To determine the clinical characteristics of children with gastrointestinal bleeding (GIB) who died during the course of their admission.METHODSWe interrogated the Pediatric Hospital Information System database, inclu...To determine the clinical characteristics of children with gastrointestinal bleeding (GIB) who died during the course of their admission.METHODSWe interrogated the Pediatric Hospital Information System database, including International Classification of Diseases, Current Procedural Terminology and Clinical Transaction Classification coding from 47 pediatric tertiary centers extracting the population of patients (1-21 years of age) admitted (inpatient or observation) with acute, upper or indeterminate GIB (1/2007-9/2015). Descriptive statistics, unadjusted univariate and adjusted multivariate analysis of the associations between patient characteristics and treatment course with mortality was performed with mortality as primary and endoscopy a secondary outcome of interest. All analyses were performed using the R statistical package, v.3.2.3.RESULTSThe population with GIB was 19528; 54.6% were male, overall mortality was 2.07%; (0.37% in patients with the principal diagnosis of GIB). When considering only the mortalities in which GIB was the principal diagnosis, 48% (12 of 25 principal diagnosis GIB mortalities) died within the first 3 d of admission, whereas 19.8% of secondary diagnosis GIB patients died with 3 d of admission. Patients who died were more likely to have received octreotide (19.8% c.f. 4.04%) but tended to have not received proton pump inhibitor therapy in the first 48 h, and far less likely to have undergone endoscopy during their admission (OR = 0.489, P < 0.0001). Chronic liver disease associated with a greater likelihood of endoscopy. Mortalities were significantly more likely to have multiple complex chronic conditions.CONCLUSIONGIB associated mortality in children is highest within 7 d of admission. Multiple comorbidities are a risk factor whereas early endoscopy during the admission is protective.展开更多
Given the overwhelming evidence that both alcoho consumption and smoking accelerate the progression of hepatitis C virus(HCV)-induced liver disease we evaluated the frequency of alcohol and smoking counseling of patie...Given the overwhelming evidence that both alcoho consumption and smoking accelerate the progression of hepatitis C virus(HCV)-induced liver disease we evaluated the frequency of alcohol and smoking counseling of patients with HCV-induced liver disease by their primary care internists and gastroenterologists.One hundred and twenty-three medical records of consecutive patients with HCV-induced liver disease referred by an internist to a gastroenterologist for its management were reviewed.Patient gender,race,history of and counseling against alcohol and tobacco use by a physician and a gastroenterologist were obtained A database was created using Microsoft Excel.There were 105 African-Americans,12 Caucasians and six patients of other races/ethnicities.Forty-six(37%)pa- tients were daily tobacco users and 34(28%)patients were daily alcohol consumers.There was a statistically significant difference in the frequencies of alcohol(P= 0.0002)and smoking cessation(P=0.0022)between gastroenterologists and internists.This study reveals that internists and gastroenterologists,alike,inadequately counsel patients with hepatitis C about tobacco and alcohol use.展开更多
Background:There is little information describing the perceptions of gastroenterology fellows and attending gastroenterologists of what constitutes effective teaching of endoscopy.We sought to identify common themes r...Background:There is little information describing the perceptions of gastroenterology fellows and attending gastroenterologists of what constitutes effective teaching of endoscopy.We sought to identify common themes regarding endoscopy training methods and their impact among fellows and attendings.Methods:Focus group exercises and surveys were conducted among fellows,about educational resources,teaching techniques and ways of improving the teaching of endoscopy.The fellows identified the‘best’teachers of endoscopy,who were interviewed regarding their training in endoscopy,their teaching methods,key points of information,and opinions on endoscopy curriculum.Results:Nineteen fellows(68%)had attended the American Society for Gastrointestinal Endoscopy First Year Fellows’Endoscopy course and found it very helpful.Thirteen fellows(46%)had exposure to an endoscopy simulator,but their median duration of use was only 1 hour.Only two out of five fellowship programs used a formal endoscopic skill assessment tool and none of the programs had an endoscopy curriculum of which the fellows were aware.Fellows reported that they learned endoscopy best by performing procedures.They also volunteered that attending gastroenterologists used variable teaching methods,and might benefit from instruction on how to teach endoscopy.Ten attending gastroenterologists(77%)had received training in advanced procedures;none received formal training on teaching endoscopy:they all felt that such training would be beneficial.Conclusions:A standardized endoscopy curriculum may be beneficial to fellows,who prefer to learn endoscopy by performing procedures—but they want explicit and specific instruction.Both those attending and the fellows thought that formal instruction for attending gastroenterologists on how to teach endoscopy would be beneficial,indicating a role for a‘teachthe-teacher’curriculum.展开更多
文摘To determine the clinical characteristics of children with gastrointestinal bleeding (GIB) who died during the course of their admission.METHODSWe interrogated the Pediatric Hospital Information System database, including International Classification of Diseases, Current Procedural Terminology and Clinical Transaction Classification coding from 47 pediatric tertiary centers extracting the population of patients (1-21 years of age) admitted (inpatient or observation) with acute, upper or indeterminate GIB (1/2007-9/2015). Descriptive statistics, unadjusted univariate and adjusted multivariate analysis of the associations between patient characteristics and treatment course with mortality was performed with mortality as primary and endoscopy a secondary outcome of interest. All analyses were performed using the R statistical package, v.3.2.3.RESULTSThe population with GIB was 19528; 54.6% were male, overall mortality was 2.07%; (0.37% in patients with the principal diagnosis of GIB). When considering only the mortalities in which GIB was the principal diagnosis, 48% (12 of 25 principal diagnosis GIB mortalities) died within the first 3 d of admission, whereas 19.8% of secondary diagnosis GIB patients died with 3 d of admission. Patients who died were more likely to have received octreotide (19.8% c.f. 4.04%) but tended to have not received proton pump inhibitor therapy in the first 48 h, and far less likely to have undergone endoscopy during their admission (OR = 0.489, P < 0.0001). Chronic liver disease associated with a greater likelihood of endoscopy. Mortalities were significantly more likely to have multiple complex chronic conditions.CONCLUSIONGIB associated mortality in children is highest within 7 d of admission. Multiple comorbidities are a risk factor whereas early endoscopy during the admission is protective.
文摘Given the overwhelming evidence that both alcoho consumption and smoking accelerate the progression of hepatitis C virus(HCV)-induced liver disease we evaluated the frequency of alcohol and smoking counseling of patients with HCV-induced liver disease by their primary care internists and gastroenterologists.One hundred and twenty-three medical records of consecutive patients with HCV-induced liver disease referred by an internist to a gastroenterologist for its management were reviewed.Patient gender,race,history of and counseling against alcohol and tobacco use by a physician and a gastroenterologist were obtained A database was created using Microsoft Excel.There were 105 African-Americans,12 Caucasians and six patients of other races/ethnicities.Forty-six(37%)pa- tients were daily tobacco users and 34(28%)patients were daily alcohol consumers.There was a statistically significant difference in the frequencies of alcohol(P= 0.0002)and smoking cessation(P=0.0022)between gastroenterologists and internists.This study reveals that internists and gastroenterologists,alike,inadequately counsel patients with hepatitis C about tobacco and alcohol use.
基金Dr.Robert C.Lowe acknowledges his faculty development grant fromthe Boston University Medical Center Department of Medicine for$1,000.
文摘Background:There is little information describing the perceptions of gastroenterology fellows and attending gastroenterologists of what constitutes effective teaching of endoscopy.We sought to identify common themes regarding endoscopy training methods and their impact among fellows and attendings.Methods:Focus group exercises and surveys were conducted among fellows,about educational resources,teaching techniques and ways of improving the teaching of endoscopy.The fellows identified the‘best’teachers of endoscopy,who were interviewed regarding their training in endoscopy,their teaching methods,key points of information,and opinions on endoscopy curriculum.Results:Nineteen fellows(68%)had attended the American Society for Gastrointestinal Endoscopy First Year Fellows’Endoscopy course and found it very helpful.Thirteen fellows(46%)had exposure to an endoscopy simulator,but their median duration of use was only 1 hour.Only two out of five fellowship programs used a formal endoscopic skill assessment tool and none of the programs had an endoscopy curriculum of which the fellows were aware.Fellows reported that they learned endoscopy best by performing procedures.They also volunteered that attending gastroenterologists used variable teaching methods,and might benefit from instruction on how to teach endoscopy.Ten attending gastroenterologists(77%)had received training in advanced procedures;none received formal training on teaching endoscopy:they all felt that such training would be beneficial.Conclusions:A standardized endoscopy curriculum may be beneficial to fellows,who prefer to learn endoscopy by performing procedures—but they want explicit and specific instruction.Both those attending and the fellows thought that formal instruction for attending gastroenterologists on how to teach endoscopy would be beneficial,indicating a role for a‘teachthe-teacher’curriculum.
