scholarly journals One-stop shop for variceal surveillance: integration of unsedated ultrathin endoscopy into the routine clinic visit

2021 ◽  
pp. flgastro-2020-101680
Author(s):  
Ali Eqbal ◽  
Tehara Wickremeratne ◽  
Stephanie Turner ◽  
Sarah Elizabeth Higgins ◽  
Andrew Sloss ◽  
...  
Keyword(s):  
Beta Blockers ◽  
Cost Savings ◽  
Kappa Statistic ◽  
Clinic Visit ◽  
Oesophageal Varices ◽  
Video Recordings ◽  
One Stop ◽  
Disposable Endoscope ◽  
Surveillance Endoscopy ◽  
Upper Gastrointestinal

BackgroundThe endoscopic appearance of oesophageal varices determines the need for prophylaxis. However, as the point prevalence of varices is low (25%), the majority of surveillance endoscopies are unnecessary and costly. Narrow diameter,ultrathin (UT) endoscopes are more tolerable than conventional upper gastrointestinal (UGI) endoscopes and can be used without sedation. We hypothesised that unsedated UT endoscopy for variceal surveillance could be implemented during the routine outpatient clinic visit allowing accurate diagnosis of varices and the timely provision of prophylaxis.MethodsPatients with cirrhosis awaiting surveillance endoscopy were identified. UT endoscopy was scheduled during routine clinic review at the same time as ultrasound surveillance for hepatocellular carcinoma. UGI endoscopy was performed unsedated using the E.G Scan II disposable endoscope. Varices were graded using the modified Paquet classification. Video recordings of procedures were reviewed by blinded assessors and agreement was assessed using the kappa statistic.Results40 patients (80% male) underwent unsedated UT endoscopy. All procedures were successful and tolerated well in 98% of cases. Median procedure time was 2 min (IQR 1–3). Varices were found in 37.5% (17.5% grade 1 and 20% grade 2). Patients with grade 2 varices were prescribed non-selective beta blockers at the clinic appointment. Kappa statistic for the finding of any varices was 0.636 (p=0.001) and 0.8–1.0 for diagnosis of grade 2 varices (p<0.0001).ConclusionsOutpatient unsedated ultrathin endoscopy in patients with cirrhosis is accurate, safe and feasible. This integrative care model is convenient, particularly for regional communities, and is likely to result in significant cost savings associated with variceal surveillance.

scholarly journals Diagnosis and management of extrahepatic oesophageal variceal bleed in children in a low resourced setting

2020 ◽  
Vol 54 (4) ◽  
pp. 274-278
Author(s):  
Taiba J. Afaa ◽  
Kokou H. Amegan-Aho ◽  
Elikem Richardson ◽  
Bamenla Goka
Keyword(s):  
Portal Hypertension ◽  
Gastrointestinal Bleeding ◽  
Portal Vein ◽  
Upper Gastrointestinal Bleeding ◽  
Liver Function Tests ◽  
Tertiary Hospital ◽  
Secondary Prophylaxis ◽  
Resource Constraint ◽  
Oesophageal Varices ◽  
Upper Gastrointestinal

Extrahepatic portal vein obstruction (EHPVO) is a major cause of portal hypertension (PH) in children. Portal vein thrombosis (PVT) is the most common cause accounting for up to 75% of cases in developing countries. Upper gastrointestinal bleeding is the most dreaded and commonest presentation of portal hypertension. Successful treatment of paediatric PH, though challenging is performed in resource constraint countries. Cases: Five children presented over three years to a tertiary hospital in Ghana, with massive upper gastrointestinal bleeding. They had anaemia, thrombocytopaenia and four had splenomegaly. Liver function tests, INR, haemoglobin electrophoresis as well as HIV serology, hepatitis B and C screening were all normal. Abdominal doppler ultrasound scan confirmed portal vein thromboses. They were resuscitated and managed with octreotide, propranolol, antibiotics and sclerotherapy or oesophageal variceal banding in the acute setting and long term secondary prophylaxis with propranolol. Subsequently, an algorithm was developed to assist with the management of bleeding from oesophageal varices and the diagnosis of EHPVO. Conclusion: Portal hypertension due to EHPVO is an important cause of upper gastrointestinal (GI) bleeding in children. This can be successfully managed even in a resource constraint setting once the appropriate measures are taken.

Beta-blockers versus placebo or no intervention for primary prophylaxis of oesophageal varices in children

2015 ◽  
Author(s):  
Juan Cristóbal Gana ◽  
Lorena I Cifuentes ◽  
Jaime Cerda ◽  
Luis A Villarroel del Pino ◽  
Alfredo Peña ◽  
...  
Keyword(s):  
Beta Blockers ◽  
Primary Prophylaxis ◽  
Oesophageal Varices

Abstract 232: Medication Cost Savings Using an On-line Drug Discount Program

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Satish Munigala ◽  
Margaret Brandon ◽  
Zackary D Goff ◽  
Richard Sagall ◽  
Paul J Hauptman
Keyword(s):  
Enzyme Inhibitors ◽  
Beta Blockers ◽  
Angiotensin Receptor Blockers ◽  
Financial Burden ◽  
Cost Savings ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Medication Cost ◽  
Converting Enzyme Inhibitors ◽  
Entire Study ◽  
Assistance Programs

Objective: To evaluate the frequency of drug discount card utilization and to estimate cost savings associated with heart failure (HF) medication prescriptions. Methods: We conducted a retrospective study of all HF prescriptions filled through the NeedyMeds.org drug discount card program nationwide, from January 2009 to December 2016. We evaluated the frequency of drug discount card prescriptions (across pharmacy types, pharmacy location, by prescriber specialty and by drug class) and calculated cost savings (average per drug discount card and total program dollars saved) for entire study period and for each year (from 2009 to 2016). Findings: A total of 381,347 prescriptions for medications that can be used for HF with drug discount cards were identified during the study period (83.7% at national, 5.7% at regional and 9.8% at local pharmacies). Most prescriptions were filled at urban locations (89.1% in urban clusters, 7.6% in urbanized areas) and in ZIP-codes with lower median household income (65.5%). Angiotensin-converting enzyme inhibitors and selected angiotensin receptor blockers were the most prescribed drugs with discount cards (44.1%) followed by beta blockers (27.5%), diuretics (21.5%), and mineralocorticoid receptor agonists (3.9%). The number of HF prescriptions with drug discount cards increased from 2577 in 2009 to 64,750 in 2016. Increase in the number of prescriptions was also noted for all drug classes from 2009 to 2016. Overall 224,049 prescriptions for HF medications (59% of the total) benefited from the program resulting in total savings of $4,739,204 with a median cost saving of $9.30 (41.5%) per prescription. Conclusion: Use of a drug discount program resulted in cost savings on HF prescription medications (approximately $9 in savings per prescription) compared to the original cost charged by pharmacies. While these drug assistance programs may reduce financial burden, continued efforts should be made to improve adherence to medications and for better outcomes.

E*Trade Securities, Inc., Poineer Online Trader, Struggles to Stay on To

2011 ◽  
pp. 48-72
Author(s):  
Adam T. Elegant ◽  
Ramiro Montealegre
Keyword(s):  
Strategic Alliances ◽  
Mutual Fund ◽  
Stock Options ◽  
Cost Savings ◽  
Management Team ◽  
Fixed Costs ◽  
Price Leader ◽  
One Stop ◽  
Fierce Competition ◽  
And Control

E*Trade revolutionized the securities brokerage industry by “creating” Internet trading. E*Trade’s original strategy was to deliver cost savings to customers while amortizing fixed costs over a greater number of accounts. In 1997, several competitors established Internet sites and E*Trade was dethroned as the price leader. Its management team introduced a strategic initiative to transform the company into a financial, one-stop shop for investors. The initiative included expanding its information technology, improving its marketing and advertising program, and developing new strategic alliances. By early 1999, E*Trade had established a popular Web site offering the convenience and control of automated stock, options, and mutual fund order placement at low commission rates. E*Trade’s success pleased management but was challenged by fierce competition and emerging ethical and operational problems.

Development of a physiotherapy-led balance clinic: the Aintree model

2014 ◽  
Vol 128 (11) ◽  
pp. 966-971 ◽  
Author(s):  
A V Kasbekar ◽  
N Mullin ◽  
C Morrow ◽  
A M Youssef ◽  
T Kay ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Benign Paroxysmal Positional Vertigo ◽  
Waiting Times ◽  
Clinic Visit ◽  
Positional Vertigo ◽  
One Stop ◽  
Set Up ◽  
High Level ◽  
Referral Letters ◽  
Paroxysmal Positional Vertigo

AbstractObjective:To create a ‘one-stop’ clinic in which assessment, diagnosis, treatment and therapies for most patients presenting with balance and dizziness disorders are delivered simultaneously.Methods:Patients triaged via referral letters were selected to attend the balance clinic, which is led by specialist balance physiotherapists. Patients were seen by an audiologist, and a ‘balance’ ENT consultant was available for joint consultations when required. Further details of the clinic set up are discussed.Results:Over an 18-month period, 200 new ‘dizzy’ patients attended the clinic. Benign paroxysmal positional vertigo and labyrinthitis were the commonest diagnoses. Fifty per cent of all patients were discharged after a single clinic visit. Questionnaires showed that patient satisfaction was high.Conclusion:The physiotherapy-led balance clinic has reduced patient waiting times to be seen, has a high level of patient satisfaction and is economically beneficial.

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