Continuous ADR50 monitoring through automated linkage between endoscopy and pathology: a quality improvement initiative in a Brussels public hospital.

Background and study aim: Adenoma detection rate in patients aged 50 years or older (ADR50) is considered by the European Society of Gastrointestinal Endoscopy (ESGE) a key performance measures for lower gastrointestinal endoscopy. Technical and human resources constrain implementation of recording quality monitoring. The aim was to deploy an infrastructure for continuous monitoring of endoscopy quality indicators. And to evaluate its potential benefit on quality performance. Methods: A company reporting system was adapted by adding a dedicated tab for quality monitoring, including: preparation, progression, number of resected polyps. Automated linkage with the pathology database resulted in continuous monitoring of inter alia: rate of adequate bowel preparation, cecal intubation rate and ADR50. Continuous monitoring was done for all nine endoscopists working at our center, with individual feedback after 4, 9 and 28 months. Results: A total of 1434 colonoscopies were performed during the first 9 months of monitoring, 682 during the first 4 months, 752 during the following 5 months. Five months after feedback a global increase in ADR50 of 4.6% (22.9% to 27.5%) (P<0.05) was observed, compared to the first 4 months. Thus meeting the benchmark (≥25%) recommended by ESGE. A durable effect of monitoring and feedback was observed after 28 months (ADR50: 29.4%). Conclusions: An easy to use infrastructure for registration of quality monitoring in daily endoscopy practice, automatically linking the pathology database, facilitates continuous monitoring of endoscopy quality indicators. A global and durable ADR50 increase was observed after feedback, considered a quality improvement in performance of lower gastrointestinal endoscopy at our center.

[Experimental paratuberculosis in sheep after intravenous or oral inoculation: pathogenicity and biologic diagnosis]. / Paratuberculose expérimentale chez le mouton après inoculation par voie veineuse ou par voie orale: pouvoir pathogène et diagnostic biologique.

An experimental paratuberculosis study was performed in sheep. One group of 6 lambs was inoculated intravenously with the equivalent of 50 mg (wet weight) of live bacilli, another group of 6 lambs was inoculated orally by placing 500 mg (wet weight) of live organisms in milk feed and a group of 3 lambs was used as controls. The degree of cellular immunity was followed by examining delayed hypersensitivity using 3 allergens (bovine tuberculin PPD, avian tuberculin PPD and johnine PPD) and that of humoral immunity using complement fixation test, agar gel immunodiffusion test and ELISA. The elimination of bacilli in the faeces was examined simultaneously. After 2 years no macroscopic or microscopic lesion was observed in intravenously inoculated lambs and in those exposed orally to M paratuberculosis; cultures were negative. It appears that domestic sheep were able to control the infection. Nevertheless, most of them developed cellular and humoral immunity against paratuberculosis antigen. The best results were obtained in intravenously inoculated lambs.