Risk stratification tools for branch-duct intraductal papillary mucinous neoplasms of the pancreas

Prediction models have been built to improve the correct identification of high‐risk IPMNs and thus the selection of patients for surgery. However, there are currently no tools to recommend the best IPMN surveillance strategy and to distinguish those who might not warrant surveillance at all

The use of a smartphone application to disseminate guidelines on pancreatic cystic neoplasms

Officially release in October 2019, iCyst was developed as part of the project entitled “Current application of the European evidence‐based guidelines on pancreatic cystic tumors”, which was promoted by the Department of General and pancreatic Surgery – The Pancreas Institute, University of Verona Hospital Trust (Institutional Review Board approval number 2390CESC – Comitato Etico delle Province di Verona e Rovigo), and received funding from the United European Gastroenterology Activity Grants – Support of Standards & Guidelines initiatives, dissemination of existing clinical practice 2019 (endorse by the European Digestive Surgery – EDS)

The upward trajectory of the UEG journal:Next Generation Trainee Editors

International audienc

Early and Sustained Elevation in Serum Pancreatic Amylase Activity: A Novel Predictor of Morbidity After Pancreatic Surgery

Objective:To characterize early postoperative serum pancreatic amylase (spAMY) trends after pancreatic resections. Summary Background Data:A postoperative spAMY elevation is a common finding but uncertainties remain about its meaning and prognostic implications. Methods:Analysis of patients who consecutively underwent pancreatectomy from 2016 to 2019. spAMY activity was assessed from postoperative day (POD) 0 to 3. Different patterns of spAMY have been identified based on the spAMY standard range (10-52 U/l). Results:Three patterns were identified: (#1) spAMY values always < the lower limit of normal/within the reference range /a single increase in spAMY > upper limit of normal at any POD; (#2) Sustained increase in spAMY activity on POD 0 + 1; (#3) Sustained increase in spAMY activity including POD 1 + 2. Shifting through spAMY patterns was associated with increase morbidity (21% in #1 to 68% in #3 at POD 7; log rank < 0.001). Almost all severe complications (at least Clavien-Dindo >= 3) occurred in patients with pattern #3 (15% vs 3% vs 5% in #1 and #2 at POD 7, P = 0.006), without difference considering >3-times or >the spAMY normal limit (P = 0.85). POPF (9% in #1 vs 48% in #3, P < 0.001) progressively increased across patterns. Pre-operative diabetes (OR 0.19), neoadjuvant therapy (OR 0.22), pancreatic texture (OR 8.8), duct size (OR 0.78), and final histology (OR 2.2) were independent predictors of pattern #3. Conclusions:A sustained increase in spAMY activity including POD 1 + 2 (#3) represents an early postoperative predictor of overall and severe early morbidity. An early and dynamic evaluation of spAMY could crucially impact the subsequent clinical course with relevant prognostic implications

What Constitutes a High-Quality Guideline:Exploring Consumers' Views

Introduction: Clinical guidelines are a cornerstone of evidence-based medicine. Little is known about clinicians' knowledge of guideline development and how they perceive guideline quality. Methods:A survey protocol was designed according to the CHERRIES (improving the quality of web surveys: the Checklist for Reporting Results of Internet E-Surveys) checklist. The survey explored three main aspects: high-quality markers of guidelines, knowledge of guideline development, and areas for improvement. The survey was conducted by contacting UEG and affiliated societies by email and via social media. All valid answers to each question were counted. Results: A total of 585 participants responded during the 3-month period. Some 65.8% were aged between 30 and 60 years, and 75.4% were doctors. The most important perceived quality indicators within a guideline were ‘clear and actionable recommendations (97%)’, followed by ‘based on systematic literature review’ (96%), and ‘transparent methodology’ (90%). 230 (39.3%) respondents were previously involved in clinical guideline development. However, the experience of working with a methodologist (18.8%) and using well-established guideline checklists (AGREE-II [21.0%]), RIGHT (Reporting Items for Practice guidelines in HealThcare) (9.9%) were limited. Just under half of the responders (289, 49.4%) were familiar with the GRADE methodology. Apps (78.5%), webinars (73.8%), and short videos (68.2%) were popular tools to access clinical guidelines. Over 90% of responders stated that the reputation of the journal (92%) and the name of the society involved in guideline development (91%) were important. Two-thirds of the responders preferred to see abridged versions of guidelines and 69.2% preferred freely accessible or open access guidelines. Conclusion: Consumers are keen to read clear and actionable guidelines that are developed transparently. There is a gap in guideline development knowledge. Initiatives by medical journals and professional societies are important to ensure the development of accessible and robust clinical guidelines.<p/

preoperative therapy with trastuzumab and oral vinorelbine endocrine therapy in patients with her2 positive breast cancer

Abstract Background Combined trastuzumab and intravenous vinorelbine yielded high clinical activity as preoperative treatment in patients (pts) with HER 2/ neu positive breast cancer. Patients and methods We tested a preoperative combination of trastuzumab with oral vinorelbine (oV) in pts with locally advanced (T2-T4 N0-3 M0) HER2-positive breast cancer. Trastuzumab was administered i.v q 3 wks and oV was administered at the dose of 55 mg/sqm on days 1 and 3 q 3 wks, for 8 courses. Pts with ER ≥ 10% tumors received endocrine therapy with letrozole 2.5 mg/day, plus monthly triptorelin if premenopausal. Results Forty-five pts entered the study. The overall response rate (CR + PR) was 76% (95% CI: 60%–87%). pCR was observed in 4 pts (10%). Among ER-positive tumors 21/25 pts obtained a clinical response (84%) and two pts obtained a pCR (8%). Conclusions The combination of trastuzumab and oral vinorelbine demonstrated encouraging activity in patients with HER 2 positive ER-positive tumors. Alternative strategies should be investigated in patients with endocrine non responsive disease