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Sutton RT, Dhillon-Chattha P, Kumagai J, Pitamber T, Meurer DP. System Configuration Evaluation for a Province-Wide Clinical Information System Using the eSafety Checklist. Appl Clin Inform 2023; 14:735-742. [PMID: 37704029 PMCID: PMC10499505 DOI: 10.1055/s-0043-1771392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 05/05/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND According to Digital Health Canada 2013 eSafety Guidelines, an estimated one-third of patient safety incidents following implementation of clinical information systems (CISs) are technology-related. An eSafety checklist was previously developed to improve CIS safety by providing a comprehensive listing of system-agnostic, evidence-based configuration recommendations. OBJECTIVES We sought to use the checklist to support safe initial configuration of a provincial system-wide CIS (Alberta, Canada), referred to as Connect Care. METHODS The checklist was applied to 13 Connect Care modules in three successive phases. First, the checklist was adapted to an abbreviated high-priority version. Second, demonstrations of each module were recorded. Finally, independent evaluation of each recording was conducted by two eSafety evaluators using the abbreviated eSafety checklist. RESULTS All modules achieved greater than 72% compliance, with an average of 84%. Overall, 273 opportunities for improvement were identified, with four major areas or themes emerging: (1) inconsistent date and time, (2) unclear patient identification, (3) ineffective alert system, and (4) insufficient decision support. These opportunities were forwarded to the appropriate build teams for review and implementation. CONCLUSION This work is the first to utilize the eSafety checklist in a real-world CIS, which will become one of the largest in Canada. The checklist has shown clinical applicability in identifying gaps in CIS configuration and should be considered for use in future and pre-existing CISs.
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Affiliation(s)
- Reed T. Sutton
- eQuality and eSafety Program, Provincial Patient Safety, Alberta Health Services, Edmonton, Alberta, Canada
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Pritma Dhillon-Chattha
- eQuality and eSafety Program, Provincial Patient Safety, Alberta Health Services, Edmonton, Alberta, Canada
| | - Jason Kumagai
- Human Factors Program, Provincial Patient Safety, Alberta Health Services, Edmonton, Alberta, Canada
| | - Tiffany Pitamber
- Human Factors Program, Provincial Patient Safety, Alberta Health Services, Edmonton, Alberta, Canada
| | - David P. Meurer
- eQuality and eSafety Program, Provincial Patient Safety, Alberta Health Services, Edmonton, Alberta, Canada
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2
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Sutton RT, Dhillon-Chattha P, Kumagai J, Pitamber T, Meurer DP. Erratum: System Configuration Evaluation for a Province-Wide Clinical Information System Using the eSafety Checklist. Appl Clin Inform 2023; 14:e1. [PMID: 38295857 PMCID: PMC10830243 DOI: 10.1055/s-0044-1779302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2024] Open
Affiliation(s)
- Reed T. Sutton
- Alberta Health Services, Edmonton, Alberta, Canada
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Canada
| | | | - Jason Kumagai
- Human Factors Program, Provincial Patient Safety, Alberta Health Services, Edmonton, Alberta, Canada
| | - Tiffany Pitamber
- Human Factors Program, Provincial Patient Safety, Alberta Health Services, Edmonton, Alberta, Canada
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Wang G, Tandon P, Rodriguez N, Ambrosio L, Sutton RT, Dieleman LA, Kroeker KI, Huang V. Impact of Disease Activity and Inflammatory Bowel Disease Subtype on Quality of Life in Preconception and Pregnant Patients. Dig Dis Sci 2022; 68:1156-1166. [PMID: 35930124 DOI: 10.1007/s10620-022-07638-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 07/19/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) and pregnancy both impact health-related quality of life (HRQoL). However, little is known about IBD-related HRQoL around pregnancy. AIMS To assess the trajectory and predictors of HRQoL in preconception and pregnant patients with Crohn's disease (CD) and ulcerative colitis (UC). METHODS Preconception and pregnant patients with IBD were followed prospectively from preconception to twelve months postpartum at a tertiary referral centre. Participants completed the Short IBD Questionnaire (SIBDQ) and were assessed for clinical disease activity (modified Harvey Bradshaw Index or partial Mayo score) and objective disease activity (C-reactive protein [CRP], fecal calprotectin [FCP]). RESULTS A total of 61 patients with IBD (25 CD, 36 UC) were included. During preconception, patients with UC had higher SIBDQ bowel and social sub-scores than those with CD, but this reversed during postpartum. Patients with CD but not UC developed a significant, sustained improvement in SIBDQ upon becoming pregnant, which persisted into 12 months postpartum. In a multivariable linear regression model, clinical disease activity negatively predicted SIBDQ at every pregnancy timepoint and up to 12 months postpartum. SIBDQ was significantly lower in patients with CRP ≥ 8.0 mg/L during trimester 1 (T1), but not later in pregnancy. SIBDQ bowel sub-scores were significantly lower in patients with FCP ≥ 250 mg/kg at T2, T3, and 6 months postpartum. CONCLUSIONS Clinical disease activity is a consistent negative predictor of HRQoL from conception to 12 months postpartum. Patients with UC experience better preconception HRQoL but suffer worse postpartum HRQoL than those with CD.
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Affiliation(s)
- Grace Wang
- Faculty of Medicine, University of Toronto, 1 King's College Cir, Toronto, M5S 1A8, Canada.
| | - Parul Tandon
- Faculty of Medicine, University of Toronto, 1 King's College Cir, Toronto, M5S 1A8, Canada.,Department of Gastroenterology, Mount Sinai Hospital, 600 University Ave, Toronto, M5G 1X5, Canada
| | - Nicole Rodriguez
- Faculty of Medicine, University of Alberta, 8440 112 St NW, Edmonton, T6G 2R7, Canada
| | - Lindsy Ambrosio
- Faculty of Medicine, University of Alberta, 8440 112 St NW, Edmonton, T6G 2R7, Canada.,Division of Gastroenterology, Zeidler Ledcor Centre, University of Alberta, 8540 112 St NW, Edmonton, T6G 2X8, Canada
| | - Reed T Sutton
- Faculty of Medicine, University of Alberta, 8440 112 St NW, Edmonton, T6G 2R7, Canada.,Division of Gastroenterology, Zeidler Ledcor Centre, University of Alberta, 8540 112 St NW, Edmonton, T6G 2X8, Canada
| | - Levinus A Dieleman
- Faculty of Medicine, University of Alberta, 8440 112 St NW, Edmonton, T6G 2R7, Canada.,Division of Gastroenterology, Zeidler Ledcor Centre, University of Alberta, 8540 112 St NW, Edmonton, T6G 2X8, Canada
| | - Karen I Kroeker
- Faculty of Medicine, University of Alberta, 8440 112 St NW, Edmonton, T6G 2R7, Canada.,Division of Gastroenterology, Zeidler Ledcor Centre, University of Alberta, 8540 112 St NW, Edmonton, T6G 2X8, Canada
| | - Vivian Huang
- Faculty of Medicine, University of Toronto, 1 King's College Cir, Toronto, M5S 1A8, Canada.,Department of Gastroenterology, Mount Sinai Hospital, 600 University Ave, Toronto, M5G 1X5, Canada
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Sutton RT, Zai Ane OR, Goebel R, Baumgart DC. Artificial intelligence enabled automated diagnosis and grading of ulcerative colitis endoscopy images. Sci Rep 2022; 12:2748. [PMID: 35177717 PMCID: PMC8854553 DOI: 10.1038/s41598-022-06726-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 02/04/2022] [Indexed: 02/07/2023] Open
Abstract
Endoscopic evaluation to reliably grade disease activity, detect complications including cancer and verification of mucosal healing are paramount in the care of patients with ulcerative colitis (UC); but this evaluation is hampered by substantial intra- and interobserver variability. Recently, artificial intelligence methodologies have been proposed to facilitate more objective, reproducible endoscopic assessment. In a first step, we compared how well several deep learning convolutional neural network architectures (CNNs) applied to a diverse subset of 8000 labeled endoscopic still images derived from HyperKvasir, the largest multi-class image and video dataset from the gastrointestinal tract available today. The HyperKvasir dataset includes 110,079 images and 374 videos and could (1) accurately distinguish UC from non-UC pathologies, and (2) inform the Mayo score of endoscopic disease severity. We grouped 851 UC images labeled with a Mayo score of 0-3, into an inactive/mild (236) and moderate/severe (604) dichotomy. Weights were initialized with ImageNet, and Grid Search was used to identify the best hyperparameters using fivefold cross-validation. The best accuracy (87.50%) and Area Under the Curve (AUC) (0.90) was achieved using the DenseNet121 architecture, compared to 72.02% and 0.50 by predicting the majority class ('no skill' model). Finally, we used Gradient-weighted Class Activation Maps (Grad-CAM) to improve visual interpretation of the model and take an explainable artificial intelligence approach (XAI).
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Affiliation(s)
- Reed T Sutton
- Division of Gastroenterology, University of Alberta, 130 University Campus, Edmonton, AB, T6G 2X8, Canada
| | - Osmar R Zai Ane
- Department of Computing Science, University of Alberta, Edmonton, AB, Canada
- Alberta Machine Intelligence Institute, University of Alberta, Edmonton, AB, Canada
| | - Randolph Goebel
- Department of Computing Science, University of Alberta, Edmonton, AB, Canada
- Alberta Machine Intelligence Institute, University of Alberta, Edmonton, AB, Canada
| | - Daniel C Baumgart
- Division of Gastroenterology, University of Alberta, 130 University Campus, Edmonton, AB, T6G 2X8, Canada.
- Department of Computing Science, University of Alberta, Edmonton, AB, Canada.
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5
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Lytvyak E, Sutton RT, Dieleman LA, Peerani F, Fedorak RN, Kroeker KI. Management of Inflammatory Bowel Disease Patients With Clinical Care Pathways Reduces Emergency Department Utilization. Crohns Colitis 360 2020; 2:otaa080. [PMID: 36777757 PMCID: PMC9802474 DOI: 10.1093/crocol/otaa080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Indexed: 01/04/2023] Open
Abstract
Background Standardizing care through pathways has the potential to reduce emergency department (ED) utilization. We developed and evaluated inflammatory bowel disease (IBD) care pathways for that purpose. Methods Over 2014-2016, IBD patients were retrospectively stratified into those managed and not managed by pathways. Patient data were extracted, and negative binomial regression used to predict the annual number of ED visits. Results There was a difference of 30.7 ED visits/100 patients between managed and nonmanaged at 12 months (P < 0.001). The incidence rate ratio of total ED visits occurring annually was 0.750 (P = 0.008). Conclusions Management with IBD care pathways reduces ED utilization.
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Affiliation(s)
- Ellina Lytvyak
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Reed T Sutton
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Levinus A Dieleman
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Farhad Peerani
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Richard N Fedorak
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Karen I Kroeker
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada,Address correspondence to: Karen I. Kroeker, MD, MSc, University of Alberta, 2-40 Zeidler Ledcor Center, 8540 112th Street NW, Edmonton, AB T6G 2X8, Canada ()
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6
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Sutton RT, Pincock D, Baumgart DC, Sadowski DC, Fedorak RN, Kroeker KI. An overview of clinical decision support systems: benefits, risks, and strategies for success. NPJ Digit Med 2020; 3:17. [PMID: 32047862 PMCID: PMC7005290 DOI: 10.1038/s41746-020-0221-y] [Citation(s) in RCA: 671] [Impact Index Per Article: 167.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 12/19/2019] [Indexed: 12/16/2022] Open
Abstract
Computerized clinical decision support systems, or CDSS, represent a paradigm shift in healthcare today. CDSS are used to augment clinicians in their complex decision-making processes. Since their first use in the 1980s, CDSS have seen a rapid evolution. They are now commonly administered through electronic medical records and other computerized clinical workflows, which has been facilitated by increasing global adoption of electronic medical records with advanced capabilities. Despite these advances, there remain unknowns regarding the effect CDSS have on the providers who use them, patient outcomes, and costs. There have been numerous published examples in the past decade(s) of CDSS success stories, but notable setbacks have also shown us that CDSS are not without risks. In this paper, we provide a state-of-the-art overview on the use of clinical decision support systems in medicine, including the different types, current use cases with proven efficacy, common pitfalls, and potential harms. We conclude with evidence-based recommendations for minimizing risk in CDSS design, implementation, evaluation, and maintenance.
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Affiliation(s)
- Reed T. Sutton
- Department of Medicine, Division of Gastroenterology, University of Alberta, Edmonton, Canada
| | - David Pincock
- Chief Medical Information Office, Alberta Health Services, Edmonton, Canada
| | - Daniel C. Baumgart
- Department of Medicine, Division of Gastroenterology, University of Alberta, Edmonton, Canada
| | - Daniel C. Sadowski
- Department of Medicine, Division of Gastroenterology, University of Alberta, Edmonton, Canada
| | - Richard N. Fedorak
- Department of Medicine, Division of Gastroenterology, University of Alberta, Edmonton, Canada
| | - Karen I. Kroeker
- Department of Medicine, Division of Gastroenterology, University of Alberta, Edmonton, Canada
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7
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Sutton RT, Wierstra K, Bal J, Ismond KP, Dieleman LA, Halloran BP, Kroeker KI, Fedorak RN, Berga KA, Huang VW. Pregnancy-Related Beliefs and Concerns of Inflammatory Bowel Disease Patients Modified After Accessing e-Health Portal. J Can Assoc Gastroenterol 2019; 4:27-35. [PMID: 33644674 PMCID: PMC7898372 DOI: 10.1093/jcag/gwz036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective Poor inflammatory bowel disease (IBD)-specific reproductive knowledge is associated with concerns and medication noncompliance. Having shown an educational portal can improve knowledge, we evaluated its effectiveness for addressing IBD patients’ reproductive and medication concerns. Methods Adult IBD participants (aged 18 to 45 years) were invited to access an e-health portal providing information on heritability, fertility, surgery, pregnancy outcomes, delivery, postpartum, and breastfeeding in the context of IBD and IBD medications. At pre-, post-, and 6+-month postintervention, participants completed a questionnaire on IBD-specific pregnancy concerns, medication concerns from the Beliefs About Medicines Questionnaire (BMQ), and medication adherence via the Medication Adherence Rating Scale (MARS). The Wilcoxon signed-rank test was used to compare median differences between scores (95% confidence). Results Demographics for 78 (70.3%) participants completing postintervention questionnaires: median age 29.3 (interquartile range: 25.6 to 32.9) years; 54 (69.2%) Crohn’s disease; 21 (26.9%) ulcerative colitis; 63 (80.3%) females, 5 (7.9%) pregnant; and 19 (30.2%) previously pregnant. Postintervention, the median number of reproductive concerns decreased from 3 to 1, and remained stable 6+ months later (P < 0.001*). The median BMQ score decreased from 28 to 25, and remained stable 6+ months later (P = 0.032*). Participants adherent to medications increased from 82.4% to 87.8% postintervention (P = 0.099). Conclusion Using an e-health portal may potentially reduce IBD-specific reproductive and medications concerns. An e-health portal is feasible as one component of managing IBD patient’s reproductive and medication concerns during preconception and pregnancy.
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Affiliation(s)
- Reed T Sutton
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Kelsey Wierstra
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jasmin Bal
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Kathleen P Ismond
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Levinus A Dieleman
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Brendan P Halloran
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Karen I Kroeker
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Richard N Fedorak
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Keri-Ann Berga
- Faculty of Nursing, MacEwan University, Edmonton, Alberta, Canada
| | - Vivian W Huang
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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8
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Sutton RT, Wierstra K, Huang VW. Knowledge translation dataset: An e-health intervention for pregnancy in inflammatory bowel disease. Data Brief 2019; 23:103647. [PMID: 30788391 PMCID: PMC6369406 DOI: 10.1016/j.dib.2018.12.085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 12/23/2018] [Accepted: 12/28/2018] [Indexed: 11/24/2022] Open
Abstract
This article presents data collected from a cohort of patients with inflammatory bowel disease, who expressed interest in family planning and reproductive health in their clinical context. They were randomized (1:1, text-only vs. multimedia content) to access an online e-health portal containing educational information on the topic. The data collected includes baseline demographics, medication history, reproductive history, as well as standardized, validated questionnaires on knowledge ('CCPKnow'), reproductive concerns, beliefs about medications ('BMQ'), and medication adherence ('MARS-5'). These questionnaires were administered prior to the intervention, immediately after accessing the materials, and a minimum of 6 months later (without re-accessing the online material). Two publications have been generated from analysis and aggregation of the CCPKnow data ("Pregnancy-related Beliefs and Concerns of Inflammatory Bowel Disease Patients are Modified After Accessing e-Health Portal" (Sutton et al., in press), "Innovative Online Educational Portal Improves Disease-Specific Reproductive Knowledge Among Patients With Inflammatory Bowel Disease" (Sutton et al., 2018) however this is an extensive dataset that could be analyzed or combined with others' datasets for further insights.
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Affiliation(s)
- Reed T. Sutton
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Kelsey Wierstra
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Vivian W. Huang
- Department of Medicine, University of Alberta, Edmonton, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
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9
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Sutton RT, Lytvyak E, Pincock D, Baumgart DC, Sadowski D, Fedorak R, Kroeker K. A110 CLINICAL DECISION SUPPORT SYSTEM FOR IBD FLARE MANAGEMENT AND CORTICOSTEROID ADMINISTRATION: PRELIMINARY RESULTS FROM AN INTERRUPED TIME SERIES. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/13/2022] Open
Affiliation(s)
- R T Sutton
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - E Lytvyak
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - D Pincock
- Chief Medical Information Office, Alberta Health Services, Edmonton, AB, Canada
| | - D C Baumgart
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - D Sadowski
- Royal Alexandra Hospital, Edmonton, AB, Canada
| | - R Fedorak
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - K Kroeker
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
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10
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Sutton RT, Lytvyak E, Pincock D, Baumgart DC, Sadowski D, Fedorak R, Kroeker K. A80 ADHERENCE TO GUIDELINES AND BEST PRACTICES FOR IBD FLARE MANAGEMENT AND CORTICOSTEROID ADMINISTRATION: A RETROSPECTIVE CHART REVIEW. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/12/2022] Open
Affiliation(s)
- R T Sutton
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - E Lytvyak
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - D Pincock
- Chief Medical Information Office, Alberta Health Services, Edmonton, AB, Canada
| | - D C Baumgart
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - D Sadowski
- Royal Alexandra Hospital, Edmonton, AB, Canada
| | - R Fedorak
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - K Kroeker
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
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11
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Cookson TA, Stern NC, Sutton RT, Fedorak R, Halloran B, Dieleman LA, Wong K, Huang V, Peerani F, van Zanten S, Lazarescu A, Kroeker K. A142 INFLAMMATORY BOWEL DISEASE PATIENTS REQUIRE AN INCREASED ADALIMUMAB DRUG LEVEL TO SIMULTANEOUSLY ACHIEVE CLINICAL AND BIOLOGICAL REMISSION. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/14/2022] Open
Affiliation(s)
- T A Cookson
- Department of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - N C Stern
- University of Alberta, Edmonton, AB, Canada
| | - R T Sutton
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - R Fedorak
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - B Halloran
- Department of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - L A Dieleman
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - K Wong
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - V Huang
- University of Alberta, Edmonton, AB, Canada
| | - F Peerani
- University of Alberta, Edmonton, AB, Canada
| | - S van Zanten
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - A Lazarescu
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - K Kroeker
- Department of Gastroenterology, University of Alberta, Edmonton, AB, Canada
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12
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Sutton RT, Wishart E, Dhami N, Sadowski D, Siffledeen J, Sauve M, Hundal R, Ismond K, van Zanten S, Huang V. A140 IBD DASHBOARD: AN INNOVATIVE E-HEALTH PROGRAM FOR PROVIDING EQUAL ACCESS TO QUALITY CARE FOR ALL INFLAMMATORY BOWEL DISEASE PATIENTS. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/12/2022] Open
Affiliation(s)
- R T Sutton
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - E Wishart
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - N Dhami
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - D Sadowski
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | | | - M Sauve
- River City Centre, Fort Mcmurray, AB, Canada
| | - R Hundal
- Mortimer Medical, Lethbridge, AB, Canada
| | - K Ismond
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - S van Zanten
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - V Huang
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
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13
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Sutton RT, Wierstra K, Ambrosio L, Dieleman LA, Halloran BP, Kroeker KI, Fedorak R, Wong K, Berga K, Huang V. A105 AN ONLINE EDUCATIONAL PORTAL IMPROVES CONCERNS OF INFLAMMATORY BOWEL DISEASE PATIENTS REGARDING PREGNANCY AND MEDICATION. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/14/2022] Open
Affiliation(s)
- R T Sutton
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - K Wierstra
- MacEwan University, Edmonton, AB, Canada
| | - L Ambrosio
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - L A Dieleman
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - B P Halloran
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - K I Kroeker
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - R Fedorak
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - K Wong
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - K Berga
- MacEwan University, Edmonton, AB, Canada
| | - V Huang
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
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14
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Rodriguez N, Ambrosio L, Sutton RT, Dieleman LA, Halloran BP, Kroeker KI, Peerani F, Wong K, Fedorak R, Huang V. A33 DOES PREGNANCY ADVERSELY IMPACT THE HEALTH-RELATED QUALITY OF LIFE AMONG WOMEN WITH IBD? J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/13/2022] Open
Affiliation(s)
- N Rodriguez
- Science, University of Alberta, Edmonton, AB, Canada
| | - L Ambrosio
- University of Alberta, Edmonton, AB, Canada
| | - R T Sutton
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - L A Dieleman
- Medicine, University of Alberta, Edmonton, AB, Canada
| | | | - K I Kroeker
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - F Peerani
- University of Alberta, Edmonton, AB, Canada
| | - K Wong
- University of Alberta, Edmonton, AB, Canada
| | - R Fedorak
- University of Alberta, Edmonton, AB, Canada
| | - V Huang
- University of Alberta, Edmonton, AB, Canada
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15
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Sutton RT, Rasmussen RG, Kester MB, Bruni KL, Rietschel JD. Picture archiving and communications systems (PACS) in private practice: St. Paul Radiology PACS project. J Digit Imaging 2001; 14:160-2. [PMID: 11442082 PMCID: PMC3452679 DOI: 10.1007/bf03190325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
While much of diagnostic radiology is practiced in a private setting, many of the papers and presentations describing picture archiving and communications systems (PACS) implementation to date have been sponsored by university and government health facilities. We will present a 4-year retrospective review of a private practice PACS project. The challenges, benefits, and cost analysis of the PACS project will be presented.
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16
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Abstract
The noninvasive diagnosis of osteomyelitis of the foot in diabetic patients with currently available radiologic and radionuclide imaging techniques is often difficult. Recently, 111In-labeled leukocyte scintigraphy has been proposed as an attractive alternative. Accordingly, we retrospectively reviewed 51 111In-labeled leukocyte scans, 49 technetium-99m bone scans, and 49 plain radiographs obtained in 51 adults with diabetes in whom osteomyelitis of the foot was suspected. The sensitivity and specificity of these techniques were evaluated in all patients, as well as in a subgroup of 11 patients with neuroarthropathy. Results with 111In-labeled leukocyte scans were also examined in subsets of patients with soft-tissue ulcers (n = 35) and those receiving antibiotics during investigation (n = 20). Confirmation or exclusion of osteomyelitis was made surgically in 28 patients and clinically in 23. Fourteen patients had osteomyelitis. Bone scans were most sensitive (93%) but least specific (43%); plain radiographs were most specific (83%) but least sensitive (43%). 111In-labeled leukocyte scans were both sensitive (79%) and specific (78%), and remained useful in patients with neuroarthropathy, soft-tissue ulcers, and antibiotic treatment. Poor spatial resolution contributed to the false-negative and false-positive 111In-labeled leukocyte scans, suggesting that this technique should not be interpreted independent of other tests. 111In-labeled leukocyte scans are a valuable diagnostic tool for the diagnosis of pedal osteomyelitis in diabetic patients.
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Affiliation(s)
- G Larcos
- Section of Nuclear Medicine, Mayo Clinic, Rochester, MN 55905
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17
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Sutton RT, Reading CC, Charboneau JW, James EM, Grant CS, Hay ID. US-guided biopsy of neck masses in postoperative management of patients with thyroid cancer. Radiology 1988; 168:769-72. [PMID: 3043550 DOI: 10.1148/radiology.168.3.3043550] [Citation(s) in RCA: 101] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
High-frequency (10-MHz) sonography demonstrated a cervical mass or lymphadenopathy, or both, during postoperative follow-up of 52 patients who had undergone surgery for thyroid cancer. Percutaneous biopsy with ultrasonographic (US) guidance was performed in all 52 masses, 44 of which were nonpalpable. Malignant cells were obtained in 29 biopsies, and the results of 20 biopsies were negative, yielding benign lymphocytes only. Results in three biopsies were nondiagnostic due to hypocellular specimens. Therefore, 94% of biopsy results (49) of 52) were confidently assigned as either positive (56%) or negative (38%) for malignancy. There were no complications. High-frequency sonography can demonstrate clinically occult thyroid bed tumor recurrence and lymph node metastases. US-guided biopsy is an accurate and safe technique to confirm or exclude malignancy in patients at high risk of recurrence of thyroid cancer.
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Affiliation(s)
- R T Sutton
- Department of Diagnostic Radiology, Mayo Clinic, Rochester, MN 55905
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