The American journal of gastroenterology
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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.
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Am. J. Gastroenterol. · May 2004
Comparative StudyEarly postoperative complications are not increased in patients with Crohn's disease treated perioperatively with infliximab or immunosuppressive therapy.
The aim was to determine whether the use of steroids, immunosuppressive agents, or infliximab prior to abdominal surgery for Crohn's disease is associated with an increased rate of early postoperative complications. ⋯ Early complications after elective abdominal surgery for CD are not associated with steroid dose, immunosuppressive therapy, or infliximab use.
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Am. J. Gastroenterol. · Apr 2004
Surgical volume and long-term survival following surgery for colorectal cancer in the Veterans Affairs Health-Care System.
The objective of this study was to examine the relationship between hospital surgical volume and long-term survival in patients with a new diagnosis of colorectal cancer who underwent surgical resection during fiscal years 1991-2000 in the Veterans Affairs (VA) health-care system. ⋯ Greater hospital surgical volume is an independent predictor of prolonged long-term survival following surgery for both colon and rectal cancer in the VA health-care system. The volume-long-term mortality relationship is greater for rectal than for colon cancer patients, perhaps reflecting the fact that surgery for rectal cancer is more technically demanding. Future studies are needed to discover what aspects of clinical management explain these differences.
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Am. J. Gastroenterol. · Apr 2004
Utilization of health care resources by individuals with inflammatory bowel disease in the United States: a profile of time since diagnosis.
There are no cost studies of inflammatory bowel disease (IBD) that describe its impact on resource utilization or treatment costs over long periods of time. Our aim was to determine if there are observable trends in health-care resource utilization by adults with IBD depending on disease duration. ⋯ Specialist physicians are visited by IBD patients, and prescription medications are provided to treat IBD patients throughout their lives. This is a statistically significant trend that is viewed from onset of the disease to up to 62 yr with IBD. Our results also suggest, at least tentatively, that patients within the first 5 yr after the onset of the disease have a stronger tendency than the general population to visit an emergency room, to be hospitalized, and to have been both hospitalized and to have had surgery. If these results were borne out by further studies, then this would indicate that we can measure the greatest proportion of treatment effects on these resources within a relatively short period.