29,036 research outputs found
Effects of COVID-19 Pandemic and Post-Vaccination Period on Gastroenterology Practice in Turkey
No full textThe sudden and intense burden due to the novel coronavirus (coronavirus disease 2019) pandemic has changed the priority of many health services. The highly contagious new variants and vaccination services have greatly impacted the daily practice of gastroenterologists. In the present study, we tried to evaluate the change in the daily practice of Turkish gastroenterologists in the coronavirus disease 2019 pandemic and the post-vaccination periods.A questionnaire was prepared using Google forms and sent online to 214 gastroenterologists registered with the Turkish Gastroenterology Association.Approximately half of the gastroenterologists moved their endoscopy unit or gastroenterology clinic to another location in the hospital during the pandemic and about one-third of the endoscopy units were completely closed. About 56% of the respondents reported the interruption of endoscopic procedures and inpatient services. In total, 85% of gastroenterologists thought that follow-up and treatment of chronic patients were disrupted due to patients obtaining their medicine directly from pharmacies. After the first case in Turkey, 74% of gastroenterologists worked in coronavirus disease 2019 patient care services, 28% of gastroenterologists were infected with coronavirus disease 2019, and 3% believed they had a cross-infected patient(s). A total of 78% of gastroenterologists reported that patient management became difficult due to the change in the priority of other departments, and 60% of gastroenterologists confirmed that they experienced a decrease in income. In the post-vaccination period, 70% of gastroenterologists returned to their pre-pandemic working schedule and 31% noticed an increase in endoscopic cancer detection.Prolongation of the pandemic has seriously damaged the practice of gastroenterology and multidisciplinary patient management
What is the role of diagnostic laparoscopy in a gastroenterology unit?
No full textBACKGROUND:
Diagnostic laparoscopy is known to be a relatively safe invasive procedure. However, its use has decreased owing to the development of imaging techniques, and fewer gastroenterologists now practice diagnostic laparoscopy. Our aim was to examine the role of diagnostic laparoscopy in a gastroenterology unit in the era of advanced imaging techniques.
METHODS:
We retrospectively reviewed 855 diagnostic laparoscopy cases. Its safety and efficacy were evaluated for various indications.
RESULTS:
No mortality was observed, and complications were noted in ten patients (1.2%). Among the indications were evaluation of chronic liver disease (n = 673), liver tumor (n = 15), ascites of unknown origin and peritoneal disease (n = 142), and staging of intra-abdominal malignancy (n = 25). In patients with chronic liver disease, 461 were diagnosed as having chronic viral hepatitis, based on clinical data including imaging studies, but the diagnosis was changed to cirrhosis after a laparoscopic exam in 69 patients (15.0%). In patients with ascites of unknown origin and peritoneal disease, the diagnostic yield was 87.2% (123/141). In 24 (19.5%) of the 123 patients, the diagnosis changed or the less probable diagnosis was confirmed after laparoscopic examination. The confirmed diagnoses were mainly primary peritoneal disease, including peritoneal tuberculosis, in 17 patients, peritoneal metastatic carcinoma in five, and mesothelioma in two.
CONCLUSIONS:
Diagnostic laparoscopy in a gastroenterology unit is safe and useful, especially for confirmation of liver cirrhosis and primary peritoneal disease evaluation.ope
Inflammatory Bowel Disease-Experience of a pediatric gastroenterology unit
No full textInflammatory bowel disease, especially Crohn disease, had increased in the last five decades. We analyzed all the patients of our unit diagnosed with the disease between 2001-2012 but we just considered the patients who respected the Porto criteria to define IBD at presentation. We diagnosed 51 children and adolescents with the disease. Crohn disease was responsible for 62.7% of cases, ulcerative colitis for 31.4% and indeterminate colitis for 5.9%. Considering the 4 different periods of time (2001-2003/2004-2006/2007-2009 and 2010-2012), we observed and increase in the number of cases, but a decrease in the time from onset of symptoms to diagnosis.
Our medical approach with tumor necrosis factor antagonists was reserved for severe disease cases and to spare patients from adverse effects of purine analogues and corticosteroids. Mucosal healing and remission of the disease was achieved in all of the patients under biologic therapy and no serious or life-threating event was reported with their use
Gastroenterology in developing countries: issues and advances.
No full textDeveloping countries shoulder a considerable burden of gastroenterological disease. Infectious diseases in particular cause enormous morbidity and mortality. Diseases which afflict both western and developing countries are often seen in more florid forms in poorer countries. Innovative techniques continuously improve and update gastroenterological practice. However, advances in diagnosis and treatment which are commonplace in the West, have yet to reach many developing countries. Clinical guidelines, based on these advances and collated in resource-rich environments, lose their relevance outside these settings. In this two-part review, we first highlight the global burden of gastroenterological disease in three major areas: diarrhoeal diseases, hepatitis B, and Helicobacter pylori. Recent progress in their management is explored, with consideration of future solutions. The second part of the review focuses on the delivery of clinical services in developing countries. Inadequate numbers of healthcare workers hamper efforts to combat gastroenterological disease. Reasons for this shortage are examined, along with possibilities for increased specialist training. Endoscopy services, the mainstay of gastroenterology in the West, are in their infancy in many developing countries. The challenges faced by those setting up a service are illustrated by the example of a Nigerian endoscopy unit. Finally, we highlight the limited scope of many clinical guidelines produced in western countries. Guidelines which take account of resource limitations in the form of "cascades" are advocated in order to make these guidelines truly global. Recognition of the different working conditions facing practitioners worldwide is an important step towards narrowing the gap between gastroenterology in rich and poor countries
Prospective study of nosocomial transmission of hepatitis C in a Swedish gastroenterology unit
No full textA prospective study of incident hepatitis C in 515 gastroenterology patients was conducted by follow-up sampling at 3-6 months after admission to the gastroenterology unit to test for antibodies to hepatitis C virus and for hepatitis C virus RNA. Universal precautions were implemented, and the use of multidose vials had been banned in this unit. Despite 5,964 exposure-days for several risk factors associated with nosocomial hepatitis C virus transmission, no incident case of hepatitis C occurred
Prospective study of nosocomial transmission of hepatitis C in a Swedish gastroenterology unit .
No full textA prospective study of incident hepatitis C in 515 gastroenterology patients was conducted by follow-up sampling at 3-6 months after admission to the gastroenterology unit to test for antibodies to hepatitis C virus and for hepatitis C virus RNA. Universal precautions were implemented, and the use of multidose vials had been banned in this unit. Despite 5,964 exposure-days for several risk factors associated with nosocomial hepatitis C virus transmission, no incident case of hepatitis C occurred
Nursing Workload At A Gastroenterology Unit.
No full textOne of the biggest challenges nurses face is the need to justify the quantity and quality of staff for care delivery. For this, management instruments are available which help them to determine the staff needed in the nursing team. This descriptive study aims to evaluate the nursing workload at a specialized clinical and surgical gastroenterology unit. To collect data, the Nursing Activities Score (NAS) was used during 30 consecutive days, with 1080 comments, obtained from the records of 149 patients. The mean NAS score was 34.9% and, considering that each point of NAS corresponds to 0.24 hour, on the average, 8.4 hours of nursing care were required within 24 hours. This means that this profile is of patients who demand intermediate and semi-intensive care, which suggests that the NAS study can be used to evaluate the workload of nurses at that unit.171009-1
Range Unit Root (RUR) Tests: Robust against Nonlinearities, Error Distributions, Structural Breaks and Outliers
No full textSince the seminal paper by Dickey and Fuller in 1979, unit-root tests have conditioned the standard approaches to analysing time series with strong serial dependence in mean behaviour, the focus being placed on the detection of eventual unit roots in an autoregressive model fitted to the series. In this paper, we propose a completely different method to test for the type of long-wave patterns observed not only in unit-root time series but also in series following more complex data-generating mechanisms. To this end, our testing device analyses the unit-root persistence exhibited by the data while imposing very few constraints on the generating mechanism. We call our device the range unit-root (RUR) test since it is constructed from the running ranges of the series from which we derive its limit distribution. These nonparametric statistics endow the test with a number of desirable properties, the invariance to monotonic transformations of the series and the robustness to the presence of important parameter shifts. Moreover, the RUR test outperforms the power of standard unit-root tests on near-unit-root stationary time series; it is invariant with respect to the innovations distribution and asymptotically immune to noise. An extension of the RUR test, called the forward?backward range unit-root (FB-RUR) improves the check in the presence of additive outliers. Finally, we illustrate the performances of both range tests and their discrepancies with the Dickey?Fuller unit-root test on exchange rate series.Publicad
Challenging endoscopy reprocessing guidelines: a prospective study investigating the safe shelf life of flexible endoscopes in a tertiary gastroenterology unit
No full textBackground and study aims: Professional practice guidelines for endoscope reprocessing recommend reprocessing endoscopes between each case and proper storage following reprocessing after the last case of the list. There is limited empirical evidence to support the efficacy of endoscope reprocessing prior to use in the first case of the day; however, internationally, many guidelines continue to recommend this practice. The aim of this study is to estimate a safe shelf life for flexible endoscopes in a high-turnover gastroenterology unit. Materials and methods: In a prospective observational study, all flexible endoscopes in active service during the 3-week study period were microbiologically sampled prior to reprocessing before the first case of the day (n = 200). The main outcome variables were culture status, organism cultured, and shelf life. Results: Among the total number of useable samples (n = 194), the overall contamination rate was 15.5 %, with a pathogenic contamination rate of 0.5%. Mean time between last case one day and reprocessing before the first case on the next day (that is, shelf life) was 37.62 h (SD 36.47). Median shelf life was 18.8 h (range 5.27 -165.35 h). The most frequently identified organism was coagulase-negative Staphylococcus, an environmental nonpathogenic organism. Conclusions: When processed according to established guidelines, flexible endoscopes remain free from pathogenic organisms between last case and next day first case use. Significant reductions in the expenditure of time and resources on reprocessing endoscopes have the potential to reduce the restraints experienced by high-turnover endoscopy units and improve service delivery
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