Level of fellowship training increases adenoma detection rates.

BACKGROUND & AIMS: The adenoma detection rate (ADR) is critical to the success of colonoscopy for colorectal cancer screening. The effects of involving gastroenterology fellows in screening colonoscopies are uncertain. We assessed the effects of gastroenterology fellow participation on ADR and whether outcomes vary with year of fellowship training. METHODS: We performed a retrospective review of all average-risk screening colonoscopies performed from April 2005-April 2007 at the University of Colorado Hospital. A gastroenterology attending physician alone performed 2895 colonoscopies; 699 were performed by a gastroenterology fellow supervised by an attending physician. Statistical analyses of polyp, adenoma, and advanced adenoma (or cancer) detection were performed by using logistic regression. RESULTS: The ADR was significantly higher (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.10-1.59) among colonoscopies that included a gastroenterology fellow compared with those performed by only a gastroenterology attending physician. Similarly, the polyp detection rate was higher (OR, 1.28; 95% CI, 1.08-1.52) among colonoscopies involving a gastroenterology fellow. There was no difference in the detection of advanced adenomas or cancers (OR, 1.05; 95% CI, 0.77-1.44) among colonoscopies involving a gastroenterology fellow. The ADR differed greatly by year of training. Compared with colonoscopies performed by an attending gastroenterologist alone, the ADR increased with each year of training: OR, 0.89 (95% CI, 0.66-1.22) for first-year fellows; OR, 1.31 (95% CI, 0.89-1.93) for second-year fellows; and OR, 1.70 (95% CI, 1.33-2.17) for third-year fellows. CONCLUSIONS: Involvement of fellows in screening colonoscopies increases the ADR, primarily because of the increased ADR in procedures involving third-year gastroenterology fellows.

The role of parenteral nutrition in acute leukemia.

Patients with acute leukemia who undergo hematopoietic stem cell transplantation (HSCT) are susceptible to malnutrition caused by several factors including intensive cytotoxic therapy. This paper discusses the significance of malnutrition in these patients and provides an overview of nutrition therapy by the oral, enteral, and parenteral routes. The goal is to investigate whether the use of parenteral nutrition (PN) produces improved clinical outcomes in patients with acute leukemia and to identify criteria for the selection of patients most likely to benefit from this therapy. Although PN may be appropriate for patients suffering from complications such as graft-versus-host disease (GVHD) and mucositis, the data available at this time do not support PN as first-line therapy for all recipients of HSCT.