The American journal of gastroenterology
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Am. J. Gastroenterol. · Mar 2004
Randomized Controlled Trial Comparative Study Clinical TrialPatient-controlled versus nurse-administered sedation with propofol during colonoscopy. A prospective randomized trial.
Patient-controlled sedation (PCS) with propofol, is well tolerated and reduces recovery time and staff required during endoscopic interventions. "Who" administers the drug proves economically crucial. With the aim of maintaining safety, medical quality, and patient satisfaction, this study investigates PCS versus nurse-administered propofol sedation (NAPS) in a cohort of consecutive patients. ⋯ Individual patient characteristics and attitudes toward self-control are crucial for PCS. While being a viable option for patients who are able and willing to handle, this technique is not applicable in a considerable portion of everyday patients.
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Am. J. Gastroenterol. · Feb 2004
Malpractice, tort reform, and you: an introduction to risk management.
The current malpractice crisis has been called the "perfect storm". Doctors are finding practice costs unsustainable. Patients are finding access to care jeopardized. ⋯ Reforms will likely be slow. Thus the practicing gastroenterologist, while working for or supporting efforts toward a solution, is well advised to keep up to date with the practice of gastroenterology, but also understand the medical legal matters and have a risk management strategy that will hopefully help keep the malpractice crisis a theoretical rather than personal concern. The following articles in this series are intended to help.
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Am. J. Gastroenterol. · Feb 2004
Comparative StudyFactors influencing the development of Barrett's epithelium in the esophageal remnant postesophagectomy.
Barrett's esophagus results from chronic reflux of both acid and bile. Reflux of gastric and duodenal contents is facilitated through the denervated stomach following esophagectomy, but the development of Barrett's changes in this model and the relationship to gastric and esophageal physiology is poorly understood. ⋯ The development of Barrett's epithelium is frequent after esophagectomy, is time-related, reflecting chronic acid and bile exposure, and is not specific for adenocarcinoma or the presence of previous Barrett's epithelium. This model may represent a useful in vivo model of the pathogenesis of Barrett's metaplasia and tumorigenesis.
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Am. J. Gastroenterol. · Jan 2004
Meta AnalysisTiming of cholecystectomy for acute calculous cholecystitis: a meta-analysis.
To compare early with delayed cholecystectomy for the treatment of acute lithiasic cholecystitis: a meta-analysis of prospective randomized trials. ⋯ Early operation (open or laparoscopic) does not carry a higher risk of mortality and morbidity compared to delayed operation and should be the preferred surgical approach for patients with acute lithiasic cholecystitis.
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Am. J. Gastroenterol. · Jan 2004
Randomized Controlled Trial Clinical TrialTechnical performance of colonoscopy in patients sedated with nurse-administered propofol.
Nurse-administered propofol has gained attention as a safe and effective means of sedation for patients undergoing endoscopic procedures. However, little is known about the effect of propofol on the technical performance of colonoscopy. ⋯ Nurse-administered propofol sedation is safe and simplifies the technical performance of colonoscopy compared to midazolam/narcotic sedation.