Editorial: Not So Nosocomial Anymore: The Growing Threat of Community-Acquired Clostridium difficile.

Am J Gastroenterol. 2012 Jan;107(1):96-8

Authors: Leffler DA, Lamont JT

Abstract
Clostridium difficile infection is widely accepted to be the leading cause of nosocomial infection-related morbidity and mortality, outpacing both antibiotic-resistant staphylococcus and enterococcus. The existence and prevalence of community-acquired Clostridium difficile infection, on the other hand, is much less well appreciated. Growing evidence now suggests that community-acquired Clostridium difficile infection may account for more than a third of Clostridium difficile-associated diarrhea overall. Similar to nosocomial Clostridium difficile infection, community-acquired cases appear to be increasing in incidence, and although associated mortality is lower than in nosocomial cases, morbidity including hospitalization and recurrence are high. Further, traditional risk factors for Clostridium difficile infection including antibiotic exposure appear to be less important in community-acquired cases and common routes of exposure and infection in the community are yet to be elucidated. In this issue of the American Journal of Gastroenterology, Khanna et al. provide important epidemiological data on the growing threat of community-acquired Clostridium difficile infection.

PMID: 22218031 [PubMed - in process]

A Comparative Evaluation of Radiologic and Clinical Scoring Systems in the Early Prediction of Severity in Acute Pancreatitis.

Am J Gastroenterol. 2011 Dec 20;

Authors: Bollen TL, Singh VK, Maurer R, Repas K, van Es HW, Banks PA, Mortele KJ

Abstract
OBJECTIVES:The early identification of clinically severe acute pancreatitis (AP) is critical for the triage and treatment of patients. The aim of this study was to compare the accuracy of computed tomography (CT) and clinical scoring systems for predicting the severity of AP on admission.METHODS:Demographic, clinical, and laboratory data of all consecutive patients with a primary diagnosis of AP during a two-and-half-year period was prospectively collected for this study. A retrospective analysis of the abdominal CT data was performed. Seven CT scoring systems (CT severity index (CTSI), modified CT severity index (MCTSI), pancreatic size index (PSI), extrapancreatic score (EP), ''extrapancreatic inflammation on CT'' score (EPIC), ''mesenteric oedema and peritoneal fluid'' score (MOP), and Balthazar grade) as well as two clinical scoring systems: Acute Physiology, Age, and Chronic Health Evaluation (APACHE)-II and Bedside Index for Severity in AP (BISAP) were comparatively evaluated with regard to their ability to predict the severity of AP on admission (first 24?h of hospitalization). Clinically severe AP was defined as one or more of the following: mortality, persistent organ failure and/or the presence of local pancreatic complications that require intervention. All CT scans were reviewed in consensus by two radiologists, each blinded to patient outcome. The accuracy of each imaging and clinical scoring system for predicting the severity of AP was assessed using receiver operating curve analysis.RESULTS:Of 346 consecutive episodes of AP, there were 159 (46%) episodes in 150 patients (84 men, 66 women; mean age, 54 years; age range, 21-91 years) who were evaluated with a contrast-enhanced CT scan (n=131 episodes) or an unenhanced CT scan (n=28 episodes) on the first day of admission. Clinically severe AP was diagnosed in 29/159 (18%) episodes; 9 (6%) patients died. Overall, the Balthazar grading system (any CT technique) and CTSI (contrast-enhanced CT only) demonstrated the highest accuracy among the CT scoring systems for predicting severity, but this was not statistically significant. There were no statistically significant differences between the predictive accuracies of CT and clinical scoring systems.CONCLUSIONS:The predictive accuracy of CT scoring systems for severity of AP is similar to clinical scoring systems. Hence, a CT on admission solely for severity assessment in AP is not recommended.Am J Gastroenterol advance online publication, 20 December 2011; doi:10.1038/ajg.2011.438.

PMID: 22186977 [PubMed - as supplied by publisher]

Editorial: fluid resuscitation in acute pancreatitis: striking the right balance.

Am J Gastroenterol. 2011 Oct;106(10):1851-2

Authors: Wu BU

Abstract
Fluid resuscitation is a key component of the early management of acute pancreatitis. Current clinical practice guidelines recommend aggressive fluid resuscitation despite limited prospective data. In this month's issue of the American Journal of Gastroenterology, de-Madaria et al. present findings from a prospective cohort study that evaluate the relationship between early resuscitation parameters and several important outcome measures. Their findings challenge several of our long held beliefs regarding the benefits of vigorous fluid resuscitation in the early phase of acute pancreatitis. Findings from this study along with several others now suggest that a more tailored approach to resuscitation is needed.

PMID: 21979206 [PubMed - indexed for MEDLINE]

Influence of fluid therapy on the prognosis of acute pancreatitis: a prospective cohort study.

Am J Gastroenterol. 2011 Oct;106(10):1843-50

Authors: de-Madaria E, Soler-Sala G, Sánchez-Payá J, Lopez-Font I, Martínez J, Gómez-Escolar L, Sempere L, Sánchez-Fortún C, Pérez-Mateo M

Abstract
OBJECTIVES: Although aggressive fluid therapy during the first days of hospitalization is recommended by most guidelines and reviews on acute pancreatitis (AP), this recommendation is not supported by any direct evidence. We aimed to evaluate the association between the amount of fluid administered during the initial 24 h of hospitalization and the incidence of organ failure (OF), local complications, and mortality.
METHODS: This was a prospective cohort study. We included consecutive adult patients admitted with AP. Local complications and OF were defined according to the Atlanta Classification. Persistent OF was defined as OF of >48-h duration. Patients were divided into three groups according to the amount of fluid administered during the initial 24 h: group A: <3.1 l (less than the first quartile), group B: 3.1-4.1 l (between the first and third quartiles), and group C: >4.1 l (more than the third quartile).
RESULTS: A total of 247 patients were analyzed. Administration of >4.1 l during the initial 24 h was significantly and independently associated with persistent OF, acute collections, respiratory insufficiency, and renal insufficiency. Administration of <3.1 l during the initial 24 h was not associated with OF, local complications, or mortality. Patients who received between 3.1 and 4.1 l during the initial 24 h had an excellent outcome.
CONCLUSIONS: In our study, administration of a small amount of fluid during the initial 24 h was not associated with a poor outcome. The need for a great amount of fluid during the initial 24 h was associated with a poor outcome; therefore, this group of patients must be carefully monitored.

PMID: 21876561 [PubMed - indexed for MEDLINE]

Editorial: drug-induced acute pancreatitis: uncommon or commonplace?

Am J Gastroenterol. 2011 Dec;106(12):2189-91

Authors: Grendell JH

Abstract
Many drugs have been implicated as causing acute pancreatitis (AP), mainly based on the recurrence of pancreatitis following rechallenge with a drug that the patient had been taking at the time of an initial episode of AP. However, estimates of the relative frequency with which drugs cause AP vary widely. This is largely because many patients may be taking a number of drugs, may have co-morbidities such as gallstone disease or hypertriglyceridemia, or may be consuming large amounts of alcohol, making it difficult to determine what actually is the primary cause of an episode of AP. Large, rigorously designed epidemdiological studies are needed to better define the frequency with which the drugs in general cause AP and the specific risk of pancreatitis associated with any individual drug.

PMID: 22138943 [PubMed - in process]

The Epidemiology of Community-Acquired Clostridium difficile Infection: A Population-Based Study.

Am J Gastroenterol. 2011 Nov 22;

Authors: Khanna S, Pardi DS, Aronson SL, Kammer PP, Orenstein R, St Sauver JL, Harmsen WS, Zinsmeister AR

Abstract
OBJECTIVES:Clostridium difficile infection (CDI) is a common hospital-acquired infection with increasing incidence, severity, recurrence, and associated morbidity and mortality. There are emerging data on the occurrence of CDI in nonhospitalized patients. However, there is a relative lack of community-based CDI studies, as most of the existing studies are hospital based, potentially influencing the results by referral or hospitalization bias by missing cases of community-acquired CDI.METHODS:To better understand the epidemiology of community-acquired C. difficile infection, a population-based study was conducted in Olmsted County, Minnesota, using the resources of the Rochester Epidemiology Project. Data regarding severity, treatment response, and outcomes were compared in community-acquired vs. hospital-acquired cohorts, and changes in these parameters, as well as in incidence, were assessed over the study period.RESULTS:Community-acquired CDI cases accounted for 41% of 385 definite CDI cases. The incidence of both community-acquired and hospital-acquired CDI increased significantly over the study period. Compared with those with hospital-acquired infection, patients with community-acquired infection were younger (median age 50 years compared with 72 years), more likely to be female (76% vs. 60%), had lower comorbidity scores, and were less likely to have severe infection (20% vs. 31%) or have been exposed to antibiotics (78% vs. 94%). There were no differences in the rates of complicated or recurrent infection in patients with community-acquired compared with hospital-acquired infection.CONCLUSIONS:In this population-based cohort, a significant proportion of cases of CDI occurred in the community. These patients were younger and had less severe infection than those with hospital-acquired infection. Thus, reports of CDI in hospitalized patients likely underestimate the burden of disease and overestimate severity.Am J Gastroenterol advance online publication, 22 November 2011; doi:10.1038/ajg.2011.398.

PMID: 22108454 [PubMed - as supplied by publisher]

The Risk of Peptic Ulcer Bleeding Mortality in Relation to Hospital Admission on Holidays: A Cohort Study on 8,222 Cases of Peptic Ulcer Bleeding.

Am J Gastroenterol. 2011 Nov 22;

Authors: Tsoi KK, Chiu PW, Chan FK, Ching JY, Lau JY, Sung JJ

Abstract
OBJECTIVES:Urgent endoscopic intervention is important in the management of patients with peptic ulcer bleeding (PUB). Hospital admission on Sundays or on public holidays may be associated with an increased mortality. This study sets to investigate whether mortality among patients with PUB differs between holiday and weekday admissions, and also to investigate the association between mortality and the waiting time for endoscopy.METHODS:Patients with PUB admitted to the Prince of Wales Hospital from 1993 to 2005 were prospectively recruited in the data set. Mortality and cause of death were documented. Predicting variables included patient characteristics, waiting time for endoscopy, and holiday or weekday admissions. Bivariate analyses and multivariate logistic regression models were used to evaluate risk factors on 30-day mortality after endoscopy.RESULTS:A total of 8,222 patients with PUB were enrolled among which 1,573 (19.1%) were admitted on holidays. A total of 334 (4.1%) patients died within 30 days after hospital admission. There was no significant difference in mortality rate between holiday and weekday admissions (4.1 vs. 4.0%, P=0.876). Using logistic regression adjusted for age, hemodynamic shock, ulcer history, and severe comorbid illness, the waiting time for endoscopy was correlated with the risk of 30-day mortality (odds ratio (OR), 95% confidence interval (95% CI)=1.10, 1.06-1.14). Holiday admission has not increased the mortality risk (OR, 95% CI=1.07, 0.80-1.43).CONCLUSIONS:When therapeutic endoscopy can be offered within 1 day after admission for PUB, holiday admission will not adversely affect bleeding mortality.Am J Gastroenterol advance online publication, 22 November 2011; doi:10.1038/ajg.2011.409.

PMID: 22108453 [PubMed - as supplied by publisher]

Treatment of Hospitalized Adult Patients With Severe Ulcerative Colitis: Toronto Consensus Statements.

Am J Gastroenterol. 2011 Nov 22;

Authors: Bitton A, Buie D, Enns R, Feagan BG, Jones JL, Marshall JK, Whittaker S, Griffiths AM, Panaccione R

Abstract
OBJECTIVES:The objective of this study was to provide updated explicit and relevant consensus statements for clinicians to refer to when managing hospitalized adult patients with acute severe ulcerative colitis (UC).METHODS:The Canadian Association of Gastroenterology consensus group of 23 voting participants developed a series of recommendation statements that addressed pertinent clinical questions. An iterative voting and feedback process was used to do this in conjunction with systematic literature reviews. These statements were brought to a formal consensus meeting held in Toronto, Ontario (March 2010), when each statement was discussed, reformulated, voted upon, and subsequently revised until group consensus (at least 80% agreement) was obtained. The modified GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria were used to rate the strength of recommendations and the quality of evidence.RESULTS:As a result of the iterative process, consensus was reached on 21 statements addressing four themes (General considerations and nutritional issues, Steroid use and predictors of steroid failure, Cyclosporine and infliximab, and Surgical issues).CONCLUSIONS:Key recommendations for the treatment of hospitalized patients with severe UC include early escalation to second-line medical therapy with either infliximab or cyclosporine in individuals in whom parenteral steroids have failed after 72?h. These agents should be used in experienced centers where appropriate support is available. Sequential therapy with cyclosporine and infliximab is not recommended. Surgery is an option when first-line steroid therapy fails, and is indicated when second-line medical therapy fails and/or when complications arise during the hospitalization.Am J Gastroenterol advance online publication, 22 November 2011; doi:10.1038/ajg.2011.386.

PMID: 22108451 [PubMed - as supplied by publisher]

Esomeprazole Compared With Famotidine in the Prevention of Upper Gastrointestinal Bleeding in Patients With Acute Coronary Syndrome or Myocardial Infarction.

Am J Gastroenterol. 2011 Nov 22;

Authors: Ng FH, Tunggal P, Chu WM, Lam KF, Li A, Chan K, Lau YK, Kng C, Keung KK, Kwan A, Wong BC

Abstract
OBJECTIVES:Little is known about the efficacy of proton pump inhibitors compared with H(2) receptor antagonists in preventing adverse upper gastrointestinal complications in patients with acute coronary syndrome (ACS) or ST elevation myocardial infarction (STEMI) receiving aspirin, clopidogrel, and enoxaparin or thrombolytics. The objective of this study was to compare the efficacies of esomeprazole and famotidine in preventing gastrointestinal complications.METHODS:A double-blind, randomized, controlled trial was performed in patients receiving a combination of aspirin, clopidogrel, and either enoxaparin or thrombolytics. Patients received either esomeprazole (20?mg nocte) or famotidine (40?mg nocte) orally for 4-52 weeks, depending on the duration of dual antiplatelet therapy. The primary end point was upper gastrointestinal bleeding (GIB), perforation, or obstruction from ulcer/erosion (http://www.clinicaltrials.gov NCT00683111).RESULTS:In all, 311 patients were recruited, with 163 and 148 patients in the esomeprazole and famotidine groups, respectively. Mean (s.d.) follow-up was 19.2 (17.6) and 17.6 (18.0) weeks, respectively. One (0.6%) patient in the esomeprazole group and 9 (6.1%) in the famotidine group reached the primary end point (log-rank test, P=0.0052, hazard ratio=0.095, 95% confidence interval: 0.005-0.504); all had upper GIB.CONCLUSIONS:In patients with ACS or STEMI, esomeprazole is superior to famotidine in preventing upper gastrointestinal complications related to aspirin, clopidogrel, and enoxaparin or thrombolytics.Am J Gastroenterol advance online publication, 22 November 2011; doi:10.1038/ajg.2011.385.

PMID: 22108447 [PubMed - as supplied by publisher]

Incidence, Prevalence, and Survival of Chronic Pancreatitis: A Population-Based Study.

Am J Gastroenterol. 2011 Sep 27;

Authors: Yadav D, Timmons L, Benson JT, Dierkhising RA, Chari ST

Abstract
OBJECTIVES:Population-based data on chronic pancreatitis (CP) in the United States are scarce. We determined incidence, prevalence, and survival of CP in Olmsted County, MN.METHODS:Using Mayo Clinic Rochester's Medical Diagnostic Index followed by a detailed chart review, we identified 106 incident CP cases from 1977 to 2006 (89 clinical cases, 17 diagnosed only at autopsy); CP was defined by previously published Mayo Clinic criteria. We calculated age- and sex-adjusted incidence (for each decade) and prevalence rate (1 January 2006) per 100,000 population (adjusted to 2000 US White population). We compared the observed survival rate for patients with expected survival for age- and sex-matched Minnesota White population.RESULTS:Median age at diagnosis of CP was 58 years, 56% were male, and 51% had alcoholic CP. The overall (clinical cases or diagnosed only at autopsy) age- and sex-adjusted incidence was 4.05/100,000 person-years (95% confidence interval (CI) 3.27-4.83). The incidence rate for clinical cases increased significantly from 2.94/100,000 during 1977-1986 to 4.35/100,000 person-years during 1997-2006 (P<0.05) because of an increase in the incidence of alcoholic CP. There were 51 prevalent CP cases on 1 January 2006 (57% male, 53% alcoholic). The age- and sex-adjusted prevalence rate per 100,000 population was 41.76 (95% CI 30.21-53.32). At last follow-up, 50 patients were alive. Survival among CP patients was significantly lower than age- and sex-specific expected survival in Minnesota White population (P<0.001).CONCLUSIONS:Incidence and prevalence of CP are low, and ?50% are alcohol related. The incidence of CP cases diagnosed during life is increasing. Survival of CP patients is lower than in the Minnesota White population.Am J Gastroenterol advance online publication, 27 September 2011; doi:10.1038/ajg.2011.328.

PMID: 21946280 [PubMed - as supplied by publisher]

Long-Term Outcome of Patients Treated With Double Balloon Enteroscopy for Small Bowel Vascular Lesions.

Am J Gastroenterol. 2011 Sep 27;

Authors: Samaha E, Rahmi G, Landi B, Lorenceau-Savale C, Malamut G, Canard JM, Bloch F, Jian R, Chatellier G, Cellier C

Abstract
OBJECTIVES:Early rebleeding rate after endoscopic therapy with double balloon enteroscopy (DBE) of hemorrhagic small bowel vascular lesions (SBVL) varies between 10 and 50%. In recent reports, long-term follow-up of patients have been described but rebleeding risk factors are still not well established. The aim of the current study was to identify long-term treatment success rate and rebleeding risk factors after DBE therapy in a large cohort.METHODS:We conducted a single-center, retrospective cohort study in a large French tertiary-referral center between January 2004 and December 2007.RESULTS:Among 261 patients presenting with obscure gastrointestinal bleeding (OGIB), SBVL was present in 133 patients and was treated successfully in 129 (97%) using mainly argon plasma coagulation. Ninety-eight patients were followed up for a mean period of 22.6±13.9 months (range 1-52). Rebleeding rate was 46% (45/98 patients) at 36 months. On multivariate analysis, the total number of observed lesions (hazard ratio (HR): 1.15, 95% confidence interval (CI): 1.06-1.25, P=0.001) and the presence of a valvular and/or arrhythmic cardiac disease (HR: 2.50, 95% CI: 1.29-4.87, P=0.007) were significantly associated with the risk of rebleeding. Complication rate of therapeutic DBE was 2.3% with no mortality.CONCLUSIONS:Endoscopic therapy using DBE for SBVL in patients with recurrent OGIB allows a long-term remission in more than half of the patients. Independent rebleeding risk factors after a first endoscopic therapy are an increased number of SBVL and an associated valvular/arrhythmic heart disease.Am J Gastroenterol advance online publication, 27 September 2011; doi:10.1038/ajg.2011.325.

PMID: 21946281 [PubMed - as supplied by publisher]

Hospital Readmissions Among Patients With Decompensated Cirrhosis.

Am J Gastroenterol. 2011 Sep 20;

Authors: Volk ML, Tocco RS, Bazick J, Rakoski MO, Lok AS

Abstract
OBJECTIVES:Early rehospitalizations have been well characterized in many disease states, but not among patients with cirrhosis. The aims of this study were to identify the frequency, costs, predictors, and preventable causes of hospital readmissions among patients with decompensated cirrhosis.METHODS:Rates of readmission were calculated for 402 patients discharged after one of the following complications of cirrhosis: ascites, spontaneous bacterial peritonitis, renal failure, hepatic encephalopathy, or variceal hemorrhage. Costs of readmissions were calculated using the hospital accounting system. Predictors of time to first readmission were determined using Cox regression, and predictors of hospitalization rate/person-years were determined using negative binomial regression. The independent association between readmission rate and mortality was determined using Cox regression. Admissions within 30 days of discharge were assessed by two reviewers to determine if preventable.RESULTS:Overall, 276 (69%) subjects had at least one nonelective readmission, with a median time to first readmission of 67 days. By 1 week after discharge, 14% of subjects had been readmitted, and 37% were readmitted within 1 month. The mean costs for readmissions within 1 week and between weeks 1 and 4 were $28,898 and $20,581, respectively. During a median follow-up of 203 days, the median number of readmissions was 2 (range 0-40), with an overall rate of 3 hospitalizations/person-years. Patients with more frequent readmissions had higher risk of subsequent mortality, despite adjustment for confounders including the Model for End-stage Liver Disease (MELD) score. Predictors of time to first readmission included MELD score, serum sodium, and number of medications on discharge; predictors of hospitalization rate included these variables as well as the number of cirrhosis complications and being on the transplant list at discharge. Among 165 readmissions within 30 days, 22% were possibly preventable.CONCLUSIONS:Hospital readmissions among patients with decompensated cirrhosis are common, costly, moderately predictable, in some cases, possibly preventable, and independently associated with mortality. These findings support the development of disease management interventions to prevent rehospitalization.Am J Gastroenterol advance online publication, 20 September 2011; doi:10.1038/ajg.2011.314.

PMID: 21931378 [PubMed - as supplied by publisher]

Association Between the Use of Antibiotics and New Diagnoses of Crohn's Disease and Ulcerative Colitis.

Am J Gastroenterol. 2011 Sep 13;

Authors: Shaw SY, Blanchard JF, Bernstein CN

Abstract
OBJECTIVES:The objective of this study was to determine if the use of antibiotics 2-5 years before diagnosis was associated with the development of inflammatory bowel disease (IBD).METHODS:This was a nested case-control analysis of the population-based University of Manitoba Inflammatory Bowel Disease Epidemiologic Database. A total of 2,234 subjects diagnosed with IBD between 2001 and 2008 were matched to 22,346 controls, based on age, sex, and geographic region. Antibiotic data were drawn from the Manitoba Drug Program Information Network, a comprehensive database of all prescription drugs for all Manitobans dating back to 1995.RESULTS:The mean age at diagnosis was 43.4 years. In all, 12% of cases had ?3 prescriptions 2 years before the case date, compared with 7% of controls. The odds ratio for those receiving ?3 dispensations 2 years before their study inclusion was 1.5 (95% confidence interval: 1.3,1.8; P<0.0001) of being an IBD case. This difference in ?3 dispensations between cases and controls was fairly consistent at 3, 4, and 5 years before IBD case date. Antibiotic dispensations were associated with both Crohn's disease (CD) and ulcerative colitis (UC), with the association nominally stronger in CD cases for ?1 and ?2 dispensations, while the association was stronger in UC cases for ?3 dispensations. A dose-dependent relationship between the number of antibiotic dispensations, and the risk of IBD was observed across all years investigated.CONCLUSIONS:Subjects diagnosed with IBD were more likely to have been prescribed antibiotics 2-5 years before their diagnosis. This possibly implicates antibiotic use as a predisposing factor in IBD etiology.Am J Gastroenterol advance online publication, 13 September 2011; doi:10.1038/ajg.2011.304.

PMID: 21912437 [PubMed - as supplied by publisher]

Acute Pancreatitis and Concomitant Use of Pancreatitis-Associated Drugs.

Am J Gastroenterol. 2011 Sep 13;

Authors: Spanier BM, Tuynman HA, van der Hulst RW, Dijkgraaf MG, Bruno MJ

Abstract
OBJECTIVES:Drug-induced pancreatitis (DIP) is considered a relative rare disease entity, perhaps due to lack of recognition. The objective of this study was to evaluate the prevalence of pancreatitis-associated drugs in a Dutch cohort of patients admitted for acute pancreatitis (AP) and to identify the proportion AP possibly attributable to the use of drugs.METHODS:This was a multicenter observational study (EARL study). Etiology, disease course, use of pancreatitis-associated drugs at hospital admittance, and discontinuation of these drugs were evaluated. Drugs were scored by means of an evidence-based DIP classification system.RESULTS:The first documented hospital admissions of 168 patients were analyzed. In all, 70 out of 168 (41.6%; 95% confidence interval (CI): 34.5-49.2%) patients used pancreatitis-associated drugs at admission. In 26.2% (44/168; 95% CI: 20.1-33.3%) of cases, at least one class I pancreatitis-associated drug was used. Possibly DIP was present in 12.5% (21/168; 95% CI: 8.3-18.4%); in less than half of these patients (9/21 or 42.9%; 95% CI: 24.5-63.5%), the prescribed drugs were actually discontinued, with no recurrence of AP later on. Among the remaining 12 patients without discontinuation of their drugs use and in absence of an alternative etiologic cause of AP, 8 patients used a class I pancreatitis-associated drug, representing 4.8% (8/168, 95% CI: 2.4-9.1%) of the total study population.CONCLUSIONS:In this series, a remarkably high percentage of patients who were admitted because of an attack of AP used pancreatitis-associated drugs. Physicians should be more aware of the possibility of DIP in patients with otherwise unexplained AP and act appropriately by discontinuation of the drug.Am J Gastroenterol advance online publication, 13 September 2011; doi:10.1038/ajg.2011.303.

PMID: 21912439 [PubMed - as supplied by publisher]

Observing Handoffs and Telephone Management in GI Fellowship Training.

Am J Gastroenterol. 2011 Aug;106(8):1410-4

Authors: Williams R, Miler R, Shah B, Chokhavatia S, Poles M, Zabar S, Gillespie C, Weinshel E

Gastroenterology (GI) training programs are mandated to teach fellows interpersonal communication and professionalism as basic competencies. We sought to assess important skill sets used by our fellows but not formally observed or measured: handoffs, telephone management, and note writing. We designed an Observed Standardized Clinical Examination (OSCE) form and provided the faculty with checklists to rate fellows' performance on specific criteria.

PMID: 21811269 [PubMed - in process]