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43 results on '"La Selva, Danielle"'

13. Tagging incidental finding of fatty liver on ultrasound: A novel intervention to improve early detection of liver fibrosis

Author

Nagra, Navroop, Penna, Rubal, La Selva, Danielle, Coy, David, Siddique, Asma, and Burman, Blaire

Subjects
nonalcoholic fatty liver disease, ultrasound, risk factors, Original Article, nonalcoholic steatohepatitis, liver fibrosis
Abstract

Background: It is not uncommon to see that a large proportion of patients with cirrhosis due to nonalcoholic steatohepatitis never had any prior evaluation or diagnosis of liver disease, and most of the times their first clinical presentation is decompensated cirrhosis. Acknowledging incidental finding of fatty liver on abdominal imaging and identifying patients at risk of having advanced liver fibrosis may help in preventing its progression to cirrhosis. Aim: We aimed to increase acknowledgement and improve evaluation of steatosis through radiology recommendation to consider hepatology referral, and to identify the predictors of hepatology referral and significant fibrosis. Methods: We performed a retrospective study of 812 patients with hepatic steatosis tagged on ultrasound (US), over 18 months, at a single center. Patients with secondary causes of fatty liver were excluded from the study. We evaluated the yield of this intervention and factors correlated with hepatology referral and presence of significant fibrosis. Results: Diagnosis of fatty liver was acknowledged for 69% of patients with tagged US, although only 29% were ultimately seen by hepatology. Patients who had US ordered by a primary care provider (PCP) were more likely to have hepatology evaluation (64.8% vs. 56.9%, P = 0.0183). Sixty-six percent of patients seen by hepatology had elevated alanine transaminase (ALT) compared to 52% not seen by hepatology (P < 0.0005). Among patients further evaluated, 53% underwent staging, and 18% had ≥stage 2 (F2) fibrosis. Type II diabetes correlated with significant to advanced fibrosis (43.5% vs. 21.4%, P = 0.0357), while ALT and Body Mass Index did not. Conclusions: Tagging US reports led to clinical acknowledgement of fatty liver in 7 of 10 patients, although fewer than 1 in 3 had further hepatology evaluation. Of those who underwent staging for incidentally noted steatosis, 18% had significant fibrosis, suggesting that we are failing to evaluate patients with potentially advanced liver disease. Relevance for Patients: Identifying incidental finding of fatty liver on US provides a unique opportunity in diagnosing liver fibrosis at an early stage and can help prevent its progression to cirrhosis. PCP should consider using noninvasive scoring systems on a regular basis to assess the risk of fibrosis in patients with fatty liver, and timely referral to hepatology should be provided in patients at high risk of having advanced fibrosis.

Published
2021

15. Safety and clinical outcomes of early dual modality drainage (< 28 days) compared to later drainage of pancreatic necrotic fluid collections: a propensity score-matched study

Author

Bomman, Shivanand, primary, Sanders, David, additional, Coy, David, additional, La Selva, Danielle, additional, Pham, Quincy, additional, Zehr, Troy, additional, Law, Joanna, additional, Larsen, Michael, additional, Irani, Shayan, additional, Kozarek, Richard A., additional, Ross, Andrew, additional, and Krishnamoorthi, Rajesh, additional

Published
2022
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16. EUS-GASTROENTEROSTOMY VERSUS SURGICAL GASTROENTEROSTOMY FOR THE MANAGEMENT OF MALIGNANT GASTRIC OUTLET OBSTRUCTION – A MULTICENTER STUDY

Author

Bomman, Shivanand, primary, Canakis, Andrew, additional, Sharaiha, Reem Z., additional, Benias, Petros C., additional, Ma, Michael, additional, Trindade, Arvind J., additional, La Selva, Danielle, additional, Law, Joanna K., additional, Larsen, Michael, additional, Ross, Andrew, additional, Krishnamoorthi, Rajesh, additional, and Irani, Shayan S., additional

Published
2022
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24. Nurse-Administered Propofol Continuous Infusion Sedation: A New Paradigm for Gastrointestinal Procedural Sedation

Author

Lin, Otto S., primary, La Selva, Danielle, additional, Kozarek, Richard A., additional, Weigel, Wade, additional, Beecher, Ryan, additional, Gluck, Michael, additional, Chiorean, Michael, additional, Boden, Elisa, additional, Venu, Nanda, additional, Krishnamoorthi, Rajesh, additional, Larsen, Michael, additional, and Ross, Andrew, additional

Published
2020
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26. Nurse-Administered Propofol Continuous Infusion Sedation: A New Paradigm for Gastrointestinal Procedural Sedation.

Author

Lin, Otto S., La Selva, Danielle, Kozarek, Richard A., Weigel, Wade, Beecher, Ryan, Gluck, Michael, Chiorean, Michael, Boden, Elisa, Venu, Nanda, Krishnamoorthi, Rajesh, Larsen, Michael, and Ross, Andrew

Subjects
*COLONOSCOPY, *DIGESTIVE system endoscopic surgery, *PROPOFOL, *DRUG administration, *PATIENT satisfaction
Abstract

INTRODUCTION: Nurse-Administered Propofol Continuous Infusion Sedation (NAPCIS) is a new nonanesthesia propofol delivery method for gastrointestinal endoscopy. NAPCIS is adopted from the computer-assisted propofol sedation (CAPS) protocol. We evaluated the effectiveness, efficiency, and safety of NAPCIS in low-risk subjects. METHODS: Between December 2016 and July 2017, patients who underwent esophagogastroduodenoscopy or colonoscopy with NAPCIS at our center were compared against 2 historical control groups of similar patients who had undergone procedures with CAPS or midazolam and fentanyl (MF) sedation. RESULTS: The mean age of the NAPCIS cohort (N = 3,331) was 55.2 years (45.8% male) for 945 esophagogastroduodenoscopies and 57.8 years (48.7% male) for 2,386 colonoscopies. The procedural success rates with NAPCIS were high (99.1%-99.2%) and similar to those seen in 3,603 CAPS (98.8%-99.0%) and 3,809 MF (99.0%-99.3%) controls. NAPCIS recovery times were shorter than both CAPS and MF (24.8 vs 31.7 and 52.4 minutes, respectively; P < 0.001). On arrival at the recovery unit, 86.6% of NAPCIS subjects were recorded as "Awake" compared with 82.8% of CAPS and 40.8% of MF controls (P < 0.001). Validated clinician and patient satisfaction scores were generally higher for NAPCIS compared with CAPS and MF subjects. For NAPCIS, there were only 4 cases of oxygen desaturation requiring transient mask ventilation and no serious sedation-related complications. These low complication rates were similar to those seen with CAPS (8 cases of mask ventilation) and MF (3 cases). DISCUSSION: NAPCIS seems to be a safe, effective, and efficient means of providing moderate sedation for upper endoscopy and colonoscopy in low-risk patients. [ABSTRACT FROM AUTHOR]

Published
2021
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32. One year experience with computer-assisted propofol sedation for colonoscopy

Author

Lin, Otto S, primary, La Selva, Danielle, additional, Kozarek, Richard A, additional, Tombs, Deborah, additional, Weigel, Wade, additional, Beecher, Ryan, additional, Koch, Johannes, additional, McCormick, Susan, additional, Chiorean, Michael, additional, Drennan, Fred, additional, Gluck, Michael, additional, Venu, Nanda, additional, Larsen, Michael, additional, and Ross, Andrew, additional

Published
2017
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