Study: Certain Gastroenterologists Likely To Skimp On Biopsy Samples

Unfortunately, not all physicians follow these guidelines, and a new study points to one possible reason. The study , performed by U.S.-based clinicians and published by the European Journal of Gastroenterology & Hepatology, used a large national database to identify all adults who had endoscopies and biopsies for celiac disease between 2006 and 2009. The researchers then analyzed those cases, which involved more than 92,000 people, to determine whether gastroenterologists who performed more endoscopies than the average tended to take fewer samples of the intestinal lining during each procedure. As it turned out, gastroenterologists with a higher procedure volume — in other words, who performed lots of endoscopies — did take fewer intestinal samples. Meanwhile, the study also found that gastroenterologists who worked more closely with other members of their medical specialty tended to take more samples, possibly because of peer-to-peer education. The authors note that most cases of celiac remain undiagnosed in the U.S., in part because too few physicians follow the guidelines calling for at least four samples of the intestinal lining. The moral of this story? If you’re undergoing celiac disease testing , try to choose a gastroenterologist who doesn’t perform tons of endoscopies, or one who works in concert with other gastroenterologists. And, stress during your pre-procedure visit that you expect the gastroenterologist to take at least four samples of your small intestine. Keep up with the latest in the celiac disease/gluten sensitivity world — sign up for my newsletter , connect with me on Facebook and Google+ , or follow me on Twitter – @AboutGlutenFree . Photo Getty Images/Rob Melnychuk

article source http://celiacdisease.about.com/b/2013/09/18/study-certain-gastroenterologists-likely-to-skimp-on-biopsy-samples.htm

Many Gastroenterologists Unaware of Appropriate Immunizations for IBD Patients

According to the studies’ authors, many IBD patients are not being vaccinated appropriately. One thousand gastroenterologists, randomly selected from the membership of the American College of Gastroenterology, were asked to complete a 19-question electronic survey regarding suitable vaccines for the immune-competent and immunosupressed IBD patient and the barriers to recommending the vaccines. The researchers also assessed the perceived role of the gastroenterologist versus the PCP. The researchers analyzed 108 responses and found only 56 (52 percent) of the gastroenterologists took an immunization history most or all of the time. There was no significant difference between gastroenterologists with smaller practices (less than 40 IBD patients) compared with those with larger practices (greater than 40 IBD patients) in how often they asked their patients about immunization history. In contrast, more academic physicians (67.5 percent) asked their patients about immunization history most or all of the time compared to 42.4 percent of private physicians. Sixty-nine (64 percent) of the respondents thought the PCP was responsible for determining which vaccinations to administer to the IBD patient and ninety (83 percent) believed the PCP was responsible for administering the vaccine. Sixteen of the 108 surveyed gastroenterologists did not regularly recommend immunization against influenza. The most common reasons included “too busy/forgot,” “no specific reason,” and “did not know my patient needed it.” In addition, the researchers found 20 to 30 percent of gastroenterologists would erroneously recommend any of the three queried live, attenuated vaccines (MMR, herpes zoster, varicella) to their immune-suppressed IBD patient. In addition, 24 to 35 percent of gastroenterologists would incorrectly not give the three queried live, attenuated vaccinations to their immune-competent patients. Of the inactivated vaccines, knowledge regarding the HPV vaccine was particularly poor, with only 71 (66 percent) recommending the vaccine to their immune-competent patients and only 51 (47 percent) recommending the vaccine to their immune-suppressed patients). In general, gastroenterologists were more likely to make the correct vaccine recommendations for their immunocompetent IBD patients. “Gastroenterologist knowledge of the appropriate immunizations to recommend to the IBD patient is limited and may be the primary reason why the majority of gastroenterologists believe that the PCP should be responsible for vaccinations,” said primary author Sharmeel Wasan, MD, MSc, an assistant professor of medicine at BUSM and a gastroenterologist at BMC. Over the last five years, the problem of vaccine preventable illnesses in patients with IBD have been described, including case reports of fulminant hepatitis and fatal varicella.

web link http://www.sciencedaily.com/releases/2011/05/110516121730.htm

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Doctor Who – A Global Phenomenon: Part 1 Australia

doctor-who-strax-australia

It wasnt only An Unearthly Child that debuted on the 23rd of November, but also the famous music that would accompany every Doctor Who episode for the next 50 years and beyond the Doctor Who theme song, which in its most original version was written by Australian musician Ron Grainer. His music has gone on to inspire the likes of Who legends Courtney Pine and Murray Gold. Australia also is home to classic series companion Tegan Jovanka, played by Aussie actress Janet Fielding. So, so far, what can we attribute to an Aussie?? The script of the first televised episode The relationship between the Doctor and his very first companion The Police Box exterior of the TARDIS And the historic Doctor Who theme song! Outside the production itself, the Australian Broadcasting Company (or the ABC for short), which is still the current primary channel for Doctor Who airing in Australia, was one of the first and longest term purchasers of the series from the BBC from its beginning, initially planning to screen the series in May 1964, within months of the UK premiere. The ABC later put up production money for an anniversary special The Five Doctors. Although a Doctor Who story has never been filmed in Australia, there have been many references to the great land down under! From the Fourth Doctor meeting Aussie opera singer Dame Nellie Melba, to the Second Doctor briefly visiting before being captured on the shores of an Australian beach in The Enemy of the World, to even Amy Pond suggesting the Australian Outback as a possible place for the Silurians to live in Cold Blood Australia is no stranger to being mentioned in Doctor Who scripts! Who knows maybe an Australian adventure may be on the cards for Series 8!!! (See what I did there Who knows) Classic Australian humour.

go to this site http://www.doctorwhotv.co.uk/doctor-who-a-global-phenomenon-part-1-australia-54916.htm

Can I Keep My Doctor Under The Affordable Care Act?

What the ACA says The health-care reform law is supposed to allow you to keep your doctor . In theory it is supposed to increase the number of primary care providers by giving pay bonuses for primary care services, allowing you access to a greater number of doctors than is currently available. What’s actually happening While some Americans have been able to keep their doctor, the reality is that not everyone is so fortunate. Those who have lost the specific physician(s) they need the most have been featured in recent reports . For some Americans, this is more than a disappointment — it has shifted the battle from finding affordable health insurance to a life-or-death circumstance. Even for those able to keep their doctor, it hasn’t necessarily been a happy ending. Some are being forced to pay for more expensive, non-marketplace insurance plans because their doctors aren’t included in any marketplace plans’ networks. Many marketplace plans don’t even offer “out of network” coverage, so individuals wishing to see a doctor not on their plan will be in the same boat as someone without an insurance plan. What you can do To better understand whether you can keep your doctor, you will need to contact your insurance company. If you plan to stay on a grandfathered plan and you haven’t been notified that your coverage will be terminated, you will probably be able to keep your coverage, as well as your doctor. However, it won’t hurt to give your insurance company a call to double-check. If you’ve already chosen a plan through the marketplace, check online to see if your provider is in the plan’s network. Do this sooner rather than later, because once open enrollment ends , you’re locked into your health plan.

you can try here http://www.fool.com/financial-advice/2014/01/26/can-i-keep-my-doctor-under-the-affordable-care-act.aspx

Australia Needs Physician Assistants. So Why Aren’t We Getting Them?

General practitioner (family physician) workforce in Australia: comparing geographic data from surveys, a mailing list and medicare

(Incidentally, he is also due to speak at at a University of Sydney seminar on May 3 titled Are we training too many doctors?.) Professional self-interest is blocking introducton of physician assistants Peter Brooks writes: Well done Croakey for running these stories on Physician Assistants (PAs). The opposition to the introduction of these health workers mirrors very much what happened in the US some 40 years ago. Strident cries from the American Medical Association that their introduction would end life as we know it. But interestingly it didnt! Why the nurses are so actively against it is interesting but one would have to ask all opposing groups are they interested in opposing for oppositions sake, are they interested in providing health services to patients who currently find it difficult to access them because the workforce is not there, or are they interested in preserving the status quo with siloed health professional practice? The health service and its constituent parts is a very complex organism but every part of it should work together to improve patient care and not work only in the interests of the health professional or have I got that wrong ? The health and social welfare workforce is currently the largest in Australia 1.4 million and like the rest of the population, it is ageing. We will need to recruit about half a million new workers at least to this sector over the next decade a significant challenge that policy makers and politicians do not seem to be fully accepting at present. Where are these new workers to come from? Current recruitment will not achieve these targets so perhaps some innovation is required. Trials of new models of care have been carried out by Queensland Health and the South Australian Health Commission in respect to PAs. These trials, albeit small, did suggest that these new health professionals would be useful across a variety of health care situations. They actually assisted doctors in care delivery, worked together with Nurse Practitioners as part of the care team, and value added to teaching of students rather than impairing it. So why the opposition? Sad to say but may I suggest pure self interest as always wrapped up in cries that the introduction will impact negatively on patient safety and quality, reduce learning opportunities for medical and nursing students and generally speed the dumbing down of health care delivery none of which can be supported by the many trials of PAs in Australia and overseas . Now I have to declare my bias, having introduced the PA program at the University of Queensland in 2009.

you could check here http://blogs.crikey.com.au/croakey/2011/04/12/australia-needs-physician-assistants-so-why-arent-we-getting-them/

The quality of spatial GP data is integral to adequately examining geographic access to GPs. The aim of the analyses presented here is to explore the issue of spatial GP data quality by comparing various geographically explicit GP datasets in Australia with different conceptualizations of the workforce metric (headcounts and workload aware statistics). Further, in order to understand the effect rurality has on data quality we implement our analyses across different degrees of rurality. The following discussion outlines the relevant context to this analysis. We first describe the issues salient to spatial GP data quality. We then discuss geographical GP datasets in different jurisdictions followed by a short description of GP datasets in Australia. Finally, we discuss existing research on GP datasets in Australia and elsewhere. Geographic GP datasets: what are we measuring? Two aspects of data quality are salient to GP accessibility studies. First is the geographic resolution or scale. If the available GP data are aggregated to coarse scales, for example the state level, then locally relevant analyses cannot be performed. Second, is the conceptualization of the workforce metric. While it is common to use GP headcounts or mere presence of a GP as a metric of GP access, there is evidence that this may produce misleading results [ 1 ]. In the Australian context, it is known that while the average GP work more hours per week with increasing rurality [ 8 ], there are also substantial numbers of GPs who provide short term locum services (henceforward called locum GPs) in rural Australia whose inclusion or exclusion from simple headcounts may skew workforce analyses [ 9 ].

review http://www.biomedcentral.com/1472-6963/13/343

Association Between Thiopurine Use And Nonmelanoma Skin Cancers In Patients With Inflammatory Bowel Disease: A Meta-analysis

METHODS: We searched electronic databases for full journal articles reporting on the risk of developing NMSC in patients with IBD on thiopurine and hand searched the reference lists of all retrieved articles. Pooled adjusted hazard ratios and 95% confidence intervals (CIs) were determined using a random-effects model. Publication bias was assessed using Funnel plots and Egger’s test. Heterogeneity was assessed using Cochran’s Q and the I2 statistic. RESULTS: Eight studies involving 60,351 patients provided data on the risk of developing NMSC in patients with IBD on thiopurines. The pooled adjusted hazards ratio of developing NMSC after exposure to thiopurines in patients with IBD was 2.28 (95% CI: 1.50 to 3.45). There was significant heterogeneity (I2=76%) between the studies but no evidence of publication bias. Meta regression analysis suggested that the population studied (hospital-based vs. population-based) and duration of follow-up contributed significantly to heterogeneity. Grouping studies based on population studied and duration showed higher hazard rations in hospital-based and shorter duration studies. CONCLUSIONS: The risk of developing NMSC in patients with IBD on thiopurines is only modestly elevated.

navigate to this site http://www.nature.com/ajg/journal/vaop/ncurrent/abs/ajg2013451a.html

Gabriel Lee, M.D., Joins Houston-Bay Area Gastroenterology

Ravi S. Mani , Dr. Nikhil Inamdar , Dr. Syed Jafri, Dr. Sezen Altug , Dr. Manish Rungta and Dr. Naveen Surapaneni . Dr. Lee obtained his medical degree from Baylor College of Medicine in Houston and completeda residency in Internal Medicine at the University of Texas Medical Branch in Galveston, before entering his fellowship programs in Galveston and Advanced training in San Antonio, Texas.He has native fluency in Spanish. Dr. Lee and his gastroenterology colleagues are part of Bay Area Gastroenterology in Clear Lake, which was the first Houston gastroenterology and endoscopy practice to offer office-based accredited Virtual colonoscopy screening .Specializing in the diagnosis and treatment of ailments of the stomach, intestines, colon, liver, gallbladder and pancreas, the group has offices in Clear Lake, Houston and Pearland. The group also offers virtual colonoscopy onsite at their accredited Imaging Center, in addition to onsite endoscopic procedures, colonoscopy and upper endoscopy at the Bay Area Houston Endoscopy Center. Contact Bay Area Gastroenterology at http://www.Gibay.com to schedule a consult. Or call 281-480-6264 for more information.

why not look here http://uk.finance.yahoo.com/news/gabriel-lee-m-d-joins-152506319.html

Inquest Opened Into Death Of Uk Doctor In Syrian Prison

Abbas Khan was reportedly days away from being freed by Syrian authorities Credit: ITV News/Family handout An inquest into the death of a British doctor who was found dead in a prison in Syria has been opened and adjourned. Inquest to open into death of British doctor in Syria An inquest is due to be opened into the death of a British doctor who was found dead in his cell in Syria earlier this month. Dr Abbas Khan was on the verge of being released when he was found dead in his cell , with the Syrian regime claiming he took his own life and his family alleging he was murdered. Dr Allas Khan went to Syria over a year ago to help treat casualties of war. Credit: ITV News/Family handout The inquest into his death will formally open at 11am this morning at Walthamstow Coroner’s court. The 32-year-old orthopaedic surgeon from London was captured in November last year in the ancient city of Aleppo after travelling from Turkey to help victims of the conflict. The distraught mother of a British surgeon found dead in a Syrian prison said she was a “failure” and told people not to comfort her as she attended her son’s funeral. Fatima Khan (second right) mother of Dr Abbas Khan. Credit: PA In a very distressed state outside the mosque, Dr Khan’s mother wailed and as well-wishers tried to comfort her, she said: “Nobody help me, I love my son. I am the loser. I’m the failure.” She added: “I beg everybody. I touch everyone’s feet. Please give me my son.” A man then wrapped his arm around her and brought her to a car and she was driven away. Brother’s tribute to ‘star’ British doctor who died in Syria The brother of a British doctor who was found dead in a Syrian prison has paid a moving tribute to him, describing him as “our star.” Dr Abbas Khan was on the verge of being released when he was found dead, with the Syrian regime claiming he took his own life and his family alleging he was murdered. Dr Abbas Khan was a surgeon from London who died while being held captive in Syria Credit: Family handout The 32-year-old orthopaedic surgeon from London was captured in November last year in the ancient city of Aleppo after travelling from Turkey to help victims of hospital bombings.

investigate this site http://www.itv.com/news/story/2013-12-26/funeral-for-british-doctor-who-died-in-syrian-prison/

A&e In Australia: ‘doctors Are Much Better Supported Here’

Doctor Who – A Global Phenomenon: Part 1 Australia

doctor-who-strax-australia

“People come, usually between the ages of 26 and 33, for various reasons. They like the lifestyle, the climate and access to the beach, although the downside is being away from family and friends. “But it’s also an easier option to come here than stay in the UK because emergency medicine doctors are much better supported here. Here they work a guaranteed 43-hour week, with five hours of that protected for teaching. “There are also far more registrars than in the UK. In a typical NHS hospital there are seven to 10. But in my hospital, we have 13 consultants, 20 registrars and 12 junior doctors. That makes working overnights and at weekends a completely different prospect: far less intense and pressured, because you have many more colleagues. “This Sunday evening, when I’m in charge, I’ll have two consultants and five registrars working with me until midnight. Those are staffing levels that could only be dreamed of in many, if not most, UK emergency departments. In the UK there would be one consultant on duty until midnight in some places. “Australian staffing levels are the aspiration of the rest of the world, a gold standard. For a trainee doctor, Australia is an easier option because of the support and training opportunities you get. “The work here is as busy as in the UK but it’s less stressful because I can delegate registrars and consultants to look after patients, whereas in the UK you can’t do that because NHS A&E consultants are stretched because of understaffing, reliance on junior staff and an inability to fill medical posts in their department. “My wife, who is Australian, and I loved our time working in the NHS in Scotland. We came here in 2011 for various reasons, but particularly because we felt it would be easier to sustain our jobs in the long term here because our work is well supported and well appreciated.

resources http://www.theguardian.com/society/2013/dec/27/accident-emergency-australia-doctors-case-study

It wasnt only An Unearthly Child that debuted on the 23rd of November, but also the famous music that would accompany every Doctor Who episode for the next 50 years and beyond the Doctor Who theme song, which in its most original version was written by Australian musician Ron Grainer. His music has gone on to inspire the likes of Who legends Courtney Pine and Murray Gold. Australia also is home to classic series companion Tegan Jovanka, played by Aussie actress Janet Fielding. So, so far, what can we attribute to an Aussie?? The script of the first televised episode The relationship between the Doctor and his very first companion The Police Box exterior of the TARDIS And the historic Doctor Who theme song! Outside the production itself, the Australian Broadcasting Company (or the ABC for short), which is still the current primary channel for Doctor Who airing in Australia, was one of the first and longest term purchasers of the series from the BBC from its beginning, initially planning to screen the series in May 1964, within months of the UK premiere. The ABC later put up production money for an anniversary special The Five Doctors. Although a Doctor Who story has never been filmed in Australia, there have been many references to the great land down under! From the Fourth Doctor meeting Aussie opera singer Dame Nellie Melba, to the Second Doctor briefly visiting before being captured on the shores of an Australian beach in The Enemy of the World, to even Amy Pond suggesting the Australian Outback as a possible place for the Silurians to live in Cold Blood Australia is no stranger to being mentioned in Doctor Who scripts! Who knows maybe an Australian adventure may be on the cards for Series 8!!! (See what I did there Who knows) Classic Australian humour. Whovian Culture Although we are no Great Britain when it comes to Doctor Who, Australia still knows how to celebrate the 50th Anniversary in style! How exactly are we bringing Who into the spotlight? Well. Cinema Screenings: Australia has become theguinea pig testing farm for Doctor Who episode screenings on the big screen. On two separate occasions, theyve had special events that have sold out in cinemas all over Australia with the first event showing The Impossible Astronaut and Day of the Moon in one epic evening, and more recently Asylum of the Daleks and The Angels Take Manhattan being screened a few weeks later.

you can look here http://www.doctorwhotv.co.uk/doctor-who-a-global-phenomenon-part-1-australia-54916.htm