Modified Socratic Method (planned and executed by Takada) for Medical Education: Grade II Acute Cholecystitis of Tokyo Guidelines 2018 as an Example Case

2021 ◽  
Author(s):  
Tadahiro Takada ◽  
Shuji Isaji ◽  
Masahiro Yoshida ◽  
Akihiko Horiguchi ◽  
Hisami Ando ◽  
...  
Keyword(s):  
Medical Education ◽  
Acute Cholecystitis ◽  
Socratic Method ◽  
Tokyo Guidelines ◽  
Grade Ii

scholarly journals COVID-19 outbreak and acute cholecystitis in a Hub Hospital in Milan: wider indications for percutaneous cholecystostomy

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Matteo Barabino ◽  
Gaetano Piccolo ◽  
Arianna Trizzino ◽  
Veronica Fedele ◽  
Carlo Ferrari ◽  
...  
Keyword(s):  
Acute Cholecystitis ◽  
Percutaneous Cholecystostomy ◽  
Disease Evolution ◽  
Tokyo Guidelines ◽  
Gallbladder Drainage ◽  
National Health Care ◽  
Percutaneous Transhepatic Gallbladder Drainage ◽  
Italian National Health ◽  
Grade Ii ◽  
The Mean

Abstract Background COVID-19 pandemic has impacted the Italian National Health Care system at many different levels, causing a complete reorganization of surgical wards. In this context, our study retrospectively analysed the management strategy for patients with acute cholecystitis. Methods We analysed all patients admitted to our Emergency Department for acute cholecystitis between February and April 2020 and we graded each case according to 2018 Tokyo Guidelines. All patients were tested for positivity to SARS-CoV-2 and received an initial conservative treatment. We focused on patients submitted to cholecystostomy during the acute phase of pandemic and their subsequent disease evolution. Results Thirty-seven patients were admitted for acute cholecystitis (13 grade I, 16 grade II, 8 grade III). According to Tokyo Guidelines (2018), patients were successfully treated with antibiotic only, bedside percutaneous transhepatic gallbladder drainage (PC) and laparoscopic cholecystectomy (LC) in 29.7%, 21.6% and 48.7% of cases respectively. Therapeutic strategy of three out of 8 cases, otherwise fit for surgery, submitted to bedside percutaneous transhepatic gallbladder drainage (37.5%), were directly modified by COVID-19 pandemic: one due to the SARS-CoV-2 positivity, while two others due to unavailability of operating room and intensive care unit for post-operative monitoring respectively. Overall success rate of percutaneous cholecystostomy was of 87.5%. The mean post-procedural hospitalization length was 9 days, and no related adverse events were observed apart from transient parietal bleeding, conservatively treated. Once discharged, two patients required readmission because of acute biliary symptoms. Median time of drainage removal was 43 days and only 50% patients thereafter underwent cholecystectomy. Conclusions Percutaneous cholecystostomy has shown to be an effective and safe treatment thus acquiring an increased relevance in the first phase of the pandemic. Nowadays, considering we are forced to live with the SARS-CoV-2 virus, PC should be considered as a virtuous, alternative tool for potentially all COVID-19 positive patients and selectively for negative cases unresponsive to conservative therapy and unfit for surgery.

scholarly journals COVID-19 outbreak and acute cholecystitis in a Hub Hospital in Milan: wider indications for percutaneous cholecystostomy.

2020 ◽  
Author(s):  
Barabino Matteo ◽  
Piccolo Gaetano ◽  
Trizzino Arianna ◽  
Fedele Veronica ◽  
Ferrari Carlo ◽  
...  
Keyword(s):  
Acute Cholecystitis ◽  
Tokyo Guidelines ◽  
Gallbladder Drainage ◽  
National Health Care ◽  
Percutaneous Transhepatic Gallbladder Drainage ◽  
Italian National Health ◽  
Grade Ii ◽  
The Mean ◽  
Different Levels ◽  
Operative Monitoring

Abstract BACKGROUND.COVID-19 pandemic has impacted the Italian national health care system at many different levels, causing a complete reorganization of surgical wards. In this context, in this study we retrospectively analyzed our management strategy for patients with acute cholecystitis.METHODSWe analyzed all patients admitted to our Emergency Department for acute cholecystitis from February 27th to April 30th, 2020. We graded each case according to the 2018 Tokyo Guidelines. All patients were tested for positivity to SARS-CoV-2 and received an initial conservative treatment. RESULTSThirty-seven patients were admitted for acute cholecystitis (13 grade I, 16 grade II and 8 grade III). According to Tokyo Guidelines 2018, patients were successfully treated with antibiotic only, bedside percutaneous transhepatic gallbladder drainage and laparoscopic cholecystectomy in 29.7%, 21.6 % and 48.7% of cases respectively. Therapeutic strategy of three out of 8 cases, otherwise fit for surgery, submitted to percutaneous transhepatic gallbladder drainage (37.5%), were directly modified by COVID-19 pandemic: one due to the SARS-CoV-2 positivity, while two others due to unavailability of operating room and intensive care unit for post-operative monitoring respectively. Overall success rate of percutaneous drainage was of 87.5%, the mean post-procedural hospitalization length was 9 days, and no related adverse event were observed.CONCLUSIONS.Bedside cholecystostomy has shown to be an effective and safe treatment, which acquired an increased relevance in the present acute phase of the pandemic. This strategy will potentially be taken into consideration in future phases, when the coexistence with the virus will require us to respond in an even more virtuous fashion.

scholarly journals COVID-19 Outbreak and Acute Cholecystitis in a Hub Hospital in Milan: Wider Indications for Percutaneous Cholecystostomy.

2020 ◽  
Author(s):  
Matteo Barabino ◽  
Gaetano Piccolo ◽  
Arianna Trizzino ◽  
Veronica Fedele ◽  
Carlo Ferrari ◽  
...  
Keyword(s):  
Acute Cholecystitis ◽  
Tokyo Guidelines ◽  
Gallbladder Drainage ◽  
National Health Care ◽  
Percutaneous Transhepatic Gallbladder Drainage ◽  
Italian National Health ◽  
Grade Ii ◽  
The Mean ◽  
Different Levels ◽  
Operative Monitoring

Abstract BACKGROUND.COVID-19 pandemic has impacted the Italian national health care system at many different levels, causing a complete reorganization of surgical wards. In this context, in this study we retrospectively analyzed our management strategy for patients with acute cholecystitis.METHODS.We analyzed all patients admitted to our Emergency Department for acute cholecystitis from February 27th to April 30th, 2020. We graded each case according to the 2018 Tokyo Guidelines. All patients were tested for positivity to SARS-CoV-2 and received an initial conservative treatment. RESULTS.Thirty-seven patients were admitted for acute cholecystitis (13 grade I, 16 grade II and 8 grade III). According to Tokyo Guidelines 2018, patients were successfully treated with antibiotic only, bedside percutaneous transhepatic gallbladder drainage and laparoscopic cholecystectomy in 29.7%, 21.6 % and 48.7% of cases respectively. Therapeutic strategy of three out of 8 cases, otherwise fit for surgery, submitted to percutaneous transhepatic gallbladder drainage (37.5%), were directly modified by COVID-19 pandemic: one due to the SARS-CoV-2 positivity, while two others due to unavailability of operating room and intensive care unit for post-operative monitoring respectively. Overall success rate of percutaneous drainage was of 87.5%, the mean post-procedural hospitalization length was 9 days, and no related adverse event were observed.CONCLUSIONS.Bedside cholecystostomy has shown to be an effective and safe treatment, which acquired an increased relevance in the present acute phase of the pandemic. This strategy will potentially be taken into consideration in future phases, when the coexistence with the virus will require us to respond in an even more virtuous fashion.

scholarly journals Risk factors for difficulty of laparoscopic cholecystectomy in grade II acute cholecystitis according to the Tokyo guidelines 2013

BMC Surgery ◽  
2017 ◽  
Vol 17 (1) ◽  
Author(s):  
Koetsu Inoue ◽  
Tatsuya Ueno ◽  
Daisuke Douchi ◽  
Kentaro Shima ◽  
Shinji Goto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Tokyo Guidelines ◽  
Grade Ii

scholarly journals 148. Retrospective Evaluation of Acute Cholangitis and Clinical Implication and Management of Secondary Bacteremia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S101-S101
Author(s):  
Ahmed Hamdi ◽  
Zachary A Yetmar ◽  
Alexander T Miller ◽  
Mark Diaz ◽  
Madiha Fida ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Acute Cholangitis ◽  
Source Control ◽  
First Episode ◽  
Tokyo Guidelines ◽  
Presenting Symptoms ◽  
Mortality Difference ◽  
Grade Ii ◽  
Gram Negative Organisms ◽  
Prime Target

Abstract Background Optimum duration of antimicrobial therapy for acute bacteremic cholangitis is not well established; however, 4–7 days is recommended by the 2018 Tokyo guidelines in those without Gram-positive bacteremia. Methods A retrospective study performed at Mayo Clinic - Rochester, Florida and Arizona sites was conducted, reviewing all adult patients with the first episode of acute cholangitis secondary to biliary stone obstruction, between January 1, 2012 and December 31, 2017. We reviewed the duration of prescribed antimicrobials. Results Among 331 included cases, 197(60%) were men, 66 (20%) were immuno-compromised. Presenting symptoms included fever in 202 (61.5%), abdominal pain in 289 (87%), jaundice 128(38.7%), and altered mentation in 49 (15%). Among these, 256 (77%) were classified as “definite” and 38 (11.5%) were “suspected” using the 2018 Tokyo guideline classification. Cholangitis grade was grade III in 134 (40.5%); grade II in 115 (34.7%); and grade I in 82 (24.8%). Majority of cases, 321 (97%), underwent source control—most commonly 309 (96%) achieved by endoscopic retrograde cholangiopancreatography (ERCP). Source control occurred within 24 hr of presentation in 197 (61.4%) of the cases. Bacteremia was documented in 131/277 (47%). Majority of bacteremias were due to Gram-negative organisms in 119 (91%). Mean duration of antibiotic therapy following “source control” was 9.6 days (SD 7.0). Cases with bacteremia, resulted in longer treatment duration, mean of 13 days (SD 5.6), regardless of the isolated organism. Overall 30 day mortality was 14/331 (4.2%). No mortality difference was noted in patients who underwent early (within 12 hours) vs. later source control (4.55% Vs. 4.53%), nor in those who received more or less than 6 days of antibiotic therapy after source control (4.7% Vs. 3.9%, P = 0.76). No difference in mortality was observed in those with or without bacteremia. Conclusion Our results note the use of longer courses of antimicrobials for management of bacteremic cholangitis, regardless of the organism type. This population could be a prime target for an antimicrobial stewardship intervention, to decrease the duration of prescribed antimicrobials in accordance with recent guidelines. Disclosures All authors: No reported disclosures.

Validation of the AAST EGS acute cholecystitis grade and comparison with the Tokyo guidelines

Surgery ◽  
2018 ◽  
Vol 163 (4) ◽  
pp. 739-746 ◽  
Author(s):  
Matthew Hernandez ◽  
Brittany Murphy ◽  
Johnathan M. Aho ◽  
Nadeem N. Haddad ◽  
Humza Saleem ◽  
...  
Keyword(s):  
Acute Cholecystitis ◽  
Tokyo Guidelines

scholarly journals Is English as a Medium of Instruction Problem for Undergraduate Medical Students?

1970 ◽  
Vol 6 (2) ◽  
pp. 32-36 ◽  
Author(s):  
S Hossain ◽  
KM Shamim ◽  
N Shahana ◽  
MA Habib ◽  
A Rahman
Keyword(s):  
Medical Education ◽  
Medical Students ◽  
Undergraduate Students ◽  
Difficulty Level ◽  
Medium Of Instruction ◽  
Undergraduate Medical Students ◽  
Medical College ◽  
Grade Ii ◽  
Written Assessment ◽  
Grade Iii

Introduction: The students of a country like Bangladesh, where language of medical education is completely English, suffer from a lot of problems in grasping English and also Latin and Greek terms used in English.Objective: This study was aimed to estimate the extents and to identify the nature of the problems faced by the undergraduate students in different aspects of English used in Anatomy.Methods: The study was conducted on 191 third year medical students, who had just passed the Anatomy portion of their undergraduate course from two renowned government medical colleges and one private medical college of Bangladesh. A written assessment test of students' performance was designed using two sets of questions as the instrument of the test. Each student was graded, according to the percentage frequency of correct responses, as having Grade IV difficulty (up to 20%), Grade III difficulty (20.01% to 40%), Grade II difficulty (40.01% to 60%), Grade I difficulty (60.01% to 80%) and Grade 0 with 'no difficulty' (above 80.01%). Comments were also collected from the students regarding their problems with English used in Anatomy.Results: An average of only about 48.2% responses on 'English used in Anatomy' was correct, ranging from about 20 to 70%. An arbitrary grading of difficulty level showed that 75% of the students were suffering from Grade II to Grade III difficulties. Performance of the students showed that the undergraduate medical students of Bangladesh were facing varying but noticeable amounts of difficulty with most of the areas of 'English used in Anatomy'.Conclusion: Organized, regular ways of dealing with these problems should be devised taking into consideration the specific aspects showing weakness and based on principles of terminology and English rather than on individual terms or words. Key words: English used in Anatomy; difficulty; undergraduate medical student DOI: 10.3329/jafmc.v6i2.7272JAFMC Bangladesh. Vol 6, No 2 (December) 2010 pp.32-36

scholarly journals Limiting factors for the strict adherence to Tokyo Guidelines 2018/2013 in the treatment of acute cholecystitis

HPB ◽  
2020 ◽  
Vol 22 ◽  
pp. S255
Author(s):  
L. Estalella ◽  
R. Memba ◽  
O. Morató ◽  
E. Llácer ◽  
M. Pavel ◽  
...  
Keyword(s):  
Acute Cholecystitis ◽  
Limiting Factors ◽  
Strict Adherence ◽  
Tokyo Guidelines
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