The Experts below are selected from a list of 30198 Experts worldwide ranked by ideXlab platform
Adonis A. Protopapas - One of the best experts on this subject based on the ideXlab platform.
-
Endoscopic sedation practices of Greek Gastroenterologists: a nationwide survey.
Annals of gastroenterology, 2020Co-Authors: Georgios Neokosmidis, Evangelos Stournaras, Dimitrios Stogiannou, Athanasios Filippidis, Adonis A. ProtopapasAbstract:Background Sedation in gastrointestinal endoscopy is rapidly evolving worldwide. However, this has led to significant disagreements, especially regarding the use of propofol by non-anesthesiologists. The aim of this study was to document the practices of Greek Gastroenterologists regarding sedation and compare them to previous surveys. Methods The study was conducted in 2 periods, December 2015 and June 2018. In each period, the same online questionnaire regarding endoscopic sedation practices was sent to all registered Greek Gastroenterologists (509 and 547 Gastroenterologists, respectively). Results The response rates were 38.3% and 47.1%, respectively. In each period, 25.1% and 16.7% of physicians did not use sedation. Most Gastroenterologists (approx. 70% in both instances) answered that they "almost never" collaborate with an anesthesiologist during endoscopy. Midazolam was by far the most popular sedation agent, used by almost 90% of physicians in both periods. Propofol was used by 30.8% and 27% of physicians, respectively. Physicians using propofol were significantly more satisfied with the sedation than other physicians, while propofol was the agent selected by most physicians if they were to undergo endoscopy themselves. Most physicians cited medicolegal reasons and inadequate training as chief reasons for not using propofol. Conclusions Sedation use is widespread among Greek Gastroenterologists. Although midazolam is the most commonly used agent, propofol is preferred (theoretically) by most physicians and achieves the best satisfaction. The introduction of a strict training curriculum for endoscopic sedation can effectively eliminate the barriers preventing Gastroenterologists from administering propofol, while at the same time ensuring optimal patient safety during endoscopy.
Uma Mahadevan - One of the best experts on this subject based on the ideXlab platform.
-
transitioning the adolescent inflammatory bowel disease patient guidelines for the adult and pediatric Gastroenterologist
Inflammatory Bowel Diseases, 2011Co-Authors: Yvette Leung, Melvin B Heyman, Uma MahadevanAbstract:Twenty percent of inflammatory bowel disease (IBD) patients present in the pediatric years, with recent reports suggesting a rising incidence in the pediatric age group. This highlights the need for both pediatric and adult Gastroenterologists to better understand issues related to the process of transition from pediatric to adult care. Research from other disciplines outside of IBD provide evidence that the transition period can be associated with poorer health outcomes and that a structured transition program may improve patient compliance and disease control. Recent data from the IBD literature support a need for transition clinics. The ideal model of a transition program has not been established. Controlled trials are not available to measure the impact of a structured transition program on clinically relevant endpoints such as disease control and hospital admissions. As local resources and availability of staffing and funding are highly variable, we have summarized some practical guidelines for the adult and pediatric Gastroenterologist that can be used as an aid to help adolescents through the transition process even without the support of an established transition clinic. (Inflamm Bowel Dis 2010;)
-
transitioning the adolescent inflammatory bowel disease patient guidelines for the adult and pediatric Gastroenterologist
Inflammatory Bowel Diseases, 2011Co-Authors: Yvette Leung, Melvin B Heyman, Uma MahadevanAbstract:Twenty percent of inflammatory bowel disease (IBD) patients present in the pediatric years, with recent reports suggesting a rising incidence in the pediatric age group. This highlights the need for both pediatric and adult Gastroenterologists to better understand issues related to the process of transition from pediatric to adult care. Research from other disciplines outside of IBD provide evidence that the transition period can be associated with poorer health outcomes and that a structured transition program may improve patient compliance and disease control. Recent data from the IBD literature support a need for transition clinics. The ideal model of a transition program has not been established. Controlled trials are not available to measure the impact of a structured transition program on clinically relevant endpoints such as disease control and hospital admissions. As local resources and availability of staffing and funding are highly variable, we have summarized some practical guidelines for the adult and pediatric Gastroenterologist that can be used as an aid to help adolescents through the transition process even without the support of an established transition clinic.
Francis A. Farraye - One of the best experts on this subject based on the ideXlab platform.
-
Vaccinating the inflammatory bowel disease patient: deficiencies in Gastroenterologists knowledge.
Inflammatory bowel diseases, 2011Co-Authors: Sharmeel K. Wasan, Jennifer Coukos, Francis A. FarrayeAbstract:Background: Current therapy for inflammatory bowel disease (IBD) patients often involves agents that suppress the immune system, placing patients at an increased risk for developing infections, of which several are potentially vaccine preventable. Many IBD patients are not being vaccinated appropriately. The aims of this study were to assess Gastroenterologist's knowledge regarding vaccinating the IBD patient, eliciting the barriers that prevent vaccinations, and defining the Gastroenterologist's role in vaccinations. Methods: One thousand Gastroenterologists, randomly selected from the membership of the American College of Gastroenterology, were asked to complete a 19 question electronic survey regarding the suitable vaccines for the immunocompetent and immunosuppressed IBD patient and the barriers to recommending the vaccines. The perceived role of the Gastroenterologist versus the primary care physician (PCP) was also assessed. Results: In all, 108 responses were analyzed; 68 (62%) Gastroenterologists managed 40+ IBD patients, with 65 (52%) asking their patients about immunization history most or all of the time. The majority believed that the PCP should determine which vaccinations to give (64%) and to administer the vaccines (83%). Overall, 66%–88% of Gastroenterologists correctly recommended the inactivated vaccines for their IBD patients not on immunosuppressive therapies while 20%–30% incorrectly recommended administering the live vaccines to their immunosuppressed patients. Conclusions: Gastroenterologist knowledge of the appropriate immunizations to recommend to the IBD patient is poor and may be the primary reason why the majority of Gastroenterologists believe that the PCP should be responsible for vaccinations. Educational programs on vaccinations directed to Gastroenterologists who prescribe immunosuppressive agents are needed. (Inflamm Bowel Dis 2011)
-
Screening for colorectal cancer with flexible sigmoidoscopy by nonphysician endoscopists
The American journal of medicine, 1999Co-Authors: Michael B. Wallace, James Alan Kemp, Frank Meyer, Kimberly Horton, Angela Reffel, Cindy L. Christiansen, Francis A. FarrayeAbstract:Abstract PURPOSE: Screening with sigmoidoscopy reduces the risk of death from colorectal cancer. Only 30% of eligible patients have undergone sigmoidoscopy, in part because of a limited supply of endoscopists. We evaluated the performance and safety of screening sigmoidoscopic examinations by trained nonphysician endoscopists in comparison with board-certified Gastroenterologists. SUBJECTS AND METHODS: Asymptomatic patients 50 years or older without evidence of fecal occult blood and no personal history or family history of a first-degree relative with colorectal cancer under age 55 years were offered sigmoidoscopy. All examinations were performed either by a Gastroenterologist or a trained nonphysician endoscopist at a staff model health maintenance organization. Outcomes included the depth of examination, number and histology of polyps, and complications. RESULTS: Nonphysicians performed 2,323 sigmoidoscopic examinations, and physicians performed 1,378 examinations. The mean (±SD) depth of sigmoidoscopy examinations performed by nonphysicians was 52 ± 10 cm compared with 55 ± 9 cm ( P P = 0.35). No major complications occurred. The cost per examination, including the nonphysician training cost, was lower for nonphysicians ($186 per examination) than for physicians ($283 per examination). CONCLUSIONS: Appropriately trained nonphysicians may be capable of performing safe and effective screening for colorectal cancer with flexible sigmoidoscopy. An increased use of nonphysicians to perform sigmoidoscopy may increase the availability and reduce the cost of the procedure.
Yvette Leung - One of the best experts on this subject based on the ideXlab platform.
-
transitioning the adolescent inflammatory bowel disease patient guidelines for the adult and pediatric Gastroenterologist
Inflammatory Bowel Diseases, 2011Co-Authors: Yvette Leung, Melvin B Heyman, Uma MahadevanAbstract:Twenty percent of inflammatory bowel disease (IBD) patients present in the pediatric years, with recent reports suggesting a rising incidence in the pediatric age group. This highlights the need for both pediatric and adult Gastroenterologists to better understand issues related to the process of transition from pediatric to adult care. Research from other disciplines outside of IBD provide evidence that the transition period can be associated with poorer health outcomes and that a structured transition program may improve patient compliance and disease control. Recent data from the IBD literature support a need for transition clinics. The ideal model of a transition program has not been established. Controlled trials are not available to measure the impact of a structured transition program on clinically relevant endpoints such as disease control and hospital admissions. As local resources and availability of staffing and funding are highly variable, we have summarized some practical guidelines for the adult and pediatric Gastroenterologist that can be used as an aid to help adolescents through the transition process even without the support of an established transition clinic. (Inflamm Bowel Dis 2010;)
-
transitioning the adolescent inflammatory bowel disease patient guidelines for the adult and pediatric Gastroenterologist
Inflammatory Bowel Diseases, 2011Co-Authors: Yvette Leung, Melvin B Heyman, Uma MahadevanAbstract:Twenty percent of inflammatory bowel disease (IBD) patients present in the pediatric years, with recent reports suggesting a rising incidence in the pediatric age group. This highlights the need for both pediatric and adult Gastroenterologists to better understand issues related to the process of transition from pediatric to adult care. Research from other disciplines outside of IBD provide evidence that the transition period can be associated with poorer health outcomes and that a structured transition program may improve patient compliance and disease control. Recent data from the IBD literature support a need for transition clinics. The ideal model of a transition program has not been established. Controlled trials are not available to measure the impact of a structured transition program on clinically relevant endpoints such as disease control and hospital admissions. As local resources and availability of staffing and funding are highly variable, we have summarized some practical guidelines for the adult and pediatric Gastroenterologist that can be used as an aid to help adolescents through the transition process even without the support of an established transition clinic.
James O. Lindsay - One of the best experts on this subject based on the ideXlab platform.
-
Barriers to transition care in inflammatory bowel disease: a survey of adult and paediatric Gastroenterologists in the UK
Gut, 2011Co-Authors: Shaji Sebastian, H. R. Jenkins, I. D. R. Arnott, Nicholas M. Croft, Tariq Ahmad, S Mccartney, R K Russell, James O. LindsayAbstract:Introduction Preliminary data highlight the importance of appropriate transition for successful transfer of adolescents with IBD from paediatric to adult care. However, the ideal transition service has not been defined. The aim of this study was to identify both the perceived needs of adolescent IBD patients and the barriers to successful transition from the perspective of professionals involved in their care. Methods A postal questionnaire was distributed to UK adult and paediatric Gastroenterologists with an interest in IBD. The questionnaire utilised closed questions as well as ranked items on the importance of the various competencies of adolescents with IBD required for successful transition. The data is presented as mean scores±SD for aspects of the competencies. Results The response rate for paediatric and adult Gastroenterologists was 53.7% (71/132) and 49.3% (358/729) respectively (p=NS). A structured transition service was perceived as very important by 80.28% paediatric Gastroenterologists compared to only 47.55 adult Gastroenterologists (p=0.001). The suggested median age for initiation and completion of transition by both groups was 16 and 18 years respectively. A higher proportion of adult than paediatric Gastroenterologists identified inadequacies in the preparation of adolescents for transfer 79.1% and 42.2% p=0.001). The main areas identified by adult Gastroenterologists were patient lack of knowledge about the condition and treatment (35.4%) and co-ordination of care (40.1%) while paediatric Gastroenterologists identified lack of self advocacy (30.9%) and co-ordination (29.5%). Lack of resources, clinical time and a critical mass of patients were the factors ranked highest by both paediatric and adult Gastroenterologists as barriers to transition care. A significant proportion of adult (65.2%) and paediatric Gastroenterologists (61.9%) highlighted suboptimal training for adult Gastroenterologists in the care of adolescents and young adults with chronic diseases. Transition services appear to be more established in teaching hospital settings although there were marked regional differences. Conclusion This survey highlights differences in the perception of adult and paediatric Gastroenterologists in the management of transition care for adolescents with IBD. The perceived competencies that patients require also differed between the two groups of healthcare professionals. Lack of training and inadequate resources are the main barriers identified for development of a successful transition service. This survey provides data which may have implications in developing structured transition care services across the country.
