Computerized disease management algorithms--the future is now.

Objective: A commentary on the value and applicability of computerized clinical tools in the delivery of health care.

Conclusion: Preliminary studies, especially in patients with psychological disorders, have indicated that the utilization of computerized clinical instruments provide value and are well accepted by patients.

Performance of panel-based criteria to evaluate the appropriateness of colonoscopy: a prospective study.

Background: Prospective data describing the appropriateness of use of colonoscopy based on detailed panel-based clinical criteria are not available.

Methods: In a cohort of 553 consecutive patients referred for colonoscopy to two university-based Swiss outpatient clinics, the percentage of patients who underwent colonoscopy for appropriate, equivocal, and inappropriate indications and the relationship between appropriateness of use and the presence of relevant endoscopic lesions was prospectively assessed. This assessment was based on criteria of the American Society for Gastrointestinal Endoscopy and explicit American and Swiss criteria developed in 1994 by a formal panel process using the RAND/UCLA appropriateness method.

Underutilization of upper gastrointestinal endoscopy.

Background & Aims: Efforts to reduce costs in health care may raise concerns about underuse of medical procedures. This study prospectively assessed underuse of upper gastrointestinal endoscopy in a cohort of patients in whom we have recently published data on overuse of endoscopy.

Methods: Underuse was identified by formal necessity criteria for endoscopy, obtained by an explicit panel process.

Overuse of upper gastrointestinal endoscopy in a country with open-access endoscopy: a prospective study in primary care.

Background: This prospective observational study was aimed at evaluating the appropriateness of use of upper gastrointestinal endoscopy (UGE) in primary care in a country with open access to and high availability of the procedure.

Methods: Outpatients were consecutively included in two clinical settings: Setting A (20 primary care physicians during 4 weeks) and B (university-based outpatient clinic during 3 weeks). In patients undergoing UGE, appropriateness of referral was judged by explicit Swiss criteria developed by the RAND/UCLA panel method.

Pneumocystis carinii pneumonia in patients with ulcerative colitis treated with corticosteroids.

Today, Pneumocystis carinii pneumonia (PCP) is typically associated with AIDS. However, in the pre-AIDS era, PCP was known to be associated with various immunodeficiency states, malignancies, and immunosuppressive therapy, particularly the use of corticosteroids. PCP has been reported to occur during immuno-suppressive therapy of some chronic inflammatory states, but it has never been reported in patients with inflammatory bowel disease.