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Yang D, Draganov PV, Pohl H, Aihara H, Jeyalingam T, Khashab M, Liu N, Hasan MK, Jawaid S, Othman M, Al-Haddad M, DeWitt JM, Triggs JR, Wang AY, Bechara R, Sethi A, Law R, Aadam AA, Kumta N, Sharma N, Hayat M, Zhang Y, Yi F, Elmunzer BJ. Development and initial validation of a video-based peroral endoscopic myotomy assessment tool. Gastrointest Endosc 2024; 99:177-185. [PMID: 37500019 DOI: 10.1016/j.gie.2023.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/18/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND AND AIMS Video analysis has emerged as a potential strategy for performance assessment and improvement. We aimed to develop a video-based skill assessment tool for peroral endoscopic myotomy (POEM). METHODS POEM was deconstructed into basic procedural components through video analysis by an expert panel. A modified Delphi approach and 2 validation exercises were conducted to refine the POEM assessment tool (POEMAT). Twelve assessors used the final POEMAT version to grade 10 videos. Fully crossed generalizability (G) studies investigated the contributions of assessors, endoscopists' performance, and technical elements to reliability. G coefficients below .5 were considered unreliable, between .5 and .7 as modestly reliable, and above .7 as indicative of satisfactory reliability. RESULTS After task deconstruction, discussions, and the modified Delphi process, the final POEMAT comprised 9 technical elements. G analysis showed low variance for endoscopist performance (.8%-24.9%) and high interrater variability (range, 63.2%-90.1%). The G score was moderately reliable (≥.60) for "submucosal tunneling" and "myotomy" and satisfactorily reliable (≥.70) for "active hemostasis" and "mucosal closure." CONCLUSIONS We developed and established initial content and response process validity evidence for the POEMAT. Future steps include appraisal of the tool using a wider range of POEM videos to establish and improve the discriminative validity of this tool.
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Affiliation(s)
- Dennis Yang
- Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA.
| | - Peter V Draganov
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, USA
| | - Heiko Pohl
- Veterans Affairs Medical Center, White River Junction, Vermont; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Hiroyuki Aihara
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Thurarshen Jeyalingam
- Division of Gastroenterology and Hepatology, University of Toronto, Toronto, Ontario, Canada
| | - Mouen Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Nanlong Liu
- Division of Gastroenterology, University of Louisville, Louisville, Kentucky, USA
| | - Muhammad K Hasan
- Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA
| | - Salmaan Jawaid
- Division of Gastroenterology, Baylor College of Medicine, Houston, Texas, USA
| | - Mohamed Othman
- Division of Gastroenterology, Baylor College of Medicine, Houston, Texas, USA
| | - Mohamed Al-Haddad
- Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - John M DeWitt
- Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Joseph R Triggs
- Division of Gastroenterology, Fox Chase Cancer Center, Temple Health, Philadelphia, Pennsylvania, USA
| | - Andrew Y Wang
- Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, USA
| | - Robert Bechara
- Division of Gastroenterology and GI Diseases Research Unit, Queen's University, Kingston, Ontario, Canada
| | - Amrita Sethi
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, Presbyterian Hospital, New York, New York, USA
| | - Ryan Law
- Division of Gastroenterology and Hepatology, Mayo Clinic, Minneapolis, Minnesota, USA
| | - Aziz A Aadam
- Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Nikhil Kumta
- Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Neil Sharma
- Division of Interventional Oncology and Surgical Endoscopy (IOSE), Parkview Cancer Institute, Fort Wayne, Indiana, USA
| | - Maham Hayat
- Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA
| | - YiYang Zhang
- Center for Collaborative Research, AdventHealth Research Institute, Orlando, Florida, USA
| | - Fanchao Yi
- Center for Collaborative Research, AdventHealth Research Institute, Orlando, Florida, USA
| | - B Joseph Elmunzer
- Department of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, USA
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Grey I, Al-Saihati BA, Al-Haddad M, McClean B. Reasons for referral, intervention approaches and demographic characteristics of clients with intellectual disability attending adult psychiatric outpatient services in the Kingdom of Bahrain. J Intellect Disabil Res 2015; 59:186-192. [PMID: 24020448 DOI: 10.1111/jir.12077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/29/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Relatively little information is available regarding the use of psychiatric services by individuals with intellectual disability (ID) in Arab countries. The current study aimed to identify (1) the reasons for referral; (2) demographic characteristics of individuals referred; (3) previous contact with child psychiatric services; (4) psychiatric diagnoses; (5) level of ID; (6) nature of interventions; and (7) patterns of medication usage in individuals attending a specialist psychiatric service for individuals with an ID in the Kingdom of Bahrain. METHOD Case file analysis was used. Files that recorded attendance at the specialist service within a specific calendar year were selected. A total of 537 files were available for review and 79 contained records indicating the individual had been seen within the year. RESULTS The primary referral reason to adult psychiatric services was the presence of behavioural disturbance. Pharmacological intervention was the dominant treatment choice and no individual was recommended for psychological/behavioural intervention. Psychiatric diagnosis was not recorded in over 90% of cases. CONCLUSION Services in the Kingdom of Bahrain for individuals with ID rely exclusively on pharmacological approaches for the treatment of behavioural disorders. Implications for best practice guidelines are discussed.
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Affiliation(s)
- I Grey
- Department of Psychology, Trinity College, Dublin, Ireland
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El Hajj II, El Chafic AH, Cramer H, Al-Haddad M. Ampullary carcinoid tumors diagnosed by endoscopic ultrasound-guided fine needle aspiration in two patients with biliary and pancreatic duct obstruction. Endoscopy 2012; 43 Suppl 2 UCTN:E422-3. [PMID: 22275034 DOI: 10.1055/s-0030-1257031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- I I El Hajj
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Indiana University Medical Center, Indianapolis, Indiana 46202, USA
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Cho CM, Dewitt J, Al-Haddad M. Echo-endoscopy: new therapeutic frontiers. MINERVA GASTROENTERO 2011; 57:139-158. [PMID: 21587144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Endoscopic ultrasound (EUS) has been established as a valuable diagnostic modality as it offers high-resolution imaging and fine-needle biopsy, which is essential in detecting and staging malignancies. Since the introduction of EUS-guided fine needle aspiration (EUS-FNA) in 1992, numerous novel EUS-based interventions and techniques have emerged. Currently, established interventional EUS techniques include celiac plexus block and neurolysis, drainage of pancreatic pseudocysts and pelvic fluid collections, and implantation of fiducial markers and radioactive seeds into the malignant tumors. Emerging EUS-guided experimental techniques include antitumor injection, ablation of tumors, and vascular access. Diagnostic and therapeutic access to the biliary tree and pancreatic duct is increasingly being used for failed ERCP procedures or inaccessible ducts. Interventional EUS is a very promising technique with many potential applications. The future holds promise for substantial progress in EUS-guided therapeutic interventions and their applications in clinical gastroenterology.
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Affiliation(s)
- C M Cho
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202-5149, USA
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LeBlanc JK, Emerson RE, Dewitt J, Symms M, Cramer HM, McHenry L, Wade CL, Wang X, Musto P, Eichelberger L, Al-Haddad M, Johnson C, Sherman S. A prospective study comparing rapid assessment of smears and ThinPrep for endoscopic ultrasound-guided fine-needle aspirates. Endoscopy 2010; 42:389-94. [PMID: 20101566 DOI: 10.1055/s-0029-1243841] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND STUDY AIMS ThinPrep is often used for endoscopic ultrasound fine-needle aspiration (EUS-FNA) samples but the sensitivity of this method is unknown. The objective of the study was to compare sensitivity and accuracy of ThinPrep versus the smear method in pancreas and lymph node samples obtained by EUS-FNA. PATIENTS AND METHODS Patients with suspected malignancy in the pancreas or lymph node underwent EUS-FNA. On-site rapid assessment of all aspirates using the smear method was performed. After rapid assessment, three additional passes from each site were submitted into ThinPrep liquid medium. Cytopathologists interpreting the smear method and ThinPrep slides were blinded to each other. The gold standard was final cytology or pathology results. RESULTS A total of 130 patients (36 % women, mean age 63 years) underwent EUS-FNA of 139 sites (50 pancreas, 89 lymph node). Malignancy was confirmed in 47 pancreas samples (94 %) and 48 lymph node samples (54 %). Mean +/- SD number of passes made for the smear method was 2.6 +/- 1.3. For pancreatic cancer, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the ThinPrep versus the smear method were: 62 % versus 98 %, 100 % versus 100 %, 100 % versus 100 %, 14 % versus 75 %, and 64 % versus 98 %, respectively. For lymph nodes the values were 67 % versus 92 %, 100 % versus 98 %, 100 % versus 98 %, 72 % versus 72 %, and 82 % versus 94 %, respectively. CONCLUSIONS The smear method is more sensitive and accurate than ThinPrep in detecting malignancy from EUS-FNA samples of the pancreas and lymph nodes. Smear method with on-site rapid assessment should be favored over ThinPrep in suspected malignancy.
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Affiliation(s)
- J K LeBlanc
- Division of Gastroenterology and Hepatology, Indiana University Medical Center, Indianapolis, Indiana 46202, USA.
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Khashab M, Mokadem M, DeWitt J, Emerson R, Sherman S, LeBlanc J, McHenry L, Al-Rashdan A, Al-Haddad M. Endoscopic ultrasound-guided fine-needle aspiration with or without flow cytometry for the diagnosis of primary pancreatic lymphoma - a case series. Endoscopy 2010; 42:228-31. [PMID: 20101569 DOI: 10.1055/s-0029-1243859] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The role of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) with flow cytometry for the diagnosis of primary pancreatic lymphoma (PPL) has not been previously described. Our aims were to describe the EUS features of PPL and the role of EUS-FNA with and without flow cytometry in the diagnosis of 16 patients. When EUS-FNA with flow cytometry was compared with EUS-FNA without flow cytometry, the sensitivities for diagnosing non-Hodgkin's lymphoma were 84.6 % versus 30.8 %, respectively ( P = 0.01). EUS-FNA with flow cytometry is a valuable tool to diagnose PPL. Flow cytometry analysis complements traditional assessment by standard cytology.
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Affiliation(s)
- M Khashab
- Department of Medicine, and Clarian/IU Digestive Diseases Center, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA
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Al-Haddad M, Gill KR, Raimondo M, Woodward TA, Krishna M, Crook JE, Skarvinko LN, Jamil LH, Hasan M, Wallace MB. Safety and efficacy of cytology brushings versus standard fine-needle aspiration in evaluating cystic pancreatic lesions: a controlled study. Endoscopy 2010; 42:127-32. [PMID: 19998218 DOI: 10.1055/s-0029-1215351] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND STUDY AIMS Cystic pancreatic lesions (CPLs) are increasingly detected by various imaging studies. Mucinous CPLs carry a risk of malignant transformation but this is often difficult to diagnose preoperatively. In a previous report of 10 suspected mucinous CPLs, the cellular yield of endoscopic ultrasonography (EUS)-guided cytology brushings was found to be superior to the yield from standard fine-needle aspiration (FNA). The aim of this prospective and blinded study was to compare the cytology yield of mucinous epithelium from brushing with FNA in suspected mucinous CPLs. PATIENTS AND METHODS In total, 37 patients with 39 CPLs measuring at least 20 mm were enrolled between June 2006 and July 2008 for EUS-cytobrushing and EUS-FNA of CPLs. Demographic, clinical, EUS, cytopathologic, and surgical data were recorded whenever available. Yield of cytology brushings was compared with that of FNA. Procedure morbidity was evaluated after 30 days. The main outcome assessed was yield of intracellular mucin (ICM) on cytobrushing specimens compared with EUS-FNA for the diagnosis of suspected mucinous CPL. RESULTS Cytobrushings were more likely to detect ICM than the EUS-FNA method ( P = 0.001). In three patients with hypocellular FNA, dysplasia was found on cytology brushing and later confirmed by surgical pathology. Significant complications occurred in three patients (8 %): one postbrushing bleeding and two acute pancreatitis. CONCLUSIONS Cytology brushings are more likely to provide an adequate mucinous epithelium specimen than standard FNA and could aid the diagnosis of CPLs in a selective group of patients.
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Affiliation(s)
- M Al-Haddad
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
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Martin S, Al-Haddad M. Continuous renal replacement therapy: are we getting the dose right? Crit Care 2010. [PMCID: PMC2934441 DOI: 10.1186/cc8745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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10
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Abstract
Pancreatic neuroendocrine tumors (PNETs) may rarely appear as cystic or mixed solid-cystic masses. The endoscopic ultrasound (EUS) morphology and cyst fluid characteristics of these tumors are not well clarified. We retrospectively identified nine adult patients with nine single cystic pancreatic neuroendocrine tumors (CNETs). These nine included 0.67 % of the 1344 patients with pancreatic cystic lesions and 9.5 % of the 95 confirmed PNETs evaluated over the 12-year study period. At presentation, four patients were asymptomatic and five had known acute pancreatitis (n = 2), MEN-1 syndrome with hypoglycemia (n = 1), and abdominal pain (n = 2). Median maximal tumor diameter was 26 mm (range 20 - 64 mm). EUS morphology was mixed solid and cystic (n = 4) or cystic alone (n = 5). Cytology from EUS-fine-needle aspiration (FNA) (median 2 passes; range 1 - 6) demonstrated a PNET, and immunocytochemistry was confirmatory in all patients. Cyst fluid carcinoembryonic antigen (CEA) (n = 4) and amylase (n = 5) ranged from 0.1 to 1.8 ng/ml (normal 0 - 2.5 ng/ml) and 72 to 1838 U/L (normal 25 - 161 U/L), respectively. Six patients underwent surgery, and the preoperative diagnosis was confirmed in all.
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Affiliation(s)
- P Kongkam
- Division of Gastroenterology and Hepatology, Indiana University Medical Center, Indianapolis, Indiana 46202-5121, USA
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Al-Haddad M, Wallace MB, Woodward TA, Gross SA, Hodgens CM, Toton RD, Raimondo M. The safety of fine-needle aspiration guided by endoscopic ultrasound: a prospective study. Endoscopy 2008; 40:204-8. [PMID: 18058615 DOI: 10.1055/s-2007-995336] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND STUDY AIMS Fine-needle aspiration (FNA) is commonly performed in conjunction with endoscopic ultrasound (EUS) procedures. The complication rate associated with FNA is considered to be low but requires further evaluation with prospective studies. PATIENTS AND METHODS A total of 483 consecutive patients who underwent EUS-guided FNA over a 12-month period were prospectively enrolled in the study. The patients were screened for postprocedural complications, including abdominal pain, nausea, vomiting, and gastrointestinal bleeding. Complications were assessed immediately after EUS-FNA and 30 days later with a telephone call, when inquiries were made about emergency room and physician's office visits or hospitalizations during this 30-day period. RESULTS Complete information was obtained from 414 patients (86 %). Complications occurred in seven patients during the first day. Five of these patients had unplanned admissions to hospital: two patients were observed because they had abdominal pain after FNA of pancreatic cysts; one patient was observed because they developed chest pain after mediastinal lymph node FNA; and two patients were monitored after celiac node FNA, one with a transient fever and one with self-limited melena. All five of these patients were discharged within 24 hours of admission, none required blood transfusion, and none showed any evidence of pancreatitis or infection. Two other patients visited the emergency department but were discharged on oral analgesics after appropriate evaluation. By day 30 six patients had died as a result of their primary disease process. There was no unexpected morbidity or mortality attributable to the EUS-FNA. CONCLUSIONS FNA is a safe intervention in patients undergoing EUS in a high-volume academic center, with a low postprocedural complication rate.
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Affiliation(s)
- M Al-Haddad
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Jacksonville, Florida 32224, USA
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Abstract
Anastomotic leaks and fistulas are unfortunate complications of esophageal-gastric surgery and esophageal dilations. Traditional management options have included surgery or a more conservative approach. There have been few reports describing the use of self-expandable plastic stents for the treatment of esophageal perforations and tracheoesophageal fistulas from benign diseases. We are reporting the use of self-expandable plastic stents for the treatment of non-malignant esophago-pleural fistulas occurring after esophagectomy in one case and esophageal perforation post dilation in the other.
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Affiliation(s)
- M Al-Haddad
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida 32224, USA
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Al-Haddad M, Raimondo M. Management of acute pancreatitis in view of the published guidelines: are we compliant enough? Dig Liver Dis 2007; 39:847-8. [PMID: 17652040 DOI: 10.1016/j.dld.2007.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2007] [Accepted: 06/18/2007] [Indexed: 12/11/2022]
Affiliation(s)
- M Al-Haddad
- Division of Gastroenterology & Hepatology, Mayo Clinic College of Medicine, 4500 San Pablo Road, Jacksonville, FL, USA
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Affiliation(s)
- M Al-Haddad
- Division of Gastroentorology and Hepatology, Mayo Clinic College of Medicine, Jacksonville, FL 32224, USA
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Affiliation(s)
- M Al-Haddad
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Jacksonville, Florida 32224, USA
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Al-Haddad M, Wallace MB. Molecular diagnostics of non-small cell lung cancer using mediastinal lymph nodes sampled by endoscopic ultrasound-guided needle aspiration. Cytopathology 2006; 17:3-9. [PMID: 16417559 DOI: 10.1111/j.1365-2303.2006.00318.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Non-small cell lung cancer is a common cancer with significant mortality. Accurate and early staging of this cancer has a significant impact on outcome. Endoscopic ultrasound-guided fine needle aspiration of involved mediastinal lymph nodes is critical for staging. Several molecular markers have been identified recently in association with non-small cell carcinoma of the lung that are promising to make early detection of metastatic disease more reliable.
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Affiliation(s)
- M Al-Haddad
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL 32224, USA
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Abstract
Bottom-up costs of sedative, analgesic and neuromuscular blocking drugs used in the intensive care unit have not been reported. We performed a prospective audit of the cost of these drugs using a bottom-up approach by prospectively recording the daily amount of drugs administered to patients over a 3-month period. Of 172 admissions, complete data were collected for 155 (92%). Propofol and alfentanil were the drugs most commonly used, being administered to 136 (88%) and 106 (68%) patients, respectively. The total cost was 14,070 pounds sterling, which was 81% of the pharmacy figure (based on central purchasing). Ninety-four per cent of the cost was for drugs administered to the 50% of patients who stayed in the intensive care unit longer than 48 h. The median (interquartile range [range]) cost per day was 9.30 pounds sterling (3.60-20.10 [0-61.20]). This represents less than 1% of reported total daily cost of intensive care per patient.
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Affiliation(s)
- M Al-Haddad
- Department of Anaesthesia, Ninewells Hospital, Dundee DD1 9SY, UK.
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