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Review : Patient-Reported Outcomes in Gastroenterology; Clinical and Research Applications
( Brennan M R Spiegel ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2013 Journal of Neurogastroenterology and Motility (JNM Vol.19 No.2
Patient-generated reports, also known as Patient-Reported Outcomes (PROs), capture the patients` illness experience in a structured format and may help bridge the gap between patients and providers. PROs measure any aspect of patient-reported health (e.g., physical, emotional or social symptoms) and can help to direct care and improve clinical outcomes. When clinicians systematically collect patient-reported data in the right place at the right time, PRO measurement can effectively aid in detection and management of conditions, improve satisfaction with care and enhance the patient-provider relationship. This review article summarizes the latest approaches to PRO measuring for clinical trials and clinical practice, with a focus on use of PROs in gastroenterology.
Effects of Bariatric Surgery on Facial Features
Papoian, Vardan,Mardirossian, Vartan,Hess, Donald Thomas,Spiegel, Jeffrey H Korean Society of Plastic and Reconstructive Surge 2015 Archives of Plastic Surgery Vol.42 No.5
Background Bariatric surgeries performed in the USA has increased twelve-fold in the past two decades. The effects of rapid weight loss on facial features has not been previously studied. We hypothesized that bariatric surgery will mimic the effects of aging thus giving the patient an older and less attractive appearance. Methods Consecutive patients were enrolled from the bariatric surgical clinic at our institution. Pre and post weight loss photographs were taken and used to generate two surveys. The surveys were distributed through social media to assess the difference between the preoperative and postoperative facial photos, in terms of patients' perceived age and overall attractiveness. 102 respondents completed the first survey and 95 respondents completed the second survey. Results Of the 14 patients, five showed statistically significant change in perceived age (three more likely to be perceived older and two less likely to be perceived older). The patients were assessed to be more attractive postoperatively, which showed statistical significance. Conclusions Weight loss does affect facial aesthetics. Mild weight loss is perceived by survey respondents to give the appearance of a younger but less attractive patient, while substantial weight loss is perceived to give the appearance of an older but more attractive patient.
Rethinking the early intubation paradigm of COVID-19: time to change gears?
Philippe Rola,Joshua Farkas,Rory Spiegel,Cameron Kyle-Sidell,Scott Weingart,Laura Duggan,Marco Garrone,Adam Thomas 대한응급의학회 2020 Clinical and Experimental Emergency Medicine Vol.7 No.2
It was felt that coronavirus disease 2019 patients needed to be intubated precociously and that is what initial guidelines supported. Current experience suggests that many patients may avoid complications of mechanical ventilation and possibly avoid clinical deterioration by the use of non-invasive ventilatory support.
Fractal Analysis of EEG During Waking and Hypnosis: Laterality and Regional Differences
JunSeok Lee,SaeByul Kim,ByungHwan Yang,David Spiegel,JuYeon Choi,JunHo Choi,SeokHyeon Kim,JangHan Lee,SunIl Kim 대한신경정신의학회 2005 PSYCHIATRY INVESTIGATION Vol.2 No.1
We studied the trends of EEG signals during waking and hypnosis, by using fractal analysis to define the physiological concomitants of hypnosis. The subjects in this study were 6 psychiatric outpatients who were in good medical condition. The hypnotist induced hypnosis using a modified version of the hypnotic induction profile (HIP) technique. EEG data were acquired by means of a Telefactor EEG monitoring device installed in the EEG recording room. Twenty-five sets of data were analyzed using detrended fluctuation analysis (DFA), which is a well-established fractal analysis technique. The following results were obtained. 1) All of the scaling exponents, which constitute the result of fractal analysis, were greater than 0.5 and less than 1.5 in both the waking and hypnotic conditions. In addition, significant differences in the scaling exponents were found between the waking and hypnotic condition in most of the channels (except, Fp1 and F4). 2) We analyzed the individual changes in the scaling exponents of each subject, resulting from a number of hypnotic trials. In all of the trials, the differences among the scaling exponents of each trial were statistically nonsignificant. 3) The examination of the right-left symmetries did not yield any statistically significant difference. In this research, the scaling exponents of fractal analysis are reduced nearly to the level of white noise during the hypnotic condition. Therefore, this technique can differentiate the hypnotic condition from the waking condition. Additionally, the findings of this study suggest that hypnosis comes from a change in organization of neural activity in the whole brain network, rather than being a “specific area” phenomenon.
Marijo Parcina,Maik Brune,Vareska Kaese,Markus Zorn,Rainer Spiegel,Valerija Vojvoda,Thomas Fleming,Gottfried Rudofsky,Peter Paul Nawroth 한국영양학회 2015 Nutrition Research and Practice Vol.9 No.2
BACKGROUND/OBJECTIVES: This study addressed the question whether the composition of supposedly ‘healthy’ or ‘unhealthy’ dietary regimes has a calorie-independent short-term effect on biomarkers of metabolic stress and vascular risk in healthy individuals. SUBJECTS/METHODS: Healthy male volunteers (age 29.5 ± 5.9 years, n = 39) were given a standardized baseline diet for two weeks before randomization into three groups of different dietary regimes: fast food, Mediterranean and German cooking style. Importantly, the amount of calories consumed per day was identical in all three groups. Blood samples were analyzed for biomarkers of cardiovascular risk and metabolic stress after two weeks of the baseline diet and after two weeks of the assigned dietary regime. RESULTS: No dietary intervention affected the metabolic or cardiovascular risk profile when compared in-between groups or compared to baseline. Subjects applied to the Mediterranean diet showed a statistically significant increase of uric acid compared to baseline and compared to the German diet group. Plasma concentrations of urea were significantly higher in both the fast food group and the Mediterranean group, when compared to baseline and compared to the German diet group. No significant differences were detected for the levels of vitamins, trace elements or metabolic stress markers (8-hydroxy-2-deoxyguanosine, malondialdehyde and methylglyoxal, a potent glycating agent). Established parameters of vascular risk (e.g. LDL-cholesterol, lipoprotein(a), homocysteine) were not significantly changed in-between groups or compared to baseline during the intervention period. CONCLUSIONS: The calorie-controlled dietary intervention caused neither protective nor harmful short-term effects regarding established biomarkers of vascular or metabolic risk. When avoiding the noxious effects of overfeeding, healthy individuals can possess the metabolic capacity to compensate for a potentially disadvantageous composition of a certain diet.
Liautaud, Alexandre,Adu, Prince A.,Yassi, Annalee,Zungu, Muzimkhulu,Spiegel, Jerry M.,Rawat, Angeli,Bryce, Elizabeth A.,Engelbrecht, Michelle C. Occupational Safety and Health Research Institute 2018 Safety and health at work Vol.9 No.2
Background: Insufficient training in infection control and occupational health among healthcare workers (HCWs) in countries with high human immunodeficiency virus (HIV) and tuberculosis (TB) burdens requires attention. We examined the effectiveness of a 1-year Certificate Program in Occupational Health and Infection Control conducted in Free State Province, South Africa in an international partnership to empower HCWs to become change agents to promote workplace-based HIV and TB prevention. Methods: Questionnaires assessing reactions to the program and Knowledge, Attitudes, Skills, and Practices were collected pre-, mid-, and postprogram. Individual interviews, group project evaluations, and participant observation were also conducted. Quantitative data were analyzed using Wilcoxon signed-rank test. Qualitative data were thematically coded and analyzed using the Kirkpatrick framework. Results: Participants recruited (n = 32) were mostly female (81%) and nurses (56%). Pre-to-post-program mean scores improved in knowledge (+12%, p = 0.002) and skills/practices (+14%, p = 0.002). Preprogram attitude scores were high but did not change. Participants felt empowered and demonstrated attitudinal improvements regarding HIV, TB, infection control, and occupational health. Successful projects were indeed implemented. However, participants encountered considerable difficulties in trying to sustain improvement, due largely to lack of pre-existing knowledge and experience, combined with inadequate staffing and insufficient management support. Conclusion: Training is essential to strengthen HCWs' occupational health and infection control knowledge, attitudes, skills, and practices, and workplace-based training programs such as this can yield impressive results. However, the considerable mentorship resources required for such programs and the substantial infrastructural supports needed for implementation and sustainability of improvements in settings without pre-existing experience in such endeavors should not be underestimated.
Eric D Shah,Christopher V Almario,Brennan M R Spiegel,William D Chey 대한소화기 기능성질환∙운동학회 2018 Journal of Neurogastroenterology and Motility (JNM Vol.24 No.2
Background/Aims We evaluated the distribution of lower and upper gastrointestinal (GI) symptoms among individuals with irritable bowel syndrome with constipation (IBS-C) and chronic idiopathic constipation (CIC) in a nationwide survey. Methods Individuals (≥ 18 years of age) were identified from a nationwide sample of > 70 000 United States adults. Participants completed the National Institutes of Health GI Patient Reported Outcomes Measurement Information System (NIH GI-PROMIS) questionnaire. Symptom frequency and intensity in the prior 7 days were assessed using validated PROMIS scores. Odds ratios (OR) with 95% confidence intervals (CI) were calculated to compare symptom prevalence in IBS-C vs CIC, and one-way ANOVA was used to assess differences in PROMIS scores. Regression analysis was performed to adjust for demographic variables. Results Nine hundred and seventy adults met eligibility criteria (275 with IBS-C, 734 with CIC). Demographics were similar among groups except for education, marital and employment status, and income. Adjusting for demographic differences, GI-PROMIS scores of global GI symptoms were higher in IBS-C (251.1; 95% CI, 230.0–273.1) compared to CIC (177.8; 95% CI 167.2–188.4) (P < 0.001). Abdominal pain was more prevalent (OR, 4.3; 95% CI, 2.9–6.6) and more severe (P = 0.007) in IBS-C. Constipation was more severe in IBS-C (P = 0.011). Incontinence was more common (OR, 2.9; 95% CI, 1.3–6.3) but just as severe (P = 0.389) in IBS-C versus CIC. Regarding upper GI symptoms, the prevalence of dysphagia, heartburn, and nausea were similar. However, IBS-C individuals had more severe heartburn (P = 0.001). Conclusion GI symptoms are generally more severe in IBS-C compared to CIC, however abdominal pain, bloating, and upper GI symptoms still commonly occur in CIC.