Cost-benefit considerations of the biased diagnostician.

Objectives: In the cognitive process of establishing a diagnosis, the performance of a diagnostician can be characterized in terms of sensitivity and specificity. The aims of the present study are to analyze in quantitative terms how cognitive bias affects the performance of a diagnostician, and how a diagnostician's biased decision making is further influenced by personal cost-benefit considerations.

Methods: The test matrices of two sequential diagnostic tests are manipulated according to the rules of linear algebra, using multiplication of the second with the first test matrix to calculate their joint test characteristics.

Optimal timing of a colonoscopy screening schedule depends on adenoma detection, adenoma risk, adherence to screening and the screening objective: A microsimulation study.

Colonoscopy-based screening provides protection against colorectal cancer (CRC), but the optimal starting age and time intervals of screening colonoscopies are unknown. We aimed to determine an optimal screening schedule for the US population and its dependencies on the objective of screening (life years gained or incidence, mortality, or cost reduction) and the setting in which screening is performed. We used our established open-source microsimulation model CMOST to calculate optimized colonoscopy schedules with one, two, three or four screening colonoscopies between 20 and 90 years of age.

Cost-utility advantage of interventional endoscopy.

Background: Gastroenterologists frequently face the dilemma of how to choose among different management options.

Aim: To develop a tool of medical decision analysis that helps choosing between competing management options of interventional endoscopy and surgery.

Methods: Carcinoma-in-situ of the esophagus, large colonic polyps, and ampullary adenoma serve as three examples for disorders being managed by both techniques.

Small bowel hemorrhage from check point inhibitor enteritis: a case report.

Background: There is rising utilization of immune checkpoint inhibitors (ICI) for a growing number of metastatic malignancies. While gastrointestinal side effects of ICI are common, isolated ICI-induced enteritis leading to small bowel hemorrhage is rare.

Case Presentation: A 71-year-old man with a previously resected right colon adenocarcinoma on atezolizumab and recently treated Clostridioides difficile presented with acute on chronic abdominal pain and non-bloody diarrhea.

Utility of the Current Procedural Terminology Codes for Prophylactic Stabilization for Defining Metastatic Femur Disease.

Introduction: Cohorts from the electronic health record are often defined by the Current Procedural Terminology (CPT) codes. The error prevalence of CPT codes for patients receiving surgical treatment of metastatic disease of the femur has not been investigated, and the predictive value of coding ontologies to identify patients with metastatic disease of the femur has not been adequately discussed.

Methods: All surgical cases at a single academic tertiary institution from 2010 through 2015 involving prophylactic stabilization of the femur or fixation of a pathologic fracture of the femur were identified using the CPT and International Classification of Disease (ICD) codes.

Many Paradoxes of My Gastroenterology Practice.

A paradox describes the clash between 2 seemingly reasonable prepositions whose joint occurrence appears impossible. Like any other human endeavor, medicine is also filled with paradoxes that await resolution. This editorial lists several common paradoxes frequently encountered by clinical gastroenterologists.

The status of tuberculosis vaccine development.

Tuberculosis represents the leading global cause of death from an infectious agent. Controlling the tuberculosis epidemic thus represents an urgent global public health priority. Epidemiological modelling suggests that, although drug treatments for tuberculosis continue to improve, WHO timelines to control the spread of the disease require a new vaccine capable of preventing tuberculosis, particularly in adolescents and adults.

When to let the fellow do the procedure.

Background And Aims: In complex endoscopies, the initial attempt is often associated with the highest success and subsequent attempts to achieve the same outcome have a higher failure rate. An attending physician needs to decide how the ultimate success may become compromised by letting a fellow start the procedure. A decision analysis is aimed to shed light on this issue.

Combining the outcomes of endoscopy, laboratory testing, and professional judgement in gastroenterological decision-making.

The need to combine the results of multiple separate tests or make decisions based on the judgement by multiple experts permeates the clinical and professional practice of a gastroenterologist. The present analysis is aimed at delineating four different means to combine results of multiple tests and discuss their applicability and limitations. In serial testing, the overall test outcome is rated as being positive if the outcome is positive in all individual tests applied in series.

Rituals in gastrointestinal endoscopy at the crossroads of shaman and science.

Background And Aim:  Over the last decades, the length of time required for endoscopic procedures has greatly expanded. The aim of the present decision analysis is to study the interactions amongst various factors that have caused such delays and to compare the relative magnitude of their influences.

Methods:  Performance of gastrointestinal endoscopy is influenced by the interaction of five domains, that is, (1) patient discomfort and fear; (2) injury, disorder, and disruption; (3) rituals to reduce fear, prevent disruption, and maintain order; (4) administrators or various health providers carrying out a ritual; (5) information, knowledge, and science, which influence fear, prevent disruption, and curtail unnecessary ritualistic behavior.

CMOST: an open-source framework for the microsimulation of colorectal cancer screening strategies.

Background: Colorectal cancer (CRC) is a leading cause of cancer-related mortality. CRC incidence and mortality can be reduced by several screening strategies, including colonoscopy, but randomized CRC prevention trials face significant obstacles such as the need for large study populations with long follow-up. Therefore, CRC screening strategies will likely be designed and optimized based on computer simulations.

Cry wolf and inflate medical urgency to expedite consult resolution through gastrointestinal endoscopy.

Background And Aims: To expedite a consult resolution, referring physicians sometimes inflate the urgency and need for endoscopic workup. The aim of the present decision analysis was to study the impact of inflationary indication on the expected benefits to gastroenterologists and referring physicians.

Methods: The study aims were pursued in terms of game theory and medical decision analysis using decision trees.