The hospital mortality project: a tool for using administrative data for continuous clinical quality assurance.

The increasing demand for greater clinical accountability requires development of convenient tools to measure healthcare safety and quality, which are able to provide information contemporaneously. The purpose of this paper is to describe the development of the Hospital Mortality Project, a quality assurance initiative designed to encourage and facilitate clinical accountability for hospital mortality by all clinical departments and clinicians. The project was carried out in two stages.

Celecoxib for the prevention of sporadic colorectal adenomas.

Background: Studies showing that drugs that inhibit cyclooxygenase-2 (COX-2) reduce the number of colorectal adenomas in animals and patients with familial adenomatous polyposis suggest that COX-2 inhibitors may also prevent sporadic colorectal neoplasia.

Methods: We randomly assigned patients who had adenomas removed before study entry to receive placebo (679 patients) or 200 mg (685 patients) or 400 mg (671 patients) of celecoxib twice daily. Randomization was stratified for the use of low-dose aspirin.

A double-blind placebo-controlled study of the effects of the bisphosphonate risedronate on bone mass in patients with inflammatory bowel disease.

Background: Low bone density and fractures are common in patients with inflammatory bowel disease (IBD).

Objective: To determine whether the bisphosphonate risedronate and calcium are safe and effective in preserving bone mass compared to calcium alone in IBD patients with low bone mass.

Patients: Sixty-one ambulatory patients with Crohn's disease (n = 31) or ulcerative colitis (n = 30) and low bone density.

Colonoscopic surveillance after surgery for colorectal cancer.

Background: Intensive colonoscopic surveillance after resection of colorectal cancer (CRC) has been shown not to improve outcome. The National Health and Medical Research Council of Australia (NHMRC) has recently published guidelines recommending appropriate surveillance intervals after CRC resection. The aims of the present study were to assess current and past patterns of postoperative CRC surveillance and to determine the yield of neoplasia from such surveillance.

Routine colonic mucosal biopsy and ileoscopy increases diagnostic yield in patients undergoing colonoscopy for diarrhea.

Background And Aims: In patients undergoing colonoscopy for diarrhea, when the examination is normal, the role of routine mucosal biopsy remains controversial, particularly in the open-access setting. It is uncertain whether routine ileoscopy adds anything to colonoscopy alone. We aimed to assess the yield of mucosal biopsy and ileoscopy in patients with diarrhea.

Colonoscopic surveillance for family history of colorectal cancer: are NHMRC guidelines being followed?

Objectives: To assess whether referrals for surveillance colonoscopy and subsequent follow-up recommendations for patients with a family history of colorectal cancer concurred with the published National Health and Medical Research Council (NHMRC) guidelines.

Design: A prospective audit of patients with a family history of colorectal cancer referred for surveillance colonoscopy. Follow-up recommendations were assessed retrospectively.

Complete colonoscopy rarely misses cancer.

Background: The assumption that colonoscopy is highly accurate for detecting colorectal cancer was tested by identifying cancer subsequent to colonoscopy in 2 cohorts of patients in which colonoscopy was reported as normal.

Methods: A multicenter endoscopy database was used to identify all reportedly normal colonoscopies. One cohort was assessed 5 years after colonoscopy with the use of a population-based health services-linked database to link patient morbidity, cancer, and mortality data.