Physician and patient factors associated with ordering a colon evaluation after a positive fecal occult blood test.
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OBJECTIVE: Successful colorectal cancer screening relies in part on physicians ordering a complete diagnostic evaluation of the colon (CDE) with colonoscopy or barium enema plus sigmoidoscopy after a positive screening fecal occult blood test (FOBT). DESIGN: We surveyed primary care physicians about colorectal cancer screening practices, beliefs, and intentions. At least 1 physician responded in 318 of 413 (77%) primary care practices that were affiliated with a managed care organization offering a mailed FOBT program for patients aged >/=50 years. Of these 318 practices, 212 (67%) had 602 FOBT+ patients from August through November 1998. We studied 184 (87%) of these 212 practices with 490 FOBT+ patients after excluding those judged ineligible for a CDE or without demographic data. Three months after notification of the FOBT+ result, physicians were asked on audit forms if they had ordered CDEs for study patients. Patient- and physician-predictors of ordering CDEs were identified using logistic regression. MEASUREMENTS AND MAIN RESULTS: A CDE was ordered for only 69.5% of 490 FOBT+ patients. After adjustment, women were less likely to have had CDE initiated than men (adjusted odds, 0.66; confidence interval, 0.44 to 0.97). Physician survey responses indicating intermediate or high intention to evaluate a FOBT+ patient with a CDE were associated with nearly 2-fold greater adjusted odds of actually initiating a CDE in this circumstance versus physicians with a low intention. CONCLUSIONS: Primary care physicians often fail to order CDE for FOBT+ patients. A CDE was less likely to be ordered for women and was influenced by physician's beliefs about CDEs. (+info)
Nurse endoscopy in a district general hospital.
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INTRODUCTION: This study describes the first full year of independent practice by a newly appointed nurse endoscopist in a district general hospital. PATIENTS AND METHODS: Patients underwent either 'one stop' flexible sigmoidoscopy and barium enema or flexible sigmoidoscopy alone. Barium enema results, video photography, clinical follow-up, and histology were used to validate the results of the flexible sigmoidoscopy. One stop clinic: 161 endoscopies were performed, with 104 female patients (65%), and a mean age of 64 years. There was one failed endoscopy due to poor bowel preparation. Abnormalities were identified in 84% of endoscopies. Flexible sigmoidoscopy detected abnormalities not seen on the barium enema in 28 cases, all of which were polyps (18%). Barium enema identified one abnormality within reach of the flexible sigmoidoscope not identified at endoscopy (small polyp in sigmoid; 1%). Elective flexible sigmoidoscopy list: 121 endoscopies were performed, with 65 female patients (54%), and a mean age of 59 years. There were two failed endoscopy procedures, both attributed to poor bowel preparation. Two-thirds of patients had an abnormality on investigation. There were no complications in either group of patients. CONCLUSIONS: The nurse-led endoscopy service has been successfully initiated with a high completion rate for flexible sigmoidoscopies. All significant conditions were identified with 99% sensitivity. Nurse endoscopy is a safe, useful and practical procedure in the setting of this district general hospital. (+info)
Precipitation of barite by Myxococcus xanthus: possible implications for the biogeochemical cycle of barium.
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Bacterial precipitation of barite (BaSO(4)) under laboratory conditions is reported for the first time. The bacterium Myxococcus xanthus was cultivated in a solid medium with a diluted solution of barium chloride. Crystallization occurred as a result of the presence of live bacteria and the bacterial metabolic activity. A phosphorous-rich amorphous phase preceded the more crystalline barite formation. These experiments may indicate the involvement of bacteria in the barium biogeochemical cycle, which is closely related to the carbon cycle. (+info)
Detection of small lesions of the large bowel; barium enema versus double contrast.
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Roentgen study with the so-called opaque barium enema with some modifications is superior to double contrast study as the primary means of demonstrating polyps in the colon as well as other lesions. The method described combines fluoroscopy, high kilovoltage radiography, fluoroscopically aimed "spot films" taken with compression, suction and evacuation studies. In this way unsuspected as well as suspected polyps can be demonstrated, particularly if attention is directed to the region where polyps are most likely to be found-namely, the distal third of the large bowel. Double contrast study is quite valuable as a supplement to the modified "single contrast" barium enema, but it has not been sufficiently perfected to replace the modified opaque barium enema as a primary procedure. In many instances a combination of methods will, of course, be required. (+info)
Barium reduction of intussusception in infancy.
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Barium enema reduction was used as the initial routine treatment in 29 infants with intussusception. In 22 of them the intussusception was reduced by this means. In three of eight patients operated upon the intussusception was found to be reduced. Four of the remaining five patients had clinical or x-ray evidence of complications before reduction by barium enema was attempted.Twenty-one of the patients, all of whom were observed in private practice, were treated without admission to the hospital. After reduction, these patients were observed closely by the clinician. None of these patients showed clinical or x-ray signs of complications before reduction. Certain clinical and roentgen criteria must be satisfied before it can be concluded that reduction by barium enema is complete. If there are clinical signs of complications with x-ray evidence of small bowel obstruction, only a very cautious attempt at hydrostatic reduction should be made. As the time factor is generally a reliable clinical guide to reducibility, the late cases should be viewed with greater caution. Long duration of symptoms, however, is not per se a contraindication to an attempt at hydrostatic reduction. (+info)
FATAL LIVER DAMAGE AFTER BARIUM ENEMAS CONTAINING TANNIC ACID.
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Tannic acid contained in the barium enema was found to have been the sole known potential hepatotoxin in four of the five cases of fulminating fatal liver failure that occurred in a 213-bed hospital over a period of 27 months. In the other case halothane anesthesia had also been administered. Autopsies (performed on four of the cases) did not suggest viral hepatitis but showed substantially indentical hepatic changes, not unlike those reported in the past following tannic acid exposure. Proof is not claimed that tannic acid was the cause of these deaths, but further investigation regarding the safety of its administration in barium enemas is advocated. (+info)
RIGHT-SIDED COLITIS.
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The term ;right-sided colitis' has been used to describe a lesion in which the right half of the colon shows maximal inflammatory changes; although the terminal ileum is always involved, the rectum is normal or shows minimal inflammatory changes. Some of these cases appear to be of atypical Crohn's disease, whilst the others resemble chronic ulcerative colitis. The high incidence of Jewish people in this series suggests a racial tendency towards this distribution of the inflammatory change. The right-sided nature of the lesion has led to unnecessarily prolonged medical treatment, to right hemicolectomy, and to ileorectal anastomosis. The results of such procedures have been disappointing, all the more so because the rectum was almost normal and hence would seem ideally suited for ileorectal anastomosis. These patients have progressed very well with ileostomy. (+info)
CORRELATION OF MANOMETRIC, OESOPHAGOSCOPIC, AND RADIOLOGICAL FINDINGS IN THE COLUMNAR-LINED GULLET (BARRETT SYNDROME).
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An intensive study has been made of the columnar-lined gullet (Barrett syndrome) and in the patient described it was shown to have the motor characteristics of the body of the oesophagus. At the distal end there was the normal receptive relaxation with swallowing. There was no discontinuity between the squamous and the columnar-lined portions. (+info)