The American journal of gastroenterology
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Am. J. Gastroenterol. · Apr 2014
Comparative StudyThe Royal Free Hospital score: a calibrated prognostic model for patients with cirrhosis admitted to intensive care unit. Comparison with current models and CLIF-SOFA score.
Prognosis for patients with cirrhosis admitted to intensive care unit (ICU) is poor. ICU prognostic models are more accurate than liver-specific models. We identified predictors of mortality, developed a novel prognostic score (Royal Free Hospital (RFH) score), and tested it against established prognostic models and the yet unvalidated Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA) model. ⋯ RFH score demonstrated good discriminative ability and calibration. Internal validation supports its generalizability. CLIF-SOFA did not perform better than RFH and the original SOFA. External validation of our model should be undertaken to confirm its clinical utility.
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Am. J. Gastroenterol. · Apr 2014
J. Edward Berk distinguished lecture: avoiding burnout: finding balance between work and everything else.
Burnout has been defined as "a state of mental exhaustion caused by one's professional life." Increasing evidence shows high rates of burnout among medical professionals, including gastroenterologists. Factors that contribute to burnout include work-home conflict and longer work hours. Among gastroenterologists, the risk for burnout seems to be highest during the first three years on the job after fellowship. Strategies to treat and prevent burnout include identifying and balancing personal and professional goals, shaping one's career to optimize meaning, identifying stressors, and nurturing wellness strategies.
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Am. J. Gastroenterol. · Mar 2014
Observational StudyA combined paging alert and web-based instrument alters clinician behavior and shortens hospital length of stay in acute pancreatitis.
There are many published clinical guidelines for acute pancreatitis (AP). Implementation of these recommendations is variable. We hypothesized that a clinical decision support (CDS) tool would change clinician behavior and shorten hospital length of stay (LOS). ⋯ The TAPER-CDS-Tool is associated with changed clinician behavior and shortened hospital LOS, which has significant financial implications.
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Am. J. Gastroenterol. · Feb 2014
Comparative StudyThe impact of physical complaints, social environment, and psychological functioning on IBS patients' health perceptions: looking beyond GI symptom severity.
In the absence of a reliable biomarker, clinical decisions for a functional gastrointestinal (GI) disorder like irritable bowel syndrome (IBS) depend on asking patients to appraise and communicate their health status. Self-ratings of health (SRH) have proven a powerful and consistent predictor of health outcomes, but little is known about how they relate to those relevant to IBS (e.g., quality of life (QOL), IBS symptom severity). This study examined what psychosocial factors, if any, predict SRH among a cohort of more severe IBS patients. ⋯ SRH are associated with psychological (anxiety, stress, depression), social (negative interactions), and extraintestinal somatic factors (fatigue, somatization, medical comorbidities). The severity of IBS symptoms appears to have a relatively modest role in how IBS patients describe their health in general.
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Am. J. Gastroenterol. · Feb 2014
Comparative StudyDiagnosis of liver cirrhosis in England, a cohort study, 1998-2009: a comparison with cancer.
There is no routine registration of the occurrence of newly diagnosed cases of cirrhosis in the United Kingdom. This study seeks to determine precise estimates and trends of the incidence of cirrhosis in England, and directly compare these figures with those for the 20 most commonly diagnosed cancers in the United Kingdom. ⋯ The occurrence of cirrhosis increased more than that of the top four cancers during 1998 to 2009 in England. Strategies to monitor and reduce the incidence of this disease are urgently needed.