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

Abstract 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. </jats:sec

Interventions for oropharyngeal dysphagia in acute and critical care: A systematic review and meta analysis

Purpose: To determine the effectiveness of dysphagia interventions compared to standard care in improving oral intake and reducing aspiration for adults in acute and critical care. Methods: We searched electronic literature for randomised and quasi randomised trials and bibliography lists of included studies to March 2020. Study screening, data extraction, risk of bias and quality assessments were conducted independently by two reviewers. Meta-analysis used fixed effects modelling. The systematic review protocol is registered and published. Results: We identified 22 studies (19 stroke, 2 intensive care stroke and 1 general intensive care) testing 9 interventions and representing 1700 patients. Swallowing treatment showed no evidence of a difference on the time to return to oral intake (n=33, MD (days) -4.5, 95% CI -10.6 to 1.6, 1 study, P = 0.15) (very low certainty) or on aspiration following treatment (n=113, RR 0.79, 95% CI 0.44 to 1.45, 4 studies, I2 = 0%, P = 0.45) (low certainty). Swallowing treatment showed evidence of a reduced risk of pneumonia (n=719, RR 0.71, 95% CI 0.56 to 0.89, 8 studies, I2 = 15%, P=0.004) (low certainty) but no evidence of a difference in swallowing quality of life scores (n=239, MD -11.38, 95% CI -23.83 to 1.08, I 2= 78%, P=0.07) (very low certainty). Conclusion: There is limited evidence for the effectiveness of swallowing treatments in the acute and critical care setting. Clinical trials consistently measuring patient centred outcomes are needed

Interventions for oropharyngeal dysphagia in acute and critical care a systematic review and meta-analysis

Purpose: To determine the effectiveness of dysphagia interventions compared to standard care in improving oral intake and reducing aspiration for adults in acute and critical care. Methods: We searched electronic literature for randomised and quasi randomised trials and bibliography lists of included studies to March 2020. Study screening, data extraction, risk of bias and quality assessments were conducted independently by two reviewers. Meta-analysis used fixed effects modelling. The systematic review protocol is registered and published. Results: We identified 22 studies (19 stroke, 2 intensive care stroke and 1 general intensive care) testing 9 interventions and representing 1700 patients. Swallowing treatment showed no evidence of a difference on the time to return to oral intake (n=33, MD (days) -4.5, 95% CI -10.6 to 1.6, 1 study, P = 0.15) (very low certainty) or on aspiration following treatment (n=113, RR 0.79, 95% CI 0.44 to 1.45, 4 studies, I2 = 0%, P = 0.45) (low certainty). Swallowing treatment showed evidence of a reduced risk of pneumonia (n=719, RR 0.71, 95% CI 0.56 to 0.89, 8 studies, I2 = 15%, P=0.004) (low certainty) but no evidence of a difference in swallowing quality of life scores (n=239, MD -11.38, 95% CI -23.83 to 1.08, I 2= 78%, P=0.07) (very low certainty). Conclusion: There is limited evidence for the effectiveness of swallowing treatments in the acute and critical care setting. Clinical trials consistently measuring patient centred outcomes are needed

Radiative capture reactions with heavy beams: extending the capabilities of DRAGON

Understanding the nucleosynthesis of stable proton-rich nuclei requires knowledge of the cross sections for both proton and alpha capture reactions. As some of the nucleosynthesis paths responsible for the production of these nuclei involve reactions on unstable isotopes, it is of particular importance to develop techniques to investigate these reactions. This requires radioactive beams and measurements in inverse kinematics, thus making recoil separators an ideal tool for direct measurements of proton and alpha capture reactions. Here, the application of the DRAGON recoil separator for measurements of capture reactions for heavy beams is presented. The performance of the separator was tested using the 58Ni(p,γ)59Cu reaction

The \u3csup\u3e33\u3c/sup\u3eS(p,γ)\u3csup\u3e34\u3c/sup\u3eCl reaction in classical nova explosions

The analysis of microscopic grains within primitive meteorites has revealed isotopic ratios largely characteristic of the conditions thought to prevail in various astrophysical environments. Recently, several grains have been identified with isotopic signatures similar to those predicted within the ejecta of nova explosions on oxygen-neon white dwarfs. A possible smoking gun for a grain of nova origin is a large 33S abundance: nucleosynthesis calculations predict as much as 150 times the solar abundance of 33S in the ejecta of oxygen-neon novae. This overproduction factor may, however, vary by factors of at least 0.01 - 3 because of uncertainties in the 33S(p,γ)34Cl reaction rate over nova temperatures. In addition, better knowledge of this rate would help with the interpretation of nova observations over the S-Ca mass region, and contribute towards the firm establishment of a nucleosynthetic endpoint in these phenomena. Finally, constraining this rate may help to finally confirm or rule out the decay of an isomeric state of 34Cl (Ex = 146 keV, t1/2 =32 min) as a source for observable gamma-rays from novae. Direct examinations of the 33S(p,γ)34Cl reaction in the past have only identified resonances down to Er = 434 keV. At nova temperatures, lower-lying resonances could certainly play a dominant role. Several recent, complementary studies dedicated to improving our knowledge of the 33S(p,γ)34Cl rate, using both indirect methods (measurement of the 34S( 3He,t)34Cl and 33S(3He,d) 34Cl reactions with the Munich Q3D spectrograph) and direct methods (in normal kinematics at CENPA, University of Washington, and in inverse kinematics with the DRAGON recoil mass separator at TRIUMF) are presented here. Our results affect predictions of sulphur isotopic ratios in nova ejecta (e.g. 32S/33S) that may be used as diagnostic tools for the nova paternity of grains. © ?Copyright owned by the author(s)