Digestive and Liver Disease

Division of Gastroenterology AO San Camillo Forlanini, Circonvallazione gianicolense 87, 00152 Rome, Italy.
Digestive and Liver Disease (Impact Factor: 2.96). 09/2010; 42(9):629-34. DOI: 10.1016/j.dld.2010.03.012
Source: PubMed


To analyze the effects of endoscopy and care in a gastroenterology ward on 30-day mortality among Italian patients hospitalized for acute non-variceal upper gastrointestinal hemorrhage (UGIH).
We conducted a population-based study based on administrative data contained in the Regional Hospital Information System (RHIS) for the Lazio Region (Italy). We identified all hospitalizations with a main diagnosis of UGIH during period 2000-2005. Discharge data were analyzed for procedures performed, ward where the patient was cared for, comorbidities, vital status at discharge. Vital status 30 days after admission was cross-checked with the Regional Registry of Causes of Death. Logistic regression models were performed taking into account patients' risk factors (OR and C.I. 95%).
A total of 13,427 hospitalizations for UGIH (mean patient age, 68 years; 60% males) were identified. The 30-day mortality was 6.9%. Significantly lower rates were observed among hospitalizations that included endoscopy (OR 0.30, 95% C.I. 0.26-0.34), specialist care (OR 0.55, 95% C.I. 0.37-0.82), or both (OR 0.12, 95% C.I. 0.07-0.22). The protective effects of endoscopy and specialist care remained strong after adjustment for potential risk factors.
Endoscopy, per se, reduces mortality among patients hospitalized for UGIH, and care in a gastroenterology ward may offer additional protective effects.

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Available from: Cosimo Prantera, Mar 21, 2014
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    • "Acute nonvariceal upper gastrointestinal bleeding (NVUGIB) is a common reason for hospitalization with substantial associated morbidity, mortality, and health care resource use [1] [2] [3] [4]. In patients suffering an episode of NVUGIB, much effort has been devoted to the identification of prognosticators of unfavourable outcome, specifically recurrent bleeding and mortality [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] or the need for therapeutic intervention at endoscopy [15]. "
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    ABSTRACT: There is a lack of validated predictors on which to decide the timing of discharge in patients already hospitalized for upper nonvariceal bleeding. Identify factors that appear to protect nonvariceal bleeders from the development of negative outcome (rebleeding, surgery, death). Secondary analysis of two prospective multicenter studies. Multivariate analyses for each investigated outcome were performed; a single model was developed including all factors that were statistically significant in each sub-model. A final score was developed to predict favourable outcomes. Prognostic accuracy was tested with ROC curve analysis. Out of 2398 patients, 211 (8.8%) developed one or more adverse outcomes: 87 (3.63%) had rebleeding, 46 (1.92%) needed surgery and 107 (4.46%) died. Predictors of favourable prognosis were: ASA score 1 or 2, absence of neoplasia, outpatient bleeding, use of low-dose aspirin, no need for transfusions, clean-based ulcer, age <70 years, no haemodynamic instability successful endoscopic diagnosis/therapy, no Dieulafoy's lesion at endoscopy, no hematemesis on presentation and no need for endoscopic treatment. Overall prognostic accuracy of the model was 83%. The final score accurately identified 20-30% of patients that eventually do not develop any negative outcome. The "good luck score" may be a useful tool in deciding when to discharge a patient already hospitalized for acute non-variceal bleeding.
    Digestive and Liver Disease 03/2014; 46(3):231-6. DOI:10.1016/j.dld.2013.10.017 · 2.96 Impact Factor
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    • "Previously published Italian studies in this field are mainly on upper GIB, and are based on analyses of a single hospital cohort [15] or multicentre registry data [10] [16]. Only one study, using administrative data, presented a description of an Italian region (Lazio), but it analysed a shorter interval of time and did not compare both upper and lower GIBs' outcomes [12]. In the present study, we observed a reduced incidence of GIB by 25% over the decade 2001–2010. "
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    ABSTRACT: Gastrointestinal bleeding is the most frequent emergency for gastroenterologists. Despite advances in management, an improvement in mortality is still not evident. Determining time trends of gastrointestinal bleeding hospitalization and outcomes from 2001 to 2010 in the Veneto Region (Italy). Data of patients admitted with gastrointestinal bleeding from Veneto regional discharge records were retrospectively evaluated. Chi-squared and multivariate logistic regression model were used. Overall, 44,343 patients (mean age 64.2±8.6 years) with gastrointestinal bleeding were analysed: 23,450 (52.9%) had upper, 13,800 (31.1%) lower, and 7093 (16%) undefined gastrointestinal bleeding. Admission rate decreased from 108.0 per 100,000 in 2001 to 80.7 in 2010, mainly owing to a decrease in upper gastrointestinal bleeding (64.4 to 35.9 per 100,000, p<0.05). Reductions in hospital fatality rate (from 5.3% to 3%, p<0.05), length of hospital stay (from 9.3 to 8.7 days, p<0.05), and need for surgery (from 5.6% to 5%, p<0.05) were observed. Surgery (OR: 2.97, 95% CI: 2.59-3.41) and undefined gastrointestinal bleeding (OR: 2.89, 95% CI: 2.62-3.19) were found to be risk factors for mortality. Patient admissions for gastrointestinal bleeding decreased significantly over the years, owing to a decrease in upper gastrointestinal bleeding. Improved outcomes could be related to regional dedicated clinical gastroenterological management.
    Digestive and Liver Disease 12/2013; 46(4). DOI:10.1016/j.dld.2013.11.005 · 2.96 Impact Factor
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    ABSTRACT: This paper investigates the degradation of a lateral resurf 40V pDMOS transistor under hot carrier stress using variable base charge pumping experiments. Upon stressing, the device exhibits N<sub>it</sub> formation in the gate overlapped drift region and electron trapping in the drift region birds beak. Injection of electrons occurs at a spot approximately 50 nm from the birds beak tip. The degradation of the electrical parameters upon hot carrier stress is only correlated with the amount of injected electrons, and not with the N<sub>it</sub> formation. The trapped electron charge will cause a walk-in of the off-state V<sub>bd</sub>.
    Solid-State Device Research Conference, 2005. ESSDERC 2005. Proceedings of 35th European; 10/2005
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