Inappropriate Analogy

Publisher Website
Google Scholar
Abstract
Amer Alkhatib, MD, Douglas Adler, MD, FACG. Department of Internal Medicine - Division of Gastroenterology, University of Utah, Salt Lake City, UT. Purpose: Determine whether there are gender-related differences among elderly patients presenting with acute upper gastrointestinal bleeding with regards to clinical presentation, laboratory and endoscopic findings, complications, length and cost of hospitalization. Methods: This is a retrospective pilot study of elderly patients ( 60 years old) presenting with AUGIB to a single hospital over a one year period. Categorical variables were analyzed using the Chi-square test. The Student's t-test was used to compare continuous variables. Results: Total of 113 patients were enrolled (61 females and 52 males). There was no difference between the two groups in regard to mean age (78.1 for females vs. 74.5 for males, p10 (HCV) patients in the past year. 48% of respondents tested patients for HCV if they had elevated transaminases; 46% routinely screened patients for HCV with a history of blood transfusion; 40% routinely screened patients with a history of intravenous drug use; 20% routinely screened patients with AIDS; 3% routinely screened patients with a history of cocaine snorting or tattoos; 2% of respondents tested all admitted in-hospital patients. Genotype 1 was reported by 47% as the most common in the U.S., while genotype 2 and 3 were reported by 39% and 7% respectively. 85% reported interferon plus ribavirin as the appropriate therapy for HCV. 55% considered alpha-fetoprotein as the screening test of choice for hepatocellular carcinoma. Any form of depression was considered a contraindication to treatment by 36% of respondents, while 31% considered cirrhosis, 3% considered AIDS and 8% considered pregnancy a contraindication. Conclusion: The results of this survey make us conclude that a large majority of IM residents are not fully familiar with recommended guidelines in the assessment and management of HCV. Core curriculum lectures should be specifically designed to fill in gaps of knowledge. A focused lecture, dictated by the results and deficiencies found in the answers to the questionnaire on hepatitis C, was delivered to IM residents at a single institution consisting of 20% of the original respondents. After the lecture, residents were re-surveyed. One hundred percent of the respondents correctly identified risk factors in transmission, whom to test, contraindications to treatment and screening for hepatocellular carcinoma in patients with hepatitis C. 90% of the residents correctly identified genotype 1 as the predominant amongst patients with hepatitis C. These results make it possible to suggest a new paradigm in teaching. Core curriculum lectures should be dictated by an analysis of the institution's resident knowledge base to have maximal impact on outcome. Himabindu Angara, Tejaswi Pamganamamula, Sirisha Tummala, Vijay Agusala, Nuvneet Khandelwal, Sailaja Dandamudi, Kiran Kodali, Tejaswi Vemuru, Reynalin Dayaday, RN, APN, Srikala Meda, Sindhu Kaitha, Richard Bartlett, MD, Ravikumar Vemuru, MD. Permian Gastroenterology Associates, LLP, Odessa, TX. Purpose: Barriers to recruitment and retention need to be identified to improve subject accrual to clinical trials. We tried to identify the factors that can predict the likelyhood of subjects participating in clinical trials and to determine the general attitudes towards clinical research. Methods: A total of 200 patients from local private practices and an affiliated clinical research center were selected and divided into two equal groups based on their prior participation in a clinical trial. Subject interviews were conducted both onsite and via telephone by volunteers. The subjects were assessed for their willingness to participate in clinical trials, factors affecting their decision making as well as their general attitudes towards clinical trials. Results: Ethnicity did not seem to affect the subject's willingness to participate in a clinical trial (Caucasian 51/68 or 75% vs. Hispanic 20/25 or 80%). Prior participation in clinical trial improved their acceptance in both groups (Caucasian 69/69 or 100% vs. Hispanic 28/30 or 93%). Other demographic factors, financial difficulties in seeking medical care and inadequate response to traditional medications did not seem to affect their choice to participate in clinical trials. Physician recommendation to participate seems to be the strongest motivating factor both for people who had never participated in clinical trials (44/100 or 44%) and those who did (46/100 or 46%). Second to this was patient's desire to help other patients like themselves. Among the trial related factors, the presence of a placebo group did have a negative impact in subject's willingness to participate, especially among those who had never participated in a trial (42/98 or 43% vs. 72/100 or 72%). The frequency and severity of potential side effects of investigative product also has a significant negative bearing on their willingness to take part in studies in both groups (93/99 or 94% vs. 72/100 or 72%). Patients were perceived to be the biggest beneficiaries of clinical trials among the group who had prior participation in clinical trials ( 59/100 or 59%). Among those who had never participated in trials before, there is a strong perception that the pharmaceutical industries are the biggest beneficiaries of clinical trials (43/98 or 44%). Conclusion: Physician recommendation seems to be the strongest detemining factor for subject's paticipation in a clinical trial. More patients who had participated in clinical trials had felt that they were the biggest beneficiaries of clinical trials. Rene Rivera, MD, Donald Kirby, MD, CNSP, Ezra Steiger, MD, CNSP. Cleveland Clinic, Cleveland, OH. Purpose: Clinical Nutrition Fellowships (CNF) were established in the early 1990s with the intent increasing the number of physician nutrition specialists (PNS). Cleveland Clinic...

This publication has 1 reference indexed in Scilit: