AIM: To summarize the magnitude and time trends of endoscopy-related claims and to compare total malpractice indemnity according to specialty and procedure. METHODS: We obtained data from a comprehensive database of c...AIM: To summarize the magnitude and time trends of endoscopy-related claims and to compare total malpractice indemnity according to specialty and procedure. METHODS: We obtained data from a comprehensive database of closed claims from a trade association of professional liability insurance carriers, representing over 60% of practicing United States physicians. Total payments by procedure and year were calculated, and were adjusted for inflation (using the Consumer Price Index) to 2008 dollars. Time series analysis was performed to assess changes in the total value of claims for each type of procedure over time. RESULTS: There were 1901 endoscopy-related closed claims against all providers from 1985 to 2008. The specialties include: internal medicine (n = 766), gastroenterology (n = 562), general surgery (n = 231), general and family practice (n = 101), colorectal surgery (n = 87), other specialties (n = 132), and unknown (n = 22). Colonoscopy represented the highest frequen-cies of closed claims (n = 788) and the highest total indemnities ($54 093 000). In terms of mean claims payment, endoscopic retrograde cholangiopancreatography (ERCP) ranked the highest ($374 794) per claim. Internists had the highest number of total claims (n = 766) and total claim payment ($70 730 101). Only total claim payments for colonoscopy and ERCP seem to have increased over time. Indeed, there was an average increase of 15.5% per year for colonoscopy and 21.9% per year for ERCP after adjusting for inflation. CONCLUSION: There appear to be differences in malpractice coverage costs among specialties and the type of endoscopic procedure. There is also evidence for secular trend in total claim payments, with colonoscopy and ERCP costs rising yearly even after adjusting for inflation.展开更多
Purpose: Interstitial cystitis/Bladder pain syndrome is an inflammatory disorder of the bladder, for which histamine has been implicated in the pathogenesis of the disease. The condition is often refractory to standar...Purpose: Interstitial cystitis/Bladder pain syndrome is an inflammatory disorder of the bladder, for which histamine has been implicated in the pathogenesis of the disease. The condition is often refractory to standard-of-care medical treatments, including the antihistamines hydroxyzine or cimetidine, and procedures. Herein we report a physician-sponsored proof-of-principle case series of four adult female patients with chronic painful bladder and frequent urination, who were treated once daily with a low dose H1 + H2 histamine receptor antagonist combination. Materials and Methods: Four adult females with Interstitial cystitis/Bladder pain syndrome were treated once daily with a compounded oral dosage form containing the H1 receptor antagonist-cetirizine 8 mg in combination with the H2 receptor antagonist-famotidine 22 mg. The case series consists of a retrospective review of the symptom severity prior to versus following H1 + H2 treatment. Results and Conclusions: The once daily dual histamine receptor antagonist therapy substantially reduced the pain and urination frequency, and prophylactically maintained all four patients long-term with substantially reduced disease severity. The reduction in symptom severity was achieved at amounts that do not exceed the US FDA approved and exceptionally safe daily doses for the two over-the-counter monotherapies. This case series provides proof-of-principle evidence that a dual antihistamine combination of cetirizine plus famotidine effectively treated and maintained female patients, who were previously refractory to standard-of-care medications and/or procedures.展开更多
Barrett’s esophagus(BE)is a well-established pre-malignant lesion for esophageal adenocarcinoma,a condition that carries a dismal five-year overall survival rate of less than 15%.Among several available methods to el...Barrett’s esophagus(BE)is a well-established pre-malignant lesion for esophageal adenocarcinoma,a condition that carries a dismal five-year overall survival rate of less than 15%.Among several available methods to eliminate BE,radiofrequency ablation(RFA)provides the most efficient modality,since it has been demonstrated to successfully eradicate BE with or without dysplasia with acceptable safety,efficacy and durability profiles.In conjunction with proton pump therapy,this new technology has quickly become the standard care for patients with dysplastic BE.However,several technical questions remain about how to deploy RFA therapy for maximum effectiveness and long-term favorable outcomes for all stages of the disease.These include how to select patient for therapy,what the best protocol for RFA is,when to use other modalities,such as endoscopic mucosal resection,and what should be considered for refractory BE.This review addresses these questions with the perspective of the best available evidence matched with the authors’experience with the technology.展开更多
文摘AIM: To summarize the magnitude and time trends of endoscopy-related claims and to compare total malpractice indemnity according to specialty and procedure. METHODS: We obtained data from a comprehensive database of closed claims from a trade association of professional liability insurance carriers, representing over 60% of practicing United States physicians. Total payments by procedure and year were calculated, and were adjusted for inflation (using the Consumer Price Index) to 2008 dollars. Time series analysis was performed to assess changes in the total value of claims for each type of procedure over time. RESULTS: There were 1901 endoscopy-related closed claims against all providers from 1985 to 2008. The specialties include: internal medicine (n = 766), gastroenterology (n = 562), general surgery (n = 231), general and family practice (n = 101), colorectal surgery (n = 87), other specialties (n = 132), and unknown (n = 22). Colonoscopy represented the highest frequen-cies of closed claims (n = 788) and the highest total indemnities ($54 093 000). In terms of mean claims payment, endoscopic retrograde cholangiopancreatography (ERCP) ranked the highest ($374 794) per claim. Internists had the highest number of total claims (n = 766) and total claim payment ($70 730 101). Only total claim payments for colonoscopy and ERCP seem to have increased over time. Indeed, there was an average increase of 15.5% per year for colonoscopy and 21.9% per year for ERCP after adjusting for inflation. CONCLUSION: There appear to be differences in malpractice coverage costs among specialties and the type of endoscopic procedure. There is also evidence for secular trend in total claim payments, with colonoscopy and ERCP costs rising yearly even after adjusting for inflation.
文摘Purpose: Interstitial cystitis/Bladder pain syndrome is an inflammatory disorder of the bladder, for which histamine has been implicated in the pathogenesis of the disease. The condition is often refractory to standard-of-care medical treatments, including the antihistamines hydroxyzine or cimetidine, and procedures. Herein we report a physician-sponsored proof-of-principle case series of four adult female patients with chronic painful bladder and frequent urination, who were treated once daily with a low dose H1 + H2 histamine receptor antagonist combination. Materials and Methods: Four adult females with Interstitial cystitis/Bladder pain syndrome were treated once daily with a compounded oral dosage form containing the H1 receptor antagonist-cetirizine 8 mg in combination with the H2 receptor antagonist-famotidine 22 mg. The case series consists of a retrospective review of the symptom severity prior to versus following H1 + H2 treatment. Results and Conclusions: The once daily dual histamine receptor antagonist therapy substantially reduced the pain and urination frequency, and prophylactically maintained all four patients long-term with substantially reduced disease severity. The reduction in symptom severity was achieved at amounts that do not exceed the US FDA approved and exceptionally safe daily doses for the two over-the-counter monotherapies. This case series provides proof-of-principle evidence that a dual antihistamine combination of cetirizine plus famotidine effectively treated and maintained female patients, who were previously refractory to standard-of-care medications and/or procedures.
文摘Barrett’s esophagus(BE)is a well-established pre-malignant lesion for esophageal adenocarcinoma,a condition that carries a dismal five-year overall survival rate of less than 15%.Among several available methods to eliminate BE,radiofrequency ablation(RFA)provides the most efficient modality,since it has been demonstrated to successfully eradicate BE with or without dysplasia with acceptable safety,efficacy and durability profiles.In conjunction with proton pump therapy,this new technology has quickly become the standard care for patients with dysplastic BE.However,several technical questions remain about how to deploy RFA therapy for maximum effectiveness and long-term favorable outcomes for all stages of the disease.These include how to select patient for therapy,what the best protocol for RFA is,when to use other modalities,such as endoscopic mucosal resection,and what should be considered for refractory BE.This review addresses these questions with the perspective of the best available evidence matched with the authors’experience with the technology.
