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Acute management and secondary prophylaxis of esophageal variceal bleeding: a western Canadian survey.

https://arctichealth.org/en/permalink/ahliterature167625
Source
Can J Gastroenterol. 2006 Aug;20(8):531-4
Publication Type
Article
Date
Aug-2006
Author
Justin Cheung
Winnie Wong
Iman Zandieh
Yvette Leung
Samuel S Lee
Alnoor Ramji
Eric M Yoshida
Author Affiliation
Department of Medicine, University of Alberta, Edmonton.
Source
Can J Gastroenterol. 2006 Aug;20(8):531-4
Date
Aug-2006
Language
English
Publication Type
Article
Keywords
Acute Disease
Adrenergic beta-Antagonists - therapeutic use
Anti-Bacterial Agents - therapeutic use
Canada
Endoscopy
Esophageal and Gastric Varices - complications - diagnosis - therapy
Gastroenterology - statistics & numerical data
Gastrointestinal Agents - therapeutic use
Gastrointestinal Hemorrhage - etiology - therapy
Guideline Adherence - trends
Health Care Surveys
Humans
Octreotide - therapeutic use
Physician's Practice Patterns
Questionnaires
Abstract
Acute esophageal variceal bleeding (EVB) is a major cause of morbidity and mortality in patients with liver cirrhosis. Guidelines have been published in 1997; however, variability in the acute management and prevention of EVB rebleeding may occur.
Gastroenterologists in the provinces of British Columbia, Alberta, Manitoba and Saskatchewan were sent a self-reporting questionnaire.
The response rate was 70.4% (86 of 122). Intravenous octreotide was recommended by 93% for EVB patients but the duration was variable. The preferred timing for endoscopy in suspected acute EVB was within 12 h in 75.6% of respondents and within 24 h in 24.6% of respondents. Most (52.3%) gastroenterologists do not routinely use antibiotic prophylaxis in acute EVB patients. The preferred duration of antibiotic therapy was less than three days (35.7%), three to seven days (44.6%), seven to 10 days (10.7%) and throughout hospitalization (8.9%). Methods of secondary prophylaxis included repeat endoscopic therapy (93%) and beta-blocker therapy (84.9%). Most gastroenterologists (80.2%) routinely attempted to titrate beta-blockers to a heart rate of 55 beats/min or a 25% reduction from baseline. The most common form of secondary prophylaxis was a combination of endoscopic and pharmacological therapy (70.9%).
Variability exists in some areas of EVB treatment, especially in areas for which evidence was lacking at the time of the last guideline publication. Gastroenterologists varied in the use of prophylactic antibiotics for acute EVB. More gastroenterologists used combination secondary prophylaxis in the form of band ligation eradication and beta-blocker therapy rather than either treatment alone. Future guidelines may be needed to address these practice differences.
Notes
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Cites: N Engl J Med. 2001 Aug 30;345(9):669-8111547722
PubMed ID
16955150 View in PubMed
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Adult liver transplant survey: policies towards eligibility criteria in Canada and the United States 2007.

https://arctichealth.org/en/permalink/ahliterature154959
Source
Liver Int. 2008 Nov;28(9):1250-5
Publication Type
Article
Date
Nov-2008
Author
Karen I Kroeker
Vincent G Bain
Thomas Shaw-Stiffel
Tse-Ling Fong
Eric M Yoshida
Author Affiliation
Department of Medicine, University of Alberta, Edmonton, AB, Cananda.
Source
Liver Int. 2008 Nov;28(9):1250-5
Date
Nov-2008
Language
English
Publication Type
Article
Keywords
Canada
Eligibility Determination
Humans
Liver Transplantation - contraindications
Questionnaires
United States
Abstract
To assess the current practice patterns of liver transplant centres in Canada and the USA regarding transplant eligibility.
Liver transplantation is an evolving field and today remains the only life-sustaining treatment for end-stage liver disease. Issues of allocation and transplant eligibility are important factors in the ethical practice of medicine.
Questionnaires were mailed to liver transplant programme directors in Canada and the USA inquiring about current practices regarding recipient eligibility.
This study demonstrates that there is consensus in the use of other eligibility criteria, including non-compliance, social status, abstinence from alcohol and methadone and cocaine use. Interestingly, literature is lacking to support the use of these parameters as eligibility criteria with the exception of alcohol. There is a lack in consensus regarding marijuana use, human immunodeficiency virus status, ability to accept blood transfusions and prisoner status. The literature suggests that liver transplantation in select patients who refuse blood transfusions results in good outcomes.
Important decisions regarding transplant eligibility still have to be made empirically in the absence of scientific literature about various social issues. While consensus among transplant programmes is useful, it is important that we continue to use the evidence in the literature to revise these eligibility criteria, keeping in mind ethical principles applied to the access and allocation of a scarce resource.
Notes
Comment In: Liver Int. 2008 Nov;28(9):1186-918822075
PubMed ID
18822078 View in PubMed
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Asian ethnicity-related differences in gastric cancer presentation and outcome among patients treated at a canadian cancer center.

https://arctichealth.org/en/permalink/ahliterature185158
Source
J Clin Oncol. 2003 Jun 1;21(11):2070-6
Publication Type
Article
Date
Jun-1-2003
Author
Sharlene Gill
Amil Shah
Nhu Le
E Francis Cook
Eric M Yoshida
Author Affiliation
Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada. gill.sharlene@mayo.edu
Source
J Clin Oncol. 2003 Jun 1;21(11):2070-6
Date
Jun-1-2003
Language
English
Publication Type
Article
Keywords
Adenocarcinoma - ethnology - mortality - pathology - therapy
Adult
Asia - ethnology
British Columbia - epidemiology
Carcinoma, Signet Ring Cell - ethnology - mortality
Ethnic Groups
Female
Humans
Male
Middle Aged
Multivariate Analysis
Prognosis
Proportional Hazards Models
Retrospective Studies
Stomach Neoplasms - ethnology - mortality - pathology - therapy
Survival Rate
Abstract
Differences in stage-stratified survival have been reported between Asian and Western populations with gastric cancer. This study examines differences in presentation and outcomes among Asian and non-Asian patients evaluated and treated at a Canadian institution.
We reviewed 2,043 patients (159 Asians and 1,884 non-Asians) with gastric adenocarcinoma treated between 1978 and 1997. Overall survival was examined by the Kaplan-Meier method, and multivariable analysis by Cox proportional hazards was used to identify whether Asian ethnicity had independent prognostic significance for survival.
Median survival was 13.1 months for Asians and 11.1 months for non-Asians (P =.0016). Asian patients were younger and had a greater proportion of signet ring cell histology but were less likely to have proximal disease. Signet ring cell histology did not adversely affect survival. By multivariable analysis, proximal location, poor differentiation, and extent of disease were independently associated with worse survival. Survival was improved with curative resection, palliative resection, and palliative chemotherapy. Asian ethnicity was not independently associated with survival (hazard ratio, 0.89; 95% confidence interval, 0.74 to 1.08). Although a similar proportion of patients underwent curative resection, an interaction was observed between Asian ethnicity and efficacy of resection, with Asians achieving a greater benefit as compared with non-Asians even when adjusted for age and location.
The disparity between Eastern and Western gastric cancer survival is not explained by the hypothesis of ethnicity-related differences in tumor biology. Although it is not an independent predictor of survival, Asian ethnicity is associated with distinct characteristics at presentation and more favorable outcomes after curative surgery.
Notes
Comment In: J Clin Oncol. 2003 Nov 15;21(22):4253; author reply 425314615460
PubMed ID
12775731 View in PubMed
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Canadian national retrospective chart review comparing the long term effect of cyclosporine vs. tacrolimus on clinical outcomes in patients with post-liver transplantation hepatitis C virus infection.

https://arctichealth.org/en/permalink/ahliterature116457
Source
Ann Hepatol. 2013 Mar-Apr;12(2):282-93
Publication Type
Article
Author
Eric M Yoshida
Leslie B Lilly
Paul J Marotta
Andrew L Mason
Marc Bilodeau
Marc Vaillancourt
Author Affiliation
Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. eric.yoshida@vch.ca
Source
Ann Hepatol. 2013 Mar-Apr;12(2):282-93
Language
English
Publication Type
Article
Keywords
Adult
Antiviral agents - therapeutic use
Biological Markers - blood
Canada
Carcinoma, Hepatocellular - immunology - virology
Chi-Square Distribution
Cyclosporine - adverse effects - therapeutic use
Diabetes Mellitus - etiology
Female
Graft Rejection - immunology - virology
Hepacivirus - genetics
Hepatitis C - complications - diagnosis - drug therapy - mortality - virology
Humans
Immunosuppressive Agents - adverse effects - therapeutic use
Kaplan-Meier Estimate
Liver Cirrhosis - immunology - virology
Liver Neoplasms - immunology - virology
Liver Transplantation - adverse effects - immunology - mortality
Logistic Models
Male
Middle Aged
Multivariate Analysis
Odds Ratio
RNA, Viral - blood
Recurrence
Retrospective Studies
Risk factors
Tacrolimus - adverse effects - therapeutic use
Time Factors
Treatment Outcome
Viral Load
Abstract
The transition from regular use of cyclosporine to the newer calcineurin-inhibitors, such as tacrolimus, has been suggested as a contributing factor to the "era effect" of worsening outcomes of post-transplant HCV recurrence. This retrospective medical chart review of 458 patients was undertaken to evaluate the role of immunosuppressant choice (cyclosporine vs. tacrolimus) in determining virologic response and clinical outcomes of post-liver transplant HCV infection recurrence. Our results showed that patients undergoing interferon-based treatment taking cyclosporine have significantly better odds (OR: 2.59, P = 0.043) of presenting a sustained viral response (66.7%) compared to tacrolimus (52.8%). This did not result in a significant effect on post-liver transplantation clinical events including HCV-related deaths, graft loss, fibrosing cholestatic hepatitis, hepatocellular carcinoma or graft rejection. Other variables, which showed a significant relationship with the achievement of sustained viral response included donor age (OR 0.96, P = 0.001) and HCV genotype 1 infection (OR 0.05, P
PubMed ID
23396740 View in PubMed
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Characteristics associated with drug-induced liver injury from interferon beta in multiple sclerosis patients.

https://arctichealth.org/en/permalink/ahliterature266928
Source
Expert Opin Drug Saf. 2014 Oct;13(10):1305-17
Publication Type
Article
Date
Oct-2014
Author
Kaarina Kowalec
Elaine Kingwell
Eric M Yoshida
Ruth Ann Marrie
Marcelo Kremenchutzky
Trudy L Campbell
Mia Wadelius
Bruce Carleton
Helen Tremlett
Source
Expert Opin Drug Saf. 2014 Oct;13(10):1305-17
Date
Oct-2014
Language
English
Publication Type
Article
Keywords
Adult
British Columbia - epidemiology
Canada - epidemiology
Drug-Induced Liver Injury - epidemiology - etiology
Female
Follow-Up Studies
Humans
Immunologic Factors - adverse effects - therapeutic use
Interferon-beta - adverse effects - therapeutic use
Male
Middle Aged
Multiple Sclerosis - drug therapy
Proportional Hazards Models
Retrospective Studies
Risk factors
Sex Factors
Sweden - epidemiology
Time Factors
United States - epidemiology
Abstract
To identify and characterize drug-induced liver injury (DILI) associated with IFN-Ã? in multiple sclerosis (MS) using recommended criteria.
This retrospective, mixed methods design included a cohort of IFN-Ã? exposed MS patients from British Columbia (BC), Canada and a series of DILI cases from other Canadian provinces and two adverse drug reaction (ADR) networks (USA and Sweden). Associations between sex, age and IFN-Ã? product, and DILI were explored in BC cohort using Cox proportional hazard analyses. Characteristics, including the time to DILI, were compared between sites.
In BC, 18/942 (1.9%) of IFN-Ã? exposed MS patients met criteria for DILI, with a trend toward an increased risk for women and those exposed to IFN-Ã?-1a SC (44 mcg 3 Ã? weekly) (adjusted Hazard Ratios: 3.15;95% CI:0.72 - 13.72, p = 0.13 and 6.26;95%CI:0.78 - 50.39, p = 0.08, respectively). Twenty-four additional cases were identified from other sites; the median time to DILI was comparable between BC and other Canadian cases (105 and 90 days, respectively), but longer for the ADR network cases (590 days, p = 0.006).
Approximately 1 in 50 IFN-Ã? exposed patients developed DILI in BC, Canada. Identification of DILI cases from diverse sources highlighted that this reaction occurs even after years of exposure.
PubMed ID
25134421 View in PubMed
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Cross-sectional study of hepatitis B awareness among Chinese and Southeast Asian Canadians in the Vancouver-Richmond community.

https://arctichealth.org/en/permalink/ahliterature175031
Source
Can J Gastroenterol. 2005 Apr;19(4):245-9
Publication Type
Article
Date
Apr-2005
Author
Justin Cheung
Tim K Lee
Chong-Ze Teh
Caroline Y M Wang
W C Peter Kwan
Eric M Yoshida
Author Affiliation
Department of Medicine, University of British Columbia, Vancouver.
Source
Can J Gastroenterol. 2005 Apr;19(4):245-9
Date
Apr-2005
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Asia, Southeastern - ethnology
Attitude to Health - ethnology
British Columbia
Carcinoma, Hepatocellular - virology
China - ethnology
Cross-Sectional Studies
Educational Status
Ethnic Groups
Female
Health Education - methods
Health Knowledge, Attitudes, Practice
Hepatitis B - ethnology
Humans
Liver Cirrhosis - virology
Liver Neoplasms - virology
Male
Mass Media
Middle Aged
Physicians
Residence Characteristics
Abstract
Hepatitis B (HBV) is endemic and a leading cause of morbidity and mortality in Asia. British Columbia has the highest proportion of Chinese and Southeast Asians among all Canadian provinces. The present study was designed to evaluate the degree of concern for and knowledge of HBV in this high-risk community.
Unselected patrons of two large Asian commercial centres in Richmond, British Columbia were surveyed. The variables studied were population demographics, concern for HBV, level of HBV knowledge and awareness of HBV-related cirrhosis or hepatocellular carcinoma (HCC). Associations were assessed using c2 testing and multiple logistic regression analysis.
A total of 1008 individuals participated in the survey. Fifteen incomplete surveys were excluded. Only 7.7% felt that HBV was not a concern for the community. Only 13% of respondents felt that HBV education was adequate in the community. The main sources of community health education were their doctor's office (56.3%) and media (49.1%). A high number stated they were "aware" of HBV (68%) but over 60% were unaware that HBV could cause HCC or cirrhosis and only 61.3% scored a 'reasonable' level of HBV knowledge. Higher HBV knowledge was significantly associated with increasing age (P
PubMed ID
15861267 View in PubMed
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Does cirrhosis affect quality of life in hepatitis C virus-infected patients?

https://arctichealth.org/en/permalink/ahliterature152194
Source
Liver Int. 2009 Mar;29(3):449-58
Publication Type
Article
Date
Mar-2009
Author
Priscilla C Hsu
Mel Krajden
Eric M Yoshida
Frank H Anderson
George A Tomlinson
Murray D Krahn
Author Affiliation
British Columbia Centre for Disease Control, Vancouver, BC, Canada.
Source
Liver Int. 2009 Mar;29(3):449-58
Date
Mar-2009
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
British Columbia
Health Status Indicators
Hepatitis C - complications
Humans
Linear Models
Liver Cirrhosis - etiology - physiopathology
Middle Aged
Quality of Life
Socioeconomic Factors
Abstract
Hepatitis C virus (HCV) infection is a major cause of chronic liver disease and is associated with impairments in health-related quality of life.
To evaluate quality of life (QOL) in cirrhotic (compensated and decompensated) and non-cirrhotic patients with chronic HCV infection, using preference-based (utilities) and non-preference-based methods of evaluating QOL.
In a tertiary care setting, 271 patients completed a self-administered time trade-off utility instrument, the Health Utility Index Mark 2 and Mark 3, and the Hepatitis Quality of Life Questionnaire Version 2. Mean QOL scores were compared across HCV disease stages and sociodemographical categories. We examined the association between QOL and disease stage using linear regression adjusting for age, education, marital status, log income and Charlson comorbidity scores. Mean utility scores were compared across disease stages using a propensity score method.
Mean utilities were lower than general population norms (0.81-0.92) and ranged from 0.62 to 0.82 in non-cirrhotic patients (n=197), 0.56-0.84 in compensated cirrhotic patients (n=17) and 0.55-0.76 for decompensated cirrhotic patients (n=57). No significant association found was between disease stage and utility for current health status. Higher income, fewer comorbidities and living in a married or common-law relationship were significantly associated with higher utilities and better QOL. No significant difference in utilities was found between disease stages using propensity score matching.
Our study confirms that changes in HCV disease stage explain only small changes in QOL and suggests that factors such as underlying comorbidities, income and marital status have a greater effect on QOL than disease stage.
PubMed ID
19267865 View in PubMed
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Efficacy of maintenance subcutaneous hepatitis B immune globulin (HBIG) post-transplant for prophylaxis against hepatitis B recurrence.

https://arctichealth.org/en/permalink/ahliterature143053
Source
Ann Hepatol. 2010 Apr-Jun;9(2):166-71
Publication Type
Article
Author
Janakie Singham
Erica D Greanya
Kirby Lau
Siegfried R Erb
Nilu Partovi
Eric M Yoshida
Author Affiliation
University of British Columbia, Vancouver BC, Canada.
Source
Ann Hepatol. 2010 Apr-Jun;9(2):166-71
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antiviral agents - therapeutic use
British Columbia
Drug Administration Schedule
Drug Therapy, Combination
Female
Hepatitis B Antibodies - blood
Hepatitis B vaccines - administration & dosage
Hepatitis B, Chronic - complications - prevention & control - surgery
Humans
Immunoglobulins - administration & dosage
Injections, Intramuscular
Injections, Subcutaneous
Liver Transplantation - adverse effects
Male
Middle Aged
Patient Preference
Pilot Projects
Prospective Studies
Questionnaires
Recurrence - prevention & control
Time Factors
Treatment Outcome
Abstract
Patients who receive liver transplantation for chronic hepatitis B infection require long-term combination therapy with hepatitis B immunoglobulin (HBIG) and oral antiviral medication to prophylax against graft re-infection. This study examines the efficacy and patient preference of subcutaneous (SC) administration of HBIG in maintaining anti HBs titres > 100 IU/L.
12 patients who were stable while receiving our standard IM HBIG protocol received an alternate formulation by SC injection, consisting of 10 mL (3120 IU) HBIG as 4 x 2.5 mL SC injections. SC injection were repeated as soon as titres reached 100-150 IU/mL during the 3 month study period. A questionnaire was administered upon study entry and exit to subjectively assess patient preference.
Anti- HBs Cmax after first injection was 441.6 IU/L +/- 81.5, and Tmax was 7.1 +/- 3.2 days. SC injections were required every 56 days, which compared well to the frequency of required IM injections prior to study enrollment of 45 days. The patients mean ratings of pain on a 0-10 scale were 5 for the IM route and 1.6 for the SC route. All patients preferred the SC injections to the IM.
SC administration of HBIG can effectively maintain anti HBs levels above the requisite 100 IU/L while substantially decreasing patient discomfort and improving patient satisfaction, and therefore becomes a very attractive alternative to IM HBIG injections. Further studies and wider use of SC HBIG based on this study may alter the standard practice of transplantation centers
PubMed ID
20526010 View in PubMed
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Estimating the economic burden of inflammatory bowel disease in Canada: physician office visits and mesalamine prescriptions dispensed as surrogate markers.

https://arctichealth.org/en/permalink/ahliterature160633
Source
Am J Gastroenterol. 2007 Nov;102(11):2602-3; author reply 2603-4
Publication Type
Article
Date
Nov-2007

Ethnic variation in the annual rates of adult inflammatory bowel disease in hospitalized patients in Vancouver, British Columbia.

https://arctichealth.org/en/permalink/ahliterature137044
Source
Can J Gastroenterol. 2011 Feb;25(2):73-7
Publication Type
Article
Date
Feb-2011
Author
Birinder K Mangat
Chad Evaschen
Tim Lee
Eric M Yoshida
Baljinder Salh
Author Affiliation
Department of Medicine, University of British Columbia, Vancouver, British Columbia.
Source
Can J Gastroenterol. 2011 Feb;25(2):73-7
Date
Feb-2011
Language
English
Publication Type
Article
Keywords
Adult
Asia, Southeastern - ethnology
British Columbia - epidemiology
Colitis - ethnology
Colitis, Ulcerative - ethnology
Crohn Disease - ethnology
Cross-Sectional Studies
European Continental Ancestry Group - statistics & numerical data
Female
Hospitalization
Humans
Inflammatory Bowel Diseases - ethnology
Male
Urban Population - statistics & numerical data
Abstract
There is currently little available information regarding the impact of ethnicity on the clinical features of inflammatory bowel disease (IBD). Migrating populations and changing demographics in Vancouver, British Columbia (BC) provide a unique opportunity to examine the role of ethnicity in the prevalence, expression and complications of IBD.
To determine the demographics of IBD and its subtypes leading to hospitalization in the adult population of BC.
A one-year retrospective study was performed for all patients who presented acutely with IBD to Vancouver General Hospital from January 1, 2006 to December 31, 2006. Data regarding sex, age, ethnicity, IBD type and extent of disease, complications and management strategies were collected. Clinical data were confirmed by pathology and radiology reports.
There were 186 cases of IBD comprising Crohn's disease (CD) 56%, ulcerative colitis (UC) 43% and indeterminate colitis (1%) 1%. The annual rate of IBD cases warranting hospitalization in Caucasians was 12.9 per 100,000 persons (7.9 per 100,000 persons for CD and 5.0 per 100,000 persons for UC). This was in contrast to the annual rate of IBD in South Asians at 7.7 per 100,000 persons (1.0 per 100,000 persons for CD and 6.8 per 100,000 persons for UC) and in Pacific Asians at 2.1 per 100,000 persons (1.3 per 100,000 persons for CD, 0.8 per 100,000 persons for UC). The male to female ratio was higher in South Asians and Pacific Asians than in Caucasians. The extent of disease was significantly different across racial groups, as was the rate of complications.
These early results suggest that there are ethnic disparities in the annual rates of IBD warranting hospitalization in the adult population of BC. There was a significantly higher rate of CD in the Caucasian population than in South Asian and Pacific Asian populations. The South Asian population had a higher rate of UC, with an increased rate of complications and male predominance. Interestingly, the rate of CD and UC was lowest in the Pacific Asian population. These racial differences - which were statistically significant - suggest a role for ethnodiversity and environmental changes in the prevalence of IBD in Vancouver.
Notes
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PubMed ID
21321677 View in PubMed
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35 records – page 1 of 4.