434 results on '"GASTROENTEROLOGISTS"'
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2. Researchers at Hamad Medical Corporation Report Research in Gastroenterology (Embracing the future of physician-patient communication: GPT-4 in gastroenterology).
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PHYSICIAN-patient relations ,CORPORATION reports ,GENERATIVE pre-trained transformers ,MEDICAL research personnel ,GASTROENTEROLOGY ,GASTROENTEROLOGISTS - Abstract
A report from researchers at Hamad Medical Corporation in Doha, Qatar discusses the integration of artificial intelligence (AI), specifically GPT-4, into healthcare and its potential to enhance physician-patient communication in the field of gastroenterology. GPT-4 can automate routine tasks, simplify complex medical jargon for patient education, and provide continuous patient care. However, the researchers emphasize that technology should augment, not replace, the human touch in healthcare, and the implementation of AI technologies must be done responsibly, adhering to ethical considerations, data privacy standards, and accountability guidelines. The research highlights the transformative opportunities AI offers while emphasizing the importance of maintaining ethical standards. [Extracted from the article]
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- 2024
3. Researchers from Takeda Pharmaceutical Company Ltd. Discuss Findings in Gaucher's Disease (Cross-sectional Web-based Survey Among Haematologists and Gastroenterologists In Japan To Identify the Key Factors for Early Diagnosis of Gaucher Disease).
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GAUCHER'S disease ,RESEARCH personnel ,DIAGNOSIS ,INTERNET surveys ,GASTROENTEROLOGISTS - Abstract
A recent study conducted by researchers from Takeda Pharmaceutical Company Ltd. in Tokyo, Japan aimed to assess the awareness and knowledge of Gaucher's Disease (GD) among Japanese haematologists and gastroenterologists. The study found that more than 50% of haematologists were aware of GD symptoms, diagnostic criteria, and treatments, while the majority of gastroenterologists were either unaware of GD or only knew the disease by name. The study also highlighted that bone pain may be a key sign of GD for early diagnosis. The findings suggest that there is a need for increased awareness and education about GD among healthcare professionals in Japan. [Extracted from the article]
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- 2024
4. Association Between Endoscopist Specialty and Colonoscopy Quality: A Systematic Review and Meta-analysis
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Matthew S. Mazurek, Mark G. Swain, Indraneel Datta, Steven J. Heitman, Christopher Ma, Nancy N. Baxter, Yibing Ruan, Sanjay K. Murthy, Risa Shorr, Stavros A. Antoniou, Nauzer Forbes, Darren R. Brenner, Devon J. Boyne, Robert J. Hilsden, and Alistair Murray
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Adenoma ,medicine.medical_specialty ,Hepatology ,medicine.diagnostic_test ,Colorectal cancer ,business.industry ,Gastroenterologists ,Perforation (oil well) ,Gastroenterology ,Specialty ,MEDLINE ,Colonoscopy ,Odds ratio ,medicine.disease ,Confidence interval ,Internal medicine ,Meta-analysis ,medicine ,Humans ,Colorectal Neoplasms ,business ,Cecum - Abstract
Background & Aims Colonoscopy quality indicators provide measurable assessments of performance, but significant provider-level variations exist. We performed a systematic review and meta-analysis to assess whether endoscopist specialty is associated with adenoma detection rate (ADR) — the primary outcome — or cecal intubation rate, adverse event rates, and post-colonoscopy colorectal cancer rates. Methods We searched EMBASE, Google Scholar, MEDLINE, and the Cochrane Central Registry of Controlled Trials from inception to December 14, 2020. Two reviewers independently screened titles and abstracts. Citations underwent duplicate full-text review, with disagreements resolved by a third reviewer. Data were abstracted in duplicate. The DerSimonian and Laird random effects model was used to calculate pooled odds ratios (ORs) with respective 95% confidence intervals (CIs). Risk of bias was assessed using Risk of Bias in Non-randomised Studies of Interventions. Results Of 11,314 citations, 36 studies representing 3,500,832 colonoscopies were included. Compared with colonoscopies performed by gastroenterologists, those by surgeons were associated with lower ADRs (OR, 0.81; 95% CI, 0.74–0.88) and lower cecal intubation rates (OR, 0.76; 95% CI, 0.63–0.92). Compared with colonoscopies performed by gastroenterologists, those by other (non-gastroenterologist, non-surgeon) endoscopists were associated with lower ADRs (OR, 0.91; 95% CI, 0.87–0.96), higher perforation rates (OR, 3.02; 95% CI, 1.65–5.51), and higher post-colonoscopy colorectal cancer rates (OR, 1.23; 95% CI, 1.14–1.33). Substantial to considerable heterogeneity existed for most analyses, and overall certainty in the evidence was low according to the Grading of Recommendations, Assessment, Development, and Evaluations framework. Conclusion Colonoscopies performed by surgeons or other endoscopists were associated with poorer quality metrics and outcomes compared with those performed by gastroenterologists. Targeted quality improvement efforts may be warranted.
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- 2022
5. Medtronic and Cosmo Pharmaceuticals forge ahead in AI-driven care.
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CONTRACTS ,ADENOMA ,MEDICAL equipment ,DRUGS ,GASTROENTEROLOGISTS - Abstract
Medtronic plc, a global leader in healthcare technology, has entered into a definitive agreement to expand its partnership with Cosmo Intelligent Medical Devices, a subsidiary of Cosmo Pharmaceuticals. This partnership aims to further capitalize on the achievements of the GI Genius intelligent endoscopy module, which uses AI technology to improve patient outcomes. The collaboration will focus on innovative and scalable AI platforms, such as AI Access, to streamline the development process of medical AI applications. The GI Genius module, powered by AI, has already made a significant impact in gastrointestinal screening by increasing the adenoma detection rate for gastroenterologists. Under the agreement, Medtronic will pay Cosmo $100 million upfront, as well as royalties and milestone payments. [Extracted from the article]
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- 2023
6. Burnout Among Transplant Hepatologists in the United States
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Thomas D. Schiano, Yash Motwani, Kamron Pourmand, Arpan Patel, Michael Kriss, and Laurie Keefer
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Response rate (survey) ,Transplantation ,medicine.medical_specialty ,Multivariate analysis ,Hepatology ,business.industry ,Gastroenterologists ,education ,Odds ratio ,Burnout, Psychological ,Burnout ,Peer support ,United States ,Confidence interval ,Liver Transplantation ,Surveys and Questionnaires ,Family medicine ,Depersonalization ,medicine ,Humans ,Surgery ,medicine.symptom ,Emotional exhaustion ,business ,Burnout, Professional - Abstract
Background & aims Burnout among transplant hepatologists has not been well-characterized. The goal of this study was to describe the prevalence and predictors of burnout among practicing transplant hepatologists in the United States. Methods We designed a 69-item survey, including the Maslach Burnout Inventory - Human Services Survey (MBI-HSS) and questions on provider demographics, practice characteristics, and psychological factors. The survey was administered to practicing U.S. transplant hepatologists between October and December 2019. We described burnout using MBI subscales [emotional exhaustion (EE), depersonalization (DP), personal accomplishment (PA)] and determined significant predictors of burnout, which we defined as high EE, using univariate and multivariate analyses. Results A total of 185 transplant hepatologists completed the survey (response rate= 25% of 738 practicing transplant hepatologists in the US). Forty percent reported high EE, while 17% and 16% reported high DP and low PA, respectively. On multivariate analysis, respondents with more than five colleagues (odds ratio [OR], 95% confidence interval [CI]: 0.44 (0.23-0.84)), reporting adequate time for outpatient visits (OR 0.42 [0.22-0.80]), reporting greater comfort with their clinical caseload (OR 0.58 [0.37-0.91]) and reporting higher confidence in their prior training (OR 0.59 [0.29-0.86]) had a lower likelihood of high EE. Working six or more hours from home outside of work per week (OR 2.04, [1.07-3.89]) predicted a higher likelihood of burnout. Compensation, age, gender, career phase, caregiver status, and transplant center volume did not predict burnout. Conclusion Forty percent of transplant hepatologists experienced burnout, predicted mostly by factors related to work-time distribution, peer support, and affect. These findings should prompt development of system-level initiatives.
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- 2021
7. Integrating Specialist Palliative Care in the Liver Transplantation Evaluation Process: A Qualitative Analysis of Hepatologist and Palliative Care Provider Views
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Myrick C. Shinall, David G. Schlundt, Manisha Verma, and Kemberlee Bonnet
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Advance care planning ,medicine.medical_specialty ,Palliative care ,Waiting Lists ,medicine.medical_treatment ,Liver transplantation ,Article ,Qualitative analysis ,medicine ,Humans ,Qualitative Research ,Specialist palliative care ,Patient Care Team ,Transplantation ,Hepatology ,Community engagement ,business.industry ,Gastroenterologists ,Palliative Care ,Focus group ,Liver Transplantation ,Patient population ,Caregivers ,Family medicine ,Surgery ,business - Abstract
Background and aims Patients undergoing evaluation for liver transplantation face heavy burdens of symptoms, healthcare utilization, and mortality. In other similarly ill populations, specialist palliative care has been shown to benefit patients, but specialist palliative care is infrequently utilized for liver transplantation patients. This project aims to describe the potential benefits of and barriers to specialist palliative care integration in the liver transplantation process. Approach and results We performed qualitative analysis of transcripts from provider focus groups followed by a community engagement studio of patients and caregivers. Focus groups consisted of 14 palliative care specialists and 10 hepatologists from 11 institutions across the US and Canada. The community engagement studio comprised patients and caregivers of patients either currently on the liver transplant wait list or recently post-transplant. The focus groups identified 19 elements of specialist palliative care that could benefit this patient population, including exploring patient's illness understanding and expectations; comprehensive assessment of physical symptoms; discussing patient values; providing caregiver support; providing a safe space to discuss non-curative options; and anticipatory guidance about likely next steps. Identified barriers included role boundaries, differences in clinical cultures, limitations of time and staff, competing goals and priorities, misconceptions about palliative care, limited resources, changes in transplant status, and patient complexity. Community studio participants identified many of the same opportunities and barriers. Conclusions This study found that hepatologists, palliative care specialists, patients, and caregivers identified areas of care for liver transplant patients that specialist palliative care can improve and address.
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- 2021
8. Knowledge of chronic intestinal failure among US gastroenterologists: Cause for concern and learning opportunity
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Katie Lucero, Nicole Zubizarreta, Marjorie Nisenholtz, Kishore Iyer, Jovana Lubarda, and Marion F. Winkler
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medicine.medical_specialty ,Nutrition and Dietetics ,business.industry ,Gastroenterologists ,Medicine (miscellaneous) ,Convenience sample ,Chronic intestinal failure ,Test (assessment) ,Intestinal Failure ,Intestinal Diseases ,Cronbach's alpha ,Chronic Disease ,Cohort ,medicine ,Humans ,Lack of knowledge ,Medical physics ,Knowledge test ,Parenteral Nutrition, Home ,business - Abstract
BACKGROUND Chronic intestinal failure (CIF) is an ultrarare disease, with an estimated national prevalence of ∼25,000 cases. There is a suspicion of widespread lack of expertise in CIF care, but no formal assessment tool or data exist. We developed and validated a knowledge test in CIF and now report our preliminary results from testing CIF knowledge in a cohort of US gastroenterologists. METHOD We developed a 20-question knowledge test in CIF, covering four key components of IF. After internal testing, refinement, and revision, we administered the test to a convenience sample of experts and nonexperts in IF. We then deployed the validated test to a cohort of 100 US gastroenterologists. RESULTS The test had a Cronbach alpha of 0.74, suggesting a reliable test, with a threshold score to discriminate experts and nonexperts of 13.4 (maximum 20) and with a sensitivity of 81.3% and specificity of 86.4%. The overall mean score of 8.2 for the 100 US gastroenterologists was at the level of nonexperts in our convenience sample. CONCLUSION The preliminary results of our validated knowledge test in IF among a broad group of US gastroenterologists demonstrate lack of knowledge in IF.
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- 2021
9. Palliative Care Always: Hepatology—Virtual Primary Palliative Care Training for Hepatologists
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Manisha Verma, Andrzej S. Kosinski, Jan C. DeNofrio, Marie Bakitas, Michael L. Volk, Tamar H. Taddei, Kavitha Ramchandran, and Victor J. Navarro
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medicine.medical_specialty ,Palliative care ,Hepatology ,Symptom management ,business.industry ,Gastroenterologists ,Palliative Care ,Gastroenterology ,MEDLINE ,Knowledge acquisition ,End Stage Liver Disease ,Formative assessment ,Coursework ,Internal medicine ,Family medicine ,Hospice and Palliative Care Nursing ,medicine ,Humans ,Cluster randomised controlled trial ,business - Abstract
Palliative care (PC) benefits patients with serious illness including end-stage liver disease (ESLD). As part of a cluster randomized trial, hepatologists were trained to deliver primary palliative care to patients with ESLD using an online course, Palliative Care Always: Hepatology (PCA:Hep). Here we present a multimethod formative evaluation (feasibility, knowledge acquisition, self-efficacy, and practice patterns) of PCA:Hep. Feasibility was measured by completion of coursework and achieving a course grade of >80%. Knowledge acquisition was measured through assessments before and throughout the course. Pre/post-course surveys were conducted to determine self-efficacy and practice patterns. The hepatologists (n = 39) enrolled in a 12-week online course and spent 1-3 hours on the course weekly. The course was determined to be feasible as 97% successfully completed the course and 100% passed. The course was acceptable to participants; 91.7 % reported a positive course experience and satisfaction with knowledge gained (91.6%). The pre/post knowledge assessment showed an improvement of 6.0% (pre 85.9% to post 91.9%, 95% CI [2.8, 9.2], P = 0.001). Self-efficacy increased significantly (P < 0.001) in psychological symptom management, hospice, and psychosocial support. A year after training, over 80% of the hepatologists reported integrating a variety of PC skills into routine patient care. Conclusion: PCA:Hep is feasible, acceptable, and improves learner knowledge and confidence in palliative care skills. This is a viable method to teach primary PC skills to specialists caring for patients with ESLD.
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- 2021
10. ECCO-ESGAR Topical Review on Optimizing Reporting for Cross-Sectional Imaging in Inflammatory Bowel Disease
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Jeroen A. W. Tielbeek, Robert V Bryant, Christian Maaser, Stuart A. Taylor, Rune Wilkens, Kerri L. Novak, Torsten Kucharzik, Christine Hoeffel, Antonino Spinelli, Giovanni Maconi, Isabelle De Kock, Damian Tolan, Martina Scharitzer, Søren Rafael Rafaelsen, Jordi Rimola, and Dan Carter
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medicine.medical_specialty ,Consensus ,Delphi method ,Cross-sectional imaging ,Settore MED/36 - Diagnostica per Immagini e Radioterapia ,Transperineal ultrasonography ,Endoanal ultrasonography ,Humans ,transperineal ultrasonography [PUS ,Medicine ,Medical physics ,Ultrasonography ,reporting ,Settore MED/12 - Gastroenterologia ,medicine.diagnostic_test ,business.industry ,Gastroenterologists ,Gastroenterology ,Magnetic resonance imaging ,Ultrasonography/methods ,intestinal ultrasound [IUS] ,General Medicine ,Inflammatory Bowel Diseases ,Inflammatory Bowel Diseases/complications ,Magnetic Resonance Imaging ,3. Good health ,Intestines ,Topical review ,Settore MED/18 - Chirurgia Generale ,Inflammatory bowel disease [IBD] ,cross-sectional imaging ,endoanal ultrasonography [EAUS] ,magnetic resonance imaging [MRI] ,Chronic Disease ,Systematic review ,Current practice ,Intestines/pathology ,business - Abstract
Background and Aims The diagnosis and follow up of patients with inflammatory bowel disease [IBD] requires cross-sectional imaging modalities, such as intestinal ultrasound [IUS], magnetic resonance imaging [MRI] and computed tomography [CT]. The quality and homogeneity of medical reporting are crucial to ensure effective communication between specialists and to improve patient care. The current topical review addresses optimized reporting requirements for cross-sectional imaging in IBD. Methods An expert consensus panel consisting of gastroenterologists, radiologists and surgeons convened by the ECCO in collaboration with ESGAR performed a systematic literature review covering the reporting aspects of MRI, CT, IUS, endoanal ultrasonography and transperineal ultrasonography in IBD. Practice position statements were developed utilizing a Delphi methodology incorporating two consecutive rounds. Current practice positions were set when ≥80% of the participants agreed on a recommendation. Results Twenty-five practice positions were developed, establishing standard terminology for optimal reporting in cross-sectional imaging. Assessment of inflammation, complications and imaging of perianal CD are outlined. The minimum requirements of a standardized report, including a list of essential reporting items, have been defined. Conclusions This topical review offers practice recommendations to optimize and homogenize reporting in cross-sectional imaging in IBD.
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- 2021
11. Proton Pump Inhibitor Prescribing and Monitoring Patterns Among Gastroenterology Practitioners
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David A. Leiman, Daniel E. Freedberg, Karthik Ravi, and C. Prakash Gyawali
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Male ,medicine.medical_specialty ,business.industry ,medicine.drug_class ,Best practice ,Gastroenterologists ,Gastroenterology ,Proton-pump inhibitor ,Proton Pump Inhibitors ,Disease ,Demographic data ,Patient safety ,Internal medicine ,Cohort ,Gastroesophageal Reflux ,Humans ,Medicine ,Female ,Practice Patterns, Physicians' ,business - Abstract
GOALS The aim was to quantify proton pump inhibitor (PPI) practice habits among gastroenterology (GI) practitioners. BACKGROUND Reports of side effects have prompted patients and practitioners alike to discontinue PPI use. Emerging evidence-based literature on PPI risks and safety seek to guide practitioners, but the impact of this literature on PPI prescribing patterns has not been evaluated. STUDY We performed an anonymous online survey of US GI practitioners across 6 academic and community affiliated medical centers. Demographic data including practice type and number of weekly gastroesophageal reflux disease patients seen were obtained. Survey questions evaluated practitioners' monitoring for PPI side effects, dose adjustments, and sources of information about PPI risks. RESULTS The survey response rate was 60% (256/429). The majority of respondents were male (169, 66%) attending physicians (178, 70%) practicing general GI (63, 25%). There were 92 (36%) respondents who reported testing for PPI side effects at least once a year. Most respondents (143, 56%) reported discontinuing PPIs at least 50% of the time because of patients' concerns about PPI side effects. The majority of respondents reported getting their information regarding PPI safety from published journals (239, 98%) as well as colleagues (222, 91%). CONCLUSIONS Despite best available evidence suggesting safety of long-term PPI use without routine monitoring, stopping PPIs and monitoring for potential side effects occurs frequently, even within a cohort of mostly academic GI practitioners. Alternative strategies are needed to improve adherence to best practices, especially since gastroenterologists often serve as PPI experts.
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- 2021
12. Pregnancy and the Working Gastroenterologist: Perceptions, Realities, and Systemic Challenges
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Lauren Tal Grinspan, Rebekah E. Dixon, Michelle K. Kim, Gaurav Kakked, Loren Galler Rabinowitz, Sharmila Anandasabapathy, David A. Greenwald, Yakira N. David, Nikhil A. Kumta, and Amrita Sethi
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Adult ,Gender equity ,medicine.medical_specialty ,Reproductive Techniques, Assisted ,medicine.medical_treatment ,media_common.quotation_subject ,Gender Role ,Physicians, Women ,Pregnancy ,Occupational Exposure ,Surveys and Questionnaires ,Perception ,medicine ,Humans ,Physician's Role ,Radiation Injuries ,media_common ,Assisted reproductive technology ,Hepatology ,business.industry ,Gastroenterologists ,Mentors ,Gastroenterology ,Middle Aged ,Radiation Exposure ,medicine.disease ,United States ,Parental Leave ,Pregnancy Complications ,Career Mobility ,Education, Medical, Graduate ,Family medicine ,Female ,Parental leave ,business ,Women, Working - Published
- 2021
13. The impact of the coronavirus disease 2019 pandemic on gastroenterologists in Southeast Asia: A mixed‐methods study
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Yeong Yeh Lee, Nonthalee Pausawasdi, Vui Heng Chong, Yock Young Dan, Sharon Ong, Wan Yen Lim, David E. Ong, Dadang Makmun, Christopher Khor, John Ong, Andrew Ming Liang Ong, Mark A. De Lusong, Shiaw Hooi Ho, and Xiaohui Xin
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Adult ,Male ,education ,Qualitative property ,Burnout ,Southeast asian ,Surveys and Questionnaires ,Environmental health ,Pandemic ,Humans ,Medicine ,Burnout, Professional ,Pandemics ,Asia, Southeastern ,Depression (differential diagnoses) ,Hepatology ,SARS-CoV-2 ,business.industry ,Gastroenterologists ,Stressor ,Gastroenterology ,COVID-19 ,Workload ,Middle Aged ,Mental health ,Female ,business - Abstract
BACKGROUND AND AIM: The coronavirus disease 2019 pandemic has impacted gastroenterology practices worldwide; however, its protracted effects within Southeast Asia were unknown. The primary aim of the study was to determine the impact of the pandemic on clinical demands including burnout among gastroenterologists within the region. The secondary aim was to identify risk factors for burnout and determine regional stressors. METHODS: This was a mixed-methods study. Gastroenterologists were surveyed electronically between September 1 and December 7, 2020, via gastroenterology and endoscopy societies of Brunei, Indonesia, Malaysia, Philippines, Singapore, and Thailand. Quantitative and qualitative data were collected. The 22-item Maslach Burnout Inventory-Human Services Survey (MBI-HSS) was used to detect burnout. Quantitative data were non-parametric; non-parametric methods were used for statistical comparisons. Logistic regression was used to determine risk factors for burnout. Content analysis method was used to analyze qualitative data. Ethical approval was obtained. RESULTS: A total of 73.0% reported that they were still significantly affected by the pandemic. Of these, 40.5% reported increased workload and 59.5% decreased workload. Statistically significant differences in weekly working hours, endoscopy, and inpatient volumes were present. No differences were observed in outpatient volumes, likely because of telemedicine. Burnout was common; however, 50.1% of gastroenterologists were unaware of or did not have access to mental health support. This, as well as depression, being a trainee, and public sector work, increased burnout risk significantly. CONCLUSION: The effects of the pandemic are multifaceted, and burnout is common among Southeast Asian gastroenterologists. Safeguards for mental health are suboptimal, and improvements are urgently needed.
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- 2021
14. Should Common Bile Duct Exploration for Choledocholithiasis Be a Specialist-Only Procedure?
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Tuck Leong Yong, Nezor Houli, Rosemary Seagar, Daniel Heathcock, Russell Hodgson, Jiun Miin Lai, Chien-Tse Kao, David Bird, and Mark Tacey
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Adult ,Male ,medicine.medical_specialty ,Operative Time ,Audit ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Laparoscopy ,Aged ,Retrospective Studies ,Common Bile Duct ,Surgeons ,Medical Audit ,Common bile duct exploration ,Common bile duct ,medicine.diagnostic_test ,business.industry ,Gastroenterologists ,Significant difference ,Retrospective cohort study ,Gallstones ,Middle Aged ,medicine.disease ,Surgery ,Choledocholithiasis ,Treatment Outcome ,surgical procedures, operative ,medicine.anatomical_structure ,General Surgery ,030220 oncology & carcinogenesis ,Female ,030211 gastroenterology & hepatology ,Clinical Competence ,business ,Specialization ,Clearance - Abstract
Background: Common bile duct exploration (CBDE) is performed uncommonly. Issues surrounding its uptake in the laparoscopic era include perceived difficulty and lack of training. We aim to determine the success of CBDE performed by "specialist" and "nonspecialist" common bile duct (CBD) surgeons to determine whether there is a substantial difference in success and safety. Methods: A 10-year retrospective audit was performed of patients undergoing CBD exploration for choledocholithiasis. Northern Health maintains an on-call available "specialist" CBD surgeon roster to aid with CBDE. Results: Five hundred fifty-one patients were identified, of which 489/551 (88.7%) patients had stones successfully cleared. Specialists had a higher success rate (90.8% versus 82.6%, P = .008), associated with a longer surgical time. Method (transcystic or transductal), approach (laparoscopic or open), and indication for operation were similar between groups. There was no significant difference in complications. To be confident of a surgeon having an 80% success rate, 70 procedures over 10 years were required, however, an "in-control" 50% success rate may only require 1 procedure per year. Conclusion: While specialist CBDE surgeons have improved success rates, nonspecialist general surgeons also have a good and comparable success rate with an equivalent complication rate. With realistic annual targets, nonspecialist CBD surgeons should be encouraged to perform CBDE in centers without specialist support.
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- 2021
15. Twelve Months with COVID-19: What Gastroenterologists Need to Know
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Michele Barone, Maria Antonietta Marcialis, Ruggiero Francavilla, Vassilios Fanos, Vanessa Nadia Dargenio, Fernanda Cristofori, Rossella Giorgio, Costantino Dargenio, and Giulia Concas
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medicine.medical_specialty ,Physiology ,Gastrointestinal Diseases ,Review ,Gut flora ,Chronic liver disease ,Inflammatory bowel disease ,Coeliac disease ,Gastrointestinal symptoms ,Internal medicine ,medicine ,Humans ,Intensive care medicine ,Pandemics ,Liver diseases ,medicine.diagnostic_test ,biology ,Transmission (medicine) ,business.industry ,SARS-CoV-2 ,Gastroenterologists ,Gastroenterology ,COVID-19 ,Hepatology ,medicine.disease ,biology.organism_classification ,Endoscopy ,Liver biopsy ,business - Abstract
Corona virus disease-19 (COVID-19) is the latest global pandemic. COVID-19 is mainly transmitted through respiratory droplets and, apart from respiratory symptoms, patients often present with gastrointestinal symptoms and liver involvement. Given the high percentage of COVID-19 patients that present with gastrointestinal symptoms (GIS), in this review, we report a practical up-to-date reference for the physician in their clinical practice with patients affected by chronic gastrointestinal (GI) diseases (inflammatory bowel disease, coeliac disease, chronic liver disease) at the time of COVID-19. First, we summarised data on the origin and pathogenetic mechanism of SARS-CoV-2. Then, we performed a literature search up to December 2020 examining clinical manifestations of GI involvement. Next, we illustrated and summarised the most recent guidelines on how to adhere to GI procedures (endoscopy, liver biopsy, faecal transplantation), maintaining social distance and how to deal with immunosuppressive treatment. Finally, we focussed on some special conditions such as faecal–oral transmission and gut microbiota. The rapid accumulation of information relating to this condition makes it particularly essential to revise the literature to take account of the most recent publications for medical consultation and patient care. Supplementary Information The online version contains supplementary material available at 10.1007/s10620-021-07158-0.
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- 2021
16. Working relationship between primary and specialist care in analysing elevated liver values—a survey from the point of view of gastroenterologists
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Stefan Claus, Michael Jansky, and Julian Wangler
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Hausarzt ,medicine.medical_specialty ,Referral ,Status quo ,Transaminasen ,media_common.quotation_subject ,Pharmacology toxicology ,Early detection ,Context (language use) ,03 medical and health sciences ,0302 clinical medicine ,Ambulatory care ,General Practitioners ,Surveys and Questionnaires ,medicine ,Humans ,030212 general & internal medicine ,Referral and Consultation ,Transaminases ,media_common ,Specialist care ,Leber ,Point (typography) ,business.industry ,Gastroenterologists ,General Medicine ,Algorithm ,Algorithmus ,Liver ,Family medicine ,Original Article ,Früherkennung ,030211 gastroenterology & hepatology ,business - Abstract
Elevated liver values are often an incidental finding in outpatient care. A solid working relationship between general practitioners and specialists plays as much of a role in effective diagnostics as do selection and examination of liver values and context as indicators for referral towards more in-depth diagnosis. This article focuses on the status quo as well as potential hurdles and challenges in the relationship between general practitioners and specialists with regard to analysing elevated liver values of uncertain origin. A total of 529 physicians in gastroenterological practices in the German states of Baden-Württemberg, Hesse and Thuringia were invited to take part in an online survey in 2020, of which 313 responded. This contribution focuses on those parts of the survey covering the relationship between general practitioners and specialists. According to the results, 72% of the surveyed gastroenterologists saw working relationships between general practitioners and specialists as beneficial and effective. Even so, a variety of challenges and difficulties in everyday care dominate. Specialists especially criticised preliminary analyses performed by general practitioners as well as time of referral. Apart from that, a wide majority (85%) saw a major role in a structured diagnostic algorithm towards improving early detection and coordination between primary and specialist care. The survey revealed problems in the relationship between general practitioners and specialists. Together with targeted training and further training programmes for general practitioners, a validated diagnostic algorithm for classifying and analysing elevated liver values may be a valuable tool for general practitioners to perform diagnostics and improve the structure within which they work with specialists.In der ambulanten Versorgung treten Leberwerterhöhungen als häufiger Zufallsbefund auf. Für eine effektive Diagnostik ist nicht nur von Bedeutung, welche Leberwerte in welchen Konstellationen als Indikatoren Beachtung finden oder wann Patienten zur weiterführenden Diagnostik überwiesen werden, sondern auch, inwiefern es eine funktionierende Kooperation zwischen Haus- und Facharztebene gibt. Im Mittelpunkt des Beitrags stehen der Status quo sowie mögliche Hürden und Herausforderungen bei der Zusammenarbeit zwischen Haus- und Fachärzten hinsichtlich der Abklärung (unklar) erhöhter Leberwerte. In Baden-Württemberg, Hessen und Thüringen erfolgte im Jahr 2020 eine Online-Befragung von insgesamt 529 Ärztinnen und Ärzten gastroenterologischer Schwerpunktpraxen; letztlich teilgenommen haben 313 Ärztinnen und Ärzte. Der Beitrag fokussiert auf diejenigen Abschnitte der Befragung, die die Kooperation zwischen Haus- und Fachärzten betreffen. Die Ergebnisse zeigen, dass die Zusammenarbeit zwischen Haus- und Facharztebene nach Ansicht der befragten Gastroenterologen in weiten Teilen funktioniert und überwiegend positiv beurteilt wird (72 %). Dennoch ist sie im Versorgungsalltag durch verschiedene Herausforderungen und Schwierigkeiten geprägt. Fachärzte kritisieren insbesondere die im Vorfeld von Hausärzten geleistete Abklärung und Diagnostik sowie den Überweisungszeitpunkt. Zudem erachten sie die Einführung eines strukturierten Diagnosealgorithmus in breiter Mehrheit (85 %) als wichtigen Ansatz für die Verbesserung der Früherkennung und eine bessere Koordination zwischen den Versorgungsebenen. Die Befragung hat Schnittstellenprobleme zwischen Haus- und Fachärzten offengelegt. Ein validierter Diagnosealgorithmus zur Einordnung und Bewertung erhöhter Leberwerte kann in Verbindung mit gezielten hausärztlichen Schulungs- und Fortbildungsformaten ein wertvolles Instrument sein, um Hausärzte effektiv bei der Diagnostik zu unterstützen und die Zusammenarbeit mit Fachärzten besser zu strukturieren.
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- 2021
17. Perception of Cancer Risk and Management Practice for Colitis-associated Dysplasia Is Influenced by Colonoscopy Experience and Workplace Affiliation: Results of an International Clinician Survey
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Ailsa Hart, Siwan Thomas-Gibson, Misha Kabir, and Ana Wilson
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medicine.medical_specialty ,Dysplasia ,Health Knowledge, Attitudes, Practice ,Internationality ,Colorectal cancer ,medicine.medical_treatment ,Colonoscopy ,colorectal cancer ,Risk Assessment ,Chromoendoscopy ,Surveys and Questionnaires ,Medicine ,Humans ,Colitis ,Practice Patterns, Physicians' ,Colectomy ,AcademicSubjects/MED00260 ,Hyperplasia ,medicine.diagnostic_test ,business.industry ,General surgery ,Gastroenterologists ,Gastroenterology ,Cancer ,General Medicine ,Original Articles ,medicine.disease ,Cross-Sectional Studies ,surveillance ,Colitis, Ulcerative ,business ,Cancer risk ,Colorectal Neoplasms ,Precancerous Conditions - Abstract
Background and Aims A successful colitis cancer surveillance programme requires effective action to be taken when dysplasia is detected. This is the first international cross-sectional study to evaluate clinician understanding of dysplasia-cancer risk and management practice since the most recent international guidelines were introduced in 2015. Methods A 15-item international online survey was disseminated to gastroenterologists and colorectal surgeons. Results A total of 294 clinicians [93.5% gastroenterologists] from 60 countries responded; 23% did not have access to high-definition chromoendoscopy. University hospitals were more likely than non-academic workplaces to provide second expert histopathologist review [67% vs 46%; p = 0.002] and formal multidisciplinary team meeting discussion [73% vs 52%; p = 0.001] of dysplasia cases. Perceptions of 5-year cancer risk associated with endoscopically unresectable low-grade dysplasia varied between 0% and 100%. Non-academic hospital affiliation was predictive of lower perceived cancer risks. Although most [98.4%] respondents advised a colectomy for endoscopically unresectable visible high-grade dysplasia, only 34.4% advised a colectomy for unresectable visible low-grade dysplasia. Respondents from university hospitals were more likely to consider colectomy for multifocal low-grade dysplasia (odds ratio [OR] 2.17). If invisible unifocal low-grade dysplasia was detected, continued surveillance over colectomy was the preferred management among clinicians working mainly in private clinics [OR 9.4] and least preferred in those who had performed more than 50 surveillance colonoscopies [OR 0.41]. Conclusions Clinicians with less surveillance colonoscopy experience and from non-academic centres appear to have lower cancer risk perceptions and are less likely to advocate colectomy for higher-risk low-grade dysplasia. Further education may align current management practice with clinical guidelines., Graphical Abstract
- Published
- 2021
18. Comparison of Urologist- vs Gastroenterologist-Directed Extracorporeal Shock Wave Lithotripsy for Pancreaticolithiasis
- Author
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Robert A. Moran, Peter B. Cotton, Norman Scott, Thomas E. Keane, Isaac Jaben, B. Joseph Elmunzer, Gregory A. Cote, Erin Forster, and Kent A. Broussard
- Subjects
medicine.medical_specialty ,Urologists ,medicine.medical_treatment ,Radiography ,Urology ,Single Center ,Gastroenterology ,Calculi ,03 medical and health sciences ,0302 clinical medicine ,Lithotripsy ,Internal medicine ,Humans ,Medicine ,Pancreatic Duct Stone ,Retrospective Studies ,Process Measures ,Cholangiopancreatography, Endoscopic Retrograde ,Endoscopic retrograde cholangiopancreatography ,Hepatology ,medicine.diagnostic_test ,business.industry ,Gastroenterologists ,Retrospective cohort study ,Extracorporeal shock wave lithotripsy ,Treatment Outcome ,Pancreatic stone ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,business - Abstract
Extracorporeal shock wave lithotripsy (ESWL) for pancreaticolithiasis is most commonly performed by urologists. We investigated the effects of transitioning from urologist- to gastroenterologist-directed ESWL on case complexity, process measures, and duct clearance.We performed a retrospective study of patients who underwent ESWL for pancreaticolithiasis from 2014 through 2019 at a single center. We collected demographic, clinical, radiographic, and procedural data in duplicate and compared case complexity and process measures between the periods the procedure was performed by urologists (January 2014 through February 2017; 18 patients, 0.47 patients/month) vs gastroenterologists (March 2017 through December 2019; 61 patients; 1.79 patients/month). We also compared data on pancreatic duct stone characteristics and technical success (duct clearance, determined by imaging analysis).There were no differences in patient demographics, comorbidities, pancreatic stone morphology, or time from referral to ESWL during the period the procedure was performed by urologists vs gastroenterologists. Patients received a higher mean number of ESWL shocks per session during the gastroenterology period (4341) than during the urology period (3117) (P.001). A higher proportion of patients underwent same-session endoscopic retrograde cholangiopancreatography during the gastroenterology time period (66%) than the urology time period (6%) (P.001). A higher proportion of patients had partial or complete duct clearance during the gastroenterology period (71%) than during the urology period (44%) (P = .04). During the urology period, a higher proportion of patients were hospitalized following ESWL, although there was no difference in captured adverse events between the periods.Transition from urologist- to gastroenterologist-directed ESWL did not affect case complexity or wait times for ESWL. However, the transition did result in increased procedure volume, more shocks per ESWL session, and improved duct clearance.
- Published
- 2021
19. Surveillance Cessation for Barrett's Esophagus: A Survey of Gastroenterologists
- Author
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Iris Lansdorp-Vogelaar, Nicole Bowers, Sarah Xinhui Tan, Joel H. Rubenstein, John M. Inadomi, Elissa M. Ozanne, Sameer D. Saini, Chin Hur, Elisabeth R. Silver, and Public Health
- Subjects
Male ,medicine.medical_specialty ,MEDLINE ,Comorbidity ,Article ,Barrett Esophagus ,Patient age ,Surveys and Questionnaires ,medicine ,Humans ,Risks and benefits ,Practice Patterns, Physicians' ,Esophagus ,Intensive care medicine ,Aged ,Hepatology ,business.industry ,Gastroenterologists ,Gold standard ,Age Factors ,Gastroenterology ,medicine.disease ,humanities ,medicine.anatomical_structure ,Barrett's esophagus ,Female ,Esophagoscopy ,business - Abstract
INTRODUCTION: Regular endoscopic surveillance is the gold standard Barrett's esophagus (BE) surveillance, yet harms of surveillance for some patients may outweigh the benefits. We sought to characterize physicians' BE surveillance cessation recommendations. METHODS: We surveyed gastroenterologists about their BE surveillance recommendations varying patient age, comorbidity, and BE length. RESULTS: Clinicians varied in recommendations for repeat surveillance. Patient age showed the largest variation among decisions, whereas BE length varied the least. DISCUSSION: Age and comorbidities seem to influence BE surveillance cessation decisions, but with variation. Clear cessation guidelines balancing the risks and benefits for BE surveillance are warranted.
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- 2021
20. Abnormal Liver Blood Tests: Hepatologist Approach
- Author
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Ratko Tomasevic, Tomica Milosavljevic, Milica Stojkovic Lalosevic, Dragana Mijac, Jovan M. Krstic, Miodrag Krstic, and Snezana Lukic
- Subjects
Liver Cirrhosis ,Pathology ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,business.industry ,Gastroenterologists ,Liver Neoplasms ,Gastroenterology ,General Medicine ,Text mining ,medicine ,Humans ,Abnormal liver ,business - Abstract
Background: Available data suggest that the prevalence of chronic liver disease (CLD) and primary liver cancer is rising in Europe and represents a major public health problem. Predictions are showing that these trends will continue to rise in the upcoming years. Summary: Alcohol-related liver disease, nonalcohol fatty liver disease, and viral hepatitis B and hepatitis C are the leading causes of liver cirrhosis and primary liver cancer in Europe. Drug-induced liver injury represents a major cause of acute hepatitis, while liver transplantation is the second most common solid organ transplantation in the world. Patients with CLD have increasing rates of hospitalization, longer hospital stays, and more adverse outcomes compared to the other chronic conditions. Direct targeting of risk factors can prevent complications of advanced liver disease and improve outcome. Patients with CLD should be referred to a hepatologist for assessment of the stage of liver disease, for specific treatment and screening for hepatocellular carcinoma. Moreover, patients with unknown etiology of abnormal liver blood tests should be referred to a hepatologist for assessment of liver disease, as well as for prevention and treatment of complications of cirrhosis and/or portal hypertension. Key Messages: CLD is amenable to prevention and treatment, while disease management strategies need to improve in order to reduce the burden of liver disease and deaths due to end-stage liver diseases.
- Published
- 2021
21. Understanding GI Twitter and Its Major Contributors
- Author
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Amporn Atsawarungruangkit, Steven F. Moss, and Yousef Elfanagely
- Subjects
Male ,Surgeons ,Hepatology ,business.industry ,Gastroenterologists ,Gastroenterology ,MEDLINE ,Professional Practice ,Public relations ,Online Social Networking ,Serial Publications ,Educational Status ,Humans ,Peer influence ,Female ,Social media ,Peer Influence ,Psychology ,business ,Social Media ,Social network analysis ,Social Network Analysis ,Societies, Medical ,Specialization - Published
- 2021
22. Intestinal Failure: What All Gastroenterologists Should Know
- Author
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Claire L. Jansson-Knodell, Ashley C. Gilmore, and Richard S. Mangus
- Subjects
Intestines ,medicine.medical_specialty ,Hepatology ,business.industry ,Intestinal failure ,Gastroenterologists ,Gastroenterology ,MEDLINE ,medicine ,Humans ,Intensive care medicine ,business - Published
- 2021
23. Gastroesophageal reflux disease – from the point of view of a gastroenterologist, otolaryngologist and surgeon
- Author
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Wioletta Pietruszewska, Wiesław Tarnowski, Paweł Jaworski, Dorota Waśko-Czopnik, Magdalena Kowalczyk, Magda Barańska, and Dariusz Jurkiewicz
- Subjects
medicine.medical_specialty ,Gastroenterology ,Internal medicine ,Otolaryngologists ,Electric Impedance ,medicine ,Humans ,Esophagus ,Surgeons ,medicine.diagnostic_test ,business.industry ,Gastroenterologists ,Reflux ,Itopride ,medicine.disease ,Endoscopy ,Regimen ,medicine.anatomical_structure ,Otorhinolaryngology ,Regurgitation (digestion) ,Gastroesophageal Reflux ,GERD ,medicine.symptom ,business ,medicine.drug - Abstract
Gastrooesophageal reflux disease is the regurgitation of stomach contents into the esophagus, which causes troublesome symptoms or complications for the patient. Before starting the treatment, it is always necessary to objectively confirm gastroesophageal reflux disease, especially in correlation with ENT symptoms, as extra esophageal complications. In diagnostics, the "gold standard" is a 24-hour impedance-pH supplemented with endoscopy. Treatment without objective confirmation of the disease is not recommended, the more so that non-acid gas proximal reflux, detectable only in the MIIpH test, causes the greatest number of laryngological complications. It is important to confirm the coexistence of clinical symptoms of GERD with ESS. Considering the time of treating the disease and its consequences, it is worthwhile to be cautious and careful with the diagnosis of the disease, and the treatment should be carried out for a long time in relation to the recommendation, preferably in cooperation with an ENT specialist and gastroenterologist. The greatest therapeutic effectiveness is achieved by combining PPI with itopride while maintaining the appropriate doses of drugs and observing a sufficiently long duration of treatment, while maintaining the correct dose reduction and drug discontinuation regimen. In case of failure of pharmacological treatment, antireflux surgery should be take into consideration.
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- 2021
24. Obesity Primer for the Practicing Gastroenterologist
- Author
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Pichamol Jirapinyo and Christopher C. Thompson
- Subjects
medicine.medical_specialty ,Hepatology ,business.industry ,Gastroenterologists ,Gastroenterology ,MEDLINE ,Bariatric Surgery ,Disease ,Endoscopic management ,Gut hormones ,medicine.disease ,Obesity ,Management of obesity ,03 medical and health sciences ,0302 clinical medicine ,Chronic disease ,030220 oncology & carcinogenesis ,Internal medicine ,Humans ,Medicine ,030211 gastroenterology & hepatology ,business - Abstract
With worsening of the obesity pandemic, gastroenterologists will see more patients with this chronic disease. Given the association between obesity and several gastrointestinal conditions and the interplay between obesity pathophysiology and gut hormones, gastroenterologists can play an important role in the management of this disease. Furthermore, because more patients undergo bariatric surgery, an understanding of postsurgical anatomy and medical and endoscopic management of bariatric surgical complications is essential. This article provides clinical tools for the assessment and management of obesity for the general gastroenterologist. Tables containing high-yield practical information are also provided for quick reference.
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- 2021
25. What Gastroenterologists Should Know About COVID-19 Vaccines
- Author
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Mary S. Hayney, Stacey Rolak, Jonathan L. Temte, Francis A Farraye, and Freddy Caldera
- Subjects
2019-20 coronavirus outbreak ,medicine.medical_specialty ,Emergency Use Authorization ,COVID-19 Vaccines ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,MEDLINE ,Food and drug administration ,EUA, emergency use authorization ,Surveys and Questionnaires ,Pandemic ,Epidemiology ,medicine ,Humans ,Intensive care medicine ,Pandemics ,Here and Now: Clinical Practice ,Hepatology ,SARS-CoV-2 ,business.industry ,Gastroenterologists ,OWS, Operation Warp Speed ,Gastroenterology ,COVID-19 ,ACIP, Advisory Committee on Immunization Practices ,FDA, Food and Drug Administration ,Clinical Competence ,business - Published
- 2021
26. Making Social Media Work for You
- Author
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Joy W. Chang, Rajitha D. Venkatesh, Evan S. Dellon, and Patricia P. Bloom
- Subjects
Marketing ,Physiology ,business.industry ,Communication ,Gastroenterologists ,Gastroenterology ,Public relations ,Transplant surgery ,Work (electrical) ,Patient Education as Topic ,Order (business) ,Humans ,Social media ,Psychology ,business ,Fellows and Young GIS Section ,Productivity ,Social Media - Abstract
Social media (SoMe) can be an effective professional tool for the gastroenterologist or trainee. SoMe can support a gastroenterologist's efforts to brand themselves, network, learn, educate, and advocate for patients. SoMe for professional use should be approached with specific aims in mind, in order to optimize impact and productivity.
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- 2021
27. Australasian Pediatric Gastroenterologists’ Perspectives and Practices of Celiac Disease Diagnosis and Management
- Author
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Sophie W. Hall, Shaun S C Ho, Jacqueline I. Keenan, and Andrew S. Day
- Subjects
Adult ,medicine.medical_specialty ,Pediatrics ,Physiology ,Duodenal biopsy ,Adult care ,Disease ,ESPGHAN ,Asymptomatic ,Paediatric gastroenterology ,Internal medicine ,Biopsy ,Diagnosis ,medicine ,Humans ,Gastroenterologist ,Child ,Management practices ,Autoantibodies ,Transglutaminases ,medicine.diagnostic_test ,business.industry ,Follow-up ,Gastroenterologists ,Gastroenterology ,Hepatology ,Immunoglobulin A ,Celiac Disease ,Original Article ,medicine.symptom ,business - Abstract
Background The application of the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) celiac disease (CeD) guidelines by pediatric gastroenterologists in Australia and New Zealand (Australasia) is unknown. Similarly, long-term management practices for patients with CeD are also unknown in this region. Aims This study aimed to explore the perceptions and practices of Australasian pediatric gastroenterologists in diagnosing and managing patients with CeD. Methods Australasian pediatric gastroenterologists and trainees were invited to complete an anonymous online survey over a 3-week period. Results The survey was completed by 28 respondents, 24 from Australia and four from New Zealand. Tissue transglutaminase antibody IgA was the most frequently ordered initial serologic test. Fifteen (54%) respondents relied on duodenal biopsies for the confirmation of CeD, six (21%) followed the ESPGHAN guidelines and the remaining seven offered either biopsy confirmation or no-biopsy diagnosis according to the parents' wishes. Following diagnosis, five (18%) respondents discharged patients from care, three (11%) discharged patients after one follow-up visit, one (4%) reviewed patients for 12 months, six (21%) reviewed patients until celiac antibodies normalized and children were clinically asymptomatic, and 13 (46%) reviewed patients until transition to adult care. Conclusion Tissue transglutaminase antibody IgA was the most common initial serologic test ordered by this group of Australasian pediatric gastroenterologists. Half of these physicians rely solely on duodenal biopsy for the confirmation of CeD diagnosis: a minority routinely use the ESPGHAN guidelines. Physicians reported a wide range of CeD follow-up practices. Supplementary Information The online version contains supplementary material available at 10.1007/s10620-021-06988-2.
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- 2021
28. Patent Issued for Endoscopic image analysis and control component of an endoscopic system (USPTO 11730491).
- Subjects
IMAGE analysis ,PATENT offices ,MINIMALLY invasive procedures ,GASTROENTEROLOGISTS - Abstract
Keywords: Arthroscopy; Business; Endoscopy; Health and Medicine; Kunnskap Medical LLC; Minimally Invasive Surgical Procedures; Orthopedic Procedures; Surgery; Surgical Procedures EN Arthroscopy Business Endoscopy Health and Medicine Kunnskap Medical LLC Minimally Invasive Surgical Procedures Orthopedic Procedures Surgery Surgical Procedures 2225 2225 1 09/11/23 20230911 NES 230911 2023 SEP 17 (NewsRx) -- By a News Reporter-Staff News Editor at Medical Devices & Surgical Technology Week -- A patent by the inventors Holmstrom, Michael C. (Cottonwood Heights, UT, US), filed on August 6, 2021, was published online on August 22, 2023, according to news reporting originating from Alexandria, Virginia, by NewsRx correspondents. The component of claim 14, wherein the image analysis engine is to determine each characteristic of the plurality of characteristics of the image from a different predefined category of characteristic. The component of claim 1, wherein the image analysis engine is to determine a plurality of characteristics of the image, and wherein the control engine is to adjust one or more components of the endoscopic system based on the plurality of characteristics of the image. URL and more information on this patent, see: Holmstrom, Michael C. Endoscopic image analysis and control component of an endoscopic system. [Extracted from the article]
- Published
- 2023
29. Patent Application Titled "Endoscopic Patch Applicator" Published Online (USPTO 20230181871).
- Subjects
PATENT applications ,PATENT offices ,INTERNET publishing ,GASTROENTEROLOGISTS - Abstract
"The device may include a second lumen defined by the catheter, the second wire or the second cable may extend through the second lumen, and the second lumen may receive each of the non-adhesive layers separate from the corresponding adhesive layer. "The distal end of the catheter may include an annular ring at a distalmost portion of the catheter and extending from a sidewall of the catheter toward the distal opening, wherein a distance between an innermost surface of the annular ring and the longitudinal axis may be less than a distance between an innermost surface of the sidewall of the catheter and the longitudinal axis. These procedures and diseases cause very thin layers in the GI tract wall, leaving the GI tract wall vulnerable to GI perforation or other trauma. [Extracted from the article]
- Published
- 2023
30. The prevalence of burnout, risk factors, and job‐related stressors in gastroenterologists: A systematic review
- Author
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Yock Young Dan, John Ong, Sharon Ong, Carla Swift, Arun Shankar, Michael F. Bath, Yasseen Al-Naeeb, and Wan Yen Lim
- Subjects
medicine.medical_specialty ,Scopus ,PsycINFO ,Burnout ,Occupational safety and health ,Occupational Stress ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Forest plot ,Prevalence ,medicine ,Humans ,Emotional exhaustion ,Burnout, Professional ,Hepatology ,business.industry ,Gastroenterologists ,Stressor ,Gastroenterology ,030220 oncology & carcinogenesis ,Family medicine ,Anxiety ,030211 gastroenterology & hepatology ,medicine.symptom ,business - Abstract
Background and aimsClinician burnout is an important occupational hazard and the scale of the problem within gastroenterology remains poorly understood. The primary objective of this study was to identify the prevalence of burnout and its symptoms in gastroenterologists. The secondary objective was to identify risk factors and job-related stressors that commonly contribute to burnout in gastroenterologists.MethodsSystematic searches were conducted in PubMed, Scopus, Cochrane and PsycINFO by two reviewers independently for articles published to 1 September 2020. The primary outcome measure was the reported prevalence of burnout in gastroenterologists. The secondary outcome measures were (i) the prevalence of burnout symptoms (emotional exhaustion, depersonalisation and low personal accomplishment) and (ii) the frequency of risk factors and stressors reported in studies. Data were tabulated and meta-analyses were presented as Funnel and Forest plots.ResultsData were extracted from 11 studies. 54.5% (6/11) of these studies reported the prevalence of burnout in gastroenterologists; this ranged from 18.3% to 64.4%. Similar to burnout prevalence, burnout symptoms showed geographical variation and were common in gastroenterologists (up to 63.9%). Factors associated with work volume, age, and female gender were the three most frequently reported risk factors for increased levels of anxiety, stress or burnout in 72.7% (8/11), 54.5% (6/11), and 45.5% (5/11) of studies respectively. Significant methodological and clinical heterogeneity was observed.ConclusionsBurnout and its symptoms are common in gastroenterologists but the syndrome is understudied within the field. Further research and good quality data are needed to help address the problem.Disclose StatementJO is funded by the British Society of Gastroenterology to conduct burnout research in the UK, and the Journal of Gastroenterology and Hepatology Foundation (Australia) to conduct burnout research in Southeast Asia.
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- 2021
31. Establishment of a North American Model Academic Gastroenterology Division in the Middle East: The Cleveland Clinic Abu Dhabi Experience
- Author
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Shiva Kumar
- Subjects
Academic Medical Centers ,medicine.medical_specialty ,Middle East ,Delivery of Health Care, Integrated ,Physiology ,business.industry ,International Cooperation ,Gastroenterologists ,Gastroenterology ,United Arab Emirates ,Culturally Competent Care ,Transplant surgery ,Abu dhabi ,Family medicine ,Humans ,Medicine ,Cooperative Behavior ,Personnel Selection ,business ,Ohio - Published
- 2021
32. A Multicenter Study of Patient Acceptability of the IBD Disk Tool and Patient-Reported Disabilities
- Author
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Neel Sharma, Benjamin Disney, Ashit Shah, Edo Savelkoul, Subrata Ghosh, Shanika De Silva, Rachel Cooney, Sanjeev Pattni, and Marietta Iacucci
- Subjects
Adult ,Male ,Sleep Wake Disorders ,medicine.medical_specialty ,Attitude of Health Personnel ,Physiology ,Disease ,Likert scale ,03 medical and health sciences ,Qualitative feedback ,0302 clinical medicine ,Surveys and Questionnaires ,medicine ,Humans ,Patient Reported Outcome Measures ,Fatigue ,Qualitative Research ,business.industry ,Gastroenterologists ,Gastroenterology ,Paper version ,Middle Aged ,Patient Acceptance of Health Care ,Inflammatory Bowel Diseases ,medicine.disease ,Arthralgia ,Ulcerative colitis ,digestive system diseases ,Abdominal Pain ,Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11] ,Multicenter study ,030220 oncology & carcinogenesis ,Joint pain ,Physical therapy ,Feasibility Studies ,Female ,030211 gastroenterology & hepatology ,medicine.symptom ,business ,Healthcare providers - Abstract
Item does not contain fulltext BACKGROUND: IBD, both Crohn's disease and ulcerative colitis, is associated with significant functional disability. Gastrointestinal symptoms alone are not the sole purpose of the interaction between patients and providers. In order to ascertain patients' disabilities, we utilized the recently developed IBD Disk to help determine their functional concerns and initiate relevant conversation. We aimed to ascertain patient acceptability and their major disabilities. PATIENTS AND METHODS: In this multicenter study, IBD patients at their outpatient visit were given the paper version of the IBD Disk. Patients were asked to score their level of disability for each item of the IBD Disk. The completed scores were then shared with their healthcare provider to act as a focus of discussion during the consultation. Patients and clinicians were also asked to provide informal qualitative feedback as to the benefits of the IBD Disk and areas for improvement. RESULTS: A total of 377 (female 60%) patients completed the questionnaires over the study period. Patient acceptability scored on a 0-10 Likert scale was excellent. All patients scored all domains of disability. Sleep, energy, and joint pain were the highest scoring domains of the IBD Disk, scoring higher than digestive symptoms. Clinicians and patients agreed that the IBD Disk allowed for ease of communication about disability symptoms and relevance to their day-to-day functioning. CONCLUSION: The IBD Disk is a novel easy-to-use tool to assess the functional disability of patients. We next plan to utilize it in the form of an electronic app internationally and in relation to treatment commencement and escalation.
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- 2021
33. Gastroprotection in patients on antiplatelet and/or anticoagulant therapy: a position paper of National Association of Hospital Cardiologists (ANMCO) and the Italian Association of Hospital Gastroenterologists and Endoscopists (AIGO)
- Author
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Fabio Monica, Andrea Di Lenarda, Giuseppe Milazzo, Michele Massimo Gulizia, Vincenzo De Francesco, Domenico Gabrielli, Maurizio Giuseppe Abrignani, Furio Colivicchi, Roberta Rossini, Luigi Gatta, Massimo Imazio, Marco Soncini, Fortunato Scotto di Uccio, Elisabetta Riccio, Leonardo De Luca, Maura Francese, and Angelo Zullo
- Subjects
medicine.medical_specialty ,Prasugrel ,030204 cardiovascular system & hematology ,Helicobacter Infections ,Dabigatran ,03 medical and health sciences ,chemistry.chemical_compound ,Cardiologists ,0302 clinical medicine ,Edoxaban ,Internal medicine ,Internal Medicine ,Humans ,Medicine ,030212 general & internal medicine ,Rivaroxaban ,Helicobacter pylori ,business.industry ,Gastroenterologists ,Warfarin ,Anticoagulants ,Proton Pump Inhibitors ,Clopidogrel ,Hospitals ,Italy ,chemistry ,Apixaban ,Gastrointestinal Hemorrhage ,business ,Ticagrelor ,Platelet Aggregation Inhibitors ,medicine.drug - Abstract
Aspirin and P2Y12 receptor antagonists are widely used across the spectrum of cardiovascular and cerebrovascular diseases. Gastrointestinal complications, including ulcer and bleeding, are relatively common during antiplatelet treatment and, therefore, concomitant proton pump inhibitor (PPI) treatment is often prescribed. However, potential increased risk of cardiovascular events has been suggested for PPIs, and, in recent years, it has been discussed whether these drugs may reduce the cardiovascular protection by aspirin and, even more so, clopidogrel. Indeed, pharmacodynamic and pharmacokinetic studies suggested an interaction through hepatic CYP2C19 between PPIs and clopidogrel, which could translate into clinical inefficacy, leading to higher rates of cardiovascular events. The FDA and the EMA sent a warning in 2010 discouraging the concomitant use of clopidogrel with omeprazole or esomeprazole. In addition, whether the use of PPIs may affect the clinical efficacy of the new P2Y12 receptor antagonists, ticagrelor and prasugrel, remains less known. According to current guidelines, PPIs in combination with antiplatelet treatment are recommended in patients with risk factors for gastrointestinal bleeding, including advanced age, concurrent use of anticoagulants, steroids or non-steroidal anti-inflammatory drugs, and Helicobacter pylori infection. Like vitamin K antagonists (VKAs), DOACs can determine gastrointestinal bleeding. Results from both randomized clinical trials and observational studies suggest that high-dose dabigatran (150 mg bid), rivaroxaban and high-dose edoxaban (60 mg daily) are associated with a higher risk of GI bleeding as compared with apixaban and warfarin. In patients taking oral anticoagulant with GI risk factor, PPI could be recommended, even if usefulness of PPIs in these patients deserves further data. Helicobacter pylori should always be searched, and treated, in patients with history of peptic ulcer disease (with or without complication). Given the large number of patients treated with antithrombotic drugs and PPIs, even a minor reduction of platelet inhibition or anticoagulant effect potentially carries a considerable clinical impact. The present joint statement by ANMCO and AIGO summarizes the current knowledge regarding the widespread use of platelet inhibitors, anticoagulants, and PPIs in combination. Moreover, it outlines evidence supporting or opposing drug interactions between these drugs and discusses consequent clinical implications.
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- 2021
34. Application of the innovative methods of mathematical modeling in the development of standards for providing the ambulatory link by doctors in Russia
- Author
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N. E. Guryanova, M. A. Ivanova, and L. A. Soprun
- Subjects
medicine.medical_specialty ,media_common.quotation_subject ,030303 biophysics ,estimation of nuclear density ,gastroenterologists ,Dermatology ,regions of the russian federation ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Medical technology ,medicine ,Quality (business) ,R855-855.5 ,media_common ,0303 health sciences ,business.industry ,Incidence (epidemiology) ,Attendance ,Clinical Practice ,Work (electrical) ,gastrointestinal diseases ,Family medicine ,Surgery ,Russian federation ,business ,Healthcare system - Abstract
The work presents data on the relationship between the regional incidence of gastrointestinal tract diseases and the number of medical personnel in various regions of the Russian Federation. Indicators for all federal districts for 2013-2017 have been studied. Mathematical models describing this relationship have been proposed. It has been shown that regional morbidity correlates with the number of medical personnel, as well as with attendance at treatment and prevention institutions. The average number of gastroenterologists from 1.3 to 1.5 per 100,000 inhabitants of the region is optimal for the timely detection of gastroenterology diseases. The data obtained can be used in management decisions to optimize the burden on the healthcare system in each region. The introduction of the standards into clinical practice under the established procedure will help to improve the quality of specialized care for patients with gastroenterological problems.
- Published
- 2021
35. Provider Viewpoints in the Management and Referral of Rectal Cancer
- Author
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Xiang Gao, Kristin S. Weeks, Irena Gribovskaja-Rupp, Imran Hassan, Mary E. Charlton, and Marcia M. Ward
- Subjects
Male ,medicine.medical_specialty ,Referral ,Colorectal cancer ,Psychological intervention ,Specialty ,Qualitative property ,Article ,Interviews as Topic ,03 medical and health sciences ,0302 clinical medicine ,Health care ,Humans ,Medicine ,Practice Patterns, Physicians' ,Medical diagnosis ,Referral and Consultation ,Surgeons ,Rectal Neoplasms ,business.industry ,Gastroenterologists ,medicine.disease ,030220 oncology & carcinogenesis ,Family medicine ,Female ,030211 gastroenterology & hepatology ,Surgery ,Rural area ,business - Abstract
Background Patients with rectal cancer treated at specialized or high-volume hospitals have better outcomes, but a minority of these patients are treated there. Physician recommendations are important considerations for patients with rectal cancer when making treatment decisions, yet little is known about the factors that affect these physician referral patterns. Methods Semistructured telephone interviews were conducted in 2018-2019 with Iowa gastroenterologists (GIs) and general surgeons (GSs) who performed colonoscopies in a community setting. A thematic approach was used to analyze and code qualitative data. Results We interviewed 10 GIs and 6 GSs with self-reported averages of 15.5 y in practice, 1100 endoscopic procedures annually, and 6 rectal cancer diagnoses annually. Physicians believed surgeon experience and colorectal specialization were directly related to positive outcomes in rectal cancer resections. Most GSs performed resections on patients they diagnosed and typically only referred patients to colorectal surgeons (CRS) in complex cases. Conversely, GIs generally referred to CRS in all cases. Adhering to existing referral patterns due to the pressure of health care networks was a salient theme for both GIs and GSs. Conclusions While respondents believe that high volume/specialization is related to improved surgical outcomes, referral recommendations are heavily influenced by existing referral networks. Referral practices also differ by diagnosing specialty and suggest rural patients may be less likely to be referred to a CRS because more GSs perform colonoscopies in rural areas and tend to keep patients for resection. System-level interventions that target referral networks may improve rectal cancer outcomes at the population level.
- Published
- 2021
36. Increased Use of Prophylactic Measures in Preventing Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis
- Author
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Weiland, C.J.S., Engels, M.M.L., Poen, A.C., Bhalla, A., Venneman, N.G., Hooft, J.E. van, Bruno, M.J., Verdonk, R.C., Fockens, P., Drenth, J.P.H., Geenen, E.J.M. van, Dutch Pancreatitis Study Grp, Gastroenterology & Hepatology, Gastroenterology and Hepatology, and AGEM - Amsterdam Gastroenterology Endocrinology Metabolism
- Subjects
Male ,Physiology ,chemistry.chemical_compound ,0302 clinical medicine ,Intravenous hydration ,Surveys and Questionnaires ,Cholangiopancreatography, Endoscopic Retrograde ,Endoscopic retrograde cholangiopancreatography ,medicine.diagnostic_test ,Ampullectomy ,Anti-Inflammatory Agents, Non-Steroidal ,Gastroenterology ,Middle Aged ,surgical procedures, operative ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Practice Guidelines as Topic ,030211 gastroenterology & hepatology ,Original Article ,Female ,Stents ,Intravenous ,Adult ,medicine.medical_specialty ,Infusions ,Other Research Radboud Institute for Molecular Life Sciences [Radboudumc 0] ,Pancreatic ducts ,digestive system ,03 medical and health sciences ,ERCP ,Internal medicine ,medicine ,Humans ,Risk reduction behavior ,Pancreatic duct ,Nonsteroidal ,business.industry ,Gastroenterologists ,Guideline ,Hepatology ,medicine.disease ,digestive system diseases ,Surgery ,Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11] ,chemistry ,Pancreatitis ,Risk factors ,business ,Nonsteroidal anti-inflammatory agents - Abstract
Background Nonsteroidal anti-inflammatory drugs (NSAIDs), pancreatic duct stenting, and intensive intravenous hydration have been proven to prevent post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. Trial participation and guideline changes demanded an assessment of the clinical practice of post-ERCP pancreatitis prophylaxis. Aims The surveys aim to identify points of improvement to inform and educate ERCPists about current evidence-based practice. Methods Two anonymous surveys were conducted among Dutch gastroenterologists in 2013 (n = 408) and 2020 (n = 575) for longitudinal views and attitudes pertaining to post-ERCP pancreatitis prophylaxis and recognition of post-ERCP pancreatitis risk factors. Results In 2013 and 2020, respectively, 121 and 109 ERCPists responded. In the 2013 survey, 98% of them utilized NSAID prophylaxis and 62% pancreatic duct stent prophylaxis in specific cases. In the 2020 survey, the use of NSAIDs (100%), pancreatic duct stents (78%), and intensive intravenous hydration (33%) increased among ERCPists. NSAID prophylaxis was the preferred prophylactic measure for all risk factors in the 2020 survey, except for ampullectomy, pancreatic duct contrast injection, and pancreatic duct cannulation, for which NSAID prophylaxis and pancreatic duct stent combined was equally favored or preferred. Conclusion Rectal NSAIDs are the most applied post-ERCP pancreatitis prophylaxis in the Netherlands, followed by pancreatic duct stents and intensive intravenous hydration. Additionally, there is reason to believe that recent guideline updates and active research participation have led to increased prophylaxis implementation. Supplementary Information The online version of this article (10.1007/s10620-020-06796-0) contains supplementary material, which is available to authorized users.
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- 2021
37. Transitional care for inflammatory bowel disease: A survey of Japanese pediatric gastroenterologists
- Author
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Takahiro Kudo, Akira Sugita, Yoshikazu Ohtsuka, Reiko Kunisaki, Hideki Kumagai, Toshiaki Shimizu, Yasuo Suzuki, Hitoshi Tajiri, Katsuhiro Arai, Mitsuru Kubota, and Keiichi Uchida
- Subjects
Transition to Adult Care ,medicine.medical_specialty ,Adolescent ,Adult care ,030204 cardiovascular system & hematology ,Inflammatory bowel disease ,Likert scale ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Surveys and Questionnaires ,030225 pediatrics ,Internal medicine ,medicine ,Humans ,Transitional care ,Young adult ,Child ,Pediatric gastroenterology ,Response rate (survey) ,business.industry ,Gastroenterologists ,Gastroenterology ,Hepatology ,Inflammatory Bowel Diseases ,medicine.disease ,Family medicine ,Pediatrics, Perinatology and Child Health ,business - Abstract
BACKGROUND In 2019 we reported the results of a Japanese national survey designed to explore the views of adult gastroenterologists regarding transitional care for patients with childhood-onset inflammatory bowel disease (IBD). For the present study, we conducted a similar survey of pediatric gastroenterologists to compare the views of the two sets of specialists. METHODS The survey conducted in 2019 involved 48 representative members of the Japanese Society for Pediatric Gastroenterology, Hepatology and Nutrition. They were contacted by conventional mail and their answers were not anonymized. Respondents who had already referred patients with IBD to adult gastroenterologists were asked in a questionnaire to rank the importance of specific statements on a Likert scale. RESULTS The response rate was 79% and 29 (60%) of the respondents had experienced transitional care for patients with IBD. Transfer to adult care was considered by 90% of the respondents to be the ideal form of medical care for adolescents/young adults with IBD. However, 59% of the respondents had experienced some degree of difficulty when making referrals for such care. The majority of pediatric gastroenterologists considered that the ideal age for transfer was 18-22 years. Among the respondents, physicians at municipal hospitals considered that the presence of diseases other than IBD and a shortage of manpower were significantly more important issues than other practice settings. CONCLUSIONS The present survey revealed that the general views regarding transitional care for IBD between pediatric and adult gastroenterologists were similar, except for the appropriate time for transfer. The results underline the importance of preparing a transition program appropriate to practice settings.
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- 2021
38. National Early Career Transplant Hepatologist Survey: Compensation, Burnout, and Job Satisfaction
- Author
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Frank I. Scott, Helen S. Te, Michael Kriss, Lisa B. VanWagner, Jennifer C. Lai, and Elizabeth C. Verna
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Adult ,Male ,medicine.medical_specialty ,education ,MEDLINE ,Burnout ,Subspecialty ,Organ transplantation ,Job Satisfaction ,Interquartile range ,Surveys and Questionnaires ,medicine ,Prevalence ,Humans ,Salary ,lcsh:RC799-869 ,Physician's Role ,Burnout, Professional ,Academic Medical Centers ,Hepatology ,Inpatient care ,Career Choice ,business.industry ,Salaries and Fringe Benefits ,Gastroenterologists ,Original Articles ,Training Support ,Hospitals ,United States ,Liver Transplantation ,Family medicine ,Medicine ,lcsh:Diseases of the digestive system. Gastroenterology ,Job satisfaction ,Original Article ,Female ,business - Abstract
Despite the growth of transplant hepatology as a subspecialty over the past decade, data on professional roles and compensation models remain lacking. Furthermore, the prevalence of physician burnout and job satisfaction are unknown in this profession. We aimed to conduct a comprehensive assessment of early career transplant hepatologists to fill these voids in knowledge and to inform current and future transplant hepatologists. An online survey designed to quantify clinical and nonclinical roles, compensation and structure, job satisfaction, and burnout was sent to 256 early career transplant hepatologists. Respondents were divided into three practice settings: university hospital clinical (n = 79), non–university hospital clinical (n = 35), and research (n = 25). The median age of respondents was 38 (interquartile range [IQR] 36‐40) years, and 44% were women. The median half‐days/week spent in clinic was 4 (IQR 3‐6) and in endoscopy was 1 (IQR 1‐2). Most of the respondents provided inpatient care (88%) for a median of 9 (IQR 6.5‐10) weeks/year. The median base compensation was $300,000 (IQR US $263,750‐$326,250), and most (76%) had salary‐based compensation. Although only 8% of respondents were dissatisfied with their position, the prevalence of burnout was high at 35%. Conclusion: This survey is a comprehensive assessment focusing on early career transplant hepatologists, is reflective of the current training paradigm and practice of transplant hepatology, and provides transparency to guide professional negotiations and empower both trainees pursuing careers in transplant hepatology and early career transplant hepatologists., Over the past decade, transplant hepatology has matured into a robust subspecialty. Despite this growth, comprehensive data on professional roles, compensation, physician burnout, and job satisfaction remain lacking, leaving trainees and early career transplant hepatologists without discrete information as they start their careers. This national survey of early career transplant hepatologists specifically addresses these gaps, and in so doing, provides a framework for both individuals and programs alike to understand varied roles of transplant hepatologists, compensation structure, and impact of these factors on physician burnout and job satisfaction.
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- 2021
39. Gastroenterologists’ Attitude Regarding Medical Cannabis for Inflammatory Bowel Diseases in Israel
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Eran Goldin, Ami Ben-Ya'acov, Aliza Neumark, Ariella Bar-Gil Shitrit, B. Mazuz, and Benjamin Koslowsky
- Subjects
Adult ,Male ,medicine.medical_specialty ,Attitude of Health Personnel ,business.industry ,Initial dose ,Gastroenterologists ,Gastroenterology ,MEDLINE ,Inflammatory Bowel Diseases ,Medical Marijuana ,General Medicine ,Middle Aged ,Internal medicine ,Medical cannabis ,Humans ,Medicine ,Female ,Israel ,Positive attitude ,business ,Clinical scenario - Abstract
Background: The use of medical cannabis (MC) for inflammatory bowel diseases (IBDs) is expanding. Current evidence does not support the efficacy of MC for reducing inflammation in IBD patients. Even so, many gastroenterologists encounter the issue of recommending use of MC to IBD patients. Methods: A Web-based survey was completed by 84 (34%) gastroenterologists in Israel. Results: Out of 84 physicians whom completed the questionnaire, 59 (70%) were male, 34 (40%) were under age 50 years, 71 (85%) were adult gastroenterologists, and 53 (63%) work mainly in a hospital. Of them, 15, 41, and 44% of physicians think that MC is very effective, mildly effective, and not effective at all, respectively. Physicians will commonly, rarely, and never recommend MC in 31, 47, and 22%, respectively. Older physicians (above age 50 years) were significantly more likely to have a positive attitude towards MC in both questions. When presented with a clinical scenario of a patient in deep remission, requesting to increase the dose, 32% would increase, 49% would maintain, and only 18% would stop prescribing MC altogether; 48% of physicians did not know the recommended initial dose for MC. Only 2 (2.5%) physicians initiated the use of MC to all patients. Female gastroenterologists were significantly more likely to initiate MC, p = 0.048. Conclusion: The use of MC for IBD patients is commonly encountered. Completely different attitudes regarding this treatment were seen. Age above 50 years and female physicians generally had a more positive attitude towards the use of MC. Guidelines and clear recommendations are needed.
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- 2021
40. Results of a National Survey on the Use of Stents for the Treatment of Colonic Obstruction
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Aina Ochogavía Seguí, Juan José Segura-Sampedro, Xavier González-Argente, N. Alonso-Hernández, Margarita Gamundi Cuesta, Carla María Soldevila Verdeguer, Jose Manuel Olea Martinez-Mediero, and Myriam Fernández Isart
- Subjects
Adult ,Male ,medicine.medical_specialty ,Attitude of Health Personnel ,medicine.medical_treatment ,Perforation (oil well) ,Specialty ,Angiogenesis Inhibitors ,030230 surgery ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Neoplasms ,Surveys and Questionnaires ,medicine ,Humans ,In patient ,Peritoneal Neoplasms ,Societies, Medical ,Aged ,Neoplasm Staging ,Surgeons ,business.industry ,General surgery ,Gastroenterologists ,Palliative Care ,General Engineering ,Stent ,Middle Aged ,Palliative Therapy ,Colonic obstruction ,Intestinal Perforation ,Spain ,Localized disease ,Colonic Neoplasms ,Practice Guidelines as Topic ,Female ,Stents ,Guideline Adherence ,Stage iv ,business ,Intestinal Obstruction - Abstract
Introduction We distributed a survey in order to determine the current indications for the use of colonic stents to treat colonic obstruction in Spain and its compliance with international guidelines. Methods Descriptive study of a survey distributed by the Spanish Association of Surgeons (Asociacion Espanola de Cirujanos), the Catalan Society of Surgery (Societat Catalana de Cirurgia) and the Spanish Society of Digestive Endoscopy (Sociedad Espanola de Endoscopia Digestiva). Results 340 valid responses were received: 25% from gastrointestinal specialists, and 75% from general surgeons. During the last year, 44.4% of respondents assessed between 10 and 20 COC. Of these, 52.2% indicated less than 5 stents/year, 75% of which were indicated as a prior step to preferential surgery and only 25% were performed with palliative intent. 55.3% of the participants reported knowing the official guidelines, and 64% of respondents would use the stent as a step prior to surgery in elderly patients with localized disease. 75.9% would place stents as palliative therapy in young patients with carcinomatosis, and 61.8% would use them in stage IV malignancies under treatment with chemotherapy. Only 18.1% knew of the risk of colon perforation after stent placement in patients undergoing treatment with antiangiogenics. Conclusions In Spain, the indication for colonic stents is reserved for selected cases and varies according to the specialty and the years of experience of the respondent. The compliance with international guidelines of most respondents is moderate. It is important to insist on the high risk of perforation after angiogenics, which is unknown to most surgeons.
- Published
- 2020
41. Safety of the LMA®Gastro™ for Endoscopic Retrograde Cholangiopancreatography
- Author
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Mike Hernandez, Benjamin Arnold, Linh T Nguyen, Richard Carlson, Katherine B. Hagan, Carin A. Hagberg, Jeffrey Lee, Tariq Syed, Lei Feng, and Brian Weston
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Adult ,Male ,Vital signs ,Laryngeal Masks ,Pacu ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Tongue ,030202 anesthesiology ,Gastro ,medicine ,Sore throat ,Humans ,Prospective Studies ,Airway Management ,Adverse effect ,Aged ,Aged, 80 and over ,Cholangiopancreatography, Endoscopic Retrograde ,Hoarseness ,Endoscopic retrograde cholangiopancreatography ,medicine.diagnostic_test ,biology ,business.industry ,Gastroenterologists ,Pharyngitis ,Carbon Dioxide ,Middle Aged ,biology.organism_classification ,Anesthesiologists ,Oxygen ,Anesthesiology and Pain Medicine ,Anesthesia ,Female ,Patient Safety ,medicine.symptom ,Propofol ,Airway ,business ,030217 neurology & neurosurgery ,medicine.drug - Abstract
Background Endoscopic retrograde cholangiopancreatography (ERCP) patients typically receive either tubeless anesthesia or general endotracheal anesthesia (GETA). Patients receiving propofol-based total intravenous anesthesia (TIVA) are at higher risk of sedation-related adverse events (SRAEs) than patients receiving GETA, primarily due to the need for additional airway maneuvers. The increasing use of non-operating room (OR) anesthesia and the perception of a higher incidence of adverse outcomes in non-OR areas has led to the development of devices to improve safety while maintaining efficiency. The purpose of this study was to evaluate if the LMA Gastro™ could be used as a safe alternative to tubeless anesthesia for successfully completing ERCPs. Methods Eligible subjects were identified within the patient population at MD Anderson Cancer Center. Inclusion criteria consisted of adult patients (≥18 years old) scheduled for elective ERCP with TIVA. This was a prospective observational study in which the following data were collected: number of attempts and time to successful supraglottic airway (SGA) placement, vital signs, peripheral oxygen saturation (SpO2), median end-tidal CO2, practitioner satisfaction, and any complications. Results A total of 30 patients were included in this study. The overall rate of successful SGA placement within 3 attempts was 96.7% (95% confidence interval [CI], 82.8-99.9) or 29/30. The rate of successful ERCP with SGA placement within 3 attempts was 93.3% (95% CI, 77.9-99.2) or 28/30. Both the gastroenterologist and anesthesiologist reported satisfaction with the device in 90% of the cases (in 66.7% of the cases both anesthesiologist and gastroenterologist scored the device a 7/7 for satisfaction). Patients maintained an SpO2 of 95%-100% from induction to discharge, with the exception of 1 patient who had an SpO2 of 93%. The median end-tidal CO2 during the procedure for all patients was 35 mm Hg. Observed aspiration did not occur in any patient. Symptoms of hoarseness (13.3%), mouth soreness (6.7%), sore throat (6.6%), and minor bleeding/cuts/redness/change in taste to the tongue (3.3%) were determined through patient questioning before postanesthesia care unit (PACU) discharge. Conclusions Our study suggests that the LMA Gastro might be a safe alternative for ERCP procedures. There was a high level of practitioner satisfaction. Only minor complications, such as hoarseness, mouth or throat soreness, or minor trauma to the tongue were experienced by patients. Similar incidences of complications may occur with GETA and tubeless anesthesia. The procedure was well tolerated by all patients; all patients maintained adequate oxygenation and required only minimal blood pressure support.
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- 2020
42. Long‐Term Outcomes After Transcatheter and Surgical Aortic Valve Replacement in Patients With Cirrhosis: A Guide for the Hepatologist
- Author
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Vuyisile T. Nkomo, Patrick S. Kamath, Thoetchai Peeraphatdit, Niyada Naksuk, Kevin L. Greason, Vijay H. Shah, Nimish Thakral, Douglas A. Simonetto, William S. Harmsen, and Grant M. Spears
- Subjects
Liver Cirrhosis ,Male ,0301 basic medicine ,medicine.medical_specialty ,Cirrhosis ,medicine.medical_treatment ,Clinical Decision-Making ,Risk Assessment ,Severity of Illness Index ,End Stage Liver Disease ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Aortic valve replacement ,Valve replacement ,Risk Factors ,medicine ,Humans ,Hospital Mortality ,Prospective Studies ,Prospective cohort study ,Aged ,Retrospective Studies ,Aged, 80 and over ,Hepatology ,business.industry ,Gastroenterologists ,Hazard ratio ,Retrospective cohort study ,Aortic Valve Stenosis ,Middle Aged ,medicine.disease ,Survival Analysis ,Surgery ,Stenosis ,Treatment Outcome ,030104 developmental biology ,Practice Guidelines as Topic ,Female ,030211 gastroenterology & hepatology ,business ,Cohort study - Abstract
BACKGROUND AND AIMS Hepatologists often determine whether transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) is preferred for patients with cirrhosis and severe aortic stenosis. The goal of this cohort study is to compare outcomes following TAVR and SAVR in patients with cirrhosis to inform the preferred intervention. APPROACH AND RESULTS Prospectively collected data on 105 consecutive patients with cirrhosis and aortic stenosis who underwent TAVR (n = 55) or SAVR (n = 50) between 2008 and 2016 were reviewed retrospectively. Two control groups were included: 2,680 patients without cirrhosis undergoing TAVR and SAVR and 17 patients with cirrhosis who received medical therapy alone. Among the 105 patients with cirrhosis, the median Society of Thoracic Surgeons score was 3.8% (1.5, 6.9), and the median Model for End-Stage Liver Disease (MELD) score was 11.6 (9.4, 14.0). The TAVR group had similar in-hospital (1.8% vs. 2.0%) and 30-day mortality (3.6% vs. 4.2%) as the SAVR group. During the median follow-up of 3.8 years (95% confidence interval, 3.0-6.9), there were 63 (60%) deaths. MELD score (adjusted hazard ratio, 1.13; 95% confidence interval, 1.05-1.21; P = 0.002) was an independent predictor of long-term survival. In the subgroup of patients with MELD score
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- 2020
43. COVID-19 and Gastrointestinal Disease: Implications for the Gastroenterologist
- Author
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Angel Lanas, Jack Satsangi, Peter Malfertheiner, Gwilym J. Webb, James E. East, Richard H. Hunt, and Carmelo Scarpignato
- Subjects
medicine.medical_specialty ,Cirrhosis ,Gastrointestinal Diseases ,medicine.medical_treatment ,Review Article ,Review ,Disease ,Chronic liver disease ,Pathophysiology ,Inflammatory bowel disease ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Gastrointestinal tract ,Internal medicine ,Humans ,Medicine ,Decompensation ,Pancreas ,SARS-CoV-2 ,business.industry ,Gastroenterologists ,Respiratory disease ,COVID-19 ,Endoscopy ,Immunosuppression ,General Medicine ,Virus Internalization ,Inflammatory Bowel Diseases ,medicine.disease ,Management ,Liver ,Gastrointestinal disease ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,business - Abstract
Background: COVID-19 was initially considered a respiratory disease but the SARS-CoV-2 virus can lead to serious systemic consequences affecting major organs including the digestive system. Summary: This review brings new clinically important information for the gastroenterologist. This includes: the mechanisms of tissue damage seen with the SARS-CoV-2 virus; the consequences of immunosuppression in patients with inflammatory bowel disease (IBD) and chronic liver disease with the additional risks of decompensation in patients with cirrhosis; the impact of COVID-19 on gastrointestinal emergencies, on gastrointestinal endoscopy, diagnosis and treatments. These highlight the need to understand the clinical pharmacology, toxicology and therapeutic implications of drugs commonly used by gastroenterologists and their links with COVID-19. Key Messages: Any part of the digestive system may be affected by the SARS-CoV-2 virus, and those with pre-existing disease are at greatest risk of adverse outcomes. The risk for drug-drug interactions is considerable in patients seriously ill with COVID-19 who often require mechanical ventilation and life support. Some repurposed drugs used against SARS-CoV-2 can cause or aggravate some of the COVID-19-related gastrointestinal symptoms and can also induce liver injury. Ongoing clinical studies will hopefully identify effective drugs with a more favourable risk-benefit ratio than many initially tried treatments.
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- 2020
44. Hepatitis B—management of acute infection and active inflammation in pregnancy—a hepatologist's perspective
- Author
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Wan-Hsin Wen, Calvin Q. Pan, and Grace Lai-Hung Wong
- Subjects
Adult ,Male ,Hepatitis B virus ,Pediatrics ,medicine.medical_specialty ,Cirrhosis ,medicine.disease_cause ,Antiviral Agents ,Virus ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,medicine ,Humans ,Hepatitis B e Antigens ,030212 general & internal medicine ,Pregnancy Complications, Infectious ,Child ,Tenofovir ,Fulminant hepatitis ,Inflammation ,Telbivudine ,Transmission (medicine) ,business.industry ,Gastroenterologists ,Infant ,virus diseases ,Obstetrics and Gynecology ,General Medicine ,Middle Aged ,Hepatitis B ,medicine.disease ,Infectious Disease Transmission, Vertical ,digestive system diseases ,DNA, Viral ,Female ,030211 gastroenterology & hepatology ,business ,Viral load - Abstract
Women at childbearing age and pregnant ladies living in the areas of high or intermediate prevalence of hepatitis B virus (HBV) remain at risk of getting the infection and passing the infections to their offspring via mother-to-child transmission (MTCT) of HBV. HBV infection may affect the mothers by active hepatitis, very occasionally liver cirrhosis and rarely fulminant hepatitis and liver failure. The virus may be transmitted to the babies despite immunoprophylaxis in the setting of very high maternal viral load. Tenofovir disoproxil fumarate (TDF) has been shown to be efficacious to reduce MTCT of HBV, which contributes to the elimination of chronic HBV infection by 2030, the goal set by World Health Organization.
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- 2020
45. Impact of COVID-19 Pandemic on Training: Global Perceptions of Gastroenterology and Hepatology Fellows in the USA
- Author
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Kofi Clarke, Mohammad Bilal, Shannon Dalessio, Sergio A. Sánchez-Luna, Shazia M. Siddique, and Jennifer L. Maranki
- Subjects
Adult ,Male ,medicine.medical_specialty ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,genetic structures ,Physiology ,education ,COVID-19 pandemic ,Gastroenterology ,Education ,Fellowship ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Surveys and Questionnaires ,Pandemic ,Health care ,medicine ,Outpatient clinic ,Training ,Humans ,Fellowships and Scholarships ,Fellowship training ,Gastrointestinal endoscopy ,business.industry ,Gastroenterologists ,COVID-19 ,Hepatology ,Gastroenterology fellowship ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Original Article ,Female ,sense organs ,business - Abstract
Background The COVID-19 pandemic has impacted numerous facets of healthcare workers’ lives. There have also been significant changes in Gastroenterology (GI) fellowship training as a result of the challenges presented by the pandemic. Aims We conducted a national survey of Gastroenterology fellows to evaluate fellows’ perceptions, changes in clinical duties, and education during the pandemic. Methods A survey was sent to Gastroenterology (GI) fellows in the USA. Information regarding redeployment, fellow restriction in endoscopy, outpatient clinics and inpatient consults, impact on educational activities, and available wellness resources was obtained. Fellows’ level of agreement with adjustments to clinical duties was also assessed. Results One hundred and seventy-seven Gastroenterology fellows responded, and 29.4% were redeployed to non-GI services during the pandemic. COVID-19 impacted all aspects of GI fellowship training in the USA (endoscopy, outpatient clinics, inpatient consults, educational activities). Fellows’ level of agreement in changes to various aspects of fellowship varied. 72.5% of respondents reported that their programs provided them with increased wellness resources to cope with the additional stress during the pandemic. For respondents with children, 17.6% reported no support with childcare. Conclusions Our results show that the COVID-19 pandemic has impacted GI fellowship training in the USA in multiple domains, including gastrointestinal endoscopy, inpatient consults, outpatient clinics, and educational conferences. Our study highlights the importance of considering and incorporating fellows’ viewpoints, as changes are made in response to the ongoing pandemic. Electronic supplementary material The online version of this article (10.1007/s10620-020-06655-y) contains supplementary material, which is available to authorized users.
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- 2020
46. Barriers to research productivity among gastroenterologists and hepatologists in Saudi Arabia
- Author
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Turki AlAmeel, Dimah AlAskar, Majid Alsahafi, Eman Al Sulais, and Mais Al-Sardi
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Medical knowledge ,medicine.medical_specialty ,Multivariate analysis ,research ,business.industry ,Gastroenterology ,Psychological intervention ,Medical practice ,RC799-869 ,gastroenterologists ,Diseases of the digestive system. Gastroenterology ,03 medical and health sciences ,Technical support ,0302 clinical medicine ,Clinical research ,030220 oncology & carcinogenesis ,Family medicine ,medicine ,030211 gastroenterology & hepatology ,Original Article ,business ,Productivity ,Barriers ,Statistician - Abstract
Background: Clinical research is essential for the advancement of medical knowledge and evidence-based medical practice. In this study, we aimed to identify barriers that limit research productivity among gastroenterologists in Saudi Arabia. Methods: We conducted a national online survey targeting gastroenterologists in Saudi Arabia. Participants were asked about the patterns of their practice, their prior research activities, and potential barriers to research productivity. Univariate and multivariate analyses were performed to examine the association between different factors and research productivity. Results: A total of 85 gastroenterologists completed the survey. Respondents were predominantly male physicians (90.6%) and 40% of them belonged to the age group of 40-49 years. About 85.9% had at least one prior research participation of any type. Around 67.1% of the respondents had been a primary investigator at least once in the last 5 years, while only 23.5% had been a primary investigator at a minimum average rate of once a year. Multiple barriers to research productivity were identified: insufficient research time (78.8%), lack of funding and compensation (77.6%), lack of a statistician (68.2%), insufficient research training (64.7%), lack of connection (60%), lack of technical support (57.6%), and lack of interest (31%). On univariate analysis, insufficient research time and lack of funding and compensation were significantly associated with no research participation (P
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- 2020
47. Non-enhanced Magnetic Resonance Imaging Compared to Ultrasound as a Surveillance Tool for Hepatocellular Carcinoma. Not all that glitters is gold: the ultrasound hepatologist’s point of view
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Valentina Giorgio, Antonio Giorgio, Massimo De Luca, and Pietro Gatti
- Subjects
medicine.medical_specialty ,Carcinoma, Hepatocellular ,medicine.diagnostic_test ,business.industry ,Ultrasound ,Gastroenterologists ,Liver Neoplasms ,Magnetic resonance imaging ,General Medicine ,medicine.disease ,Magnetic Resonance Imaging ,Settore MED/38 - PEDIATRIA GENERALE E SPECIALISTICA ,Hepatocellular carcinoma ,Internal Medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Radiology ,business ,Letter to the Editor ,Ultrasonography - Published
- 2022
48. Management of coeliac disease patients after the confirmation of diagnosis in Central Europe
- Author
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Daniele Sblattero, Tarcisio Not, Tomaz Krencnik, Goran Palčevski, Luigina De Leo, Petra Riznik, Judit Gyimesi, Martina Klemenak, Jasmina Dolinsek, Katharina Julia Werkstetter, Berthold Koletzko, Jernej Dolinsek, Sibylle Koletzko, Ilma Rita Korponay-Szabó, Marina Milinović, Tunde Koltai, Riznik, Petra, De Leo, Luigina, Dolinsek, Jasmina, Gyimesi, Judit, Klemenak, Martina, Koletzko, Berthold, Koletzko, Sibylle, Koltai, Tunde, Korponay-Szabó, Ilma Rita, Krencnik, Tomaz, Milinovic, Marina, Not, Tarcisio, Palcevski, Goran, Sblattero, Daniele, Werkstetter, Katharina Julia, and Dolinsek, Jernej
- Subjects
Pediatrics ,medicine.medical_specialty ,MEDLINE ,Patient care ,Coeliac disease ,medicine ,Humans ,Child ,Referral and Consultation ,Management practices ,Autoantibodies ,Transglutaminases ,Hepatology ,business.industry ,Follow-up ,Gastroenterologists ,Gastroenterology ,nutritional and metabolic diseases ,adults , coeliac disease , children , Central Europe , management ,medicine.disease ,celiac disease ,digestive system diseases ,Europe ,Celiac Disease ,business - Abstract
Background Recently published paediatric guidelines for diagnosing coeliac disease do not include recommendations on the follow-up of coeliac disease patients. Goal The aim of this study was to assess the management practices and experience of coeliac disease patients with their follow-up appointments in Central Europe. Study Gastroenterologists and coeliac disease patients in five Central European countries were asked to complete the web-based questionnaire focusing on coeliac disease management practices. Results Answers from 147 gastroenterologists and 2041 coeliac disease patients were available for the analysis. More than half of the gastroenterologists (58.5%) schedule the first follow-up visit within 3 months after the diagnosis. At follow-up, tissue transglutaminase antibodies are checked in almost all patients (95.9%). Approximately two-thirds (60.7%) of gastroenterologists refer all of their patients to the dietitian at diagnosis. Similarly, 42.8% of coeliac disease patients reported that they had not been appointed to a dietitian. Almost one-third of coeliac disease patients (30.8%) reported that they had no follow-up appointments with gastroenterologist at all. Conclusions Follow-up of coeliac disease patients is suboptimal in Central Europe. Many patients are not followed regularly. A lot of patients are not referred to a dietitian. The recommendations on the optimal follow-up of coeliac disease patients are needed in order to improve patient care.
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- 2022
49. Ensuring High and Equitable COVID-19 Vaccine Uptake Among Patients With IBD
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Sophie Balzora, Raymond K. Cross, Francis A Farraye, Mary S. Hayney, and Freddy Caldera
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Emergency Use Authorization ,medicine.medical_specialty ,COVID-19 Vaccines ,Vaccination Coverage ,Coronavirus disease 2019 (COVID-19) ,Ibdjnl/9 ,immunization ,Risk Assessment ,Inflammatory bowel disease ,03 medical and health sciences ,0302 clinical medicine ,Editors Commentary ,Preventive Health Services ,medicine ,Humans ,Immunology and Allergy ,030212 general & internal medicine ,Physician's Role ,Intensive care medicine ,AcademicSubjects/MED00260 ,preventive care ,ulcerative colitis ,Crohn's disease ,SARS-CoV-2 ,business.industry ,Gastroenterologists ,Vaccination ,Gastroenterology ,COVID-19 ,Inflammatory Bowel Diseases ,medicine.disease ,Ulcerative colitis ,High uptake ,Immunization ,030211 gastroenterology & hepatology ,Patient Participation ,business - Abstract
The recent emergency use authorization of a third COVID-19 vaccine means that most patients with inflammatory bowel disease (IBD) will soon be eligible to be vaccinated. Gastroenterology clinicians should be prepared to address patients’ concerns regarding safety and efficacy of vaccines. They should also strongly recommend that all their patients be vaccinated with a COVID-19 vaccine. Additionally, they should be prepared to educate patients about logistics that will result in successful vaccination completion. All these measures will be crucial to ensure high uptake among their patients with IBD.
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- 2021
50. How Hepatologists Can Contribute to Value-Based Care
- Author
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Meena B. Bansal
- Subjects
medicine.medical_specialty ,Hepatology ,business.industry ,medicine.medical_treatment ,Gastroenterologists ,Gastroenterology ,Value based care ,MEDLINE ,Liver transplantation ,Liver Transplantation ,medicine ,Humans ,Intensive care medicine ,Fee-for-service ,business - Published
- 2020
Catalog
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