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Item does not contain fulltext, BACKGROUND: In collaboration with United European Gastroenterology, the working group on 'Harmonizing diagnosis and treatment of chronic pancreatitis across Europe' (HaPanEU) developed European guidelines for the management of chronic pancreatitis using an evidence-based approach. METHODS: Recommendations of multidisciplinary review groups based on systematic literature reviews to answer predefined clinical questions are summarised. Recommendations are graded using the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS: Recommendations covered topics related to the clinical management of chronic pancreatitis: aetiology, diagnosis of chronic pancreatitis with imaging, diagnosis of pancreatic exocrine insufficiency, surgical therapy, medical therapy, endoscopic therapy, treatment of pancreatic pseudocysts, pancreatic pain, nutrition and malnutrition, diabetes mellitus and the natural course of the disease and quality of life. CONCLUSIONS: The HaPanEU/United European Gastroenterology guidelines provide evidence-based recommendations concerning key aspects of the medical and surgical management of chronic pancreatitis based on current available evidence. These recommendations should serve as a reference standard for existing management of the disease and as a guide for future clinical research. This article summarises the HaPanEU recommendations and statements.

Contains fulltext : 169869.pdf (Publisher’s version ) (Open Access), BACKGROUND: There have been substantial improvements in the management of chronic pancreatitis, leading to the publication of several national guidelines during recent years. In collaboration with United European Gastroenterology, the working group on 'Harmonizing diagnosis and treatment of chronic pancreatitis across Europe' (HaPanEU) developed these European guidelines using an evidence-based approach. METHODS: Twelve multidisciplinary review groups performed systematic literature reviews to answer 101 predefined clinical questions. Recommendations were graded using the Grading of Recommendations Assessment, Development and Evaluation system and the answers were assessed by the entire group in a Delphi process online. The review groups presented their recommendations during the 2015 annual meeting of United European Gastroenterology. At this one-day, interactive conference, relevant remarks were voiced and overall agreement on each recommendation was quantified using plenary voting (Test and Evaluation Directorate). After a final round of adjustments based on these comments, a draft version was sent out to external reviewers. RESULTS: The 101 recommendations covered 12 topics related to the clinical management of chronic pancreatitis: aetiology (working party (WP)1), diagnosis of chronic pancreatitis with imaging (WP2 and WP3), diagnosis of pancreatic exocrine insufficiency (WP4), surgery in chronic pancreatitis (WP5), medical therapy (WP6), endoscopic therapy (WP7), treatment of pancreatic pseudocysts (WP8), pancreatic pain (WP9), nutrition and malnutrition (WP10), diabetes mellitus (WP11) and the natural course of the disease and quality of life (WP12). Using the Grading of Recommendations Assessment, Development and Evaluation system, 70 of the 101 (70%) recommendations were rated as 'strong' and plenary voting revealed 'strong agreement' for 99 (98%) recommendations. CONCLUSIONS: The 2016 HaPanEU/United European Gastroenterology guidelines provide evidence-bas

Final Report to Welsh Government, prepared by CEH on behalf of the Glastir Monitoring & Evaluation Programme Team. The Glastir Monitoring and Evaluation Programme (GMEP) provides a comprehensive programme to establish a baseline against which future assessments of Glastir can be made. GMEP also contributes national trend data which supports a range of national and international biodiversity and environmental targets. GMEP fulfils a commitment by the Welsh Government to establish a monitoring programme concurrently with the launch of the Glastir scheme. The use of models and farmer surveys provides early indicators of the likely direction, magnitude and timing of future outcomes. The programme ensures compliance with the rigorous requirements of the European Commission’s Common Monitoring and Evaluation Framework (CMEF) through the Rural Development Plan (RDP) for Wales. This report represents the final results of the GMEP programme which ran from 2012 to 2016.

The overwhelming post splenectomy infection (OPSI) in splenectomised patients is a rare but severe infection mostly caused by encapsulated bacteria. We analyse the case of a 65-year-old female patient who was presented with clinical and laboratory findings indicating gastroenteritis. Two years years before admission, the patient underwent a splenectomy for a two stage splenic rupture following resuscitation for pulmonary embolism. Immunisation of the patient was complete and timely. As a result of the unspecific clinical presentation, there was a delay in administration of antibiotics. However, administration of antibiotics induced a fulminant shock. The patient died 4 hours after attending the hospital due to a pneumococcal sepsis. The discussion highlights epidemiological and pathophysiological aspects and potential prevention strategies in the international context. Vaccination failed in our patient as the isolated pneumococcal strain (serogroup: 12F) is usually covered by the 23-valent pneumococcal polysaccharide vaccination (Pneumovax®). The case reported here indicates that there may be a potential benefit of prophylactic antibiotic treatment within the first 3 years after splenectomy for patients above the age of 65 years. Awareness of OPSI (prevention strategies, symptoms and treatment) among patients and their treating physicians is crucial for the improvement of prognosis. We partly address these issues in a standard operating procedure for the assessment of splenectomised patients in our departments of emergency medicine., Die Post-Splenektomie-Sepsis ist eine seltene, häufig tödlich verlaufende Erkrankung bei splenektomierten Patienten, die überwiegend durch kapseltragende Bakterien verursacht wird. Wir berichten den Fall einer 65-jährigen Patientin, die sich aufgrund von seit 12 Stunden bestehendem, allgemeinen Krankheitsgefühl, Übelkeit, Erbrechen und Durchfall in der Notaufnahme vorstellte. Zwei Jahre zuvor war sie aufgrund einer fulminanten Lungenembolie reanimationspflichtig geworden. Im Anschluss daran entwickelte die Patientin eine zweizeitige Milzruptur. Die Milz wurde entfernt und empfohlene Impfungen zeitgerecht verabreicht. Die Zusammenschau der initial erhobenen Befunde machte die Diagnose einer Gastroenteritis wahrscheinlich. Dies wiederum führte zu einer verzögerten Antibiotikagabe. Die Antibiotikagabe wiederum löste ein fulminantes Schockgeschehen aus. Die Patientin verstarb 4 Stunden nach Krankenhausaufnahme an einer Post-Splenektomie-Pneumokokken-Sepsis. Die Diskussion widmet sich der Epidemiologie der Erkrankung, dem Verlauf der Erkrankung und den möglichen Präventionsstrategien. In der Zusammenschau kann die Aufklärung der betroffenen Patienten über die Notwendigkeit, auch bei geringen Infektionssymptomen ihren Arzt aufzusuchen nicht überbewertet werden. Auch die Bereitschaft der behandelnden Ärzte, auf den bloßen Verdacht hin bereits intravenös Antibiotika zu verabreichen, ist mitentscheidend. Wir haben daher eine Standard-Arbeitsanweisung für splenektomierte Patienten in unseren Notaufnahmen implementiert. Zudem wirft die Diskussion des Falles die Frage eines möglichen Nutzens einer prophylaktischen Antibiotika-Therapie bei über 65-jährigen Patienten auf (analog zu den Empfehlungen für Kinder).

What is the purpose of Glastir Monitoring and Evaluation Programme? Glastir is the main scheme by which the Welsh Government pays for environmental goods and services whilst the Glastir Monitoring and Evaluation Programme (GMEP) evaluates the scheme’s success. Commissioning of the monitoring programme in parallel with the launch of the Glastir scheme provides fast feedback and means payments can be modified to increase effectiveness. The Glastir scheme is jointly funded by the Welsh Government (through the Rural Development Plan) and the EU. GMEP will also support a wide range of other national and international reporting requirements. What is the GMEP approach? GMEP collects evidence for the 6 intended outcomes from the Glastir scheme which are focussed on climate change, water and soil quality, biodiversity, landscape, access and historic environment, woodland creation and management. Activities include; a national rolling monitoring programme of 1km squares; new analysis of long term data from other schemes combining with GMEP data where possible; modelling to estimate future outcomes so that adjustments can be made to maximise impact of payments; surveys to assess wider socio-economic benefits; and development of novel technologies to increase detection and efficiency of future assessments. How has GMEP progressed in this 2nd year? 90 GMEP squares were surveyed in Year 2 to add to the 60 completed in Year 1 resulting in 50% of the 300 GMEP survey squares now being completed. Squares will be revisited on a 4 year cycle providing evidence of change in response to Glastir and other pressures such as changing economics of the farm business, climate change and air pollution. This first survey cycle collects the baseline against which future changes will be assessed. This is important as GMEP work this year has demonstrated land coming into the scheme is different in some respects to land outside the scheme. Therefore, future analysis to detect impact of Glastir will