Cancer Care Ontario Colonoscopy Standards: standards and evidentiary base.

Colorectal cancer (CRC) is the most common cause of non-tobacco-related cancer deaths in Canadian men and women, accounting for 10% of all cancer deaths. An estimated 7800 men and women will be diagnosed with CRC, and 3250 will die from the disease in Ontario in 2007. Given that CRC incidence and mortality rates in Ontario are among the highest in the world, the best opportunity to reduce this burden of disease would be through screening. The present report describes the findings and recommendations of Cancer Care Ontario's Colonoscopy Standards Expert Panel, which was convened in March 2006 by the Program in Evidence-Based Care. The recommendations will form the basis of the quality assurance program for colonoscopy delivered in support of Ontario's CRC screening program.

Effects of discharge planning and compliance with outpatient appointments on readmission rates.

OBJECTIVE: This study examined whether patients discharged from inpatient psychiatric care would have lower rehospitalization rates if they kept an outpatient follow-up appointment after discharge. METHODS: Complete data were collected in 1998 on 3,113 psychiatric admissions in eight Southeastern states; 542 were readmissions. Patients' health care was managed by United Behavioral Health of Georgia (UBH-GA), which encouraged inpatient facilities to ensure that an outpatient appointment was scheduled for all discharged patients. UBH-GA contacted outpatient providers to determine whether patients kept at least one appointment. Rehospitalization rates were calculated for 90, 180, 270, and 365 days after discharge to examine effects over time of keeping an initial appointment. RESULTS: Of the 542 patients who were rehospitalized, 136 kept at least one outpatient appointment after discharge from their initial admission; 406 did not. For patients who did not keep an appointment, rehospitalization rates increased over time, ranging from 15 percent to 29 percent. For patients who kept an outpatient appointment, the rehospitalization rate remained the same over time, about 10 percent. The 270- and 365-day rehospitalization rates and the aggregated annual rates were significantly higher (p>.01) for patients who did not keep an appointment. CONCLUSIONS: Patients who did not have an outpatient appointment after discharge were two times more likely to be rehospitalized in the same year than patients who kept at least one outpatient appointment. Aggregated annual rates indicated that patients who kept appointments had a one in ten chance of being rehospitalized, whereas those who did not had a one in four chance.

Multiple familial gastrointestinal autonomic nerve tumors and small intestinal neuronal dysplasia.

Multiple small intestinal stromal tumors were removed from mother and natural daughter within 15 months of each other. Both had long histories of recurrent iron deficiency anemia and upper gastrointestinal bleeding. Light microscopy revealed that the tumors had arisen in conjunction with diffuse hyperplasia/ dysplasia of Auerbach's myenteric plexus. Immunohistochemistry generally did not show myogenic or paraganglionic phenotypes; CD34 was positive in most tumors. Electron microscopy confirmed the association with the abnormal Auerbach's plexus and showed the structure of gastrointestinal autonomic nerve tumors (GANTs). These findings provide information as to the origin and evolution of GANTs, and also have implications for the clinical management of these tumors which appear to occur more frequently than previously thought.

One-stage surgery with a nonsubmerged implant system.

Although nonsubmerged implant surgery can reduce patient trauma and costs by eliminating the uncovering procedure, one-piece implants cannot be shortened for esthetic results. However, a new implant design that comes preattached on a multipurpose collar is used for insertion, nonsubmerged healing, and as an abutment base. For submucosal margins, the collar can be replaced by an esthetic abutment that connects directly to the implant. Surface treatments include midsections roughened by hydroxyapatite or titanium plasma spray coatings, with smoother, acid-etched necks and self-tapping apical ends. Screw-retained, friction-fit abutments offer prosthodontic stability and uniformity, despite the submucosal implant type.

Breath pentane analysis as an index of lipid peroxidation: a functional test of vitamin E status.

Pentane, which evolves from the reaction involving omega-6 fatty acids, is a good index of lipid peroxidation. We describe a method for measuring breath pentane excretion in adult humans. After a 4-minute washout period, expired air was analyzed by gas chromatography. Breath was passed through a cooled loop of alumina to adsorb, concentrate, and release, on heating, pentane. Pentane was analyzed by a Porasil-D column with a derived calibration curve. The mean excretion of pentane in 10 normal adults was 6.34 +/- 0.96 pmol X kg-1 X min-1 (mean +/- SEM) and was significantly higher in five patients with plasma vitamin E deficiency (15.39 +/- 1.84 pmol X kg-1 X min-1). There was a significant negative correlation between pentane output and plasma vitamin E levels (r = -0.66, p less than 0.01). Moreover, breath pentane excretion was significantly decreased after a 10-d supplementation with vitamin E in five normal subjects. We conclude that breath pentane output is a sensitive, noninvasive, functional test for assessing vitamin E status.