35 results on '"de Garmo P"'
Search Results
2. The time and financial impact of training fellows in endoscopy
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Elizabeth Lyden, Randall E. Brand, Timothy M. McCashland, and de Garmo P
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medicine.medical_specialty ,Hepatology ,medicine.diagnostic_test ,Esophagogastroduodenoscopy ,business.industry ,General surgery ,Gastroenterology ,MEDLINE ,Colonoscopy ,Endoscopy ,Private practice ,Family medicine ,Biopsy ,medicine ,Outcomes research ,business ,Reimbursement - Abstract
Objective To use a national endoscopy database (Clinical Outcomes Research Initiative, CORI) to determine 1) if fellow involvement increases procedure time; and 2) the financial impact of fellow participation for academic centers compared to private practice. Methods CORI database from 4/1/97 to 4/1/99 was used to compare endoscopists from private practices, academic medical centers, and Veterans Administration hospitals, with or without fellows-in-training. Data were captured in a computer-generated endoscopy report and transmitted to a central database for analysis. Duration of procedure (minutes) was recorded for diagnostic esophagogastroduodenoscopy (EGD), EGD with biopsy, diagnostic colonoscopy, and colonoscopy with biopsy, in ASA 1 patients. Financial outcomes used 1999 Medicare reimbursement rates for respective procedures and were calculated as procedures per hour on a theoretical practice of 4000 procedures. Results Teaching fellows endoscopy added 2-5 min for EGD, with or without biopsy, and 3-16 min for colonoscopy, with or without biopsy. Calculating the number of procedures/h of endoscopy, the reimbursement loss resulting from using fellows-in-training in a university setting would be half a procedure/h. In Veterans Administration hospitals, training of fellows would lose a full procedure/h. In a model of 1000 procedures each of EGD, EGD with biopsy, colonoscopy, and colonoscopy with biopsy, the reimbursement difference between private practice physicians or academic attending physicians and procedures involving fellows-in-training would be $500,000 to $1,000,000/yr. Conclusions Fellow involvement prolonged procedure time by 10-37%. Thus, per-hour reimbursement is reduced at teaching institutions, causing financial strain related to these time commitments. more...
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- 2000
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3. Sigmoidoscopy may inadequately screen older women
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Walter, L.C., de Garmo, P., and Covinsky, K.E.
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Aged women -- Medical examination ,Sigmoidoscopy -- Evaluation ,Colorectal cancer -- Diagnosis ,Health ,Seniors - Abstract
Walter LC, de Garmo P, Covinsky KE. Association of older age and female sex with inadequate reach of screening flexible sigmoidoscopy. Am J Med 2004; 116(3):174-8. The use of flexible [...]
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- 2004
4. Rapid urease testing (RUT) in routine clinical practice: Do practice guidelines make a difference
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Vakil, N, primary, de Garmo, P, additional, and Lieberman, D, additional
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- 1998
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5. Fibrinogen and the albumin-globulin ratio in recurrent stroke.
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Beamer, N, primary, Coull, B M, additional, Sexton, G, additional, de Garmo, P, additional, Knox, R, additional, and Seaman, G, additional
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- 1993
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6. Chronic blood hyperviscosity in subjects with acute stroke, transient ischemic attack, and risk factors for stroke.
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Coull, B M, primary, Beamer, N, additional, de Garmo, P, additional, Sexton, G, additional, Nordt, F, additional, Knox, R, additional, and Seaman, G V, additional
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- 1991
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7. A national study of cardiopulmonary unplanned events after GI endoscopy.
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Sharma VK, Nguyen CC, Crowell MD, Lieberman DA, de Garmo P, and Fleischer DE
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BACKGROUND: Cardiopulmonary unplanned events (CUE) related to conscious sedation constitute a major proportion of GI endoscopy-associated complications. OBJECTIVES: Our purpose was to study the incidence of CUE during GI endoscopy and to determine factors that may predict CUE. DESIGN: Retrospective CORI (Clinical Outcomes Research Initiative) database review. PATIENTS: Undergoing GI endoscopy under conscious sedation. MAIN OUTCOME MEASUREMENT: CUE associated with GI endoscopy. RESULTS: Data on 324,737 unique procedures (EGD, 140,692; colonoscopy, 174,255; ERCP, 6092; and EUS, 3698) performed with the patient under conscious sedation were analyzed. Unplanned events were reported in 1.4% of procedures; 0.9% were associated with CUE. Rates of CUE with EGD, colonoscopy, ERCP, and EUS were 0.6%, 1.1%, 2.1%, and 0.9%, respectively. Multiple logistic regression revealed patient age (odds ratio [OR] 1.02, 95% CI 1.01-1.02) and ASA class were significant predictors of CUE (OR compared with ASA I: ASA II 1.05, 95% CI 0.95-1.16; ASA III 1.8, 95% CI 1.6-2.0, ASA IV 3.2, 95% CI 2.5-4.1, ASA V 7.5; 95% CI 3.2-17.6). Inpatient procedures were associated with higher CUE (OR 1.5, 95% CI 1.3-1.7). Compared with universities, nonuniversity sites (OR 1.2, 95% CI 1.1-1.4) and Veterans Administration Medical Centers (OR 1.4, 95% CI 1.2-1.5) had significantly higher CUE. Use of supplemental oxygen during a procedure was associated with significantly more CUE (OR 1.2, 95% CI 1.1-1.3). Involvement of a trainee with a procedure was also associated with higher CUE (OR 1.3, 95% CI 1.1-1.4). LIMITATIONS: Retrospective review of data entered voluntarily by endoscopists not trained on CORI data entry. CONCLUSIONS: During GI endoscopy with conscious sedation, patient's age, higher ASA grade, inpatient status, trainee participation, and routine use of oxygen are associated with a higher incidence of CUE. [ABSTRACT FROM AUTHOR] more...
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- 2007
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8. Elevated plasma homocyst(e)ine concentration as a possible independent risk factor for stroke.
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Coull, B M, primary, Malinow, M R, additional, Beamer, N, additional, Sexton, G, additional, Nordt, F, additional, and de Garmo, P, additional
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- 1990
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9. Impact of colonoscopy preparation quality on detection of suspected colonic neoplasia
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Harewood, Gavin C., Sharma, Virender K., and de Garmo, Pat
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Background:Suboptimal bowel preparation for colonoscopy can lead to missed colonic lesions. The aim of this study was to describe the impact of preparation quality on detection of suspected colonic neoplasia. Methods:Data from the Clinical Outcomes Research Initiative national endoscopic database for the period January 1, 2000 to December 31, 2001, were analyzed. Patient demographics, quality of preparation, and colonoscopy findings were abstracted from the database. Results:Overall, 93,004 colonoscopies with adequate documentation were reviewed. Preparation was adequate for 71,501 (76.9%) of these procedures. On multivariate analysis, preparation adequacy was associated with colonic lesion detection, odds ratio (OR) 1.21: 95% CI [1.16, 1.25]. Adequate preparation demonstrated a closer association with identification of “nonsignificant” lesions (polyps ≤9 mm), OR 1.23: 95% CI [1.19, 1.28], compared with “significant” lesion detection (mass lesion, polyps >9 mm), OR 1.05: 95% CI [0.98, 1.11]. Conclusions:Bowel preparation is inadequate for almost a quarter of patients undergoing colonoscopy. These results suggest that inadequate preparation quality only hinders detection of smaller lesions, while having negligible impact on detection of larger lesions. These results should be confirmed in prospective studies. (Gastrointest Endosc 2003;58:76-9.) more...
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- 2003
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10. Potential impact of preoperative EUS on esophageal cancer management and cost
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Shumaker, Douglas A., de Garmo, Patricia, and Faigel, Douglas O.
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Background:The purpose of this study was to determine the relative proportions of esophageal cancer stages in a group of patients referred for preoperative EUS, to determine the proportions of EUS stage 1 and 4 tumors that would not be treated with combined modality therapy, and to estimate the impact of the EUS diagnosis of these stages on costs. Methods:A large national endoscopic database was reviewed retrospectively to identify cases of esophageal cancer in which there was a referral for preoperative staging with EUS. Data were analyzed as to demographics, histology and tumor stage by EUS according to the American Joint Commission for Cancer tumor node metastasis classification system for esophageal cancer. Cost estimates were based on Medicare reimbursement rates and published figures. Results:Of 188 EUS procedures done for preoperative staging of esophageal cancer (82% men, mean age 66.5 years), the histopathologic types of cancer were: adenocarcinoma, 107; squamous cell carcinoma, 39; and unknown histology, 42. Numbers and proportions of patients by American Joint Commission for Cancer group stage based on 162 procedures for which complete staging information was available are as follows: Stage I, 23 patients (14%); Stage II, 51 (31%); Stage III, 69 (43%); and Stage IV, 19 (12%). Therefore, for every 100 patients staged before surgery with EUS (cost $63,420), 14 patients with Stage I disease would be spared neoadjuvant chemoradiotherapy (saving $122,192) and 12 patients with Stage IV cancer would be spared surgery (saving $285,600) for an average cost savings of $3443 per patient. Conclusion:Preoperative staging of esophageal cancer with EUS identifies a significant proportion of patients (26% in this series) with stage I and IV tumors who may be spared combined modality therapy with an associated potential for cost savings. (Gastrointest Endosc 2002;56:391-6.) more...
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- 2002
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11. Colonic neoplasia in patients with nonspecific GI symptoms
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Lieberman, David A., de Garmo, Patricia L., Fleischer, David E., Eisen, Glenn M., Chan, Benjamin K.S., and Helfand, Mark
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Background:The purpose of this study was to determine the prevalence rate of colonic polyps or masses 1 cm or greater in diameter in patients with nonspecific abdominal symptoms, from diverse practice settings, using a national endoscopic database. Methods:Consecutive patients undergoing colonoscopy were included based on procedure indication. Endoscopic data were generated with a computer database at each practice site, transmitted to a central data bank and merged with data from multiple sites for analysis. Group 1 patients had nonspecific abdominal symptoms, which were defined as pain, constipation and diarrhea. Group 2 patients had a positive fecal occult blood test. Group 3 patients were asymptomatic, undergoing screening colonoscopy. Serious colon pathology was defined as a polyp or mass greater than 9 mm in size. Results:Data were collected from 31 practice sites in 21 states during a period of 18 months. Of the 20,745 colonoscopy examinations, 9.2% were performed to evaluate patients with nonspecific abdominal symptoms, excluding other indications. Among patients with nonspecific symptoms 7.27% had polyp(s) 1 cm or greater in diameter compared with 17.05% of patients with positive fecal occult blood test (odds ratio 2.12: CI [1.73, 2.60]; p< 0.001). Patients with nonspecific symptoms had similar rates of large polyps as asymptomatic patients (7.27% vs. 6.45%, p= 0.32). Multivariate analysis identified several independent variables including increasing age, male gender and practice site at a Veterans Affairs Medical Center. Conclusions:In diverse, practice-based settings, patients with nonspecific abdominal symptoms who are referred for colonoscopy do not have a higher risk of serious colonic pathology than asymptomatic patients. (Gastrointest Endosc 2000;51:647-51.) more...
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- 2000
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12. Patterns of endoscopy use in the United States
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Lieberman^*, D.A., de Garmo^*, P.L., Fleischer^@?, D.E., Eisen^&, G.M., and Helfand^*, M.
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Background & Aims: The aim of this study was to use a large national endoscopic database to determine why routine endoscopy is performed in diverse practice settings. Methods: A computerized endoscopic report generator was developed and disseminated to gastrointestinal (GI) specialists in diverse practice settings. After reports were generated, a data file was transmitted electronically to a central databank, where data were merged from multiple sites for analysis. Results: From April 1, 1997, to October 28, 1998, 276 physicians in 31 practice sites in 21 states provided 18,444 esophagogastroduodenoscopy (EGD) reports, 20,748 colonoscopy reports, and 9767 flexible sigmoidoscopy reports to the central databank. EGD was most commonly performed to evaluate dyspepsia and/or abdominal pain (23.7%), dysphagia (20%), symptoms of gastroesophageal reflux without dysphagia (17%), and suspected upper GI bleeding (16.3%). Colonoscopy was most often performed for surveillance of prior neoplasia (24%) and evaluation of hematochezia (19%) or positive fecal occult blood test (15%). Flexible sigmoidoscopy was most commonly performed for routine screening (40%) and evaluation of hematochezia (22%). There were significant differences between academic and nonacademic sites. Conclusions: The endoscopic database can be an important resource for future research in endoscopy by documenting current practice patterns and changes in practice over time. GASTROENTEROLOGY 2000;118:619-624 more...
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- 2000
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13. TWO HUNDRED AND FIFTY BASSINI OPERATIONS FOR THE CURE OF INGUINAL HERNIA; WITHOUT MORTALITY.
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DE GARMO, W. B.
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The 250 operations here reported have been done upon 216 patients; 34 of the cases having been operated on on both sides. Fifty-two of the patients were females, 164 were males. I am quite sure that no one can accuse me of having selected my cases, when their ages and conditions are considered. Fifty-five of the patients were under 14 years of age, 43 were between 14 and 25, while 118 had passed their 25th year. Of the latter number, 8 were between 60 and 70, 6 between 70 and 80 and 2 were over 80 years of age. The youngest child operated on was 5 months old, and this is the first instance in my experience where I have been obliged to operate on a child less than 1 year of age. The operation was for strangulated scrotal hernia on the right side. The left was operated on at more...
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- 1897
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14. Kind and Amount of Formal Moral Instruction to be Given in Public Schools
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De Garmo, Charles
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- 1908
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15. Progress in Approved Courses for Student Dietitians1
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BRYAN, MARY DE GARMO
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- 1933
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16. A FEW POINTS ON THE MANAGEMENT OF STRANGULATED HERNIA.
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DE GARMO, W. B.
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The death rate from strangulated hernia throughout the land, has not diminished as it should have done in the face of modern surgery. Notwithstanding the mass of literature that has been devoted to this subject, and the fact that its importance has been fully recognized, from the earliest times to the present, strangulated hernia remains to-day as in years gone by, the dread of the average practitioner of medicine. Physicians who ordinarily act promptly and in the best interest of their patient, hesitate over strangulated hernia, trying first one thing, and then another, actually "frittering" away valuable time, and thereby sacrificing life.This hesitation, and fear, not doing the right thing at the right time, perhaps has its origin, first, in the dread of former years, of touching any thing relating to the peritoneal cavity, and second, to the manner in which most of us were taught the anatomy of more...
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- 1892
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17. Some Sources of Illustrative Health Material of Use to The Hospital Dietitian
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THOMPSON, MAY ELIZABETH and BRYAN, MARY DE GARMO
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- 1931
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18. Cranial dystonia: Double-blind crossover study of anticholinergics
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Nutt, J. G., primary, Hammerstad, J. P., additional, de Garmo, P., additional, and Carter, J., additional
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- 1984
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19. Cranial dystonia
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Nutt, John G., Hammerstad, John P., de Garmo, Pat, and Carter, Julie
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In patients with cranial dystonia, we compared the effects of central anticholinergic, peripheral anticholinergic, and placebo treatments in a double-blind crossover study. One of the nine patients who completed the study improved markedly with central anticholinergic therapy. The three treatments were indistinguishable in the other eight patients except for the higher incidence of central and peripheral anticholinergic side effects with trihexyphenidyl. more...
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- 1984
20. MONROE, PAUL. (Ed.) Cyclopedia of Education. Vol. IV. Pp. xiii, 740. Price, $5.00. New York: Macmillan Company, 1913
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De Garmo, Charles
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- 1913
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21. MONROE, PAUL (Ed.). A Cyclopedia of Education. Vol. III. Pp. xi, 682. Price, $5.00. New York: Macmillan Company, 1912
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De Garmo, Charles
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- 1913
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22. Herbart and Herbartlan
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De Garmo, Charles
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- 1895
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23. Herbart's A B C of Sense-Perception
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De Garmo, Charles
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- 1897
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24. ⁎⁎Invited to participate in the poster session of the asge meeting.4684 Why is ercp performed? results of a national consortium.
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Eisen, Glenn M., Vakil, Nimish B., de Garmo, Pat, Brodner, Rick, Johanson, John F., and Lieberman, David A.
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Purpose:The purpose of this study was to collect data regarding the utilization of ERCP among a broad spectrum of practice types and sites in order to determine the most prevalent indications for endoscopic retrograde cholangiopancreatography (ERCP) in the United States. Methods: A physician network of 32 practice sites comprising 23 states and 116 endoscopists entered endoscopic reports into the CORI (Clinical Outcomes Research Initiative) database from 6/30/97-9/30/99. Data was merged at a central databank. Results:2601 reports on 2291 unique patients had ERCP reports transmitted to the databank. 58% of patients were male and the mean age of patients was 55.7. 1700/2601 (65.4%) of ERCPs involved therapy. CORI indications for ERCP include symptoms, evaluation of known or suspected ampullary, biliary, pancreatic or liver diseases, peri-operative evaluation,and planned therapeutic intervention. Endoscopists may enter more than one indication. The most common indications for ERCP were: Conclusions: ERCP data can be collected among different practice types. These data can demonstrate current endoscopic practice patterns, whcih have not been previously evaluated. it appears that ERCP in the U.S. is primarily utilized to diagnose and treat biliary disorders. Other than for evaluation or therapy of pancreatitis, ERCP is not utilized frequently for pancreatic disease in this consortium. more...
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- 2000
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25. ⁎⁎Invited to participate in the poster session of the asge meeting.4577 Physician resource utilization for endoscopic ultrasound vs. ercp.
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Gopal, Deepak V., Faigel, Douglas O., and de Garmo, Patricia
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INTRODUCTION: EUS and ERCP each represent hybrids of endoscopy and radiology that require special expertise and equipment. Despite these similarities, reimbursement for EUS is less than for ERCP. HYPOTHESIS: Physician resource utilization for EUS and ERCP as determined by procedure length is similar. AIM: Compare EUS and ERCP procedure lengths from a large multicenter database. METHODS: We performed a retrospective review of the CORI (Clinical Outcomes Research Initiative) database of all EUS (recorded 2/4/98 - 6/30/99) and ERCPs (recorded 6/30/97 - 6/30/99). Data were analyzed as to demographics and procedure length (minutes) of upper EUS vs ERCP, with subset analysis of EUS with fine needle aspiration (FNA) vs. therapeutic ERCP (ERCP with at least one therapeutic procedure: sphincterotomy, stent placement/replacement, stone removal, dilation). Statistical analysis was performed using the JMP module of SAS software. P-values were calculated using Student's T-test. RESULTS: 1452 upper EUS exams (65% male & 35% female) and 2110 ERCPs (57% male & 43% female) were recorded during the periods specified. EUS was performed by 42 endoscopists (60% University based, 40% VA based) at 19 sites (50% University, 50% VA). ERCP was performed by 103 endoscopists (60% University based, 28% VA based, 12% private practice) at 28 sites (69% University, 23% VA, 8% private practice). The mean age of patients undergoing upper EUS vs. ERCP was 61.0±13.6 yrs vs. 55.3 ± 17.5 yrs (mean ± SD, p<0.0001). Data on procedure length was available in 1073(74%) of upper EUS cases vs. 1380(65%) of ERCPs. The mean procedure length of upper EUS vs. ERCP was only 2 1/2 minutes different: 39.8 ± 22.7 min vs. 42.3 ± 26.2 min (mean ± SD,p=0.01). When comparing EUS with FNA (n=318) to therapeutic ERCP (n=615), data on procedure length was available in 215(68%) and 379(62%) cases, respectively. The mean procedure length of EUS with FNA vs. therapeutic ERCP was 61.2 ± 23.3 min vs. 47.7 ± 28.2 min (mean ± SD,p<0.0001). CONCLUSIONS:(1) Resource utilization as reflected in the average procedure length is similar for EUS and ERCP. (2)The average procedure length of EUS with FNA is substantially longer than therapeutic ERCP. (3) Given the complexity of both procedures, procedure lengths, need for additional specialized training, and demands on technical/nursing support, these data favor at least equal financial reimbursement for EUS procedures. more...
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- 2000
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26. ⁎⁎⁎⁎⁎⁎Selected for presentation at the asge plenary session.4464 Can the asa grade predict the risk of endoscopic complications?
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Eisen, . Glenn M., de Garmo, Pat, Brodner, Rick, and Lieberman, David A.
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Background:The American Society of Anesthesiologists (ASA) grade has been used for over 50 years as a predictor of risk for perioperative morbidity and mortality. This measure has been incorporated into the CORI endoscopic database as a potential stratification tool for adverse outcomes related to endoscopy. There are 5 designated levels, ranging from Class Ihealthy patient without comorbidities, to Class V-moribund paient with little chance of survival. Purpose: To utilize a national endoscopic database (CORI) to asses the predicitve ability of the ASA grade for endoscopic complications. Methods:A physician network of 116 endoscopists at 32 sites entered data from 6/30/97-9/30/99. 141,572 endoscopic exams were performed on 104,311 unique patients. EGD, colonoscopy, ERCP and FS exams were used for this study. The ASA grade was entered in 81% of cases. Multivariate analysis, controlling for age and gender was performed to assess the association of ASA grade and risk for complications. This analysis was performed separately for total complications and bleeding and/or perforation. ASA grade V was not analyzed due to the low number of cases (50). Conclusions: The ASA grade strongly predicts the risk of overall complications and the subset with bleeding and/or perforation secondary to endoscopy. The risk of complications for grade IV patients appears 4-8X greater than grade I patients. The ASA grade may be used to stratify the risk of endoscopic complications and as an adjustment tool for patient case-mix. more...
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- 2000
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27. ⁎⁎Invited to participate in the Poster Session of the ASGE meeting.3379 Do endoscopists utilize and understand the asa grade?
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Eisen, Glenn M., de Garmo, Pat, Brodner, Rick, and Lieberman, David A.
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Background: The American Society of Anesthesiologists (ASA) grade has been used for over 50 years as a risk predictor of peri-operative morbidity and mortality. This measure may also be a predictor of endoscopy related complications, but has not yet been validated. The CORI endoscopic database has included the ASA grade as a query for endoscopic practitioners. There are 5 designated levels, from Class I-healthy patient without comorbidity to Class V- moribund patient with little chance of survival. Little is currently known about endoscopists' understanding and use of this classification system. Purpose:to assess the comprehension and utilization of the ASA grade among a large, heterogeneous group of endoscopists. Methods: All CORI sites were surveyed regardignt their use of the ASA classification and were asked to grade 5 hypothetical patients. Demographic information concerning practice type, training and years since feloowship were collectd for all responding endoscopists. Results: 41 sites and 124 providers responded to the survey. 87% were gastroenterologists, 51% at non-academic sites. 84% stated that they used the ASA classification all or most of the time. 12% utilized the CORI help feature to explain ASA classification. Overall correct grading for the hypothetical patients was 69%. This ranged from 49-98% for the 5 cases. 95% of the responses were within 1 grade of the correct response. Endoscopists using CORI for >12 months were more likely (p<.05) to correctly grade ASA classification. There were no significant differences between academic and non-academic affiliated endoscopists. There were also no signficant differences in grading for training (GI vs. surgery) or years since fellowship. Conclusions: 1. Endoscopists using CORI generally use and understand the ASA classification system. 2.The majority correctly classified hypothetical patients. 3. Once validated, this grade may be used as a tool for risk stratification in endoscopy. more...
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- 2000
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28. The Council of Sheep*: (A Fable)
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De Garmo, Charles
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- 1915
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29. The Point of View
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De Garmo, Charles
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- 1898
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30. The Voluntary Element in Education
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De Garmo, Charles
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- 1903
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31. PROGRESSIVE FRIENDS.
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CHANDLER, THOS., MOTT, ISAAC G., DE GARMO, EMELINE, MERRITT, PHEBE H., WALTON, JR., JACOB, FULLER, LUCINDA, LAPHAM, ABIGAIL, and MOORE, SAM'L D.
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- 1855
32. Association of older age and female sex with inadequate reach of screening flexible sigmoidoscopy.
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Walter LC, de Garmo P, and Covinsky KE
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- Age Factors, Aged, Aged, 80 and over, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Sex Factors, Sigmoidoscopy
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Purpose: Estimates of the sensitivity of screening sigmoidoscopy assume an adequate depth of insertion is reached. However, in clinical practice, the frequency that sigmoidoscopy reaches various lengths of the colon is not known. We assessed the frequency of inadequate reach (depth of <50 cm of the colon) in a large U.S. cohort, according to age and sex., Methods: We performed a cross-sectional study of 15,406 asymptomatic persons aged 50 years or older who underwent screening flexible sigmoidoscopy between April 1997 and October 2001 at sites participating in the Clinical Outcomes Research Initiative, which examines outcomes of endoscopy in "real life" settings. The maximum depth of insertion of the sigmoidoscope was measured in centimeters from the anus and classified as adequate (> or =50 cm) or inadequate (< 50 cm). Patient characteristics as well as procedure-related variables were also recorded., Results: Eighteen percent (n = 2801) of subjects had an inadequate examination. In men, the percentage of inadequate examinations increased progressively with age, from 10% (343/3338) in those aged 50 to 59 years to 22% (53/248) in those aged 80 years or older (P <0.001). Inadequate examinations were more common in women at all ages, ranging from 19% (733/3798) in those aged 50 to 59 years to 32% (86/267) in those aged 80 years or older (P <0.001). These associations were confirmed in a multivariable analysis., Conclusion: Our finding that advancing age and female sex were independently associated with the risk of inadequate reach of screening sigmoidoscopy suggests that the sensitivity of sigmoidoscopy may be lower in these populations. Estimates of the benefits of sigmoidoscopy may need to be tailored to the age and sex of the patient. more...
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- 2004
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33. Gender differences in colorectal polyps and tumors.
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McCashland TM, Brand R, Lyden E, and de Garmo P
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- Adenocarcinoma pathology, Age Distribution, Aged, Colonic Polyps pathology, Colonoscopy, Colorectal Neoplasms pathology, Female, Humans, Intestinal Polyps pathology, Male, Middle Aged, Prevalence, Rectal Diseases pathology, Risk Factors, Sex Distribution, United States, Adenocarcinoma epidemiology, Colonic Polyps epidemiology, Colorectal Neoplasms epidemiology, Intestinal Polyps epidemiology, Rectal Diseases epidemiology
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Objectives: To use a national endoscopy database (CORI) to determine 1) whether gender differences are noted in the prevalence and location of polyps and tumors; 2) whether women have a higher rate of right-sided polyps or tumors; and 3) whether age influences these results., Methods: CORI database from April 1, 1997 to February 19, 1999, captured in a computer-generated report, was analyzed. Polyps for this study were defined as sessile or pedunculated and as >9 mm. Tumors were defined as lesions characteristic of adenocarcinoma (mass, apple-core). Pure right-sided colon (PRS) was defined as cecum, ascending, hepatic flexure; right-sided as PRS plus the transverse colon; and left-sided as the splenic flexure, descending, sigmoid and rectum., Results: Men have a greater risk of polyps [odds ratio (OR), 1.5] and tumors (OR, 1.4) than women. The risk of finding polyps and tumors at colonoscopy increases with age, with the highest risk noted in those >69 yr of age relative to patients <50 yr of age (polyps, OR = 2.7; tumors, OR = 4.0). Right-side polyps and pure right-sided polyps as defined by the study design were noted to be more frequent than left-sided polyps in patients >60 yr of age. Women have a greater risk of developing pure right-sided polyps (OR, 1.2), tumors (OR, 1.6) and right-sided tumors (OR, 1.5) than men., Conclusions: Men have a higher prevalence of colon polyps and tumors than women. A progressive risk of polyp or tumor formation is noted with aging. Women had a greater number of pure right-sided polyps and tumor development. Colonoscopy is needed to correctly diagnose an increasing prevalence of right-sided pathology in the elderly. more...
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- 2001
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34. Role of leukocyte adhesion in clinical stroke.
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Clark WM, Coull BM, Corliss L, Bearner N, Austin T, de Garmo P, and Briley DP
- Abstract
Activated neutrophils appear to be directly involved in potentiating central nervous system ischemic injury. After initial endothelial adherence, neutrophils can produce capillary plugging with subsequent parenchymal infiltration and resulting cytotoxic neuronal injury. We used an in vitro leukocyte adherence assay to determine if adhesion is increased in acute stroke (within 72 h) or in patients at high risk for stroke (two or more risk factors) compared to matched controls. Neutrophils were isolated using density gradient centrifugation, and adherence to laminin or fibronectin was determined using a myeloperoxidase assay. The adhesion to laminin was significantly higher (p < 0.05) in the stroke group (23.6 ± 4.3; n = 14) compared to controls (9.7 ± 2.3; n = 12), with the risk group being intermediate (16.3 ± 4.3; n = 14). Total WBC counts were significantly higher in the stroke 8.0 ± 0.72 and risk 7.8 ± 0.41 groups (p < 0.05), compared to controls 5.3 ± 0.27. These data indicate that neutrophil adherence is increased in acute stroke and suggests that the total number of potentially adherent cells (total neutrophils times percent adherent cells) is greatly increased., (Copyright © 1992 National Stroke Association. Published by Elsevier Inc. All rights reserved.) more...
- Published
- 1992
- Full Text
- View/download PDF
35. Organic solvent-induced encephalopathy in industrial painters.
- Author
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Linz DH, de Garmo PL, Morton WE, Wiens AN, Coull BM, and Maricle RA
- Subjects
- Adult, Cognition drug effects, Female, Humans, Male, Memory drug effects, Middle Aged, Motor Skills drug effects, Nervous System Diseases diagnosis, Neuropsychological Tests, Occupational Diseases diagnosis, Personality drug effects, Time Factors, Wechsler Scales, Nervous System Diseases chemically induced, Occupational Diseases chemically induced, Paint poisoning, Solvents poisoning
- Abstract
Although organic solvents are essential components of an industrial economy, they are not used without risk. The relationship between excessive exposure to organic solvents and subsequent development of chronic encephalopathy has been recognized for nearly 100 years. Fifteen industrial painters who underwent evaluation in an occupational health clinic for symptoms that they related to their work were found to have a high prevalence of neurasthenic symptoms, most frequently, memory loss and personality change. Although neurologic and screening laboratory examinations showed no consistent abnormalities, psychological tests documented poor short-term memory and an array of neuropsychologic deficits. Personality profiles revealed depression, anxiety, and preoccupation with somatic concerns. These findings agree well with previous reports of "chronic painter's syndrome." Heightened awareness among industrial physicians and prospective studies to evaluate existing threshold limit values and personal protective equipment requirements are indicated. more...
- Published
- 1986
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