June 29th, 2011 by Mark Crislip, M.D. in Health Tips, Research
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At home the kids’ current TV show of choice is How I Met Your Mother, supplanting Scrubs as the veg out show in the evening. Both shows are always on a cable channel somewhere and are often broadcast late at night. Late night commercials can be curious, and as I work on projects, I watch the shows and commercials out of the corner of my eye.
Law firms trolling for business seem common. If you or a family member has had a serious stroke, heart attack or death from Avandia, call now. The non-serious deaths? I suppose do not bother. One ad in particular caught my eye: anyone who developed ulcerative colitis or Crohn’s disease (collectively referred to inflammatory bowel disease, or IBD) after using Accutane, call now. Millions have been awarded.
My eye may have been caught because of my new progressive lenses, but I will admit to an interest in inflammatory bowel disease, having had ulcerative colitis for years until I took the steel cure. It also piqued my interest as these were three conditions among which I could not seen any connections. Accutane, ulcerative colitis, and Crohn’s. One of these is not like the other. Read more »
*This blog post was originally published at Science-Based Medicine*
June 22nd, 2011 by M. Brian Fennerty, M.D. in Opinion
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I have observed extreme variation in how my colleagues manage GI foreign-body retrieval from the stomach. Some always use general anesthesia and endotracheal intubation; others (myself included) use conscious sedation. Some use an overtube to withdraw the object into if possible; others simply pull it up to the endoscope and use the endoscope to guide it through the esophagogastric junction and upper esophageal sphincter. The reasons for this variation are clearly related to the perceived risk of airway compromise or gastrointestinal wall injury during withdrawal of the object from the stomach.
So my questions to you are:
1) When do you ask for endotracheal intubation during foreign-body retrieval?
2) Do you use an overtube when removing foreign bodies from the stomach, and, if so, always or in what situations?
3) If you don’t use an overtube, what technique do you use during withdrawal of the object?
4) What is your favorite “tool” or endoscopic accessory to grab objects from the stomach?
I look forward to hearing your thoughts on this issue.
*This blog post was originally published at Gut Check on Gastroenterology*
June 12th, 2011 by DeborahSchwarzRPA in Expert Interviews
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Francine Johanna Castillo, MS
Administrative Director, The Pancreas Center
Administrator, Division of GI/Endocrine Surgery
NewYork-Presbyterian Hospital/Columbia University Medical Center
Patients usually seek treatment at centers such as NewYork-Presbyterian/Columbia because of the expert care they know they will receive from the hospital’s physicians and surgeons. Patients may be less aware that a vast network of dedicated, highly trained staff is quietly working behind the scenes, tending to every detail of their office visits, testing, procedures, and follow-up care. The contributions of such personnel in ensuring the quality of patients’ and families’ experiences at the hospital can not be overstated.
In this brief interview, we highlight one such person: Francine Castillo, MS, Administrative Director of the Pancreas Center. As John A. Chabot, MD, Executive Director of the Pancreas Center explains, Francine is “the heart and soul” of the Pancreas Center. She bears central responsibility for ensuring that all aspects of the center run well: financial operations, patient care, community outreach, and fund-raising events. In addition, she is the administrator of the Division of Endocrine Surgery/NY Thyroid Center. Francine’s commitment to providing patients and staff with the best services possible has earned her tremendous respect among both patients and colleagues, who rely heavily on her administrative expertise.
What are your responsibilities at the Pancreas Center? Read more »
*This blog post was originally published at Columbia University Department of Surgery Blog*
May 24th, 2011 by M. Brian Fennerty, M.D. in Health Tips
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I have noticed that we all think we are the best endoscopist around (in my case, that is indeed true!). However, we really never measured colonoscopy skill as a “patient-centered” metric and instead often use speed, efficiency, sedation needs, etc. when judging our colleagues. What is more important than these measures, however, is whether we find and remove adenomas, thereby preventing colon cancer downstream in our patients.
A number of surrogate markers for quality colonoscopy and polyp detection have been used in the past, including scope-withdrawal time from the cecum. But the one measure that has been the best predictor of quality is an endoscopist’s ADR (adenoma detection rate). In fact, this is the most reliable quality measure yet determined, and it may become the basis for being paid for these procedures in the not so distant future.
So I need to ask you:
1) Do you know your ADR?
2) Do you or does your group compare your ADR to other endoscopists within your endoscopy unit or practice?
3) Is there a program to increase ADR in low performers in your endoscopy unit?
4) Do you use your ADR as a marketing tool?
5) What is your take on the ADR as a quality measure?
I look forward to hearing from you on this topic!
*This blog post was originally published at Gut Check on Gastroenterology*
May 23rd, 2011 by Michael Kirsch, M.D. in True Stories
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Photo Credit
I barely escaped from an embarrassing situation recently in the hospital. I was consulted to place a feeding tube, called a PEG, in an ICU patient. We gastroenterologists are rarely consulted for our opinion on whether these tubes make sense, which they often don’t. We are recruited to these patients simply to perform the technical function of inserting the tubes, so that Granny, or Great-Granny, or Great-Great… , won’t starve. Multiple medical studies have demonstrated that providing this nutrition to individuals with advanced dementia doesn’t benefit them. In addition, while it may seem intuitive that artificial feeding provides comfort, this may not be the case. It may provide more comfort to the physicians and family than it does to the patient. Read more »
*This blog post was originally published at MD Whistleblower*
