Sleeve gastrectomy is the most common cause of Gastro-esophageal Reflux Disease in comparison with other bariatric operations

2021 ◽  
Author(s):  
majdi abu sneineh ◽  
malek abu sneineh ◽  
Monther Abu Sneineh ◽  
mustafa abu sneineh ◽  
muneer abu snineh ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Medical Center ◽  
Bariatric Procedure ◽  
P Value ◽  
Significant Difference ◽  
Symptomatic Gerd ◽  
Swallow Study ◽  
Contrast Swallow ◽  
Gerd Symptoms

Abstract Introduction GERD is one of the complications of bariatric operations that might affect the quality of life. We aim to perform a retrospective cohort study to determine the incidence of symptomatic GERD following different types of bariatric surgery and which operations are considered a contraindication of GERD. Besides, we are attempting to identify the risk factors of GERD after bariatric surgery. Methods Medical records of 729 patients undergone bariatric operations between January 2010 and June 2019 at Shamir (Assaf Harofeh) Medical Center were reviewed. Results There was a significant difference between the type of bariatric procedure and the incidence of GERD symptoms after the operation. The incidence of symptomatic GERD in patients who underwent SG was 39.9% (p =0.0131). This was significantly higher compared to 16.4% following roux en y gastric bypass, 23.4% following LAGB, and 11% following OAGB. 113 patients out of 718 had a positive swallow test and of these patient 71 developed GERD symptoms post-operatively without correlation to the degree of reflux at the swallow test but with statistically significant correlation to the type of operation especially for SG (P-value <0.001) and to our knowledge this was never reported in the literature. Conclusion SG is a good bariatric procedure option but should be contraindicated in asymptomatic reflux contrast swallow study and symptomatic GERD patients preoperatively because of high levels of symptomatic GERD post-operatively. Asymptomatic reflux at contrast swallow study pre-operatively should be considered a risk factor for GERD after the operation.

PERAN WARGA PEDULI AIDS CAHAYA CARE TUREN DALAM MENINGKATKAN KUALITAS HIDUP ODHA

2017 ◽  
Vol 3 (1) ◽  
Author(s):  
Tri Nurhudi Sasono
Keyword(s):  
Quality Of Life ◽  
Antiretroviral Drugs ◽  
P Value ◽  
People Living With Hiv ◽  
Purposive Sampling ◽  
Significant Difference ◽  
Development Goals ◽  
Living With Hiv ◽  
Hiv Aids

Abstract : Indicator of the health welfare through Sustanable Development Goals (SDGs) is to reduce the incidence of HIV-AIDS, decrease the rate of the epidemic and maintain the quality of life of people living with HIV-AIDS (PLWHA). Trend cases of HIV-AIDS is the most recent spread among people, especially housewives. In Malang until 2015 found 278 Housewife of 409 cases of AIDS. The prevalence of HIV-AIDS in Malang Regency is ranked second after Surabaya city in East Java. For the importance of public participation and citizen care AIDS Cahaya Care Turen take responsibility for the condition. Determination Rule Goverment number 2 2015 year on the Participation of the community response to HIV-AIDS in Malang as a legal rule. Concerned Citizens activities AIDS (WPA). WPA Cahaya Care Turen is increases HIV risk and quality of life PLWHA. The purpose of this study was to determine the role of Citizens AIDS Cahaya Care Quality of Care Turen against people living with HIV in Puskesmas Turen Malang. The study design using a quasi-experimental, with purposive sampling using a sampling technique. Total number of research subjects 23. Based on test results obtained with the Wilcoxon p value <0.005, which means that there is a significant difference before and after PLWHA joining participated in the WPA Cahaya Care Turen. The conclusion of this study is WPA activities involving people living with HIV and at risk groups can optimize compliance with antiretroviral drugs that have an impact on improving the quality of life of PLHIV. Suggestions in this research is done WPA Program activities are structured and ongoing cross-sector in order to improve the quality of life and empower PLWHA.Keywords : WPA Cahaya Care Turen, Quality of life, PLWHA Abstrak : Salah satu indikator kesejahteraan kesehatan melalui Sustanable Development Goals (SDGs) adalah menekan angka kejadian HIV-AIDS, menurunkan laju epidemik dan mempertahankan kualitas hidup Orang dengan HIV-AIDS (ODHA). Trend kasus HIV-AIDS terkini terbanyak adalah menjangkit dikalangan masyarakat khususnya pada ibu rumah tangga. Kabupaten Malang sampai dengan tahun 2015 ditemukan 278 Ibu Rumah Tangga dari 409 kasus AIDS. Prevalensi HIV-AIDS di Kabupaten Malang ini merupakan peringkat kedua di Jawa Timur setelah Kota Surabaya. Untuk itu pentingnya peran serta masyarakat dan warga peduli AIDS Cahaya Care Turen ikut bertanggung jawab terhadap kondisi tersebut. Penetapan Peraturan Bupati Malang no.2 th.2015 tentang Peran serta masyarakat penanggulangan HIV-AIDS di Kabupaten Malang diharapkan dapat mengurangi risiko penularan HIV dan meningkatkan kualitas hidup ODHA. Tujuan dari penelitian ini adalah untuk mengetahui Peran Warga Peduli AIDS Cahaya Care Turen terhadap Kualitas ODHA Di Wilayah Kerja Puskesmas Turen Kabupaten Malang. Desain penelitian menggunakan quasi eksperimen, dengan teknik sampling menggunakan purposive sampling. Jumlah subyek penelitian sejumlah 23. Berdasarkan hasil uji dengan Wilcoxon didapatkan nilai p value < 0.005 yang berarti bahwa terdapat perbedaan bermakna sebelum dan sesudah ODHA bergabung mengikuti kegiatan WPA Cahaya Care Turen. Kesimpulan dalam penelitian ini adalah kegiatan WPA dengan melibatkan ODHA dan kelompok beresiko dapat mengoptimalkan kepatuhan obat ART sehingga berdampak terhadap peningkatan kualitas hidup ODHA. Saran dalam penelitian ini adalah dilakukannya Program kegiatan WPA yang terstruktur dan berkesinambungan lintas sektor guna meningkatkan kualitas hidup dan memberdayakan ODHA.     Kata kunci : WPA Cahaya Care Turen, kualitas hidup, ODHA

scholarly journals Does Bariatric Surgery Improve Faecal Incontinence? A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Fardowsa Mohamed ◽  
Megna Jeram ◽  
Christin Coomarasamy ◽  
Melanie Lauti ◽  
Don Wilson ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Bariatric Surgery ◽  
Gastric Bypass ◽  
Faecal Incontinence ◽  
Meta Analysis ◽  
One Anastomosis Gastric Bypass ◽  
Significant Difference ◽  
Post Bariatric Surgery

Abstract Introduction Obesity increases the risk of pelvic floor disorders in individuals with obesity, including faecal incontinence. Faecal incontinence (FI) is a condition with important clinical and psychosocial consequences. Though it is associated with obesity, the effect of bariatric surgery on the prevalence and severity of FI is not well reported. Objective To assess the effect of bariatric surgery on the prevalence and severity of FI in adult patients with obesity. Methods This systematic review was conducted in accordance with the PRISMA statement. Two independent reviewers performed a literature search in MEDLINE, PubMed, Cochrane and Embase from 1 January 1980 to 12 January 2019. We included published English-language randomized control trials and observational studies assessing pre- and post-bariatric surgery prevalence or severity of FI. Random-effects models with DerSimonian and Laird’s variance estimator were used for meta-analysis. Results Thirteen studies were included, eight assessing prevalence (678 patients) and 11 assessing severity of FI (992 patients). There was no significant difference in prevalence post-operatively overall, though it trended towards a reduction [pooled OR=0.55; =0.075]. There was a significant reduction of FI prevalence in women post-bariatric surgery [95% CI 0.22 to 0.94, p=0.034]. There was a statistically significant reduction in FI prevalence following Roux-en-Y gastric bypass and one anastomosis gastric bypass [0.46, 95% CI 0.26 to 0.81; p=0.007]. There was no significant reduction of incontinence episodes post-operatively [pooled mean difference =−0.17, 95% CI −0.90 to 0.56; p=0.65]. Quality of life (QOL) was not significantly improved post-bariatric surgery [mean differences for the following facets of QOL: behaviour −0.35, 95% CI −0.94 to 0.24; depression 0.04, 95% CI −0.12 to 0.2; lifestyle −0.33, 95% CI −0.98 to 0.33; p values of 0.25, 0.61 and 0.33, respectively]. Discussion There was a significant reduction in FI prevalence in women and those who underwent Roux-en-Y or one anastomosis gastric bypass. Our results for FI prevalence overall, FI severity and impact on quality of life were not statistically significant. Larger studies are needed in this under-researched area to determine the true effect of bariatric surgery on FI. Graphical abstract

scholarly journals Quality of life of obstetrics fistula patients before and after surgical repair in the Jimma University Medical Center, Southwest Ethiopia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tilahun Fufa Debela ◽  
Zerihun Asefa Hordofa ◽  
Aster Berhe Aregawi ◽  
Demisew Amenu Sori
Keyword(s):  
Quality Of Life ◽  
Surgical Repair ◽  
Obstetric Fistula ◽  
Medical Center ◽  
Mean Value ◽  
Significant Difference ◽  
Before And After ◽  
The Mean ◽  
Jimma University

Abstract Background The consequences of obstetric fistula on affected women are more than the medical condition. It has extensive physical, psychological, social, and economic consequences on them. Obstetric fistula affects the entire health and entire life of women. Women suffering from obstetric fistula are often abandoned by her partner, relatives, and the community. This study aimed to determine the quality of life of obstetrics fistula patients before and after surgical repair. Methods Institutional-based prospective, before and after study design was conducted in the Jimma University Medical Center from November 1, 2019–October 30, 2020. A face-to-face interview was conducted with fistula patients who visited Jimma University Medical center, fistula clinic during the study period. All fistula patients were included in the study. Accordingly, 78 women who underwent surgical repair were interviewed. The means and the standard deviation were computed using conventional statistics formulas. The unpaired t-test was used to compare two independent means, and one-way analysis of variance (ANOVA) was used to compare the quality of life before repair and after a successful repair. Linear regression analysis was done for identifying determinants of quality of life. A P value of 0.05 will be considered statistical significance. Result The overall quality of life of women was 58.17 ± 7.2 before the surgical repair and 71.20 ± 10.79 after surgical repair. The result indicates there is a significant difference in the mean value of pre and post-operative (P < 0.001). The overall satisfaction of women with their health status before the surgical repair was 22.5 ± 1.30and it has increased to 53.0 ± .90after surgical repair. The physical health dimension score was 16.51 ± 5.27 before the surgical repair while it has increased to 21.77 ± 5.38 after the surgical repair. The score of the social domain before the surgical repair was 5.19 ± 1.34 and it has increased to 7.13 ± 3.67 after the surgical repair. The score of the environmental health domain was 17.41 ± 2.89 before the surgery while it also increased to 21.65 ± 4.04 after the surgical repair. The results have shown there was a significant difference in the mean values of pre and post-operatives in both social and environmental scores (P < 0.001). The score of the psychological health domain before the surgery was 19.06 ± 1.46 and it was increased to 19.84 ± 3.21 after the surgical repair. The result showed there is a significant difference in mean value pre and post-operative (P = 0.048), though it is a slight improvement compared to other domains. Conclusion The overall quality of life of the patient with fistula was improved after successful surgical repair. Although all domains of quality of life had shown significant improvement after successful surgical repair, the psychological domain showed slight improvement.

Do-It-Yourself Microsuture from Human Hair for Basic Microsurgical Training

2018 ◽  
Vol 35 (05) ◽  
pp. 315-321
Author(s):  
Pobe Luangjarmekorn ◽  
Pravit Kitidumrongsook ◽  
Sittisak Honsawek
Keyword(s):  
Human Hair ◽  
Statistical Difference ◽  
Smooth Curve ◽  
P Value ◽  
Excellent Quality ◽  
Likert Score ◽  
Significant Difference ◽  
Do It Yourself ◽  
Knot Security

Background Microsuture is an essential material for basic microsurgical training. However, it is consumable, expensive, and sometimes unavailable in the microsurgical laboratory. To solve this problem, we developed a microsuture made from human hair and needle gauge. Methods Do-It-Yourself (DIY) microsuture is made from human hair and needle gauge 32G (BD Ultra-Fine Pen Needles 4 mm × 32G). Methods are explained step by step. This DIY microsuture (labeled as “test microsuture”) and nylon 8–0 (Ethilon suture 8–0, labeled as “standard microsuture”) were used for teaching orthopaedic residents to perform arterial anastomosis in chicken thighs. All residents practiced without knowing that “test microsuture” was made from the DIY method. After completing the training, quality of both microsutures was evaluated by questionnaire in topics of (1) thread quality (size, strength, elasticity, handing, knot perform, and knot security), (2) needle quality (size, curve, shape, sharpness, handling, and strength), (3) needle–thread interface (size, strength, and smoothness), and (4) overall quality of microsuture. Each category was evaluated by Likert score (5 = excellent, 4 = good, 3 = fair, 2 = poor, and 1 = very poor). Results The DIY microsuture was performed in three steps: (1) insert human hair into needle gauge by microforceps, (2) bend needle into smooth curve, and (3) disconnect needle and create needle–hair interface. The questionnaire was completed by 30 orthopaedic residents and showed that thread quality of DIY and standard microsuture had “good” and “good-to-excellent” quality (mean Likert score: 3.77–4.23 and 3.80–4.27, respectively, with no statistical difference). Thread–needle interface quality of DIY and standard microsuture also had “good” and “good-to-excellent” quality (Likert score: 3.73–4.20 and 4.07–4.33, respectively, with no statistical difference). Needle part of DIY microsuture had lower quality than standard suture (fair-to-good compared with good-to-excellence quality, score 3.30–3.67 vs. 4.20–4.27, respectively, with a statistically significant difference, p-value < 0.05). However, overall quality of DIY suture and standard microsuture had “good” and “good-to-excellent” (mean Likert score: 3.73 and 4.00, respectively, with no statistical difference). Conclusion The DIY microsuture from human hair and needle gauge could be an alternative for basic microsurgical training with lower cost, easy production, and more availability for use in practice with acceptable quality compared with that of standard microsuture.

Morbidity and quality of life in patients with vulvar cancer after inguinal sentinel lymphadenectomy compared to radical inguinofemoral lymphadenectomy

2021 ◽  
Author(s):  
Fabinshy Thangarajah ◽  
Kristina Rogeé ◽  
Caroline Pahmeyer ◽  
Kathrin Kuhr ◽  
Matthias Schmidt ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Vulvar Cancer ◽  
Lymph Node Status ◽  
P Value ◽  
Sentinel Lymphadenectomy ◽  
Significant Difference ◽  
Inguinofemoral Lymphadenectomy

Abstract Aim Probability of survival of patients with vulvar cancer directly depends on the lymph node status. Surgery of lymph nodes can be performed as radical inguinofemoral lymphadenectomy or in cases with certain conditions as sentinel lymph node surgery. The aim of this study is to obtain an overview of the intervention-related morbidity and quality of life in patients with vulvar carcinoma after lymphadenectomy. Methods Quality of life and morbidity was compared between patients who underwent radical inguinofemoral lymphadenectomy with those who underwent sentinel lymph node surgery. Results All recorded postoperative complications occur more frequently in the non-sentinel group, Significant difference was shown for the occurrence of lymphedema (p-value = 0.024) and sensitivity loss (p-value = 0.024). Recurrence of disease was more frequent in the non-sentinel group (38 % vs. 20 %, p = 0.621, n.s.) and satisfaction with groin surgery is slightly higher in the sentinel group (94 % vs. 89 %, p = 1.000, n.s.). Conclusion We could demonstrate a significantly lower morbidity of sentinel lymphadenectomy compared to conventional inguinofemoral lymphadenectomy while maintaining the same oncological safety. The low morbidity of sentinel- lymphadenectomy does not seem to influence the postoperative quality of life significantly. However, recording of the individual burden of lymphadenectomy by questionnaires should be optimized.

Prevalence of Helicobacter Pylori Antibody among Outpatients of Federal Medical Center, Yenagoa, Niger Delta Region of Nigeria

2021 ◽  
Vol 8 (07) ◽  
pp. 5521-5527
Author(s):  
Dr Oluwayemisi Agnes Olorode ◽  
Ofonime M. Ogba ◽  
Williams E. Ebisin
Keyword(s):  
Helicobacter Pylori ◽  
Blood Test ◽  
Medical Center ◽  
P Value ◽  
World Population ◽  
Age Group ◽  
Test Kit ◽  
Significant Difference ◽  
Chi Square Analysis ◽  
Helicobacter Pylori Antibody

Helicobacter Pylori is the most common chronic bacterial infection (acquired early childhood) in humans affecting 50% of the world population and much attention has not been paid to this. This study was carried out between February and October 2019 to test for the presence of Helicobacter Pylori antibody among asymptomatic individuals attending Federal Medical Center, Yenagoa, Bayelsa State. A total of 200 {114(57%) males, 86(43%) females} blood samples were collected at ramdom into Ethylene diamine tetraacetic acid (EDTA) bottles and immediately transported to the laboratory for analysis using Helicobacter pylori Serology rapid blood test kit. Age was stratified to allow for comparison because the entire outcome was age dependent. Chi square analysis was conducted for the categorical variable. Findings showed that out of 200 samples examined, 88(44%) forty (40 (45%) males and 48(55%) females were positive to Helicobacter pylori infection while 112(56%) were negative. Females of age range 24 -33 had the highest prevalence of 24 (27%) while male of age group 14 to 23 had 21(24%); females of 34 to 44 was 16(18%); 54-63 had 4(05%) and the least was 44 to 53 years with prevalence of 3(03%).  There was a significant difference across the age group and socio-demographic characteristic at p-value = 0.0001 < 0.05 and p-value =0.002068 < 0.05, p-value = 0.000916 <0.05 respectively. Observations showed the higher prevalence in females (53%) than their males (47%) counterparts; likewise the infected individuals host this organism ignorantly and busy treating out of line.  Study with more than one diagnostic technique is recommended to determine the presence of Helicobacter pylori, as rapid blood test is limited due to the presence of antibody in the serum for long after eradication. In conclusion, routine medical examination on Helicobacter pylori is encouraged among individuals in respective of age and status.

Analisis Faktor Faktor yang berhubungan dengan Pelaksanaan Pendidikan Kesehatan Oleh Perawat di Ruang Rawat Inap RS PMC

2019 ◽  
Vol 10 (1) ◽  
pp. 17-23
Author(s):  
Awaliyah Ulfah Ayudytha Ezdha ◽  
Ummu Habibah ◽  
Dwi Elka Fitri
Keyword(s):  
Health Education ◽  
Discharge Planning ◽  
Medical Center ◽  
Cross Sectional Study ◽  
Hospital Length ◽  
P Value ◽  
Cross Sectional ◽  
Nursing Services ◽  
Optimal Health

ABSTRACT The hospital as a provider of health services in the form of maintaining and improving health and aims to achieve optimal health status for the community. One indicator of the quality of nursing services is whether the nursing services provided are satisfying the patient or not. One of the roles performed by nurses is to carry out health education in discharge planning for patients in the inpatient room. Health education is very important to be carried out by a nurse. The purpose of this study was to analyze the factors related to the implementation of health education by nurses in the Inpatient at PMC Hospital. The research design used is a quantitative method with analytic cross-sectional study design. This research was conducted at Pekanbaru Medical Center Hospital with a sample of 35 nurses on duty at the hospital according to inclusion criteria. From the results of the study found factors related to the implementation of health education by nurses in the inpatient room of the PMC Hospital : Length of Work (p value 0.010), Training attended (p value = 0,000) and Level of Knowledge (p value = 0.002). This means that factors related to the implementation of health education by nurses must be maintained and considered by management to improve the implementation of health education by nurses so that the quality of service and satisfaction can be improved.

scholarly journals Quality of Life in Children with Asthma versus Healthy Children

2018 ◽  
Vol 6 (8) ◽  
pp. 1413-1418 ◽  
Author(s):  
Samaneh Kouzegaran ◽  
Parisa Samimi ◽  
Hamid Ahanchian ◽  
Maryam Khoshkhui ◽  
Fatemeh Behmanesh
Keyword(s):  
Quality Of Life ◽  
Physical Performance ◽  
Control Group ◽  
P Value ◽  
Healthy Children ◽  
Significant Difference ◽  
Children With Asthma ◽  
And Performance ◽  
Asthma Group

BACKGROUND: Asthma is the most prevalent chronic disease in the pediatric age group. The disease affects different aspects of the children's lives, such as physical, emotional, social and educational aspects. Thus, more focus has been on the quality of life in these patients rather than the duration of their illness in recent years.AIM: This study examined the different aspects of quality of life in asthmatic children for the first time in this geographic area.METHODS: The study was cross-sectional conducted in 2015-2016. The asthmatic group was 100 patients aged 8 to 12 admitted to the Asthma and Allergy Clinic of Ghaem Hospital (as) in Mashhad with the control group composed of 100 healthy children of the same age and gender. The standard questionnaire pedsQLTM was used for comparing the quality of life of children in the two groups. Statistical analysis was SPSS23 with P-value less than 0.05, which was statistically significant.RESULTS: In each group, 58 patients were boys, and 42 were girls. In a comparison of the quality of life of children, the asthma group with a mean total score of Peds QL 20.99 ± 12.54 compared to the healthy children with a mean total score of Peds QL of 8.8 ± 5.41 had a lower quality of life (P < 0.001). Moreover, regarding various aspects of quality of life asthma group had a lower quality of life in physical performance, emotional performance and performance in school (P < 0.001). Nonetheless, there was no significant difference between the two groups considering social function (P = 0.267). Examining the relationship between Peds QL score of patients with asthma with various variables was indicative of the fact that Peds QL scores were significantly correlated with the gender of the patients, showing better quality of life in the girls (P = 0.001).CONCLUSION: The results indicated that children with asthma have a significantly lower quality of life compared with healthy children of the same age. Also, in examining the different aspects of quality of life, these children had a lower quality of life in physical performance, emotional performance, and performance at school, and were at the level as that of healthy children only in social performance.

P025 THE PRIOR AUTHORIZATION PREDICAMENT: AN EVALUATION OF TIME TO INITIATION OF BIOLOGIC TREATMENT IN IBD PATIENTS

2020 ◽  
Vol 26 (Supplement_1) ◽  
pp. S56-S57
Author(s):  
Vinay Rao ◽  
Scott Baumgartner ◽  
Danielle Kirelik ◽  
Katherine Negreira ◽  
Jessica Gibilisco ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Medical Center ◽  
Wait Time ◽  
Indeterminate Colitis ◽  
Prior Authorization ◽  
Biologic Treatment ◽  
Patient Demographics ◽  
Time To Initiation ◽  
Significant Difference

Abstract Background Biologics are a mainstay in the treatment of moderate-severe IBD. Unlike other IBD medications, biologics typically require prior authorization from insurance providers. There is a paucity of information characterizing the length of the authorization process. Delays in the initiation of biologic therapy have the potential to impact clinical outcomes and quality of life. This study identified the time of biologic prescription and subsequent time for authorization and time of administration at a university medical center. Methods A chart review evaluating IBD patients seen in the GI clinic of a university medical center over a 5-year period was performed. Patient age, gender, race, IBD diagnosis, and biologic use were recorded in a confidential database generated using Microsoft Excel. Biologic agents evaluated included infliximab, adalimumab, vedolizumab and ustekinumab. The agreed upon date (AUD) of starting a biologic, length of time to approval (TTA), and length of time to first infusion (TFI) were recorded. TTA was set as the number of days between agreeing to start a biologic and prior authorization approval. TFI was set as the number of days between agreeing to start a biologic and their first infusion or injection. Patients were excluded if biologic was initiated at another institution or documentation of AUD or TFI was not apparent. Statistical analysis was performed using a t-test with significance set at p&lt;0.05. The study was approved by the institutional IRB. Results 458 total IBD patients were analyzed. 66 are currently being treated with a biologic (32 infliximab, 14 adalimumab, 13 vedolizumab, 7 ustekinumab). 37 patients had ulcerative colitis, 27 Crohn’s disease, and 2 indeterminate colitis. There were 38 men and 28 women (mean age 43.2 years; range 23–76). 32 patients were white, 26 African American, 1 Asian, 5 other/unknown, and 2 declined. Average TTA was 30.5 days (range 1–145) and average TFI was 45.3 days (range 2–166). There was no significant difference in TFI between a specific biologic compared to all others: infliximab (p=0.615), adalimumab (p=0.183), vedolizumab (p=0.804), ustekinumab (p=0.812). There were no significant differences in TFI with regard to gender (p=0.562), race (p=0.575), or IBD diagnosis (p=0.209). Discussion In IBD patients with an indication for biologic treatment, reducing the time to initiation of biologics can result in improved patient outcomes and quality of life. Average wait time for first infusion at our institution was 43.5 days with no difference based on the type of biologic or patient demographics. While a national benchmark does not exist for initiating patients on biologics, there is a need for continued evaluation of the authorization and treatment processes. As new biologic therapies for IBD become available, streamlining the approval process will be of increasing importance.

The utility of HCC screening among cirrhotics

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15108-15108
Author(s):  
P. Niravath ◽  
T. Hayes ◽  
S. Hilsenbeck
Keyword(s):  
Statistical Analysis ◽  
Medical Center ◽  
Treatment Options ◽  
Hepatocellular Cancer ◽  
Veterans Affairs ◽  
P Value ◽  
Cancer Stage ◽  
Stage At Diagnosis ◽  
American Population ◽  
Significant Difference

15108 Background: Screening known cirrhotics for hepatocellular cancer (HCC) has long been a contentious topic. Studies to date have failed to conclusively prove or disprove the validity of AFP and hepatic ultrasound as screening mechanisms for HCC among cirrhotics, particularly in the American population. It is not clear whether these screening mechanisms provide any benefit in terms of reduced morbidity and mortality. Methods: The study examined all cirrhotics who developed HCC at the Houston Veterans Affairs Medical Center between 1999 and 2005. Those who were screened with AFP and/or imaging (either ultrasound, triphasic liver protocol CT, or MRI) were compared to those patients who were not screened at all. The screened and unscreened patients were compared in terms of Barcelona Clinic Liver Cancer Stage (BCLC) at the time of diagnosis. Results: Statistical analysis revealed a significant difference between the screened and unscreened groups in terms of BCLC stage at diagnosis, with the unscreened group being diagnosed at later stages than the screened group. Of the 155 patients observed, 26 were appropriately screened, and 129 were not. The BCLC stages at diagnosis for the two groups are shown in the table . The different trend in the two groups was found to be statistically significant with a p-value of 0.004. Furthermore, among the screened group, no particular method of screening (AFP vs. imaging vs. combination) was shown to be superior to another. Conclusions: Screening for HCC among cirrhotics using AFP and/or imaging every 6 months does correlate with HCC diagnosis at an earlier BCLC stage, thus portending better treatment options and improved prognosis. Therefore, screening all known cirrhotics for HCC may lead to decreased mortality. [Table: see text] No significant financial relationships to disclose.

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