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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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PubMed ID
16955150 View in PubMed
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The burden of large and small duct primary sclerosing cholangitis in adults and children: a population-based analysis.

https://arctichealth.org/en/permalink/ahliterature165042
Source
Am J Gastroenterol. 2007 May;102(5):1042-9
Publication Type
Article
Date
May-2007
Author
Gilaad G Kaplan
Kevin B Laupland
Decker Butzner
Stefan J Urbanski
Samuel S Lee
Author Affiliation
Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
Source
Am J Gastroenterol. 2007 May;102(5):1042-9
Date
May-2007
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Alberta - epidemiology
Child
Cholangiopancreatography, Magnetic Resonance
Cholangitis, Sclerosing - diagnosis - epidemiology
Female
Hepatitis, Autoimmune - diagnosis - epidemiology
Humans
Incidence
Inflammatory Bowel Diseases - diagnosis - epidemiology
Male
Middle Aged
Statistics, nonparametric
Abstract
The epidemiology of primary sclerosing cholangitis (PSC) has been incompletely assessed by population-based studies. We therefore conducted a population-based study to determine: (a) incidence rates of large and small duct PSC in adults and children, (b) the risk of inflammatory bowel disease on developing PSC, and (c) patterns of clinical presentation with the advent of magnetic resonance cholangiopancreatography (MRCP).
All residents of the Calgary Health Region diagnosed with PSC between 2000 and 2005 were identified by medical records, endoscopic, diagnostic imaging, and pathology databases. Demographic and clinical information were obtained. Incidence rates were determined and risks associated with PSC were reported as rate ratios (RR) with 95% confidence intervals (CI).
Forty-nine PSC patients were identified for an age- and gender-adjusted annual incidence rate of 0.92 cases per 100,000 person-years. The incidence of small duct PSC was 0.15/100,000. In children the incidence rate was 0.23/100,000 compared with 1.11/100,000 in adults. PSC risk was similar in Crohn's disease (CD; RR 220.0, 95% CI 132.4-343.7) and ulcerative colitis (UC; RR 212.4, 95% CI 116.1-356.5). Autoimmune hepatitis overlap was noted in 10% of cases. MRCP diagnosed large duct PSC in one-third of cases. Delay in diagnosis was common (median 8.4 months). A minority had complications at diagnosis: cholangitis (6.1%), pancreatitis (4.1%), and cirrhosis (4.1%).
Pediatric cases and small duct PSC are less common than adult large duct PSC. Surprisingly, the risk of developing PSC in UC and CD was similar. Autoimmune hepatitis overlap was noted in a significant minority of cases.
PubMed ID
17313496 View in PubMed
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Health and socioeconomic status differences among antibody hepatitis C positive and negative transfusion recipients, 1986-1990.

https://arctichealth.org/en/permalink/ahliterature186003
Source
Can J Public Health. 2003 Mar-Apr;94(2):130-4
Publication Type
Article
Author
Robert S Hogg
Kevin J P Craib
David Pi
Samuel S Lee
Gerald Y Minuk
Colin M Shapiro
Martin T Schechter
Michael V O'Shaughnessy
Author Affiliation
Division of Epidemiology, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC. bobhogg@hivnet.ubc.ca
Source
Can J Public Health. 2003 Mar-Apr;94(2):130-4
Language
English
Publication Type
Article
Keywords
Aged
Blood Transfusion - utilization
British Columbia - epidemiology
Cross-Sectional Studies
Fatigue
Female
Health status
Hepatitis C - economics - physiopathology - transmission
Hepatitis C Antibodies - blood
Humans
Logistic Models
Male
Middle Aged
Quality of Life
Seroepidemiologic Studies
Social Class
Abstract
To characterize the socioeconomic and health status, disease symptoms of anti-HCV-positive and negative transfusion recipients.
A cross-sectional interviewer-administered survey of subjects identified through the British Columbia Blood Recipient Program. Study subjects were 18 years and over and had to have had a transfusion between August 1, 1986 and June 30, 1990 and completed an interview of satisfactory quality. Anti-HCV-positive subjects were those seeking monetary compensation from the provincial and Canadian governments and the comparison group was randomly selected from a pool of anti-HCV-negative subjects. The study was designed to detect an assumed difference of 20% in signs and symptoms between the two groups. Statistical comparisons were conducted using bivariate and multivariate logistic regression analyses.
A total of 241 and 222 anti-HCV-positive and negative subjects were respectively interviewed and met the study's eligibility criteria. Results from the multivariate analysis indicated that anti-HCV-positive recipients were more likely to have two or more clinical symptoms (OR = 3.53; 95% CI: 1.44, 8.70), to be in worse health status as compared to ten years previous (OR = 1.60; 95% CI: 1.30, 1.96), to have a higher illness intrusiveness rating (OR = 1.35; 95% CI: 1.25, 1.46), and to be younger (OR = 0.97; 95% CI: 0.95, 0.98).
Our results show that persons exposed to HCV were more likely to have had two or more clinical symptoms, be male, have worse health status as compared to ten years previous, have a higher illness intrusiveness rating, and be younger in age.
PubMed ID
12675170 View in PubMed
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Hepatocellular carcinoma incidence trends in Canada: analysis by birth cohort and period of diagnosis.

https://arctichealth.org/en/permalink/ahliterature157924
Source
Liver Int. 2008 Nov;28(9):1272-9
Publication Type
Article
Date
Nov-2008
Author
Gaia Pocobelli
Linda S Cook
Rollin Brant
Samuel S Lee
Author Affiliation
Department of Epidemiology, University of Washington, WA, USA. gpocobel@u.washington.edu
Source
Liver Int. 2008 Nov;28(9):1272-9
Date
Nov-2008
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Aged, 80 and over
Canada - epidemiology
Carcinoma, Hepatocellular - diagnosis - epidemiology
Cohort Studies
Female
Forecasting
Humans
Incidence
Likelihood Functions
Liver Neoplasms - diagnosis - epidemiology
Male
Middle Aged
Time Factors
Young Adult
Abstract
We examined birth cohort and calendar period trends in hepatocellular carcinoma (HCC) incidence in Canada (1976-2000). We also projected HCC incidence rates through 2015.
Data were obtained from the Canadian Cancer Registry on all cases of HCC diagnosed among persons aged 20 years and older in Canada from 1976 to 2000 and was used to describe trends in HCC incidence rates.
We found that age-adjusted HCC incidence rates increased faster in males compared with females, 3.4% per year [95% confidence interval (CI): 3.0-3.8%] vs 2.2% per year (95% CI: 1.5-2.8%). An increasing birth cohort trend accelerated among males around the 1940 birth cohort and decelerated among females around the 1935 birth cohort. For calendar period trends, the increasing HCC risk was relatively constant over time among males whereas there was an acceleration in HCC risk around 1988 among females. Age-adjusted HCC incidence rates were projected to increase 73% in males and 28% in females from 1996 to 2015.
Our results suggest that HCC incidence rates will continue to increase in Canada during the next decade as persons born in more recent birth cohorts, who face a relatively greater risk for HCC, age.
PubMed ID
18384523 View in PubMed
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Impact of pharmaceutical industry versus university sponsorship on survey response: a randomized trial among Canadian hepatitis C care providers.

https://arctichealth.org/en/permalink/ahliterature164509
Source
Can J Gastroenterol. 2007 Mar;21(3):169-75
Publication Type
Article
Date
Mar-2007
Author
Robert P Myers
Abdel Aziz M Shaheen
Samuel S Lee
Author Affiliation
University of Calgary, Calgary, Canada. rpmyers@ucalgary.ca
Source
Can J Gastroenterol. 2007 Mar;21(3):169-75
Date
Mar-2007
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Canada
Data Collection
Drug Industry
Hepatitis C, Chronic - therapy
Humans
Interprofessional Relations
Nurses - psychology
Physicians - psychology
Postal Service
Universities
Abstract
Surveys originating from universities appear to have higher response rates than those from commercial sources. In light of the growing scrutiny placed on physician-industry relations, the present study aimed to determine the impact of the pharmaceutical industry versus university sponsorship on response to a postal survey completed by Canadian hepatitis C virus (HCV) care providers.
In the present controlled trial, 229 physicians and nurses involved in HCV treatment were randomly assigned to receive a survey with sponsorship from a pharmaceutical company or university. The primary outcome was the proportion of completed surveys returned. The secondary outcomes included the response rate after the first mailing and the number of days taken to respond.
One hundred fifteen participants were randomly assigned to receive the pharmaceutical industry survey and 114 were assigned to receive the university survey. The final response rate was 72.9% (167 of 229), which did not differ between the industry and university groups (RR=0.91; 95% CI 0.78 to 1.07). Nurses (OR=2.20; 95% CI 1.08 to 4.48) and participants from an academic centre (OR=3.14; 95% CI 1.64 to 6.00) were more likely to respond. The response rate after the first mailing (RR=0.85; 95% CI 0.68 to 1.07) and the median number of days taken to respond (21 days in both groups; P=0.20) did not differ between the industry and university groups.
Pharmaceutical industry sponsorship does not appear to negatively impact response rates to a postal survey completed by Canadian HCV care providers.
Notes
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Cites: Can J Gastroenterol. 2002 Jan;16(1):17-2111826333
PubMed ID
17377646 View in PubMed
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Transplant immunosuppressive agents in non-transplant chronic autoimmune hepatitis: the Canadian association for the study of liver (CASL) experience with mycophenolate mofetil and tacrolimus.

https://arctichealth.org/en/permalink/ahliterature174002
Source
Liver Int. 2005 Aug;25(4):723-7
Publication Type
Article
Date
Aug-2005
Author
Nazira Chatur
Alnoor Ramji
Vincent G Bain
Mang M Ma
Paul J Marotta
Cameron N Ghent
Leslie B Lilly
E Jenny Heathcote
Marc Deschenes
Samuel S Lee
Urs P Steinbrecher
Eric M Yoshida
Author Affiliation
Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
Source
Liver Int. 2005 Aug;25(4):723-7
Date
Aug-2005
Language
English
Publication Type
Article
Keywords
Adult
Aged
Canada
Drug Therapy, Combination
Female
Glucocorticoids - therapeutic use
Hepatitis, Autoimmune - drug therapy - etiology - immunology
Humans
Immunosuppressive Agents - therapeutic use
Male
Middle Aged
Mycophenolic Acid - analogs & derivatives - therapeutic use
Prednisone - therapeutic use
Recurrence - prevention & control
Retrospective Studies
Tacrolimus - therapeutic use
Transaminases - analysis
Treatment Outcome
Abstract
Conventional treatment of autoimmune hepatitis consists of either prednisone alone or in combination with azathioprine. Ten to 20% of patients do not respond to or are intolerant of this treatment. Novel drug treatments include immunosuppressive drugs such as tacrolimus (TAC), mycophenolate mofetil (MMF), methotrexate and cyclosporine. We describe a multi-centre Canadian experience with MMF and TAC.
To study a multi-centre patient population who had failed conventional therapy and were treated with non-conventional medical therapy for autoimmune hepatitis and document response.
Members of the Canadian Association for the Study of Liver (CASL) obtained MMF from Hoffmann-La Roche Ltd, as part of a compassionate release program, were contacted for standardized data on patients with AIH who received MMF or TAC. Response definitions based on aminotransferase changes were: Complete response (CR)-sustained normalization, partial response (PR)-improvement by greater than 50%, non-response (NR)-less than 50% improvement and relapse (RP)-initial CR or PR followed by an increase in aminotransferases.
A total of 16 patients were identified: six in Ontario, one in Quebec, five in Alberta and four in British Columbia. Three were treated with TAC, eleven with MMF and two with combination MMF and TAC. CR was observed in 50%, PR in 12.5%, RP in 25% and NR occurred in 12.5%. The CR for MMF without TAC was approximately 64%.
MMF is effective and well tolerated by patients with autoimmune hepatitis who do not respond to, or are intolerant of, conventional immunosuppressive agents.
PubMed ID
15998421 View in PubMed
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6 records – page 1 of 1.