The optimal method for monitoring quiescent disease in patients with Crohn's disease(CD) and ulcerative colitis is yet to be determined. Endoscopic evaluation with ileocolonoscopy is the gold standard but is invas...The optimal method for monitoring quiescent disease in patients with Crohn's disease(CD) and ulcerative colitis is yet to be determined. Endoscopic evaluation with ileocolonoscopy is the gold standard but is invasive,costly,and time-consuming. There are many commercially available biomarkers that may be used in clinical practice to evaluate disease status in patients with inflammatory bowel disease(IBD),but the most widely adopted biomarkers are C-reactive protein(CRP) and fecal calprotectin(FC). This review summarizes the evidence for utilizing CRP and FC for monitoring IBD during clinical remission and after surgical resection. Endoscopic correlation with CRP and FC is evaluated in each disease state. Advantages and drawbacks of each biomarker are discussed with special consideration of isolated ileal CD. Fecal immunochemical testing,traditionally used for colorectal cancer screening,is mentioned as a potential new alternative assay in the evaluation of IBD. Based on a mixture of information gleaned from biomarkers,clinical status,and endoscopic evaluation,the best treatment decisions can be made for the patient with IBD.展开更多
To assess first-year gastroenterology fellows’ ability to address difficult interpersonal situations in the workplace using objective structured clinical examinations (OSCE).METHODSTwo OSCEs (“distracted care team”...To assess first-year gastroenterology fellows’ ability to address difficult interpersonal situations in the workplace using objective structured clinical examinations (OSCE).METHODSTwo OSCEs (“distracted care team” and “frazzled intern”) were created to assess response to disruptive behavior. In case 1, a fellow used a colonoscopy simulator while interacting with a standardized patient (SP), nurse, and attending physician all played by actors. The nurse and attending were instructed to display specific disruptive behavior and disregard the fellow unless requested to stop the disruptive behavior and focus on the patient and procedure. In case 2, the fellow was to calm an intern managing a patient with massive gastrointestinal bleeding. The objective in both scenarios was to assess the fellows’ ability to perform their duties while managing the disruptive behavior displayed by the actor. The SPs used checklists to rate fellows’ performances. The fellows completed a self-assessment survey.RESULTSTwelve fellows from four gastrointestinal fellowship training programs participated in the OSCE. In the “distracted care team” case, one-third of the fellows interrupted the conflict and refocused attention to the patient. Half of the fellows were able to display professionalism despite the heated discussion nearby. Fellows scored lowest in the interprofessionalism portion of post-OSCE surveys, measuring their ability to handle the conflict. In the “frazzled intern” case, 68% of fellows were able to establish a calm and professional relationship with the SP. Despite this success, only half of the fellows were successfully communicate a plan to the SP and only a third scored “well done” in a domain that focused on allowing the intern to think through the case with the fellow’s guidance.CONCLUSIONFellows must receive training on how to approach disruptive behavior. OSCEs are a tool that can assess fellow skills and set a culture for open discussion.展开更多
文摘The optimal method for monitoring quiescent disease in patients with Crohn's disease(CD) and ulcerative colitis is yet to be determined. Endoscopic evaluation with ileocolonoscopy is the gold standard but is invasive,costly,and time-consuming. There are many commercially available biomarkers that may be used in clinical practice to evaluate disease status in patients with inflammatory bowel disease(IBD),but the most widely adopted biomarkers are C-reactive protein(CRP) and fecal calprotectin(FC). This review summarizes the evidence for utilizing CRP and FC for monitoring IBD during clinical remission and after surgical resection. Endoscopic correlation with CRP and FC is evaluated in each disease state. Advantages and drawbacks of each biomarker are discussed with special consideration of isolated ileal CD. Fecal immunochemical testing,traditionally used for colorectal cancer screening,is mentioned as a potential new alternative assay in the evaluation of IBD. Based on a mixture of information gleaned from biomarkers,clinical status,and endoscopic evaluation,the best treatment decisions can be made for the patient with IBD.
文摘To assess first-year gastroenterology fellows’ ability to address difficult interpersonal situations in the workplace using objective structured clinical examinations (OSCE).METHODSTwo OSCEs (“distracted care team” and “frazzled intern”) were created to assess response to disruptive behavior. In case 1, a fellow used a colonoscopy simulator while interacting with a standardized patient (SP), nurse, and attending physician all played by actors. The nurse and attending were instructed to display specific disruptive behavior and disregard the fellow unless requested to stop the disruptive behavior and focus on the patient and procedure. In case 2, the fellow was to calm an intern managing a patient with massive gastrointestinal bleeding. The objective in both scenarios was to assess the fellows’ ability to perform their duties while managing the disruptive behavior displayed by the actor. The SPs used checklists to rate fellows’ performances. The fellows completed a self-assessment survey.RESULTSTwelve fellows from four gastrointestinal fellowship training programs participated in the OSCE. In the “distracted care team” case, one-third of the fellows interrupted the conflict and refocused attention to the patient. Half of the fellows were able to display professionalism despite the heated discussion nearby. Fellows scored lowest in the interprofessionalism portion of post-OSCE surveys, measuring their ability to handle the conflict. In the “frazzled intern” case, 68% of fellows were able to establish a calm and professional relationship with the SP. Despite this success, only half of the fellows were successfully communicate a plan to the SP and only a third scored “well done” in a domain that focused on allowing the intern to think through the case with the fellow’s guidance.CONCLUSIONFellows must receive training on how to approach disruptive behavior. OSCEs are a tool that can assess fellow skills and set a culture for open discussion.
