LEADING THE NEWS
With the election just five days away, AGA has prepared an overview of where the candidates stand on health-care issues. Take a look at how the candidates stack up on Medicare, medical liability and insurance reform.
After the election, join us for webinars during which you will learn what will happen in the lame-duck session of Congress that will affect both the practice and research of gastroenterology.
Post-election Lame Duck: What This Will Mean for GI
On Thursday, Nov. 15 at 8 p.m. ET, Carla Ginsburg, MD, MPH, AGAF, chair, AGA Public Affairs & Advocacy Committee, will host a webinar on issues important to practice. Learn more about the additional hits projected for practice reimbursement, the effect of sequestration on the practice of medicine and quality reporting milestones.
How Will the Fiscal Cliff Impact Research Programs?
On Friday, Nov. 16 at noon ET, Timothy Wang, MD, AGAF, chair, AGA Institute Research Policy Committee, will host a webinar on the future of GI research. Learn more about the effect of sequestration on research funding and the outlook for federal agencies, including NIH, CDC, the Department of Defense, the Veterans’ Administration and the Agency for Healthcare Research and Quality.
New therapeutic strategies are needed for patients with refractory Crohn's disease. Administration of antigen-specific T-regulatory (Treg) cells to patients with refractory Crohn's disease was well tolerated and had dose-related efficacy, stated researchers in a study in Gastroenterology. The ovalbumin-specific immune response correlated with clinical response, supporting immune-suppressive mechanisms of ova-Tregs. The consistency of results among different assessment methods supports the efficacy of ova-Tregs; this immune therapy approach warrants further clinical and mechanistic studies in refractory Crohn's disease.
Adequate bowel cleansing is an important determinant of the efficacy of screening colonoscopy. Polyethylene glycol (PEG)-based solutions are used commonly in bowel preparation, but their poor palatability and large volumes (four liters) influence compliance. Adjunct therapies, such as bisacodyl, split-dose regimens and lower-volume regimens have been tested. A meta-analysis in Clinical Gastroenterology and Hepatology showed that a four liter split dose of PEG is better than other bowel preparation methods for colonoscopy. Significant heterogeneity among studies might result from differences in patient demographics and protocols. A four liter split dose of PEG should be considered the standard with which new bowel preparation methods are compared.
Clinical Gastroenterology and Hepatology 2012; 10(11): 1225-1231
Chemotherapy for metastatic lung or colorectal cancer can prolong life by weeks or months and may provide palliation, but it is not curative. According to data published in the New England Journal of Medicine, many patients receiving chemotherapy for incurable cancers may not understand that chemotherapy is unlikely to be curative, which could compromise their ability to make informed treatment decisions that are consonant with their preferences. Physicians may be able to improve patients' understanding, but this may come at the cost of patients' satisfaction with them.
New England Journal of Medicine 2012; 367:1616-1625
Norovirus outbreaks are common among vulnerable, elderly populations in U.S. nursing homes. According to a study in the Journal of the American Medical Association, norovirus outbreaks were associated with significant concurrent increases in all-cause hospitalization and mortality in nursing homes.
Journal of the American Medical Association 2012; 308(16): 1-8
Spilled Gallstones Mimicking a Liver Tumor
A 65-year-old man was referred to a hospital by his general practitioner for examination of an abnormal liver mass detected on ultrasonography during a periodic medical check-up. The patient had undergone laparoscopic cholecystectomy for gallstones four years earlier. On examination, he showed no clinical symptoms; his blood test results were normal and tumor marker levels were within the normal range. Enhanced CT and fat-suppressed, T2-weighted magnetic resonance imaging revealed an abnormal mass in the right lobe of the liver, which is in contact with the diaphragm. Establishing a definitive diagnosis was difficult; therefore, doctors conducted routine enhanced CT three months after the first examination. Findings revealed that the size of the mass had slightly increased; hence, the doctors considered the possibility of a malignant tumor of hepatic origin. Next, they performed partial resection of the liver and right diaphragm and found a subphrenic abscess containing spilled gallstones (figure).
Read more in Clinical Gastroenterology and Hepatology.
These images illustrate the causes, diagnosis and management of autoimmune injury to the liver and biliary tree. The images are separated into the following sections:
- Part I: Primary Sclerosing Cholangitis
- Part II: Primary Biliary Cirrhosis
- Part III: Autoimmune Hepatitis
- Part IV: Overlap Syndromes
- Part V: Illustrative Cases
Order these slides individually as you need them or purchase a one-year subscription for access to the entire GastroSlides library of more than 4,000 images. Preview and order slides.
Special offer: get your free download of the GastroSlides unit on liver cancer (revised).
GastroSlides is a continuing education resource directed by the AGA Institute Education and Training Committee.
PDR® drug alerts offer immediate, electronic delivery of FDA-approved, specialty-specific drug alerts and safety information emailed directly to you and available on http://www.aga.pdr.net for convenient review.
Register today at http://www.aga.pdr.net to receive up-to-date, ongoing delivery of important product safety and recall information. This valuable PDR Network service provides:
- Free FDA-approved drug alerts and recalls sent electronically to you.
- CME opportunities for reviewing drug alerts and full FDA labels on PDR.net.
- Endorsement by AGA.
- Improved patient safety, which may help reduce physician liability.
- Elimination of the delays and inefficiencies of traditional paper alerts.
- Privacy oversight from the governing not-for-profit board, the iHealth Alliance.
Amanda E. Troy received a 2012 AGA-Horizon Pharma Student Abstract Prize for research conducted at the Pennsylvania State University.
“Receiving the 2012 AGA-Horizon Student Abstract Prize was an unexpected surprise. First, I would like to thank both organizations for sponsoring this award so that young researchers like me can have the opportunity to present their research. I have had the privilege of working in the lab of Kirsteen Browning, MD, at the Penn State College of Medicine for the past year. This being my first conference, your financial support in attending opened my eyes to a whole new world and allowed me to develop relationships with investigators and students who will be great sources of information and collaboration in the future. I greatly appreciate the opportunity to see the breadth of research that is ongoing in my field. Being blessed by this award so early in my career serves as the fuel to continue working to advance my project and contribute to the vast field of research and knowledge.”
Lloyd Shapley and Alvin Roth have been awarded the Nobel Prize in economics for their theoretical and practical work in matching theory. Shapley and his colleague, David Gale, developed the "stable marriage" algorithm in which men and women rank each other as potential mates and a series of offer rounds produces a best match. The Gale-Shapley algorithm is the basis of the matching algorithm used by the National Resident Matching Program (NRMP). Roth worked with NRMP to adapt it so that it proposes matches on the basis of the applicant rather than the program rank order lists. Roth has also applied the algorithm to New York City schools, and research is underway to use it for kidney donors and patients who need transplants.
The FDA announced that it has recalled the following products:
- Ethicon PROXIMATE HCS Hemorrhoidal Circular Stapler and Accessories 33mm (Product Code: PPH01)
- Ethicon PROXIMATE PPH Hemorrhoidal Circular Stapler and Accessories 33mm (Product Code: PPH03)
- Ethicon TRANSTAR Circular Stapler Procedure Set (Product Code: STR10)
Users have difficulty firing the stapler devices, resulting in incomplete firing stroke and incomplete staple formation. Failure to complete the firing stroke of the stapler can result in severe pain, sphincter dysfunction, rectal wall damage, sepsis, bleeding and occlusion of the rectal canal. Failure to complete the firing stroke can also result in poor staple formation, dehiscence of the rectal wall staple line and bleeding.
This product may cause serious adverse health consequences, including death. Read the full details.
William S. Haubrich, MD, master physician, author, mentor and scholar, died at his La Jolla home Oct. 1, 2012, at the age of 89.
After attending Franklin & Marshall College, he enlisted in the Army to help cover tuition at the medical school of Case Western Reserve in Cleveland, OH. He graduated in 1947 as the president of his class and headed for Graduate Hospital in Philadelphia, PA for a year of rotating internship. He returned to Cleveland for three years of residency at Cleveland City Hospital — a year in pathology and two years in internal medicine. Then it was back again to Philadelphia for a year in a gastroenterology residency with Henry Bockus, MD, at Graduate Hospital.
At the end of 1951, Dr. Haubrich opened a private practice office in Lakewood, OH. Only one year later, the Army recalled him into service. He was stationed at Madigan Army Hospital in Tacoma, WA for the next two years.
Dr. Haubrich was recruited by Henry Ford Hospital in Detroit, MI. In 1954, he joined the department of gastroenterology where he served for 15 years, during which his research was focused mainly on the ultrastructure of the small bowel mucosa.
In 1970, Dr. Haubrich was invited to Scripps Clinic and Research Foundation (SCFR) in La Jolla, CA where he became head of the GI department two years later. He recognized the crucial need for the Scripps Clinic Medical Group to advance from primarily a medical clinic to a full-service entity incorporating all specialties. This required major changes, including the establishment of a department of surgery which he successfully promoted and recruited its first chairman. Concurrently, Dr. Haubrich served as a clinical professor of medicine at the University of California, San Diego. He performed his duties without monetary compensation because he “wanted to give back to medicine what he had gratefully received.”
In 1960, he was awarded the Vincent Lyon Prize by AGA, and in 1985 received the Rudolph Schindler Award of ASGE. He has been named a master physician of the American College of Physicians.
A self-trained lexicographer, Dr. Haubrich authored Medical Meanings: A Glossary of Word Origins that defined the etymology of more than 3,000 medical terms with scholarship, affection and humor. Legacy: Pioneers in Digestive Disease, complied by Dr. Haubrich, is based on a series of biographical sketches that appeared monthly in Gastroenterology from October 1997 to October 2008.
Dr. Haubrich is the author or coauthor of more than 115 original or review articles in major medical journals and has contributed more than 65 chapters to various textbooks. From 1971 to 1981, he edited the journal Gastrointestinal Endoscopy. Dr. Haubrich served as consultant in the life sciences for The American Heritage Dictionary of the English Language, third and fourth editions. At his retirement from active practice, an annual distinguished lectureship was established in his name at the Scripps Clinic & Research Foundation.
Dr. Haubrich was predeceased by his daughter, Linda, in 1999. He is greatly missed by his wife, Eila; daughters Lisa, Christina and husband Dan Dworsky, and Karen and husband Geoffrey Miller; grandchildren Noah and Alden Pressing, Erik and Bryan Dworsky, and Eila and Robert Miller.
A celebration of life and birthday remembrance will be held on July 4. Anyone wishing to make a gift in commemoration of Dr. Haubrich’s lifetime might like to contribute to the Graduate Medical Education Department at Scripps Clinic. Please indicate your gift is In memory of Dr. William Haubrich; the address is Scripps Health Foundation at 10666 North Torrey Pines Road 109N, La Jolla CA 92037.
The editors of Gastroenterology and Clinical Gastroenterology and Hepatology (CGH) would like to bring to your attention highlighted articles from the November issues of the journals.
- Once-Daily Budesonide MMX® Extended-Release Tablets Induce Remission in Patients With Mild to Moderate Ulcerative Colitis: Results From the CORE I Study; By William J. Sandborn, et al.
- Enoxaparin Prevents Portal Vein Thrombosis and Liver Decompensation in Patients With Advanced Cirrhosis; By Erica Villa, et al.
- A Porcine Model of Familial Adenomatous Polyposis; By Tatiana Flisikowska, et al.
- Burden of Gastrointestinal Disease in the United States: 2012 Update; By Anne F. Peery, et al.
Safety and Efficacy of Antigen-Specific Regulatory T-Cell Therapy for Patients With Refractory Crohn's Disease; By Pierre Desreumaux, et al.
- Efficacy of Buspirone, a Fundus-Relaxing Drug, in Patients With Functional Dyspepsia; By Jan Tack, et al.
- 4-Liter Split-Dose Polyethylene Glycol Is Superior to Other Bowel Preparations, Based on Systematic Review and Meta-analysis; By Brintha K. Enestvedt, et al.
- Treatment of Necrotizing Pancreatitis; By Sandra van Brunschot, et al.
- Effects of Dropping the Requirement for Goblet Cells From the Diagnosis of Barrett's Esophagus; By Maria Westerhoff, et al.
- Covert Hepatic Encephalopathy: Not as Minimal as You Might Think; By Matthew R. Kappus, et al.
The editors of Gastroenterology are excited to announce the debut of a new section, “Gastroenterology in Motion.” This section features videos of imaging and advanced technology in the field of gastroenterology and hepatology. The videos illustrate:
- Unique research methods.
- Substantial new imaging-based findings.
- Novel strategies to facilitate imaging-based findings related to real-time physiological processes and in situ histology.
- Unique case studies.
Each video is accompanied by a brief article that expands upon the essential information in the video. The article is published in print and online, with the print version including a QR code linking to the video online. Overseen by Thomas D. Wang, MD, PhD, University of Michigan, Ann Arbor; and Ralf Kiesslich, MD, PhD, Johannes Gutenberg University of Mainz, Rhineland-Palatinate, Germany, “Gastroenterology in Motion” is scholarly and of broad appeal to Gastroenterology’s clinically oriented readership as well as to those interested in translational research. The section’s first article focuses on the enteric nervous system, which, for the first time, is visualized in humans using endomicroscopy.
For more information about “Gastroenterology in Motion” or to propose an article for the section, contact Jennifer Tarr.
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For as little as $82.50, you can place a classified ad of 100 words or less in AGA's weekly email newsletter, AGA eDigest, or AGA's bi-monthly magazine, AGA Perspectives. If you place ads in both AGA Perspectives and AGA eDigest, you will receive a 10 percent discount. Advertising in either includes a free online classified listing. Learn more.
University of Louisville — The Division of Gastroenterology, Hepatology and Nutrition at the University of Louisville School of Medicine is seeking faculty with a career interest in IBD, general GI, hepatology and endoscopic ultrasound. There is considerable support for both clinical/bench research and excellent collaboration. J-1 visa conversion will be considered. The University of Louisville is an equal opportunity affirmative action employer. Interested candidates are invited to submit a curriculum vitae to Kristine Krueger, MD, professor and chief, clinical and academic affairs, division of gastroenterology, hepatology and nutrition, University of Louisville School of Medicine, Louisville, KY 40292 or firstname.lastname@example.org.
Job Description: Excellent opportunity exists with a regional leader in health care. Covenant Medical Group is seeking to hire a motivated BE/BC gastroenterologist with commitment to excellence in clinical care to perform all aspects of GI care, both inpatient and outpatient. Call is 1:7.
Enjoy brand new state-of-the-art facilities, including endoscopy suite; the largest hospital-integrated physician group in the region with a tremendous referral network of over 500 physicians from 52 medical specialties performing advanced techniques that are on the leading edge of medicine, and a quality of life second to none.
Covenant HealthCare is one of the largest, most comprehensive health-care providers north of metro Detroit. Located in the heart of the Great Lakes Bay Region, Covenant is the sixth largest hospital in Michigan with 675 beds and the region’s only level II trauma center, including air medical transport service. Covenant employs more than 4,000 employees and supports an empowered and accountable workforce that embraces diversity with a track record of clinical and workplace excellence. A strong competitive salary, excellent benefit package and much more compliment this outstanding opportunity.
Well-established GI practice in northern New Jersey looking for a part-time gastroenterology associate. Long-term position. Two to three days per week. No night or weekend call. Malpractice, health and pension.
Contact Cathy Shanahan at 973-633-1484. Fax: 973-633-7980. Email: email@example.com.
Federal Staffing Resources is seeking a civilian gastroenterologist for a permanent position to provide services at Langley AFB in Hampton, VA.
- Competitive compensation.
- Malpractice coverage.
- Any state license.
Federal Staffing Resources is a minority woman-owned small business and an SBA 8(a) program participant. Federal Staffing Resources provides multi-disciplinary single call professional and allied health-care staffing services. Federal Staffing Resources has demonstrated sensitivity and expert understanding of the military medical environment.
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