Skip header and navigation

Refine By

65 records – page 1 of 7.

Adapting national and international leg ulcer practice guidelines for local use: the Ontario Leg Ulcer Community Care Protocol.

https://arctichealth.org/en/permalink/ahliterature173361
Source
Adv Skin Wound Care. 2005 Jul-Aug;18(6):307-18
Publication Type
Article
Author
Ian D Graham
Margaret B Harrison
Karen Lorimer
Tadeusz Piercianowski
Elaine Friedberg
Maureen Buchanan
Connie Harris
Author Affiliation
School of Nursing, University of Ottawa, and Ottawa Health Research Institute, Ottawa, Ontario, Canada.
Source
Adv Skin Wound Care. 2005 Jul-Aug;18(6):307-18
Language
English
Publication Type
Article
Keywords
Community Health Services - standards
Evidence-Based Medicine
Humans
International Cooperation
Leg Ulcer - diagnosis - therapy
National Health Programs - standards
Ontario
Practice Guidelines as Topic
Severity of Illness Index
Total Quality Management
Abstract
Because of growing resources devoted to individuals requiring community care for leg ulcers, the authority responsible for home care in Ottawa, Ontario, Canada, established and evaluated a demonstration leg ulcer service. In an effort to provide current and evidence-based care, existing leg ulcer clinical practice guidelines were identified and appraised for quality and suitability to the new service.
The Practice Guideline Evaluation and Adaptation Cycle guided development of a local protocol for leg ulcer care, which included: (1) systematically searching for practice guidelines, (2) appraising the quality of identified guidelines using a validated guideline appraisal instrument, (3) conducting a content analysis of guideline recommendations, (4) selecting recommendations to include in the local protocol, and (5) obtaining practitioner and external expert feedback on the proposed protocol. Updating the protocol followed a similar process.
Of 19 identified leg ulcer practice guidelines, 14 were not evaluated because they did not meet the criteria (ie, treatment-focused guidelines, written in English and developed after 1998). Of the 5 remaining guidelines, 3 were fairly well developed and made similar recommendations. The level of evidence supporting specific recommendations ranged from randomized clinical trial evidence to expert opinion. By comparing the methodologic quality and content of the guidelines, the Task Force reached consensus regarding recommendations appropriate for local application. Two additional guidelines were subsequently identified and incorporated into the local protocol during a scheduled update.
Local adaptation of international and national guidelines is feasible following facilitation of the Practice Guidelines Evaluation and Adaptation Cycle.
PubMed ID
16096396 View in PubMed
Less detail

The adoption of laparoscopic colorectal surgery: a national survey of general surgeons.

https://arctichealth.org/en/permalink/ahliterature146673
Source
Can J Surg. 2009 Dec;52(6):455-62
Publication Type
Article
Date
Dec-2009
Author
Husein Moloo
Fatima Haggar
Guillaume Martel
Jeremy Grimshaw
Doug Coyle
Ian D Graham
Elham Sabri
Eric C Poulin
Joseph Mamazza
Fady K Balaa
Robin P Boushey
Author Affiliation
Minimally Invasive Surgery Research Group, Division of General Surgery, Ottawa Hospital and University of Ottawa, Ottawa, Ont.
Source
Can J Surg. 2009 Dec;52(6):455-62
Date
Dec-2009
Language
English
Publication Type
Article
Keywords
Adult
Canada
Colectomy - statistics & numerical data
Colonic Diseases - surgery
Female
General Surgery - trends
Health Care Surveys
Humans
Laparoscopy - utilization
Male
Middle Aged
Physician's Practice Patterns - statistics & numerical data
Rectal Diseases - surgery
Abstract
Laparoscopic surgery may become the standard of care for the treatment of colorectal disease. Little is known regarding North American patterns of practice or the limiting factors and strategies for adoption among surgeons.
We sent a 28-item questionnaire to all general surgeon members of the Royal College of Physicians and Surgeons of Canada. We derived descriptive and correlative information using chi(2), Wilcoxon rank sum and Student t tests and multivariate logistic regression.
The return rate was 55% (694/1266). A total of 67% (462/694; 95% confidence interval 63%-70%) of respondents perform colorectal surgery. Of these, 54% perform laparoscopic colorectal surgery. Multivariate logistic regression identified 5 factors related to performing laparoscopic colorectal surgery: fewer years in practice (p
Notes
Cites: Surg Oncol. 1998 Nov-Dec;7(3-4):165-7310677167
Cites: Surg Endosc. 2009 Apr;23(4):862-818649096
Cites: Lancet. 2002 Jun 29;359(9325):2224-912103285
Cites: Surg Endosc. 2002 Aug;16(8):1152-712015620
Cites: Surg Endosc. 2003 Mar;17(3):371-712436233
Cites: N Engl J Med. 2004 May 13;350(20):2050-915141043
Cites: Surg Endosc. 1995 Jan;9(1):46-87725213
Cites: Surg Endosc. 1998 Sep;12(9):1131-69716766
Cites: Colorectal Dis. 2005 Jan;7(1):86-915606593
Cites: Lancet. 2005 May 14-20;365(9472):1718-2615894098
Cites: Lancet Oncol. 2005 Jul;6(7):477-8415992696
Cites: Surg Endosc. 2005 Dec;19(12):1533-716222465
Cites: Ann Surg. 2006 Jun;243(6):730-5; discussion 735-716772776
Cites: Arch Surg. 2007 Feb;142(2):181-6; discusssion 18617309970
Cites: Am J Surg. 2007 May;193(5):589-91; discussion 591-217434361
Cites: Can J Surg. 2007 Apr;50(2):110-417550713
Cites: J Clin Oncol. 2007 Jul 20;25(21):3061-817634484
Cites: Ann Surg. 2007 Oct;246(4):655-62; discussion 662-417893502
Cites: Can J Surg. 2007 Aug;50(4):256-6017897513
Cites: Surg Innov. 2007 Sep;14(3):205-1017928620
Cites: Dis Colon Rectum. 2008 Jun;51(6):818-26; discussion 826-818418653
Cites: Ann Surg. 2008 Jul;248(1):1-718580199
Cites: Surg Endosc. 2009 Feb;23(2):341-618437467
Cites: Dis Colon Rectum. 2001 Feb;44(2):217-2211227938
PubMed ID
20011180 View in PubMed
Less detail

Assessing venous ulcer population characteristics and practices in a home care community.

https://arctichealth.org/en/permalink/ahliterature185512
Source
Ostomy Wound Manage. 2003 May;49(5):32-4, 38-40, 42-3
Publication Type
Article
Date
May-2003
Author
Karen R Lorimer
Margaret B Harrison
Ian D Graham
Elaine Friedberg
Barbara Davies
Author Affiliation
Clinical Epidemiology Program, Ottawa Health Research Institute, Canada. klorimer@ohri.ca
Source
Ostomy Wound Manage. 2003 May;49(5):32-4, 38-40, 42-3
Date
May-2003
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Female
Home Care Services - statistics & numerical data
Humans
Male
Middle Aged
Ontario - epidemiology
Physician's Practice Patterns - statistics & numerical data
Varicose Ulcer - epidemiology - therapy
Abstract
To plan for a new community leg ulcer service in one Ontario region, venous ulcer population characteristics and current community care practices were obtained from a home care cohort of people with venous ulcers. A secondary analysis was conducted on the venous ulcer cohort using data collected during a Regional Prevalence and Profile Study. Patients were identified based on the clinical syndrome for venous disease criteria described in the Royal College of Nurses clinical practice guidelines and by the presence of an ankle-brachial pressure index 0.8. The Regional Prevalence and Profile Study identified 263 people with leg ulcers for a rate of 2.0 per 1,000 people >25 years of age. One hundred, seven ulcers (41%) were the result of venous disease; of these, 83 (78% of cases) were associated with a single nursing agency and formed the study cohort. Most patients (51, 61%) were female and 65 years old. Thirty-eight (46%) had 4 comorbid conditions, 63 spoke English, 29 lived alone, 38 did not require physical aids or assistance for mobility, and 81 (98%) were able to travel outside of their home. The current ulcer had been present for an average of 15 months (median 6 months), 51 participants had a previous leg ulcer, and 22 had episodes of ulceration for > 5 years. Of the 121 ulcers in the study, 48 (41%) were located at the ankle, and the majority (85%) were > 1 cm2. General practitioners were the main medical care providers for 48 participants, and 52 (62%) had seen a specialist physician for their current ulcer. These findings are similar to large studies conducted in other industrialized countries and confirm that venous ulcers are a chronic problem in a population with complex health needs.
PubMed ID
12732756 View in PubMed
Less detail

Barriers and facilitators influencing call center nurses' decision support for callers facing values-sensitive decisions: a mixed methods study.

https://arctichealth.org/en/permalink/ahliterature167025
Source
Worldviews Evid Based Nurs. 2005;2(4):184-95
Publication Type
Article
Date
2005
Author
Dawn Stacey
Ian D Graham
Annette M O'Connor
Marie-Pascale Pomey
Author Affiliation
University of Ottawa, School of Nursing, Ottawa, Ontario, Canada. dstacey@uottawa.ca
Source
Worldviews Evid Based Nurs. 2005;2(4):184-95
Date
2005
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Canada
Clinical Competence
Communication Barriers
Consultants
Decision Support Systems, Clinical - utilization
Decision Support Techniques
Evidence-Based Medicine - education
Health Care Surveys
Hotlines
Humans
Nurses - psychology - standards
Patient Education as Topic
Quality of Health Care
Social Values
Triage
Abstract
Call center nurses triage symptoms and provide health information. However, information alone is not adequate for people facing values-sensitive health decisions. For these decisions, effective interventions are evidence-based patient decision aids and in-person nurse coaching using a structured process. Little is known about the quality of decision support provided by call center nurses.
To identify the barriers and facilitators influencing the provision of decision support by call center nurses to callers facing values-sensitive health decisions at a Canadian province-wide health call center.
A mixed qualitative and quantitative descriptive study from December 2003 to January 2004 using key informant interviews (n= 4), two focus groups (n= 7), a barriers assessment survey (n= 57), and analysis of simulated patient calls (n= 38) were carried out. Triangulation of these data was conducted using a conceptual content analysis method.
Participants indicated positive attitudes toward call center nurses preparing callers facing values-sensitive decisions. Facilitators included decision support resources, nurses' ability to recognize callers having difficulty, and having a supportive organizational infrastructure. The most frequently identified barriers were (a) limited usability of patient decision aids via telephone; (b) lack of a structured process to guide nurses during these types of calls; (c) nurses' inadequate knowledge, skills, and confidence in providing values-sensitive decision support; (d) unclear program direction; (e) organizational pressure to minimize call length; and (f) low public awareness of the services.
Despite call center nurses having positive attitudes, several modifiable barriers were interfering with nurses' current approaches to supporting callers facing values-sensitive decisions. Nurses wanted educational opportunities to further develop their decision support knowledge and skills, and decision support resources that are easier to use via telephone. As well, changes to organizational policies that address identified barriers could further facilitate the provision of decision support.
PubMed ID
17040526 View in PubMed
Less detail

Barriers to implementation of stroke rehabilitation evidence: findings from a multi-site pilot project.

https://arctichealth.org/en/permalink/ahliterature124055
Source
Disabil Rehabil. 2012;34(19):1633-8
Publication Type
Article
Date
2012
Author
Mark T Bayley
Amanda Hurdowar
Carol L Richards
Nicol Korner-Bitensky
Sharon Wood-Dauphinee
Janice J Eng
Marilyn McKay-Lyons
Edward Harrison
Robert Teasell
Margaret Harrison
Ian D Graham
Author Affiliation
Neuro Rehabilitation Program, Toronto Rehabilitation Institute, University of Toronto, Toronto, Canada. Bayley.Mark@torontorehab.on.ca
Source
Disabil Rehabil. 2012;34(19):1633-8
Date
2012
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Canada
Communication
Education, Continuing
Evidence-Based Medicine
Focus Groups
Health Knowledge, Attitudes, Practice
Health Personnel - education
Humans
Pilot Projects
Professional Competence
Qualitative Research
Rehabilitation Centers - organization & administration
Stroke - rehabilitation
Translational Medical Research
Abstract
To describe the barriers to implementation of evidence-based recommendations (EBRs) for stroke rehabilitation experienced by nurses, occupational therapists, physical therapists, physicians and hospital managers.
The Stroke Canada Optimization of Rehabilitation by Evidence project developed EBRs for arm and leg rehabilitation after stroke. Five Canadian stroke inpatient rehabilitation centers participated in a pilot implementation study. At each site, a clinician was identified as the "local facilitator" to promote the 6-month implementation. A research coordinator observed the process. Focus groups done at completion were analyzed thematically for barriers by two raters.
A total of 79 rehabilitation professionals (23 occupational therapists, 17 physical therapists, 23 nurses and 16 directors/managers) participated in 21 focus groups of three to six participants each. The most commonly noted barrier to implementation was lack of time followed by staffing issues, training/education, therapy selection and prioritization, equipment availability and team functioning/communication. There was variation in perceptions of barriers across stakeholders. Nurses noted more training and staffing issues and managers perceived fewer barriers than frontline clinicians.
Rehabilitation guideline developers should prioritize evidence for implementation and employ user-friendly language. Guideline implementation strategies must be extremely time efficient. Organizational approaches may be required to overcome the barriers. [Box: see text].
PubMed ID
22631218 View in PubMed
Less detail

Barriers to palliative radiotherapy referral: a Canadian perspective.

https://arctichealth.org/en/permalink/ahliterature163080
Source
Acta Oncol. 2007;46(5):659-63
Publication Type
Article
Date
2007
Author
Rajiv S Samant
Edward Fitzgibbon
Joanne Meng
Ian D Graham
Author Affiliation
The Ottawa Hospital Regional Cancer Centre, Ottawa, Ontario, Canada. rsamant@ottawahospital.on.ca
Source
Acta Oncol. 2007;46(5):659-63
Date
2007
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Data Collection
Female
Humans
Male
Neoplasms - radiotherapy
Ontario
Palliative Care
Physicians, Family - psychology
Referral and Consultation - statistics & numerical data
Abstract
Radiotherapy is an effective but underutilized treatment modality for cancer patients. We decided to investigate the factors influencing radiotherapy referral among family physicians in our region. A 30-item survey was developed to determine palliative radiotherapy knowledge and factors influencing referral. It was sent to 400 physicians in eastern Ontario (Canada) and the completed surveys were evaluated. The overall response rate was 50% with almost all physicians seeing cancer patients recently (97%) and the majority (80%) providing palliative care. Approximately 56% had referred patients for radiotherapy previously and 59% were aware of the regional community oncology program. Factors influencing radiotherapy referral included the following: waiting times for radiotherapy consultation and treatment, uncertainty about the benefits of radiotherapy, patient age, and perceived patient inconvenience. Physicians who referred patients for radiotherapy were more than likely to provide palliative care, work outside of urban centres, have hospital privileges and had sought advice from a radiation oncologist in the past. A variety of factors influence the referral of cancer patients for radiotherapy by family physicians and addressing issues such as long waiting times, lack of palliative radiotherapy knowledge and awareness of Cancer Centre services could increase the rate of appropriate radiotherapy patient referral.
PubMed ID
17562442 View in PubMed
Less detail
Source
Dig Dis Sci. 2007 Apr;52(4):1087-95
Publication Type
Article
Date
Apr-2007
Author
Ann Cranney
Marion Zarkadas
Ian D Graham
J Decker Butzner
Mohsin Rashid
Ralph Warren
Mavis Molloy
Shelley Case
Vernon Burrows
Connie Switzer
Author Affiliation
Department of Medicine, Ottawa Health Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
Source
Dig Dis Sci. 2007 Apr;52(4):1087-95
Date
Apr-2007
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Canada
Celiac Disease - complications - diagnosis - diet therapy
Data Collection
Diet, Protein-Restricted
Family Health
Female
Glutens
Health status
Humans
Male
Middle Aged
Patient compliance
Quality of Life
Abstract
The purpose of this study was to characterize the diagnostic process, frequency of associated disorders, family history, and impact of a gluten-free diet in individuals with celiac disease. All members of the Canadian Celiac Association (n=5240) were surveyed with a questionnaire. Respondents included 2681 adults with biopsy-proven celiac disease. The mean age was 56 years. Most common presenting symptoms included abdominal pain (83%), diarrhea (76%), and weight loss (69%). The mean delay in diagnosis was 11.7 years. Diagnoses made prior to celiac disease included anemia (40%), stress (31%), and irritable bowel syndrome (29%). Osteoporosis was common. Prior to diagnosis, 27% of respondents consulted three or more doctors about their symptoms. Delays in diagnosis of celiac disease remain a problem. Associated medical conditions occur frequently. More accurate food labeling is needed. Improved awareness of celiac disease and greater use of serological screening tests may result in earlier diagnosis and reduced risk of associated conditions.
PubMed ID
17318390 View in PubMed
Less detail

The Canadian celiac health survey--the Ottawa chapter pilot.

https://arctichealth.org/en/permalink/ahliterature185452
Source
BMC Gastroenterol. 2003 May 11;3:8
Publication Type
Article
Date
May-11-2003
Author
Ann Cranney
Marion Zarkadas
Ian D Graham
Connie Switzer
Author Affiliation
Division of Rheumatology, Department of Medicine, Queen's University, Kingston, Ontario, Canada. cranneya@kgh.kari.net
Source
BMC Gastroenterol. 2003 May 11;3:8
Date
May-11-2003
Language
English
Publication Type
Article
Keywords
Celiac Disease - complications - diagnosis - diet therapy
Diagnosis, Differential
Family Health
Feasibility Studies
Female
Glutens - administration & dosage - adverse effects
Health Surveys
Humans
Male
Middle Aged
Nutrition Policy
Ontario
Pilot Projects
Quality of Life
Questionnaires
Abstract
Celiac disease may manifest with a variety of symptoms which can result in delays in diagnosis. Celiac disease is associated with a number of other medical conditions. The last national survey of members of the Canadian Celiac Association (CCA) was in 1989. Our objective was to determine the feasibility of surveying over 5,000 members of the CCA, in addition to obtaining more health related information about celiac disease.
The Professional Advisory Board of the CCA in collaboration with the University of Ottawa developed a comprehensive questionnaire on celiac disease. The questionnaire was pre-tested and then a pilot survey was conducted on members of the Ottawa Chapter of the CCA using a Modified Dillmans' Total Design method for mail surveys.
We had a 76% response to the first mailout of the questionnaire. The mean age of participants was 55.5 years and the mean age at diagnosis was 45 years. The majority of respondents presented with abdominal pain, diarrhea, fatigue or weight loss. Prior to diagnosis, 30% of respondents consulted four or more family doctors. Thirty seven percent of individuals were told they had either osteoporosis or osteopenia. Regarding the impact of the gluten-free diet (GFD), 45% of individuals reported that they found following a GFD was very or moderately difficult. The quality of life of individuals with celiac disease was comparable to the mean quality of life of Canadians.
On the basis of our results, we concluded that a nationwide survey is feasible and this is in progress. Important concerns included delays in the diagnosis of celiac disease and the awareness of associated medical conditions. Other issues include awareness of celiac disease by health professionals and the impact of the GFD on quality of life. These issues will be addressed further in the national survey.
Notes
Cites: CMAJ. 2000 Aug 8;163(3):265-7110951722
Cites: Gastroenterology. 1999 Aug;117(2):297-30310419909
Cites: Am J Gastroenterol. 2001 Jan;96(1):112-911197239
Cites: Am J Gastroenterol. 2001 Jan;96(1):126-3111197241
Cites: Gastroenterology. 2001 Feb;120(3):636-5111179241
Cites: Med Care. 2001 Aug;39(8):867-7811468505
Cites: Dig Dis Sci. 2002 Jul;47(7):1427-3112141796
Cites: Arch Intern Med. 2003 Feb 10;163(3):286-9212578508
Cites: Br Med J (Clin Res Ed). 1983 Jan 8;286(6359):95-76401509
Cites: Gut. 1989 Mar;30(3):333-82707633
Cites: Med Care. 1996 Mar;34(3):220-338628042
Cites: J Clin Gastroenterol. 1996 Jul;23(1):21-38835894
Cites: Scand J Gastroenterol. 1998 Sep;33(9):933-89759948
Cites: J Intern Med. 1999 Jan;245(1):63-810095818
Cites: Gut. 2000 Nov;47(5):628-3111034577
PubMed ID
12740024 View in PubMed
Less detail

Celebrating 8 projects that improved our world.

https://arctichealth.org/en/permalink/ahliterature148323
Source
CMAJ. 2009 Oct 13;181(8):E132-3
Publication Type
Article
Date
Oct-13-2009
Author
Sharon E Straus
Chaidwick Leneis
Ian D Graham
Author Affiliation
LiKaShing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. sharon.straus@utoronto.ca
Source
CMAJ. 2009 Oct 13;181(8):E132-3
Date
Oct-13-2009
Language
English
Publication Type
Article
Keywords
Canada
Delivery of Health Care - standards
Health Services Research - standards
Humans
Quality Indicators, Health Care - trends
Notes
Cites: CMAJ. 2009 Oct 13;181(8):E136-719786480
Cites: CMAJ. 2009 Oct 13;181(8):E134-519786481
Erratum In: CMAJ. 2009 Nov 10;181(10):716
PubMed ID
19786479 View in PubMed
Less detail

Celiac disease: evaluation of the diagnosis and dietary compliance in Canadian children.

https://arctichealth.org/en/permalink/ahliterature171743
Source
Pediatrics. 2005 Dec;116(6):e754-9
Publication Type
Article
Date
Dec-2005
Author
Mohsin Rashid
Ann Cranney
Marion Zarkadas
Ian D Graham
Connie Switzer
Shelley Case
Mavis Molloy
Ralph E Warren
Vernon Burrows
J Decker Butzner
Author Affiliation
Division of Gastroenterology and Nutrition, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada. mohsin.rashid@iwk.nshealth.ca
Source
Pediatrics. 2005 Dec;116(6):e754-9
Date
Dec-2005
Language
English
Publication Type
Article
Keywords
Adolescent
Canada
Celiac Disease - diagnosis - diet therapy - epidemiology
Child
Child, Preschool
Female
Humans
Infant
Male
Abstract
We sought to characterize the clinical features at presentation as well as the associated disorders, family history, and evaluation of compliance with a gluten-free diet in children with celiac disease from across Canada.
All members (n = 5240) of the Canadian Celiac Association were surveyed with a questionnaire. Of the 2849 respondents with biopsy-confirmed celiac disease, 168 who were or = 2 pediatricians before confirmation of the diagnosis. Before the recognition of celiac disease, other diagnoses received by these children included anemia (15%), irritable bowel syndrome (11%), gastroesophageal reflux (8%), stress (8%), and peptic ulcer disease (4%). A serological test was performed to screen for celiac disease in 70% of those in this population. Eight percent had either type 1 diabetes mellitus or a first-degree relative with celiac disease. Almost all respondents (95%) reported strict adherence to a gluten-free diet, and 89% noted improved health. Reactions after accidental gluten ingestion developed in 54% of the children between 0.5 and 60 hours after ingestion with a median of 2.0 hours. Reactions included abdominal discomfort (87%), diarrhea (64%), bloating (57%), fatigue (37%), headache (24%), and constipation (8%), and most displayed > 1 symptom. Although most adjusted well to their disease and diet, 10% to 20% reported major disruptions in lifestyle. Twenty-three percent felt angry all or most of the time about following a gluten-free diet. Only 15% avoided traveling all or most of the time, and during travel, 83% brought gluten-free food with them all of the time. More than half of the families avoided restaurants all or most of the time. Twenty-eight percent of the respondents found it extremely difficult to locate stores with gluten-free foods, and 27% reported extreme difficulty in finding gluten-free foods or determining if foods were free of gluten. Sixty-three percent of the respondents felt that the information supplied by the Canadian Celiac Association was excellent. Gastroenterologists provided excellent information to 44%, dietitians to 36%, and the family physician to 11.5%. When asked to select 2 items that would improve their quality of life, better labeling of gluten-containing ingredients was selected by 63%, more gluten-free foods in the supermarket by 49%, gluten-free choices on restaurant menus by 49%, earlier diagnosis of celiac disease by 34%, and better dietary counseling by 7%.
In Canada, children with celiac disease present at all ages with a variety of symptoms and associated conditions. Delays in diagnosis are common. Most children are compliant with a gluten-free diet. A minority of these children experience difficulties in modifying their lifestyles, and gluten-free foods remain difficult to obtain.
PubMed ID
16322131 View in PubMed
Less detail

65 records – page 1 of 7.