Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 12.606
Filtrar
1.
Am J Gastroenterol ; 119(7): 1235-1271, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38958301

RESUMO

Focal liver lesions (FLLs) have become an increasingly common finding on abdominal imaging, especially asymptomatic and incidental liver lesions. Gastroenterologists and hepatologists often see these patients in consultation and make recommendations for management of multiple types of liver lesions, including hepatocellular adenoma, focal nodular hyperplasia, hemangioma, and hepatic cystic lesions including polycystic liver disease. Malignancy is important to consider in the differential diagnosis of FLLs, and healthcare providers must be familiar with the diagnosis and management of FLLs. This American College of Gastroenterology practice guideline uses the best evidence available to make diagnosis and management recommendations for the most common FLLs.


Assuntos
Adenoma de Células Hepáticas , Cistos , Hiperplasia Nodular Focal do Fígado , Hemangioma , Hepatopatias , Neoplasias Hepáticas , Humanos , Hiperplasia Nodular Focal do Fígado/diagnóstico , Hiperplasia Nodular Focal do Fígado/patologia , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/terapia , Neoplasias Hepáticas/diagnóstico por imagem , Hepatopatias/diagnóstico , Hepatopatias/terapia , Hepatopatias/diagnóstico por imagem , Hepatopatias/patologia , Hemangioma/diagnóstico , Hemangioma/terapia , Hemangioma/patologia , Hemangioma/diagnóstico por imagem , Cistos/diagnóstico , Cistos/diagnóstico por imagem , Cistos/patologia , Adenoma de Células Hepáticas/diagnóstico , Adenoma de Células Hepáticas/patologia , Adenoma de Células Hepáticas/terapia , Adenoma de Células Hepáticas/diagnóstico por imagem , Diagnóstico Diferencial , Gastroenterologia/normas , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/terapia , Carcinoma Hepatocelular/diagnóstico por imagem
2.
Am J Gastroenterol ; 119(3): 417, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38995292

RESUMO

Article Title: The Role of Imaging for GI Bleeding: Consensus Recommendations From the American College of Gastroenterology and Society of Abdominal Radiology.


Assuntos
Gastroenterologia , Hemorragia Gastrointestinal , Humanos , Gastroenterologia/educação , Consenso , Educação Médica Continuada
3.
Am J Gastroenterol ; 119(3): 590, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38995294
4.
Am J Gastroenterol ; 119(3): 418, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38995293

RESUMO

Article Title: American College of Gastroenterology Guidelines: Management of Acute Pancreatitis.


Assuntos
Gastroenterologia , Pancreatite , Humanos , Pancreatite/terapia , Gastroenterologia/educação , Educação Médica Continuada/métodos , Estados Unidos , Doença Aguda
10.
J Med Internet Res ; 26: e48092, 2024 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-38833695

RESUMO

BACKGROUND: Asynchronous outpatient patient-to-provider communication is expanding in UK health care, requiring evaluation. During the pandemic, Aberdeen Royal Infirmary in Scotland expanded its outpatient asynchronous consultation service from dermatology (deployed in May 2020) to gastroenterology and pain management clinics. OBJECTIVE: We conducted a mixed methods study using staff, patient, and public perspectives and National Health Service (NHS) numerical data to obtain a rounded picture of innovation as it happened. METHODS: Focus groups (3 web-based and 1 face-to-face; n=22) assessed public readiness for this service, and 14 interviews with staff focused on service design and delivery. The service's effects were examined using NHS Grampian service use data, a patient satisfaction survey (n=66), and 6 follow-up patient interviews. Survey responses were descriptively analyzed. Demographics, acceptability, nonattendance rates, and appointment outcomes of users were compared across levels of area deprivation in which they live and medical specialties. Interviews and focus groups underwent theory-informed thematic analysis. RESULTS: Staff anticipated a simple technical system transfer from dermatology to other receptive medical specialties, but despite a favorable setting and organizational assistance, it was complicated. Key implementation difficulties included pandemic-induced technical integration delays, misalignment with existing administrative processes, and discontinuity in project management. The pain management clinic began asynchronous consultations (digital appointments) in December 2021, followed by the gastroenterology clinic in February 2022. Staff quickly learned how to explain and use this service. It was thought to function better for pain management as it fitted preexisting practices. From May to September 2022, the dermatology (adult and pediatric), gastroenterology, and pain management clinics offered 1709 appointments to a range of patients (n=1417). Digital appointments reduced travel by an estimated 44,712 miles (~71,956.81 km) compared to the face-to-face mode. The deprivation profile of people who chose to use this service closely mirrored that of NHS Grampian's population overall. There was no evidence that deprivation impacted whether digital appointment users subsequently received treatment. Only 18% (12/66) of survey respondents were unhappy or very unhappy with being offered a digital appointment. The benefits mentioned included better access, convenience, decreased travel and waiting time, information sharing, and clinical flexibility. Overall, patients, the public, and staff recognized its potential as an NHS service but highlighted informed choice and flexibility. Better communication-including the use of the term assessment instead of appointment-may increase patient acceptance. CONCLUSIONS: Asynchronous pain management and gastroenterology consultations are viable and acceptable. Implementing this service is easiest when existing administrative processes face minimal disruption, although continuous support is needed. This study can inform practical strategies for supporting staff in adopting asynchronous consultations (eg, preparing for nonlinearity and addressing task issues). Patients need clear explanations and access to technical support, along with varied consultation options, to ensure digital inclusion.


Assuntos
Grupos Focais , Satisfação do Paciente , Humanos , Escócia , Masculino , Adulto , Feminino , Satisfação do Paciente/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Pessoa de Meia-Idade , Internet , Medicina Estatal , COVID-19 , Dermatologia/métodos , Dermatologia/estatística & dados numéricos , Assistência Ambulatorial/estatística & dados numéricos , Assistência Ambulatorial/métodos , Manejo da Dor/métodos , Manejo da Dor/estatística & dados numéricos , Gastroenterologia/estatística & dados numéricos , Gastroenterologia/métodos , Idoso
12.
Hepatology ; 80(1): 1-2, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38896074
15.
Am J Gastroenterol ; 119(3): 438-449, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38857483

RESUMO

Gastrointestinal (GI) bleeding is the most common GI diagnosis leading to hospitalization within the United States. Prompt diagnosis and treatment of GI bleeding is critical to improving patient outcomes and reducing high healthcare utilization and costs. Radiologic techniques including computed tomography angiography, catheter angiography, computed tomography enterography, magnetic resonance enterography, nuclear medicine red blood cell scan, and technetium-99m pertechnetate scintigraphy (Meckel scan) are frequently used to evaluate patients with GI bleeding and are complementary to GI endoscopy. However, multiple management guidelines exist which differ in the recommended utilization of these radiologic examinations. This variability can lead to confusion as to how these tests should be used in the evaluation of GI bleeding. In this document, a panel of experts from the American College of Gastroenterology and Society of Abdominal Radiology provide a review of the radiologic examinations used to evaluate for GI bleeding including nomenclature, technique, performance, advantages, and limitations. A comparison of advantages and limitations relative to endoscopic examinations is also included. Finally, consensus statements and recommendations on technical parameters and utilization of radiologic techniques for GI bleeding are provided.


Assuntos
Hemorragia Gastrointestinal , Humanos , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/diagnóstico , Consenso , Estados Unidos , Gastroenterologia/normas , Sociedades Médicas , Diagnóstico por Imagem/métodos , Diagnóstico por Imagem/normas , Endoscopia Gastrointestinal
16.
Rev Esp Enferm Dig ; 116(7): 363-368, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38835233

RESUMO

The Asociación Española de Pancreatología (AESPANC), Asociación Española de Gastroenterología (AEG), and Sociedad Española de Patología Digestiva (SEPD) have developed a consensus document on the standards and recommendations they consider essential for the organization of pancreas units (PUs) within gastroenterology services (GSs) in order to conduct their activities in an efficient, high-quality manner. The consensus document defines PUs and lays down standards relating to their organization, structure, service portfolio, processes, and teaching and research activities. Standards have been categorized as mandatory (requirements to be met to qualify for certification by the scientific societies responsible for the standards) or recommendations. Standards should be updated at most within five years based on the experience gained in Spanish PUs and the advance of knowledge regarding pancreas disease. Development of health outcome indicators, including patient-reported outcome measures (PROMs), is considered a relevant challenge, as is evidence on the association of PU structure and activity standards with health outcomes.


Assuntos
Gastroenterologia , Assistência Centrada no Paciente , Humanos , Gastroenterologia/normas , Gastroenterologia/organização & administração , Assistência Centrada no Paciente/normas , Assistência Centrada no Paciente/organização & administração , Pancreatopatias/terapia , Espanha
18.
Acta Paediatr ; 113(8): 1965-1971, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38850099

RESUMO

AIM: Although sexual health (SH) impairment and sexually transmitted infections (STI) are occasionally encountered in patients with inflammatory bowel disease (IBD), paediatric gastroenterologists (PedGI) do not often discuss these issues. Literature about SH in the paediatric IBD population is limited. We aimed to assess PedGI knowledge and common practice related to sexual advice and STI workups in patients with IBD. METHODS: A questionnaire comprising 25 questions addressing sexual activity in youth, SH, recommendations, and workup for STI in adolescents with IBD was sent to all registered PedGI in Israel. RESULTS: Fifty-two physicians completed the questionnaire (27 males,52%). Only 50% correctly predicted the mean age that Israeli youth start practicing sex. Seventy-five per cent responded that providers should discuss sexual activity with their patients, but only 19% do so, most often in response to a patient's query. Ninety six percent answered that they do not have enough knowledge about SH in IBD. Finally, only 2% obtain rectal swabs for STI in patients with refractory proctitis. CONCLUSION: Sexual issues and recommendations are not routinely discussed by the majority of PedGI in paediatric IBD clinics. Providers should obtain more knowledge in the field and initiate discussion of these issues with adolescent patients with IBD.


Assuntos
Doenças Inflamatórias Intestinais , Saúde Sexual , Humanos , Adolescente , Masculino , Doenças Inflamatórias Intestinais/complicações , Feminino , Padrões de Prática Médica/estatística & dados numéricos , Infecções Sexualmente Transmissíveis , Gastroenterologistas , Inquéritos e Questionários , Israel , Pediatria , Comportamento Sexual , Gastroenterologia
20.
BMC Health Serv Res ; 24(1): 752, 2024 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-38902682

RESUMO

BACKGROUND & AIM: Smoking is a major risk factor for multiple gastrointestinal cancers, and adversely affects peptic ulcer disease, gastroesophageal reflux, pancreatitis and Crohn's disease. Despite key recommendations for diagnosing and treating tobacco use disorder in healthcare settings, the degree to which this is implemented in Gastroenterology (GI) clinics is unknown. We aimed to assess our providers' practices, identify barriers for implementing evidence-based smoking cessation treatments, and address these barriers by implementing a novel low-burden point of care Electronic health record-enabled evidence-based tobacco treatment (ELEVATE), in GI clinics. METHODS: An online survey was distributed to clinic gastroenterologists. ELEVATE module training was implemented in 1/2021. Data were evaluated during pre (7/2020-12/2020) and post (1/2021-12/2021) implementation periods to evaluate the reach and effectiveness of ELEVATE. Generalized estimating equations (GEE) were used to generate rate ratios (RR) to evaluate the intervention. RESULTS: 91% (20/22) of GI physicians responded to our survey, and only 20% often assisted patients who smoke with counseling. Lack of a systematic program to offer help to patients was reported by 80% of providers as an extremely/very important barrier limiting their smoking cessation practices. The proportion of current patients who smoke receiving cessation treatment increased from pre-ELEVATE to post-ELEVATE (14.36-27.47%, RR = 1.90, 95% CI 1.60-2.26, p < .001). Post-ELEVATE, 14.4% (38/264) of patients with treatment quit smoking, compared to 7.9% (55/697) of patients without treatment (RR = 1.89, 95% CI 1.26-2.82, p = .0021). CONCLUSION: Smoking practices are frequently assessed in GI clinics but barriers limiting cessation treatment exist. The use of a low burden point of care EHR enabled smoking cessation treatment module has led to a significant improvement in the treatment of smoking and subsequent cessation in our clinics. This study sheds light on an often under-recognized source of morbidity in GI patients and identifies an efficient, effective, and scalable strategy to combat tobacco use and improve clinical outcomes in our patients.


Assuntos
Sistemas Automatizados de Assistência Junto ao Leito , Abandono do Hábito de Fumar , Humanos , Abandono do Hábito de Fumar/métodos , Masculino , Feminino , Gastroenterologia , Pessoa de Meia-Idade , Adulto , Inquéritos e Questionários , Registros Eletrônicos de Saúde , Padrões de Prática Médica/estatística & dados numéricos , Tabagismo/terapia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...