Gastrointestinal endoscopy clinics of North America
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Abdominal and pelvic abscesses have traditionally been drained by percutaneous techniques or surgery. While surgical drainage is associated with considerable morbidity and mortality, percutaneous techniques are associated with the need for multiple interventions, increased length of hospital stay, and an indwelling external catheter for prolonged periods. ⋯ Although data are limited, evidence supporting its clinical efficacy is increasing rapidly. This article summarizes the current status of EUS-guided approach for drainage of gastrointestinal abscess collections.
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Gastrointest. Endosc. Clin. N. Am. · Jan 2012
ReviewGastroenterologists and the triple aim: how to become accountable.
US medicine is fragmented and economically unsustainable and has vast opportunities for quality improvement. A current solution is to create large accountable care organizations. ⋯ The pay-off in improved patient care and financial stability can be substantial. This article discusses a proposed evolution toward clinical service line management that might be achieved by an independent single specialty practice.
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Gastrointest. Endosc. Clin. N. Am. · Jan 2012
ReviewMedical practice integration: going big in private practice.
Historically, gastroenterologists entered into solo, small group, or academic practices. The current economic environment and looming regulatory mandates have led to gastroenterologists integrating into large, single-specialty groups to acquire costly practice infrastructure, gain negotiating leverage with health plans, promote high-quality care, and benefit from professional practice management. ⋯ The decision to integrate into a large practice will also be affected by local practice patterns and regulatory issues. For these and other reasons, gastroenterologists are going big in private practice.
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Gastrointest. Endosc. Clin. N. Am. · Jan 2012
ReviewA letter to fellows: transitioning from training into practice in uncertain times.
The end of training marks the beginning of learning. Moving into practice is exciting, and there are good opportunities. ⋯ Each person has an ideal practice. Choose your new practice setting with your eyes wide open, especially regarding new changes that are expected with health care reform.
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Upper gastrointestinal (UGI) bleeding secondary to ulcer disease occurs commonly and results in significant patient morbidity and medical expense. After initial resuscitation, carefully performed endoscopy provides an accurate diagnosis of the source of the UGI hemorrhage and can reliably identify those high-risk subgroups that may benefit most from endoscopic hemostasis. Effective endoscopic hemostasis of ulcer bleeding can significantly improve outcomes by reducing rebleeding, transfusion requirement, and need for surgery, as well as reduce the cost of medical care. This article discusses the important aspects of the diagnosis and treatment of bleeding from ulcers, with a focus on endoscopic therapy.