检索结果-南通市图书馆

Interventions and targets aimed at improving quality in inflammatory bowel disease ambulatory care

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Gastroenterology 2013年第38期19卷 6375-6382页

作者： Adam V Weizman geoffrey c nguyen Division of Gastroenterology Women’s College HospitalUniversity of TorontoTorontoON M5S 1B2Canada Mount Sinai Hospital centre for Inflammatory Bowel Disease University of TorontoTorontoON M5G 1X5Canada Division of Gastroenterology and Hepatology Johns Hopkins School of MedicineBaltimoreMD 21205United States

Over the past decade,there has been increasing focus on improving the quality of healthcare delivered to patients with chronic diseases,including inflammatory bowel *** bowel disease is a complex,chronic condition with associated morbidity,health care costs,and reductions in quality of *** condition is managed primarily in the outpatient *** delivery of high quality of care is suboptimal in several ambulatory inflammatory bowel disease domains including objective assessments of disease activity,the use of steroid-sparing agents,screening prior to anti-tumor necrosis factor therapy,and monitoring thiopurine *** review outlines these gaps in performance and provides potential initiatives aimed at improvement including reimbursement programs,quality improvement frameworks,collaborative efforts in quality improvement,and the use of healthcare information technology.

关键词： Ambulatory care crohn’s disease Inflammatory bowel disease Quality improvement Ulcerative colitis

Presence of phthalates in gastrointestinal medications: Is there a hidden danger?

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Gastroenterology 2013年第41期19卷 7042-7047页

作者： Zane R Gallinger geoffrey c nguyen Mount Sinai Hospital centre for Inflammatory Bowel Disease University of TorontoTorontoOntarioM5G 1X5Canada Division of Gastroenterology Johns Hopkins University School of MedicineBaltimoreMD 21287United States

Pharmaceutical companies that produce gastrointestinal(GI)medications often utilize phthalates for their ability to localize medication *** prescribed GI medications that may utilize phthalates are 5-Aminosalicylates,proton pump inhibitors,and pancreatic *** understanding of the cumulative health effects of phthalates from medications remains unclear,and there is increasing evidence that phthalates are not *** studies in animals have shown that phthalates,specifically dibutyl phthalate and Di-(2-ethyl-hexyl)phthalate,have the potential to alter and/or inhibit reproductive biology and in utero *** the lack of definitive human data,many cohort and cross-sectional studies demonstrate concerning associations between phthalates and poor health status,specifically developmental *** studies and studies with larger sample sizes are required to determine whether phthalates actually cause negative health *** is also important that physicians regularly review and discuss with patients the medicinal ingredients in their medications and supplements,specifically in pregnant woman with inflammatory bowel disease.

关键词： Phthalates Dibutyl phthalate 5-Aminosalicylates Medications Development Pregnancy

Quality of care delivered to hospitalized inflammatory bowel disease patients

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Gastroenterology 2013年第38期19卷 6360-6366页

作者： Adam V Weizman geoffrey c nguyen Division of Gastroenterology Women’s College HospitalUniversity of TorontoTorontoM5S 1B2OntarioCanada Mount Sinai Hospital centre for Inflammatory Bowel Disease University of TorontoTorontoM5G 1X5OntarioCanada Division of Gastroenterology and Hepatology Johns Hopkins School of MedicineBaltimoreMD 21201United States

Hospitalized patients with inflammatory bowel disease(IBD)are at high risk for morbidity,mortality,and health care utilization *** the literature on trends in hospitalization rates for this disease is conflicting,there does appear to be significant variation in the delivery of care to this complex group,which may be a marker of suboptimal quality of *** is a need for improvement in identifying patients at risk for hospitalization in an effort to reduce ***,appropriate screening for a number of hospital acquired complications such as venous thromboembolism and clostridium difficile infection is *** review discusses areas of inpatient care for IBD patients that are in need of improvement and outlines a number of potential quality improvement initiatives such as payfor-performance models,quality improvement frameworks,and healthcare information technology.

关键词： crohn’s disease Hospitalization Inflammatory bowel disease Quality improvement Ulcerative colitis

Outcomes of patients with cirrhosis undergoing non-hepatic surgery:Risk assessment and management

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Gastroenterology 2007年第30期13卷 4056-4063页

作者： Farida Millwala geoffrey c nguyen Paul J Thuluvath Hepatology Section The Johns Hopkins University School of Medicine Baltimore MD 2105 United States

The reported mortality rates in patients with cirrhosis undergoing various non-transplant surgical procedures range from 8.3% to 25%. This wide range of mortality rates is related to severity of liver disease, type of surgery, demographics of patient population, expertise of the surgical, anesthesia and intensive care unit team and finally, reporting bias. In this article, we will review the pathophysiology, morbidity and mortality associated with non-hepatic surgery in patients with cirrhosis, and then recommend an algorithm for risk assessment and evidence based management strategy to optimize post-surgical outcomes.

关键词： Pre-operative risk assessment Risk stratification cirrhosis Model for end-stage liver disease Non-transplant surgery Outcomes

Quality improvement in pediatric inflammatory bowel disease: Moving forward to improve outcomes

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Gastroenterology 2013年第38期19卷 6367-6374页

作者： Pauline Quach geoffrey c nguyen Eric I Benchimol cHEO IBD centre Division of GastroenterologyHepatology and NutritionChildren’s Hospital of Eastern OntarioOttawa K1H 8L1Canada Institute for clinical Evaluative Sciences Ottawa K1Y 4E9Canada Zane cohen center for Digestive Research Division of GastroenterologyMount Sinai HospitalToronto M5T 3L9Canada Department of Medicine University of TorontoToronto M5S 2J7Canada Departments of Pediatrics Epidemiology and Community MedicineUniversity of OttawaOttawa K1H 8M5Canada

In recent years,pediatric health care has embraced the concept of quality improvement to improve patient *** quality improvement efforts are implemented,network collaboration(where multiple centers and practices implement standardized programs)is a popular *** a collaborative network,improvement in the conduct of structural,process and outcome quality measures can lead to improvements in overall health,and benchmarks can be used to assess and compare *** this review article,we provided an overview of the quality improvement movement and the role of quality indicators in this *** reviewed current quality improvement efforts in pediatric inflammatory bowel disease (IBD),as well as other pediatric chronic *** discussed the need to standardize the development of quality indicators used in quality improvement networks to assess medical care,and the validation techniques which can be used to ensure that process indicators result in improved outcomes of clinical *** aimed to assess current quality improvement efforts in pediatric IBD and other diseases,such as childhood asthma,childhood arthritis,and neonatal *** doing so,we hope to learn from their successes and failures and to move the field forward for future improvements in the care provided to children with IBD.

关键词： Inflammatory bowel disease colitis Ulcerative crohn’s disease child Adolescent Quality of health care Review

Impact of adalimumab on disease burden in moderate-to-severe ulcerative colitis patients: The one-year, real-world UcanADA study

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Gastroenterology 2022年第34期28卷 5058-5075页

作者： Talat Bessissow geoffrey c nguyen Osman Tarabain Laurent Peyrin-Biroulet Nathalie Foucault Kevin McHugh Joannie Ruel Department of Medicine McGill University Health CenterMontreal H3G 1A4QuebecCanada Mount Sinai Hospital Inflammatory Bowel Disease centre Toronto M5T 3L9OntarioCanada Dr.O.Tarabain clinic Windsor N8W 1E6OntarioCanada Department of Gastroenterology University of LorraineCHRUNancyNancy F-54000France AbbVie corporation Saint-Laurent H4S 1Z1QuebecCanada Department of Medicine Sherbrooke University Hospital CenterSherbrooke J1H 5N4QuebecCanada

BAcKGROUND A gap remains in documenting the impact of anti-tumor necrosis factor therapy on disease burden in ulcerative colitis(Uc)patients treated in a real-world *** use of patient-reported outcomes(PROs)has been discussed as a primary endpoint in the context of the FDA PRO Guidance,for labelling ***,the efficacy and safety of adalimumab have been demonstrated in pivotal trials;however,data are needed to understand how clinical results translate into improvements in key aspects of the daily lives of Uc patients,such as symptoms,health-related quality of life(HRQoL),and *** To assess real-world effectiveness of adalimumab on PRO measures in patients with moderate-to-severe *** UcanADA was a single arm,prospective,1-year multicenter canadian post-marketing observational study in which multiple PRO questionnaires were completed—with psychologic distress/depression symptoms as the primary endpoint—by patients with moderate-to-severe *** were performed during patients’routine care visit schedule,which was at the initiation of adalimumab(baseline),after induction(approximately 8 wk),and 52 wk after *** optional assessments between weeks 8 and 52 were collected at least once but no more than two times during this *** safety events and per-protocol adverse events were *** From 23 canadian centres,100 patients were enrolled and 48 completed the *** with the Patient Health Questionnaire–9 items at week 52,61.5%(40/65)[95%confidence interval(cI):49.7%-73.4%]of the patients improved in psychologic distress/depression symptoms,which was slightly higher in completers[65.9%(29/44);95%cI:51.9%-79.9%].At week 52,clinical response and clinical remission were achieved respectively by 65.7%(44/73)and 47.8%(32/73)of the *** odds of improving depressive symptoms for those achieving a clinical remission at week 52 was 7.94 higher compared with those not achieving a clinic

关键词： Disease burden Patient-reported outcome Depressive symptoms Ulcerative colitis Adalimumab Real-world data

colectomy is a risk factor for venous thromboembolism in ulcerative colitis

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Gastroenterology 2015年第4期21卷 1251-1260页

作者： Gilaad G Kaplan Allen Lim cynthia H Seow Gordon W Moran Subrata Ghosh Yvette Leung Jennifer Debruyn geoffrey c nguyen James Hubbard Remo Panaccione Inflammatory Bowel Disease clinic University of CalgaryCalgary AB T2N 4N1Canada Division of Gastroenterology University of CalgaryCalgary AB T2N 4N1Canada Departments of Medicine University of CalgaryCalgary AB T2N 4N1Canada community Health Sciences University of CalgaryCalgary AB T2N 4N1Canada Paediatrics University of CalgaryCalgary AB T2N 4N1Canada Mount Sinai centre for Inflammatory Bowel Disease University of TorontoToronto ON M5SCanada Institute for clinical Evaluative Sciences Toronto ON M5SCanada

AIM: To compare venous thromboembolism(VTE) in hospitalized ulcerative colitis(Uc) patients who respond to medical management to patients requiring colectomy. METHODS: Population-based surveillance from 1997 to 2009 was used to identify all adults admitted to hospital for a flare of Uc and those patients who underwent colectomy. All medical charts were reviewed to confirm the diagnosis and extract clinically relevant information. Uc patients were stratified by:(1) responsive to inpatient medical therapy(n = 382);(2) medically refractory requiring emergent colectomy(n = 309); and(3) elective colectomy(n = 329). The primary outcome was the development of VTE during hospitalization or within 6 mo of discharge. Heparin prophylaxis to prevent VTE was assessed. Logistic regression analysis determined the effect of disease course(i.e., responsive to medical therapy, medically refractory, and elective colectomy) on VTE after adjusting for confounders including age, sex, smoking, disease activity, comorbidities, extent of disease, and IBD medications(i.e., corticosteroids, mesalamine, azathioprine, and infliximab). Point estimates were presented as odds ratios(OR) with 95%***: The prevalence of VTE among patients with Uc who responded to medical therapy was 1.3% and only 16% of these patients received heparinprophylaxis. In contrast, VTE was higher among patients who underwent an emergent(8.7%) and elective(4.9%) colectomy, despite greater than 90% of patients receiving postoperative heparin prophylaxis. The most common site of VTE was intra-abdominal(45.8%) followed by lower extremity(19.6%). VTE was diagnosed after discharge from hospital in 16.7% of cases. Elective(adjusted OR = 3.69; 95%cI: 1.30-10.44) and emergent colectomy(adjusted OR = 5.28; 95%cI: 1.93-14.45) were significant risk factors for VTE as compared to medically responsive Uc patients. Furthermore, the odds of a VTE significantly increased across time(adjusted OR = 1.10; 95%cI: 1.01-1.20). Age, sex, c

关键词： Inflammatory bowel diseases Ulcerative colitis Dee

Non-invasive diagnosis of advanced fibrosis and cirrhosis

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Gastroenterology 2014年第45期20卷 16820-16830页

作者： Suraj Sharma Korosh Khalili geoffrey christopher nguyen Toronto centre for Liver Disease Toronto Western Hospital Department of Medical Imaging University Health Network Joseph and Wolf Lebovic Health complex Mount Sinai Hospital

Liver cirrhosis is a common and growing public health problem *** diagnosis of cirrhosis portends an increased risk of morbidity and *** biopsy is considered the gold standard for diagnosis of cirrhosis and staging of ***,despite its universal use,liver biopsy is an invasive and inaccurate gold standard with numerous *** order to overcome the limitations of liver biopsy,a number of non-invasive techniques have been investigated for the assessment of *** review will focus on currently available non-invasive markers of *** evidence behind the use of these markers will be highlighted,along with an assessment of diagnostic accuracy and performance characteristics of each ***-invasive markers of cirrhosis can be radiologic or *** techniques based on ultrasound,magnetic resonance imaging and elastography have been used to assess liver ***-based biomarkers of cirrhosis have also been *** are broadly classified into indirect and direct *** biomarkers reflect liver function,which may decline with the onset of *** biomarkers,reflect extracellular matrix turnover,and include molecules involved in hepatic *** the whole,radiologic and serum markers of fibrosis correlate well with biopsy scores,especially when excluding cirrhosis or excluding *** feature is certainly clinically useful,and avoids liver biopsy in many cases.

关键词： cirrhosis Biomarker Non-invasive Fibrosis Viral Non-alcoholic fatty liver disease Primary biliary cirrhosis Autoimmune hepatitis Hepatitis B virus Hepatitis c virus

A stable cS-FEM for the static and seismic stability of a single square tunnel in the soil where the shear strength increases linearly with depth

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Journal of Rock Mechanics and Geotechnical Engineering 2022年第4期14卷 1253-1265页

作者： H.c.nguyen L.nguyen-Son Department of civil and Environmental Engineering Imperial College LondonLondonUK Department of civil Engineering and Industrial Design University of LiverpoolLiverpoolUK Faculty of civil Engineering Ho Chi Minh City University of Technology(HUTECH)Ho Chi Minh CityViet Nam

A numerical procedure using a stable cell-based smoothed finite element method(cS-FEM)is presented for estimation of stability of a square tunnel in the soil where the shear strength increases linearly with *** kinematically admissible displacement fields are approximated by uniform quadrilateral elements in conjunction with the strain smoothing technique,eliminating volumetric locking issues and the singularity associated with the Mohrecoulomb ***,a rich set of simulations was performed to compute the static stability of a square tunnel with different geometries and soil *** presented results are in excellent agreement with the upper and lower bound solutions using the standard finite element method(FEM).The stability charts and tables are given for practical use in the tunnel design,along with a newly proposed formulation for predicting the undrained stability of a single square ***,the seismic stability number was computed using the present numerical *** results reveal that the seismic stability number reduces with an increasing value of the horizontal seismic acceleration(a_(h)),for both cases of the weightless soil and the soil with unit ***,the link between the static and seismic stability numbers is described using corrective factors that represent reductions in the tunnel stability due to seismic *** is shown from the numerical results that the corrective factor becomes larger as the unit weight of soil mass increases;however,the degree of the reduction in seismic stability number tends to reduce for the case of the homogeneous ***,this advanced numerical procedure is straightforward to extend to three-dimensional(3D)limit analysis and is readily applicable for the calculation of the stability of tunnels in highly anisotropic and heterogeneous soils which are often encountered in practice.

关键词： Tunnels Stability Limit analysis cell-based smoothed finite element method (cS-FEM) Second-order cone programming(SOcP)