Gastrointestinal endoscopy is an integral tool in the evaluation and management of many gastrointestinal and hepatobiliary conditions. Although rare, media reports of infectious complications ...following gastrointestinal endoscopy persist in this new millennium. With only limited data available, society guidelines continue to suggest that endoscopes undergo a reprocessing cycle before the first patient of the day. This preliminary study aimed to assess the microbiological stability of gastrointestinal endoscopes after high-level disinfection.
In this multiphase study, four endoscopic retrograde cholangiopancreatography (ERCP) scopes and three colonoscopes were evaluated. In phase 1, endoscopes were assayed after initial high-level disinfection and daily for a period of 2 weeks. In phase 2, this procedure was repeated to confirm phase 1 results. In phase 3, endoscopes were assayed after high-level disinfection and again following a 7-day storage period.
In phase 1, 6 of 70 (8.6 %) assays were positive. This involved 4 of 7 (57 %) endoscopes (2 colonoscopes and 2 ERCP scopes) and was limited to the first 5 days of the study. No cultures were positive in phase 2. In phase 3, one endoscope had a positive culture. Positive cultures grew only STAPHYLOCOCCUS EPIDERMIDIS, a low-virulence skin organism.
With proper disinfection and storage, it appears that reprocessing of gastrointestinal endoscopes is unnecessary after periods of disuse of at least 7 days and possibly up to 2 weeks. Despite recent media reports of infectious complications, society guidelines that recommend more frequent reprocessing seem to lack scientific merit and need to be revisited.
Background: Traditional narrative operative reports have historically been of poor quality. Synoptic operative reporting has been utilized as an effective and efficient communication tool. For ...patients with rectal cancer, synoptic reports are required for pathology, radiology and major oncologic resections but have never previously been developed for transanal endoscopic surgery (TES). The objective of this study was to develop consensus-derived quality indicators (QIs) for TES reports. Methods: An online Delphi protocol was used. Colorectal surgeons and other key physician stakeholders across Canada were recruited to participate via a secure web-based platform. Delphi participants were asked to submit potential QIs according to 6 reporting themes proposed by the study authors, based on thorough literature review. The initial QIs were recirculated to participants and rated on 9-point Likert scales. Scores of 70% or greater were used for inclusion consensus, and scores of 30% or less denoted exclusion. Elements scoring 30% to 70% were recirculated by runoff in a subsequent round to generate the final list. Results: Fifteen physicians consented to participate, including 7 academic and 2 community colorectal surgeons, a surgical oncologist, a general surgeon with expertise in synoptic operative reporting, 2 gastrointestinal pathologists, an abdominal radiologist and a radiation oncologist. Round 1 achieved 100% (15/15) response and identified 79 potential QIs for consideration. Round 2 had an 87% (13/15) response, with 61 of the 79 proposed items reaching consensus for inclusion. Round 3 achieved a 93% (14/15) response. Sixty-seven items reached final inclusion. Conclusion: This study is the first to establish multidisciplinary, consensus-derived QIs for TES reports. This will allow generation of a synoptic reporting template to improve perioperative communication for these patients.
Background: Discharging patients on postoperative day 1 has become common for bariatric surgery over recent years because of the increase in severe obesity. However, limited data are available to ...identify which patients require a longer hospital stay after surgery. The aim of this study is to build a prediction model to identify prolonged hospital stay following bariatric surgery. Methods: A retrospective chart review was performed between January 2012 and October 2017. Patients' age, sex, preoperative weight, body mass index (BMI), medication (narcotics, gabapentin and anticoagulant) and comorbidities (hypertension, coronary artery disease, type 1 or 2 diabetes mellitus T1DM, T2DM, chronic obstructive pulmonary disease, asthma, obstructive sleep apnea OSA, chronic kidney disease CKD, gastroesophageal reflux disease GERD, dyslipidemia and chronic pain) and delayed outcome were recorded. Prediction analysis was performed. Cross-validation (CV) was used to assess the generalizability of the model. CV error was used to choose the best predictor set. Results: A total of 539 charts were reviewed. The model best predicts prolonged hospital stay with a combined CV error of 0.1545. The CV errors with an additional variable were asthma (0.1590), weight (0.1578), GERD (0.1574), gabapentin (0.1567), BMI (0.1561), anticoagulation (0.1552), chronic pain (0.1550), OSA (0.1547), dyslipidemia (0.1547), CKD (0.1547) and T2DM (0.1545). Conclusion: A prediction model including preoperative BMI, comorbidities and medications is generated from this study. It could be applied to predict prolonged patient stay following bariatric surgery. It has the potential to reduce costs, increase quality of care and meet the growing demand for bariatric surgery.
Background: Procedural simulation has been shown to enhance early endoscopy training. In this proof of concept study, we aimed to show that a first-person shooter (FPS) video game with a novel ...in-house designed modified endoscope controller shares similar constructs with real-life endoscopy. Methods: A nonfunctioning colonoscope was fashioned to a wooden platform and suspended over a sensor connected to a computer. Customized software translated the colonoscope's movements into computer input. Participants completed the first three levels on an FPS video game, Portal (Valve Corporation), first using conventional mouse and keyboard controls and then using the novel endoscope controller. Twelve expert endoscopists and 12 surgical residents with minimal endoscopy experience participated. Participants were evaluated on the basis of completion time, number of button presses, and hand motion analyses. Results: Experts outperformed novices for time to study completion (expert 944 s, novice 1515 s; p = 0.006) and number of hand movements (expert 1263.1 s, novice 2052.6 s; p = 0.004) using the novel colonoscope controller. There was no difference in number of button presses or total path length travelled. Self-reported number of past endoscopies was moderately linearly correlated with time to game completion (r = -0.493, p = 0.020) and total hand movements (r = -0.462, p = 0.030). Novices and experts did not statistically differ while using the conventional video game controls. Conclusion: Experts outperformed novices using the endoscope controller but not the conventional game controller with respect to economy of movement and completion time. This result confirms that our endoscope-controlled video game shares similar constructs with real-life endoscopy and serves as a first step toward creating a more enjoyable and cheaper alternative to commercially available endoscopy simulators.
Background: Repeat preoperative endoscopy is common for patients with colorectal neoplasms. This can result in treatment delays and risks of colonoscopy-related complications. Repeat preoperative ...endoscopy has been attributed to poor communication between endoscopists and surgeons. In January 2019, mandatory electronic synoptic reporting for endoscopy was implemented to include elements consistent with quality indicators proposed in national guidelines. The aim of the present study is to assess whether the repeat preoperative endoscopy rate for colorectal lesions changed following synoptic report implementation. Methods: A retrospective review was performed of all patients who underwent elective surgical resection for colorectal neoplasms from January 2007 to June 2020 at a tertiary hospital in Canada. Patients who had an index endoscopy documented via synoptic report were compared with those reported via narrative report. Primary outcomes were rates of repeat preoperative endoscopy and inclusion of colonoscopy quality indicators (e.g., photo-documentation, tattoo placement and bowel preparation score). A total of 1429 patients who underwent elective colorectal resection for colorectal cancers or polyps between January 2007 and June 2020 were included. Of these, 115 had index endoscopies recorded via synoptic report and 1314 by narrative report. The repeat preoperative endoscopy rate after endoscopies documented by narrative report was 29.1% (95% confidence interval CI 26.6%-31.6%) and 25.2% (95% CI 17.6%-34.2%) for synoptic report. Patients whose index endoscopies where performed by a practitioner other than their operating surgeon had a re-endoscopy rate of 36.0% (95% CI 32.8%-39.3%) after narrative report and 38.8% (95% CI 27.1%-51.5%) for synoptic report. Rates of tattoo placement, photo-documentation and reporting of bowel preparation quality were all significantly increased with synoptic reports (p ≤ 0.003). Conclusion: Endoscopy synoptic reports based on current guidelines were not associated with a decrease in rates of repeat preoperative endoscopy at a high-volume colorectal cancer centre. Future study should examine synoptic report contents for this purpose and make necessary modifications.
Background: Obesity and type 2 diabetes mellitus (T2DM) are growing global health concerns and Canada's Indigenous population is at higher lifetime risk of both. Obesity increases the risk for ...insulin resistance, T2DM, cardiovascular disease and all-cause mortality. Bariatric surgery is an effective method for improvement or cure of all obesity-related comorbidities, including T2DM. The objective of this scoping review was to interrogate the literature and explore the experiences and outcomes of Indigenous people undergoing bariatric surgery. Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews (PRISMA-ScR) guidelines, we conducted a search of Medline, Scopus, CINAHL and Embase. Two independent reviewers identified all studies exploring the experiences and outcomes of Indigenous patients undergoing bariatric surgery. Included quantitative and qualitative data were evaluated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) and Critical Appraisal Skills Programme (CASP) approaches, respectively. Results: A total of 92 articles were returned in our search. Thirteen articles were included in our analysis: 4 qualitative studies and 9 quantitative studies. Substantial heterogeneity precluded pooled analysis. Analysis of quantitative data revealed that Indigenous patients underwent fewer bariatric procedures, had poorer clinic attendance (both preoperative and postoperative), similar weight loss outcomes and slightly higher postoperative complication rates. Qualitative data analysis revealed that obese Indigenous patients have a strong desire to improve their health and quality of life with bariatric surgery. Family is a very important support mechanism and motivator for pursuing bariatric surgery; however, nonsurgeon bariatric pathway supports for Indigenous patients are lacking. Conclusion: There is a paucity of literature examining the experiences or outcomes of Indigenous patients undergoing bariatric surgery. Existing literature appears to suggest inequity in access to bariatric surgery for Indigenous patients despite strong motivators for pursuing surgery. To identify and address the gaps in access and health outcomes for Indigenous peoples, more research needs to be conducted in this area.
Equipment which measure femorotibial motions indirectly by using a patellar pad are reported to have errors caused by deformation of soft tissues and slippage of the device. For the purpose of ...validation, the tibial translation in relation to the femur per degree of knee extension was estimated from the slope coefficients of the flexion‐displacement curve, obtained by both fluoroscopic and electrogoniometric tests, in the knee of the dominant limb in healthy subjects and in both knees of patients with unilateral anterior cruciate ligament (ACL) deficiency. In addition, the anterior and posterior static knee laxity limits and the tibial resting position were evaluated. Within all knee groups, the tibia moved posteriorly in relation to the femur during extension. The measured movement was similar both with the electrogoniometer and with fluoroscopy thereby indicating that sagittal plane knee translation measurements with the CA‐4000 electrogoniometer are reliable and in good agreement with the X‐ray measurements, even though the measurements were made separately. The ACL injured knees showed approximately 20% smaller posterior movement of tibia in relation to femur per degree change of knee extension than the non‐injured or control knees (p < 0.05) and a more anterior resting position of the tibia relative to femur as compared to the contralateral healthy knee during knee laxity testing (p = 0.002).
Methods: This is a prospective cross-sectional study involving all internal medicine residents at the University of Illinois College of Medicine at Chicago (n=142) were eligible for enrollment. The ...delta of scores across the individual interventions were as follows: LS showed 17.7% improvement (p-value =<0.001, Z-value -3.58) SS showed 21.4% improvement (p-value =<0.001, Z-value -4.33) The mean + SD numerical scores given to the statement "I feel comfortable managing a rapid response," were as follows: LS group: pre-lecture score was 2.52 ± 0.73 versus post-lecture of 3.07± 0.80 (Z-value = -1.4676; not a statistically significant improvement).
