Background There has been constant speculation about the association between metabolic syndrome (MetS) and colorectal neoplasia (CN); however, the published results are conflicting. The aims of this study are to systematic search, and assess literature to determine the available evidence on the association between these two conditions. Methods Meta-analysis was conducted based on relevant studies identified through a systematic literature review from PubMed, OvidSP and Cochrane database during January 1980 to July 2011. A combined analysis was performed, followed by a subgroup analyses stratified by the study design, type of colorectal lesions and gender. Publication bias was assessed using the Begg’s and Egger’s tests and visual inspection of funnel plot. Results Eighteen studies were included in the final analysis. Overall, MetS was associated with 34% increase in the risk of CN (summary RR - 1.34, 95% CI 1.24–1.44). The association between MetS and CN was found to be statistically significant in separate analysis for both case-control studies (summary RR -1.58, 95% CI 1.44–1.79) and cohort studies (summary RR – 1.21, 95% CI 1.13–1.29). The association remained significant when analyses were restricted by type of colorectal lesions (colorectal cancer: RR – 1.30, 95% CI 1.18–1.43; colorectal adenoma: RR – 1.37, 95% CI 1.26–1.49). Further subgroup analysis by gender showed significant association between MetS and CN in both male and female population. Conclusion Our meta-analysis showed significant association between presence of MetS and CN. These results may help in identifying high risk individuals at early stage that might benefit from targeted CRC screening intervention.

Chronic obstructive pulmonary disease (COPD) is the cause of substantial economic and social burden. We evaluated the temporal trends of hospitalizations from acute exacerbation of COPD and determine its outcome and financial impact using the National Inpatient Sample (NIS) databases (2002 to 2010). Individuals with age ≥ 18 years were included. Subjects who were hospitalized with primary diagnosis of COPD exacerbation and those who were admitted for other causes; but had underlying acute exacerbation of COPD (secondary diagnosis) were captured by ICD-9 codes. The hospital outcomes and length of stay were determined. Multivariate logistic regression was used to identify independent predictors of inpatient mortality. Overall acute exacerbation of COPD related hospitalizations accounted for nearly 3.31% of all hospitalizations in year 2002. This did not change significantly to year 2010 (3.43%, p=0.608). However, there was an increase in hospitalization with secondary diagnosis of COPD. Elderly white patients accounted for most of the hospitalizations. Medicare was the primary payer source for most of the hospitalizations (73%–75%). There was a significant decrease in inpatient mortality from 4.8% in 2002 to 3.9% in 2010 (slope −0.096, p<.001). Similarly, there was significant decrease in average length of stay from 6.4 days in 2002 to 6.0 days in 2010 (slope −0.042, p<.001). Despite this the hospitalization cost was increased substantially from $22,187 in 2002 to $38,455 in 2010. However, financial burden has increased over the years.

Hospitalized patients with ALD have significantly high prevalence of concomitant psychiatric and substance abuse disorders when compared to those with chronic liver diseases not caused by alcohol and those without underlying liver diseases. Screening and appropriate intervention should be implemented as part of routine clinical care for these patients.

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Background Currently there is no consensus on ideal teaching method to train novice trainees in EBUS. Simulation-based procedure training allows direct observation of trainees in a controlled environment without compromising patient safety. Objective We wanted to develop a comprehensive assessment of endobronchial ultrasound (EBUS) performance of pulmonary fellows and assess the impact of a multimodal simulation-based curriculum for EBUS-guided transbronchial needle aspiration. Methods Pretest assessment of 11 novice pulmonary fellows was performed using a three-part assessment tool, measuring EBUS-related knowledge, self-confidence, and procedural skills. Knowledge was assessed by 20 multiple-choice questions. Self-confidence was measured using the previously validated EBUS–Subjective Assessment Tool. Procedural skills assessment was performed on Simbionix BRONCH Express simulator and was modeled on a previously validated EBUS–Skills and Task Assessment Tool (EBUS-STAT), to create a modified EBUS-STAT based on internal faculty input via the Delphi method. After baseline testing, fellows participated in a structured multimodal curriculum, which included simulator training, small-group didactics, and interactive problem-based learning sessions, followed by individual debriefing sessions. Posttest assessment using the same three-part assessment tool was performed after 3 months, and the results were compared to study the impact of the new curriculum. Results The mean knowledge score improved significantly from baseline to posttest (52.7% vs. 67.7%; P = 0.002). The mean EBUS–Subjective Assessment Tool confidence scores (maximum score, 50) improved significantly from baseline to posttest (26 ± 7.6 vs. 35.2 ± 6.3 points; P < 0.001). The mean modified EBUS-STAT (maximum score, 105) improved significantly from baseline to posttest (44.8 ± 10.6 [42.7%] vs. 65.3 ± 11.4 [62.2%]; P < 0.001). There was a positive correlation ( r = 0.81) between the experience of the test participants and the modified EBUS-STAT scores. Conclusion This study suggests a multimodal simulation-based curriculum can significantly improve EBUS-guided transbronchial needle aspiration–related knowledge, self-confidence, and procedural skills among novice pulmonary fellows. A validation study is needed to determine if skills attained via a simulator can be replicated in a clinical setting.

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