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يتناول كتاب (التخطيط الاستراتيجي للمشروعات) والذي قام بتأليفه سكوت سافرانسكي وإيك وان وون في حوالي (35) صفحة من القطع المتوسط موضوع (إدارة المشروعات) مستعرضا المحتويات التالية : البيئة المحيطة بالعمل، الإدارة المستقبلية مقابل الإدارة التفاعلية، الحاجة إلى خطة استراتيجية، تطوير خطة استراتيجية، خطة العمل، تنفيذ الاستراتيجية.

ObjectiveSphincter of Oddi disorders (SOD) are contentious conditions in patients whose abdominal pain, idiopathic acute pancreatitis (iAP) might arise from pressurisation at the sphincter of Oddi. The present study aimed to measure the benefit of sphincterotomy for suspected SOD.DesignProspective cohort conducted at 14 US centres with 12 months follow-up. Patients undergoing first-time endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy for suspected SOD were eligible: pancreatobiliary-type pain with or without iAP. The primary outcome was defined as the composite of improvement by Patient Global Impression of Change (PGIC), no new or increased opioids and no repeat intervention. Missing data were addressed by hierarchal, multiple imputation scheme.ResultsOf 316 screened, 213 were enrolled with 190 (89.2%) of these having a dilated bile duct, abnormal labs, iAP or some combination. By imputation, an average of 122/213 (57.4% (95% CI 50.4% to 64.4%)) improved; response rate was similar for those with complete follow-up (99/161, 61.5% (54.0% to 69.0%)); of these, 118 (73.3%) improved by PGIC alone. Duct size, elevated labs and patient characteristics were not associated with response. AP occurred in 37/213 (17.4%) at a median of 6 months post ERCP and was more likely in those with a history of AP (30.9% vs 2.9%, p<0.0001).ConclusionNearly 60% of patients undergoing ERCP for suspected SOD improve, although the contribution of a placebo response is unknown. Contrary to prevailing belief, duct size and labs are poor response predictors. AP recurrence was common and like observations from prior non-intervention cohorts, suggesting no benefit of sphincterotomy in mitigating future AP episodes.

Pancreatic cystic neoplasms are discovered with increasing frequency. Accurate knowledge of the natural history of cystic neoplasms is crucial to develop useful and cost-effective strategies for surveillance and surgical resection. To date, the natural history of cystic neoplasms is still incomplete due to lack of adequate diagnostic accuracy in the absence of surgical pathology. Nevertheless, current evidence points to risk factors for malignant transformation to help clinical management. New biomarkers that accurately distinguish cyst neoplasms and those most likely to progress to cancer would help clarify the natural history of cystic neoplasms.

BackgroundPancreatic fluid collections (PFCs) may recur after resolution with endoscopic transmural drainage (ETD) and standard stent removal (SSR). Herein, we compared the efficacy and safety of leaving long-term indwelling plastic stents (LTIS) vs. standard stent removal after PFC resolution with ETD.MethodsWe performed a systematic review of MEDLINE, EMBASE, CINAHL, Scopus, and Cochrane databases from inception to September 2022. Full-text articles comparing long-term (> 6 months) outcomes of LTIS and SSR were eligible, as well as single-arm studies with ≥ 10 patients with LTIS. Two independent reviewers selected studies, extracted data, and assessed the risk of bias using the Newcastle–Ottawa Scale. Measured outcomes included the following: (A) PFC recurrence; (B) interventions for PFC recurrence; (C) technical success; and (D) adverse events (AEs). Meta-analysis was carried out using random-effects models.ResultsWe included 16 studies, encompassing 1285 patients. Compared to SSR after PFC resolution with ETD, LTIS was associated with significantly lower risk of PFC recurrence (3% vs. 23%; OR 0.22 [95%CI 0.09–0.52]; I2 = 45%) and need for interventions (2% vs. 14%; OR 0.35 [95%CI 0.16–0.78]; I2 = 0%). The superiority of LTIS on reducing PFC recurrence was found with walled-off necrosis, with or without disconnected pancreatic duct, and with placement of ≥ 2 LTIS. When using LTIS, the pooled proportion of AEs was 8% (95%CI 4–11%) and technical success was 93% (95%CI 86–99%).ConclusionsOur results show that LTIS after PFC resolution with ETD is feasible, safe, and superior to SSR in reducing the risk of PFC recurrence and need for interventions.

The risk of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis has been extensively studied; however, non-pancreatic adverse events, such as cholangitis, bleeding, and cardiopulmonary complications, are under characterized. We aimed to characterize the 30-day incidence and financial burden of non-pancreatic post-ERCP adverse events.INTRODUCTIONThe risk of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis has been extensively studied; however, non-pancreatic adverse events, such as cholangitis, bleeding, and cardiopulmonary complications, are under characterized. We aimed to characterize the 30-day incidence and financial burden of non-pancreatic post-ERCP adverse events.We performed a cross-sectional analysis using the Merative MarketScan commercial claims database from January 1, 2019 to December 31, 2021. The study included 27,482 patients who underwent 42,318 inpatient and outpatient ERCPs. Primary outcomes were post-ERCP cholangitis, bleeding, and cardiopulmonary complications within 30 days. Financial burden was measured using total direct healthcare costs and out-of-pocket costs during the 30-day period after ERCP. Multivariable logistic regression was used to identify associated risk factors and to estimate adjusted costs.METHODSWe performed a cross-sectional analysis using the Merative MarketScan commercial claims database from January 1, 2019 to December 31, 2021. The study included 27,482 patients who underwent 42,318 inpatient and outpatient ERCPs. Primary outcomes were post-ERCP cholangitis, bleeding, and cardiopulmonary complications within 30 days. Financial burden was measured using total direct healthcare costs and out-of-pocket costs during the 30-day period after ERCP. Multivariable logistic regression was used to identify associated risk factors and to estimate adjusted costs.Among 27,482 patients who underwent a total of 42,318 ERCPs, non-pancreatic adverse events occurred in 5.3% of cases: cholangitis in 3.6% (95%CI 3.5%-3.8%), bleeding in 1.3% (95%CI 1.2%-1.4%), and cardiopulmonary complications in 1.1% (95% CI 1.0-1.3). In multivariable analysis, adverse events were more common among men and those with higher comorbidity burden. Patients with complications had significantly higher adjusted 30-day costs: cholangitis ($38,512 vs. $30,881, difference $7,631), bleeding ($43,702 vs. $30,918; difference $12,748), and cardiopulmonary complications ($53,649 vs. $30,918; difference $22,930). Out-of-pocket costs varied by region and insurance type but exceeded $1000 for many patients.RESULTSAmong 27,482 patients who underwent a total of 42,318 ERCPs, non-pancreatic adverse events occurred in 5.3% of cases: cholangitis in 3.6% (95%CI 3.5%-3.8%), bleeding in 1.3% (95%CI 1.2%-1.4%), and cardiopulmonary complications in 1.1% (95% CI 1.0-1.3). In multivariable analysis, adverse events were more common among men and those with higher comorbidity burden. Patients with complications had significantly higher adjusted 30-day costs: cholangitis ($38,512 vs. $30,881, difference $7,631), bleeding ($43,702 vs. $30,918; difference $12,748), and cardiopulmonary complications ($53,649 vs. $30,918; difference $22,930). Out-of-pocket costs varied by region and insurance type but exceeded $1000 for many patients.Non-pancreatic ERCP adverse events occur in over 5% of cases and can impose a substantial financial burden on both healthcare systems and patients.DISCUSSIONNon-pancreatic ERCP adverse events occur in over 5% of cases and can impose a substantial financial burden on both healthcare systems and patients.

The risk of postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis has been extensively studied; however, nonpancreatic adverse events, such as cholangitis, bleeding, and cardiopulmonary complications, are under characterized. We aimed to characterize the 30-day incidence and financial burden of nonpancreatic post-ERCP adverse events. We performed a cross-sectional analysis using the Merative MarketScan commercial claims database from January 1, 2019 to December 31, 2021. The study included 27,482 patients who underwent 42,318 inpatient and outpatient ERCPs. Primary outcomes were post-ERCP cholangitis, bleeding, and cardiopulmonary complications within 30 days. Financial burden was measured using total direct healthcare costs and out-of-pocket costs during the 30-day period after ERCP. Multivariable logistic regression was used to identify associated risk factors and to estimate adjusted costs. Among 27,482 patients who underwent a total of 42,318 ERCPs, nonpancreatic adverse events occurred in 5.3% of cases: cholangitis in 3.6% (95% confidence interval [CI] 3.5%-3.8%), bleeding in 1.3% (95% CI 1.2%-1.4%), and cardiopulmonary complications in 1.1% (95% CI 1.0-1.3). In multivariable analysis, adverse events were more common among men and those with higher comorbidity burden. Patients with complications had significantly higher adjusted 30-day costs: cholangitis ($38,512 vs $30,881, difference $7,631), bleeding ($43,702 vs $30,918; difference $12,748), and cardiopulmonary complications ($53,649 vs $30,918; difference $22,930). Out-of-pocket costs varied by region and insurance type but exceeded $1,000 for many patients. Nonpancreatic ERCP adverse events occur in over 5% of cases and can impose a substantial financial burden on both healthcare systems and patients.

Background Esophageal fully covered self-expandable metal stents (FCSEMS) are indicated for the management of benign and malignant conditions of the esophagus including perforations, leaks, and strictures. FCSEMS are resistant to tissue ingrowth and are removable; however, stent migration occurs in 30–55% of cases. Endoscopic suture fixation of FCSEMS has been utilized to decrease the risk of stent migration though data supporting this practice remain limited. The primary aim of this study was to compare clinical outcomes and migration rate of patients who underwent placement of esophageal FCSEMS with and without endoscopic suture fixation. Methods Our single-center, retrospective, cohort study includes patients who underwent esophageal FCSEMS placement with and without endoscopic suture fixation between January 1, 2012, and November 11, 2015. Baseline patient characteristics, procedural details, and clinical outcomes were abstracted. Logistic regression was performed to identify clinical and technical factors associated with outcomes and stent migration. Results A total of 51 patients underwent 62 FCSEMS placements, including 21 procedures with endoscopic suture fixation and 41 without. Suture fixation was associated with reduced risk of stent migration (OR 0.13, 95% CI 0.03–0.47). Prior stent migration was associated with significantly higher risk of subsequent migration (OR 6.4, 95% CI 1.6–26.0). Stent migration was associated with lower likelihood of clinical success (OR 0.21, 95% CI 0.06–0.69). There was a trend toward higher clinical success among patients undergoing suture fixation (85.7 vs. 60.9%, p  = 0.07). Conclusions Endoscopic suture fixation of FCSEMS was associated with a reduced stent migration rate. Appropriate patient selection for suture fixation of FCSEMS may lead to reduced migration in high-risk patients.