Comparing the Safety and Efficacy of Two Commercially Available Single-Use Duodenoscopes: A Multicenter Study.

INTRODUCTION: Single-use disposable duodenoscopes (SDD) have been developed to mitigate infectious risks related to reusable duodenoscopes. The aim of this study is to compare the safety and efficacy of the two available SDDs in the United States. METHODS: We conducted a comparative study of 2 SDD in consecutive ERCP procedures performed by expert endoscopists from 9 academic centers. Performance ratings, procedure details, and adverse events were collected. RESULTS: A total of 201 patients were included: 129 patients underwent ERCP with Exalt (mean age 63, Males- 66 (51%), 72 with aScope Duodeno (mean age 65, males=30 (42%). A majority of endoscopists had performed >2000 ERCPs in both groups (71% Exalt, 93% aScope Duodeno). Technical success was 92% in both groups (n=119 Exalt-group, n=66 aScope-Duodeno-group). The procedural complexity for the ERCP cases performed were: Grade 1: 35 cases (18%), Grade 2: 83 cases (41%), Grade 3: 65 cases (32%), and Grade 4: 18 cases (9%). Thirteen patients (10%) from the Exalt group and 16 patients (22%) from the aScope Duodeno group required conversion to a reusable duodenoscope. On a scale of 1 to 5, Exalt and aScope Duodeno, respectively, were rated: 2.31 versus 2.60 for location and visualization quality, 1.38 versus 1.57 for maneuverability based on papillary orientation, 1.48 versus 1.15 for suction/air control, and 2.31 versus 2.34 for elevator efficiency. None of the adverse events were related to the SDDs. CONCLUSIONS: The 2 SDDs were comparable. Further ongoing enhancements to these devices will improve maneuverability and clinical effectiveness.

A pediatric virtual care evaluation framework and its evolution using consensus methods.

BACKGROUND: The use of virtual care has increased dramatically in response to the COVID-19 pandemic, yet evidence is lacking regarding the impact of virtual care on patient outcomes, particularly in pediatrics. A standardized evaluation approach is required to support the integration of virtual care into pediatric health care delivery programs. The objective of this work was to develop a comprehensive and structured framework for pediatric virtual care evaluation. This framework is intended to engage and guide care providers, health centres, and stakeholders towards the development of a standardized approach to the evaluation of pediatric virtual care. METHODS: We brought together a diverse multidisciplinary team, including pediatric clinicians, researchers, digital health leads and analysts, program leaders, a human factors engineer, a family advisor and our manager of health equity and diversity. The team reviewed the literature, including published evaluation frameworks, and used a consensus-based method to develop a virtual care evaluation framework applicable to a broad spectrum of pediatric virtual care programs. We used an iterative process to develop framework components, including domains and sub-domains, examples of evaluation questions, measures, and data sources. Team members met repeatedly over seven months to generate and provide feedback on all components of the framework, making revision as needed until consensus was reached. The framework was then applied to an existing virtual care program. RESULTS: The resulting framework includes four domains (health outcomes, health delivery, individual experience, and program implementation) and 19 sub-domains designed to support the development and evaluation of pediatric virtual care programs. We also developed guidance on how to use the framework and illustrate its utility by applying it to an existing pediatric virtual care program. CONCLUSIONS: This virtual care evaluation framework expands on previously developed frameworks by providing additional detail and a structure that supports practical application. It can be used to evaluate a wide range of pediatric virtual care programs in a standardized manner. Use of this comprehensive yet easy to use evaluation framework will inform appropriate implementation and integration of virtual care into routine practice and support its sustainability and continuous improvement.

Ovarian hyperstimulation syndrome prevention strategies: reducing the human chorionic gonadotropin trigger dose.

This article reviews the biological plausibility and evidence for the use of a low triggering dose of human chorionic gonadotropin (hCG) in the prevention of ovarian hyperstimulation syndrome (OHSS). A systematic search of the literature revealed very little published data for or against the use of low-dose hCG in the prevention of OHSS after assisted reproductive technology. We have had success at avoiding OHSS as a result of gentle stimulation and low-dose sliding scale hCG trigger based on estradiol (E2) levels. We therefore present the biological plausibility for such an approach by reviewing the relationship between OHSS, vascular endothelial growth factor, and hCG; the physiology of hCG; the relationship between risk of OHSS and E2 at trigger; and the physiology of alternative methods of triggering such as recombinant luteinizing hormone and gonadotropin-releasing hormone agonist. We also present the results of a quasi-experimental before and after study of the sliding scale protocol for hCG trigger dose in in vitro fertilization with or without intracytoplasmic sperm injection cycles.

Effects of modifying physical activity and sedentary behavior on psychosocial adjustment in overweight/obese children.

OBJECTIVES: To evaluate the relationship between changes in physical activity (PA), sedentary behavior, and physical self-perceptions and global self-worth in 30, 8-12 years old, overweight/obese children (13 boys, 17 girls). METHODS: Secondary analyses from a randomized controlled trial designed to increase PA and reduce sedentary behavior. PA was measured by accelerometers worn by participants every day for 8 weeks. Sedentary behavior, defined as minutes per day spent in television viewing, was assessed by self-report. RESULTS: Increases in PA were associated with increases in perceived physical conditioning (r = .54, p < .01), body satisfaction (r = .55, p < .01), and overall physical self-worth (r = .44, p < .05) independent of changes in body mass index (BMI). Reductions in TV viewing were also related to increased physical and global self-worth. CONCLUSIONS: Increases in PA are associated with improvements in physical self-perceptions but not global self-worth, while reductions in TV viewing are associated with increased physical and global self-worth, and these psychosocial benefits appear to be independent of changes in adiposity.

Effects of open-loop feedback on physical activity and television viewing in overweight and obese children: a randomized, controlled trial.

OBJECTIVES: Television viewing and physical inactivity increase the risk of obesity in youth. Thus, identifying new interventions that increase physical activity and reduce television viewing would be helpful in the prevention and treatment of pediatric obesity. This study evaluated the effects of open-loop feedback plus reinforcement versus open-loop feedback alone on physical activity, targeted sedentary behavior, body composition, and energy intake in youth. METHODS: Thirty overweight or obese 8- to 12-year-old children were randomly assigned to an intervention (n = 14) or control group (n = 16). Participants wore accelerometers every day for 8 weeks and attended biweekly meetings to download the activity monitors. For children in the open-loop feedback plus reinforcement (intervention) group, accumulating 400 counts of physical activity on pedometers earned 1 hour of television/VCR/DVD time, which was controlled by a Token TV electronic device. Open-loop feedback control subjects wore activity monitors but had free access to targeted sedentary behavior. RESULTS: Compared with controls, the open-loop feedback plus reinforcement group demonstrated significantly greater increases in daily physical activity counts (+65% vs +16%) and minutes per day of moderate-to-vigorous physical activity (+9.4 vs +0.3) and greater reductions in minutes per day spent in television viewing (-116.1 vs +14.3). The intervention group also showed more favorable changes in body composition, dietary fat intake, and energy intake from snacks compared with controls. Reductions in sedentary behavior were directly related to reductions in BMI, fat intake, snack intake, and snack intake while watching television. CONCLUSIONS: Providing feedback of physical activity in combination with reinforcing physical activity with sedentary behavior is a simple method of modifying the home environment that may play an important role in treating and preventing child obesity.