91 results on '"Neal Shahidi"'
Search Results
52. ID: 3524839 TECHNICAL INNOVATIONS IN ENDOSCOPIC MUCOSAL RESECTION HAVE IMPROVED CLINICAL OUTCOMES FOR LARGE NON-PEDUNCULATED COLORECTAL POLYPS INVOLVING THE ILEOCECAL VALVE
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Arnout van Hattem, Michael J. Bourke, Mayenaaz Sidhu, Nicholas G. Burgess, Anthony Whitfield, Sunil Gupta, Karen Byth, Owen McKay, Neal Shahidi, Eric Y. Lee, David J. Tate, Sergei Vosko, Stephen J. Williams, and Simmi Zahid
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medicine.medical_specialty ,Ileocecal valve ,medicine.anatomical_structure ,business.industry ,Gastroenterology ,medicine ,Radiology, Nuclear Medicine and imaging ,Endoscopic mucosal resection ,business ,Surgery - Published
- 2021
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53. ID: 3524808 PROCEDURALIST-DIRECTED BALANCED-SEDATION IS SAFE FOR THE ENDOSCOPIC MUCOSAL RESECTION OF LARGE NON-PEDUNCULATED COLORECTAL POLYPS
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Rajiv Kurup, Stephen J. Williams, Owen McKay, Anthony Whitfield, Sergei Vosko, Nicholas G. Burgess, Michael J. Bourke, Neal Shahidi, Eric Y. Lee, Sunil Gupta, and Simmi Zahid
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medicine.medical_specialty ,business.industry ,Sedation ,Gastroenterology ,Medicine ,Radiology, Nuclear Medicine and imaging ,Endoscopic mucosal resection ,medicine.symptom ,business ,Surgery - Published
- 2021
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54. ID: 3526497 STRICTURE FORMATION FOLLOWING THE ENDOSCOPIC RESECTION OF LARGE NON-PEDUNCULATED COLORECTAL POLYPS
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Mayenaaz Sidhu, Eric Y. Lee, Owen McKay, Sunil Gupta, Nicholas G. Burgess, Rajiv Kurup, Sergei Vosko, Michael J. Bourke, Simmi Zahid, Anthony Whitfield, Neal Shahidi, and Stephen J. Williams
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medicine.medical_specialty ,business.industry ,Gastroenterology ,medicine ,Radiology, Nuclear Medicine and imaging ,Endoscopic resection ,business ,Surgery - Published
- 2021
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55. How to Manage the Large Nonpedunculated Colorectal Polyp
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Neal Shahidi and Michael J. Bourke
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medicine.medical_specialty ,Endoscopic Mucosal Resection ,Hepatology ,Adenoma ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,Colonic Polyps ,Disease Management ,Intestinal Polyps ,Cancer ,Colonoscopy ,medicine.disease ,Endoscopy ,Rectal Diseases ,Colorectal Polyp ,Internal medicine ,Practice Guidelines as Topic ,medicine ,Humans ,business - Published
- 2021
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56. The role of vedolizumab in patients with moderate-to-severe Crohn’s disease and ulcerative colitis
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Brian Bressler, Remo Panaccione, and Neal Shahidi
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0301 basic medicine ,medicine.medical_specialty ,MEDLINE ,Reviews ,Disease ,Gastroenterology ,Inflammatory bowel disease ,law.invention ,Vedolizumab ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Internal medicine ,medicine ,In patient ,lcsh:RC799-869 ,Crohn's disease ,business.industry ,medicine.disease ,Ulcerative colitis ,030104 developmental biology ,lcsh:Diseases of the digestive system. Gastroenterology ,030211 gastroenterology & hepatology ,business ,medicine.drug - Abstract
Vedolizumab, an α4β7-integrin antagonist, is the first gut-selective monoclonal antibody that has been approved for the treatment of moderate-to-severe ulcerative colitis and Crohn’s disease in many countries in the world. However, questions still remain regarding its appropriate use and placement in current treatment algorithms. Therefore, we sought out to evaluate the existing literature on the use of vedolizumab in inflammatory bowel disease. From inception to 21 June 2015 we searched MEDLINE for phase III randomized control trials assessing the utility of vedolizumab in inflammatory bowel disease, of which three were identified. The GEMINI trials demonstrate that vedolizumab is an effective and safe treatment for patients suffering from moderate-to-severe ulcerative colitis (GEMINI I) and Crohn’s disease (GEMINI II and III). However, further studies are needed comparing its efficacy directly with anti-tumor necrosis factor therapies to allow for further delineation of current treatment algorithms as well as ensuring its long-term safety profile.
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- 2016
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57. 110 PIECEMEAL COLDSNARE EXCISION OF LARGE SESSILE SERRATED POLYPS IS SAFER AND EQUALLY EFFICACIOUS IN COMPARISON TO CONVENTIONAL ENDOSCOPIC MUCOSAL RESECTION
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Arnout van Hattem, Iddo Bar-Yishay, Imogen Hartley, Alan C. Moss, Kaushali Britto, David G. Hewett, Michael J. Bourke, Mayenaaz Sidhu, Scott Schoeman, David J. Tate, Sergei Vosko, Neal Shahidi, Nicholas J. Tutticci, and Luke F. Hourigan
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medicine.medical_specialty ,business.industry ,SAFER ,Gastroenterology ,Medicine ,Radiology, Nuclear Medicine and imaging ,Endoscopic mucosal resection ,business ,Surgery - Published
- 2020
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58. Tu1030 SNARE-TIP SOFT COAGULATION IS EFFECTIVE AND EFFICIENT FOR TREATING INTRAPROCEDURAL BLEEDING DURING BARRETT’S MUCOSECTOMY
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Nicholas G. Burgess, Arnout van Hattem, Iddo Bar-Yishay, Naaz Sidhu, Neal Shahidi, Scott Schoeman, Sergei Vosko, and Michael J. Bourke
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medicine.medical_specialty ,business.industry ,Gastroenterology ,Medicine ,Coagulation (water treatment) ,Radiology, Nuclear Medicine and imaging ,business ,Surgery - Published
- 2020
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59. 248 OUTCOMES IN TREATMENT OF INTRAPROCEDURAL DEEP MURAL INJURY IN A PROSPECTIVE COHORT OF LARGE POLYP RESECTION
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Gregor J. Brown, Arnout van Hattem, Iddo Bar-Yishay, Luke F. Hourigan, Neal Shahidi, Scott Schoeman, David J. Tate, Nicholas G. Burgess, Alan C. Moss, Steven J. Heitman, Sergei Vosko, Mayenaaz Sidhu, Michael J. Bourke, Spiro Raftopoulos, and Rajvinder Singh
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medicine.medical_specialty ,business.industry ,Gastroenterology ,medicine ,Radiology, Nuclear Medicine and imaging ,Mural ,Prospective cohort study ,business ,Polyp resection ,Surgery - Published
- 2020
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60. 1070 FULL-THICKNESS ENDOSCOPIC MUCOSAL RESECTION FOR DEEPLY INVASIVE SUBMUCOSAL COLORECTAL NEOPLASIA
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Michael J. Bourke, Arnout van Hattem, Neal Shahidi, Mayenaaz Sidhu, and Scott Schoeman
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medicine.medical_specialty ,business.industry ,Gastroenterology ,Medicine ,Radiology, Nuclear Medicine and imaging ,Endoscopic mucosal resection ,Full thickness ,Radiology ,business - Published
- 2020
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61. Mo1629 OPTICAL EVALUATION FOR PREDICTING CANCER IN LARGE COLORECTAL LATERALLY SPREADING LESIONS IS DEPENDENT ON LESION MORPHOLOGY
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Iddo Bar-Yishay, Nicholas G. Burgess, Michael J. Bourke, Alan C. Moss, Neal Shahidi, Karen Byth, David J. Tate, Sergei Vosko, Eric Y. Lee, Scott Schoeman, Stephen J. Williams, Naaz Sidhu, Luke F. Hourigan, Rajvinder Singh, and Arnout van Hattem
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Lesion ,Pathology ,medicine.medical_specialty ,Morphology (linguistics) ,business.industry ,Gastroenterology ,medicine ,Cancer ,Radiology, Nuclear Medicine and imaging ,medicine.symptom ,medicine.disease ,business - Published
- 2020
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62. Vedolizumab for the treatment of ulcerative colitis
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Remo Panaccione, Neal Shahidi, and Brian Bressler
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Integrins ,medicine.medical_specialty ,Clinical Biochemistry ,Antibodies, Monoclonal, Humanized ,Gastroenterology ,Inflammatory bowel disease ,law.invention ,Vedolizumab ,03 medical and health sciences ,Clinical Trials, Phase II as Topic ,0302 clinical medicine ,Crohn Disease ,Gastrointestinal Agents ,Randomized controlled trial ,law ,Internal medicine ,Drug Discovery ,medicine ,Animals ,Humans ,Intensive care medicine ,Pharmacology ,Gastrointestinal agent ,Clinical Trials, Phase I as Topic ,business.industry ,Crohn disease ,medicine.disease ,Ulcerative colitis ,Clinical Trials, Phase III as Topic ,030220 oncology & carcinogenesis ,Colitis, Ulcerative ,030211 gastroenterology & hepatology ,business ,medicine.drug - Abstract
Introduction: With a need for a larger armamentarium of therapeutic options for those suffering from moderate-to-severe ulcerative colitis, vedolizumab, an α4β7-integrin biologic therapy, has recently received approval in the United States, Canada and Europe. However, it is unclear where it should be positioned in relation to current therapies for moderate-to-severe ulcerative colitis.Areas covered: We systematically reviewed the literature for phase 1, phase 2 and phase 3 randomized controlled trials assessing the role of vedolizumab in ulcerative colitis.Expert opinion: Trials assessing vedolizumab highlight its arrival as an effective and safe therapy for patients suffering from ulcerative colitis.
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- 2015
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63. When trainees reach competency in performing ERCP: a systematic review
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George Ou, Jennifer J. Telford, Neal Shahidi, and Robert Enns
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medicine.medical_specialty ,MEDLINE ,Pancreatic duct cannulation ,digestive system ,Duct cannulation ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Endoscopy, Digestive System ,Fellowships and Scholarships ,Cholangiopancreatography, Endoscopic Retrograde ,Pancreatic duct ,Common bile duct ,medicine.diagnostic_test ,business.industry ,General surgery ,Gastroenterology ,Internship and Residency ,digestive system diseases ,Surgery ,Endoscopy ,surgical procedures, operative ,medicine.anatomical_structure ,General Surgery ,Clinical Competence ,Clinical competence ,business ,Learning Curve - Abstract
Background and Aims ERCP is an advanced endoscopic procedure that is technically more challenging and carries a higher risk of adverse events compared with standard endoscopy. A discrepancy currently exists among guidelines regarding the number of ERCPs that a trainee needs to complete before procedural competency should be assessed. Our aim was to assess the learning curve for performing ERCP. Methods Two authors independently searched MEDLINE (1946 to November 25, 2014) along with the gray literature to identify relevant citations. To warrant inclusion, citations were required to report successful trainee cannulation rate. Successful cannulation rate, set at a value of 80% or higher, was used as our baseline reference for competency. Results Nine studies, assessing 137 trainees and 17,100 ERCPs, were included in our analysis. Overall, competency was achieved among the included studies between 70 to 400 ERCPs. In the 2 studies that used pancreatic duct cannulation rate, competency was achieved by 70 to 160 ERCPs. Of the 5 studies that used selective duct cannulation rate, competency was achieved by 79 to 300 ERCPs. Finally, in the 4 studies that used common bile duct cannulation rate, 2 studies reached the reference competency threshold by 160 to 400 ERCPs. On further stratification, when assessing native papilla deep common bile duct cannulation, only 1 study reached the reference competency threshold by 350 to 400 ERCPs. Conclusions Our findings suggest that as ERCP has evolved from a predominantly diagnostic to therapeutic procedure, procedural thresholds have risen well above North American training guidelines. Therefore, advanced endoscopy training programs need to reassess their current structure to ensure that procedural competency is being reached.
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- 2015
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64. Will Computer-Aided Detection and Diagnosis Revolutionize Colonoscopy?
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Neal Shahidi, Douglas K. Rex, and Michael F. Byrne
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medicine.medical_specialty ,Narrow-band imaging ,Hepatology ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,Colonoscopy ,Colonic Polyps ,Computer aided detection ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Surgery, Computer-Assisted ,Computer-aided diagnosis ,030220 oncology & carcinogenesis ,medicine ,Humans ,030211 gastroenterology & hepatology ,Medical physics ,Diagnosis, Computer-Assisted ,business - Published
- 2017
65. Establishing the learning curve for achieving competency in performing colonoscopy: a systematic review
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Neal Shahidi, Robert Enns, Jennifer J. Telford, and George Ou
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,MEDLINE ,Colonoscopy ,Learning curve ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Medical physics ,Clinical Competence ,Radiology ,Clinical competence ,business ,Learning Curve - Published
- 2014
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66. Capsule Endoscopy for Obscure Gastrointestinal Bleeding in Patients with Comorbid Rheumatic Diseases
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Ricky Kwok, Robert Enns, George Ou, Cherry Galorport, Joanna K. Law, Jessica Tong, and Neal Shahidi
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medicine.medical_specialty ,education.field_of_study ,lcsh:Medical technology ,Article Subject ,business.industry ,Population ,Charlson index ,Surgery ,law.invention ,lcsh:R855-855.5 ,Capsule endoscopy ,law ,Internal medicine ,Oral steroid ,medicine ,Radiology, Nuclear Medicine and imaging ,In patient ,Inpatient status ,education ,business ,Positive Finding ,Research Article ,Obscure gastrointestinal bleeding - Abstract
Background and Aim. We evaluated the association between patients with rheumatic diseases (RD) suffering from obscure gastrointestinal bleeding (OGIB) and positive capsule endoscopy (CE) findings. Methods. All CE procedures performed on patients with RD and OGIB were assessed from a large database at St. Paul’s Hospital (Vancouver, BC, Canada) between December 2001 and April 2011. A positive finding on CE was defined as any pathology, including ulcers/erosions, vascular lesions, and mass lesions, perceived to be the source of bleeding. Results. Of the 1133 CEs performed, 41 (4%) complete CEs were for OGIB in patients with RD. Of these, 54% presented with overt bleeding. Mean age was 66 years. Positive findings were seen in 61% of patients. Ulcerations/erosions (36%) and vascular lesions (36%) were the most common findings. Significant differences between the RD versus non-RD populations included: inpatient status, nonsteroidal anti-inflammatory drug (NSAIDs) use, oral steroid use, and mean Charlson index score (all P≤0.008). Similar nonsignificant trends were seen between positive and negative CEs among the RD population. Conclusions. The correlation between RD and positive CE findings is likely influenced by ongoing anti-inflammatory drug use, poorer health status, and a predisposition for angiodysplastic lesions.
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- 2014
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67. 256 – Artificial Intelligence for Real-Time Multiple Polyp Detection with Identification, Tracking, and Optical Biopsy During Colonoscopy
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Rachel E. Lahr, Nicolas Guizard, Neal Shahidi, Liqiang Ding, DK Rex, Sina Hamidi Ghalehjegh, Florent Chandelier, Garcia R. Jonathan, Milagros L. Henkel, and Michael F. Byrne
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Identification (information) ,Hepatology ,medicine.diagnostic_test ,Computer science ,business.industry ,Gastroenterology ,medicine ,Colonoscopy ,Computer vision ,Artificial intelligence ,Optical Biopsy ,business ,Tracking (particle physics) - Published
- 2019
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68. Colorectal cancer screening: Opportunities to improve uptake, outcomes, and disparities
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Winson Y. Cheung and Neal Shahidi
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Oncology ,medicine.medical_specialty ,Colorectal cancer ,Perforation (oil well) ,Colonoscopy ,Context (language use) ,Review ,03 medical and health sciences ,Fecal occult blood test ,0302 clinical medicine ,Polyp ,Internal medicine ,medicine ,Intensive care medicine ,Adverse effect ,medicine.diagnostic_test ,Neoplasia ,business.industry ,Fecal immunochemical test ,Incidence (epidemiology) ,Fecal occult blood ,medicine.disease ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,business ,Developed country - Abstract
Colorectal cancer screening has become a standard of care in industrialized nations for those 50 to 75 years of age, along with selected high-risk populations. While colorectal cancer screening has been shown to reduce both the incidence and mortality of colorectal cancer, it is a complex multi-disciplinary process with a number of important steps that require optimization before tangible improvements in outcomes are possible. For both opportunistic and programmatic colorectal cancer screening, poor participant uptake remains an ongoing concern. Furthermore, current screening modalities (such as the guaiac based fecal occult blood test, fecal immunochemical test and colonoscopy) may be used or performed suboptimally, which can lead to missed neoplastic lesions and unnecessary endoscopic evaluations. The latter poses the risk of adverse events, such as perforation and post-polypectomy bleeding, as well as financial impacts to the healthcare system. Moreover, ongoing disparities in colorectal cancer screening persist among marginalized populations, including specific ethnic minorities (African Americans, Hispanics, Asians, Indigenous groups), immigrants, and those who are economically disenfranchised. Given this context, we aimed to review the current literature on these important areas pertaining to colorectal cancer screening, particularly focusing on the guaiac based fecal occult blood test, the fecal immunochemical test and colonoscopy.
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- 2016
69. Use of Monitoring Gamma-Glutamyl Transpeptidase Levels After Liver Transplant: A Longitudinal Retrospective Analysis of a Single-Center's Experience
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Neal, Shahidi, Vladimir, Marquez Azalgara, and Eric, Yoshida
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Male ,Time Factors ,British Columbia ,Reproducibility of Results ,gamma-Glutamyltransferase ,Clinical Enzyme Tests ,Middle Aged ,Hospitals, General ,Liver Transplantation ,Up-Regulation ,Postoperative Complications ,Treatment Outcome ,Predictive Value of Tests ,Risk Factors ,Humans ,Female ,Longitudinal Studies ,Biomarkers ,Retrospective Studies - Abstract
Recently, gamma-glutamyl transpeptidase has garnered increased attention as a diagnostic tool in the early identification of liver disease. However, its value in liver transplant is largely unknown, as the disease processes leading to abnormal gamma-glutamyl transpeptidase levels and the expected temporal trends in gamma-glutamyl transpeptidase levels during the period after liver transplant remain unclear.Between January 2010 and August 2013, consecutive patients who underwent liver transplant at Vancouver General Hospital (Vancouver, Canada) were assessed longitudinally up to 1 year after liver transplant. A "gamma-glutamyl transpeptidase event" was defined as 2 abnormal gamma-glutamyl transpeptidase values (exceeding sex-specific limits of normal, at 55 U/L for female and 80 U/L for male patients) ≥ 1 week apart.Our study included 147 liver transplant recipients. The median gamma-glutamyl transpeptidase level on day 1 after liver transplant was 73 U/L, which peaked to 435 U/L during the first month after liver transplant and returned to within normal parameters by 1 year. In total, there were 282 gamma-glutamyl transpeptidase events, with biliary complications (22%), acute rejection (16%), and hepatitis C virus recurrence (10%) being the most common causes. In 39% of events, no cause was identified. When attempting to identify a disease-associated event, if gamma-glutamyl transpeptidase was the initial liver biochemistry test to double in value, it had 42% sensitivity and 40% specificity. Comparatively, if gamma-glutamyl transpeptidase was the initial liver biochemistry test to become abnormal, it had 3% sensitivity and 93% specificity.Although gamma-glutamyl transpeptidase almost universally becomes abnormal after liver transplant, a specific pathologic cause was not commonly identified. Interpreting the characteristics of gamma-glutamyl transpeptidase elevation has limited use for identifying the underlying reason for its elevation.
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- 2016
70. Performance of interferon-gamma release assays in patients with inflammatory bowel disease: A systematic review and meta-analysis
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Neal Shahidi, Hong Qian, Brian Bressler, and Yi-Tzu Nancy Fu
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medicine.medical_specialty ,Latent tuberculosis ,business.industry ,Concordance ,Gastroenterology ,Interferon gamma release assay ,Tuberculin ,Odds ratio ,Inflammatory Bowel Diseases ,bacterial infections and mycoses ,medicine.disease ,Inflammatory bowel disease ,Confidence interval ,Interferon-gamma ,Review Literature as Topic ,Latent Tuberculosis ,Meta-analysis ,Internal medicine ,Immunology ,medicine ,Humans ,Immunology and Allergy ,business ,Interferon-gamma Release Tests - Abstract
Background: Guidelines mandate screening for latent tuberculosis infection (LTBI) prior to anti-tumor necrosis factor (anti-TNF) therapy in patients with inflammatory bowel disease (IBD). However, many are already on immunosuppressive therapy (IST) that may affect the precision of the Tuberculin skin test (TST). Our aim was to assess the performance of the new interferon-gamma release assays (IGRAs) to detect LTBI in patients with IBD. Methods: MEDLINE and EMBASE were searched (up to June 2011) to identify studies evaluating the performance of IGRAs (QuantiFERON-TB Gold [QFT-2G], QuantiFERON-TB Gold In-Tube [QFT-3G] and T-SPOT.TB) in individuals with IBD. Forest plots and pooled estimates using random effects models were created where applicable. Results: Nine unique studies encompassing 1309 patients with IBD were included for analysis. The pooled concordance between the TST and QFT-2G/QFT-3G was 85% (95% confidence interval [CI] 77%–90%). The concordance of the TST and TSPOT.TB was 72% (95% CI 64%–78%). Studies assessing agreement reported more IGRA−/TST+ results versus IGRA+/TST− results. The pooled percentage of indeterminate results was 5% (95% CI 2%–9%) for QFT-2G/QFT-3G. TSPOT.TB showed similar results. Both positive QFT-2G/QFT-3G results (pooled odds ratio [OR] 0.37, 95% CI 0.16–0.87) and positive TST results (pooled OR 0.28, 95% CI 0.10–0.80) were significantly influenced by IST (both P = 0.02). Conclusions: While it remains difficult to determine superiority between the IGRAs and the TST, both are negatively affected by IST. Therefore, screening prior to initiation of IST should be considered. Nevertheless, it is imperative that all patients receive screening prior to anti-TNF therapy. (Inflamm Bowel Dis 2012;)
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- 2012
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71. Computer-aided diagnosis to differentiate colorectal polyps: are we nearing primetime?
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Michael F. Byrne and Neal Shahidi
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medicine.medical_specialty ,Adenomatous polyps ,business.industry ,Rectum ,Sigmoid colon ,digestive system ,digestive system diseases ,surgical procedures, operative ,medicine.anatomical_structure ,Hyperplastic Polyp ,Colorectal cancer screening ,Computer-aided diagnosis ,otorhinolaryngologic diseases ,medicine ,Radiology ,business ,neoplasms - Abstract
Colorectal cancer screening has proven to be an effective preventative health measure (1). This is, in part, achieved by the identification and removal of neoplastic adenomatous polyps. However, within the rectum and sigmoid colon, non-neoplastic hyperplastic polyps are also common.
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- 2018
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72. A statistical method was used for the meta-analysis of tests for latent TB in the absence of a gold standard, combining random-effect and latent-class methods to estimate test accuracy
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Carlo A. Marra, Kevin Elwood, Mohsen Sadatsafavi, Mark FitzGerald, Na Guo, Fawziah Marra, and Neal Shahidi
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Models, Statistical ,Latent tuberculosis ,Diagnostic Tests, Routine ,Tuberculin Test ,Epidemiology ,business.industry ,Concordance ,Gold standard (test) ,Random effects model ,medicine.disease ,Latent class model ,Confidence interval ,Interferon-gamma ,Latent Tuberculosis ,Meta-analysis ,Predictive value of tests ,Statistics ,Humans ,Medicine ,Epidemiologic Methods ,business - Abstract
Objective Because of the lack of a gold standard, the diagnostic performance of tests for the detection of latent tuberculosis infection (LTBI) is not known. However, statistical methods can be used to estimate the accuracy from the studies reporting the concordance among the tests. Study Design and Setting We developed a random-effect latent-class model to estimate performance characteristics of three LTBI diagnostic tests: tuberculin skin test (TST, at 10-mm cutoff), QuantiFERON-TB gold (QFG), and TSPOT-TB from the studies evaluating agreement among the tests. Results Nineteen studies were included. QFG had a sensitivity of 0.642 (95% confidence interval [CI]: 0.593–0.691) and specificity of 0.996 (95% CI: 0.989–1.000), TSPOT-TB had a sensitivity of 0.500 (95% CI: 0.334–0.666) and specificity of 0.906 (95% CI: 0.882–0.929), and TST had a sensitivity of 0.709 (95% CI: 0.658–0.761) and specificity of 0.683 (95% CI: 0.522–0.844). Results were not sensitive to the inclusion of any single study. When only the three studies that reported on TSPOT were removed, estimates for the other two tests varied minimally. Conclusions Statistical methods can help estimate the accuracy of LTBI tests. Although the specificities were close to their reported values in the literature, the estimates for sensitivities were low; a finding that should be carefully evaluated.
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- 2010
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73. When Trainees Reach Competency in Performing EUS: A Systematic Review
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Robert Enns, Neal Shahidi, Jennifer J. Telford, Eric Lam, and George Ou
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Medical education ,Hepatology ,business.industry ,Gastroenterology ,Medicine ,business - Published
- 2016
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74. Mo1697 Correlating Quantitative Fecal Immunochemical Test (FIT) Results With Neoplastic Findings on Colonoscopy in a Population-Based Colorectal Cancer Screening Program: A Prospective Study
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Laura Gentile, Jennifer J. Telford, Colleen E. McGahan, Neal Shahidi, Jeremy Hamm, Lovedeep Gondara, and Robert Enns
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Oncology ,medicine.medical_specialty ,Hepatology ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,Colonoscopy ,Population based ,Fecal Immunochemical Test ,Colorectal cancer screening ,Internal medicine ,medicine ,Prospective cohort study ,business - Published
- 2016
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75. Factors associated with suboptimal colorectal cancer screening in US immigrants
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Neal Shahidi, Winson Y. Cheung, and Babak Homayoon
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Oncology ,Male ,Rural Population ,congenital, hereditary, and neonatal diseases and abnormalities ,Cancer Research ,medicine.medical_specialty ,Urban Population ,Cross-sectional study ,MEDLINE ,Colonoscopy ,Emigrants and Immigrants ,Risk Assessment ,Sex Factors ,Internal medicine ,medicine ,Confidence Intervals ,Odds Ratio ,Humans ,neoplasms ,health care economics and organizations ,Early Detection of Cancer ,Aged ,medicine.diagnostic_test ,business.industry ,Incidence (epidemiology) ,Incidence ,Age Factors ,Odds ratio ,Middle Aged ,digestive system diseases ,Confidence interval ,United States ,Cross-Sectional Studies ,Logistic Models ,Family medicine ,Occult Blood ,Needs assessment ,Female ,Risk assessment ,business ,Colorectal Neoplasms ,Attitude to Health ,Needs Assessment - Abstract
Our objectives were to: (1) compare colorectal cancer screening (CRCS) among US born citizens (USBs), naturalized citizens (NACs), and noncitizens (NOCs) and (2) evaluate clinical factors and potential barriers associated with CRCS in these populations.Screening-eligible patients were identified from the 2007 California Health Interview Survey. Up-to-date CRCS was defined as a fecal occult blood test within 1 year, a sigmoidoscopy within 5 years, or a colonoscopy within 10 years. Using logistic regression, we determined the effects of immigrant status on CRCS. Stratified analyses based on location of residence, health insurance status, and English proficiency were conducted.A total of 30,434 average-risk adults aged 50 years or older completed the survey. Only 67% of USBs, 61% of NACs, and 46% of NOCs underwent CRCS. Advanced age, male sex, high-income earners, nonsmokers, and those who were married or visited their physicians frequently were more likely to receive CRCS (all P0.05). Compared with USBs, both NACs and NOCs showed decreased odds of CRCS (odds ratio 0.88, 95% confidence interval, 0.74-1.06 and odds ratio 0.68, 95% confidence interval, 0.53-0.88, respectively; P = 0.011). Stratified analyses revealed that the associations between immigrants and decreased CRCS were more prominent for those who lived in rural areas, lacked insurance, or were not English proficient.CRCS remains suboptimal, especially in new US immigrants. Improving health care access and mitigating language barriers may minimize this disparity.
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- 2012
76. Impact of asian ethnicity on colorectal cancer screening: a population-based analysis
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Winson Y. Cheung, Babak Homayoon, and Neal Shahidi
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Oncology ,Male ,congenital, hereditary, and neonatal diseases and abnormalities ,Cancer Research ,medicine.medical_specialty ,Multivariate analysis ,Vietnamese ,Population ,Health Behavior ,Logistic regression ,White People ,Odds ,Asian People ,Internal medicine ,medicine ,Ethnicity ,Humans ,education ,neoplasms ,Early Detection of Cancer ,Aged ,education.field_of_study ,business.industry ,Confounding ,Place of birth ,Middle Aged ,digestive system diseases ,language.human_language ,Logistic Models ,Cohort ,language ,Patient Compliance ,Female ,business ,Colorectal Neoplasms ,Demography - Abstract
OBJECTIVES Although research shows that African Americans and Hispanics frequently receive less colorectal cancer screening (CRCS) than whites, few studies have focused on CRCS among Asians. The aims of this study were to compare CRCS between Asians and whites and to evaluate for clinical predictors of CRCS. METHODS From the 2007 California Health Interview Survey, we identified all Asian and white respondents who were eligible for CRCS. Logistic regression was performed to evaluate for differences in CRCS. We used stratified and interaction analyses to examine whether associations between race and CRCS were modified by insurance status, birthplace, or language skills, while controlling for other confounders. RESULTS Baseline characteristics were similar between Asians and whites. Only 58% of Asians and 66% of whites reported undergoing up-to-date CRCS (P < 0.01). In multivariate analyses, visiting a physician more than 5 times produced the highest odds of being up-to-date with screening. When compared with whites, Asians had decreased odds of being up-to-date with screening. Stratified analyses showed that this disparity existed mainly in the insured, but not in the uninsured, and it was not modified by place of birth or English language proficiency. CONCLUSIONS Despite its ability to reduce mortality, CRCS is suboptimal in our US population-based cohort of Asians when compared with whites. A contributing factor to this problem for the Chinese and Koreans may be a lack of awareness regarding CRCS, whereas the source of the problem in the Vietnamese seems to be related to healthcare access.
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- 2012
77. Factors associated with positive findings from capsule endoscopy in patients with obscure gastrointestinal bleeding
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Ricky Kwok, Jessica Tong, George Ou, Joanna K. Law, Neal Shahidi, Sigrid Svarta, Robert Enns, and Eric C. Lam
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Enteroscopy ,Male ,medicine.medical_specialty ,Canada ,Gastroenterology ,Capsule Endoscopy ,law.invention ,Lesion ,Capsule endoscopy ,law ,Diabetes mellitus ,Internal medicine ,medicine ,Humans ,Aged ,Univariate analysis ,Hepatology ,medicine.diagnostic_test ,business.industry ,Esophagogastroduodenoscopy ,Odds ratio ,Middle Aged ,medicine.disease ,Connective tissue disease ,Occult Blood ,Female ,medicine.symptom ,business ,Gastrointestinal Hemorrhage - Abstract
Capsule endoscopy (CE) is used most frequently to identify causes of obscure gastrointestinal bleeding (OGIB). Identifying factors associated with the detection of lesions by CE could improve resource utilization and thereby improve patient selection for CE examination. We sought to identify clinical factors associated with positive findings from CE in patients with OGIB.We analyzed data from 698 CE procedures performed between December 2001 and April 2011 at St Paul's Hospital, Vancouver, Canada (50.3% of patients were female; mean age, 63.4 years). A positive finding was defined as a lesion that was believed to be the source of the bleeding (ulceration, mass lesion, vascular lesion, or visible blood). Univariate and multivariate logistic regression analyses were used to correlate demographic and clinical parameters with positive findings.A lesion believed to be the cause of bleeding was identified in 42% of cases. In univariate analysis, the number of esophagogastroduodenoscopies (EGDs), the presence of connective tissue disease or diabetes with end-organ damage, Charlson comorbidity index scores, and increasing transfusion requirements were significantly associated with identification of causative pathology from CE (all P.027). In multivariate analysis, increasing number of EGDs (odds ratio [OR], 1.17; 95% confidence interval [CI], 1.00-1.37), increasing transfusion requirements (3-9 units: OR, 1.70; 95% CI, 1.08-2.66, and ≥10 units: OR, 2.72; 95% CI, 1.69-4.37), and connective tissue disease (OR, 2.24; 95% CI, 1.14-4.41) were all significantly associated with identification of positive findings by using CE (all P.045).Patients with a higher number of precapsule EGDs or transfusions, or connective tissue disease, are superior candidates for analysis of OGIB by CE.
- Published
- 2012
78. Increased versus stable doses of inhaled corticosteroids for exacerbations of chronic asthma in adults and children
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Bradley S, Quon, J Mark, Fitzgerald, Catherine, Lemière, Neal, Shahidi, and Francine M, Ducharme
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Adult ,Adrenal Cortex Hormones ,Chronic Disease ,Humans ,Anti-Asthmatic Agents ,Child ,Asthma - Abstract
Written action plans providing guidance in the early treatment of asthma exacerbations have traditionally advocated doubling of inhaled corticosteroids (ICS) as one of the first steps in treatment.To compare the clinical effectiveness of increasing the dose of ICS versus keeping the usual maintenance dose as part of a patient-initiated action plan at the onset of asthma exacerbations.We searched the Cochrane Airways Group Specialised Register (last search October 2009) which is derived from searches of CENTRAL, MEDLINE, EMBASE and CINAHL, as well as handsearched respiratory journals and meeting abstracts.Randomised controlled trials (RCTs) that compared the strategy of increasing the daily dose of ICS to continuing the same ICS dose in the home management of asthma exacerbations in children or adults with persistent asthma on daily maintenance ICS.Two review authors independently selected trials, assessed quality and extracted data. We contacted authors of RCTs for additional information.Five RCTs (four parallel-group and one cross-over) involving a total of 1250 patients (28 children and 1222 adults) with mild to moderate asthma were included. The mean daily baseline ICS dose was 555 mg (range 200 mg to 795 mg) and the mean daily ICS dose achieved following increase was 1520 mg (range 1000 mg to 2075 mg), in CFC beclomethasone dipropionate equivalents. Three parallel-group studies in adults (two doubling and one quadrupling; mean achieved daily dose of 1695 mg with a range of 1420 to 2075 mg), involving 1080 patients contributed data to the primary outcome. There was no significant reduction in the need for rescue oral corticosteroids when patients were randomised to the increased ICS compared to stable maintenance dose groups (OR 0.85, 95% CI 0.58 to 1.26). There was no significant difference in the overall risk of non-serious adverse events associated with the increased ICS dose strategy, but the wide confidence interval prevents a firm conclusion. No serious adverse events were reported.There is very little evidence from trials in children. In adults with asthma on daily maintenance ICS, a self-initiated ICS increase to 1000 to 2000 mcg/day at the onset of an exacerbation is not associated with a statistically significant reduction in the risk of exacerbations requiring rescue oral corticosteroids. More research is needed to assess the effectiveness of increased ICS doses at the onset of asthma exacerbations (particularly in children).
- Published
- 2010
79. Increased versus stable doses of inhaled corticosteroids for exacerbations of chronic asthma in adults and children
- Author
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Bradley S Quon, J. Mark FitzGerald, Catherine Lemière, Neal Shahidi, and Francine M Ducharme
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- 2010
- Full Text
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80. Achieving asthma control in patients with moderate disease
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Neal Shahidi and J. Mark FitzGerald
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medicine.medical_specialty ,Clinical Trials as Topic ,Maintenance dose ,business.industry ,medicine.drug_class ,Inhaler ,Immunology ,Disease ,medicine.disease ,Asthma ,Surgery ,Maintenance therapy ,Patient Education as Topic ,Relative risk ,Bronchodilator ,medicine ,Immunology and Allergy ,Corticosteroid ,Humans ,Anti-Asthmatic Agents ,Intensive care medicine ,business - Abstract
Patients with moderate asthma are symptomatic on an ongoing basis. They are usually treated initially with low-dose inhaled corticosteroids (ICSs) supplemented with a short-acting bronchodilator as a rescue medication. Most steroid-naive patients will achieve good control with this strategy. For patients in whom adherence, inhaler technique, environmental control, and comorbidities have been addressed but who still have uncontrolled symptoms, the addition of a long-acting beta-adrenergic agonist should be considered. Some patients might require a higher dose of ICS. Leukotriene receptor antagonists might be considered as alternate initial therapy or as an add-on to maintenance therapy with an ICS. All patients should receive a structured education program emphasizing the need for ongoing maintenance treatment, even when control is achieved. Patients should also be provided with a written action plan that clearly explains which additional anti-inflammatory therapy should be taken if asthma symptoms worsen. The most effective strategy in this situation has been shown to be the quadrupling of the maintenance dose of ICS.
- Published
- 2009
81. The Utility of Monitoring Gamma-glutamyl Transpeptidase (GGT) Levels Post-liver Transplantation: A Longitudinal Retrospective Analysis
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Eric M. Yoshida, Vladimir Marquez Azalgara, and Neal Shahidi
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medicine.medical_specialty ,Hepatology ,business.industry ,Internal medicine ,medicine.medical_treatment ,Gastroenterology ,medicine ,Retrospective analysis ,Liver transplantation ,business - Published
- 2015
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82. Su1559 When Do Trainees Reach Competency in Performing Endoscopic Retrograde Cholangiopancreatography (ERCP): a Systematic Review
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Robert Enns, George Ou, Jennifer J. Telford, and Neal Shahidi
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medicine.medical_specialty ,Endoscopic retrograde cholangiopancreatography ,medicine.diagnostic_test ,business.industry ,General surgery ,Gastroenterology ,Medicine ,Radiology, Nuclear Medicine and imaging ,business - Published
- 2015
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83. Sa1705 Factors Associated With Positive Outcomes in Capsule Endoscopy for the Indication of Obscure Gastrointestinal Bleeding
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Jessica Tong, Kieran Donaldson, Robert Enns, Neal Shahidi, Sigrid Svarta, Ricky Kwok, Joseph Frenette, George Ou, and Eric C. Lam
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medicine.medical_specialty ,Capsule endoscopy ,law ,business.industry ,General surgery ,Gastroenterology ,medicine ,Radiology, Nuclear Medicine and imaging ,business ,Obscure gastrointestinal bleeding ,law.invention - Published
- 2012
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84. Effect of longer battery life on small bowel capsule endoscopy
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Oliver Takach, Terry Lee, George Ou, Neal Shahidi, Cherry Galorport, and Robert Enns
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Adult ,Male ,medicine.medical_specialty ,Gastrointestinal bleeding ,Time Factors ,Bowel habit ,Transit time ,Capsule Endoscopy ,Inflammatory bowel disease ,law.invention ,Tertiary Care Centers ,Electric Power Supplies ,Predictive Value of Tests ,Retrospective Study ,Capsule endoscopy ,law ,Intestine, Small ,Operating time ,Humans ,Medicine ,Gastrointestinal Transit ,Aged ,Retrospective Studies ,British Columbia ,business.industry ,Significant difference ,Gastroenterology ,Retrospective cohort study ,Equipment Design ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Intestinal Diseases ,Capsule Endoscopes ,Female ,Anatomic Landmarks ,business - Abstract
AIM: To determine if longer battery life improves capsule endoscopy (CE) completion rates. METHODS: A retrospective study was performed at a tertiary, university-affiliated hospital in Vancouver, Canada. Patients who underwent CE with either PillCam™ SB2 or SB2U between 01/2010 and 12/2013 were considered for inclusion. SB2 and SB2U share identical physical dimensions but differ in their battery lives (8 h vs 12 h). Exclusion criteria included history of gastric or small bowel surgery, endoscopic placement of CE, interrupted view of major landmarks due to technical difficulty or significant amount of debris, and repeat CE using same system. Basic demographics, comorbidities, medications, baseline bowel habits, and previous surgeries were reviewed. Timing of major landmarks in CE were recorded, and used to calculate gastric transit time, small bowel transit time, and total recording time. A complete CE study was defined as visualization of cecum. Transit times and completion rates were compared. RESULTS: Four hundred and eight patients, including 208 (51.0%) males, were included for analysis. The mean age was 55.5 ± 19.3 years. The most common indication for CE was gastrointestinal bleeding (n = 254, 62.3%), followed by inflammatory bowel disease (n = 86, 21.1%). There was no difference in gastric transit times (group difference 0.90, 95%CI: 0.72-1.13, P = 0.352) and small bowel transit times (group difference 1.07, 95%CI: 0.95-1.19, P = 0.261) between SB2U and SB2, but total recording time was about 14% longer in the SB2U group (95%CI: 10%-18%, P < 0.001) and there was a corresponding trend toward higher completion rate (88.2% vs 93.2%, OR = 1.78, 95%CI 0.88-3.63, P = 0.111). There was no statistically significant difference in the rates of positive findings (OR = 0.98, 95%CI: 0.64-1.51, P = 0.918). CONCLUSION: Extending the operating time of CE may be a simple method to improve completion rate although it does not affect the rate of positive findings.
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- 2015
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85. Su1550 Establishing the Learning Curve for Achieving Competency in Performing Colonoscopy: a Systematic Review
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Neal Shahidi, George Ou, Jennifer J. Telford, and Robert a. Enns
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Gastroenterology ,Radiology, Nuclear Medicine and imaging - Published
- 2014
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86. Mo1561 Clinical Impact of Longer Battery Life in Small Bowel Capsule Endoscopy: a Single-Center Experience
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Robert Enns, Cherry Galorport, Neal Shahidi, George Ou, and Oliver Takach
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medicine.medical_specialty ,Capsule endoscopy ,law ,business.industry ,Gastroenterology ,Battery (vacuum tube) ,Medicine ,Radiology, Nuclear Medicine and imaging ,business ,Single Center ,law.invention ,Surgery - Published
- 2014
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87. Sa1224 Assessing the Performance of Interferon-Gamma Release Assays in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis
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Yi Tzu Nancy Fu, Hong Qian, Neal Shahidi, and Brian Bressler
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Hepatology ,business.industry ,Meta-analysis ,Immunology ,Gastroenterology ,medicine ,Interferon gamma ,medicine.disease ,business ,Inflammatory bowel disease ,medicine.drug - Published
- 2012
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88. Current recommendations for the treatment of mild asthma
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Neal Shahidi and J. Mark FitzGerald
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Pulmonary and Respiratory Medicine ,asthma education ,medicine.medical_specialty ,Exacerbation ,Mild asthma ,Inhaled corticosteroids ,Review ,03 medical and health sciences ,0302 clinical medicine ,Asthma control ,medicine ,Immunology and Allergy ,030212 general & internal medicine ,Disease management (health) ,Intensive care medicine ,Asthma ,treatment ,business.industry ,medicine.disease ,Frequent use ,3. Good health ,030228 respiratory system ,Physical therapy ,inhaled corticosteroids ,business ,mild asthma ,Patient education - Abstract
Patients suffering from mild asthma are divided into intermittent or persistent classes based on frequency of symptoms and reliever medication usage. Although these terms are used as descriptors, it is important to recognize the approach of focusing on asthma control in managing asthma patients. Beta-agonists are considered first-line therapy for intermittent asthmatics. If frequent use of beta-agonists occurs more than twice a week, controller therapy should be considered. For persistent asthma, low-dose inhaled corticosteroids are recommended in addition to reliever medication. Compliance to regular therapy can pose problems for disease management, and while intermittent controller therapy regimens have been shown to be effective, it is imperative to stress the value of regular therapy especially if an exacerbation occurs. It is also important when such an approach is adopted that there is regular re-evaluations of asthma control. This is because regular anti-inflammatory therapy may become necessary if symptoms become more persistent. Other therapies are seldom needed. Antileukotrienes can be considered an option for mild asthma; however, studies have shown that they are not as effective as inhaled corticosteroids. Aside from therapy, patient education, which includes a written action plan, should be a component of the patient’s strategy for disease management.
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- 2010
- Full Text
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89. Diagnostic Accuracy of Echocardiography for Pulmonary Hypertension: A Systematic Review and Meta-analysis
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John R. Swiston, Surinder Janda, Kenneth Gin, and Neal Shahidi
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Adult ,Pulmonary and Respiratory Medicine ,Cardiac Catheterization ,medicine.medical_specialty ,Correlation coefficient ,medicine.medical_treatment ,Hypertension, Pulmonary ,MEDLINE ,Context (language use) ,Doppler echocardiography ,Critical Care and Intensive Care Medicine ,Young Adult ,Internal medicine ,medicine ,Humans ,Cardiac catheterization ,Aged ,medicine.diagnostic_test ,business.industry ,Respiratory disease ,Gold standard (test) ,Middle Aged ,Random effects model ,medicine.disease ,Pulmonary hypertension ,Echocardiography, Doppler ,Surgery ,Data extraction ,Meta-analysis ,Cardiology ,Radiology ,Epidemiologic Methods ,Cardiology and Cardiovascular Medicine ,business - Abstract
Context Right heart catheterisation is the gold standard for the diagnosis of pulmonary hypertension. However, echocardiography is frequently used to screen for this disease and monitor progression over time because it is non-invasive, widely available and relatively inexpensive. Objective To perform a systematic review and quantitative meta-analysis to determine the correlation of pulmonary pressures obtained by echocardiography versus right heart catheterisation and to determine the diagnostic accuracy of echocardiography for pulmonary hypertension. Data sources MEDLINE, EMBASE, Papers First, the Cochrane collaboration and the Cochrane Register of controlled trials were searched and were inclusive as of February 2010. Study selection Studies were only included if a correlation coefficient or the absolute number of true-positive, false-negative, true-negative and false-positive observations was available, and the 'reference standards' were described clearly. Data extraction Two reviewers independently extracted the data from each study. Quality was assessed with the quality assessment for diagnostic accuracy studies. A random effects model was used to obtain a summary correlation coefficient and the bivariate model for diagnostic meta-analysis was used to obtain summary sensitivity and specificity values. Results 29 studies were included in the meta-analysis.The summary correlation coefficient between systolic pulmonary arterial pressure estimated from echocardiography versus measured by right heart catheterisation was 0.70 (95% CI 0.67 to 0.73; n=27).The summary sensitivity and specificity for echocardiography for diagnosing pulmonary hypertension was 83% (95% CI 73 to 90) and 72% (95% CI 53 to 85;n=12), respectively. The summary diagnostic OR was 13(95% CI 5 to 31).Conclusions Echocardiography is a useful and noninvasive modality for initial measurement of pulmonary pressures but due to limitations, right heart catheterisation should be used for diagnosing and monitoring pulmonary hypertension.
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- 2010
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90. St. Paul's Advanced Resection Center Cohort for Colorectal Neoplasia (SPARC-C) (SPARC-C)
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Neal Shahidi, Assistant Professor of Medicine
- Published
- 2022
91. Colorectal cancer screening: Opportunities to improve uptake, outcomes, and disparities.
- Author
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Shahidi N and Cheung WY
- Abstract
Colorectal cancer screening has become a standard of care in industrialized nations for those 50 to 75 years of age, along with selected high-risk populations. While colorectal cancer screening has been shown to reduce both the incidence and mortality of colorectal cancer, it is a complex multi-disciplinary process with a number of important steps that require optimization before tangible improvements in outcomes are possible. For both opportunistic and programmatic colorectal cancer screening, poor participant uptake remains an ongoing concern. Furthermore, current screening modalities (such as the guaiac based fecal occult blood test, fecal immunochemical test and colonoscopy) may be used or performed suboptimally, which can lead to missed neoplastic lesions and unnecessary endoscopic evaluations. The latter poses the risk of adverse events, such as perforation and post-polypectomy bleeding, as well as financial impacts to the healthcare system. Moreover, ongoing disparities in colorectal cancer screening persist among marginalized populations, including specific ethnic minorities (African Americans, Hispanics, Asians, Indigenous groups), immigrants, and those who are economically disenfranchised. Given this context, we aimed to review the current literature on these important areas pertaining to colorectal cancer screening, particularly focusing on the guaiac based fecal occult blood test, the fecal immunochemical test and colonoscopy., Competing Interests: Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
- Published
- 2016
- Full Text
- View/download PDF
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