The fragility of randomized placebo-controlled trials for irritable bowel syndrome.

Background: The fragility index (FI) represents the number of participants whose status in a trial would have to change from a non-event (not experiencing the primary endpoint) to an event (experiencing the primary endpoint) in order to turn a statistically significant result into a non-significant result. We sought to evaluate the fragility indices of irritable bowel syndrome [IBS-mixed (IBS-M), IBS-constipation (IBS-C), & IBS-diarrhea (IBS-D)] trials.

Methods: Irritable bowel syndrome trials published in high-impact journals were identified from Medline.

Rectal Distension Increased the Rectoanal Gradient in Patients with Normal Rectal Sensory Function.

Background: Frequent observation of abnormal manometric patterns consistent with dyssynergia in healthy volunteers has warranted the need for reassessment of the current methods to enhance the diagnostic value of anorectal manometry in functional defecatory disorders. Whether rectal distention at simulated evacuation will affect anorectal pressure profile and increase rectoanal gradient is not known.

Methods: One hundred and eight consecutive patients with chronic constipation, 93 females, median age 53 years (interquartile range: 40-65), were studied.

CE: Original Research: The Clinical Research Nurse: Exploring Self-Perceptions About the Value of the Role.

Unlabelled: : Background: Clinical research nursing is an emerging specialty practice. Clinical research nurses (CRNs) work to make protocol-related care safe for the research subjects while simultaneously maintaining protocol fidelity. They must continuously balance the needs of the research subjects and the study requirements.

Primary Hepatic Follicular Lymphoma Presenting as Sub-acute Liver Failure: A Case Report and Review of the Literature.

Sub-acute liver failure is a term that describes the relatively sudden loss of liver function, usually >21 days and <26 weeks, with impaired synthetic function and associated encephalopathy in a person with no pre-existing liver disease or cirrhosis. It is commonly caused by viruses and drugs, less so by malignancy. Our patient is a 71-year-old Japanese man who presented with signs of sub-acute liver failure.

From the Medical Board of the National Psoriasis Foundation: Treatment targets for plaque psoriasis.

Background: An urgent need exists in the United States to establish treatment goals in psoriasis.

Objective: We aim to establish defined treatment targets toward which clinicians and patients with psoriasis can strive to inform treatment decisions, reduce disease burden, and improve outcomes in practice.

Methods: The National Psoriasis Foundation conducted a consensus-building study among psoriasis experts using the Delphi method.

Survey of heat use during peripheral IV insertion by health care workers.

Health care workers at an academic medical center in the Midwest were surveyed to identify common practices regarding heat use during peripheral intravenous (PIV) catheter insertion. Of the 907 who responded, the majority used heat to facilitate PIV insertion at least sometimes, when veins were not easily seen or not palpable, applying a commercial dry hot pack for 2 to 5 minutes before selecting an insertion site. Heat use correlated with practice role and population, frequency of PIV insertion, and perceived PIV skill.

Informed consent and research subject understanding of clinical trials.

Context: Current evidence suggests many clinical trial participants have incomplete understanding of research objectives and methods.

Objective: Determine consent standards compliance, satisfaction with facility and study staff, and research subject understanding of clinical trials.

Design: Retrospective review of responses gathered when subjects were interviewed at the inception of clinical trial participation.

A systems analysis of obstetric triage.

Objective: The purpose of this study is to examine some of the variables involved in obstetric triage in an effort to develop a more efficient patient care delivery system in a high-volume obstetric unit. An efficient triage system is essential to a busy labor and delivery unit for the evaluation of unscheduled patient visits. In hospitals that lack an efficient obstetric triage system, it is very difficult to regulate patient flow and wait times.