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| 1 | Association of overexpression of TIF1γ with colorectal carcinogenesis and advanced colorectal adenocarcinoma显示文摘AIM:To determine the expression and clinical significance of transcriptional intermediary factor 1 gamma (TIF1γ),Smad4 and transforming growth factor-beta (TGFβR) across a spectrum representing colorectal cancer (CRC) development.METHODS:Tissue microarrays were prepared from archival paraffin embedded tissue,including 51 colorectal carcinomas,25 tubular adenomas (TA) and 26 HPs,each with matched normal colonic epithelium.Immunohistochemistry was performed using antibodies against TIF1γ,Smad4 and TGFβ RⅡ.The levels of expression were scored semi-quantitatively (score 0-3 or loss and retention for Smad4).RESULTS:Overexpression of TIF1γ was detected in 5/26 (19%) HP;however,it was seen in a significantly higher proportion of neoplasms,15/25 (60%) TAs and 24/51 (47%) CRCs (P<0.05).Normal colonic mucosa,HP,and TAs showed strong Smad4 expression,while its expression was absent in 22/51 (43%) CRCs.Over-expression of TGFβ RⅡ was more commonly seen in neoplasms,13/25 (52%) TAs and 29/51 (57%) CRCs compared to 9/26 (35%) HP (P<0.05).Furthermore,there was a correlation between TIF1γ overexpression and Smad4 loss in CRC (Kendall tau rank correlation value=0.35,P<0.05).The levels of TIF1γ overexpression were significantly higher in stage Ⅲ than in stage Ⅰ and Ⅱ CRC (P<0.05).CONCLUSION:The findings suggest that over-expression of TIF1γ occurs in early stages of colorectal carcinogenesis,is inversely related with Smad4 loss,and may be a prognostic indicator for poor outcome. | Shilpa Jain Shashideep Singhal Franto Francis Cristina Hajdu Jin-Hua Wang Arief Suriawinata Yin-Quan wang Miao Zhang Elizabeth H Weinshel Fritz Francois Zhi-Heng Pei Peng Lee Ru-Liang Xu | 2011 | World Journal of Gastroenterology2011，17，35： | 3 |
| 2 | Assessing cultural competency skills in gastroenterology fellowship training显示文摘AIM:To assess and teach cultural competency skills at the fellowship training level through the use of objective structured clinical examinations(OSCEs).METHODS:We revised four scenarios to infuse a specific focus on cross-cultural care,and to render them appropriate for gastroenterology fellows.Three are discussed here:(1)Poor Health Literacy;(2)Disclosing/Apologizing for a Complication to a Patient Who Mistrusts the Healthcare System;and(3)Breaking Bad News to a Fatalistic Patient.A fourth case emphasizing shared decision-making will be described elsewhere.Four stations were completed by fellows and observed live by four faculty members,and the fellows’performance was assessed.RESULTS:Eleven fellows from four programs participated in the four OSCE.In the'Poor Health Literacy'case,18%(2/11)of participants recognized that the standardized patient(SP)had below-basic health literacy.None successfully evaluated the SP’s reading skills in a culturally-sensitive manner.In'Disclosing/Apologizing for a Complication',4/11(36%)personally apologized for the complication.1/11 recognized the SP’s mistrust of the medical system.With'Breaking Bad News',27%(3/11)explored the patient’s values to identify her fatalistic beliefs.CONCLUSION:OSCEs can be used to assess deficiencies in culturally-competent care at the fellowship level.OSCEs also afford fellowships the opportunity to inform future training curricula. | Sophie Balzora Benjamin Abiri Xiao-Jing Wang James Mc Keever Michael Poles Sondra Zabar Colleen Gillespie Elizabeth Weinshel | 2015 | World Journal of Gastroenterology2015，21，6： | 2 |
| 3 | Systematic evaluation of complications related to endoscopy in a training setting: A prospective 30-day outcomes study显示文摘 | Edmund J. Bini Babak Firoozi Rosa J. Choung Eyad M. Ali Mohamed Osman Elizabeth H. Weinshel | 2003 | Gastrointestinal Endoscopy2003，，1： | 1 |
| 4 | Evaluation of the gastrointestinal tract in premenopausal women with iron deficiency anemia显示文摘 | Edmund J Bini Philip L Micale Elizabeth H Weinshel | 1998 | The American Journal of Medicine1998，，： | 1 |
| 5 | Systematic evaluation of complications related to endoscopy in a training setting: A prospective 30-day outcomes study显示文摘 | Edmund J. Bini Babak Firoozi Rosa J. Choung Eyad M. Ali Mohamed Osman Elizabeth H. Weinshel | 2003 | Gastrointestinal Endoscopy2003，，1： | 1 |
| 6 | CASE REPORT: Endoscopic Band Ligation of Bleeding Rectal Varices显示文摘 | Babak Firoozi Zoi Gamagaris Elizabeth H. Weinshel Edmund J. Bini | 2002 | Digestive Diseases and Sciences2002，，7： | 1 |
| 7 | Teaching the Competencies: Using Objective Structured Clinical Encounters for Gastroenterology Fellows显示文摘 | Bani Chander Robert Kule Peter Baiocco Sita Chokhavatia Don Kotler Michael Poles Sondra Zabar Colleen Gillespie Tavinder Ark Elizabeth Weinshel | 2009 | Clinical Gastroenterology and Hepatology2009，，5： | 1 |
| 8 | Disruptive behavior in the workplace: Challenges for gastroenterology fellows显示文摘AIM To assess first-year gastroenterology fellows' ability to address difficult interpersonal situations in the workplace using objective structured clinical examinations(OSCE).METHODS Two OSCEs('distracted care team' and 'frazzled intern') were created to assess response to disruptive behavior. In case 1, a fellow used a colonoscopy simulator while interacting with a standardized patient(SP), nurse, and attending physician all played by actors. The nurse and attending were instructed to display specific disruptive behavior and disregard thefellow unless requested to stop the disruptive behavior and focus on the patient and procedure. In case 2, the fellow was to calm an intern managing a patient with massive gastrointestinal bleeding. The objective in both scenarios was to assess the fellows' ability to perform their duties while managing the disruptive behavior displayed by the actor. The SPs used checklists to rate fellows' performances. The fellows completed a selfassessment survey.RESULTS Twelve fellows from four gastrointestinal fellowship training programs participated in the OSCE. In the 'distracted care team' case, one-third of the fellows interrupted the conflict and refocused attention to the patient. Half of the fellows were able to display professionalism despite the heated discussion nearby. Fellows scored lowest in the interprofessionalism portion of post-OSCE surveys, measuring their ability to handle the conflict. In the 'frazzled intern' case, 68% of fellows were able to establish a calm and professional relationship with the SP. Despite this success, only half of the fellows were successfully communicate a plan to the SP and only a third scored 'well done' in a domain that focused on allowing the intern to think through the case with the fellow's guidance.CONCLUSION Fellows must receive training on how to approach disruptive behavior. OSCEs are a tool that can assess fellow skills and set a culture for open discussion. | Nalinee Srisarajivakul Catherine Lucero Xiao-Jing Wang Michael Poles Colleen Gillespie Sondra Zabar Elizabeth Weinshel Lisa Malter | 2017 | World Journal of Gastroenterology2017，23，18： | 1 |
| 9 | Subtle skills: Using objective structured clinical examinations to assess gastroenterology fellow performance in system based practice milestones显示文摘BACKGROUND System based practice(SBP) milestones require trainees to effectively navigate the larger health care system for optimal patient care. In gastroenterology training programs, the assessment of SBP is difficult due to high volume, high acuity inpatient care, as well as inconsistent direct supervision. Nevertheless,structured assessment is required for training programs. We hypothesized that objective structured clinical examination(OSCE) would be an effective tool for assessment of SBP.AIM To develop a novel method for SBP milestone assessment of gastroenterology fellows using the OSCE.METHODS For this observational study, we created 4 OSCE stations: Counseling an impaired colleague, handoff after overnight call, a feeding tube placement discussion, and giving feedback to a medical student on a progress note. Twentysix first year fellows from 7 programs participated. All fellows encountered identical case presentations. Checklists were completed by trained standardized patients who interacted with each fellow participant. A report with individual and composite scores was generated and forwarded to program directors to utilize in formative assessment. Fellows also received immediate feedback from a faculty observer and completed a post-session program evaluation survey.RESULTS Survey response rate was 100%. The average composite score across SBP milestones for all cases were 6.22(SBP1), 4.34(SBP2), 3.35(SBP3), and 6.42(SBP4)out of 9. The lowest composite score was in SBP 3, which asks fellows to advocate for cost effective care. This highest score was in patient care 2, which asks fellows to develop comprehensive management plans. Discrepancies were identified between the fellows’ perceived performance in their self-assessments and Standardized Patient checklist evaluations for each case. Eighty-seven percent of fellows agreed that OSCEs are an important component of their clinical training,and 83% stated that the cases were similar to actual clinical encounters. All participating fellows stated that the immediate feedback was 'very useful.' One hundred percent of the fellows stated they would incorporate OSCE learning into their clinical practice.CONCLUSION OSCEs may be used for standardized evaluation of SBP milestones. Trainees scored lower on SBP milestones than other more concrete milestones. Training programs should consider OSCEs for assessment of SBP. | Marianna Papademetriou Gabriel Perrault Max Pitman Colleen Gillespie Sondra Zabar Elizabeth Weinshel Renee Williams | 2020 | World Journal of Gastroenterology2020，26，11： | 0 |
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