Management of the dyspeptic patient: anything goes?

Guidelines on the initial management of dyspeptic patients are remarkably conflicting or ambiguous and recommend a variety of initial approaches and no single strategy has been successfully implemented in primary care. In this issue of the American Journal of Gastroenterology, Jarbol and colleagues report the results of a large Danish trial comparing a test-and-treat strategy, an empiric PPI strategy, and a combined strategy with Helicobacter testing if symptoms improved after the PPI. Patient-related outcomes at 1 yr did not differ, but the use of endoscopy was highest in the PPI strategy. From the patient's perspective it seems that anything goes as long as the clinician sticks to a well-defined and proven strategy. Helicobacter pylori testing is still recommendable owing to the long-term benefits, but the rapidly decreasing Helicobacter prevalence will soon make the test-and-treat strategy cost-ineffective as the initial step.     

JICE goes “social”

Social media is transforming health care. The Journal of Interventional Cardiac Electrophysiology (JICE) has launched its own social media presence and is now on Facebook. JICE will post each issue’s table of contents, special articles, online-first publications to allow real-time notifications to JICE’s readers and fans of our Facebook page. We encourage you to take the plunge and connect to our Facebook page.     

When a liver transplant recipient goes back to alcohol abuse: Should we be more selective?

Alcoholic liver disease (ALD) is one of the most common indications for liver transplantation (LT). However, it has always remained as a complicated topic from both medical and ethical grounds, as it is seen for many a “self-inflicted disease”. Over the years, the survival rate of transplanted patients has significantly improved. The allocation system and the inclusion criteria for LT has also undergone some modifications. Early LT for acute alcoholic hepatitis has been subject to recent clinical studies with encouraging results in highly selected patients. We have learned from studies the importance of a multidisciplinary evaluation of candidates for LT. Complete abstinence should be attempted to overcome addiction issues and to allow spontaneous liver recovery. Risk factors for relapse include the presence of anxiety or depressive disorder, short duration of sobriety pre-LT and lack of social support. The identification of risk factors and the strengthen of social support system may decrease relapse among these patients. Family counseling of candidates is highly encouraged to prevent relapse to alcohol. Relapse has been associated with different histopathological changes, graft damage, graft loss and even decrease in survival among some studies. Therefore, each patient should be carefully selected and priority is to continue to lean on patients with high probability of success. The ethical issue remains as to the patient returning to drinking after the LT, hindering the way for other patients who could have received the same organ.     

When does the good of the group override the advantage of the individual?

In a system of N populations of n reproductive individuals apiece, in which each population has constant variance v² and lasts L generations, group selection on a quantitative character has a reasonable chance of overriding selection within populations if (and only if) the populations never exchange migrants, each population is founded by colonists from a single parent population, and the number of populations exceeds the effective number of reproductive individuals per population. If each population derives from a single parent population, then the exchange of a single successful migrant per population per L generations can triple the strength of group selection required to overcome a given selection within populations. If populations exchange no migrants, then the derivation of one in every N populations from two equally represented parents (while the others all derive from a single parent) doubles the strength of group selection required to prevail. Group selection is accordingly likely to be effective only in certain categories of parasites.     

Can the Internet Improve the Well-being of the Elderly?

In this paper we report on a project that aimed to evaluate the potential of the Internet to reduce social isolation amongst the elderly, and thereby, improve psychosocial functioning. Twenty residents of a retirement village volunteered to be given access to, and training in, the use of computers and the Internet. After 3 months, they exhibited little change in measures of self-esteem, positive affect, personal well-being, optimism and social connectedness. However, they reported that they found the use of the Internet to be of great benefit. Over the 12 months of the study 12 participants discontinued their involvement for a variety of reasons. After 12 months, the eight participants who remained in the study again reported a range of positive outcomes however, quantitative survey data did not confirm these findings of a generally-positive experience. This discrepancy between the qualitative (interview) data and the quantitative (survey) data suggests that impact of the Internet on the wellbeing of the elderly may be more complex than suggested, and broader than was assessed psychometrically. We make specific recommendations about the introduction of computers to elderly with care both in how participants are selected and how their well being is monitored subsequently.