Acute Bloody Diarrhea with Right Sided Colitis

A 50-year-old woman presented with bloody diarrhea and radiological evidence of right sided colitis. Enterohemorrhagic Escherichia coli was isolated from the stool. The illness subsided spontaneously but was complicated by the development of hypoproteinemia and ascites. This disease presents a variable clinical picture but apparent 'ischemic colitis' in younger patients is especially suggestive of infection with E coli 0157:H7

Granulomatous Hepatitis in Association with Fever and a Palmar Rash

Secondary syphilis may present without the classical features of the disease and should be considered in patients acutely ill with abnormal liver function tests and a nonspecific pattern on liver biopsy. Secondary syphilis may present in association with granulomatous hepatitis and serological testing should be performed if the etiology of the hepatic granulomas is unclear. While the finding of a disproportionate elevation of alkaline phosphatase relative to serum bilirubin may be a useful pointer towards the diagnosis this pattern is not specific and not consistently observed. The definitive answer to the question of whether syphilitic hepatitis exists awaits the development of comprehensive rests to exclude viral pathogens

HIPPP: Health Information Portal for Patients and Public

Cancer misinformation is becoming an increasingly complex issue. When a person or a loved one receives a diagnosis of possible cancer, that person, family and friends will try to better inform themselves in this area of healthcare. Like most people, they will turn to their clinician for guidance and the internet to better verse themselves on the topic. But can they trust the information provided online? Are there ways to provide a quick evaluation of such information in order to prevent low-quality information and potentially dangerous consequences of trusting it? In the context of the UL Cancer Research Network (ULCan), this interdisciplinary project aims to develop the Health Information Portal for Patients and Public (HIPPP), a web-based application co-designed with healthcare domain experts that helps to improve people navigate the health information space online. HIPPP will be used by patients and the general public to evaluate user-provided web-based health information (WBHI) sources with respect to the QUEST framework and return a quality score for the information sources. As a web application, HIPPP is developed with modern extreme model-driven development (XMDD) technologies in order to make it easily adaptable and evolvable. To facilitate the automated evaluation of WBHI, HIPPP embeds an artificial intelligence (AI) pipeline developed following model-driven engineering principles. Through co-design with health domain experts and following model-driven engineering principles, we have extended the Domain Integrated Modelling Environment (DIME) to include a graphical domain-specific language (GDSL) for developing websites for evaluating WBHI. This GDSL allows for greater participation from stakeholders in the development process of both the user-facing website and the AI-driven evaluation pipeline through encoding concepts familiar to those stakeholders within the modelling language. The time efficiency study conducted as part of this research found that the HIPPP evaluation pipeline evaluates a sample of WBHI with respect to the QUEST framework up to 98.79% faster when compared to the time taken by a human expert evaluator

The 2012 Sage Wait Times Program: Survey of Access to Gastroenterology in Canada

BACKGROUND: Periodically surveying wait times for specialist health services in Canada captures current data and enables comparisons with previous surveys to identify changes over time. METHODS: During one week in April 2012, Canadian gastroenterologists were asked to complete a questionnaire (online or by fax) recording demographics, reason for referral, and dates of referral and specialist visits for at least 10 consecutive new patients (five consultations and five procedures) who had not been seen previously for the same indication. Wait times were determined for 18 indications and compared with those from similar surveys conducted in 2008 and 2005. RESULTS: Data regarding adult patients were provided by 173 gastroenterologists for 1374 consultations, 540 procedures and 293 same-day consultations and procedures. Nationally, the median wait times were 92 days (95% CI 85 days to 100 days) from referral to consultation, 55 days (95% CI 50 days to 61 days) from consultation to procedure and 155 days (95% CI 142 days to 175 days) (total) from referral to procedure. Overall, wait times were longer in 2012 than in 2005 (P<0.05); the wait time to same-day consultation and procedure was shorter in 2012 than in 2008 (78 days versus 101 days; P<0.05), but continued to be longer than in 2005 (P<0.05). The total wait time remained longest for screening colonoscopy, increasing from 201 days in 2008 to 279 days in 2012 (P<0.05). DISCUSSION: Wait times for gastroenterology services continue to exceed recommended targets, remain unchanged since 2008 and exceed wait times reported in 2005

A study of the prevalence of cytotoxic and non-cytotoxic Klebsiella oxytoca fecal colonization in two patient populations

BACKGROUND: Klebsiella oxytoca is a cause of antibiotic-associated hemorrhagic colitis. Few reports of the occurrence of K oxytoca within stool exist and there is no gold standard method for its isolation

Canadian Association of Gastroenterology position statement on screening individuals at average risk for developing colorectal cancer: 2010

The Canadian Association of Gastroenterology and the Canadian Digestive Health Foundation published guidelines on colon cancer screening in 2004. Subsequent to the publication of these guidelines, many advances have occurred, thereby necessitating a review of the existing guidelines in the context of new technologies and clinical knowledge. The assembled guideline panel recognized three recent American sets of guidelines and identified seven issues that required comment from a Canadian perspective. These issues included, among others, the role of program-based screening, flexible sigmoidoscopy, computed tomography colonography, barium enema and quality improvement. The panel also provided context for the selection of the fecal immunochemical test as the fecal occult blood test of choice, and the relative role of colonoscopy as a primary screening tool. Recommendations were also provided for an upper age limit for colon cancer screening, whether upper endoscopy should be performed following a negative colonoscopy for a positive fecal occult blood test and when colon cancer screening should resume following negative colonoscopy

Insurance Rating of Patients with Inflammatory Bowel Disease: Report of a Conference on Morbidity and Mortality

Patient members reported to the Crohn’s and Colitis Foundation of Canada (CCFC) about their difficulties to obtain insurance. In 1991, the Lay Board of the CCFC requested its Medical Advisory Board (MAB) to investigate this problem. At that time, insurance ratings could be illustrated by the 1985 edition of Brackenridge’s monograph on life risks. The MAB found that data on mortality were outdated. A conference on morbidity and mortality of inflammatory bowel disease (IBD) was organized by the authors and held in May 1992. Based on questionnaires to patients, evidence provided by invited speakers and the results of small group conferences, it was concluded that patients with IBD have difficulties in obtaining insurance, even though the quality of life and mortality of IBD patients is not very different from that of the general population. However, the mortality rate of the healthy insured population is lower than that of the general population, and thus much lower than that of IBD patients. Patients have a better chance to obtain insurance if there is a close cooperation between the treating physician and the medical officer of the insurance company. Changes have occurred since the conference held in May 1992. The recent edition of Brackenridge’s text (1992) provides a better prognosis but unfortunately unchanged rating for patients with IBD than did the 1985 edition. Close cooperation between the Patient Advisory Committee of the CCFC and the Executives of the Canadian Life Insurance Medical Officers Association may further improve the insurance rating of patients with IBD