Celiac Disease: Education, Barriers to Care, Dietary Recommendations, and Screening
Notice bibliographique
Résumé
Introduction: After the diagnosis of celiac disease (CD) is made, there are varying levels of support provided to patients by their gastroenterologists. The prevalence of CD appears to be rising dramatically, and is suspected to affect nearly 3 million Americans. If left untreated, CD can cause a variety of complications ranging from iron deficiency to osteoporosis to small intestinal neoplasms. To gain a deeper understanding of gastroenterologists’ practices pertaining to CD, we examined physician-_provided patient education, identified barriers to care, discerned what dietary recommendations are made, established screening labs, and identified vaccination practices via physician completed survey. Methods: Gastroenterology physicians at Digestive Diseases Weekly in Chicago, IL (May 2014) were asked to complete a survey regarding their practices related to CD. Results: Seventy-eight gastroenterologists working in 5 continents were polled; 53% practice in the U.S. and Canada, and 86% were attending physicians. The number of CD patients (and % of MDs) seen on a monthly basis in clinic were: 1-9 (73%), 10-30 (22%), and >30% (5%), respectively. Lack of time, lack of compensation, and limitation in knowledge of gluten restricted products were cited as barriers to care 52.5%, 7.7%, and 24.4% of the time, respectively. The most frequent form of education provided by MDs was referrals to dietitians (64%) and nutritionists (36%). Some physicians also provided educational resources via the internet, various smartphone applications, and nutrition books. Approximately 54% of MDs provided direct recommendations on consumption of gluten-free products. A majority (91%) recommend strict adherence to a gluten-free diet, whereas only 2.5% recommend permissive gluten intake and 6% deferred to nutritionists. The 3 most commonly screened labs were iron studies (78%), vitamins A,D, E, B12 (82%), and folic acid (53.8%). Forty-four percent of gastroenterologists took primary responsibility to vaccinate their patients with pneumococcal polysaccharide vaccination. Conclusion: Treatment approaches for CD are highly dependent on the practicing gastroenterologist. Lack of time, compensation, and understanding of gluten-free products are major barriers in physiciandirected education. As a result, physicians are making the appropriate referrals to dietitians, nutritionists, and online resources to improve patient education. Despite variable symptomatic response to gluten restriction among CD patients, most physicians recommend life-long and strict gluten restriction. The majority of gastroenterologists are not vaccinating their patients, and instead, defer this responsibility to primary care physicians.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,008 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».