Abstract:
BACKGROUND:Endoscopic retrograde cholangiopancreatography (ERCP) is a technically demanding procedure that can cause substantial complications. Competence in performing ERCP and the learning curve for achieving competence are poorly understood. OBJECTIVE:To evaluate the number of supervised ERCPs that physicians must do to achieve procedural competence. Competence was defined as a 0.8 probability of successfully completing specific technical components of ERCP and an overall grading of competence as judged by the attending physician. DESIGN:Prospective study. SETTING:University training program for gastroenterologists. PARTICIPANTS:17 gastroenterology fellows at various stages of training. MEASURES:Experienced therapeutic endoscopists prospectively graded gastroenterology fellows during 1796 consecutive ERCPs. Fellows were graded on their overall level of competence for the procedure and on specific technical components of ERCP. RESULTS:Grading data were available for 1450 ERCPs (81%). The number of ERCPs done before adequate skill was achieved was 160 for cholangiography, 140 for pancreatography, 160 for deep cannulation of the pancreatic duct, 120 for stone extraction, and 60 for stent insertion. Fellows achieved overall competence after completing 180 to 200 ERCPs. The predicted probability of overall competence was 0.8 after 137 ERCPs and 0.9 after 185 ERCPs. CONCLUSIONS:At least 180 ERCPs were required before these gastroenterology fellows could be considered competent in ERCP. This number is much greater than that previously recommended, and these findings have substantial implications for training guidelines and issues of competence and certification in ERCP. The methods used to define and evaluate competence in ERCP could also be used to assess competence in other medical procedures.
journal_name
Ann Intern Medjournal_title
Annals of internal medicineauthors
Jowell PS,Baillie J,Branch MS,Affronti J,Browning CL,Bute BPdoi
10.7326/0003-4819-125-12-199612150-00009subject
Has Abstractpub_date
1996-12-15 00:00:00pages
983-9issue
12eissn
0003-4819issn
1539-3704journal_volume
125pub_type
杂志文章abstract::To re-evaluate the relationship between Crohn's disease and sarcoidosis, we compared the numbers and types of cells recovered by bronchoalveolar lavage from normal volunteers and patients with Crohn's disease, with other forms of inflammatory bowel disease, and with sarcoidosis. Patients with Crohn's disease, but not ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-104-1-17
更新日期:1986-01-01 00:00:00
abstract:BACKGROUND:Few recent data are available on risk factors for perioperative supraventricular arrhythmia (SVA) after noncardiac surgery or on the effect of SVA on clinical outcomes. OBJECTIVE:To determine the incidence, clinical correlates, and effect on length of stay of perioperative SVA in patients having major nonca...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-129-4-199808150-00003
更新日期:1998-08-15 00:00:00
abstract:BACKGROUND:Residual renal function is an important determinant of mortality and morbidity in patients receiving peritoneal dialysis. However, few studies have evaluated therapeutic approaches for preserving residual renal function after the initiation of dialysis. OBJECTIVE:To test the hypothesis that the angiotensin-...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.7326/0003-4819-139-2-200307150-00010
更新日期:2003-07-15 00:00:00
abstract:STUDY OBJECTIVE:To define the clinical and hematologic effects of recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) on patients with chronic severe neutropenia. DESIGN:Open-label, phase II study of rhGM-CSF. SETTING:Inpatient hematology and surgery clinic at a university medical center. P...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-111-11-887
更新日期:1989-12-01 00:00:00
abstract:PURPOSE:To develop a clinical perspective on bilateral massive adrenal hemorrhage and an algorithm for its diagnosis and treatment. DATA IDENTIFICATION:Case reports were identified through a computer search using MEDLIN (1976 to 1987), and from bibliographies in review articles (up to 1978). STUDY SELECTION:Twelve re...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-110-3-227
更新日期:1989-02-01 00:00:00
abstract:OBJECTIVE:To evaluate whether a brief course of treatment with gallium nitrate can reduce biochemical parameters of accelerated bone turnover in patients with advanced Paget disease. DESIGN:Unblinded trial, decreasing dose schedules of gallium nitrate. SETTING:University hospital with primary orthopedic and metabolic...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-113-11-847
更新日期:1990-12-01 00:00:00
abstract::Past efforts to reverse or limit the effects of acute stroke have been largely unsuccessful, in part because of the inability to evaluate and treat most patients soon after stroke onset. One important factor in the delay of treatment has been the nihilistic attitude of medical personnel, including physicians, toward t...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:
更新日期:1995-04-15 00:00:00
abstract::Deficiency of fat-soluble vitamins (A,D,E, and K) was evaluated in 15 patients with exocrine pancreatic insufficiency secondary to chronic alcoholic pancreatitis. Mild to moderate steatorrhea was present in all patients despite oral pancreatic enzyme therapy for 27 +/- 4 months (mean +/- SE). Deficiency of a single fa...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-97-4-549
更新日期:1982-10-01 00:00:00
abstract::Chronic lymphocytic leukemia developed in four of five siblings, whose father succumbed to the same disease. The pattern of immune deficiency in the leukemic siblings resembled that found in nonfamilial cases of chronic lymphocytic leukemia, and was correlated with the severity of clinical involvement. In three siblin...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-84-5-554
更新日期:1976-05-01 00:00:00
abstract::In five patients with hypertension and marked impairment of renal function due to renal artery stenosis in a solitary functioning kidney, a nonsurgical technique, percutaneous transluminal angioplasty, was used to dilate the stenotic renal artery. Blood pressure improved in all five patients, and renal function improv...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-91-5-684
更新日期:1979-11-01 00:00:00
abstract:OBJECTIVE:To develop an early diagnostic test for pancreatic cancer based on the identification of K-ras mutations in pure pancreatic juice collected during endoscopic retrograde pancreatography. DESIGN:Prospective study with masked comparison. The standard criteria for the diagnosis of pancreatic cancer were pancreat...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章
doi:10.7326/0003-4819-123-3-199508010-00005
更新日期:1995-08-01 00:00:00
abstract:BACKGROUND:Short-term aspirin therapy can lower the risk for venous thromboembolism (VTE) in high-risk patients, but whether the long-term use of low-dose aspirin reduces risk in healthy adults is uncertain. OBJECTIVE:To test the efficacy of long-term aspirin therapy for preventing VTE. DESIGN:Secondary analysis of a...
journal_title:Annals of internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.7326/0003-4819-147-8-200710160-00004
更新日期:2007-10-16 00:00:00
abstract:BACKGROUND:Impressive decreases in cardiovascular mortality have been achieved through risk factor reduction and clinical intervention, yet cardiovascular disease remains a leading cause of death nationally. OBJECTIVE:To estimate up-to-date preventable fractions of cardiovascular mortality associated with elimination ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/M14-1753
更新日期:2015-08-18 00:00:00
abstract::Barrett's esophagus denotes the presence of columnar epithelium in the esophagus instead of the usual stratified squamous epithelium. Barrett's esophagus had been thought to represent a mediastinal extension of the stomach in patients with a congenital short esophagus. Subsequent clinical and experimental data have es...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-97-1-103
更新日期:1982-07-01 00:00:00
abstract:BACKGROUND:Prediction of perioperative cardiac complications is important in the medical management of patients undergoing noncardiac surgery. Several indices have been developed to aid prediction, but their performance has not been systematically compared. OBJECTIVE:To compare four existing methods for predicting per...
journal_title:Annals of internal medicine
pub_type: 杂志文章,多中心研究
doi:10.7326/0003-4819-133-5-200009050-00011
更新日期:2000-09-05 00:00:00
abstract:BACKGROUND:Many dispensing errors made in hospital pharmacies can harm patients. Some hospitals are investing in bar code technology to reduce these errors, but data about its efficacy are limited. OBJECTIVE:To evaluate whether implementation of bar code technology reduced dispensing errors and potential adverse drug ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-145-6-200609190-00006
更新日期:2006-09-19 00:00:00
abstract:OBJECTIVE:To identify and describe patients with hepatotoxicity possibly caused by flutamide, an antiandrogen drug. DESIGN:Case series of reports, submitted to the Adverse Drug Event Reporting System of the Food and Drug Administration. SETTING:Outpatient clinics and physicians' offices in the United States. PATIENT...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-118-11-199306010-00006
更新日期:1993-06-01 00:00:00
abstract::Approximately 3000 people in Bennington, Vermont, 19% of the population, had a diarrheal illness during the first and second weeks of June 1978. Persons affected reported abdominal cramps (86%), diarrhea (82%), malaise (73%), and headache (47%). The mean duration of illness was 4.6 days. The illness was associated wit...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-96-3-292
更新日期:1982-03-01 00:00:00
abstract::Experimental findings in animals and epidemiologic studies in humans provide strong evidence that hypertension promotes the onset and progression of atherosclerosis. However, effective antihypertensive therapy has not consistently reduced the incidence of cardiac events in the major trials of treatment for mild hypert...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,评审
doi:10.7326/0003-4819-110-12-1017
更新日期:1989-06-15 00:00:00
abstract::Treatment advances and outcomes data have raised new concerns about how to optimize care for patients with HIV infection. This paper reviews evidence on 1) the relation between experience and type of training and patient outcomes, 2) the relation between the components of primary care and patient outcomes, and 3) prim...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-131-2-199907200-00011
更新日期:1999-07-20 00:00:00
abstract:BACKGROUND:Indinavir, a protease inhibitor widely used to treat patients with HIV infection, has been associated with nephrolithiasis. Distinctive urinary crystals and a spectrum of urologic disorders were noted in patients receiving indinavir. OBJECTIVE:To determine the composition of urinary crystals and the frequen...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-127-2-199707150-00004
更新日期:1997-07-15 00:00:00
abstract:PURPOSE:To synthesize new data on breast cancer screening for the U.S. Preventive Services Task Force. DATA SOURCES:MEDLINE; the Cochrane Controlled Trials Registry; and reference lists of reviews, editorials, and original studies. STUDY SELECTION:Eight randomized, controlled trials of mammography and 2 trials evalua...
journal_title:Annals of internal medicine
pub_type: 杂志文章,meta分析
doi:10.7326/0003-4819-137-5_part_1-200209030-00012
更新日期:2002-09-03 00:00:00
abstract::Increased adrenocorticotropic hormone (ACTH) levels after bilateral adrenalectomy could be secondary to a pituitary tumor, under replacement with cortisol, or an abnormality in the hypothalamic-pituitary-adrenal feedback loop. To distinguish between these possibilities, ACTH levels were measured before and after corti...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-96-3-277
更新日期:1982-03-01 00:00:00
abstract:OBJECTIVE:To determine whether a statistical association exists between "low-count" bacteriuria (> 10(2) to 10(4) colony-forming units/mL) and acute urinary symptoms in young women. DESIGN:Prospective, case-control study. SETTING:Gynecology clinic at a student health center. PATIENTS:Women with or without urinary or...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-119-6-199309150-00002
更新日期:1993-09-15 00:00:00
abstract::Treatment selection markers, sometimes called predictive markers, are factors that help clinicians select therapies that maximize good outcomes and minimize adverse outcomes for patients. Existing statistical methods for evaluating a treatment selection marker include assessing its prognostic value, evaluating treatme...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-154-4-201102150-00006
更新日期:2011-02-15 00:00:00
abstract:OBJECTIVE:To identify the cause of a hypersensitivity pneumonitis and to determine its pathogenesis. DESIGN:Case study. SETTING:Intensive care unit of a referral hospital. PATIENT:A 51-year-old man with chronic bronchitis who developed a hypersensitivity pneumonitis within 1 month after exposure to minocycline, amox...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-117-6-476
更新日期:1992-09-15 00:00:00
abstract::To describe more explicitly the components of competence required of the internist, The American Board of Internal Medicine has analyzed the medical encounter and defined the major variables involved: the abilities required of the internist, the tasks that must be performed to solve a medical problem, the medical illn...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-90-3-402
更新日期:1979-03-01 00:00:00
abstract:BACKGROUND:Many nonpharmacologic therapies are available for treatment of low back pain. PURPOSE:To assess benefits and harms of acupuncture, back schools, psychological therapies, exercise therapy, functional restoration, interdisciplinary therapy, massage, physical therapies (interferential therapy, low-level laser ...
journal_title:Annals of internal medicine
pub_type: 杂志文章,meta分析,评审
doi:10.7326/0003-4819-147-7-200710020-00007
更新日期:2007-10-02 00:00:00
abstract:PURPOSE:To review the available data on the treatment of chronic stable angina and formulate a rational approach to the use of pharmacologic therapy, percutaneous transluminal coronary angioplasty (PTCA), and coronary artery bypass graft surgery (CABG). DATA SOURCES:A MEDLINE search of English-language literature publ...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-128-3-199802010-00008
更新日期:1998-02-01 00:00:00
abstract::Twenty-three patients with hyperparathyroidism from six families with the multiple endocrine adenomatosis (MEA) I-syndrome were tested by secretin provocation. In nine cases this led to increases in serum gastrin ranging from 298 to 13 300 pg/ml, whereas the maximum rise in gastrin in the other 14 patients was 32 pg/m...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-86-6-719
更新日期:1977-06-01 00:00:00