Background: Complementary and alternative medicine (CAM) is increasingly used in adults and children. Studies on CAM in neurological disorders have focused on the adult population and its use among pediatric neurology patients has not been well characterized. Objectives: The purpose of this study was: 1) To characterize the prevalence of CAM in pediatric neurology patients; 2) To determine the perceived effectiveness of CAM in these children; 3) To compare the cost of CAM with conventional therapies; and 4) To describe caregiver or patient-related variables associated with the use of CAM. Methods: This was a cross-sectional survey of patients and families attending the Alberta Children's Hospital neurology clinic between February and May 2004. Patients were considered eligible if they were between two and 18 years of age and had a known history of neurological disorders. Caregivers completed several self-administered questionnaires regarding their socio-demographic profile, their child's neurological illness, and their experience with CAM. Caregivers also rated their child's quality of life using the Pediatric Quality of Life Inventory. Results: One hundred and five of 228 (46%) families completed the survey. The mean age of the neurology patients was 9.8 ± 4.5 years. Forty-six (44%) out of 105 patients received one or more types of CAM, with the most common types being chiropractic manipulations (15%), dietary therapy (12%), herbal remedies (8%), homeopathy (8%), and prayer/faith healing (8%). Caregivers' sociodemographic variables or pediatric health-related quality of life were not significantly associated with the use of CAM. Fifty-nine percent of CAM users reported benefits, and only one patient experienced side effects. There was no significant difference in the total median cost of CAM compared to conventional therapies ($31.70 vs. $50.00 per month). Caregivers' personal experience or success stories from friends and media were common reasons for trying CAM. Conclusions: The use of CAM was common among pediatric neurology patients. Over half of the families reported benefits with CAM, and side effects were perceived to be few. Physicians should initiate discussion on CAM during clinic visits so that the families and patients can make informed decisions about using CAM. Further studies should address the specific role of CAM in children with neurological disorders, and to determine the potential interactions between CAM and conventional therapies in these patients. RÉSUMÉ: Utilisation de thérapies médicales complémentaires et alternatives dans une clinique de neurologie pédiatriques. Contexte: La médecine complémentaire et alternative (MCA) est de plus en plus utilisée chez les adultes et chez les enfants. Il existe des études sur l'utilisation de la MCA pour traiter les maladies neurologiques chez l'adulte, mais son utilisation chez l'enfant a été peu étudiée. Objectifs: Les buts de cette étude étaient : 1) de caractériser la prévalence de l'utilisation de la MCA chez les patients pédiatriques a...

For patients who present with hemodynamically stable variceal bleeding, hemostasis after endoscopy is high, and the time to endoscopy does not appear to be associated with mortality.

The purpose of this study is to describe patient-related variables in a cohort of advanced cancer patients (ACPs) enrolled in a home parenteral nutrition (HPN) program. This study reviewed the cohort of ACPs enrolled in the Northern Alberta Home Total Parenteral Nutrition Program (NAHTPNP). Thirty-eight ACPs received HPN during the study period, 24% of all patients admitted for PN. Of these, 27 (71%) were female. Mean age was 48.76 y (SD 13.8 y). Bowel obstruction was the most common indication for initiating HPN (84%, 32) and ovarian cancer was the most common malignancy (34%, 13). Patients who began HPN with a Karnofsky performance status (KPS) of greater than 50 (median of 70) were found to have a longer duration of life (median: 6 months) compared with patients who began HPN with a KPS of 50 or below (median=50; median 3 months; p=0.01; two-tailed). There was no difference in survival between malignancy type (p=NS). Advanced cancer is the fastest growing indication for enrollment in the HPN program. ACP demonstrated a 3% average annual increase proportionate to all indications for HPN starts, accounting for 7%-48% of HPN starts from 1999-2006. HPN is an increasingly used therapy for patients with advanced cancer, most commonly for intestinal failure in the setting of bowel obstruction. Initiation of HPN at a higher KPS was associated with a longer duration of life. Further studies are needed to validate the use of TPN in end-stage cancer patients.

Mucosal alkaline sphingomyelinase activity is reduced in the intestine of IL10KO mice with colitis and in humans with ulcerative colitis. VSL#3 probiotic therapy upregulates mucosal alkaline sphingomyelinase activity.

Only a minority of surveillance colonoscopies were performed according to guideline recommendations. Deviation from the guidelines did not improve the adenoma detection rate. Interventions aimed at improving adherence to surveillance guidelines are needed.