The American journal of gastroenterology
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Am. J. Gastroenterol. · Jun 2004
Historical ArticleComplete elimination of reflux symptoms does not guarantee normalization of intraesophageal and intragastric pH in patients with gastroesophageal reflux disease (GERD).
Acid plays a significant role in the development of gastroesophageal reflux symptoms, such as heartburn and regurgitation. It is generally assumed that acid suppressive therapy improves or eliminates symptoms by normalizing intraesophageal pH. ⋯ Fifty percent of patients with GERD without BE continue to exhibit pathologic GERD and low intragastric pH despite PPI therapy that achieves complete reflux symptom control.
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Am. J. Gastroenterol. · Jun 2004
Review Comparative StudyInformed consent: not just for procedures anymore.
The ethical and legal requirement to obtain informed consent prior to performing a procedure or administering a treatment derives from the concept of personal (patient) autonomy. The competent patient, after receiving appropriate disclosure of the material risks of the procedure or treatment, understanding those risks, the benefits, and the alternative approaches, makes a voluntary and uncoerced informed decision to proceed. ⋯ The benefits of informed decision making as a communication and risk management tool are presented. This review is intended as general information, and not as legal advice, which should be sought from a health-care attorney.
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Am. J. Gastroenterol. · Jun 2004
Comparative StudyAn initial investigation of bispectral monitoring as an adjunct to nurse-administered propofol sedation for colonoscopy.
Bispectral (BIS) monitoring has been used to evaluate depth of sedation in intensive care and surgical patients. We sought to explore its utility as a monitoring device for nurse-administered propofol sedation (NAPS) during colonoscopy. ⋯ The BIS index in its current version is not useful in titrating boluses of propofol to an adequate level of sedation, because there is a substantial lag time between decrease of BIS scores to <70 and OAA/S scores indicative of deep sedation. There is also a substantial lag time between recovery of alertness and return of BIS scores to normal. A controlled trial of whether BIS values can assist in avoiding unnecessary propofol dosing during the maintenance phase of sedation appears warranted.