Thiopurine therapy increases the risk of nonmelanoma skin cancers (NMSCs) in organ transplant patients. The data on NMSC in patients with IBD on thiopurines is conflicting. METHODS: We searched electronic databases for full journal articles reporting on the risk of developing NMSC in patients with IBD on thiopurine and hand searched the reference lists of all retrieved articles. Pooled adjusted hazard ratios and 95% confidence intervals (CIs) were determined using a random-effects model. Publication bias was assessed using Funnel plots and Egger’s test. Heterogeneity was assessed using Cochran’s Q and the I2 statistic. RESULTS: Eight studies involving 60,351 patients provided data on the risk of developing NMSC in patients with IBD on thiopurines. The pooled adjusted hazards ratio of developing NMSC after exposure to thiopurines in patients with IBD was 2.28 (95% CI: 1.50 to 3.45). There was significant heterogeneity (I2=76%) between the studies but no evidence of publication bias. Meta regression analysis suggested that the population studied (hospital-based vs. population-based) and duration of follow-up contributed significantly to heterogeneity. Grouping studies based on population studied and duration showed higher hazard rations in hospital-based and shorter duration studies. CONCLUSIONS: The risk of developing NMSC in patients with IBD on thiopurines is only modestly elevated.
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Drugs cut need for surgery for Crohn’s disease sufferers by more than half
Crohn’s affects more than quarter-of-a-million people in the UK leading to an inflamed intestine. Researchers from St George’s, University of London, St George’s Hospital, London and Imperial College, London, monitored more than 5,000 patients in the UK living with Crohn’s disease for more than 20 years and looked at the effect of thiopurine drugs that suppress inflammation in the gut. Gastroenterologist Dr Richard Pollok, an honorary senior lecturer at St George’s, University of London, said “Our discovery is timely since new guidelines from the USA have played down the benefits of these drugs in favour of newer agents. “A year of treatment with the newer ‘biologics’, which are administered by injection, cost about 10,000 more compared to thiopurines. “We try to avoid surgery but some patients face multiple procedures because the disease can flare up again particularly where the intestine has been rejoined. “The fact that thiopurines can cut the need for surgical intervention and remain affordable is good news for patients and the NHS.” They found patients taking thiopurines, such as Azathioprine, for more than 12 months had a 60% reduction within the first 5 years of diagnosis. Thiopurines have been used in the treatment of inflammatory bowel conditions like Crohn’s disease since the 1970s but their long-term benefits have just come to light. There has been a major increase in the number of patients who receive these drugs in the past decade and rates of surgery in patients with this condition have dropped, partly as a result of these and other treatments. But up to a quarter of patients still go on to have their first corrective surgery to remove the worst affected areas within 5 years of being diagnosed. The study, published in the American Journal of Gastroenterology, was funded by the National Institute for Health Research. More information: Chatu S, Saxena S, Subramanian V, Curcin V, Yadegarfar G, Gunn L, Majeed A, Pollok R.C. The Impact of Timing and Duration of Thiopurine Treatment on First Intestinal Resection in Crohn ‘ s Disease: National UK Population-Based Study 1989 2010 Am J Gastroenterol 28 Jan 2013; DOI: 10.1038/ajg.2013.462 Provided by St.
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Related Doctor salaries have shot up 30% in past decade over fears of physician shortage, brain drain to U.S.: report I think that there is no question that almost doubling medical school enrolments since the late 1990s combined with easier paths to licensure for international medical grads was the wrong thing to do. We didnt think it through as a country. The study was conducted for and released by the Royal College of Physicians and Surgeons. The principal investigator was Danielle Frechette, executive director for health systems innovation for the college. Frechette said the organization, which sets standards for physician education in the country, had been hearing anecdotes about rising numbers of unemployed doctors, so decided to assess the situation. The ensuing report, released Thursday, is based on a survey of over 4,000 newly graduated doctors and interviews with about 50 people knowledgeable about the situation deans of medical schools, hospital CEOs and the like. Were hoping that our research shows that this is not a simple issue. And that we shouldnt have any knee-jerk reactions, otherwise we will perpetuate this boom-bust cycle that weve been in. Its like Groundhog Day The report paints a grim picture but does not recommend ways to fix it; that was not the mandate. The Royal College of Physicians and Surgeons is convening a national summit in February to explore ideas for developing a co-ordinated approach to planning health system workforce needs, Frechette said. She noted a fix will not be easy. Were hoping that our research shows that this is not a simple issue. And that we shouldnt have any knee-jerk reactions, otherwise we will perpetuate this boom-bust cycle that weve been in. Its like Groundhog Day, she said, referring to the popular Bill Murray movie. Frechette suggested, however, that a national health systems workforce planning body would be an important start.
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Canada to Host World’s Medical Specialists
The beautiful city of Vancouver, B.C. will welcome the world’s dermatology community as it hosts the 23rd World Congress of Dermatology in 2015. The Canadian Dermatology Association is delighted by the announcement that delegates at the 22nd World Congress of Dermatology (WCD) in Seoul voted to see the largest conference of dermatologic specialists come to Canada. Other locations that were in the running to the host the 23rd WCD included Rome, Vienna, Istanbul and Bangalore. “The Vancouver Bid Committee has worked tirelessly over the last three years attending countless dermatology meetings and strengthening international relationships in order to put a face to the Canadian bid,” says Dr Ian Landells, CDA President. The theme for the Vancouver WCD will be A Global Celebration of Dermatology and will mark the first time the conference has ever been held in Canada. To encourage participation from dermatologists around the globe, the Committee established a comprehensive scholarship program targeted at dermatologists and trainees from developing countries who might otherwise be unable to attend. “Vancouver is a dynamic, multicultural city in a spectacular natural environment and we’re honoured our colleagues around the world elected to use it as the setting for the 2015 World Congress of Dermatology,” says Dr Jerry Shapiro, Vancouver Bid Committee President. Canada’s dermatologists and their supporters will be taking time to celebrate this well-earned victory at the WCD Gala in Seoul before returning home to begin planning for the 2015 WCD. About CDA The Canadian Dermatology Association, founded in 1925, represents Canadian dermatologists. The association exists to advance the science and art of medicine and surgery related to the health of the skin, hair and nails; provide continuing professional development for its members; support and advance patient care; provide public education on sun protection and other aspects of skin health; and promote a lifetime of healthy skin, hair and nails. For further information:
Crohn’s Disease – Professor Thomas Borody Of Australia Comes To New York To Discuss Significant New Findings
There were a total of nine gastroenterologists working across the two tertiary units [RCH and MMC] at the time of the study. Hospital records of all participants were audited, with any vaccinations administered recorded in the outpatient notes and/or a medication chart if administered at the RCH Immunization Drop-in-centre. A telephone interview survey was conducted with consenting parents using the parent-held child immunization record. The vaccination history was checked against the primary care physician and ACIR records. The routine primary childhood vaccinations and administration of the recommended additional influenza and pneumococcal vaccines was clarified. Therapies were categorized into four groups: ASA derivatives (sulphasalazine, osalazine, mesalazine and balsalazide); oral corticosteroids (prednisolone); immunosuppressive agents (azathioprine, methotrexate) and biologics (infliximab). The RCH patient’s hospital laboratory results were reviewed to identify if any baseline serological testing was performed to review the requirement for additional protection against VPD such as varicella and hepatitis B. Multiple sources were reviewed for any vaccine safety concerns or reports of adverse events following immunization, including: hospital records, general practitioner records and parent reports through interviews. A random sample of 101 participants was taken from the IBD register. The random sample was generated using the statistical software STATA Version 10.0 (StataCorp, TX), which was also used for data analysis. This overall sample size calculation was based on the outcome of routine immunization up-to-date status by hospital medical record audit and allowed a determination of proportions within +/- 10% with 95% confidence. Proportions of up-to-date status and additional vaccines administered were compared using a Pearson chi-square test with point estimate odds ratios (OR) and 95% confidence intervals determined and a p value < 0.05 considered statistically significant. The study was approved by the Royal Children's Hospital Human Research Ethics Committee.
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Borody’s own patients, to his anti-mycobacteria therapy research. According to Prof. Borody’s report, as many as 95% of his patients have responded to treatment with full remission achieved by 65% of these patients. Dr. Borody says, “These results exceed all documented evidence of response to Crohn’s Disease therapies and promise significant relief for a large number of the estimated one million Crohn’s patients around the world.” Dr. Borody MD PhD FRACP, a graduate of the University of New South Wales, from which he holds a doctorate in medicine, will be presenting his findings in an open forum at: The Suffolk Y Jewish Community Center 74 Hauppauge Road in Commack, Long Island March 20, 2006 from 7-9 PM. Suggested donation $3 As the founder and current Medical Director of the Centre for Digestive Diseases (CDD), Dr. Borody has created a unique medical institution, internationally regarded for its novel approaches in research, diagnosis and the treatment of gastrointestinal conditions. He has been a recipient of the Winthrop Traveling Fellowship, the Neil Hamilton Fairly Fellowship and the Marshall & Warren Prize, and was a Clinical Fellow in Gastroenterology at the Mayo Clinic in Rochester in 1983. He is a member of the Australian Medical Association, the Gastroenterological Society of Australia, the European Gastroenterology Society, the Functional Brain-Gut Research Group and Fellow of the American College of Gastroenterology and the American College of Physicians. Prof. Borody supervises a number of major research programs as well as being involved as a reviewer for the American Journal of Gastroenterology, Digestive Diseases and Sciences, Endoscopy, Journal of Gastroenterology and Hepatology, Medical Journal of Australia and Digestive and Liver Diseases. He has published in excess of 120 scientific papers. In 2004 he was appointed an Adjunct Professor of the Faculty of Science at the University of Technology, Sydney.
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Public hospital specialists slam Campbell Newman’s plan to force contacts, set up $1.8m fighting fund
Perth intensive care specialist Professor Geoffrey Dobb said sometimes he went to work in the morning and half of the people in intensive care were there due to alcohol. “An action that lasts for just a second can impact on people for the rest of their lives,” he said. The effect of alcohol misuse also extends to children, with tens of thousands of cases each year of alcohol-related child mistreatment, the AMA says. DAVID PENBERTHY: A NEW GENERATION OF GUTLESS THUGS Prof Dobb said there needed to be a change in the drinking culture in Australia. While the group is looking to the commonwealth for help, Acting Prime Minister Warren Truss told reporters on Wednesday people should not rely on the government to stop alcohol fuelled-violence. He said governments could make it easier for people to be jailed, but they could not solve the problem. “People have got to take responsibility for their own lives, recognise the impact on people that they may hurt as the result of some silly drunken violence but also on their own lives.” Opposition Leader Bill Shorten has thrown his support behind the AMA’s proposal, saying it wasn’t a problem in just one small pocket of Sydney. “It isn’t just a challenge for local and state governments. This is a national issue that demands national attention,” he said in a statement with Labor health spokeswoman Catherine King. Mr Shorten said the community owed it to innocent one-punch victims like Daniel Christie , who died after being assaulted in Kings Cross on New Year’s Eve, to face up to the problem of alcohol-fuelled violence. He said a national summit was the most appropriate way to bring key groups together, including the hotel industry and health experts, to work in partnership with government to tackle the issue. NSW Premier Barry O’Farrell said it was up to the federal government to decide whether a national summit on alcohol was necessary. “These are problems that extend beyond state borders,” he told reporters today. “The prime minister has made clear …
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An analysis of closed cases from 2001 to 2010 shows that five per cent of all college cases, and five per cent of all hospital complaints cases, now involve adisruptive behaviora by doctors, according to a new CMPA discussion paper. The majority of the cases, the organization warns, had an aunfavourable outcomea for the doctor. aWhile unprofessional conduct by physicians was never acceptable, it is clearly no longer tolerated in todayas healthcare environment,a the paper states. aIn the long-term, disruptive behaviour can lead to ineffective care, harm to patients and poorer clinical outcomes.a aPhysician disruptive behavioura isnat a one-off, or asingle, egregiousa act, the doctorsa liability insurer says. Rather, itas a enduring pattern of offensive behaviour that poisons morale and potentially harms patients. If a doctor chronically ignores pages, for example, or gets abusive if called at night, nurses and colleagues might be reluctant to report a change in a patientas condition and instead wait for the next doctor to come on duty, delaying treatment. Studies suggest up to six per cent of doctors engage in recurrent disruptive behaviour, says Dr. James Sproule, managing director of physician services at the CMPA. The number is small, but significant, and throws a poor light on the entire profession, he said. Sometimes the offensive behaviour is overt: bullying, yelling and swearing; throwing things and demeaning people in front of others; and uncontrolled outbursts of anger that can leave people feeling constantly on edge. Other times itas more passive-aggressive: not responding to pages or emails; skipping meetings and anot behaving as part of the team,a Sproule said. In one U.S.
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Conflicts of Interest Ethics: Silencing Expertise in the Development of International Clinical Practice Guidelines
Of those patients in our cohort who did not meet classic criteria for AIP, 3 had sclerosing cholangitis with high IgG4. Their response to immunosuppression was not dramatic, and notably they had limited radiologic evidence of more classic AIP. This cautions clinicians about the initial optimism for steroids in a subset of PSC patients with elevated IgG4, and again reiterates the need for prospective research in this area. Additionally, it favours the importance of radiologic features of autoimmune pancreatitis in predicting outcome from steroid treatment. Retrospective descriptive review is inevitably limited as compared to prospective studies, but for a rare disease managed by many clinicians, across in-patient and out-patient settings, it remains distinctly hard to be prospective in ones approach. Nevertheless clinicians and patients are in need of descriptions of disease that match their own experience and practice, as is the case here: our data therefore adds to the breadth of experience described for this difficult and often enigmatic disease, and highlights how patients have presented and been managed over time, as concepts about the disease have evolved, and clinicians have grown in their experience. Ideally specialist clinics would triage referrals and facilitate more prospective studies to address more closely the role of radiology over histology in diagnosing this syndrome. Clearly our approach cant formally validate the scoring systems in use (and isnt designed to; nor is it designed to utilise every scoring system presently available not least because not all clinical information was available to us, and this obstacle could not be overcome retrospectively), but nevertheless we can demonstrate their applied utility, which reflects the interest of clinicians. Similarly our observations largely reflect the type 1 AIP disease spectrum, and there will inevitably be patients presenting with type 2 disease (albeit much less common) who do not adequately fit into our description. Autoimmune pancreatitis is notably a highly steroid sensitive disease. In our series there was a lower than expected steroid response to treatment. The likely explanation for this, once again, reflects the real world practice described. In settings where patients present to a variety of clinicians, in which referral pathways are set and potentially limited by pressure on resources, it is more likely that patients will have a delay in diagnosis and hence a potential impact on treatment. Additionally without clinical confidence from treating prior patients, clinicians may not always capture diagnosis accurately i.e. there is a risk of over-diagnosis. Our series, and many others, are therefore of importance in repeatedly highlighting this disease once again to a general audience.
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Critical revision of the article for important intellectual content: D.J. Jones, A.N. Barkun, Y. Lu, R. Enns, P. Sinclair, I. Gralnek, M. Bardou, E.J. Kuipers. Final approval of the article: D.J. Jones, A.N. Barkun, Y. Lu, R. Enns, P. Sinclair, I. Gralnek, M.
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High-quality care is built around multidisciplinary teams, and specialist nurses are a really key component of these teams, professor Hawkey told a meeting to raise awareness of gastroenterological conditions at 11 Downing Street. Specialist nurses are the interface that patients most value, and they play a predominant role in patient care. Although many hospitals do have them, we want every hospital in the UK to have a nurse specialist, he said. The specialists will be needed to play a key role in delivering six new minimum standards of care for patients with inflammatory bowel disease. The standards have been developed by seven stakeholder organisations including the BSG and the RCN s Crohns and Colitis special interest group. The stakeholder group wants all UK commissioners to implement the standards by October 2010. They include maintaining a patient-centred service, providing patient education and support, and delivering high-quality care to all UK patients with IBD. We want every strategic health authority to be aware of these standards, and all 161 commissioning bodies to adopt these standards of care as the norm for their local community, said professor Hawkey. The call for more specialist nurses was also backed by the National Association for Colitis and Crohns disease , which launched a campaign in 2005 to increase the number of inflammatory bowel disease (IBD) nurse specialists. The campaign was started after a NACC survey revealed that just 26% of UK colitis and Crohns patients had the support of an IBD nurse specialist. According to data from the UK IBD national audits, this figure increased quite dramatically to 56% in 2006, and to 62% by 2008. But this still falls short of the number of nurse specialists required to deliver effective patient care, said NACC chief executive Richard Driscoll, who also attended the Downing Street meeting.
Locum Consultant Gastroenterologist, N.Ireland
Job Description We are looking for GMC registered consultant doctor to cover a locum assignment within Gastro Medicine with our client in based in Northern Ireland. Locum Consultant Gastroenterologist We are looking for GMC registered consultant doctor to cover a locum assignment within Gastroenterologist with our client in based in Northern Ireland. This locum position will require a locum consultant doctor to work within a busy department (NHS) in Northern Ireland. Vacancy dates from 15 July 2013 for 4 wks initially: Job Plan * Monday to Friday – 9 to 5 pm (various sites) * Possibly oncall on a 1:10 basis (rate to be agreed. Applicants must have GMC registration and at least 6 months UK experience to be considered for this position. Please send ref SZD080702 with cv to email@example.com What you can expect from Mediplacements: – A dedicated one to one service – Fast track registration process – Assistance with travel and accommodation – Excellent rates of pay – Weekly pay – on time, every time – Access to exclusive NHS and Private sector jobs – 24 hour service from our friendly consultants Additional benefits include: – Our loyalty scheme; TPG incentives – thousands of online and in store discounts – No Registration Fee! Why choose us? Prior to applying for this job please note that all applicants must be able to provide proof of the following criteria: Your right to work within the UK (e.g. copy of your UK or EU passport or relevant work permit or visa). If applicable, registration with the relevant UK governing body (e.g. the Health and Care Professions Council, General Pharmaceutical Council, General Medical Council etc). Relevant experience of the role you are applying for. You will also be required to complete the following prior to any offer of work: A Disclosure and Barring Service (DBS) check (formerly CRB check), Mediplacements can assist you with this process (please note this is not applicable for Medical Lab Staff). Full occupational health clearance regarding immunisations etc. in the form of a valid ‘fitness to practice certificate’ as per current Government Procurement Service (GPS) standards (e.g. an occupational health report stating dates of your last TB, Hep B immunisations etc.).
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