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Gastrointestinal system
Published in David A Lisle, Imaging for Students, 2012
Acute mesenteric ischaemia (AMI) is caused by abrupt disruption of blood flow to the bowel. AMI usually presents with sudden onset of severe abdominal pain and bloody diarrhoea. The goal of diagnosis and therapy in AMI is prevention or limitation of bowel infarction. Prompt diagnosis requires a high index of suspicion and early referral for angiography in patients with clinical evidence of AMI. The most common causes of AMI are superior mesenteric artery (SMA) embolus, SMA thrombosis and non-occlusive SMA vasospasm. In the case of SMA embolus, the patient may have a history of cardiac disease, previous embolic event or simultaneous peripheral artery embolus. SMA thrombosis is usually associated with an underlying stenotic atherosclerotic lesion in the SMA.
Intraobserver and interobserver reliability of visible light spectroscopy during upper gastrointestinal endoscopy
Published in Expert Review of Medical Devices, 2018
Louisa J.D. van Dijk, Twan van der Wel, Desirée van Noord, Adriaan Moelker, Hence J.M. Verhagen, Daan Nieboer, Ernst J. Kuipers, Marco J. Bruno
Chronic mesenteric ischemia (CMI) is defined as ischemic symptoms caused by insufficient blood supply to the gastrointestinal tract [1]. CMI affects the upper gastrointestinal tract, while colonic ischemia affects the lower gastrointestinal tract. Patients with CMI may present with a range of symptoms, including postprandial abdominal pain and weight loss, malabsorption, villous atrophy, and gastroduodenal ulceration. These result from insufficient mesenteric blood flow, usually caused by atherosclerotic stenosis of the supplying gastrointestinal arteries. For long, a diagnosis of CMI could only be based on symptoms, physical exam, and vascular imaging. The lack of a functional test was an important shortcoming, likely leading to underdiagnosis and overdiagnosis of CMI. In recent years, substantial research efforts led to two functional tests; tonometry [2,3] and more recently visible light spectroscopy (VLS) [4,5]. VLS oximetry is a technique to determine the mucosal capillary hemoglobin oxygen saturation [6] by closely mimicking the widely used pulse oximetry. VLS performed during upper endoscopy allows measuring the oxygen saturation of the mucosa of the upper gastrointestinal tract. CMI is characterized by decreased mucosal saturation. Functional testing by means of VLS thus represents a tool for diagnosis of CMI and this technique is currently used in clinical practice for the diagnostic workup of patients suspected of CMI [7].
Towards a Triadic Quality Measurement Framework for U.S. Healthcare
Published in Quality Management Journal, 2018
Subhajit Chakraborty, Hale Kaynak
Hospital quality performance measurement has been in vogue for quite a few years, albeit it may be known by different names such as overall hospital star rating and may be calculated differently by many organizations. On one hand, it could be fairly sophisticated as using 10 Hospital Quality Alliance (HQA) performance indicators to calculate a summary performance score for each of the three clinical conditions [acute mesenteric ischemia acute myocardial infarction] (AMI) or heart attack, congestive heart failure (CHF), and pneumonia (Jha et al. 2007). On the other hand, it could be as simple as averaging all hospital star ratings given by patients or their families on websites like Healthgrades, RateMDs, Vitals, and Yelp. As a third example, the overall hospital star ratings introduced by the Centers for Medicare and Medicaid Services (CMS) in 2015 (CMSc 2016) could be considered. The current (2016) CMS overall hospital rating follows a detailed methodology using 57 items from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey grouped into seven subcategories. HCAHPS is a patient satisfaction survey required by CMS for all hospitals in the United States (Cahill and Wang 2012).