Publications by authors named "Heel N"

For non-dysplastic Barrett's Esophagus (BE) patients, guidelines recommend endoscopic surveillance every 3 to 5 years with four-quadrant random biopsies every 2 cm of BE length. Adherence to these guidelines is low in clinical practice. Pooling BE surveillance endoscopies on dedicated endoscopy lists performed by dedicated endoscopists could possibly enhance guideline adherence, detection of visible lesions, and dysplasia detection rates (DDRs).

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Article Synopsis
  • A study in Dutch hospitals evaluated the effectiveness of a brief outpatient consultation (OC) with a gastroenterologist versus standard referral letters (SRL) for scheduling colonoscopies.
  • The outpatient consultation led to better identification of patient needs, reducing the number of unnecessary colonoscopies and prioritizing those at higher risk for cancer.
  • Overall, patients who had an OC had more accurate medication and health condition reporting, which contributed to an increase in cancer diagnoses among prioritized patients.
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Background: Self-expanding metal stents (SEMSs) provide effective palliation in patients with malignant dysphagia. However, although life expectancy is generally limited, reintervention rates because of stent dysfunction are significant. New SEMSs are being designed to overcome this drawback.

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Background: Self-expandable metals stents (SEMSs) have increasingly been used as a temporary device to bridge chemoradiotherapy in patients with malignant esophageal disease or in patients with benign esophageal defects or stenosis.

Objective: To evaluate the outcome of removal of SEMSs in a large cohort of patients with benign and malignant esophageal disease.

Design: Observational study with standardized treatment and follow-up.

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Background: Despite advances in staging methods, surgical techniques, and adjuvant treatment, recurrent cancer after esophagectomy is a major cause of morbidity and mortality.

Objective: Our purpose was to investigate the safety and efficacy of a self-expandable metal stent (SEMS) in patients with dysphagia or fistula caused by recurrent cancer after esophagectomy.

Design: Prospective, observational study with standardized treatment and follow-up.

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Background And Study Aims: In patients with primary esophageal cancer, luminal patency can be restored by placement of a self-expandable metal stent (SEMS). The use of SEMS in patients with dysphagia caused by malignant extrinsic compression has largely been unreported. In this study we evaluated the efficacy of SEMS in a large cohort of patients with malignant extrinsic compression.

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Objectives: The standard approach to benign esophageal perforations consists of conservative treatment or surgery. In this study, we investigated the efficacy of short-term stent placement for nonmalignant esophageal perforations.

Methods: This is a prospective single-center study of patients with benign esophageal perforations in whom a removable self-expandable stent was placed.

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In response to the need to assess both food and supplemental sources of nutrients, we have expanded the capabilities of Nutrition Data System for Research (NDSR) software to allow for assessing dietary supplement use. A Dietary Supplement Assessment Module allows for the automated collection and coding of dietary supplement use. The module is designed for use in conjunction with the software's 24-hour dietary recall features.

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The aim of this report is to describe INTERMAP standardized procedures for assessing dietary intake of 4680 individuals from 17 population samples in China, Japan, UK and USA: Based on a common Protocol and Manuals of Operations, standardized collection by centrally trained certified staff of four 24 h dietary recalls, two timed 24-h urines, two 7-day histories of daily alcohol intake per participant; tape recording of all dietary interviews, and use of multiple methods for ongoing quality control of dietary data collection and processing (local, national, and international); one central laboratory for urine analyses; review, update, expansion of available databases for four countries to produce comparable data on 76 nutrients for all reported foods; use of these databases at international coordinating centres to compute nutrient composition. Chinese participants reported 2257 foods; Japanese, 2931; and UK, 3963. In US, use was made of 17,000 food items in the online automated Nutrition Data System.

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The International Study of Macronutrients and Blood Pressure (INTERMAP) is a four-country study investigating relationships between individual dietary intakes and blood pressure. Dietary intake patterns of individuals were estimated for macronutrients (proteins, lipids, carbohydrates, alcohol) and their components (amino acids, fatty acids, starch), as well as minerals, vitamins, caffeine, and dietary fiber. The dietary assessment phase of the study involved collection of four 24-h recalls and two 24-h urine specimens from each of 4680 adults, ages 40-59, at 16 centers located in the People's Republic of China, Japan, the United Kingdom and the United States.

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Objective: This study examined the accuracy of a multiple-pass, 24-hour dietary recall method for estimating energy intakes of men and women by comparing it with energy intake required for weight maintenance.

Design: Three-day, multiple-pass, 24-hour recalls were obtained on randomly selected days during a self-selected diet period when subjects were preparing their own meals and during a controlled diet period when all meals were provided by the study. During the dietary intervention, weight was maintained; body weight and dietary intake were monitored closely, thereby allowing estimation of the energy intake required for weight maintenance.

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Objective: To describe the process and results of diet standardization, diet validation, and monitoring of diet composition, which were key components of protocol 1 of Dietary Effects on Lipoproteins and Thrombogenic Activity (DELTA-1), the initial protocol in a program of multicenter human feeding studies designed to evaluate the effects of amount and type of fat on lipoproteins and hemostasis parameters in various demographic groups.

Design: DELTA-1 was based on a randomized, blinded, crossover experimental design. Three diets were fed for 8 weeks to 103 healthy men and women aged 22 to 67 years at 4 field centers.

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Background: Questions regarding the efficacy of nonpharmacologic approaches for the treatment of stage 1 hypertension were addressed as part of the Treatment of Mild Hypertension Study (TOMHS), a 4-year, randomized clinical trial (N = 902). This report describes the lifestyle intervention program used in TOMHS, presents data on the lifestyle changes observed, and focuses on the effect of weight loss on blood pressure and blood lipid levels.

Methods: Participants were randomly assigned to receive either placebo or one of five different antihypertensive medications.

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Studies generally indicate that excretion of sodium, potassium, and water is greater during the day than during the night. To determine whether hypertensive patients exhibit this same pattern of excretion, diurnal variations in excretion of sodium, potassium, creatinine, and water were examined in 107 hypertensive men and women from a clinical trial on control of hypertension by nonpharmacological means--the Hypertension Control Program. Each participant provided two carefully timed 24-hour urine collections divided into daytime and overnight specimens.

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A four-year trial assessed whether less severe hypertensives could discontinue antihypertensive drug therapy, using nutritional means to control blood pressure. Randomization was to three groups: group 1--discontinue drug therapy and reduce overweight, excess salt, and alcohol; group 2--discontinue drug therapy, with no nutritional program; or group 3--continue drug therapy, with no nutritional program. In groups 1 and 2 patients resumed drug therapy if pressure rose to hypertensive levels.

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Ability to safely withdraw well-controlled mild hypertensives from drugs is being tested in a three-group randomized trial. Group I (intervention) was removed from drugs after the first 2 months of nutrition counseling. Counseling is continuing through the remaining years of the trial to achieve a minimum weight loss of 10 lb if overweight, reduction of sodium intake to less than 1,800 mg, and reduction of alcohol intake to not more than two drinks per day.

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Ability to safely withdraw medication from well-controlled mild hypertensives was tested in a 3-group randomized trial. Group I (Intervention): drugs were stopped 2 months after nutrition counseling began. Counselling continued throughout the remaining years of the trial to achieve: a minimum of 10 lb weight loss if overweight; reduction of sodium intake to 1800 mg/day or less; reduction of alcohol intake to not more than 2 drinks per day.

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