Newly designed OTS Clip for preventing fully-covered self-expandable metal stent migration in the gastrointestinal tract.

Fully-covered self-expandable metal stents (FCSEMS) are frequently used for endoscopic management of gastrointestinal lesions. However, stent migration occurs in up to one-third of patients. Different tools are used to anchor stents to prevent migration.

First-line endoscopic treatment with over-the-scope clips in patients with either upper or lower gastrointestinal bleeding: a multicenter study.

Endoscopic treatment is the mainstay approach for gastrointestinal bleeding, in either upper (UGIB) or lower (LGIB) tract. The over-the-scope clip (OTSC) may overcome limitations of standard clips or thermocoagulation in high-risk bleeding lesions. We evaluate the main clinically relevant outcomes following endoscopic hemostasis with OTSC in high-risk lesions and/or patients.

Interprofessional education involving didactic TeamSTEPPS® and interactive healthcare simulation: A systematic review.

The didactic portion of TeamSTEPPS®, which focuses on teaching teamwork and communication, coupled with interactive simulation methods provides a unique interprofessional education (IPE) learning environment. Across the literature there are a wide variety of such programs described, but there is not a consensus on the most effective methodology. A systematic review was therefore undertaken to synthesize, critically appraise, and evaluate existing literature on IPE programs that utilize didactic TeamSTEPPS in conjunction with interactive healthcare simulation.

Insulinoma and Chronic Kidney Disease: An Uncommon Conundrum Not to Be Overlooked.

A hypertensive man with chronic kidney disease (CKD) secondary to polycystic disease was hospitalized for symptoms related to hypoglycemia. Fasting test elicited symptomatic hypoglycemia after 12 hours, which was associated with inappropriately unsuppressed normal insulin and C-peptide levels. Neither ultrasonography (US) nor magnetic resonance imaging detected any pancreatic tumor.

Colon capsule endoscopy to screen for colorectal neoplasia in those with family histories of colorectal cancer.

Background And Aims: Colon capsule endoscopy (CCE) has been recognized as an alternative for colorectal cancer (CRC) screening in average-risk people. Our aim was to prospectively assess the accuracy of CCE as a screening tool in first-degree relatives (FDRs) of people with CRC by using optical colonoscopy (OC) with segmental unblinding as the reference standard.

Methods: Consecutive patients admitted with a CRC diagnosis (index cases) were prospectively evaluated and invited to contact their FDRs.

Endoscopic stenting as bridge-to-surgery (BTS) in left-sided obstructing colorectal cancer: Experience with conformable stents.

Background: Compared to emergency surgery, self-expandable metallic stents are effective and safe when used as bridge-to-surgery (BTS) in operable patients with acute colorectal cancer obstruction. In this study, we report data on the new conformable colonic stents.

Objectives: To evaluate clinical effectiveness of conformable stents as BTS in patients with acute colorectal cancer obstruction.

Full thickness endoscopic resection of a colonic cancer: a case report.

We present a case of a 40-year-old woman, diagnosed with a flat lesion (type 0-IIa+IIc) of the colon. There was a strong suspicion for submucosal invasion, however the patient initially refused surgical intervention. Therefore, the lesion was treated with full-thickness endoscopic resection.

Gastrointestinal motility disorder assessment in systemic sclerosis.

Objectives: SSc is a clinically heterogeneous and generalized disease, characterized by thickness of the connective tissue of the skin and internal organs, such as the digestive tract, impairing gastrointestinal (GI) motility. Our aim is to evaluate retrospectively abnormalities of oesophageal motility, gastric emptying, oro-cecal transit time (OCTT) and small intestine bacterial overgrowth (SIBO) in a large cohort of SSc patients.

Methods: Ninety-nine SSc patients were included in the study.

Lactulose breath test to assess oro-cecal transit delay and estimate esophageal dysmotility in scleroderma patients.

Objectives: To assess the correlation between delayed oro-cecal transit time (OCTT) and esophageal motility abnormalities in a cohort of systemic sclerosis (SSc) patients.

Methods: We prospectively enrolled 50 consecutive SSc patients and 60 healthy volunteers (HVs) as controls. Both groups underwent glucose breath test (GBT) to exclude small intestine bacterial overgrowth, lactulose hydrogen, and octanoic acid breath tests (LHBT and OBT) to measure OCTT and gastric emptying (GE), respectively, and manometry to assess esophageal motility.

External adjustment for unmeasured confounders improved drug-outcome association estimates based on health care utilization data.

Objectives: Health care utilization (HCU) databases are widespread sources of data for pharmacoepidemiologic investigations. Possible confounders are typically not measured in such databases. We show how to assess the impact of confounders in a study aimed at comparing cardiovascular (CV) risk according to drug regimen prescribed at starting antihypertensive therapy, nominally one agent (monotherapy) or a combination of agents in a unique tablet (fixed-dose combination) or in at least two distinct tablets (extemporaneous combination).

A comparison between lactose breath test and quick test on duodenal biopsies for diagnosing lactase deficiency in patients with self-reported lactose intolerance.

Background: A lactose breath test (LBT) is usually used to diagnose lactase deficiency, and a lactose quick test (LQT) has been proposed as a new test on duodenal biopsies to detect this disorder.

Goals: We aimed to assess the diagnostic accuracy of LBT and LQT and their ability to predict the clinical response to a lactose-free diet in patients with self-reported lactose intolerance.

Study: Fifty-five patients (age 47 ± 14 y; M/F 15/36) underwent upper gastrointestinal endoscopy and 25g-LBT.

Theoretically-driven infrastructure for supporting health care teams training at a military treatment facility.

Designated a Department of Defense Team Resource Center (TRC) in 2008, Naval Medical Center Portsmouth (NMCP) currently hosts three tri-service health care teams training courses annually. Each consists of didactic learning coupled with simulation-based training exercises to provide an interactive educational experience for health care professionals. Simulated cases are developed to reinforce specific teamwork skills and behaviors, and to incorporate a variety of technologies including standardized patients, manikins, and virtual reality.

Incidence of cardiovascular events in Italian patients with early discontinuations of antihypertensive, lipid-lowering, and antidiabetic treatments.

Background: Aim of the present investigation was to quantify the early discontinuation phenomenon in patients treated for hypertension, dyslipidemia or diabetes, and to assess their clinical characteristics and incidence of cardiovascular (CV) outcomes to see whether an incorrect diagnosis was involved or treatment continuation might have been indicated.

Methods: Using the health-care databases on beneficiaries of the National Health Service (NHS) living in Lombardy, we studied patients aged 40-79 years who received their first prescription during 2003. Patients were classified according to whether they received only one or multiple prescriptions and data were compared with those obtained in individuals who did not receive any prescription.

Endoscopic management of hilar cholangiocarcinoma.

Hilar cholangiocarcinoma has a poor prognosis and surgery remains the only curative option. However, few patients are diagnosed at a curable stage and palliative therapies are, therefore, mandatory. Endoscopy could have a useful role in the work-up of patients with hilar cholangiocarcinoma who are unsuitable for surgery.

Cardiovascular protection by initial and subsequent combination of antihypertensive drugs in daily life practice.

Guidelines recommend a combination of 2 drugs to be used as first-step treatment strategy in high-risk hypertensive individuals to achieve timely blood pressure control and avoid early events. The evidence that this is associated with cardiovascular (CV) benefits compared with initial monotherapy is limited, however. The objective of this study was to assess whether, compared with antihypertensive monotherapy, a combination of antihypertensive drugs provides a greater CV protection in daily clinical practice.

Venous thromboembolism after major orthopaedic surgery: a population-based cohort study.

Venous thromboembolism (VTE) is an important cause of morbidity and mortality following major orthopaedic surgery. However, the incidence of VTE and the role of additional risk factors have not yet been well explored in Italian clinical practice. The objective of the study is to estimate the incidence of VTE in the 3 months following elective hip and knee replacement (HR, KR) in a large cohort of patients, and the association between some selected risk factors and the occurrence of VTE.

Heterogeneity in antihypertensive treatment discontinuation between drugs belonging to the same class.

Objectives: Discontinuation of antihypertensive treatment is known to be different for different classes of antihypertensive drugs. No information is available on whether this phenomenon differs for drugs belonging to the same class. This is clinically relevant because treatment discontinuation is mainly responsible for poor blood pressure control in the antihypertensive population.

Chemotherapy versus tamoxifen versus chemotherapy plus tamoxifen in node-positive, oestrogen receptor-positive breast cancer patients. Very late results of the 'gruppo di ricerca per la chemio-ormonoterapia adiuvante (GROCTA)' 01-Trial in early breast cancer.

First, to evaluate whether the benefits of combined chemotherapy (CT) and Tamoxifen (T), previously documented in the GROCTA-01 Trial, were long-lasting and, second, to show whether ER or PgR levels could allow the identification of the patients who could benefit from T alone. 504 node-positive, ER-positive, women were randomly assigned to ten CT courses or to 5 years of T or to the combination of the two (CTT). Disease-free (DFS) and overall survival (OS) were the primary trial-endpoints.

Better compliance to antihypertensive medications reduces cardiovascular risk.

Objective: The effect of compliance with antihypertensive medications on the risk of cardiovascular outcomes in a population without a known history of cardiovascular disease has been addressed by a large population-based prospective, cohort study carried out by linking Italian administrative databases.

Methods: The cohort of 242 594 patients aged 18 years or older, residents in the Italian Lombardy Region, who were newly treated for hypertension during 2000-2001, was followed from index prescription until 2007. During this period patients who experienced a hospitalization for coronary or cerebrovascular disease were identified (outcome).

Endoscopic management of GI perforations with a new over-the-scope clip device (with videos).

Background: Through-the-scope endoclips have been used to manage small perforations in the GI tract, but they have limitations. A new over-the-scope clip system, OTSC (Ovesco Endoscopy, Tuebingen, Germany), may be suitable for the closure of larger GI leaks.

Objective: To evaluate the clinical outcomes of patients with GI perforations of up to 20 mm, treated with OTSC.

Reduced discontinuation of antihypertensive treatment by two-drug combination as first step. Evidence from daily life practice.

Objectives: To measure persistence with antihypertensive drug therapy in patients initiating treatment with mono or combination therapy.

Methods: Data analysis was based on two cohorts of patients, that is, a cohort derived from the registration of drug prescriptions in all residents of the Lombardy region receiving Public Health Service and a cohort of patients followed by general practitioners throughout the Italian territory. Data were limited to patients aged 40-80 years who received their first antihypertensive drug prescription (n = 433,680 and 41,199, respectively) in whom persistency of treatment was examined over 9 months.

(13)C-octanoic acid breath test (OBT) with a new test meal (EXPIROGer): Toward standardization for testing gastric emptying of solids.

Background: Standardization of the (13)C-octanoic acid breath test is still lacking.

Aim: To evaluate the accuracy of the (13)C-octanoic acid breath test using a new standardized ready-to-eat, gluten-, glucose-, and lactose-free muffin.

Methods: Healthy subjects were recruited and sorted by sex and age.

Characteristics of reflux episodes and symptom association in patients with erosive esophagitis and nonerosive reflux disease: study using combined impedance-pH off therapy.

Objectives: We sought to compare reflux and symptom association patterns in patients with nonerosive reflux disease (NERD), erosive esophagitis (EE), and in healthy volunteers (HVs).

Methods: Patients with EE and NERD underwent combined impedance-pH monitoring. Normal values were defined on the basis of previously collected data from 48 HVs.