Ulsterhttp://hdl.handle.net/10147/1226632024-03-25T17:40:39Z2024-03-25T17:40:39ZA community-based advanced nurse practitioner-led integrated oncology care model for adults receiving oral anticancer medication: a pilot study.Richmond, Janice PKelly, Mary GraceJohnston, AlisonMurphy, Patrick JO'Connor, LauraGillespie, PaddyHobbins, AnnaAlvarez-Iglesias, AlbertoMurphy, Andrew Whttp://hdl.handle.net/10147/6412082024-03-16T04:09:37Z2024-02-29T00:00:00ZA community-based advanced nurse practitioner-led integrated oncology care model for adults receiving oral anticancer medication: a pilot study.
Richmond, Janice P; Kelly, Mary Grace; Johnston, Alison; Murphy, Patrick J; O'Connor, Laura; Gillespie, Paddy; Hobbins, Anna; Alvarez-Iglesias, Alberto; Murphy, Andrew W
Oral anti‑cancer medications (OAMs) are being used increasingly within cancer care. OAMs offer the potential
to improve patient convenience and increase hospital capacity. The clinical assessment for each cycle of OAMs
requires specialist patient review often performed in hospital‑based oncology units. Consequently, any potential
improvement in patient expediency or increased hospital capacity that OAMs can offer is not realised. This study
aimed to develop and pilot the specialist assessment of patients receiving OAMs by an Advanced Nurse Practitioner
(ANP) in a community‑based location.
The primary aim of this pilot study was to assess the feasibility of a community‑based ANP‑led integrated oncol‑
ogy care model for adults receiving OAMs in Ireland who met the pre‑specified eligibility criteria. The objectives
were to determine the feasibility of a definitive trial of this intervention by measuring patient safety, acceptability
to patients and staff and cost of the new model of care.
This single‑centre pilot study provided patient care (n = 37) to those receiving OAM therapies within a community
setting for a 4‑month period. Consent rate was high with no attrition other than for clinical reasons. There were 151
contacts with the sample during that time.
Results demonstrated that the ANP‑led intervention and new model for OAM care was safe, highly acceptable
to patients and staff and that related healthcare costs could be captured. Based on the success of this pilot study,
the authors conclude that a community‑based ANP‑led integrated oncology care model for adults receiving OAMs
is feasible, and a definitive trial is warranted.
2024-02-29T00:00:00ZCurrent management of adults receiving oral anti-cancer medications: A scoping review.Richmond, J PKelly, M GJohnston, AMurphy, P JMurphy, A Whttp://hdl.handle.net/10147/6342972022-09-24T03:05:51Z2021-08-14T00:00:00ZCurrent management of adults receiving oral anti-cancer medications: A scoping review.
Richmond, J P; Kelly, M G; Johnston, A; Murphy, P J; Murphy, A W
Purpose: Oral anti-cancer medication (OAM) has revolutionised oncology care. Due to their potential toxicities and associated safety challenges ongoing assessment and monitoring is essential; currently generally performed in acute care settings. Internationally there exists a transformative vision to shift patient care from acute to primary care. A nurse-led integrated model of care could be developed for OAM patient management in primary care. The aim of this study was to examine international literature regarding current clinical management practices for assessment and monitoring of patients receiving OAM.
Methods: Following PRISMA-ScR guidelines, databases MEDLINE, CINAHL and Web of Science were searched for English studies published between 2010 and 2020 using keywords: assessment, cancer, care, management, oral anticancer medications. Articles were screened and assessed for eligibility. From eligible studies, data were extracted to summarize, collate and make a narrative account of the findings.
Results: 2261 papers were reviewed, 14 met inclusion criteria. Three phases of management are reported: 1. Patient treatment plan development; 2. Patient education; 3. Patient monitoring. Within these phases seven specific stages of care were identified broadly representing the patient's journey: (1) treatment decision, (2) prescribing of OAM, (3) OAM dispensing and administration, (4) maximising patient safety (5) ongoing patient assessment (6) patient support (7) communication with other health-care professionals.
Conclusions: Despite a paucity of international literature, a dedicated OAM clinic was endorsed as a means to achieve improved care. Nurses and pharmacists were identified as being of particular importance especially in education and ongoing management of patients receiving OAMs.
2021-08-14T00:00:00ZSystematic Review and Meta-Analysis of Wound Bundles in Emergency Midline Laparotomy Identifies That It Is Time for Improvement.Mc Geehan, GearóidEdelduok, Itoro MBucholc, MagdaWatson, AngusBodnar, ZsoltJohnston, AlisonSugrue, Michaelhttp://hdl.handle.net/10147/6342822022-09-03T01:52:01Z2021-02-11T00:00:00ZSystematic Review and Meta-Analysis of Wound Bundles in Emergency Midline Laparotomy Identifies That It Is Time for Improvement.
Mc Geehan, Gearóid; Edelduok, Itoro M; Bucholc, Magda; Watson, Angus; Bodnar, Zsolt; Johnston, Alison; Sugrue, Michael
Background: Emergency midline laparotomy is the cornerstone of survival in patients with peritonitis. While bundling of care elements has been shown to optimize outcomes, this has focused on elective rather than emergency abdominal surgery. The aim of this study was to undertake a systematic review and meta-analysis of factors affecting the development of surgical site infection (SSI) in patients undergoing midline emergency laparotomy.
Methods: An ethically approved, PROSPERO registered (ID: CRD42020193246) meta-analysis and systematic review, searching PubMed, Scopus, Web of Science and Cochrane Library electronic databases from January 2015 to June 2020 and adhering to PRISMA guidelines was undertaken. Search headings included "emergency surgery", "laparotomy", "surgical site infection", "midline incision" and "wound bundle". Suitable publications were graded using Methodological Index for Non-Randomised Studies (MINORS); papers scoring ≥16/24 were included for data analysis. The primary outcome in this study was SSI rates following the use of wound bundles. Secondary outcomes consisted of the effect of the individual interventions included in the bundles and the SSI rates for superficial and deep infections. Five studies focusing on closure techniques were grouped to assess their effect on SSI.
Results: This study identified 1875 articles. A total of 58 were potentially suitable, and 11 were included after applying MINORS score. The final cohort included 2,856 patients from eight countries. Three papers came from the USA, two papers from Japan and the remainder from Denmark, England, Iran, Netherlands, Spain and Turkey. There was a 32% non-significant SSI reduction after the implementation of wound bundles (RR = 0.68; CI, 0.39-1.17; p = 0.16). In bundles used for technical closure the reduction in SSI of 15% was non-significant (RR = 0.85; CI, 0.57-1.26; p = 0.41). Analysis of an effective wound bundle was limited due to insufficient data.
Conclusions: This study identified a significant deficit in the world literature relating to emergency laparotomy and wound outcome optimisation. Given the global burden of emergency general surgery urgent action is needed to assess bundle's ability to potentially improve outcome after emergency laparotomy.
2021-02-11T00:00:00ZCurrent management of adults receiving oral anti-cancer medications: A scoping review protocol.Richmond, Janice PKelly, Mary GraceJohnston, AlisonHynes, LisaMurphy, Patrick JMurphy, Andrew Whttp://hdl.handle.net/10147/6342142022-08-23T02:09:08Z2022-03-09T00:00:00ZCurrent management of adults receiving oral anti-cancer medications: A scoping review protocol.
Richmond, Janice P; Kelly, Mary Grace; Johnston, Alison; Hynes, Lisa; Murphy, Patrick J; Murphy, Andrew W
Oncology has been undergoing a profound transition in the last ten years with the increased usage in oral anti-cancer medication. Approximately 25% of all anti-cancer medication is now designed for oral use and this is likely to increase prospectively. These treatments are convenient for patients and are often preferred by them, yet there are similar safety and toxicity concerns as there are to intravenous treatment. Oral anti-cancer medications (OAMs) have the potential to alleviate capacity issues in cancer treating units as patients receive their treatment at home, however there remains a requirement for safe and efficient assessment and care. Consequently, the management of patients on OAMs is of paramount importance. The optimum setting, whether within primary or secondary care, in addition to the appropriate health care professional to carry out patient assessment and monitoring needs to be established. This paper presents a protocol for a scoping review which aims to systematically and comprehensively map the literature on the current management of adults receiving OAMs. The review will follow the published guidance to direct the various steps involved. The protocol will be guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) framework to ensure methodological and reporting quality. Independent full text review will be performed by two reviewers and any disagreements resolved through discussion with a third reviewer. The process will be iterative in nature. This scoping review will provide a narrative synthesis and map the literature on the management of individuals receiving OAMs. This work is an appropriate initial stage in presenting the literature to inform the subsequent steps in a multi-phased research study which aims to establish and analyse the safety and efficacy of an integrated care model for the management of patients receiving OAM in the community by an advanced practitioner.
2022-03-09T00:00:00ZAcceptability of a Mobile Health Behavior Change Intervention for Cancer Survivors With Obesity or Overweight: Nested Mixed Methods Study Within a Randomized Controlled Trial.Groarke, Jenny MRichmond, JaniceMc Sharry, JennyGroarke, AnnMarieHarney, Owen MKelly, Mary GraceWalsh, Jane Chttp://hdl.handle.net/10147/6333652022-07-09T01:49:31Z2021-02-16T00:00:00ZAcceptability of a Mobile Health Behavior Change Intervention for Cancer Survivors With Obesity or Overweight: Nested Mixed Methods Study Within a Randomized Controlled Trial.
Groarke, Jenny M; Richmond, Janice; Mc Sharry, Jenny; Groarke, AnnMarie; Harney, Owen M; Kelly, Mary Grace; Walsh, Jane C
Background
A significant proportion of cancer survivors have overweight or obesity. Although this has negative implications for health, weight management is not a standard component of oncology aftercare. Mobile health (mHealth) technology, in combination with behavior change techniques (BCTs), has the potential to support positive lifestyle changes. Few studies have been carried out with cancer survivors; therefore, the acceptability of these tools and techniques requires further investigation.
Objective
The aim of this study is to examine the acceptability of a behavior change intervention using mHealth for cancer survivors with a BMI of 25 or more and to gather constructive feedback from participants.
Methods
The intervention consisted of educational sessions and an 8-week physical activity goal setting intervention delivered using mobile technology (ie, Fitbit activity monitor plus SMS contact). In the context of a two-arm randomized controlled trial, semistructured interviews were conducted to assess the retrospective acceptability of the intervention from the perspective of the recipients. The theoretical framework for the acceptability of health care interventions was used to inform a topic guide. The interviews were transcribed and analyzed using thematic analysis. A quantitative survey was also conducted to determine the acceptability of the intervention. A total of 13 participants were interviewed, and 36 participants completed the quantitative survey.
Results
The results strongly support the acceptability of the intervention. The majority of the survey respondents held a positive attitude toward the intervention (35/36, 97%). In qualitative reports, many of the intervention components were enjoyed and the mHealth components (ie, Fitbit and goal setting through text message contact) were rated especially positively. Responses were mixed as to whether the burden of participating in the intervention was high (6/36, 17%) or low (5/36, 14%). Participants perceived the intervention as having high efficacy in improving health and well-being (34/36, 94%). Most respondents said that they understood how the intervention works (35/36, 97%), and qualitative data show that participants’ understanding of the aim of the intervention was broader than weight management and focused more on moving on psychologically from cancer.
Conclusions
On the basis of the coherence of responses with theorized aspects of intervention acceptability, we are confident that this intervention using mHealth and BCTs is acceptable to cancer survivors with obesity or overweight. Participants made several recommendations concerning the additional provision of social support. Future studies are needed to assess the feasibility of delivery in clinical practice and the acceptability of the intervention to those delivering the intervention.
2021-02-16T00:00:00ZTrauma quality indicators: internationally approved core factors for trauma management quality evaluation.Coccolini, FedericoKluger, YoramMoore, Ernest EMaier, Ronald VCoimbra, RaulOrdoñez, CarlosIvatury, RaoKirkpatrick, Andrew WBiffl, WalterSartelli, MassimoHecker, AndreasAnsaloni, LucaLeppaniemi, AriReva, ViktorCivil, IanVega, FelipeChiarugi, MassimoChichom-Mefire, AlainSakakushev, BorisPeitzman, AndrewChiara, OsvaldoAbu-Zidan, FikriMaegele, MarcMiccoli, MarioChirica, MirceaKhokha, VladimirSugrue, MichaelFraga, Gustavo POtomo, YasuhiroBaiocchi, Gian LucaCatena, Faustohttp://hdl.handle.net/10147/6319742022-05-25T01:47:30Z2021-02-23T00:00:00ZTrauma quality indicators: internationally approved core factors for trauma management quality evaluation.
Coccolini, Federico; Kluger, Yoram; Moore, Ernest E; Maier, Ronald V; Coimbra, Raul; Ordoñez, Carlos; Ivatury, Rao; Kirkpatrick, Andrew W; Biffl, Walter; Sartelli, Massimo; Hecker, Andreas; Ansaloni, Luca; Leppaniemi, Ari; Reva, Viktor; Civil, Ian; Vega, Felipe; Chiarugi, Massimo; Chichom-Mefire, Alain; Sakakushev, Boris; Peitzman, Andrew; Chiara, Osvaldo; Abu-Zidan, Fikri; Maegele, Marc; Miccoli, Mario; Chirica, Mircea; Khokha, Vladimir; Sugrue, Michael; Fraga, Gustavo P; Otomo, Yasuhiro; Baiocchi, Gian Luca; Catena, Fausto
Introduction: Quality in medical care must be measured in order to be improved. Trauma management is part of health care, and by definition, it must be checked constantly. The only way to measure quality and outcomes is to systematically accrue data and analyze them.
Material and methods: A systematic revision of the literature about quality indicators in trauma associated to an international consensus conference RESULTS: An internationally approved base core set of 82 trauma quality indicators was obtained: Indicators were divided into 6 fields: prevention, structure, process, outcome, post-traumatic management, and society integrational effects.
Conclusion: Present trauma quality indicator core set represents the result of an international effort aiming to provide a useful tool in quality evaluation and improvement. Further improvement may only be possible through international trauma registry development. This will allow for huge international data accrual permitting to evaluate results and compare outcomes.
2021-02-23T00:00:00ZCorrection to: Intraoperative surgical site infection control and prevention: a position paper and future addendum to WSES intra-abdominal infections guidelines.De Simone, BelindaSartelli, MassimoCoccolini, FedericoBall, Chad GBrambillasca, PietroChiarugi, MassimoCampanile, Fabio CesareNita, GabrielaCorbella, DavideLeppaniemi, AriBoschini, ElenaMoore, Ernest EBiffl, WalterPeitzmann, AndrewKluger, YoramSugrue, MichaelFraga, GustavoDi Saverio, SalomoneWeber, DieterSakakushev, BorisChiara, OsvaldoAbu-Zidan, Fikri MTen Broek, RichardKirkpatrick, Andrew WWani, ImtiazCoimbra, RaulBaiocchi, Gian LucaKelly, Micheal DAnsaloni, LucaCatena, Faustohttp://hdl.handle.net/10147/6316122022-03-02T01:46:26Z2021-04-14T00:00:00ZCorrection to: Intraoperative surgical site infection control and prevention: a position paper and future addendum to WSES intra-abdominal infections guidelines.
De Simone, Belinda; Sartelli, Massimo; Coccolini, Federico; Ball, Chad G; Brambillasca, Pietro; Chiarugi, Massimo; Campanile, Fabio Cesare; Nita, Gabriela; Corbella, Davide; Leppaniemi, Ari; Boschini, Elena; Moore, Ernest E; Biffl, Walter; Peitzmann, Andrew; Kluger, Yoram; Sugrue, Michael; Fraga, Gustavo; Di Saverio, Salomone; Weber, Dieter; Sakakushev, Boris; Chiara, Osvaldo; Abu-Zidan, Fikri M; Ten Broek, Richard; Kirkpatrick, Andrew W; Wani, Imtiaz; Coimbra, Raul; Baiocchi, Gian Luca; Kelly, Micheal D; Ansaloni, Luca; Catena, Fausto
2021-04-14T00:00:00ZComparing Single-Page, Multipage, and Conversational Digital Forms in Health Care: Usability Study.Iftikhar, AleehaBond, Raymond RMcGilligan, VictoriaLeslie, Stephen JRjoob, KhaledKnoery, CharlesQuigg, CiaraCampbell, RyanBoyd, KyleMC SHANE, ANNEPeace, Aaronhttp://hdl.handle.net/10147/6313422022-02-08T02:15:36Z2021-05-26T00:00:00ZComparing Single-Page, Multipage, and Conversational Digital Forms in Health Care: Usability Study.
Iftikhar, Aleeha; Bond, Raymond R; McGilligan, Victoria; Leslie, Stephen J; Rjoob, Khaled; Knoery, Charles; Quigg, Ciara; Campbell, Ryan; Boyd, Kyle; MC SHANE, ANNE; Peace, Aaron
Background: Even in the era of digital technology, several hospitals still rely on paper-based forms for data entry for patient admission, triage, drug prescriptions, and procedures. Paper-based forms can be quick and convenient to complete but often at the expense of data quality, completeness, sustainability, and automated data analytics. Digital forms can improve data quality by assisting the user when deciding on the appropriate response to certain data inputs (eg, classifying symptoms). Greater data quality via digital form completion not only helps with auditing, service improvement, and patient record keeping but also helps with novel data science and machine learning research. Although digital forms are becoming more prevalent in health care, there is a lack of empirical best practices and guidelines for their design. The study-based hospital had a definite plan to abolish the paper form; hence, it was not necessary to compare the digital forms with the paper form.
Objective: This study aims to assess the usability of three different interactive forms: a single-page digital form (in which all data input is required on one web page), a multipage digital form, and a conversational digital form (a chatbot).
Methods: The three digital forms were developed as candidates to replace the current paper-based form used to record patient referrals to an interventional cardiology department (Cath-Lab) at Altnagelvin Hospital. We recorded usability data in a counterbalanced usability test (60 usability tests: 20 subjects×3 form usability tests). The usability data included task completion times, System Usability Scale (SUS) scores, User Experience Questionnaire data, and data from a postexperiment questionnaire.
Results: We found that the single-page form outperformed the other two digital forms in almost all usability metrics. The mean SUS score for the single-page form was 76 (SD 15.8; P=.01) when compared with the multipage form, which had a mean score of 67 (SD 17), and the conversational form attained the lowest scores in usability testing and was the least preferred choice of users, with a mean score of 57 (SD 24). An SUS score of >68 was considered above average. The single-page form achieved the least task completion time compared with the other two digital form styles.
Conclusions: In conclusion, the digital single-page form outperformed the other two forms in almost all usability metrics; it had the least task completion time compared with those of the other two digital forms. Moreover, on answering the open-ended question from the final customized postexperiment questionnaire, the single-page form was the preferred choice.
2021-05-26T00:00:00ZIntraoperative surgical site infection control and prevention: a position paper and future addendum to WSES intra-abdominal infections guidelines.De Simone, BelindaSartelli, MassimoCoccolini, FedericoBall, Chad GBrambillasca, PietroChiarugi, MassimoCampanile, Fabio CesareNita, GabrielaCorbella, DavideLeppaniemi, AriBoschini, ElenaMoore, Ernest EBiffl, WalterPeitzmann, AndrewKluger, YoramSugrue, MichaelFraga, GustavoDi Saverio, SalomoneWeber, DieterSakakushev, BorisChiara, OsvaldoAbu-Zidan, Fikri MTen Broek, RichardKirkpatrick, Andrew WWani, ImtiazCoimbra, RaulBaiocchi, Gian LucaKelly, Micheal DAnsaloni, LucaCatena, Faustohttp://hdl.handle.net/10147/6304492021-09-28T01:41:13Z2020-02-10T00:00:00ZIntraoperative surgical site infection control and prevention: a position paper and future addendum to WSES intra-abdominal infections guidelines.
De Simone, Belinda; Sartelli, Massimo; Coccolini, Federico; Ball, Chad G; Brambillasca, Pietro; Chiarugi, Massimo; Campanile, Fabio Cesare; Nita, Gabriela; Corbella, Davide; Leppaniemi, Ari; Boschini, Elena; Moore, Ernest E; Biffl, Walter; Peitzmann, Andrew; Kluger, Yoram; Sugrue, Michael; Fraga, Gustavo; Di Saverio, Salomone; Weber, Dieter; Sakakushev, Boris; Chiara, Osvaldo; Abu-Zidan, Fikri M; Ten Broek, Richard; Kirkpatrick, Andrew W; Wani, Imtiaz; Coimbra, Raul; Baiocchi, Gian Luca; Kelly, Micheal D; Ansaloni, Luca; Catena, Fausto
Background: Surgical site infections (SSI) represent a considerable burden for healthcare systems. They are largely preventable and multiple interventions have been proposed over past years in an attempt to prevent SSI. We aim to provide a position paper on Operative Room (OR) prevention of SSI in patients presenting with intra-abdominal infection to be considered a future addendum to the well-known World Society of Emergency Surgery (WSES) Guidelines on the management of intra-abdominal infections.
Methods: The literature was searched for focused publications on SSI until March 2019. Critical analysis and grading of the literature has been performed by a working group of experts; the literature review and the statements were evaluated by a Steering Committee of the WSES.
Results: Wound protectors and antibacterial sutures seem to have effective roles to prevent SSI in intra-abdominal infections. The application of negative-pressure wound therapy in preventing SSI can be useful in reducing postoperative wound complications. It is important to pursue normothermia with the available resources in the intraoperative period to decrease SSI rate. The optimal knowledge of the pharmacokinetic/pharmacodynamic characteristics of antibiotics helps to decide when additional intraoperative antibiotic doses should be administered in patients with intra-abdominal infections undergoing emergency surgery to prevent SSI.
Conclusions: The current position paper offers an extensive overview of the available evidence regarding surgical site infection control and prevention in patients having intra-abdominal infections.
2020-02-10T00:00:00ZPerforated and bleeding peptic ulcer: WSES guidelines.Tarasconi, AntonioCoccolini, FedericoBiffl, Walter LTomasoni, MatteoAnsaloni, LucaPicetti, EdoardoMolfino, SarahShelat, VishalCimbanassi, StefaniaWeber, Dieter GAbu-Zidan, Fikri MCampanile, Fabio CDi Saverio, SalomoneBaiocchi, Gian LucaCasella, ClaudioKelly, Michael DKirkpatrick, Andrew WLeppaniemi, AriMoore, Ernest EPeitzman, AndrewFraga, Gustavo PereiraCeresoli, MarcoMaier, Ronald VWani, ImtazPattonieri, VittoriaPerrone, GennaroVelmahos, GeorgeSugrue, MichaelSartelli, MassimoKluger, YoramCatena, Faustohttp://hdl.handle.net/10147/6304482021-09-28T01:41:06Z2020-01-07T00:00:00ZPerforated and bleeding peptic ulcer: WSES guidelines.
Tarasconi, Antonio; Coccolini, Federico; Biffl, Walter L; Tomasoni, Matteo; Ansaloni, Luca; Picetti, Edoardo; Molfino, Sarah; Shelat, Vishal; Cimbanassi, Stefania; Weber, Dieter G; Abu-Zidan, Fikri M; Campanile, Fabio C; Di Saverio, Salomone; Baiocchi, Gian Luca; Casella, Claudio; Kelly, Michael D; Kirkpatrick, Andrew W; Leppaniemi, Ari; Moore, Ernest E; Peitzman, Andrew; Fraga, Gustavo Pereira; Ceresoli, Marco; Maier, Ronald V; Wani, Imtaz; Pattonieri, Vittoria; Perrone, Gennaro; Velmahos, George; Sugrue, Michael; Sartelli, Massimo; Kluger, Yoram; Catena, Fausto
Background: Peptic ulcer disease is common with a lifetime prevalence in the general population of 5-10% and an incidence of 0.1-0.3% per year. Despite a sharp reduction in incidence and rates of hospital admission and mortality over the past 30 years, complications are still encountered in 10-20% of these patients. Peptic ulcer disease remains a significant healthcare problem, which can consume considerable financial resources. Management may involve various subspecialties including surgeons, gastroenterologists, and radiologists. Successful management of patients with complicated peptic ulcer (CPU) involves prompt recognition, resuscitation when required, appropriate antibiotic therapy, and timely surgical/radiological treatment.
Methods: The present guidelines have been developed according to the GRADE methodology. To create these guidelines, a panel of experts was designed and charged by the board of the WSES to perform a systematic review of the available literature and to provide evidence-based statements with immediate practical application. All the statements were presented and discussed during the 5th WSES Congress, and for each statement, a consensus among the WSES panel of experts was reached.
Conclusions: The population considered in these guidelines is adult patients with suspected complicated peptic ulcer disease. These guidelines present evidence-based international consensus statements on the management of complicated peptic ulcer from a collaboration of a panel of experts and are intended to improve the knowledge and the awareness of physicians around the world on this specific topic. We divided our work into the two main topics, bleeding and perforated peptic ulcer, and structured it into six main topics that cover the entire management process of patients with complicated peptic ulcer, from diagnosis at ED arrival to post-discharge antimicrobial therapy, to provide an up-to-date, easy-to-use tool that can help physicians and surgeons during the decision-making process.
2020-01-07T00:00:00Z