Biomedical subjects

J Inadomi

Publications and source records attributed to J Inadomi.

6 recordsLinked to original sources

PubMed2006

Sub-optimal proton pump inhibitor dosing is prevalent in patients with poorly controlled gastro-oesophageal reflux disease.

BACKGROUND: Proton pump inhibitors are the most potent drug treatment for gastro-oesophageal reflux disease. Pre-meal dosing maximizes efficacy while sub-optimal dose timing may limit efficacy. AIM: To determine the prevalence of sub-optimal proton pump inhibitor dosing in a community-based gastro-oesophageal reflux disease population. MATERIALS AND METHODS: One hundred patients on proton pump inhibitors referred for persistent gastro-oesophageal reflux disease symptoms were questioned about their proton pump inhibitor dosing habits and classified as optimal or sub-optimal dosers. Optimal dosers took proton pump inhibitors with or up to 60 min before meals. Sub-optimal dosers took proton pump inhibitors >60 min before meals, after meals, as needed, or at bedtime. RESULTS: Forty-six percent dosed optimally. Fifty-four percent dosed sub-optimally with 21 of 54 (39%) dosing >60 min before meals, 16 (30%) after meals, 15 (28%) at bedtime and two (4%) as needed. Only 6% of the subjects on once-daily proton pump inhibitor regimens and 33% of subjects taking proton pump inhibitors two- to three times daily dosed in a manner that maximized acid suppression (15-30 min before a meal). CONCLUSIONS: In this study, 54% of patients dosed proton pump inhibitors sub-optimally and only 12% dosed in a manner that maximized acid suppression. As sub-optimal proton pump inhibitor dose timing can limit efficacy, patients with refractory symptoms should be asked about dose timing to avoid inappropriate and costly dose escalations.

2-Pyridinylmethylsulfinylbenzimidazoles↗

PubMed2004

Projections of demand and capacity for colonoscopy related to increasing rates of colorectal cancer screening in the United States.

BACKGROUND: There is debate about the optimal colorectal cancer screening test, partly because of concerns about colonoscopy demand. AIM: To quantify the demand for colonoscopy with different screening tests, and to estimate the ability of the United States health care system to meet demand. METHODS: We used a previously published Markov model and the United States census data to estimate colonoscopy demand. We then used an endoscopic database to compare current rates of screening-related colonoscopy with those projected by the model, and to estimate the number of endoscopists needed to meet colonoscopy demand. RESULTS: Annual demand for colonoscopy ranges from 2.21 to 7.96 million. Based on current practice patterns, demand exceeds current supply regardless of screening strategy. We estimate that an increase of at least 1360 gastroenterologists would be necessary to meet demand for colonoscopic screening undergone once at age 65, while colonoscopy every 10 years could require 32 700 more gastroenterologists. A system using dedicated endoscopists could meet demand with fewer endoscopists. CONCLUSIONS: Colorectal cancer screening leads to demand for colonoscopy that outstrips supply. Systems to train dedicated screening endoscopists may be necessary in order to provide population-wide screening. The costs and feasibility of establishing this infrastructure should be studied further.

Aged↗

PubMed1997

Cost-analysis of prophylactic antibiotics in spontaneous bacterial peritonitis.

BACKGROUND & AIMS: Antibiotic prophylaxis has been shown to decrease the incidence of spontaneous bacterial peritonitis (SBP) in patients with cirrhosis and ascites. The aim of this study was to test whether antibiotic prophylaxis for SBP is cost-effective and to compare the costs associated with different patient groups and treatment strategies. METHODS: A cost-effectiveness analysis was performed using a Markov chain model. The costs incurred during 1-year treatment with prophylactic antibiotics vs. no prophylaxis in patients with cirrhosis and ascites were calculated. The incidence rates of primary and recurrent SBP and the mortality rate of SBP were obtained from the literature. Total direct costs of SBP treatment were determined from the wholesale price of drugs and from disbursements by the Health Care Financing Administration. RESULTS: Norfloxacin prophylaxis resulted in savings between $2216 and $8545 per patient per year, depending on the patient group studied. Trimethoprim-sulfamethoxazole prophylaxis resulted in savings between $2934 and $9251 per patient per year. The groups that benefited most from prophylaxis were patients with an ascitic fluid total protein concentration of < or = 1 g/dL and those with a previous history of SBP. CONCLUSIONS: The use of prophylactic antibiotics to decrease the incidence of SBP is a cost-saving strategy in patients with cirrhosis and ascites.

Antibiotic Prophylaxis↗

PubMed1996

Ultrasonographic determination of ascitic volume.

The purpose of this study was to develop a method by which ascitic volume can be calculated using transcorporeal ultrasonography, and to determine the accuracy of this method by comparison with the volume of distribution of a radiolabeled tracer (indicator dilution technique [IDT]). Subjects with ascites confirmed by ultrasonography were recruited from the San Francisco General Hospital Gastroenterology and Liver Clinics. With subjects in the prone position on their hands and knees, ultrasonographic measurements were obtained along the ventral surface of the abdomen. The greatest vertical depth of ascitic fluid was recorded, and the abdominal circumference was measured from this point. The ascitic fluid volume was modeled as a segment of a sphere. IDT was performed as the reference method by injecting 99mTc-labeled macroalbumin into the peritoneal cavity and determining the volume of distribution of the indicator. Nine patients were evaluated. The median volume of ascites measured by the IDT was 11.2 L (range, 1.5-17.0 L). The median volume calculated by the ultrasonographic method was 10.3 L (range, 1.2-18.0 L). The correlation coefficient between the ultrasonographic and IDT was 0.96 (P < .001). Our technique accurately determines the volume of ascites using simple ultrasonographic measurements.

Ascites↗

PubMed1995

Long-term follow-up of endoscopic treatment for bleeding gastric and duodenal ulcers.

OBJECTIVE: To examine the long-term consequences of endoscopic therapy for bleeding peptic ulcers. METHODS: Eighty-seven consecutive patients who underwent endoscopic treatment for bleeding gastric ulcer (GU) and/or duodenal ulcer (DU) over a 42-month period were identified. Long-term follow-up was available for 76 (mean, 495 days; SEM, 45 days). Therapy consisted of epinephrine injection, heater probe use, or both. Recurrent hemorrhage only at the primary treatment site was considered. RESULTS: The sites of hemorrhage were GU (40 patients), DU (34 patients), and both (2 patients). Emergent surgery was required in two GU patients for whom endoscopic treatment was ineffective. Recurrent hemorrhage ultimately occurred in 33% of patients--40% of GU and 25% of DU patients. Surgical therapy was eventually required in 26% of patients after endoscopic hemostasis and was more frequent in patients with recurrent hemorrhage from DU than GU (78% vs 56%). For those patients who re-bled within 8 days of the index endoscopy, 82% required surgery, compared with 33% of patients who re-bled more than 8 days after the index endoscopy (p = 0.03). CONCLUSIONS: The rate of recurrent hemorrhage after endoscopic hemostasis for bleeding GU and DU was 33% in our long-term follow-up. After endoscopic hemostasis, surgery was eventually required in 24% of all patients and in 64% of patients who had recurrent hemorrhage. Patients who had recurrent hemorrhage more than 1 wk after initial endoscopic hemostasis were effectively treated by repeated endoscopic therapy and were significantly less likely to require surgery than patients who re-bled within 1 wk.

Duodenal Ulcer↗

PubMed1986

A compliant interface for total knee arthroplasty.

Low pressure sensitive Fujifilm was used to measure the load distribution between the resected tibial surface and a tibial component at axial loads up to 3,000 N for a rigid interface, a compliant interface of dacron double-sided velour, and a cemented interface. The pressure patterns consisted of a multitude of small red dots, generally reflecting the slight irregularities of the cut surface and the stiffness of the cancellous bone at the surface. The pressure patterns were photographed with high-contrast film and input into a computer using a photodiode matrix camera. The data were analyzed to yield the number of contact points for each sample. The velour was more effective in distribution of load to the proximal tibia than the rigid and cemented interfaces, while there was no significant difference between the cemented interface and the rigid interface. A second series of tests showed significant increases in contact points from rigid to one layer to two layers of velour. Cyclic axial loading tests were performed to study the characteristics of rigid and compliant interfaces in a model of in vitro subsidence. Static pressure patterns taken at regular intervals showed that subsidence occurred in vitro in up to 1/3 of the tibias, and that the regions of load transfer could change with time. A model of subsidence was proposed and it was suggested that a velour layer could inhibit the subsidence.

Biomechanical Phenomena↗