Eric Esrailian

Is Irritable Bowel Syndrome a Diagnosis of Exclusion?: A Survey of Primary Care Providers, Gastroenterologists, and IBS Experts

OBJECTIVES:Guidelines emphasize that irritable bowel syndrome (IBS) is not a diagnosis of exclusion and encourage clinicians to make a positive diagnosis using the Rome criteria alone. Yet many clinicians are concerned about overlooking alternative diagnoses. We measured beliefs about whether IBS is a diagnosis of exclusion, and measured testing proclivity between IBS experts and community providers.METHODS:We developed a survey to measure decision-making in two standardized patients with Rome III-positive IBS, including IBS with diarrhea (D-IBS) and IBS with constipation (C-IBS). The survey elicited provider knowledge and beliefs about IBS, including testing proclivity and beliefs regarding IBS as a diagnosis of exclusion. We surveyed nurse practitioners, primary care physicians, community gastroenterologists, and IBS experts.RESULTS:Experts were less likely than nonexperts to endorse IBS as a diagnosis of exclusion (8 vs. 72%; P<0.0001). In the D-IBS vignette, experts were more likely to make a positive diagnosis of IBS (67 vs. 38%; P<0.001), to perform fewer tests (2.0 vs. 4.1; P<0.01), and to expend less money on testing (US

Biomarkers and Health-Related Quality of Life in End-Stage Renal Disease: A Systematic Review

297 vs.

Differences in the management of Crohn's disease among experts and community providers, based on a national survey of sample case vignettes.

658; P<0.01). Providers who believed IBS is a diagnosis of exclusion ordered 1.6 more tests and consumed

The cost-effectiveness and budget impact of competing therapies in hepatic encephalopathy – a decision analysis

364 more than others (P<0.0001). Experts only rated celiac sprue screening and complete blood count as appropriate in D-IBS; nonexperts rated most tests as appropriate. Parallel results were found in the C-IBS vignette.CONCLUSIONS:Most community providers believe IBS is a diagnosis of exclusion; this belief is associated with increased resource use. Experts comply more closely with guidelines to diagnose IBS with minimal testing. This disconnect suggests that better implementation of guidelines is warranted to minimize variation and improve cost-effectiveness of care.

Measuring irritable bowel syndrome patient‐reported outcomes with an abdominal pain numeric rating scale

BACKGROUND AND OBJECTIVES Health-related quality of life (HRQOL) predicts mortality in ESRD, yet adoption of HRQOL monitoring is not widespread, and regulatory authorities remain predominantly concerned with monitoring traditional biologic parameters. To assist with future efforts to adopt HRQOL monitoring while acknowledging the importance of biomarkers, this study sought to establish which domains of HRQOL are most affected by ESRD and to measure the strength of evidence linking common biomarkers to HRQOL in ESRD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A systematic review was performed to identify studies that measured HRQOL in ESRD. Data were abstracted according to a conceptual model regarding the measurement of HRQOL differences, and HRQOL data were converted to weighted mean effect sizes and correlation coefficients. RESULTS The impact of ESRD was largest in the Short Form 36 domains of physical functioning (e.g., role-physical, vitality) and smallest in mental functioning (e.g., mental health, role-emotional). Dialysis adequacy, as measured by Kt/V, was a poor correlate for Short Form 36 scores. Similarly, mineral metabolism (e.g., calcium x phosphorous, parathyroid hormone) and inflammatory (e.g., C-reactive protein, TNF) biomarkers had small effect sizes and correlations with HRQOL. In contrast, hematocrit demonstrated small to moderate relationships with mental and physical HRQOL, and nutritional biomarkers (e.g., albumin, creatinine, body mass index) demonstrated moderate to large relationships. CONCLUSIONS HRQOL in ESRD is most affected in the physical domains, and nutritional biomarkers are most closely associated with these domains. In contrast, Kt/V, mineral metabolism indices, and inflammatory markers are poor HRQOL correlates.

Measuring symptoms in the irritable bowel syndrome: development of a framework for clinical trials

Background  When faced with the same set of facts, healthcare providers often make different diagnoses, employ different tests and prescribe disparate therapies.

Development and validation of a disease-targeted quality of life instrument in chronic hepatitis B: The hepatitis B quality of life instrument, version 1.0†‡

Background  Treatment options for hepatic encephalopathy have disparate risks and benefits. Non‐absorbable disaccharides and neomycin are limited by uncertain efficacy and common dose‐limiting side effects. In contrast, rifaximin is safe and effective in hepatic encephalopathy, but is more expensive.

Developing Valid and Reliable Health Utilities in Irritable Bowel Syndrome: Results from The IBS PROOF Cohort

Background  Controversy exists on how to measure patient‐reported outcomes in irritable bowel syndrome (IBS) clinical trials effectively. Pain numeric rating scales (NRS) are widely used in the non‐IBS pain literature. The Food and Drug Administration has proposed using the NRS in IBS.

Controversies in Ulcerative Colitis: A Survey Comparing Decision Making of Experts Versus Community Gastroenterologists

Aliment Pharmacol Ther 2010; 32: 1275–1291

Clinical impact of adjuvant chemotherapy in glioblastoma multiforme: a meta-analysis

Despite the increasing realization that health‐related quality of life (HRQOL) is an important outcome in chronic HBV infection, there are no validated, disease‐targeted instruments currently available. We sought to develop and validate the first disease‐targeted HRQOL instrument in noncirrhotic HBV: the Hepatitis B Quality of Life instrument, version 1.0 (HBQOL v1.0). We established content validity for the HBQOL v1.0 by conducting a systematic literature review, an expert focus group, and cognitive interviews with HBV patients. We administered the resultant questionnaire to 138 HBV patients. We used factor analysis to test hypotheses regarding HRQOL domains and measured construct validity by comparing HBQOL v1.0 scores across several anchors, including viral response to treatment, SF‐36 scores, and global health. Finally, we measured test–retest and internal consistency reliability. Content validation revealed that HBV affects multiple aspects of psychological, social, and physical health. The resultant questionnaire summarized this HRQOL impact with 31 items across six subscales: psychological well‐being, anticipation anxiety, vitality, disease stigma, vulnerability, and transmissibility. Internal consistency and test–retest reliability were excellent. The HBQOL v1.0 discriminated between viral responders versus nonresponders and correlated highly with SF‐36 scores and global health. Conclusion: Patients with chronic HBV infection attribute a wide range of negative psychological, social, and physical symptoms to their condition, even in the absence of cirrhosis or cancer. The HBQOL v1.0 is a valid and reliable measure that captures this HRQOL decrement. This instrument may be useful in everyday clinical practice and in future clinical trials. (HEPATOLOGY 2007;46:113–121.)