John Mayberry | University of Leicester (original) (raw)

Papers by John Mayberry

Gastrointestinal Disorders (ISSN 2624-5647) , 2019

The growing international popularity of screening programs for the early detection of pre-cancero... more The growing international popularity of screening programs for the early detection of pre-cancerous changes or early cancer in the colon has brought to the fore the issue of people with asymptomatic inflammatory bowel disease. What are the legal and clinical responsibilities for endoscopists and managers of screening programs towards such patients? This review assesses the magnitude of the problem and discusses the legal responsibilities, including human rights issues. In addition, it discusses whether such patients who do not have symptoms should be given active treatment.

Gastrointest. Disord., 2019

Objectives: In this review the management of colorectal disease will be investigated as an exempl... more Objectives: In this review the management of colorectal disease will be investigated as an exemplar of common practice in the UK in an attempt to identify factors responsible for the more general experiences of patients from ethnic minorities. Within this field such populations have a lower uptake of cancer screening programmes and their experience of day-today care for chronic gastrointestinal disorders is poor. Study design: PubMed and Google Scholar were reviewed in 2016 to identify publications concerning colorectal screening in patients with inflammatory bowel disease and healthy communities. Methods: Data were extracted from each paper and the references exploded to identify other potential reports. Results: It is reported that barriers exist both at individual and access levels but little has been done to overcome these. There have been a number of suggestions as to how to provide equitable access, but there is a clear need to ensure that these are evidence based and have been tested and shown to be effective in clinical trials. Conclusions: Clearly, current systems of surveillance and screening will only make a difference if they provide effective and acceptable services to all potential clients. Most programmes fail to address the specific risks and anxieties of minority groups, which are thought to be poorly compliant. This review considers those factors that may play a part and suggests approaches that could overcome these deficiencies. Some clues as to these factors may come from work with patients with chronic disorders.

J Clin Gastroenterol, 1982

The Ulster medical journal, 2015

The Medico-legal journal, Jan 15, 2015

Ulcerative colitis is common in migrant communities. There is evidence that access to care in gen... more Ulcerative colitis is common in migrant communities. There is evidence that access to care in general is impaired among such communities. The purpose of this study was to investigate whether South Asians experienced the same quality of care as English patients with ulcerative colitis. The study assessed clinical care in the decade subsequent to diagnosis through a retrospective review of case notes. Newly diagnosed patients who lived in Leicester were identified and the frequency and type of consultation, in-patient admissions, surveillance colonoscopies, discharge rates, surgery and death were recorded. Of 372 candidate cases identified, 70 met the criteria to be included in the study. Forty-two were of English origin and 28 South Asian. South Asian patients were significantly less likely to see a consultant and more likely to be discharged. South Asian patients were admitted to hospital more often but had significantly fewer tests than European patients. This trend was also seen i...

British journal of hospital medicine (London, England : 2005), 2014

The Ulster medical journal, 2013

The purpose of this study was to identify the number of medical graduates registered with the Gen... more The purpose of this study was to identify the number of medical graduates registered with the General Medical Council (GMC) between 1990 and 2005, whose initial training was in Eastern Europe and who came from universities which have subsequently developed an "English Parallel" course and are now within the European Union (EU). A similar exercise was undertaken with graduates registered with the Medical Council, Ireland. Between 1990 and 2005 one thousand six hundred and fourteen (1614) doctors, who had trained in the selected universities from Eastern Europe, registered with the General Medical Council (GMC) in the United Kingdom (Table 1). The Register of Medical Practitioners for Ireland as at 1st July 2005 was also scanned manually to identify graduates from these countries who were registered in Ireland. Sixty four such graduates were identified of whom 6 qualified before 1990 and 5 were in their internship year. The study suggests that since 2000 younger graduates wh...

Arquivos de Gastroenterologia, 2014

Despite intensive research we remain ignorant of the cause of both Crohn&... more Despite intensive research we remain ignorant of the cause of both Crohn's disease and ulcerative colitis. The dramatic rise in incidence, particularly of Crohn's disease, points towards environmental factors as playing a significant role. A major purpose of this review is to stimulate a co-ordinated international effort to establish an on-going data base in Central and South America in which new cases are registered and through which investigations into aetiology can be conducted. In both Brazil and Mexico there is evidence that the incidence of ulcerative colitis is increasing, as also is the case for Crohn's disease in Brazil. The pattern of disease is, therefore, directly comparable to that reported from Europe and the USA during the 1970s and 1980s, but much lower than contemporary data from Spain. Although the incidence is similar to that reported from Portugal, the studies from Almada and Braga were conducted a decade before that from Sao Paulo. The situation in Brazil compares dramatically with Uruguay and Argentina where the reported incidence of inflammatory bowel disease is significantly less. However, with growing industrialisation it is likely that there will be an explosion of inflammatory bowel disease in some areas of Central and South America over the next 20 years. The creation of a network of researchers across South and Central America is a real possibility and through a Concerted Action there is the possibility that major strides could be made towards understanding the cause of inflammatory bowel disease and so develop preventive strategies.

The Medico-legal journal, 2013

During the last 20 years, there has been a significant growth in the training of overseas student... more During the last 20 years, there has been a significant growth in the training of overseas students especially within the European Union. Informal discussions with past and present students revealed a marked reluctance to take part in interviews about the nature of "English Parallel" courses. Alternative sources of information include blogs and commentaries written on the internet by present and former students at these schools. Such blogs are relatively limited in number and of variable length. They have been written for a variety of reasons and range in content from commentaries on training to wider discussion of life in Central and Eastern Europe. Six blogs were identified from an internet search, and a qualitative approach was adopted for the analysis of text content. Their experience is assessed, and potential approaches to greater integration of training across Europe are considered.

European Journal of Gastroenterology & Hepatology, 2001

To determine the level of knowledge achieved by patients who have read a simple information sheet... more To determine the level of knowledge achieved by patients who have read a simple information sheet on gastroscopy and flexible sigmoidoscopy, and to determine the levels of information required by patients and solicitors specializing in clinical negligence. Self-administered questionnaires were sent to 516 patients in Leicester and 79 solicitors specializing in clinical negligence in England and Wales. The main objective outcome measures were the correct scores measured in a simple test of the content of information sheets about gastroscopy and flexible sigmoidoscopy. Other scores were based on the opinions of patients and solicitors on the type of information patients should receive and the levels of risk about which they should be informed. Of the clinical negligence specialists, 75%, compared with 44% of patients, felt that consent to procedures should be obtained 2 weeks before the test. In addition, 86% of solicitors felt that patients needed to be told about tests on at least two occasions and favoured booklets and videos. Both 48% of solicitors and 38% of patients felt that patients should be told of very uncommon risks, with 16% of clinical negligence specialists expecting patients to be told of risks of 1 in 1,000,000. The majority of patients (98%) and solicitors (95%) felt that patients should be formally tested as to whether they understand what they are told in the consent process. In an initial study of an information leaflet, South Asian patients had significantly poorer scores than English patients on formal testing of their knowledge of the leaflet's content. The poorest response (61% correct) was to a question including the word 'indigestion', which had been omitted from the information leaflet. Its inclusion led to a significant increase in the number answering the question correctly (96%). The positioning of a word in the list of reasons for doing the test was also important. In the flexible sigmoidoscopy leaflet, the word 'anaemia' was placed in the middle of a list of reasons for doing the test; only 85% answered the question correctly. In the sample of patients who received the modified gastroscopy leaflet, recall at 6 months was significantly impaired with most loss of memory being related to the purpose of the test. Consent needs to be supported by easy-to-read information and the patients' understanding needs to be formally tested. Important concepts must be included in this information as well as any uncommon risks of the procedure. In order to ensure that the information can be understood, the text should be reviewed by an experienced educationalist. If the text is to be used in a multicultural setting, it is important to ensure that patients for whom English is not their first language can easily understand it. The movement away from 'informed consent' towards an 'informed decision' process should facilitate these improvements.

American Journal of Gastroenterology, 1999

The aim of this study was to develop a valid and reliable questionnaire assessing patient knowled... more The aim of this study was to develop a valid and reliable questionnaire assessing patient knowledge of inflammatory bowel disease (IBD) and its treatment-the Crohn's and Colitis Knowledge (CCKNOW) Score.

European Journal of Gastroenterology & Hepatology, 1998

To investigate any correlation between infection with Helicobacter pylori (H. pylori) and overall... more To investigate any correlation between infection with Helicobacter pylori (H. pylori) and overall symptoms of dyspepsia, in a general population sample. Analysis of test results and questionnaire replies from a population screening study involving subjects registered at a single general practice in Market Harborough, UK. H. pylori status was established using a commercial enzyme-linked immunosorbent assay (ELISA), and frequent dyspepsia was assessed using a previously validated self-completion symptom questionnaire. Complete results for dyspepsia and H. pylori status were obtained and analysed for 1524 men and women aged 21-55 years at the start of the study. In those who attended for screening, the prevalence of dyspepsia was 39%, with a 15% prevalence of infection with H. pylori. No significant correlation was found between H. pylori status and frequent dyspepsia, upper abdominal pain or reflux-like symptoms. Adjustment for age, gender, smoking and alcohol consumption did not alter these findings. The analysis suggested that H. pylori infection does not play an important role in overall symptoms of non-ulcer dyspepsia in the community, nor is it important in protecting against acid reflux in patients without duodenal ulcer.

Digestion, 1993

The purpose of this study was to measure the incidence of coeliac disease in different ethnic com... more The purpose of this study was to measure the incidence of coeliac disease in different ethnic communities and investigate the hypothesis that the incidence is decreasing in most European countries and the role incomplete retrieval of data may play. In a retrospective study of histologically confirmed cases of coeliac disease between 1975 and 1989 in the City of Leicester, 106

Digestive Diseases and Sciences, 1981

The consumption of sugar and sugar-containing foods in 32 patients with recently diagnosed Crohn'... more The consumption of sugar and sugar-containing foods in 32 patients with recently diagnosed Crohn's disease was significantly greater than in matched controls; the assessment was made by a questionnaire and depended upon patients recalling their eating habits. In a further study of 16 patients with Crohn's disease, all food eaten over 5 days was weighed and recorded, and no significant difference was found in the consumption of carbohydrate, protein, fats, or sugars, although the consumption of “added sugars” in patients was greater than controls. Patients who participated in both studies significantly reduced their intake of added sugar, and this was not found to correlate with either total intake of monosaccharides and disaccharides or the total carbohydrate consumption. The increased consumption of added sugar in patients with Crohn's disease does not appear to be related to other dietary abnormalities and may simply reflect a deficiency in perception of sweet taste in patients with this condition.

European Journal of Gastroenterology & Hepatology, 1998

To define whether gastroenterology patients wish to receive more information concerning many aspe... more To define whether gastroenterology patients wish to receive more information concerning many aspects of their illness and to elicit their attitude after receiving written communication from their hospital practitioner. In stage 1, 73 gastroenterology patients were interviewed and completed a structured questionnaire after their hospital outpatient visit, to assess whether they would like to receive more information about their condition. Stage 2 involved posting a copy of the general practitioner's letter, dictated in the clinic, to the patient and assessing their opinion of its value, by using a second questionnaire. In stage 3 a group of outpatients received a letter specifically prepared for them which summarized the outcome of their clinic visit (with avoidance of medical terms) and they again completed a questionnaire. More than 75% of patients wished to receive written communication from their hospital practitioner. Ninety percent wanted to know more about diagnostic tests and 92% requested more information about their medication. Ninety percent of patients who received a copy of their GP's letter claimed to understand its contents and felt it was beneficial. Ninety four percent wanted the service to continue. However, there was no advantage in preparing a special letter for patients compared with a simple copy of that sent to their GP. There is considerable interest amongst gastroenterology patients concerning their diagnosis and the management of their disease. The provision of simplified letters about their outpatient management does not seem to have any advantage over simply providing copies of all relevant correspondence sent to GPs.

Journal of Gastroenterology and Hepatology, 1988

One hundred and fifty-two patients with achalasia were first admitted to hospital in New Zealand ... more One hundred and fifty-two patients with achalasia were first admitted to hospital in New Zealand between 1980 and 1984. The discharge of these patients was recorded by the National Health Statistics Centre which records details of all public health hospitals in New Zealand. The overall incidence was 0.95/100 000 population per year and was similar in North and South Islands and in men and women. The incidence increased with age and was 5.4/100 000 population per year in people aged over 80 years old. The disease was more common in Polynesian migrants (1.3/100 000 population per year) than other ethnic groups. Variations in incidence were seen across the Health Boards with the highest incidence of 2.9/100 000 population per year in Hawkes Bay and Tauranga.

Gastrointestinal Endoscopy, 2000

Patients with ulcerative colitis (UC) are at increased risk of colorectal carcinoma. 1-3 Many cli... more Patients with ulcerative colitis (UC) are at increased risk of colorectal carcinoma. 1-3 Many clinicians practice colonoscopic surveillance in this group of patients in the hope of detecting an early cancer at a surgically curable stage. However, much debate surrounds the efficacy of surveillance programs in UC. 4-6 These programs were widely introduced without the benefit of randomized controlled trials needed to assess their efficacy and cost-effectiveness. It would now be unethical to randomize patients into a study of the benefits of surveillance, and the only acceptable approach is to critically appraise current practices in surveillance.

Gastrointestinal Disorders (ISSN 2624-5647) , 2019

The growing international popularity of screening programs for the early detection of pre-cancero... more The growing international popularity of screening programs for the early detection of pre-cancerous changes or early cancer in the colon has brought to the fore the issue of people with asymptomatic inflammatory bowel disease. What are the legal and clinical responsibilities for endoscopists and managers of screening programs towards such patients? This review assesses the magnitude of the problem and discusses the legal responsibilities, including human rights issues. In addition, it discusses whether such patients who do not have symptoms should be given active treatment.

Gastrointest. Disord., 2019

Objectives: In this review the management of colorectal disease will be investigated as an exempl... more Objectives: In this review the management of colorectal disease will be investigated as an exemplar of common practice in the UK in an attempt to identify factors responsible for the more general experiences of patients from ethnic minorities. Within this field such populations have a lower uptake of cancer screening programmes and their experience of day-today care for chronic gastrointestinal disorders is poor. Study design: PubMed and Google Scholar were reviewed in 2016 to identify publications concerning colorectal screening in patients with inflammatory bowel disease and healthy communities. Methods: Data were extracted from each paper and the references exploded to identify other potential reports. Results: It is reported that barriers exist both at individual and access levels but little has been done to overcome these. There have been a number of suggestions as to how to provide equitable access, but there is a clear need to ensure that these are evidence based and have been tested and shown to be effective in clinical trials. Conclusions: Clearly, current systems of surveillance and screening will only make a difference if they provide effective and acceptable services to all potential clients. Most programmes fail to address the specific risks and anxieties of minority groups, which are thought to be poorly compliant. This review considers those factors that may play a part and suggests approaches that could overcome these deficiencies. Some clues as to these factors may come from work with patients with chronic disorders.

J Clin Gastroenterol, 1982

The Ulster medical journal, 2015

The Medico-legal journal, Jan 15, 2015

Ulcerative colitis is common in migrant communities. There is evidence that access to care in gen... more Ulcerative colitis is common in migrant communities. There is evidence that access to care in general is impaired among such communities. The purpose of this study was to investigate whether South Asians experienced the same quality of care as English patients with ulcerative colitis. The study assessed clinical care in the decade subsequent to diagnosis through a retrospective review of case notes. Newly diagnosed patients who lived in Leicester were identified and the frequency and type of consultation, in-patient admissions, surveillance colonoscopies, discharge rates, surgery and death were recorded. Of 372 candidate cases identified, 70 met the criteria to be included in the study. Forty-two were of English origin and 28 South Asian. South Asian patients were significantly less likely to see a consultant and more likely to be discharged. South Asian patients were admitted to hospital more often but had significantly fewer tests than European patients. This trend was also seen i...

British journal of hospital medicine (London, England : 2005), 2014

The Ulster medical journal, 2013

The purpose of this study was to identify the number of medical graduates registered with the Gen... more The purpose of this study was to identify the number of medical graduates registered with the General Medical Council (GMC) between 1990 and 2005, whose initial training was in Eastern Europe and who came from universities which have subsequently developed an "English Parallel" course and are now within the European Union (EU). A similar exercise was undertaken with graduates registered with the Medical Council, Ireland. Between 1990 and 2005 one thousand six hundred and fourteen (1614) doctors, who had trained in the selected universities from Eastern Europe, registered with the General Medical Council (GMC) in the United Kingdom (Table 1). The Register of Medical Practitioners for Ireland as at 1st July 2005 was also scanned manually to identify graduates from these countries who were registered in Ireland. Sixty four such graduates were identified of whom 6 qualified before 1990 and 5 were in their internship year. The study suggests that since 2000 younger graduates wh...

Arquivos de Gastroenterologia, 2014

Despite intensive research we remain ignorant of the cause of both Crohn&... more Despite intensive research we remain ignorant of the cause of both Crohn's disease and ulcerative colitis. The dramatic rise in incidence, particularly of Crohn's disease, points towards environmental factors as playing a significant role. A major purpose of this review is to stimulate a co-ordinated international effort to establish an on-going data base in Central and South America in which new cases are registered and through which investigations into aetiology can be conducted. In both Brazil and Mexico there is evidence that the incidence of ulcerative colitis is increasing, as also is the case for Crohn's disease in Brazil. The pattern of disease is, therefore, directly comparable to that reported from Europe and the USA during the 1970s and 1980s, but much lower than contemporary data from Spain. Although the incidence is similar to that reported from Portugal, the studies from Almada and Braga were conducted a decade before that from Sao Paulo. The situation in Brazil compares dramatically with Uruguay and Argentina where the reported incidence of inflammatory bowel disease is significantly less. However, with growing industrialisation it is likely that there will be an explosion of inflammatory bowel disease in some areas of Central and South America over the next 20 years. The creation of a network of researchers across South and Central America is a real possibility and through a Concerted Action there is the possibility that major strides could be made towards understanding the cause of inflammatory bowel disease and so develop preventive strategies.

The Medico-legal journal, 2013

During the last 20 years, there has been a significant growth in the training of overseas student... more During the last 20 years, there has been a significant growth in the training of overseas students especially within the European Union. Informal discussions with past and present students revealed a marked reluctance to take part in interviews about the nature of "English Parallel" courses. Alternative sources of information include blogs and commentaries written on the internet by present and former students at these schools. Such blogs are relatively limited in number and of variable length. They have been written for a variety of reasons and range in content from commentaries on training to wider discussion of life in Central and Eastern Europe. Six blogs were identified from an internet search, and a qualitative approach was adopted for the analysis of text content. Their experience is assessed, and potential approaches to greater integration of training across Europe are considered.

European Journal of Gastroenterology & Hepatology, 2001

To determine the level of knowledge achieved by patients who have read a simple information sheet... more To determine the level of knowledge achieved by patients who have read a simple information sheet on gastroscopy and flexible sigmoidoscopy, and to determine the levels of information required by patients and solicitors specializing in clinical negligence. Self-administered questionnaires were sent to 516 patients in Leicester and 79 solicitors specializing in clinical negligence in England and Wales. The main objective outcome measures were the correct scores measured in a simple test of the content of information sheets about gastroscopy and flexible sigmoidoscopy. Other scores were based on the opinions of patients and solicitors on the type of information patients should receive and the levels of risk about which they should be informed. Of the clinical negligence specialists, 75%, compared with 44% of patients, felt that consent to procedures should be obtained 2 weeks before the test. In addition, 86% of solicitors felt that patients needed to be told about tests on at least two occasions and favoured booklets and videos. Both 48% of solicitors and 38% of patients felt that patients should be told of very uncommon risks, with 16% of clinical negligence specialists expecting patients to be told of risks of 1 in 1,000,000. The majority of patients (98%) and solicitors (95%) felt that patients should be formally tested as to whether they understand what they are told in the consent process. In an initial study of an information leaflet, South Asian patients had significantly poorer scores than English patients on formal testing of their knowledge of the leaflet's content. The poorest response (61% correct) was to a question including the word 'indigestion', which had been omitted from the information leaflet. Its inclusion led to a significant increase in the number answering the question correctly (96%). The positioning of a word in the list of reasons for doing the test was also important. In the flexible sigmoidoscopy leaflet, the word 'anaemia' was placed in the middle of a list of reasons for doing the test; only 85% answered the question correctly. In the sample of patients who received the modified gastroscopy leaflet, recall at 6 months was significantly impaired with most loss of memory being related to the purpose of the test. Consent needs to be supported by easy-to-read information and the patients' understanding needs to be formally tested. Important concepts must be included in this information as well as any uncommon risks of the procedure. In order to ensure that the information can be understood, the text should be reviewed by an experienced educationalist. If the text is to be used in a multicultural setting, it is important to ensure that patients for whom English is not their first language can easily understand it. The movement away from 'informed consent' towards an 'informed decision' process should facilitate these improvements.

American Journal of Gastroenterology, 1999

The aim of this study was to develop a valid and reliable questionnaire assessing patient knowled... more The aim of this study was to develop a valid and reliable questionnaire assessing patient knowledge of inflammatory bowel disease (IBD) and its treatment-the Crohn's and Colitis Knowledge (CCKNOW) Score.

European Journal of Gastroenterology & Hepatology, 1998

To investigate any correlation between infection with Helicobacter pylori (H. pylori) and overall... more To investigate any correlation between infection with Helicobacter pylori (H. pylori) and overall symptoms of dyspepsia, in a general population sample. Analysis of test results and questionnaire replies from a population screening study involving subjects registered at a single general practice in Market Harborough, UK. H. pylori status was established using a commercial enzyme-linked immunosorbent assay (ELISA), and frequent dyspepsia was assessed using a previously validated self-completion symptom questionnaire. Complete results for dyspepsia and H. pylori status were obtained and analysed for 1524 men and women aged 21-55 years at the start of the study. In those who attended for screening, the prevalence of dyspepsia was 39%, with a 15% prevalence of infection with H. pylori. No significant correlation was found between H. pylori status and frequent dyspepsia, upper abdominal pain or reflux-like symptoms. Adjustment for age, gender, smoking and alcohol consumption did not alter these findings. The analysis suggested that H. pylori infection does not play an important role in overall symptoms of non-ulcer dyspepsia in the community, nor is it important in protecting against acid reflux in patients without duodenal ulcer.

Digestion, 1993

The purpose of this study was to measure the incidence of coeliac disease in different ethnic com... more The purpose of this study was to measure the incidence of coeliac disease in different ethnic communities and investigate the hypothesis that the incidence is decreasing in most European countries and the role incomplete retrieval of data may play. In a retrospective study of histologically confirmed cases of coeliac disease between 1975 and 1989 in the City of Leicester, 106

Digestive Diseases and Sciences, 1981

The consumption of sugar and sugar-containing foods in 32 patients with recently diagnosed Crohn'... more The consumption of sugar and sugar-containing foods in 32 patients with recently diagnosed Crohn's disease was significantly greater than in matched controls; the assessment was made by a questionnaire and depended upon patients recalling their eating habits. In a further study of 16 patients with Crohn's disease, all food eaten over 5 days was weighed and recorded, and no significant difference was found in the consumption of carbohydrate, protein, fats, or sugars, although the consumption of “added sugars” in patients was greater than controls. Patients who participated in both studies significantly reduced their intake of added sugar, and this was not found to correlate with either total intake of monosaccharides and disaccharides or the total carbohydrate consumption. The increased consumption of added sugar in patients with Crohn's disease does not appear to be related to other dietary abnormalities and may simply reflect a deficiency in perception of sweet taste in patients with this condition.

European Journal of Gastroenterology & Hepatology, 1998

To define whether gastroenterology patients wish to receive more information concerning many aspe... more To define whether gastroenterology patients wish to receive more information concerning many aspects of their illness and to elicit their attitude after receiving written communication from their hospital practitioner. In stage 1, 73 gastroenterology patients were interviewed and completed a structured questionnaire after their hospital outpatient visit, to assess whether they would like to receive more information about their condition. Stage 2 involved posting a copy of the general practitioner's letter, dictated in the clinic, to the patient and assessing their opinion of its value, by using a second questionnaire. In stage 3 a group of outpatients received a letter specifically prepared for them which summarized the outcome of their clinic visit (with avoidance of medical terms) and they again completed a questionnaire. More than 75% of patients wished to receive written communication from their hospital practitioner. Ninety percent wanted to know more about diagnostic tests and 92% requested more information about their medication. Ninety percent of patients who received a copy of their GP's letter claimed to understand its contents and felt it was beneficial. Ninety four percent wanted the service to continue. However, there was no advantage in preparing a special letter for patients compared with a simple copy of that sent to their GP. There is considerable interest amongst gastroenterology patients concerning their diagnosis and the management of their disease. The provision of simplified letters about their outpatient management does not seem to have any advantage over simply providing copies of all relevant correspondence sent to GPs.

Journal of Gastroenterology and Hepatology, 1988

One hundred and fifty-two patients with achalasia were first admitted to hospital in New Zealand ... more One hundred and fifty-two patients with achalasia were first admitted to hospital in New Zealand between 1980 and 1984. The discharge of these patients was recorded by the National Health Statistics Centre which records details of all public health hospitals in New Zealand. The overall incidence was 0.95/100 000 population per year and was similar in North and South Islands and in men and women. The incidence increased with age and was 5.4/100 000 population per year in people aged over 80 years old. The disease was more common in Polynesian migrants (1.3/100 000 population per year) than other ethnic groups. Variations in incidence were seen across the Health Boards with the highest incidence of 2.9/100 000 population per year in Hawkes Bay and Tauranga.

Gastrointestinal Endoscopy, 2000

Patients with ulcerative colitis (UC) are at increased risk of colorectal carcinoma. 1-3 Many cli... more Patients with ulcerative colitis (UC) are at increased risk of colorectal carcinoma. 1-3 Many clinicians practice colonoscopic surveillance in this group of patients in the hope of detecting an early cancer at a surgically curable stage. However, much debate surrounds the efficacy of surveillance programs in UC. 4-6 These programs were widely introduced without the benefit of randomized controlled trials needed to assess their efficacy and cost-effectiveness. It would now be unethical to randomize patients into a study of the benefits of surveillance, and the only acceptable approach is to critically appraise current practices in surveillance.