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Biomedical subjects

D T Rubin

Publications and source records attributed to D T Rubin.

7 recordsLinked to original sources
PubMed2001

Virtual colonoscopy: a novel imaging modality for colorectal cancer.

Advances in computed tomography (CT) technology and computer capabilities have contributed to the development of a new imaging modality for colorectal lesions called CT colonography or virtual colonoscopy. Virtual colonoscopy is a rapid, minimally invasive scan of the cleansed and distended colon. Early work has demonstrated that this test is safe and well tolerated, and that it may be sensitive and specific enough to identify most significant precancerous or cancerous lesions. A number of technical and practical problems remain before virtual colonoscopy can be applied at a population level.

Colonoscopy↗
PubMed2001

Effects of billing and documentation requirements on the quantity and quality of teaching by attending physicians.

PURPOSE: The Health Care Financing Administration's guidelines for billing and documentation by attending physicians have increased the amount of time that attending physicians spend documenting the services that they provide for patients. This study assessed the impact of these guidelines on attending physicians' teaching of housestaff on inpatient medical wards. METHOD: A survey of 92 housestaff from the department of medicine at one teaching hospital was conducted in 1998 to determine how attending physicians' billing and documentation requirements, clinic responsibilities, teaching styles, and inpatient census affected the quantity and quality of their teaching. The questionnaire included a rank-order analysis of factors affecting quantity and quality of attending physicians' teaching, as well as a five-point Likert scale assessing the quality of attending physicians' teaching. RESULTS: All housestaff responded. A total of 39% of housestaff perceived billing and documentation requirements to be the major detriment to quantity of teaching by attending physicians, and 30% perceived these requirements to be the major detriment to quality of teaching by attending physicians. Housestaff perceived more teaching and higher-quality teaching on services where attending physicians did not perform billing and documentation during teaching rounds. CONCLUSION: Billing and documentation requirements are a major detriment to the quantity of teaching on inpatient services, especially when faculty attempt to meet these requirements during teaching rounds.

Attitude of Health Personnel↗
PubMed2001

Treatment of anal fissures with topical nitroglycerin.

Anal fissure is a painful condition that is caused by anodermal tearing after the passage of hard stool. Severe cases result in involuntary internal anal sphincter spasm and have traditionally been treated surgically with a lateral sphincterotomy. Investigators have demonstrated that nitric oxide causes relaxation of the smooth muscle of the anal canal, so topical nitroglycerin ointment preparations have recently been studied as an efficacious alternative to surgery. Despite the fact that there are a number of trials examining topical nitroglycerin for the treatment of anal fissures, there remains no consensus about concentrations, compositions and applications necessary to obtain good results. This review summarises current literature regarding topical nitroglycerin pharmacotherapy for anal fissure.

Administration, Topical↗
PubMed2000

Malabsorption testing: a review.

Malabsorption syndromes often present diagnostic dilemmas to even the most experienced clinicians. Several malabsorption screening tests are available, but d-xylose testing is our initial screening method of choice. Recent innovations such as serum assays for antibodies associated with celiac sprue are improving the work-up of patients with suspected malabsorption. In addition, physicians are applying technological advances in imaging to determine the underlying pathologies responsible for the occurrence of malabsorption and maldigestion. Breath testing remains a controversial modality in the work-up of patients with malabsorption. Tubeless tests of pancreatic function are also the subject of debate due to a lack of sensitivity for diagnosing mild to moderate chronic pancreatic insufficiency. This review identifies and provides critical analysis of new developments in the field of malabsorption testing. The authors also provide a clinical algorithm for diagnosing malabsorption.

Algorithms↗
PubMed2000

Smoking and inflammatory bowel disease.

It is well established that smoking cigarettes is associated with Crohn's disease (CD) and that non-smoking is associated with ulcerative colitis (UC). Furthermore, there is convincing evidence that smoking cigarettes has a negative effect on the course of CD, and that smoking cigarettes may improve the disease severity or have a 'protective' effect in some patients with UC. Despite these well-described associations, the mechanism by which cigarette smoking affects CD and UC is not known. Researchers have studied the systemic effects, cellular and humoral immune effects, mucosal changes, and the intestinal permeability changes with inflammatory bowel disease (IBD) and smoking. To date, none of these studies adequately explains the observed clinical patterns. It has been assumed that nicotine is the active agent in these associations, but clinical trials of nicotine chewing gum and transdermal nicotine in UC have shown limited benefit, and have been complicated by significant side-effects. Topical delivery systems for nicotine therapy are currently under development and await future clinical trials.

Comorbidity↗
PubMed1998

CT colonography with three-dimensional problem solving for detection of colonic polyps.

OBJECTIVE: We performed CT colonography in patients referred for conventional colonoscopy, interpreted the axial images, and used commercially available software to reconstruct endoluminal perspective views to differentiate polyps from folds. SUBJECTS AND METHODS: We prospectively examined 44 patients (27 men and 17 women; mean age, 58 years old) with CT colonography by interpreting the axial images and using three-dimensional rendering for problem solving only. The CT scans were interpreted by two radiologists who were unaware of patients' histories as revealed by colonoscopic findings. The findings on colonography were compared with those of conventional colonoscopy to determine sensitivity, specificity, time spent on interpretation, and confidence of interpretation. RESULTS: Colonoscopy showed normal findings in 28 patients and 22 polyps in the remaining 16 patients. Six polyps were 8 mm or larger, three were 5-7 mm, and 13 were 5 mm or smaller. The findings of the two observers revealed an overall sensitivity of 50% and 38%, respectively, and a specificity of 93% and 86%, respectively. Sensitivity for polyps larger than 8 mm was 83% and specificity was 100% for both observers. The average amount of time spent on interpretation was 28 min 30 sec (range, 14-65 min). Both observers used the endoluminal view for differentiating folds from polyps in 23 (52%) of 44 patients, which had only minimal impact on interpretation time. CONCLUSION: CT colonography can be performed and the images interpreted using currently available hardware and software by initially using the axial images to search for polyps of significant size. Endoluminal views should be used only when necessary to help distinguish normal folds from fixed raised lesions that are suggestive of polyps.

Colonic Polyps↗