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Quality indicator for a endoscopic unit

Jennifer Anne Campbell, Andrew James Irvine, Andrew Derek Hopper
There is compelling evidence to support the quality, cost effectiveness and safety profile of non-anesthesiologist-administered propofol for endoscopic ultrasound (EUS). However in the United Kingdom, it is recommended that the administration and monitoring of propofol sedation for endoscopic procedures should be the responsibility of a dedicated and appropriately trained anaesthetist only. The majority of United Kingdom EUS procedures are performed with opiate and benzodiazepine sedation rather than anaesthetist led propofol lists due to anaesthetist resource availability...
January 21, 2017: World Journal of Gastroenterology: WJG
Nabeel Khan, Dhruvan Patel, Yash Shah, Yu-Xiao Yang
BACKGROUND: Iron deficiency anemia (IDA) is an often unrecognized and undertreated complication of ulcerative colitis (UC). We conducted the first nationwide study in the United States to evaluate the prevalence of testing for iron deficiency (ID) in anemic UC patients and determine the frequency of treatment with iron supplementation in patients with IDA. METHODS: Nationwide cohort of patients with newly diagnosed UC in the Veterans Affairs health care system was identified...
October 18, 2016: Inflammatory Bowel Diseases
Els Wieten, Manon C W Spaander, Ernst J Kuipers
Colorectal cancer (CRC) screening is widely implemented to reduce CRC incidence and related mortality. The impact of screening as well as the balance between screening burden and benefits strongly depends on the quality of colonoscopy. Besides quality, safety of the endoscopic procedure and patient satisfaction are important outcome parameters for a screening program. Therefore the requirements for both CRC screening endoscopy services and endoscopists focus on technical aspects, patient safety, and patient experience...
June 2016: Best Practice & Research. Clinical Gastroenterology
Maria Sylvia Ribeiro, Michael B Wallace
Colorectal cancer is the fourth most common cancer diagnosis worldwide and the second leading cause of cancer death. In the United States, it is estimated that in 2015 there will be 132,700 new cases of colorectal cancer (representing 8.43% of all new cancer cases) and 49,700 deaths. Colonoscopy plays a fundamental role in the prevention and management of colorectal cancer patients and is used for both the diagnosis and treatment of early colorectal cancer and its precursors. Improvements in colonoscopy preparation, new techniques of adenoma detection, and recent progress in endoscopic imaging methods are providing higher-quality results and reducing the incidence and mortality of the disease...
July 2015: Gastroenterology & Hepatology
Claus Bachert, Leda Mannent, Robert M Naclerio, Joaquim Mullol, Berrylin J Ferguson, Philippe Gevaert, Peter Hellings, Lixia Jiao, Lin Wang, Robert R Evans, Gianluca Pirozzi, Neil M Graham, Brian Swanson, Jennifer D Hamilton, Allen Radin, Namita A Gandhi, Neil Stahl, George D Yancopoulos, E Rand Sutherland
IMPORTANCE: Dupilumab has demonstrated efficacy in patients with asthma and atopic dermatitis, which are both type 2 helper T-cell-mediated diseases. OBJECTIVE: To assess inhibition of interleukins 4 and 13 with dupilumab in patients with chronic sinusitis and nasal polyposis. DESIGN, SETTING, AND PARTICIPANTS: A randomized, double-blind, placebo-controlled parallel-group study conducted at 13 sites in the United States and Europe between August 2013 and August 2014 in 60 adults with chronic sinusitis and nasal polyposis refractory to intranasal corticosteroids with 16 weeks of follow-up...
February 2, 2016: JAMA: the Journal of the American Medical Association
Sebastian Schostek, Melanie Zimmermann, Jan Keller, Mario Fode, Michael Melbert, Marc O Schurr, Thomas Gottwald, Ruediger L Prosst
Acute upper gastrointestinal bleedings from ulcers or esophago-gastric varices are life threatening medical conditions which require immediate endoscopic therapy. Despite successful endoscopic hemostasis, there is a significant risk of rebleeding often requiring close surveillance of these patients in the intensive care unit (ICU). Any time delay to recognize bleeding may lead to a high blood loss and increases the risk of death. A novel telemetric real-time bleeding sensor can help indicate blood in the stomach: the sensor is swallowed to detect active bleeding or is anchored endoscopically on the gastrointestinal wall close to the potential bleeding source...
April 15, 2016: Biosensors & Bioelectronics
Amar M Wahid, Kalyaan Devarajan, Alexander Ross, Matthias Zilbauer, Robert Heuschkel
OBJECTIVE: Gastrointestinal endoscopy is an invasive procedure used to diagnose and/or treat diseases of the gut. As with any invasive procedure, there is a small risk for complications, and it is therefore important that due consideration be taken when reviewing the indications for endoscopy, particularly in children. Despite this, there remains a wide variation nationally in clinical practice among paediatric gastroenterologists. In the absence of a standard, we critically reviewed current endoscopy practice at Addenbrooke's Hospital with the aim of creating robust measures that could be used to achieve and maintain an efficient, high-quality paediatric endoscopy service...
January 2016: European Journal of Gastroenterology & Hepatology
Ian M Gralnek, Jean-Marc Dumonceau, Ernst J Kuipers, Angel Lanas, David S Sanders, Matthew Kurien, Gianluca Rotondano, Tomas Hucl, Mario Dinis-Ribeiro, Riccardo Marmo, Istvan Racz, Alberto Arezzo, Ralf-Thorsten Hoffmann, Gilles Lesur, Roberto de Franchis, Lars Aabakken, Andrew Veitch, Franco Radaelli, Paulo Salgueiro, Ricardo Cardoso, Luís Maia, Angelo Zullo, Livio Cipolletta, Cesare Hassan
This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It addresses the diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH). Main Recommendations MR1. ESGE recommends immediate assessment of hemodynamic status in patients who present with acute upper gastrointestinal hemorrhage (UGIH), with prompt intravascular volume replacement initially using crystalloid fluids if hemodynamic instability exists (strong recommendation, moderate quality evidence)...
October 2015: Endoscopy
James H Tabibian, Ju Dong Yang, Todd H Baron, Sunanda V Kane, Felicity B Enders, Christopher J Gostout
BACKGROUND: Acute cholangitis (AC) requires prompt diagnosis and treatment for optimal management. AIMS: To examine whether a putative "weekend effect" impact outcomes of patients hospitalized for AC. METHODS: We conducted a retrospective study of patients admitted with AC between 2009 and 2012. After excluding those not meeting Tokyo consensus criteria for AC, the cohort was categorized into weekend (Saturday-Sunday) and weekday (Monday-Friday) hospital admission and endoscopic retrograde cholangiography (ERC) groups...
January 2016: Digestive Diseases and Sciences
Rym Ennaifer, Nour Elleuch, Safa Sabbagh, Hayfa Romdhane, Rania Hefaiedh, Houda Ben Nejma, Najet Belhadj
BACKGROUND: Colonoscopy is a powerful tool for prevention and early diagnosis of colorectal cancer. However, the effectiveness of colonoscopy is dependent on the quality of the procedure, which is assessed by a number of key quality indicators. Among them, cecal intubation and adenoma detection rate are historically the most commonly used indicators of quality of colonoscopy. The aim of our study was to evaluate these two indicators of quality of colonoscopy in a Tunisian endoscopy center...
March 2015: La Tunisie Médicale
Otto S Lin, Danielle La Selva, Jae-Myung Cha, Michael Gluck, Andrew Ross, Michael Chiorean, Richard A Kozarek
BACKGROUND: Endoscopic documentation software can generate research data on large numbers of subjects automatically. There are increasing numbers of published studies based on endoscopic databases such as the Clinical Outcomes Research Initiative. However, no study has yet validated such data. We compared colonoscopic findings reported by an endoscopic documentation software (Provation) against manually collected medical records data from two similar patient cohorts in the same endoscopy unit...
April 2016: Surgical Endoscopy
Yaron Niv, Gabriela Moeslein, Hans F A Vasen, Judith Karner-Hanusch, Jan Lubinsky, Christoph Gasche
Lynch syndrome (LS) accounts for 2 - 4 % of all colorectal cancers. Affected family members have a germline mutation in one of the DNA mismatch repair genes MLH1, PMS2, MSH2, or MSH6, and a lifetime risk for development of colorectal cancer of 25 - 75 %. Current guidelines recommend annual to biannual surveillance colonoscopy in mutation carriers. Several factors may predict failure to prevent interval cancer in LS: more lesions in the right colon; more flat ("non polypoid") and lateral growing polyps; small adenomas may already harbor high grade dysplasia or a high percentage of villous component and become advanced adenomas; there is a short duration of the adenoma - carcinoma sequence; synchronous lesions have high prevalence; patients are younger and less tolerant to colonoscopy (need more sedation); and repeated colonoscopies are needed for lifelong surveillance (patient experience is important for compliance)...
December 2014: Endoscopy International Open
Gyanprakash A Ketwaroo, Mandeep S Sawhney
PURPOSE OF REVIEW: Approximately 14 million colonoscopies are performed annually in the United States making this the most common gastrointestinal endoscopic procedure. Although the demand for colonoscopy remains strong, improvements in fecal DNA technology and computed tomography colonography now compete with colonoscopy as viable colon cancer screening alternatives. Increasing costs of providing healthcare have renewed the focus on the value of medical services. For colonoscopy to remain the dominant colon cancer screening strategy, it is imperative that we continue to measure and improve the quality of colonoscopy...
January 2015: Current Opinion in Gastroenterology
Marty Zdichavsky, Andreas Schmidt, Tobias Luithle, Sebastian Manncke, Jörg Fuchs
BACKGROUND: Laparoscopic procedures for children and adults already provide many advantages in two-dimensional (2D) vision. Only limited experiences exist for laparoscopic three-dimensional (3D) procedures in vivo. The aim of this prospective trial was to identify indications and limitations of the 3D-system in laparoscopic minimally invasive procedures in children and adults. MATERIAL AND METHODS: In a prospective quality assurance for laparoscopic 3D evaluation in children and adults, a total of 53 consecutive patients (22 children, 31 adults) were included...
June 2015: Minimally Invasive Therapy & Allied Technologies: MITAT
Paula M Buchanan, Jennifer R Kramer, Hashem B El-Serag, Steven M Asch, Youssef Assioun, Bruce R Bacon, Fasiha Kanwal
OBJECTIVES: Practice guidelines define the criteria and standards of care in patients with cirrhosis and varices. However, the extent to which the patients receive recommended care is largely unknown. We evaluated the quality of varices related care and factors associated with receipt of such care. METHODS: We conducted a retrospective cohort study of 550 patients with cirrhosis who sought care at three VA facilities between 2000 and 2007. Using administrative and clinical data, we assessed quality of varices care as measured by eight explicit Delphi panel-derived quality indicators...
July 2014: American Journal of Gastroenterology
Kerry B Dunbar, Stuart Jon Spechler
Barrett esophagus develops when metaplastic columnar epithelium predisposed to develop adenocarcinoma replaces esophageal squamous epithelium damaged by gastroesophageal reflux disease. Although several types of columnar metaplasia have been described in Barrett esophagus, intestinal metaplasia with goblet cells currently is required for a definitive diagnosis in the United States. Studies indicate that the risk of adenocarcinoma for patients with nondysplastic Barrett esophagus is only 0.12% to 0.38% per year, which is substantially lower than previous studies had suggested...
July 2014: Mayo Clinic Proceedings
Catherine Rongey, Hui Shen, Nathan Hamilton, Lisa I Backus, Steve M Asch, Sara Knight
BACKGROUND: Specialist physician concentration in urban areas can affect access and quality of care for rural patients. As effective drug treatment for hepatitis C (HCV) becomes increasingly available, the extent to which rural patients needing HCV specialists face access or quality deficits is unknown. We sought to determine the influence of rural residency on access to HCV specialists and quality of liver care. METHODS: The study used a national cohort of 151,965 Veterans Health Administration (VHA) patients with HCV starting in 2005 and followed to 2009...
2013: PloS One
Therdkiat Trongwongsa, Jantima Tanboon, Akarin Nimmannit, Ananya Pongpaibul
OBJECTIVE: Histologic diagnostic foci on GI mucosal biopsy may be patchy. Therefore, slides with good orientation of mucosal tissue in a perpendicular plane and demonstrating an entire layer of mucosa will increase the diagnostic yield. Department of Pathology Faculty of Medicine Siriraj Hospital has launched the two steps quality improvement program and a parallel research aiming to demonstrate the importance of tissue orientation of GI biopsy. MATERIAL AND METHOD: Step 1: quality improvement was introduced at the pathology laboratory...
October 2013: Journal of the Medical Association of Thailand, Chotmaihet Thangphaet
William W Hope, William Richardson, Robert Fanelli, Dimitrios Stefanidis
BACKGROUND: The development of practice guidelines should take into consideration the opinions of end users. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) has implemented several changes in its guideline development and dissemination process based on previous end-user input. METHODS: An anonymous electronic survey was conducted via e-mail solicitation in September 2011. Respondents were asked to submit their feedback on the 26 guidelines produced by our society using a 32-item questionnaire and to suggest topics for new guideline development and areas of improvement...
April 2014: Surgical Endoscopy
Oriol Domenech, Pedro Oliveira
Transoesophageal echocardiography (TEE) allows imaging of the heart through the oesophagus using a special transducer mounted on a modified endoscope. The proximity to the heart and minimal intervening structures enables the acquisition of high-resolution images that are consistently superior to routine transthoracic echocardiography and optimal imaging of the heart base anatomy and related structures. TEE provides high-quality real-time imaging free of ionizing radiation, making it an ideal instrument not only for diagnostic purposes, but also for monitoring surgical or minimally invasive cardiac procedures, non-cardiac procedures and critical cases in the intensive care unit...
November 2013: Veterinary Journal
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