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Background: Cold snare polypectomy (CSP) is increasingly used for polypectomy and is recommended as first-line modality for small (

Background Standard colonoscopy practice requires removal and histological characterization of almost all detected small ( Methods A post hoc analysis was performed on patients enrolled in a prospective study. The primary outcome was surveillance interval agreement of the PBRD strategy with pathology-based management according to 2020 US Multi-Society Task Force guidelines. Chart analysis also evaluated clinician adherence to pathology-based recommendations. One-sided testing was performed with a null-hypothesis of 90 % agreement with pathology-based surveillance intervals and a two-sided 96.7 % confidence interval (CI) using correction for multiple testing. Results 452 patients were included in the study. Surveillance intervals assigned using the PBRD strategy were correct in 97.8 % (96.7 %CI 96.3–99.3 %) of patients compared with pathology-based management. The PBRD strategy reduced pathology examinations by 58.7 % while providing 87.8 % of patients with immediate surveillance interval recommendations on the day of colonoscopy, compared with 47.1 % when using pathology-based management. Chart analysis of surveillance interval assignments showed 63.3 % adherence to pathology-based guidelines. Conclusion The PBRD strategy surpassed the 90 % agreement with the pathology-based standard for determining surveillance interval, reduced the need for pathology examinations, and increased the proportion of patients receiving immediate surveillance interval recommendations. The PBRD strategy does not require expertise in optical diagnosis and may replace histological characterization of small and diminutive colorectal polyps.

BACKGROUND: Current clinical practice assigns post-polypectomy surveillance intervals based on the number, size and histological aspects of polyps. AIMS: Our goal was to test a novel polyp-based resect and discard model that assigns surveillance intervals for small polyps based only on size and number of polyps. METHODS: A post hoc analysis was performed on patients enrolled in a prospective colonoscopy trial. We created a model for polyp-based surveillance interval allocation based on clinical experience for what the most likely pathology-based surveillance interval would be for certain scenarios. The primary outcome was the surveillance interval agreement of the polyp-based resect and discard strategy compared to histopathology and USMSTF based surveillance intervals. Secondary outcomes were the overall reduction in required pathology exams and the number of surveillance intervals that can be provided immediately to patients before leaving the endoscopy unit. In addition, we conducted a medical chart review to assess current clinical practise of surveillance interval guideline adherence at our institution. RESULTS: 457 patients (mean age 62.7, 49.4% female, 514 small polyps, 430 diminutive polyps) were enrolled in the study. When using the polyp-based resect and discard model, the assigned surveillance intervals were correct for 89,3% (95% CI: 0.86–92) of patients when compared to pathology-based surveillance interval assignment. When using the polyp-based model, 88,8% of patients can be provided with immediate surveillance interval recommendations compared to 47,7% when using the pathology-based surveillance interval allocation. When using the polyp-based model, 61.4% of pathology examinations can be omitted. Medical chart review showed that at our institution 43.8% of patients received a correct surveillance interval recommendation. CONCLUSIONS: The polyp-based resect and discard model reaches an almost 90% agreement compared to pathology-based surveillance interval allocation recommendations. This alternative model reduces the need for pathology examinations, increases the amount of patients that can be provided with immediate surveillance interval recommendations and has the potential to reduce colonoscopy-associated costs. Clinical adherence to pathology results and guideline recommendations was found to be low, but in the range of what has been previously reported in the literature. FUNDING AGENCIES: None

Cronkhite-Canada syndrome is a rare syndrome consisting of extensive gastrointestinal polyposis and ectodermal changes including cutaneous hyperpigmentation, alopecia, and onychodystrophy. We report the case of a 45-year-old Caucasian male patient who failed multiple treatments over 2 years including steroids, azathioprine, adalimumab, and cyclosporine. He had recurrent and prolonged hospitalizations because of diarrhea, abdominal pain, weight loss, and malnutrition. Sirolimus was initiated with a significant clinical and endoscopic benefit apparent within, respectively, 2 and 8 weeks. An ongoing remission was achieved and maintained for over 6 months after prednisone tapering. We review the current evidence on treatment of Cronkhite-Canada syndrome and suggest the incorporation of sirolimus in that algorithm.

The prognosis of decompensated cirrhosis resulting from chronic hepatitis B is poor, and the benefits of treatment with interferon are outweighed by serious side effects and by the risk of fatal exacerbation of disease activity. Lamivudine rapidly reduces hepatitis B virus (HBV)-DNA in serum to undetectable levels. We have treated 35 patients with chronic hepatitis B and decompensated cirrhosis with lamivudine 100 mg or 150 mg orally once daily. Pretreatment, all were positive for HBV-DNA in serum. Ten had Child-Pugh class B and 25 had Child-Pugh class C liver disease. Seven patients underwent liver transplantation within 6 months of treatment initiation, 5 patients died within 6 months, and 23 patients were treated for at least 6 months (mean = 19 months). In a majority of these 23 cases, there was a slow but marked improvement in liver function, which was most apparent after 9 months of treatment, with a decrease in serum bilirubin from 67 +/- 13 to 30 +/- 4 micromol/L (P

The presence of human papillomavirus (HPV) DNA in esophageal brushings from human immunodeficiency virus (HIV)-seropositive hosts was investigated in a cross-sectional study. Oral and esophageal brushings from individuals scheduled for esophagogastroscopy (53 HIV-positive and 61 age-matched HIV-negative patients) were tested for the presence of HPV DNA by a consensus L1 polymerase chain reaction assay. HPV DNA was detected in esophageal brushings of 9 (17%) of the 53 HIV-seropositive patients and 0 of the 61 HIV-negative individuals. HPV-16 DNA was the most frequently detected. No proliferative mucosal lesion was noted in individuals with HPV-positive esophageal brushings. Cytological smears were done for 6 of the 9 patients with HPV-positive esophageal brushings, and epithelial atypia was recorded for 1. HIV infection and a history of genital herpes were strong independent predictors of HPV, suggesting that HPV is transmitted sexually in the esophagus.

In mice, the transfer of CD172a(+) (SIRP-α) dendritic cells (DCs) elicits T cell-driven colitis, whereas treatment with CD47-Fc protein, a CD172a-binding agent, confers protection. The aim of this study was to elucidate the nature and functional properties of human CD172a(+) DCs in chronic intestinal inflammation. Here, we show that CD172a(+)CD11c(+) cells accumulate in the mesenteric lymph nodes (mLNs) and inflamed intestinal mucosa in patients with Crohn's disease (CD). These cells are distinct from resident DCs and may coexpress markers typically associated with monocyte-derived inflammatory DCs such as CD14 and/or DC-SIGN, E-Cadherin, and/or CX3CR1. Spontaneous IL-1β and TNF production by HLA-DR(+) cells in CD tissues is restricted to those expressing CD172a. An avidity-improved CD47 fusion protein (CD47-Var1) suppresses the release of a wide array of inflammatory cytokines by CD172a(+) cells, which may include HLA-DR(-)CD172a(+) neutrophils, in inflamed colonic explant cultures and impairs the ability of HLA-DR(+)CD172a(+) cells to activate memory Th17 but not Th1 responses in mLNs. In conclusion, targeting CD172a(+) cells may represent novel therapeutic perspectives for patients with CD., Journal Article, Research Support, Non-U.S. Gov't, SCOPUS: ar.j, info:eu-repo/semantics/published

Over its 101 year history, IBM has had a strong commitment to diversity and the advancement of women. IBM hired women before women could vote in the United States, had documented CEO commitment to “same work for equal pay” decades before the Equal Pay Act, and had a woman Vice President in 1943. At IBM the commitment to diversity has been not just a moral imperative, but a business imperative.

Traditionally, patient information has been recorded on paper and stored in file folders at healthcare facilities and within physicians’ offices. The implementation of electronic health records (EHRs), the lifetime record of an individual’s health and health services delivered, allows for information to be stored on computers and offers the opportunity to store considerably more data, in much less space, with new efficiencies and value added as information is easier to access, legible, timely, non-redundant and readily available. However, there are many issues to consider with the implementation of a fully shared EHR. The protection of the information contained in the record is of the utmost importance as individuals stand to become quite vulnerable if that personal health information is compromised or accessed by unauthorized users. Therefore, one of the goals of this chapter is to uncover ways in which personal health information is being protected in EHR systems. The second objective, a broader one, examines what regulations, legislation and policies are in place that remove some of the uncertainty and risk and make the use of shared information safe and secure. Many of the techniques and technologies used so far are adopted from the corporate world, where data security has been an issue for some time. Current legislation in the United States and Canada at both the federal and state/provincial levels has addressed the general principles of data security and privacy but are still lacking in specifics with regard to cross-jurisdictional sharing of health information and the implementation and use of EHRs. Many of the researchers and studies on the subject find this to be one of the most important areas of concern moving forward. The opportunities for EHR implementation and use are exciting as they have the strong potential to improve both individual health care and population health, but without proper regulation and policies in place it is possible that the risks may outweigh the benefits.

As with many disciplines, the fields of healthcare in general and medicine, in particular, have made vast strides in improving patient outcomes and healthcare delivery. But, have healthcare professionals and medical academia been able to maximize the utilization of new technologies to improve the delivery of the right knowledge, to the right people, at the right time across geographical boundaries? In order to provide the best quality of care, regardless of patient or provider location, specific issues must be addressed.

The Canadian healthcare system strives to serve a population altered by ever-changing demographics, cultural shifts, and diverse societal populations, and to serve those in rural communities with remote access to health care. The following chapter examines Canada’s current healthcare system and the effects on demand for services and the supply of healthcare providers created by the need to service rural populations, by limited access to medical schools, and by the introduction of foreign medical/health professionals. More specifically, the chapter reviews the symptoms of a strained medical system plagued by “brain waste” due to the non-use of qualified immigrant healthcare professionals, long wait times as a result of inadequate staffing and resources, and a school system that hinders the development of aspiring medical care professionals from rural and international areas. If Canada is to face these challenges with efficacy and vigour, effective human resources management techniques and competent human resources professionals are a necessary prologue. Medical knowledge and skill must be valued; healthcare professionals should be utilized more efficiently to improve healthcare access and minimize brain waste.

This study examines the nature of the relationship between entrepreneurs and consultants, including how entrepreneurs choose consultants, for what services, and the sources of reference information used. Various studies of entrepreneurs have concluded that they lack management expertise, especially in general management areas. It was therefore a natural question to examine whether they used outside sources of management expertise, such as consultants, and for what types of management assistance. The research examined what services clients most often used, how consultants were selected and evaluated, what other sources of assistance were being used by firms, and possible recommendations to both entrepreneurs and consultants on improving the process. The research also compares similarities and differences between the two groups, consultants and clients, on their expectations and impressions of the relationship.

Background This paper addresses the health care system from a global perspective and the importance of human resources management (HRM) in improving overall patient health outcomes and delivery of health care services. Methods We explored the published literature and collected data through secondary sources. Results Various key success factors emerge that clearly affect health care practices and human resources management. This paper will reveal how human resources management is essential to any health care system and how it can improve health care models. Challenges in the health care systems in Canada, the United States of America and various developing countries are examined, with suggestions for ways to overcome these problems through the proper implementation of human resources management practices. Comparing and contrasting selected countries allowed a deeper understanding of the practical and crucial role of human resources management in health care. Conclusion Proper management of human resources is critical in providing a high quality of health care. A refocus on human resources management in health care and more research are needed to develop new policies. Effective human resources management strategies are greatly needed to achieve better outcomes from and access to health care around the world.

Information and communication technology (ICT) is constantly changing the world around us. This not only affects the way that we conduct our personal lives but also our business lives. It is changing the very make up of society (Neff, 2000). For organizations, it seems that there is a requirement for success that they ride along with the new technological wave or risk getting left behind. As a result, some organizations are implementing telework programs to take advantage of new technologies (Kaye et al., 2000).

To investigate in a cross-sectional study the determinants of oral human papillomavirus infection in 287 individuals who are sexually active.To assess prevalence as well as risk factors for oral human papillomavirus infection.One hundred seventy-eight human immunodeficiency virus-seropositive (158 men and 20 women) and 109 human immunodeficiency virus-negative (73 men and 36 women) individuals were recruited consecutively from sexually transmitted disease-human immunodeficiency virus clinics and gastrointestinal endoscopy clinics. Oral brushings were tested with the L1 consensus polymerase chain reaction assay for human papillomavirus detection.Human papillomavirus DNA was detected in 32 (11.2%) of 287 individuals. Associated with oral human papillomavirus infection on univariate analyses were human immunodeficiency virus infection (odds ratio, 6.9; 95% confidence interval, 2.0-23.2), homosexuality (odds ratio, 3.7; 95% confidence interval, 1.5-9.4), unprotected oral sex (odds ratio, 5.5; 95% confidence interval, 1.6-18.4), syphilis (odds ratio, 2.5; 95% confidence interval, 1.1-6.3), gonorrhea (odds ratio, 4.2; 95% confidence interval, 1.9-9.1), Chlamydia trachomatis (odds ratio, 4.4; 95% confidence interval, 1.8-10.6), and genital herpes (odds ratio, 2.9; 95% confidence interval, 1.3-6.5). Human immunodeficiency virus infection and C. trachomatis were independently predictive of human papillomavirus infection in multivariate stepwise logistic regression.

Studies were undertaken to assess the contribution of lipoprotein cholesterol to bile and to determine whether already-existent hepatic free cholesterol and the free cholesterol which is newly generated from the hydrolysis of hepatic cholesteryl esters are equally available for secretion into bile or constitute metabolically separate pools. Rats with a bile fistula were injected with an intravenous bolus of high-density lipoprotein recombinants containing free [14C]cholesterol and [3H]cholesteryl esters. Results showed (1) that bile free [14C]cholesterol secretion was a constant and linear proportion of the whole liver free [14C]cholesterol pool, (2) that secretion into bile of free [3H]cholesterol was in direct proportion to the rate of hydrolysis of hepatic [3H]cholesteryl esters, and (3) that rates of biliary cholesterol secretion were very similar when secretion was calculated using the specific activity of free [14C]cholesterol and free [3H]cholesterol in the entire liver to ‘label’ the precursor free cholesterol pool. Furthermore, rates of secretion that were calculated using either isotope closely approximated the mass of free cholesterol that was directly measured in bile. Results thus indicate that because of equilibration and extensive dilution by the large pool of already-existent free cholesterol, the transport of isotopic cholesterol from lipoproteins cannot be used to directly assess the contribution of lipoprotein cholesterol to the cholesterol that is secreted in bile. These studies further suggest that the totality of preformed free cholesterol in the liver is in metabolic equilibrium in one single kinetic pool and that all hepatic free cholesterol is potentially available for secretion into bile.

An investigation of the basic components of Lupinuswyethii S. Wats. has revealed the presence of at least four alkaloids, three of which, i.e., l-sparteine, d-lupanine, and hydroxylupanine, are known. The fourth has not been found in sufficient quantity to permit proper characterization. A similar investigation of Baptisiaversicolor Lodd. has yielded three alkaloids, i.e., d-sparteine, l-lupanine, and l-anagyrine.