Background and Aim
Dye‐based chromoendoscopy (DCE) with targeted biopsies is recommended for inflammatory bowel disease (IBD) surveillance. However, DCE has not yet been widely adopted into clinical ...practice. We evaluated quality indicators in IBD surveillance following introduction of structured changes in service delivery.
Methods
In August 2016, we introduced a number of changes to IBD surveillance practice in our endoscopy unit. These included training using interactive videos/images in a structured module, DCE as standard by using a foot‐pedal operated pump jet, allocation of 45‐minute procedure timeslots, targeted biopsies (except in high‐risk patients), scoring of endoscopic disease activity, and lesion detection/morphology characterization. All IBD surveillance colonoscopies were allocated to a small team of four DCE‐trained endoscopists. We compared quality measures for surveillance procedures carried out pre‐ and post‐August 2016. The two groups were compared using chi‐squared statistics
Results
A total of 598 IBD surveillance procedures (277 pre‐August 2016 and 321 post‐August 2016) were done and included in the study. Use of DCE increased (54.2% vs 76.0% P < 0.0005) whereas random biopsy surveillance decreased (12.3% vs 3.1% P < 0.0005). Use of Paris classification (26.1% vs 57.0% P < 0.0005) and Kudo pit pattern increased (21.7% vs 59.0% P < 0.0005). There was also an increase in lesion detection rate (24.9% vs 33.1% P < 0.05).
Conclusions
Implementation of extensive changes in practice of surveillance colonoscopy resulted in significant improvement in quality indicators within a short period of time. Training, education and audit may continue to facilitate the adoption of DCE and further improve quality of performance in IBD surveillance.
Loss of Estrogen Inactivation in Colonic Cancer English, Mark A; Kane, Kate F; Cruickshank, Neil ...
The journal of clinical endocrinology and metabolism,
06/1999, Letnik:
84, Številka:
6
Journal Article
Recenzirano
Odprti dostop
Age and sex differences in the incidence of colonic cancer, together
with epidemiological data on patients taking hormone replacement
therapy, suggest the involvement of estrogens. Analogous to the
...role of aromatase in breast cancer, we postulated that steroid
metabolism within the colon itself may be a crucial mechanism in
regulating tissue exposure to estrogens. We have characterized
expression of aromatase (responsible for converting C19
androgens to C18 estrogens) and 17β-hydroxysteroid
dehydrogenase (17β-HSD) responsible for interconversion of active
estradiol (E2) to less potent estrone (E1) in
normal and neoplastic human colon from 24 patients undergoing tumor
resection. Aromatase activity was similar in homogenates from normal
mucosa, tissue adjacent to tumors, and the tumors themselves. Analysis
of 17β-HSD activity indicated that the predominant activity was
oxidative (E2 to E1), and this conversion was
significantly lower in colonic tumors 444 (90–1735); median (95%
confidence interval) pmol/mg protein·h, compared with normal mucosa
1709 (415–13828), P < 0.001. Northern blot
analyses indicated expression of messenger RNAs (mRNAs) for the type 2
and 4 isozymes of 17β-HSD in normal colon; messenger RNA for
17β-HSD 4 was significantly lower in tumor tissue 0.75 ± 0.22
(mean ± sd) arbitrary U vs. 0.43±
0.17, P < 0.01. Studies in
vitro, using three colonic cancer cell lines, indicated that
there was an inverse correlation between 17β-HSD oxidative activity
and the rate of cell proliferation. In addition, E1, but
not E2, was shown to significantly decrease proliferation
when added exogenously to the colonic epithelial cell line, SW620
cells. Colonic mucosa can regulate estrogen hormone action in an
intracrine fashion. The loss of estrogen inactivation may be an
important mechanism in the pathogenesis of colonic cancer.
Introduction: In the management of dysphagic stroke patients, percutaneous endoscopic gastrostomies (PEGs) are frequently sited early due to the failure of nasogastric tube (NGT) feeding, with NGTs ...becoming displaced in over 58% of cases. PEG insertion is a procedure with significant mortality and morbidity. We adapted a novel technique of securing NGTs (a nasal loop) which is non-invasive, allows successful NG feeding and may avoid the need for PEG placement.
Aims: To show that nasal loops result in improved delivery of enteral nutrition. To compare the outcome and complication rate of nasal loop fed patients with those undergoing PEG feeding.
Methods: A 6 month prospective audit of dysphagic stroke patients who were referred for PEG. All patients who were referred with failed NG feeding within 28 days of presentation were offered a nasal loop. Patients who were 28 days post-stroke had a PEG placed if appropriate. The daily feed intake was monitored before and after nasal loop placement. Complication rates and patient outcomes were documented at 2 week and 3 month follow-up.
Results: Nasal loop group: 14 patients had a nasal loop for a median of 15 days. The median daily feed provided was 0% before nasal loop and 100% after. Four patients went on to recover normal swallowing, 4 patients died and 6 later proceeded to PEG.
PEG group: Seven patients proceeded direct to PEG, 1 died and 6 were alive and PEG fed at 3 months. There were 6 complications from PEG insertion. No patients recovered normal swallowing.
Conclusions:
1.
Nasal loops are safe, well tolerated, and effective at delivering full enteral nutrition.
2.
Nasal loops allow time for patients who may recover normal swallowing to do so, and thus avoid a PEG.
3.
Nasal loops avoid unnecessary PEG insertion in those with a poor prognosis who will not ultimately survive their initial stroke.
Gender differences in culture are usually visible around food. In fast food advertising we can see some of those differences played out as fantasies of consumption. How fast food advertising mediates ...the real experience of taking a meal, and what that says for symbolic constructions of the body is the subject of this essay. A McDonald's commercial is a text rich in cultural information. I shall argue that McDonald's positions itself as the new Mother in a social order determined by the conditions of contemporary American culture.
There is a growing momentum in paediatric ethics to develop respectful research and healthcare protocols. We developed, tested and refined our 'Respectful Approach to Child-centred Healthcare' ...(ReACH), to underpin respectful participant interactions in a clinical trial.
To determine whether a ReACH-based approach is acceptable to children and parents, and effective in obtaining compliance with common healthcare assessments in a clinical trial of healthy 4-6-year-old children.
ReACH-based child assessments were evaluated at two baseline clinics and one post-intervention, using mixed methods. Children (n = 49; 46.9% female; mean age = 5.24±0.88 years at baseline) and their parents provided independent evaluation, via customised 5-point Likert scales and qualitative feedback. A dedicated child researcher evaluated adherence to the study ReACH principles.
Children achieved compliance rates of 95% for body composition (BodPod) assessments; 89% for blood pressure measurements, and 92% (baseline) and 87% (post-intervention) for blood draws. Adherence to ReACH principles during clinic visits was positively associated with child compliance, significantly for baseline BodPod (p = 0.002) and blood test (p = 0.009) clinics. Satisfaction with BodPod protocols was positively associated with compliance, for children at baseline (p = 0.029) and for parents post-intervention (p <0.001). Parents rated the study itself very highly, with 91.7% satisfied at baseline and 100% post-intervention. Qualitative feedback reflected an enjoyable study experience for both parents and children.
Adherence to our emerging ReACH approach was associated with high child compliance rates for common healthcare assessments, although no causality can be inferred at this preliminary stage of development. Participants expressed satisfaction with all aspects of the study. Our use of child-centred methods throughout a research intervention appears feasible and acceptable to children and their parents.
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