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Nguyen D.L.,University of California at Irvine | Jamal M.M.,University of California at Irvine | Nguyen E.T.,University of California at Irvine | Puli S.R.,University of Illinois Peoria | Bechtold M.L.,Columbia University
Gastrointestinal Endoscopy | Year: 2016

Background and Aims Colonoscopy is extremely important for the identification and removal of precancerous polyps. Bowel preparation before colonoscopy is essential for adequate visualization. Traditionally, patients have been instructed to consume only clear liquids the day before a colonoscopy. However, recent studies have suggested using a low-residue diet, with varying results. We evaluated the outcomes of patients undergoing colonoscopy who consumed a clear liquid diet (CLD) versus low-residue diet (LRD) on the day before colonoscopy by a meta-analysis. Methods Scopus, PubMed/MEDLINE, Cochrane databases, and CINAHL were searched (February 2015). Studies involving adult patients undergoing colonoscopy examination and comparing LRD with CLD on the day before colonoscopy were included. The analysis was conducted by using the Mantel-Haenszel or DerSimonian and Laird models with the odds ratio (OR) to assess adequate bowel preparations, tolerability, willingness to repeat diet and preparation, and adverse effects. Results Nine studies (1686 patients) were included. Patients consuming an LRD compared with a CLD demonstrated significantly higher odds of tolerability (OR 1.92; 95% CI, 1.36-2.70; P <.01) and willingness to repeat preparation (OR 1.86; 95% CI, 1.34-2.59; P <.01) with no differences in adequate bowel preparations (OR 1.21; 95% CI, 0.64-2.28; P =.58) or adverse effects (OR 0.88; 95% CI, 0.58-1.35; P =.57). Conclusion An LRD before colonoscopy resulted in improved tolerability by patients and willingness to repeat preparation with no differences in preparation quality and adverse effects. © 2016 American Society for Gastrointestinal Endoscopy. Source


Brown III C.A.,Harvard University | Cox K.,University of Illinois Peoria | Hurwitz S.,Harvard University | Walls R.M.,Harvard University
Western Journal of Emergency Medicine | Year: 2014

Introduction: Pre-hospital airway management is a key component of resuscitation although the benefit of pre-hospital intubation has been widely debated. We report a large series of pre-hospital emergency airway encounters performed by air-transport providers in a large, multi-state system. Methods: We retrospectively reviewed electronic intubation flight records from an 89 rotorcraft air medical system from January 01, 2007, through December 31, 2009. We report patient characteristics, intubation methods, success rates, and rescue techniques with descriptive statistics. We report proportions with 95% confidence intervals and binary comparisons using chi square test with p-values <0.05 considered significant. Results: 4,871 patients had active airway management, including 2,186 (44.9%) medical and 2,685 (55.1%) trauma cases. There were 4,390 (90.1%) adult and 256 (5.3%) pediatric (age ≤ 14) intubations; 225 (4.6%) did not have an age recorded. 4,703 (96.6%) had at least one intubation attempt. Intubation was successful on first attempt in 3,710 (78.9%) and was ultimately successful in 4,313 (91.7%). Intubation success was higher for medical than trauma patients (93.4% versus 90.3%, p=0.0001 JT test). 168 encounters were managed primarily with an extraglottic device (EGD). Cricothyrotomy was performed 35 times (0.7%) and was successful in 33. Patients were successfully oxygenated and ventilated with an endotracheal tube, EGD, or surgical airway in 4809 (98.7%) encounters. There were no reported deaths from a failed airway. Conclusion: Airway management, predominantly using rapid sequence intubation protocols, is successful within this high-volume, multi-state air-transport system. Copyright 2014 by the article author(s). Source


Rahman R.,University of Missouri | Nguyen D.L.,University of California at Irvine | Sohail U.,University of Missouri | Almashhrawi A.A.,University of Missouri | And 3 more authors.
Annals of Gastroenterology | Year: 2016

Background In patients suffering from upper gastrointestinal bleeding (UGIB), adequate visualization is essential during endoscopy. Prior to endoscopy, erythromycin administration has been shown to enhance visualization in these patients; however, guidelines have not fully adopted this practice. Thus, we performed a comprehensive, up-to-date meta-analysis on the issue of erythromycin administration in this patient population. Methods After searching multiple databases (November 2015), randomized controlled trials on adult subjects comparing administration of erythromycin before endoscopy in UGIB patients to no erythromycin or placebo were included. Pooled estimates of adequacy of gastric mucosa visualized, need for second endoscopy, duration of procedure, length of hospital stay, units of blood transfused, and need for emergent surgery using odds ratio (OR) or mean difference (MD) were calculated. Heterogeneity and publication bias were assessed. Results Eight studies (n=598) were found to meet the inclusion criteria. Erythromycin administration showed statistically significant improvement in adequate gastric mucosa visualization (OR 4.14; 95% CI: 2.01-8.53, P<0.01) while reduced the need for a second-look endoscopy (OR 0.51; 95% CI: 0.34-0.77, P<0.01) and length of hospital stay (MD -1.75; 95% CI: -2.43 to -1.06, P<0.01). Duration of procedure (P=0.2), units of blood transfused (P=0.08), and need for emergent surgery (P=0.88) showed no significant differences. Conclusion Pre-endoscopic erythromycin administration in UGIB patients significantly improves gastric mucosa visualization while reducing length of hospital stay and the need for second-look endoscopy. © 2016 Hellenic Society of Gastroenterology. Source


Yong F.A.,University of Illinois Peoria | Alvarado A.M.,University of Illinois Peoria | Wang H.,University of Illinois Peoria | Tsai J.,Kaiser Permanente | Estes N.C.,University of Illinois Peoria
American Journal of Surgery | Year: 2015

Background The appendix, considered an intestinal microbiota reservoir, may be protective against the risk of fulminant Clostridium difficile infection. Methods Retrospective analysis was performed in patients with C. difficile infection at St. Francis Medical Center from 2007 to 2011. Outcome of infection and history of appendectomy were compared. Statistical analysis was by chi-square and multivariate logistic regression. Results In total, 507 patients were hospitalized for C. difficile. Of 388 patients with intact appendix, 20 (5.2%) developed fulminant infection and required colectomy, whereas of 119 patients with previous appendectomy, 13 (10.9%) required colectomy. An increased severity of disease, indicated by increased rate of colectomy, occurred for the group with a history of appendectomy (P =.03). Age and sex were adjusted by multivariant regression (P =.05). Conclusions Appendectomy may be a risk factor for increased severity of C. difficile infection. Although the mechanism is unknown, further studies are warranted. © 2015 Elsevier Inc. All rights reserved. Source

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