease (e.g. beta-blockers, statins), heart failure (e.g. beta-blockers, angiotensin converting enzyme inhibitors, furosemide), stroke (e.g. statins, clopidogrel), diabetes (e.g. insulin), and chronic obstructive pulmonary disease (e.g. long-acting bronchodilators, prednisone). Discharge to a nursing home was associated with an increased risk of primary non-adherence (OR 2.25, 95% CI 1.01-4.95).Primary non-adherence after medications are newly prescribed during a hospitalization is common, and was more likely to occur in patients discharged to a nursing home

Identification of study patients.

<p>Identification of study patients.</p

Characteristics of study patients divided by primary medication adherence at 7 days after discharge.

*<p>Sd  =  standard deviation. ⁺ IQR  =  interquartile range. ^** PCP  =  Primary care physician. ⁺⁺ ED  =  Emergency department.</p

Descriptive characteristics of study patients.

*<p>Sd  =  standard deviation. ⁺ IQR  =  interquartile range. ^** PCP  =  Primary care physician. ⁺⁺ ED  =  Emergency department.</p

Prescription adherence at 7 and 30 days after hospital discharge.

*<p>Adherent patients picked up all medications, while non-adherent patients failed to pick-up at least 1 medication. ⁺“Important” medications exclude PRN, symptom control, dermatological, and supplements. ^**Adherent to “important medications means either fully adherent or non-adherent to medications not classified as "important".</p