Once-daily omeprazole/sodium bicarbonate heals severe refractory reflux esophagitis with morning or nighttime dosing.

BACKGROUND: Morning dose or twice-daily proton pump inhibitor (PPI) use is often prescribed to heal severe reflux esophagitis. AIM: Compare the effect of single dose morning (control arm) versus nighttime (experimental arm) omeprazole/sodium bicarbonate (Zegerid(®)) (IR-OME) on esophagitis and gastroesophageal reflux symptoms. METHODS: Adult outpatients with Los Angeles grade C or D esophagitis were allocated to open-label 40 mg IR-OME once a day for 8 weeks in a prospective, randomized, parallel design, single center study. Esophagogastroduodenoscopy (EGD) and validated self-report symptom questionnaires were completed at baseline and follow-up. Intention-to-treat and per-protocol analyses were performed. RESULTS: Ninety-two of 128 (72 %) eligible subjects participated [64 (70 %) male, mean age 58 (range 19-86), median BMI 29 (range 21-51), 58 C:34 D]. Overall, 81 (88 %) subjects healed [n = 70 (76 %)] or improved [n = 11 (12 %)] erosions. There was no significant difference (morning vs. night) in mucosal healing [81 vs. 71 %, (p = 0.44)] or symptom resolution [heartburn (77 vs. 65 %, p = 0.12), acid regurgitation (82 vs. 73 %, p = 0.28)]. Prevalence of newly identified Barrett's esophagus was 14 % with half diagnosed only after treatment. CONCLUSIONS: Once-daily IR-OME (taken morning or night) effectively heals severe reflux esophagitis and improves GERD symptoms. Results support the clinical practice recommendation to repeat EGD after 8 weeks PPI therapy in severe esophagitis patients to assure healing and exclude Barrett's esophagus.

Provider satisfaction with virtual specialist consultations in a family medicine department.

Virtual consultations (VCs) are being ordered by primary care physicians in 1 large multispecialty clinic, replacing face-to-face visits with specialists. Virtual consultations involve electronic communication between physicians, including exchanging medical information. The purpose of this study was to assess provider satisfaction with VCs via e-mail survey. Although approximately 30% of the 56 family medicine providers had not tried the VC system after it had been in place for over a year or said that they often forgot that VCs were an option, most of the providers surveyed (73%) felt that VCs provided good medical care. A majority felt that VCs are a cost-effective and efficient tool for our department (65%). Most specialists (81%) reported that VCs were an efficient use of their time, and 67% said that VCs were less disruptive than contacts by telephone or pager. Only 5% felt that VCs do not provide good medical care. Although several of our primary care providers have been enthusiastic about VCs, others have been reluctant to adopt this innovation. Specialists providing VCs tended to be supportive. This illustrates both the difficulty of incorporating e-health innovations in primary care practice and the potential for increased efficiency.

Validity of overall self-rated health as an outcome measure in small samples: a pilot study involving a case series.

OBJECTIVE: A single-item measure of overall self-rated health (SRH) commonly is used in population surveys, but has not been used in small pilot projects. The purpose of this study was to assess the validity of SRH in small samples. DESIGN: We used data from a prospective, observational weight-loss project to compare change in SRH with change in body weight and physical activity (PA) (minutes) over 30 days (n = 34). Body mass index at baseline ranged from 25.5 to 50.4 (mean = 36.1, median = 34.6). SRH was self-assessed using the following question: How would you rate your health overall? Results An increase in weight was associated with a reduction in SRH (r = 0.37, P = 0.03). An increase in PA was associated with improved SRH (r = 0.39, P = 0.02). CONCLUSIONS: A single-item SRH measure may be an efficient method for measuring programme outcomes, and may also be useful for comparing the relative effectiveness of different programmes in pilot projects and quality improvement studies.

Obesity and symptom burden in family medicine patients.

BACKGROUND: Medical visits are initiated by patients in search of symptom relief. The extent to which obesity independently increases the risk of common symptoms is unknown. OBJECTIVES: To assess how obesity affects symptom burden among family medicine patients, after adjustment for severity of illness, via retrospective analysis of electronic medical records pertaining to 1738 adult family medicine patients treated in a large family medicine department in Rochester, Minnesota, USA. METHODS: A symptom index was used to measure symptom burden. Body mass index (BMI; kg/m) was measured during clinic visits. Multiple logistic regression analysis was used to test for an independent relationship between BMI category and the presence of three or more common symptoms. RESULTS: Adjusting for co-morbidity and other confounders using multiple logistic regression analysis revealed that having a BMI ≥35 kg/m was independently related to symptom burden (adjusted odds ratio [OR] = 1.80; 95% CI 1.24, 2.63). Patients with low and moderate co-morbidities (as measured by the Charlson Co-morbidity Index) also had higher odds of reporting more symptoms (OR = 1.60; 95% CI 1.17, 2.17 and OR = 1.87; 95% CI 1.36, 2.56, respectively). Symptom burden increased with age. Odds of having three or more symptoms were lower for married patients (OR 0.63; 95% CI 0.47, 0.83). CONCLUSIONS: In our sample of family medicine patients, increased symptom burden may be associated with a BMI ≥35 kg/m. Lower levels of obesity do not appear to be related to symptom burden.

Accuracy of rapid strep testing in patients who have had recent streptococcal pharyngitis.

BACKGROUND: Some clinicians have questioned the accuracy of rapid diagnosis of group A streptococcal pharyngitis by commercial immunochemical antigen test kits in the setting of recent streptococcal pharyngitis, believing that the false-positive rate was increased because of presumed antigen persistence. METHODS: We studied 443 patients--211 cases--who had clinical pharyngitis diagnosed as group A beta-hemolytic streptococcus infection in the past 28 days and compared them with 232 control patients who had symptoms of pharyngitis but no recent diagnosis of streptococcal pharyngitis. Our aim was narrowly focused to compare the rapid strep test with the culture method we used in our clinical practice. RESULTS: We found that the rapid strep test in this setting showed no difference in specificity (0.96 vs 0.98); hence, the assertion that rapid antigen testing had higher false-positive rates in those with recent infection was not confirmed. We also found that in patients who had recent streptococcal pharyngitis, the rapid strep test appears to be more reliable (0.91 vs 0.70, P < .001) than in those patients who had not had recent streptococcal pharyngitis. CONCLUSIONS: The findings of this study indicate that the rapid strep test is both sensitive and specific in the setting of recent group A beta-hemolytic streptococcal pharyngitis, and its use might allow earlier treatment in this subgroup of patients.